Models of Health Promotion

1. Models of Health Promotion Stages of Change, Prochaska et al (1982) Health Belief Model, Rosenstock (1974)

2. Why do people ... • do things that are bad for their health such as smoke cigarettes or drink too much alcohol? • not do things that are health- enhancing like exercise or eating low fat foods? • not do things that maximize the likelihood of better outcomes such as wearing seat belts?

3. Stages of Change Model • Prochaska et al (1982) • “Ordered categories along a continuum of motivational readiness to change a problem behavior” • Assumption: most people will pass through these stages, or go back and forth, when adopting a healthy habit http://www.uri.edu/research/cprc/transtheoretical.htm

4. Five Stages of Change • Precontemplation • Contemplation • Preparation • Action • Maintenance

5. Precontemplation • No intention to change behavior in the foreseeable future (next 6 months). • Includes people who are unaware of the problem plus those who know about the problem but are not considering change. • “I am not thinking about changing my risky sexual behavior within the next 6 months to reduce the risk of getting HIV.”

6. Contemplation • People are aware that a problem exists and are seriously thinking about overcoming it but have not yet made a firm commitment to take action. • Intending to change within 6 months; open to feedback and information about how to change. However, ambivalent about the costs and benefits of their behavior. • “I am thinking about changing my risky sexual behavior within the next 6 months to reduce the risk of getting HIV.”

7. Preparation • Individual is intending to take action in the next month and has unsuccessfully taken action in the past year (combines intention and behavior criteria). • Actively planning change and already taking some steps toward action such as reducing frequency of problem behavior. • “I know I should change my behavior, and I think I will soon.”

8. Action • Stage in which individuals modify their behavior, experiences, or environment in order to overcome their problems. Involves overt behavioral changes and requires commitment of time and energy. • e.g., cessation of smoking has occurred and last cigarette was less than 6 months ago. • “In the last few months I have changed my risky sexual behavior to reduce the risk of getting HIV.”

9. Maintenance • People work to prevent relapse and consolidate the gains attained during action. • Sustaining change and resisting temptation to relapse. • Stage extends from 6 months andbeyond the initial behavioral change. • “For more than 6 months I have changed my (former) risky sexual behavior to reduce the risk of getting HIV.” • Most people take several action attempts before they are able to maintain the behavior

10. Examples of the Stages of Change Model • Do you know what it means to floss your teeth? • No -> {Precontemplation} • Yes -> {go to next q} • Do you floss your teeth now? • Yes, for more than 6 months -> {Maintenance} • Yes, I recently started -> {Action} • No -> {go to next q} • Which of the following best describes you? • I’ve never thought about flossing. {Precontemplation} • I should probably floss. {Contemplation} • I have floss at home, and I know I should floss, but I keep forgetting to actually do it, or I don’t have time. {Preparation}

11. Prochaska et al (1982) • Stages of Change model was developed after studying 872 former smokers • Quitting was a dynamic process; people moved back and forth between the stages

12. Stages of Change Model • Summary: What does this model help us understand? • Where a person is in the process of acquiring a new healthy habit

13. Health Belief Model • Rosenstock (1974) • Predicts the likelihood of healthy behavior • Assumes people are rational

14. Health Belief Model A person evaluates: • The risk - • 1. Vulnerability • 2. Severity • 3. Self-Efficacy • 4. Costs/Benefits • 5. Cues/Motivation • 6. Barriers

15. Vulnerability • How likely one thinks a bad outcome (e.g., get sick or a disease) is if unhealthy behavior persists.

16. Severity • The consequence is perceived to be severe (death) as opposed to mild (yellower teeth).

17. Self Efficacy • Perceived ability to perform a task. • Self efficacy predicts future behavior if there are adequate incentives and skills. • “Can I do it?” “Will I stick to it?” “Will it work?”

18. Costs & Benefits of Behavior • Will it work to reduce the likelihood of the negative consequence (e.g., disease)? • Benefits are perceived to outweigh costs. • Example: I should exercise because it lowers stress and body weight, but if I spend an hour a day exercising I won’t have time to do my homework and I will fail out of school!

19. Motivational cues • Cues (internal or external) that help convert intentions into behavior • Could be good cues (friend started exercising more and looks great now) or bad cues (overweight relative is having chest pains)

20. Barriers • Anything standing in the way from allowing a person to take the decided action • Not enough money or time to perform the behavior you want to • Negative feedback from family and friends

22. Jane is not likely to continue smoking because… • She thinks that she might get lung cancer if she continues to smoke (susceptibility). • She believes that dying from lung cancer is terrible (severity). • Jane does not find smoking to be very pleasurable (cost/benefits). • Her friends are supportive of her quitting (absence of barrier)

23. Jon is likely to continue smoking because • He agrees with the tobacco industry--smoking doesn’t cause lung cancer (susceptibility). • He believes that dying from lung cancer is not any worse than any other way of dying (severity). • Jon feels that smoking relaxes him (cost/benefits). • His friends offer him cigarettes (barrier to quitting)