Lecture Slides on Behavior Modification Models | HNFE 4644, Study notes of Public Health

Download Lecture Slides on Behavior Modification Models | HNFE 4644 and more Study notes Public Health in PDF only on Docsity! BEHAVIOR MODIFICATION MODELS Reading: Chapter 4 & Posted readings Lecture 6 & 7 Objectives for this week • Client Intake • Behavior Modification Models – Understand the rationale for behavioral approaches to changing behavior • Begin Individual Models CLIENT INTAKE OR INITIAL ASSESSMENT Client Intake or Initial Assessment • Client intake • What should we ask? How do you develop one? Behavior Modification Behavior Analysis & Therapy • A counseling approach that assumes that behavior is lawful and obeys certain principles that can be discerned through careful analysis • Involves the application of learning principles to deviant or abnormal behavior Target Behavior • First step, identify & operationalize the target behavior – defined in terms of frequency, intensity, topography, or time-related dimension (duration, latency, time elapse between response) Target Behavior • Target behavior should be defined in the following terms: – Objective – Clear – Complete Traits vs. Behavior • Traits are assumed to be enduring personality characteristics, they are not useful in a behavior approaches – They are not specific – Do not help predict or explain actions • Behaviors refers to what a person does – Focusing on what a person does permits attention to be drawn to the function & influence of that behavior Identifying Goals • Criteria for Identifying Goals – Normative level – Danger to self or others – Preventative – Promotion • Focus on promoting healthy or positive behaviors – Therapeutic (addressing clinical depression, attention deficit disorder, anxiety) Functional Analysis • The process of testing hypotheses regarding the functional relations among antecedents, target behaviors and consequences; used in the behavioral approach – Decide which antecedents are most problematic – Decide which reinforcements are perpetuating behavior Antecedents • Antecedents: preceding events, conditions or causes to behavior • Questions to get antecedents? – When, where, with whom, and under what circumstances Consequences • Consequence: result or outcome of a behavior • Questions to consider consequences: – What happens when. . . ? Intervention Strategies • Match the intervention strategy to the functional analysis • Many techniques can be used but general categories include – Stimulus control – Consequences/Reinforcement – Cognitive Behavioral therapies Stimulus Control • For antecedents to control behavior – Associated repeatedly with the target behavior – Receive reinforcing consequences • If antecedents exert control over a behavior, changing the antecedents might change behavior • If antecedent is environmental stimuli – Interventions focus on changing the physical environment, modifying social interactions, and attending to internal dialogues Stimulus Control • Setting events • Stimulus events • Prompts & Fading Cognitive Behavioral Coping Skills • Techniques are used when the problem is maintained by a deficit in adaptive cognitions • Treatment goal is to train the client in obtaining skills necessary to change behavior • Techniques – Self-Instructional Training – Problem Solving Therapy (Skills Training) – Stress Inoculation Training (SIT) Cognitive Behavioral Coping Skills • Key components – Social Support – Behavior al contract – Maintenance – Relapse prevention THEORY Theory, Research & Practice • The task of health education is both to understand health behavior and to transform knowledge about behavior into effective strategies for health enhancement • Health educators need to understand some of the most important theoretical underpinnings of health behavior. • Design of effective interventions can be best done with understanding theories of behavior change and an ability to use them in practice. • Most health educators work in situations in which resources are limited, which makes judgments about the choice of intervention very important. • The professional who understand theory and research comprehends the WHY? And can design well-tailored interventions • He/She does not blindly follow but can critically evaluate and change for each situation • In health education, the circumstances include the nature of the target audience, setting, resources goals, and constraints Theory, Research & Practice What is theory? • Definition – 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 of situations. (Kerlinger, 1986 in Glanz et al). • Characteristics of Theories • Types of theories MODELS OF INDIVIDUAL HEALTH BEHAVIOR The Individual • Health professionals must understand the role of individuals in health behavior • Focus in these models is on individual health behavior Legacy of Lewin • Lewin’s seminal text Field Theory (1935) was one of the early and most comprehensive theories of behavior • Most contemporary theories of health behavior are based in Lewin • Lewinian tradition focus on: – Barriers and facilitators to behavior change – Propose the existence of stages Theories we will discuss • Value Expectancy Models – Health Belief Model – Theory of Reasoned Action & Theory of Planned Behavior (TRA/TPB) • Transtheorectical Model or Stages of Change • Social Cognitive Stimulus Response & Cognitive Theory • S-R