Behavioral Change Models

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 Behavioral Change Models

 Behavioral Change Models

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Behavioral Change Models

Introduction

Public health is a multi-disciplinary field that aims to 1) prevent disease and death, 2)

promote a better quality of life, and 3) create environmental conditions in which

people can be healthy by intervening at the institutional, community, and societal level.

Whether public health practitioners can achieve this mission depends upon their

ability to accurately identify and define public health problems, assess the fundamental

causes of these problems, determine populations most at-risk, develop and implement

theory- and evidence-based interventions, and evaluate and refine those interventions

to ensure that they are achieving their desired outcomes without unwanted negative

consequences.

To be effective in these endeavors, public health practitioners must know how to apply

the basic principles, theories, research findings, and methods of the social and

behavioral sciences to inform their efforts. A thorough understanding of theories

used in public health, which are mainly derived from the social and behavioral sciences,

allow practitioners to:

• Assess the fundamental causes of a public health problem, and
• Develop interventions to address those problems.

The Health BeliefModel

The Health BeliefModel (HBM)was developed in the early 1950s by social scientists

at the U.S. Public Health Service in order to understand the failure of people to adopt

disease prevention strategies or screening tests for the early detection of disease.

Later uses of HBM were for patients’ responses to symptoms and compliance with

medical treatments. The HBM suggests that a person’s belief in a personal threat of an

illness or disease together with a person’s belief in the effectiveness of the

recommended health behavior or action will predict the likelihood the person will

adopt the behavior.

The HBM derives from psychological and behavioral theory with the foundation that

the two components of health-related behavior are 1) the desire to avoid illness, or

conversely get well if already ill; and, 2) the belief that a specific health action will

prevent, or cure, illness. Ultimately, an individual’s course of action often depends on

the person’s perceptions of the benefits and barriers related to health behavior. There

are six constructs of the HBM. The first four constructs were developed as the original

tenets of the HBM. The last two were added as research about the HBM evolved.

1. Perceived susceptibility – This refers to a person’s subjective perception of

the risk of acquiring an illness or disease. There is wide variation in a

person’s feelings of personal vulnerability to an illness or disease.

2. Perceived severity – This refers to a person’s feelings on the seriousness of

contracting an illness or disease (or leaving the illness or disease untreated).

There is wide variation in a person’s feelings of severity, and often a person

considers the medical consequences (e.g., death, disability) and social

consequences (e.g., family life, social relationships) when evaluating the

severity.

3. Perceived benefits – This refers to a person’s perception of the effectiveness

of various actions available to reduce the threat of illness or disease (or to

cure illness or disease). The course of action a person takes in preventing (or

curing) illness or disease relies on consideration and evaluation of both

perceived susceptibility and perceived benefit, such that the person would

accept the recommended health action if it was perceived as beneficial.

4. Perceived barriers – This refers to a person’s feelings on the obstacles to

performing a recommended health action. There is wide variation in a

person’s feelings of barriers, or impediments, which lead to a cost/benefit

analysis. The person weighs the effectiveness of the actions against the

perceptions that it may be expensive, dangerous (e.g., side effects),

unpleasant (e.g., painful), time-consuming, or inconvenient.

5. Cue to action – This is the stimulus needed to trigger the decision-making

process to accept a recommended health action. These cues can be internal

(e.g., chest pains, wheezing, etc.) or external (e.g., advice from others, illness

of family member, newspaper article, etc.).

6. Self-efficacy – This refers to the level of a person’s confidence in his or her

ability to successfully perform a behavior. This construct was added to the

model most recently in mid-1980. Self-efficacy is a construct in many

behavioral theories as it directly relates to whether a person performs the

desired behavior.

Limitations of Health BeliefModel

There are several limitations of the HBMwhich limit its utility in public health.

Limitations of the model include the following:

• It does not account for a person’s attitudes, beliefs, or other individual

determinants that dictate a person’s acceptance of a health behavior.

• It does not take into account behaviors that are habitual and thus may

inform the decision-making process to accept a recommended action (e.g.,

smoking).

• It does not take into account behaviors that are performed for non-health

related reasons such as social acceptability.

• It does not account for environmental or economic factors that may prohibit

or promote the recommended action.

• It assumes that everyone has access to equal amounts of information on the

illness or disease.

• It assumes that cues to action are widely prevalent in encouraging people to

act and that “health” actions are the main goal in the decision-making

process.

The HBM is more descriptive than explanatory and does not suggest a strategy for

changing health-related actions. In preventive health behaviors, early studies showed

that perceived susceptibility, benefits, and barriers were consistently associated with

the desired health behavior; perceived severity was less often associated with the

desired health behavior. The individual constructs are useful, depending on the health

outcome of interest, but for the most effective use of the model it should be integrated

with other models that account for the environmental context and suggest strategies

for change.

