chapter 11 health behavior theories
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Chapter 11Health Behavior
Theories
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Introduction
• Health behavior is central to disease prevention and management.
• Nurses play a pivotal role in health behavior change due to their credibility as patient educators.
• Nurses may provide intensive patient counseling in a variety of settings, including clinics, work sites, and communities.
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Evolution of Health Behavior Theory
• Theories reflect an amalgamation of approaches, methods, and strategies from social and health sciences.
• Many professionals contribute to and conduct health behavior and education research and programs.
• Nurses bring unique expertise for working with individuals and families to teaching about change and quality of life.
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Trends in Use of Theories and Models• The most dominant theories of health behavior
therapy are the social cognitive theory, the transtheoretical model, and the health belief model.
• Importance of individual worldview, behavior change as a process, and motivation versus intention cut across many theories.
• In recent years, behavior change has focused on obstacle reduction and empowerment.
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The Health Belief Model (HBM)• Posits that beliefs about susceptibility and
perceptions about the benefits of prevention influence patients’ readiness to act.
• Readiness based on six criteria:– Perceived susceptibility– Perceived severity– Perceived benefits– Perceived barriers– Cue to action– Self-efficacy
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Examples of Application of the HBM
• An extensive HBM research project sought to develop a preconceptual counseling program for teens with type 1 diabetes.
• Focused on teen’s perceptions of reproductive problems due to diabetes and their adherence to safe sex practices.
• Led to development of a reproductive health program to aid decision making by diabetic teens.
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The Theories of Reasoned Action (TRA) and Planned Behavior (TPB)
• TPB evolved from TRA.• Posits that health decisions are influenced by a
person’s view of actions and whether important others would approve.
• Useful for explaining why some people change behavior and others do not after completion of health education programs.
• Good fit for predicting behaviors like exercise, and health services utilization.
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The Integrated Behavior Model (IBM)
• IBM is a combination of TPB, TR, and other behavioral theories.
• Developed in response to criticism that TPB ideas were too far removed from individuals to accurately predict behavior.
• Identifies specific belief targets for behavior change interventions based on attitudes, norms, control, and self-efficacy.
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Examples of Application of TPB
• A study of condom use by male South Korean college students sought to establish a TPB link between condom self-efficacy and parent-adolescent relationships.
• Revealed that good mother-son relationships yielded higher condom use intention and self-efficacy.
• Illustrated how cultural practices in parenting can influence intention and behaviors.
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The Transtheoretical Model and Stages of Change (1 of 2)
• Posits that people are at different stages of readiness to adopt healthful behaviors.
• Describes a sequence of steps in successful behavior change:– Pre-contemplation– Contemplation– Preparation– Action– Maintenance
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• Ability to advance through stages and need to repeat stages is based on patient level of motivation and self-efficacy.
• Useful for explaining why patients are not ready to change and helps improve the success of patient education.
The Transtheoretical Model and Stages of Change (2 of 2)
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Examples of Application of the Transtheoretical Model
• A study of individuals with co-occurring conditions sought to understand the way people undergo change.
• Revealed that one disorder can make it difficult to recognize the need for assistance with the other disorder.
• Suggested that individuals with co-occurring conditions need different interventions than individuals with only a single condition.
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Social Cognitive Theory (SCT) (1 of 2)
• Developed from the social learning theory.• Explains behavior in terms of a three-way,
dynamic, reciprocal model in which personal factors, environmental influences, and behavior continually interact.
• Posits that people learn through their own experiences and by observing the actions of others.
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Social Cognitive Theory (SCT) (2 of 2)
• Focuses on self-efficacy and deliberate efforts to increase self-efficacy in patients via three strategies:– Setting small, incremental goals– Using formalized behavior contracts– Monitoring and reinforcing behavior
• Environmental changes, role models, and reinforcement can be used to promote good behavior.
• Useful for nutritional interventions.
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Examples of Application of SCT
• A study of self-monitoring via paper and electronic diaries sought to understand the ways in which feedback acts as a behavioral reinforcement.
• Revealed that electronic diaries with built-in feedback messages related to progress added an extra reinforcement element that improved patient success.
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Social Ecological Models• Posits that behaviors both shape and are shaped
by the social environment.• Focuses on factors affecting behavior and provides
guidance for developing successful programs through social environments.
• Suggests that creating an environment conducive to change is important for making it easier to adopt healthy behaviors.
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The Representational Approach (RA)• Posits that linking health psychology to
educational theory aids patient-centered interventions.
• Relies on seven elements:– Representational assessment– Misconception exploration– Condition creation for conceptual change– Introduction of new information– Goal setting and maintenance– Summary– Evaluation and revision
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Examples of Application of RA
• A study of symptom management in ovarian cancer patients sought to understand the success of written interactions between patients and nurses.
• Revealed that written interactions were more effective than face-to-face interactions because of the greater time and flexibility allowed in communication.
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Cross-Cutting Concepts: Patient’s View of the World
• Behavior change depends on sound understanding of the patient’s worldview.
• Poor adherence arises because patients lack behavioral skills to make lifestyle changes.
• Relationships between knowledge, awareness, intention, and actual change are complex.
• Attention to group patterns combined with individual understanding is key.
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Cross-Cutting Concepts: Behavior Change as a Process
• Behavior change is a process, not an event.• Sustained health behavior change involves
multiple actions and adaptations over time.• Four concerns are important to this process:– Motivation vs. intention– Intention vs. action– Changing behavior vs. maintaining change– The role of biobehavioral factors
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Control Over Behavior and Health: Control Beliefs and Self-Efficacy
• Control beliefs and self-efficacy are common deterrents to positive health behavior change.
• Found in both the SCT and TPB models.• Important to enhance perceived behavioral
control and increase self-efficacy to improve patient motivation and persistence in the face of obstacles.
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Applications in Nursing and Nursing Research
• Nurses should use theory to guide research and theory application.
• Theory framework shapes the research process and data interpretation, and influences intervention design.
• Theory functions as a thread consistently interwoven with a study and is not merely a statement.
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Summary• Health behavior theories are important for
understanding patient actions and the success or failure of nursing interventions.
• Many theories exist, and common themes cut across these theories and suggest that change is largely based on a patient’s worldview and treatment of change as a process.
• Research design and application are closely tied to theoretical frameworks.