Health Behavior Theories and Models

HEALTH AND BEHAVIOR
3/28/2023 Seek wisdom, Elevate your intellect and Serve humanity 1

Course content
Introduction
 Behavior Vs health
Intrapersonal theories/model

Introduction
Health
Complete physical, mental, spiritual, social wellbeing….not merely
the absence of disease or infirmity(WHO)
Health is characterized by:
anatomic, physiologic and psychological integrity,
ability to perform personally valued family, work and
community roles,
ability to deal with physical, biological, psychological and social
stressors,
a feeling of well-being,
freedom from the risk of disease and untimely death

Determinants of health
Physical environment
Social environment
Genetic inheritance
Health behavior
Health care / constellation

Multi-factorial health
determinants
6

Health…Wellbeing is a comprehensive,complex and multi-
disciplinary
Economic wellbeing
Demand, supply ability to buy
HEALTH food, prodtn,
consuptn and
dist
Physical env’t
.Clean water
.Hygiene
.Sanitation
Food prod’n
Population
•HH size
•Fertility
Social services
•Education
•Housing
•Health
Psychology,
Emotional
stability Economics
Emotional stability
Satisfaction
Friendliness

Why do we study behaviors ?
The study of health behavior is based up on two
assumptions:-
1. The substantial proportion of morbidity and mortality is
caused due to a particular pattern of a behavior.
2. These behavioral patterns are modifiable.
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Cont’d…
 Behavior: an action that has specific frequency,
duration, and purpose, whether conscious or
unconscious.
 It is associated with practice
 It is “what we do” and “how we act”
 Readmorehttp://www.alleydog.com/glossary/definition.
php?term=Human%20Behavior#ixzz4WbgeY219

Cont’d…
The term health behavior (or health-related behavior)
is used very broadly to mean any behavior that may
affect a individual’s health or
any behavior that an individual believes may affect
their health.
Health behavior includes both risky and protective
behaviors.

Human behavior is caused by:
1) genetic and 2) environmental factors.
Genetic behaviors are inherited.
What an individual inherits is the potential.
Potential is influenced by the environment.
The multiple environmental factors include: culture,
society, values, and other environmental factors.

Types of behavior
Healthy Behaviors: Behaviors which can promotes
health and prevent diseases or illness. Eg. Physical ex.
Healthy B: action taken by a person to maintain, attain or regain good
health and prevent illnesses
 Risky/Unhealthy behaviors : Behaviors that damage
or affect health of an individual, family or community
negatively
Risky B: voluntary movements and purposive acts,
E.g. Excessive alcohol consumption
Smoking

Categories of health behavior
1. Preventive health behavior:
any activity undertaken by an individual who believes
himself (or herself) to be healthy, for the purpose of
preventing or detecting illness in an asymptomatic state.

Con’t…
2. Sick-role behavior
any activity undertaken by an individual who considers himself
to be ill, for the purpose of getting well. It includes receiving
treatment from medical providers, generally involves a whole
range of dependent behaviors and leads to some degree of
exemption from one’s usual responsibilities

Domains of behavior
Basically our behavior has 3 domains
A) Cognitive domain- stored information
Knowledge, Perception , Thinking
B) Affective domain-cognition +feeling
Attitude, Beliefs, Value
C) Psychomotor domain – action/practice/skill
Voluntary (purposeful) or Involuntary (not purposeful)

Cont’d…
Perception: is giving meaning and interpretation of data and
information received by the five sense organs of the body
available to the brain.
Eg: perceived severity
Knowledge: a clear and certain mental perception,
understanding, the fact of being aware of something.
 It is the collection and storage of information or experience.

Cont’d…
It is the storage of information or experience in the brain
 The means of acquiring knowledge by the brain is by
perception.
Perception + Storage of information in the brain = Knowledge
Knowledge is acquired through our sensory organs

Cont’d…
Often comes from information collected from:
written materials,
mass media,
teachers,
parents,
friends, etc...
It could also come from personal and other people’s
experience.
E.g., knowledge about disease causation and transmission

Cont’d…
Attitude:
tendency of mind or of a relatively constant feeling towards a
certain category of objects, people, or situation (Mucchielli,
1970)
a sum total of man’s inclination and feelings, prejudice or bias,
preconceived notions, ideas, fears, threats and conviction
about any specific topic (Luis Thurston,1928)

Cont’d…
Relatively constant feelings, predisposition or set of beliefs
directed towards an object, persons situation
Are evaluative feelings
Reflect our likes or dislikes (can be positive or negative)
Often comes from experience or from people who are close to
us (friends, parents, etc...)

