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  3. 3. INTRODUCTION • Health promotion is a philosophy that has at its core the idea that good health, or wellness, is a personal and collective achievement. For the individual, it involves developing a program of good health habits. • For the medical practitioner, health promotion involves teaching people how to achieve a healthy lifestyle and helping people at risk for particular health problems off set or monitor those risks. • For the health psychologist, health promotion involves the development of interventions to help people practice healthy behaviours.
  4. 4. • For community and national policy makers, health promotion involves emphasizing good health and providing information and resources to help people change poor health habits. Successful modification of health behaviors will have several beneficial effects. • First, it will reduce deaths due to lifestyle-related diseases. • Second, it may delay time of death, thereby increasing life expectancy. • Third and most important, the practice of good health behaviors may expand the number of years during which a person may enjoy life free from the complications of chronic disease.
  5. 5. HEALTH BEHAVIOUR AND HEALTH HABITS. Health behaviors are behaviors undertaken by people to enhance or maintain their health. A health habit is a health behavior that is firmly established and often performed automatically, without awareness. These habits usually develop in childhood and begin to stabilize around age 11 or 12 .Wearing a seat belt, brushing one’s teeth, and eating a healthy diet are examples of these kinds of behaviors.
  6. 6. Although a health habit may develop initially because it is reinforced by positive outcomes, such as parental approval, it eventually becomes independent of the reinforcement process. It is important to establish good health behaviors and to eliminate poor ones early in life.
  7. 7. The importance of good health habits is provided by a classic study of people living in Alameda County, California. Health enhancing behavior are:- • Sleeping 7 to 8 hours a night • Not smoking • Eating breakfast each day • Having no more than one or two alcoholic drinks each day • Getting regular exercise • Not eating between meals • Being no more than 10 percent overweight
  8. 8. Efforts to prevent illness can be of three types: • Behavioral influence. In this approach, we might promote tooth brushing and flossing by providing information and demonstrating the techniques. • Environmental measures. Public health officials might support fluoridating water supplies. • Preventive medical efforts. Dental professionals can remove tartar from teeth and repair cavities.
  9. 9. Primary Prevention Instilling good health habits and changing poor ones is the task of primary prevention. This means taking measures to combat risk factors for illness before an illness has a chance to develop. There are two general strategies of primary prevention. The first and most common strategy is to get people to alter their problematic health behaviors, such as helping people lose weight through an intervention. The second, more recent approach is to keep people from developing poor health habits in the first place. Ex- smoking prevention program for adolescents
  10. 10. Determinants of Practicing and Changing Health Behaviors. Demographic Factors: Younger, more affluent, better-educated people with low levels of stress and high levels of social support typically practice better health habits than people under higher levels of stress with fewer resources. Age: Health habits are typically good in childhood, deteriorate in adolescence and young adulthood, but improve again among older people. Values: Values affect the practice of health habits. For example, exercise for women may be considered desirable in one culture but undesirable in another
  11. 11. Personal Control: People who regard their health as under their personal control practice better health habits than people who regard their health as due to chance. Ex-health locus control scale. Social Influence: Family, friends, and workplace companions influence health-related behaviours, sometimes in a beneficial direction, other times in an adverse direction. For example, peer pressure often leads to smoking in adolescence but may influence people to stop smoking in adulthood.
  12. 12. Personal Goals and Values: Health habits are tied to personal goals. If personal fitness is an important goal, a person is more likely to exercise. Perceived Symptoms: Some health habits are controlled by perceived symptoms. For example, a smoker who wakes up with a smoker’s cough and raspy throat may cut back in the belief that he or she is vulnerable to health problems at that time. Access to the Health Care Delivery System: Access to the health care delivery system affects health behaviors. Ex- receiving immunizations for childhood diseases depend on access to health care.
  13. 13. Knowledge and Intelligence: The practice of health behaviours is tied to cognitive factors, such as knowledge and intelligence. More knowledgeable and smarter people typically take better care of themselves. LIFESTYLES AND RISK FACTORS. The typical person’s lifestyle includes many behaviours that are risk factors for illness and injury. For instance, millions of Americans smoke cigarettes, drink excessively, use drugs, eat high-fat and high-cholesterol diets, eat too much and become overweight, have too little physical activity, and behave in unsafe ways, such as by not using seat belts in automobiles.
