Health Behavior Change Models and Intervention Design

Posted on Sep 13, 2024 in Psychology and Sociology

Health Behavior Change Models

Social Cognitive Theory (Bandura, 1986)

Core Concept: Behavior is influenced by the interplay of personal factors, environmental factors, and the behavior itself (reciprocal determinism).

Personal Factors

  • Outcome Expectancies: Anticipated effects of a behavior (physical, social, self-evaluative).
  • Self-Efficacy: Belief in one’s ability to perform a behavior.
    • Magnitude: How easy or difficult the behavior is perceived to be.
    • Strength: How confident one feels in their ability to perform the behavior.
    • Generality: The ability to perform the behavior in different situations.

Environmental Factors

  • Social Conditions
  • Physical Conditions

Theory of Planned Behavior (Ajzen, 1991)

Core Concept: Behavioral intention is the most important predictor of behavior, and is influenced by attitudes, perceived behavioral control (self-efficacy), and subjective norms.

  • Attitude: Positive or negative evaluation of the behavior (considering action, context, and time).
  • Perceived Behavioral Control/Self-Efficacy: Belief in one’s ability to perform the behavior and control its execution.
  • Subjective Norm: Belief about whether important others approve or disapprove of the behavior and the motivation to comply with their expectations.

Transtheoretical Model (Prochaska & DiClemente, 1983)

Core Concept: Behavior change is a process that unfolds over time through a series of stages.

  • Precontemplation: No intention to take action within the next 6 months.
  • Contemplation: Intends to take action in the next 6 months.
  • Preparation: Intends to take action within the next 30 days and has taken some behavioral steps in this direction.
  • Action: Has changed behavior for less than 6 months.
  • Maintenance: Has maintained behavior for more than 6 months.

Protection Motivation Theory (Rogers, 1975, 1983)

Core Concept: Health behaviors are motivated by two appraisal processes: threat appraisal and coping appraisal.

Likelihood of Maladaptive Response (Determinants of Unhealthy Behavior)

  • Intrinsic/Extrinsic Rewards: Perceived benefits of the unhealthy behavior.
  • Severity/Vulnerability: Perceived seriousness and likelihood of experiencing negative consequences from the threat.
  • Threat Appraisal: Evaluation of the threat and its potential impact.

Likelihood of Adaptive Response (Determinants of Health Behavior)

  • Response Efficacy/Self-Efficacy: Belief that the recommended action will be effective in reducing the threat and confidence in one’s ability to perform the action.
  • Response Cost: Perceived costs or barriers associated with performing the recommended action.
  • Coping Appraisal: Evaluation of the coping response and its feasibility.

Outcome: Protection Motivation leads to either Action (adaptive response) or Inaction (maladaptive response).

Health Belief Model (Becker, 1974)

Core Concept: Health behaviors are influenced by perceptions of susceptibility to a health threat, severity of the threat, benefits of taking action, barriers to taking action, cues to action, and self-efficacy.

  • Perceived Susceptibility: Belief about the chances of getting a condition.
  • Perceived Severity: Belief about the seriousness of a condition and its consequences.
  • Perceived Benefits: Belief about the effectiveness of taking action to reduce risk or seriousness.
  • Perceived Barriers: Belief about the material and psychological costs of taking action.
  • Cues to Action: Factors that trigger the readiness to change.
  • Self-Efficacy: Confidence in one’s ability to take action (e.g., goal setting).

Bridging the Intention-Behavior Gap (Triandis, 1980)

Challenge: The intention to perform a health behavior often does not lead to the actual behavior. This gap can be explained by various factors:

  • Lack of Control
  • Bad Habits
  • Forgetting
  • Procrastination
  • Problems with Self-Regulation (e.g., difficulty avoiding distractions)

Dual System Perspective

Core Concept: Behavior is influenced by two interacting systems: an impulsive system and a reflective system.

Impulsive System

  • Automatic responses to specific situations.
  • Immediate and temporally focused.
  • Driven by hedonic and behavioral reactions.
  • Smooth and efficient.
  • Can generate interpersonal conflict.

Reflective System

  • Supports mental operations for self-control (e.g., reasoning, planning, inhibiting impulses).
  • Slow process requiring cognitive resources.
  • Strenuous and requires attention.

The Role of Habits

  • Most behaviors are habits (automatic responses to environmental cues).
  • When habits are strong, intentions become less predictive of behavior.
  • Strong link between cue (situation) and behavior.