Characteristics of attitude
Predisposition
has to have knowledge about the attitudinal object
Has direction or polarity
+ or -, good or bad
Intensity(judgment)
favorable or unfavorable, convenient or inconvenient
Changeability
can be changed, adapted, modified (not static).
Stability and relation to time
 has consistency Vs “mood”-change quite often

Value
It is guiding principle
Is a preference and can be shared or transmitted within a
community.
Characteristics held to be important and prized by an individual or
community
A person may have his or her own individual values.
However, values are usually part of culture and shared at a
community or national level.
E.g. Being a good mother, Being attractive to opposite sex , Being
modern, healthy, wealthy etc…

Con’t…
Value clarification: trying to encourage people to think about
their values.
We want our people to value “Being Healthy”
E.g we have to clarify the difference b/n smokers and non-smokers ,
Clarify the difference b/n unplanned family and planned family
Value conflict- Occurs when someone is in dilemma (conflict)
b/n the advantages of performing and not performing a particular
behaviour.
Conflict of values: inconsistencies between two or more values.
E.g. Smoking – Feels good (Excited) -Unhealthy
Stop smoking – Feel healthy

Criteria for value
Free choice
Alternatives
Selection by reason, consideration is made from its advantage
and disadvantage
Proud of selection
Accept openly
Act upon it
Act consistently

Behaviour change
In theory
An action or activity that aims to get an individual or
population to behave differently from how s/he or they would
have acted without such an action
 change the incidence/rate/duration of occurrence of a given type of
behaviour from what it would otherwise have been
 change the way that a given behaviour is performed
In practice
A coordinated set of behaviour change techniques applied to a
group or population to change the prevalence or rate of a given
behaviour pattern

Behavior change for preventionand promotion
Primary – Prevent
disease from
occurrence
Secondary –
Shorten duration
and transmission
Tertiary –
Rehabilitation and
quality of life with the
problem

Cont’d…
Primary …:
Directed at apparently healthy people where the primary aim
is to prevent the occurrence of illness or health problems.
Example: provision of good nutrition, immunization, hygiene and
basic sanitation etc.

Cont’d…
Secondary…:
Given after the disease or problem has occurred to stop the
progress of the disease to the severest forms of the problem
Tertiary …:
prevent further disabilities and complications, prolonging of life
and maintenance of normal function-provided for patients with
irreversible, incurable and chronic conditions.

Behavior change process
Changes in behavior can be natural or planned changes.
Natural change - our behavior changes all the time. Some
changes take place because of natural events or processes
such as age-sex related behaviors.
Planned change - we make plans to improve our lives or to
survive for that matter and we act accordingly.
Example: plan to stop smoking or drinking, avoid unsafe sex,
multiple partners

Con’t…
For planned health behaviour change, preparation and planned
sequence of steps is required.
Step-1- Recognition of the problem
Identifying a certain type of behaviour that needs to be changed,
or be overcome
Step -2- Analysis of the problem or Diagnosis
Study of the behaviour to be changed and the underlying reason
for the behaviour
Step -3- Educational prescription
Deciding what educational effort or programme is required, and
describing how this is to be done

Con’t…
Step -4- Educational treatment
After receiving instructions and any necessary training, the
staff begin the new educational programme
Step -5- Recording and review of results, with evaluation
The work done on the educational programme and the
response that is received is recorded

Learning
Learning is relatively permanent change in behavior as a
result of knowledge, experience or practice.
 Change in behavior may be positive or negative.
Positive when it is acceptable by society e.g. education.
Negative when it is unacceptable by society e.g. theft.

Principles of learning
There are three principles of learning:
1. Learning by association Connection between events in
time, place, person etc…
It is the most important part of the learning process.
examples,
If we see lightening we expect thunder
When we see a needle/syringe, we think of injection
When we see pregnancy we expect delivery
Pavlov's, Dogs Pavlovian Conditioning, bell

2. Learning by reinforcement
Reinforcement increases the likelihood of the occurrence of
the situation.
 It increases the association between the response and
stimulus.
 For example, mothers who are getting ANC services.
Therefore, attendance is associated with better outcome. A
mother will learn that ANC is important both for her child and
herself.