  14. 14. Many people realize these dangers and adjust their behavior to protect their health. Adults with healthful lifestyles that include exercising, eating diets with fruits and vegetables, not smoking, and not drinking too much, can expect to live 12 years longer than they would otherwise.
  15. 15. Risk Factors for the Leading Causes of Death in the United States. Disease Risk Factors Heart disease - Tobacco, high cholesterol, high blood pressure, physical inactivity, obesity, diabetes, stress Cancer - Smoking, unhealthy diet, environmental factors Stroke - High blood pressure, tobacco, diabetes, high cholesterol, Physical inactivity, obesity Accidental injuries- On the road (failure to wear seat belts), in the home (falls, Poison, fire) Chronic lung disease- Tobacco, environmental factors (pollution, radon, Asbestos)
  16. 16. RISK FACTORS FOR LEADING CAUSES OF DEATH INDIA/ KERALA • Alcohol and drug usage • Smoking • Junk- food • Improper exercise • Lack of personal hygiene • Life style decrease • Lack of nutritional support • Emission of carbon- dioxide • Infectious diseases • Lack of proper and sudden health care support • Over usage of chemical fertilizers and pesticides • Extreme climatic conditions • Pollution • Radiation • Improper usage of resources.
  17. 17. Barriers to Modifying Poor Health Behaviours There is often little immediate incentive for practicing good health behaviors. Health habits develop during childhood and adolescence when most people are healthy. Smoking, a poor diet, and lack of exercise have no apparent effect on health for years, and few children and adolescents are concerned about what their health will be like when they are 40 or 50 years old . As a result, once bad habits have a chance to make inroads and ingrained, people may not be motivated to change them
  18. 18. Unhealthy behavior can be pleasurable, automatic, addictive and resistant to change. Many people find it hard to change their health habits because their bad habits are enjoyable. Emotional Factors Emotions may lead to or perpetuate unhealthy behaviors. These behaviors can be pleasurable, automatic, addictive, and resistant to change. Ex- Stress- leads to smoking Stress- overeating Peer pressure
  19. 19. Threatening messages designed to change health behaviors can produce psychological distress and lead people to respond defensively. People may perceive a health threat to be less relevant than it really is and they may falsely see themselves as less vulnerable than other people with the same habit. Instability of Health Behaviors: Health habits are only modestly related to each other. Health habits are unstable overtime. A person may stop smoking for a year but take it up again during a period of high stress
  20. 20. First, different health habits are controlled by different factors. For example, smoking may be related to stress, whereas exercise depends heavily on ease of access to athletic facilities. Second, different factors may control the same health behavior for different people. One person’s overeating may be “social,” and she may eat primarily in the presence of other people, whereas another person may overeat only when under stress.
  21. 21. Third, factors controlling a health behavior may change over the history of the behavior . For example, although peer group pressure (social factors) is important in initiating smoking, over time, smoking may be maintained because it reduces feelings of stress. Fourth, factors controlling a health behavior may change across a person’s lifetime. In childhood, regular exercise is practiced because it is built into the school curriculum, but in adulthood, this behavior must be practiced intentionally
  22. 22. PROBLEMS IN PROMOTING WELLNESS The process of preventing illness and injury can be thought of as operating as a system, in which the individual, his or her family, health professionals, and the community play a role. According to health psychologist Craig Ewart (1991), many interrelated factors and problems can impair the influence of each component in the system, and each component affects each other. INDIVIDUAL DIFFERENCE People who consider ways to promote their own health often face an uphill battle with themselves.
  23. 23. One problem is that many people perceive some healthful behaviors as less appealing or convenient than their unhealthful alternatives. Some people deal with this situation by maintaining a balance in their lives, setting reasonable limits on the unhealthful behaviors they perform. But other people do not, opting too frequently in favor of pleasure even when individuals know they have health problems, many drop out of treatment or fail to follow some of the recommendations of their physician.
  24. 24. Four other factors within the individual are also important. First, adopting wellness lifestyles may require individuals to change longstanding behaviors that have become habitual .Habitual and addictive behaviors are very difficult to modify. Second, people need to have certain cognitive resources, such as the knowledge and skills, to know what health behaviors to adopt to make plans for changing existing behavior, and to overcome obstacles to change. Third, individuals need sufficient self-efficacy regarding their ability to carry out the change. Without self-efficacy, their motivation to change will be impaired. Fourth, being sick or taking certain drugs can affect people’s moods and energy levels, which may affect their cognitive resources and motivation.
