Health Promotion THEORIES OF BEHAVIOR:

The ECOLOGICAL MODEL:

Explanatory and Change Theory:

INTRA-PERSONAL THEORIES

1. Health belief Model

a. Perceived susceptibility to disease “X” + Perceived Severity/Seriousness of disease →
i. Perceived THREAT→
1. Percieved BENEFITS + BARRIERS↕
2. Demographic/ Psychsocial Variables↕
a. BEHAVIOR
 i. Cues to action ↖
Constructs examples:
- Perceived threat: how serious do you think it is and how it will affect you
- Perceived benefits: health benefits
- Perceived barriers: cost/distances/protection adequate?
- Cue to action: incentives to support the desired behavior

Using HBM:

- Relevance of problem to individual (susceptibility)

- Degree of negative consequences (severity)
- Way out (solution which may cost)
- Do this (behavior)
- Reward likely (benefits of action)

2. Theory of Reasoned Action/ Theory of Planned Behavior

a. Attitude toward the behavior: (+)
i. Belief that behavior leads to certain outcomes
ii. Person’s evaluation of the outcome: outcome expectation
b. Subjective Norm →
i. Beliefs that individuals or groups think person should or should not perform
behavior
ii. Person’s evaluation of that belief and motivation to comply
c. Behavioral Intention → Behavior
i. KAB gap (knowledge/attitude/belief practice gap)
1. You can have all factors in place and intend to do but still not follow
through/do it
ii. Perceived behavioral control/ self-efficacy (TPB)
THEORY of Planned Behavior Extension
- Adds the degree of control the person has over the behavior
o Both personal and external factors
o Can be influenced by:
 Modeling (commercial that shows how easy it is to get a flu shot)
 Practice: had previously gotten a shot and released it was ok
 Physiological cue: when you sit down to get a shot does your heart
begin to erased– is there methods to overcome this?
 Social persuasion: if you are persuaded by someone you trust

3. Transtheoretical Model “Stages of Change”

a. Addresses stages and processes of change/ 5 distinct phases people pass through
b. Relapse can happen at any of the 5 stages
1. Precontemplation
a. No Knowledge of needed change
b. No interest in changing
c. No intention to change in (X) time period
 2. Contemplation
a. Being aware of the problem
b. Thinking about changing behavior
c. Unaware of how problem might affect selves/others
d. No actual movement to behavior
e. Increased perception of the pro’s
3. Preparation
a. Increased perception of pro’s/decreased of cons
b. Continues self-reeval
c. Making small steps toward new behavior
d. Increaded confidence in change
e. MADE a PLAN to perform behavior
4. Action
a. Consistent plan for action followed for X time
b. Recognizing success of small steps
c. Intention to maintain behavior as needed
5. Maintenance
a. Identify themselves by new/changed behavior
b. Has a reward system in place
c. Knows strategies for dealing with relapse
d. Long term change (>6mo) has occurred

Concept Definition Application

Pre- contemplation Unaware of problem, hasn’t Increase awareness of need for

change, personalize information on
thought about change
risks and benefits

Contemplation Thinking about change, in the near Motivate, encourage to make specific
future plans

Preparation Making a plan to change Assist in developing concrete action

(decision) plans, setting gradual goals

Action Implementation of specific action Assist with feedback, problem

plans solving, social support, reinforcement

Maintenance Continuation of desirable actions, Assist in coping, reminders, finding

or repeating periodic alternatives, avoiding slips/relapses
recommended step(s) (as applies)

Interpersonal Level Theories:

1. Social Cognitive Theory:
a. Integration of Behavioral (frequency/consistency), Personal (knowedge/self-
efficacy/expectations/goals) and Environmental (social/institutional/physical)
b. 3 main factors affect the likelihood that a person will change a health behavior
i. Self-Efficacy
1. Confidence in one’s ability to perform a specific action
ii. Goals
iii. Expectations/Expectancies
1. Expectations = beliefs about an outcome from some action
2. Expectancies = perceived value of expectation
c. Concepts:
i. Reciprocal determinism: the dynamic interaction of the person, behavior,
and the environment in which the behavior is performed
1. Application: involve person and others, work to change environ.
ii. Behavioral capability: knowledge and skill to perform a given behavior
1. Application: provide info/training about action
iii. Expectations: anticipated outcomes of a behavior and value placed on
results
1. Application: incorporate info about likely results in advance
iv. Self-efficacy: confidence in one’s ability to act and overcome barriers
1. Application: use social persuasion and encouragement; role models;
biofeedback; small practice steps
v. Observational learning: behavioral acquisition that occurs by watching the
actions and outcomes of others’ behaviors
1. Application: Point out others’ experiences/physical changes/
identify role models to emulate
vi. Reinforcements: responses to a person’s behavior that increase or decrease
the likelihood of reoccurrence
1. Can be internal or external
2. Application: provide incentives, rewards, praise
d. Integrative model (self-efficacy, environmental, and individual factors)
COMMUNITY LEVEL theories:

1. Participatory Models
a. Emphasize community driven approaches to assessing and solving health/social
problems
b. Social systems theory: exploring how organizations in a community interact wih each
other and the outside world
c. Community organizing as 3 general types:
i. Locality development: process oriented.
1. Aim = developing group I.D. and cohesion- building consensus/capacity
ii. Social planning: task oriented
1. Problem solving and relies heavily on expert practitioners
iii. Social action: process and task oriented
1. Goals= increase the community’s capacity to solve problems/achieve
changes that redress social injustices

2. Diffusion of Innovations Theory

a. Addresses how new ideas, products, and social practices spread within an organization,
community, or society, or from one society to another
b. 2 part theory
i. Innovations (behaviors) diffuse over tie and across populations
ii. Addressing specific constructs help speed adoption of behavior
c. 5 main constructs impacting adoption/diffusion of innovations
i. Relative advantage: degree with innovation better than old behavior
ii. Compatibility: consistent with existing needs, values, systems
iii. Complexity: ease of implementation
iv. Trialability: trail opportunities
v. Observability: seeing others do it/ visible results
d. 5 step process in behavior change
 i. Awareness
ii. Interest
iii. Evaluation
iv. Trial
v. Adoption

3. Social Marketing Approach

a. Process for planning and managing a behavior change program
b. Relies on the notion of exchange between audience and program components
c. Think from audience perspective
d. Find a MATCH between the desired program behavior and WHY the audience might
WANT to do it