3. Learning by motivation
Motivation comes at the gate of learning.
The psychological result as outcome of reinforcement
It is a want and desire. An individual who is not motivated
will gain or learn nothing i.e. it can affect the learning
process

Non-behavioral factors contributing to
learning
Age, gender, existing disease, physical/mental
impairment
Places of work and residence
In general, it encompasses the various social and
environmental factors beyond the control of the individual.

“As medical research continues and technology
enables new breakthroughs, there will be a day most
all major deadly diseases are eradicated on Earth” Peter
Diamandis

Introduction to theories and
models of behavior change

A theory is a set of interrelated concepts, definitions, and
propositions that present a systematic view of events or
situations by specifying relations among variables, in
order to explain and predict the events or situations.

CONCEPTS are the building blocks of theory, the
primary elements of theory.
A CONSTRUCT is the term used for a concept developed
or adopted for use in a particular theory. Thus, a
CONSTRUCT has a very specific and technical meaning.
"Key concepts" of a given theory are its constructs.

VARIABLES are the operational forms of
constructs.
They state how a construct is to be
measured in a specific situation. It is important to keep in
mind that VARIABLES should be matched to
CONSTRUCTS when you are identifying what needs to be
assessed in the evaluation of a theory-driven program.
 MODELS are generalized, hypothetical
descriptions, often based on an analogy, used to
analyze or explain something

No single theory dominates health education and
promotion.
Some theories focus on individuals as the unit of change,
while others focus on change in organizations or cultures.

Still, no one theory will be right in all cases
Depending on the unit of analysis or change
(individuals, groups, organizations, communities) and
the topic and type of behavior you are concerned with.

First, behavior is viewed as being affected by, and
affecting, multiple levels of influence.
Five levels of influence for health-related behaviors
and conditions have been identified. They are:
(1) intrapersonal, or individual factors;
(2) interpersonal factors;
(3) institutional, or organizational factors;
(4) community factors; and
(5) public policy factors.

For example, a woman might delay getting a recommended
cancer screening test (a mammogram) because she is afraid
of finding out she has cancer. This is an individual-level, or
intrapersonal factor. However, her inaction might also be
influenced by her doctor's not recommending mammography,
the difficulty of scheduling an appointment because there is
only a part-time radiologist at the clinic, and her inability to
pay the high fee. These interpersonal, organizational, and
policy factors also influence behavior.

Why Are Theories and Models
Important in Health Promotion?

Why theories and models ?
1. Theory can help us during the various stages of planning,
implementing, and evaluating an intervention.
In guiding a search to answer
• WHY people are or are not following public health and
medical advice, or not caring for themselves in healthy
ways.
• WHAT you need to know before developing or organizing an
intervention program.
• HOW you shape program strategies to reach people and
organizations and make an impact on them.
• WHAT should be monitored, measured, and/or compared in
the program evaluation.

Why theories and models…cont’
2. Theories can help us understand the nature of targeted
health behaviors.
3. Theories can explain the dynamics of the behavior, the
processes for changing the behavior, and the effects of
external influences on the behavior.
4. Theories can help us identify the most suitable targets for
programs, the methods for accomplishing change, and the
outcomes for evaluation.
5. Theories and models EXPLAIN behavior and suggest ways
to achieve behavior CHANGE.

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Theory/model in HE and HP
Planning theories/models
Precede-proceed model
Behavior change theories/ models
Intra-personal
theory / models
HBM, TRA,
TPB, TTM, Anderson
Inter-personal
theory/ models
eg. SCT
Community
theory/models
eg. TDOI, anderson
Continuum theory
eg.HBM, TPB, TRA
Stage theory
eg. TTM
general classification theories and models in health education and promotion

Factors affecting human behavior
A. predisposing factor
B. Enabling factors Anderson behavioral model
C. Reinforcing factors
 Each of has a different type of influence on behavior

Predisposing factors
Perception
Knowledge
Value
Attitude
Confidence/self-efficacy
Outcome efficacy
Belief
Behavioral intention
Prior to behavior that provide the rationale or
creation of motivation for the behavior to occur.
 Provide the rationale motivation for the behavior
to occur are

Cont’d…
For example, consulting health care provider for an illness,
one may need to have knowledge of the services provided
or develop positive attitude towards consultation.