  25. 25. Interpersonal Factors Many social factors influence people’s likelihood to adopt health-related behaviors. For instance, one partner’s exercising or eating unhealthful before marriage can lead his or her partner to adopt the same behavior over time. Friends and family can encourage or discourage children’s practice of health-related behaviors, such as smoking and exercising, by providing consequences, such as praise or complaints, for a behavior. Modelling it and conveying a value for good health. These social processes may also lead to gender differences in health behavior, such as the greater physical activity of boys than girls.
  26. 26. Factors in the Community People are more likely to adopt healthful behaviors if these behaviors are promoted or encouraged by community organizations, such as governmental agencies and the health care system. Ex- ban on smoking in public areas. PERSONALITY CHARACTERISTICS Two other factors that are linked to health-related behavior are the person’s personality and emotional state, particularly stress. Conscientiousness— the tendency of a person to be dutiful, plan full, organized, and industrious—is a personality characteristic that is associated with practicing many health behaviors.
  27. 27. The role of emotions can be seen in two ways. First, among women who have a close relative with breast cancer and are low in conscientiousness, or those who are very distressed about cancer are especially unlikely to have a mammogram. Second, we see people who experience high levels of stress engage in less exercise and consume poorer diets and more alcohol and cigarettes than those who experience less stress.
  28. 28. THE TRANSTHEORETICAL MODEL OF BEHAVIOR CHANGE • James O. Prochaska of the University of Rhode Island and colleagues developed the Trans theoretical Model beginning in 1977. • It’s a model of behaviour change, a model that analyses the stages and processes people go through in bringing about a change in behavior and suggested treatment goals and interventions for each stage. • People go through stages while they are trying to change their health behaviors and the support they need from therapists or formal behavior change programs may vary depending on the particular stage they are in with respect to their poor health habit.
  29. 29. Stages of Change Pre-contemplation • The pre-contemplation stage occurs when a person has no intention of changing his or her behavior. • Many people in this stage are not aware that they have a problem, although families, friends, neighbors, or co-workers may well be. • An example is the problem drinker who is largely oblivious to the problems he creates for his family. Techniques: • Validate lack of readiness • Encourage re-evaluation of current behaviour • Encourage self-exploration, not action • Explain and personalize the risk
  30. 30. Contemplation • Contemplation is the stage in which people are aware that they have a problem and are thinking about it but have not yet made a commitment to take action. • Individuals in this stage are still weighing the pros and cons of changing their behaviour, continuing to find the positive aspects of behavior enjoyable. Techniques: • Encourage evaluation of pros and cons of behaviour change. • Re-evaluation of group image through group activities. • Identify and promote new, positive outcome expectations
  31. 31. Preparation In the preparation stage, people intend to change their behaviour but have not yet done so successfully. In some cases, they have modified the target behavior somewhat, such as smoking fewer cigarettes than usual, but have not yet made the commitment to eliminate the behavior altogether. Techniques: • The individual needs encouragement to evaluate pros and cons of behaviour change. • The therapist needs to identify and promote new, positive outcome expectations in the individual. • Encourage small initial steps.
  32. 32. PREPARATION • These individuals have taken some actions in the past year such as joining a health education class, consulting a counsellor, talking to their physician, buying a self-help book or relying on a self-change approach. • These group of individuals are suitable for action- oriented programs for smoking cessation, weight loss, or exercise programs.
  33. 33. Action The action stage occurs when people modify their behaviour to overcome the problem. Action requires the commitment of time and energy to making real behavior change. It includes stopping the behavior and modifying one’s lifestyle and environment to rid one’s life of cues associated with the behaviour. Techniques: • Help the individual on restructuring cues and social support. • Enhance self-efficacy for dealing with obstacles. • Help to guard against feelings of loss and frustration
  34. 34. Maintenance In the stage of maintenance, people work to prevent relapse and to consolidate the gains they have made. For example, if a person is able to remain free of an addictive behaviour for more than 6 months, he or she is assumed to be in the maintenance stage. Techniques: • Follow-up support • Reinforce internal rewards • Discuss coping with relapse
  35. 35. TERMINATION People have learned and adapted the coping skills and have no desire to return to their previous behavior and are sure they will not relapse into their earlier unhealthy behaviors. This stage model is conceptualized as a spiral, i.e. a person may take action, attempt maintenance, relapse, return to the pre-contemplation phase, cycle through the subsequent stages to action, repeat the cycle again, and do so several times until they have eliminated the behaviour.