The Theory of Planned Behavior

The Theory of Planned Behavior (TPB) started as the Theory of Reasoned Action in

1980 to predict an individual’s intention to engage in a behavior at a specific time and

place. The theory was intended to explain all behaviors over which people have the

ability to exert self-control. The key component to this model is behavioral intent;

behavioral intentions are influenced by the attitude about the likelihood that the

behavior will have the expected outcome and the subjective evaluation of the risks and

benefits of that outcome.

The TPB has been used successfully to predict and explain a wide range of health

behaviors and intentions including smoking, drinking, health services utilization,

breastfeeding, and substance use, among others. The TPB states that behavioral

achievement depends on both motivation (intention) and ability (behavioral control). It

distinguishes between three types of beliefs – behavioral, normative, and control. The

TPB is comprised of six constructs that collectively represent a person’s actual control

over the behavior.

1. Attitudes – This refers to the degree to which a person has a favorable or

unfavorable evaluation of the behavior of interest. It entails a consideration

of the outcomes of performing the behavior.

2. Behavioral intention – This refers to the motivational factors that influence a

given behavior where the stronger the intention to perform the behavior,

the more likely the behavior will be performed.

3. Subjective norms – This refers to the belief about whether most people

approve or disapprove of the behavior. It relates to a person’s beliefs about

whether peers and people of importance to the person think he or she

should engage in the behavior.

4. Social norms – This refers to the customary codes of behavior in a group or

people or larger cultural context. Social norms are considered normative, or

standard, in a group of people.

5. Perceived power – This refers to the perceived presence of factors that may

facilitate or impede performance of a behavior. Perceived power

contributes to a person’s perceived behavioral control over each of those

factors.

6. Perceived behavioral control – This refers to a person’s perception of the

ease or difficulty of performing the behavior of interest. Perceived

behavioral control varies across situations and actions, which results in a

person having varying perceptions of behavioral control depending on the

situation. This construct of the theory was added later and created the shift

from the Theory of Reasoned Action to the Theory of Planned Behavior.

Limitations of the Theory of Planned Behavior

There are several limitations of the TPB, which include the following:

• It assumes the person has acquired the opportunities and resources to be

successful in performing the desired behavior, regardless of the intention.

• It does not account for other variables that factor into behavioral intention

And motivation, such as fear, threat, mood, or past experience.

• While it does consider normative influences, it still does not take into

account environmental or economic factors that may influence a person’s

intention to perform a behavior.

• It assumes that behavior is the result of a linear decision-making process,

and does not consider that it can change over time.

• While the added construct of perceived behavioral control was an important

addition to the theory, it doesn’t say anything about actual control over

behavior.

• The time frame between “intent” and “behavioral action” is not addressed by

the theory.

The TPB has shown more utility in public health than the Health BeliefModel, but it is

still limiting in its inability to consider environmental and economic influences. Over

the past several years, researchers have used some constructs of the TPB and added other components from behavioral theory to make it a more integrated model. This has

been in response to some of the limitations of the TPB in addressing public health

problems.

Diffusion of Innovation Theory

Diffusion of Innovation (DOI) Theory, developed by E.M. Rogers in 1962, is one of the

oldest social science theories. It originated in communication to explain how, over time,

an idea or product gains momentum and diffuses (or spreads) through a specific

population or social system. The end result of this diffusion is that people, as part of a

social system, adopt a new idea, behavior, or product. Adoption means that a person

does something differently than what they had previously (i.e., purchase or use a new

product, acquire and perform a new behavior, etc.). The key to adoption is that the

person must perceive the idea, behavior, or product as new or innovative. It is through

this that diffusion is possible.

Adoption of a new idea, behavior, or product (i.e., “innovation”) does not happen

simultaneously in a social system; rather it is a process whereby some people are more

apt to adopt the innovation than others. Researchers have found that people who

adopt an innovation early have different characteristics than people who adopt an

innovation later. When promoting an innovation to a target population, it is important

to understand the characteristics of the target population that will help or hinder

adoption of the innovation. There are five established adopter categories, and while the majority of the general population tends to fall in the middle categories, it is still

necessary to understand the characteristics of the target population. When promoting

an innovation, there are different strategies used to appeal to the different adopter

categories.

1. Innovators – These are people who want to be the first to try the innovation.

They are venturesome and interested in new ideas. These people are very

willing to take risks, and are often the first to develop new ideas. Very little,

if anything, needs to be done to appeal to this population.

2. Early Adopters – These are people who represent opinion leaders. They

enjoy leadership roles, and embrace change opportunities. They are already

aware of the need to change and so are very comfortable adopting new

ideas. Strategies to appeal to this population include how-to manuals and

information sheets on implementation. They do not need information to

convince them to change.

3. Early Majority – These people are rarely leaders, but they do adopt new

ideas before the average person. That said, they typically need to see

evidence that the innovation works before they are willing to adopt it.

Strategies to appeal to this population include success stories and evidence

 

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The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper.
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