Enabling factors
Enabling factors are those antecedents to behavior that
facilitate a motivation to be realized.
Can help or hinder the desired behavioral and
environmental changes
They help individuals to choose, decide and adopt
behaviors and may be barriers and assets to needed
changes.

Cont’d…
These are characteristics of the environment that
facilitates healthy behavior and any skill or resource
required to attain the behavior.
 Enabling factors enable a motivation to be realized.

Cont’d….
 Availability
 Accessibility
 Affordability
 New skills
 Resources.
E.g... Facilities, money, time, labor services, skills,
transportation, materials and the distribution and their
location.

Cont’d…
Example 1. Enabling factors for a mother to give oral
dehydration solution to her child with diarrhea could be:
 Time
 containers,
 salt and sugar and
 skill how to prepare and administer it.
For a latrine construction?
For FP program ?

Cont’d…
Behavior intention = Behavioral change
Enabling factors:
time,
money, and materials,
accessibility to health services

Reinforcing factors
Subsequent to a behavior that provide the continuing reward
or incentives for the behavior to be persistent and repeated.
Are those consequences of actions that determine whether
the actor receives positive or negative feedback and is
supported socially or by significant others after it occur.
Family, Peers, Employers, health providers. Community
leaders, Decision makers….

The ABCs of Behavior Modification
When we look at behavior modification it is
helpful to break it down into the ABCs where A =
Antecedent, B = Behavior, and C = Consequence.
According to behaviorists such as B. F. Skinner,
almost all behavior can be broken down into the
ABC components. Ante means before. The
antecedent occurs before the behavior while the
consequence occurs after the behavior.

Intrapersonal theories and model

Health Belief Model
HBM was originally introduced in the 1950s by psychologists
working in the U.S. Public Health Service (Godfrey
Hochbaum, Stephen Kegels, Irwin Rosenstock).
HBM assumes that the best predictor of a behavior is one's
perception.
Their focus was on increasing the use of then-available
preventive services, such as chest x-rays for tuberculosis
screening and immunizations such as flu vaccines.

They assumed that people feared diseases, and that
health actions were motivated in relation to the degree
of fear (perceived threat). And
expected fear-reduction potential of actions, as long
as that potential outweighed practical and
psychological obstacles to taking action (net benefits).

The HBM was spelled out in terms of four constructs
representing the perceived threat and net benefits:
perceived susceptibility, perceived severity, perceived
benefits, and perceived barriers.
Perceived susceptibility One's opinion of chances of
getting a condition.
Perceived severity One's opinion of how serious a
condition and its consequences are.
Perceived susceptibility + perceived severity = perceived
threat.

Perceived benefit One's opinion of the advantage of
the advised action to reduce risk or seriousness of
impact.
Perceived barrier One's opinion of the tangible and
psychological costs of the advised action.
 Perceived net benefit

 Self efficacy-the belief that one has the ability to
change one's behavior
 Cues to Action (reminder: something that prompts
or reminds somebody to do something )- may be
internal or external.

An added concept, cues to action, would activate
that readiness and stimulate overt behavior.
 A recent addition to the HBM is the concept of self-
efficacy, or one's confidence in the ability to
successfully perform an action.

Cont’d…
Assumption: once an individual perceives a threat to his/her
health and is simultaneously cued to action, and his/her
perceived benefits outweighs his/her perceived barriers, then
that individual is most likely to undertake the recommended
preventive health action

Perception of threat of disease + perception of the behavior
= the Likelihood of action.
Threat of disease = perceived (susceptibility + severity)
Perception of behavior = perceived (Benefit - barriers)

Application of health belief model
HBM can be applied for preventive behaviors, sick role
behaviors, health care utilization behaviors etc…
application was noted in the following areas:
AIDS and other STDs, contraceptive practices, diabetes,
alcohol & driving, child care & child health behaviors,
participation in screening programs, use of clinical health
services, immunization, asthma, patient adherence to
medical regimens, and others

Limitations of health belief model???