  36. 36. Relapse is the rule rather than the exception with many health behaviors. Techniques: • Evaluate trigger for relapse • Re-assess motivation and barriers • Plan stronger coping strategies Using the Stage Model of Change • Providing people in the pre-contemplation stage with information about their problem may move them to the contemplation phase. • To move people from the contemplation phase into preparation, an appropriate intervention may induce them to assess how they feel and think about the problem and how stopping it will change them
  37. 37. Interventions designed to get people to make explicit commitments as to when and how they will change their behavior can bridge the gap between preparation and action. Individuals already moving through the action phase into long-term maintenance, interventions that emphasize providing self- reinforcement, social support, stimulus control, and coping skills should be most successful. The model has been used with many different health behaviors, including smoking cessation, quitting cocaine, weight control, modification of a high fat diet, adolescent delinquent behavior practice of safe sex and exercise acquisition etc.
  38. 38. Processes of Change in Trans-theoretical Model. Processes of change is a major dimension of the Trans-theoretical model that enables us to understand how shifts in behavior occur. Change processes are covert and overt activities and experiences that individuals engage in when they attempt to modify problem behaviors. Each process is a broad category encompassing multiple techniques, methods, and interventions. Numerous studies have shown that successful self-changers employ different processes at each particular stage of change The ten processes of change are experiential and behavioral
  39. 39. I. Processes of Change: Experiential 1. Consciousness Raising [Increasing awareness] I recall information people had given me on how to stop smoking 2. Dramatic Relief [Emotional arousal] I react emotionally to warnings about smoking cigarettes 3. Environmental Re-evaluation [Social reappraisal] I consider the view that smoking can be harmful to the environment 4. Social Liberation [Environmental opportunities] I find society changing in ways that make it easier for the non-smoker 5. Self-Re-evaluation [Self reappraisal] My dependency on cigarettes makes me feel disappointed in myself.
  40. 40. II. Processes of Change: Behavioural 6. Stimulus Control [Re-engineering] I remove things from my home that remind me of smoking 7. Helping Relationship [Supporting] I have someone who listens when I need to talk about my smoking 8. Counter Conditioning [Substituting] I find that doing other things with my hands is a good substitute for smoking 9. Reinforcement Management [Rewarding] I reward myself when I don’t smoke 10. Self-Liberation [Committing] I make commitments not to smoke Experiential process are used in primary stages and behavioral process are used in later stages.
  41. 41. The TTM is comprised of a number of core constructs that include the Stages of Change, Processes of Change, Decisional Balance, Self-Efficacy, and Temptation. The Decisional Balance construct refers to an individual’s weighing of the pros and cons of their behaviour change. Sound decision making requires the consideration of the potential benefits (pros) and costs (cons) associated with a behaviour’s consequences. Decisional balance is one of the best predictors of future change.
  42. 42. Self-Efficacy construct outlines an individual’s confidence in their ability to not relapse when in high-risk situations that tempt them to engage in a specific behavior. It plays a major role in how successful people are in changing their behavior and maintaining the change. Temptation reflects the intensity of URGE, the strength of the drive within, which urges us to engage in specific behavior when in midst of a situation. Although the majority of the applications of TTM have focused on smoking cessation, the model has also been applied to other problem behaviors such as alcohol and substance abuse, eating disorders, and domestic violence.
  43. 43. CONCLUSION Health psychology is a rapidly growing field. Health psychologists are focused on educating people about their own health and well-being. Many health psychologists work specifically in the areas of prevention and focus on helping people prevent health problems before they start. It includes helping people maintain a healthy weight, avoid risky or unhealthy behaviors and maintain a positive outlook through identifying the individual differences and personality characteristics, and the influence of social, community and interpersonal factors. The Trans Theoretical model of change is also used effectively to help individuals to cope, change unhealthy behaviors and to maintain healthy behavior.
  44. 44. THANK- YOU