Theory – Skinner hypothesis: frequency of behavior is determined by its consequences (reinforcements). – No mental components of thinking or reasoning are required to explain behavior. • Cognitive – Behavior is a function of the subjective value or expectation for an outcome – Thinking, reasoning, hypothesizing and expecting are critical components Value-Expectancy • Value-Expectancy in health-related behaviors – The desire to avoid illness or to get well (value) – The belief that a specific health action available to a person would prevent (or eliminate) illness (expectation). • Expectancy is further defined: – individual’s estimate of personal susceptibility to and severity of an illness – the likelihood of being able to reduce the threat through personal action. Components of HBM • Perceived Susceptibility • Perceived Severity • Perceived Benefits • Perceived Barriers • Cues to Action • Other Variables • Self-Efficacy Components of HBM • Perceived Susceptibility – Definition: • Application: – define population at risk, risk levels – Personalized risk based on person’s characteristics or behavior – Make perceived susceptibility more consistent with an individual’s actual risk Components of HBM • Perceived Severity • Applications • Perceived threat = perceived severity & perceived susceptibility Components of HBM • Perceived Benefits • Application • Define action to take: how, where, when; clarify the positive effects to be expected Components of HBM • Perceived Barriers • Applications – Identify and reduce perceived barriers through reassurance, correction of misinformation, incentives, assistance Components of HBM • Cues to Action • Application • Provide how-to information, promote awareness, employ reminder systems HBM in Multicultural Settings • What might change about individual perceptions? • What might change about cues to action? • What might be the different about the barriers? Support for HBM • Critical review in 1984 (on studies from 1974-1984) – Substantial empirical support for HBM – Perceived barriers was the most powerful single predictor of the HBM dimensions across all studies & behaviors. – Perceived susceptibility & benefits were important overall, perceived susceptibility was stronger predictor of preventive health behavior. – Perceived severity was the least powerful predictor Limitations of the HBM • Measures of constructs have been inconsistent at times • Reliance on health as the primary driving force behind behavior • Developed to predict a single instance of a specific behavior • Has not been applied in the appropriate manner – Primarily used as a behavior prediction model (vs. a behavior change model) THEORY REASONED ACTION/PLANNED BEHAVIOR History of TRA/TPB • TRA introduced in 1967 (Fishbein, 1967) • Developed to understand relationship between attitudes and behavior • Concerned with relationship between beliefs, attitudes, intentions, and behavior. Constructs of TRA/TPB • Behavioral intention • Attitude • Subjective Norm In TPB • Perceived Behavioral Control – Control Belief – Perceived power Strengths of TRA • Provides a framework for deciphering individuals’ actions by identifying, measuring, and combining beliefs that are relevant to individuals or groups – Allows us to understand reasons that motivate the behavior of interest. • Does not specify the particular beliefs about behavioral outcomes or normative referents that should be measured – The relevant behavioral outcomes and referents will be different for different behaviors, different populations. Theory of Planned Behavior Perceived Behavioral Control • Adds perceived behavioral control to TRA – PBC: Assumptions • Perceived control is an independent determinant of behavioral intention along with attitude and subjective norms • Perceived control is determined by control beliefs and perceived power • Is similar to self-efficacy, but operationalize differently – Perceived behavior control is concerned with the factors that influence whether intention is translated into behavior. TRA/TPB Attitude toward behavior Behavioral intention Behavioral beliefs Evaluation of behavioral outcomes Behavior Normative Beliefs Motivation to comply Subjective norm Control beliefs Perceived power Perceived behavioral control Conclusions TRA/TPB • Provide excellent framework for conceptualizing, measuring and identifying factors that determine behavior • Allows for empirical testing of factors most likely to be influenced by intervention • Allow for assessment of the effect of interventions on beliefs TTM Core Constructs • Preparation – Intends to take action within the next 30 days and has taken some behavioral steps in this direction TTM Core Constructs • Action – Has changed overt behavior for less than six months TTM Core Constructs • Maintenance – Has changed overt behavior for more than six months TTM Core Constructs • Termination – Stage in which individuals no longer succumb to temptation & have total self-efficacy TTM Other Constructs • Decisional Balance – Pros and cons of changing behavior • Self-efficacy – Confidence that one can engage in the healthy behavior across different challenging settings Process in TTM • Process of change are covert and overt activities that people use to progress through stages • Process of change has important implications for intervention programs. • 10 processes have received the most support.