Limitations of health belief model
Focus more on the cognitive domain/perception of the
individual.
The general failure to operationalize the HBM in its entirety is
the combination of the two threat components and trying to
measure as a single construct ‘threat’
And also the benefit and barriers; rather than subtracting one
from the other treating as separate components mixing them
together
variability in measurement of the central HBM constructs.
lack of specification of casual ordering among the variables in
the HBM as is done in other models.

Theory of reasoned action
Introduced in 1967 the theory has over the years been
refined, developed and tested (Fishbein & Ajzen) 1975.
TRA assume the best predictor of a behavior is behavioral
intention, which in turn is determined by attitude toward
the behavior and social normative perceptions regarding
it.

Intra-personal…cont’d
Theory of Reasoned Action/Theory of Planned Behavior
Fishbein and Ajzen 1975 – (TRA) intention to act  Ajzen
1985, 1991; Ajzen and Madden 1986 – TPB (perceived
behavioral control)
Intention is an outcome of attitudes towards a behavior
(+ve or –ve expected outcome ) and subjective norms
(social pressures on individual resulting from perceived
expectations)

Intention: The intent to perform a behavior is the best
predictor that a desired behavior will actually occur.
Both attitude and norms influence one's intention to
perform a behavior.
Attitude: A person's positive or negative feelings
toward performing the defined behavior.
Behavioral Beliefs: Behavioral beliefs are a
combination of a person's beliefs regarding the
outcomes of a defined behavior and the person's
evaluation of potential outcomes.

Normative Beliefs: Societal
The influences that others have on the individual’s attitudes and
intention.
People may have incorrect perceptions of how others view the
behavior
Subjective norm are a combination of a person's
beliefs regarding other people's views of a behavior and
the person's willingness to conform to those views.
Subjective norms are a person’s own estimate of the
social pressure to perform or not perform the target
behavior
I feel pressure from patients to refer them for an x-ray

Theory of reasoned action

Key assumptions
1) behavior is under volitional control
2) people are rational beings
From the perspective of TRA, we behave in a certain way
because we choose to do so and we use a rational
decision-making process in choosing and planning our
actions.

Application of theory of reasoned action
Applications of the theory of reasoned action could be found
in the literature on dental health, smoking, alcohol, drug
abuse, seat belt use, contraceptive practices etc…

Limitation of the theory of reasoned action
In suggesting that, behavior is under the control of
intention the TRA restricts itself to volitional behaviors.
Those behaviors which requires skills, resources or
opportunities that are not freely available are not
considered to be within the domain of applicability of TRA
or will be poorly predicted.

Theory of planned behavior
Given that the theory of reasoned action was limited to the
prediction of behaviors under volitional control, extended the
theory to enable prediction of behaviors that an individual
may not be able to perform at will. This extension, the theory
of planned behavior, incorporated perceptions of control
over performance of the behavior as an additional predictor.
This predictor, perceived behavioral control, is considered
to influence behavior directly and/or indirectly via intentions.

Cont’d…
A modified version of TRA includes the addition of perceived
control over the behavior and is referred to as the Theory of
Planned Behavior (TPB).
Perceived behavioral control – is about perceived ease or
difficulty to perform behavior – similar to self efficacy (Bandura
1986, 1997; Terry et al. 1993)

A related concept, self-efficacy, or the extent to which
performance of the behavior is perceived by the individual to
be easy or difficult, has also been used as a successful
predictor of behavioral intentions.

TRA/TPB
Perceived
behavioral control

Limitation of theory of planned behavior
TPB deals with perception of control not actual control

Tip---Measurement
Attitude
Direct measurement:
 Direct measurement involves the use of bipolar adjectives (i.e.
pairs of opposites) which are evaluative (e.g. good – bad).
Indirect measurement:
 Measuring behavioral beliefs and outcome evaluations
 Conduct an elicitation study to elicit commonly held beliefs:
 Identify the content of behavioral beliefs that are shared by the
target population.
 Construct questionnaire items to assess the strength of
behavioral beliefs.
 Construct questionnaire items to assess outcome evaluations.

Elicitation study
Take sample: about 25 of the total
Open ended questions
One to one interview/FGD
Content analyze the responses into themes (behavioral beliefs)
and label the themes extracted.
To increase the validity of the analysis, at least two researchers
should do this independently.
 List the themes in order, from most frequently mentioned to least
frequently mentioned.