Characteristics of Automatic Behavior

  • Efficient
  • Unconscious
  • Unstoppable and uncontrollable
  • Hard to change
  • Unintentional

Intervention Design and Techniques

Persuasive Communication

Goal: Guiding individuals and environmental agents toward the adoption of an idea, attitude, or action by using communication strategies.

Theoretical Frameworks:

  • Persuasive Communication Matrix
  • Elaboration Likelihood Model
  • Social Cognitive Theory
  • Diffusion of Innovations Theory

Key Principles:

  • Messages need to be relevant and not too discrepant from the beliefs of the individual.
  • Surprise and repetition can stimulate attention and processing.
  • Include arguments supported by evidence.
  • General pro-behavior communication is not sufficient; messages should be tailored and specific.
  • Credible sources presenting arguments in favor of the behavior enhance persuasiveness.

Modeling

Goal: Providing an appropriate model being reinforced for the desired action.

Theoretical Frameworks:

  • Social Cognitive Theory
  • Theories of Learning

Key Elements:

  • Attention: The observer must pay attention to the model.
  • Retention: The observer must remember the modeled behavior.
  • Self-Efficacy and Skills: The observer must believe they can perform the behavior and have the necessary skills.
  • Reinforcement of Model: Observing the model being reinforced for the behavior increases the likelihood of imitation.
  • Identification with Model: Observers are more likely to imitate models they identify with.
  • Copying vs. Mastering: Observers may initially copy the model’s behavior and then develop their own mastery over time.

Providing Information about Relevant Others’ Approval

Goal: Encourage individuals to consider the opinions and expectations of others regarding their behavior.

Theoretical Frameworks:

  • Theory of Planned Behavior
  • Theory of Reasoned Action

Key Principle: Make positive expectations and social norms salient in the environment.

Guided Practice

Goal: Promote rehearsal and repetition of the behavior with feedback.

Theoretical Frameworks:

  • Social Cognitive Theory
  • Theories of Self-Regulation

Key Elements:

  • Subskill demonstration, instruction, and enactment with individual feedback.
  • Requires supervision by an experienced person.
  • Note: Some environmental changes cannot be rehearsed.

Goal Setting

Goal: Prompt planning and commitment to specific, achievable goals related to the target behavior.

Theoretical Frameworks:

  • Goal-Setting Theory
  • Theories of Self-Regulation

Key Elements:

  • Commitment to the goal.
  • Goals that are challenging but attainable within the individual’s skill level.

Self-Monitoring

Goal: Encourage individuals to track their behavior and progress.

Theoretical Framework: Theory of Self-Regulation

Key Elements:

  • Monitoring must be specific to the target behavior (not just a physiological state or health outcome).
  • The data must be interpreted and used to make adjustments.
  • Rewards for progress should be reinforcing to the individual.

Intervention Development Process

1. Consult Intended Participants and Implementers

  • Consider both surface and deep structure of the intervention.
  • Take into account: characteristics of the program setting, sustainability (human and financial resources), and the needs and preferences of participants and implementers.

2. Create Program

  • Define themes, vehicles, scope, sequence, delivery channels, material list, and messages.

3. Collaboration with Designers and Producers

  • Health educators and researchers may have different aims than designers and producers. Ensure alignment and shared understanding of goals.
  • Objectives (from step 2) and change methods (from step 3) should be integrated into the program materials.

4. Review Available Program Materials

  • Adapt existing materials to fit the intervention’s objectives and theoretical methods (parameters of use).

5. Draft and Pre-test Program Materials; Collaboration

  • Pretesting and pilot testing: Try out messages and conduct a small-scale implementation to gather feedback and refine the intervention.
  • Considerations: Lack of time for pretesting, funder preferences for large sample sizes, ensuring intervention quality, and adapting materials as needed.

6. Oversee Final Production

  • Ensure high-quality production of materials and maintain the integrity of the intervention design.

Example Intervention: “Workout @ Work”

Scope

  • Access to fitness facilities.
  • Lunchbag meetings on healthy lifestyle.
  • Organizational policy that supports flexible working hours and exercise among employees.
  • Training of key persons in the organization.

Sequence

  1. Supportive policy + training of key persons in the organization.
  2. Introduction of the program in the organization by director/managers.
  3. Meetings with staff.
  4. Access to fitness facilities throughout the program.

Vehicle

  • Organization key persons.
  • Director.
  • Email.

Theme

“Workout @ Work”

Message

“When you are physically doing well, you are more productive and happy in your work.”