Select the behavioral beliefs most often listed and convert
these into a set of statements.
75% of all it
Pilot test these items
A= (a x e) + (b x f) + (c x g) + (d x h) Where
 A = total attitude score
 a, b, c and d are scores for each of four behavioral
beliefs
 e, f, g and h are scores for outcome evaluations relating
to each behavioral belief

a positive (+) score means that, overall, the participant
is in favour of taking the recommended care service
a negative (-) score means that, overall, the participant
is against taking the recommended health care service

Measuring subjective norm
Indirect measurement of subjective norm: measuring
normative beliefs and motivation to comply
N= (a x d) + (b x e) + (c x f) Where N = total subjective
norm score a, b and c are scores for each of the three
normative beliefs d, e and f are scores for motivation to
comply relating to each source of social pressure
positive (+) score means that, overall, the participant
experiences social pressure to measure the BP of
patients for with diabetes.
 a negative (-) score means that, overall, the participant
experiences social pressure not to measure the BP of
patients for with diabetes

PBC
Self efficacy
Belief about controllability
Direct measurement
Indirect measurement
Self-efficacy is assessed by asking people to report
a) how difficult it is to perform the behavior.
b) how confident they are that they could do it.
 Controllability is assessed by asking people to report
a) whether performing the behavior is up to them.
b) whether factors beyond their control determine their behavior.

PBC = (a x d) + (b x e) + (c x f)
Where PBC = total perceived behavioural control score.
a, b and c are scores for each of three control beliefs.
d, e and f are scores for control belief power relating to each control
belief
a positive (+) score means that, overall, the participant feels in
control of measuring patients’ blood pressure.
 a negative (-) score means that, overall, the participant does not
feel in control of measuring patients’ blood pressure.

Tips…
Direct measurement-internal consistency (to determine whether the
items in the scale are measuring the same construct)
Indirect measurement- test-retest reliability (or ‘temporal stability’)
Measure of reliability obtained by administrating the same test twice
over a period of time to a group of individuals
The scores from time 1 and time 2 can then be correlated in order to
evaluate the test for stability over time
To determine a consistency of a test across time
Correlation-low- measure with low reliability of true changes in the
persons being measured or both

The Extended Parallel Process Model
(EPPM)
• Kim Witte
• Focuses on how to channel fear in a positive, protective
direction instead of a negative, maladaptive direction
• Based on fear appeal, but also incorporates elements of
HBM,TRA/TPB
93

Constructs
• Campaign messages should contain:
• Threat component
•Increase perceived
susceptibility
•Increase perceived severity
• Efficacy component
•Perceived self-efficacy
•Response efficacy
94

Respond intelligently even to
unintelligent treatment

Applications:
Risk Behavior Diagnosis Scale
• A Quick 12-item Rapid Assessment Scale
98
Steps:
1. Sum threat score and efficacy score
separately.
2. Subtract threat score from efficacy score,
yielding a critical value.

Risk Behavior Diagnosis Scale
Define Threat=________________; Define Recommended Response:______________________________________
Strongly Strongly
Disagree Agree
RE 1. [Recommended response] is effective in preventing [health threat]: 1 2 3 4 5
RE 2. [Recommended response] work in preventing [health threat]: 1 2 3 4 5
RE 3. If I [do recommended response], I am less likely to get [health threat]: 1 2 3 4 5
SE 4. I am able to [do recommended response] to prevent getting [health threat]: 1 2 3 4 5
SE 5. I have the [skills/time/money] to [do recommended response] to prevent [health threat]: 1 2 3 4 5
SE 6. I can easily [do recommended response] to prevent [health threat]: 1 2 3 4 5
SEff____
****************************************************************************************************************
***
Strongly Strongly
Disagree Agree
SEV 7. I believe that [health threat] is severe: 1 2 3 4 5
SEV 8. I believe that [health threat] has serious negative consequences: 1 2 3 4 5
SEV 9. I believe that [health threat] is extremely harmful: 1 2 3 4 5
SUSC 10. It is likely that I will get [health threat]: 1 2 3 4 5
SUSC 11. I am at risk for getting [health threat]: 1 2 3 4 5
SUSC 12. It is possible that I will get [health threat]: 1 2 3 4 5
SThr_____
15
19
Efficacy - Threat = Critical Value
In this example, 15 - 19 = - 4 (person is in fear control, needs efficacy messages, no threat).
99

Example of Risk Behavior Diagnosis Scale.
Define Threat= HIV/AIDS Define Recommended Response: Use Condoms
Strongly Strongly
Disagree Agree
RE 1. Condoms are effective in preventing HIV/AIDS infection: 1 2 3 4 5
RE 2. Condoms work in preventing HIV/AIDS infection: 1 2 3 4 5
RE 3. If I use condoms, I am less likely to get infected with HIV/AIDS: 1 2 3 4 5
SE 4. I am able to use condoms to prevent getting infected with HIV/AIDS : 1 2 3 4 5
SE 5. I am capable of using condoms to prevent HIV/AIDS infection: 1 2 3 4 5
SE 6. I can easily use condoms to prevent HIV/AIDS infection: 1 2 3 4 5
SEff___
****************************************************************************************************************
***
Strongly Strongly
Disagree Agree
SEV 7. I believe that HIV/AIDS infection is severe: 1 2 3 4 5
SEV 8. I believe that getting HIV/AIDS has serious negative consequences: 1 2 3 4 5
SEV 9. I believe that getting HIV/AIDS is extremely harmful: 1 2 3 4 5
SUSC 10. It is possible that I will get HIV/AIDS: 1 2 3 4 5
SUSC 11. I am at risk for getting HIV/AIDS: 1 2 3 4 5
SUSC 12. It is likely that I will get HIV/AIDS: 1 2 3 4 5
SThr_____
Efficacy - Threat = _____
Positive score indicates danger control processes dominating (needs threat to motivate with high efficacy message).
Negative score indicates fear control processes dominating (needs only efficacy messages; no threat).
100

Creating Appropriate Messages
• A high threat message is:
• personalistic
• vivid (language and pictures)
• A high efficacy message:
• explains how to do the recommended response
• addresses barriers to recommended response
• gives evidence of recommended response’s effectiveness
• may role play recommended response
101

Combination of Models & Theories
• Perceived behavioral control Vs self efficacy
• Self efficacy in TTM and HBM
• We can add or omit Constructs
103

Thransetheoretical model
Stages of Change(Prochaska and DiClemente)
The stage construct is important, in part, because it
represents a temporal dimension.
In the past, behavior change often was construed as a
discrete event, such as quitting smoking, drinking, or
overeating.
The TTM posits change as a process that unfolds over
time, with
progress through a series of six stages, although
frequently not in a linear manner.

Pre‐contemplation
 This is the stage at which individuals are not even considering the
idea of a change.
Some persons may remain always at this stage.
Contemplation
At this stage, people begin to think actively both about the health risk
and the actions required to reduce that risk.
The issue is now on their agenda, but no action is planned.

Preparation
Contemplation moves into early action, such as developing a
plan, joining a class or group, and getting materials (new foods,
nicotine gum)
Action is planned for the coming month.
Action
There is observable change in the health‐related behavior itself.
The battle is under way.
There may be relapses, but these are part of the change
process and not an excuse to slide back into contemplation.
The action stage may go on for about six months.
If successful the person, or group, moves on to the less intense
maintenance stage.

Maintenance/relapse
The new health action needs to be firmly consolidated as a
permanent lifestyle.
Prevention of relapse to the less healthy behavior is essential.
The strategy of the health promotion program or the
health counselor is to move groups and individuals
forward one step at a time through the stages of change
Not all people change their behaviors or adopt new behaviors.

Limitation of the thranstheoretical model
Brainstorming

Inter-personal
The Social Cognitive Theory/SCT
Is the updated version of social learning theory (SLT) both
of which were articulated by Albert Bandura (1977, 1986).
Bandura was dissatisfied with respondent and operant
learning theories:

Environment behavior
 Environment behavior
(Reciprocal determinism)
Learning theories assumed that cognitions, or thoughts, were
merely the side effects of contingencies of reinforcements
People can learn many things and alter their behavior with out
being reinforced. (Observation)

Thank you
There is nothing so practical as a
good theory
Kurt Lewin

Health Behavior Theories and Models

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