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FNH 473 Video 1: Introduction to Health Behaviour Theories — Transcript

by Candice Rideout · 1,815 words · 334 segments · language en · Watch on YouTube

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0:01Would you like to hear something
0:02surprising, but true?
0:05Learning about the various health
0:06behavior theories may be one of the most
0:09useful and exciting things you will
0:11learn in this course.
0:13Though theories may seem a little bit
0:14dry at first, and I totally get that,
0:17knowing and applying various health
0:19behavior theories is like having a
0:21sophisticated set of tools to help you
0:23achieve your goals for health promotion.
0:25After watching this video, you should
0:27have a pretty good understanding of what
0:29a theory is and why they are important
0:32in public health nutrition.
0:34Be able to justify why using an
0:36appropriate health behavior theory, or
0:38perhaps more than one, is essential to
0:41good program planning.
0:42And be able to explain the health belief
0:44model, one of the earliest health
0:45behavior theories. First, what is a
0:48theory?
0:49A theory is a systematic way of
0:51understanding things.
0:53Theories synthesize bodies of evidence
0:55into key principles that explain and
0:58predict various phenomena.
1:01Think of the theories you might have
1:02heard of already. Things like the Big
1:04Bang Theory, the Theory of Evolution,
1:07the Theory of Relativity.
1:09All these theories synthesize evidence
1:11into explanations for observations, and
1:14they enable us to make informed
1:16predictions regarding expected outcomes
1:19given a particular set of circumstances.
1:22Let's turn our attention to why theories
1:24about health behavior are so important.
1:27We want to promote health and
1:29well-being.
1:30Consider the leading causes of death in
1:32Canada. Things like cancer, heart
1:34disease, stroke, and diabetes.
1:37Our health-related behavior plays an
1:39important role in whether or not we
1:41develop these conditions.
1:43So many aspects of our behavior
1:45influence our health status, not the
1:47least of which is our dietary habits.
1:50So, understanding human behavior and
1:52designing interventions that are aligned
1:55with what we know about human behavior
1:57and behavior change can make efforts to
1:59promote health more likely to succeed.
2:02Let's take a look at one of the earliest
2:04theories of health behavior, the health
2:06belief model.
2:08This model has a lot of appeal because
2:10it's logical,
2:11simple, and it provides very useful
2:14insights into behavior and behavior
2:16change. There are four key constructs in
2:19the health belief model.
2:21Perceived susceptibility, perceived
2:24severity, perceived benefits, and
2:27perceived barriers.
2:29Note the recurrence of the word
2:30perceived.
2:32According to the health belief model,
2:33it's our perceptions of benefits and
2:36barriers that are associated with
2:37particular actions that determine our
2:40behavior, not the real benefits and
2:42behaviors. Perceived susceptibility
2:45refers to your opinion regarding your
2:47chance of getting a particular
2:48condition.
2:50How likely do you think it is that you
2:51will develop osteoporosis, for example?
2:55Perceived severity refers to your
2:57opinion of how serious the condition
2:59would be if you were to get it.
3:02If you were to get osteoporosis, do you
3:04think that would be a mild
3:05inconvenience, or do you think it would
3:06be painful and debilitating? Perceived
3:09benefits refers to your opinion of how
3:12effective the advised action would be.
3:15For example, you may be advised that
3:17weight-bearing physical activity and
3:18appropriate calcium and vitamin D
3:20intake, in the context of an overall
3:22healthy diet, would promote bone health
3:25and reduce your chance of developing
3:26osteoporosis.
3:28How beneficial do you think those
3:30actions would be, both in terms of
3:32effectively preventing osteoporosis and
3:34with respect to the other benefits of
3:36those behaviors?
3:38Perceived barriers refers to your
3:40opinion of the costs or drawbacks of the
3:43advised action.
3:45Perhaps you don't like exercise, for
3:46example, or you find it really hard to
3:48fit it into your day.
3:50Maybe you don't like dairy products or
3:51swallowing supplement pills, or you
3:53don't think you can afford supplements
3:55or sufficient healthy food. These would
3:57all be barriers to your undertaking the
3:59recommended action. The health belief
4:02model notes that all these perceptions
4:04are affected by modifying factors.
4:07Things such as age, ethnicity,
4:09socioeconomic status, peer groups,
4:12knowledge, and so on. So, how do these
4:14perceptions come together to explain and
4:17predict behavior?
4:20Our evaluations of our perceived
4:21susceptibility for a particular
4:23condition and the perceived severity of
4:26that condition combined to create the
4:28perception of threat.
4:30If perceived threat is high, the
4:33likelihood of engaging in the health
4:35protective behavior is higher than it
4:37would be if the perception of threat was
4:39low, which might result in little
4:40motivation to change behavior.
4:43This points to one goal for health
4:45promotion programs based upon the health
4:47belief model.
4:48Creating realistic perceptions of threat
4:51in the target population.
4:53Strategies for increasing perceived
4:54threat could include educational
4:56materials to increase perceived severity
4:59or fear appeals to increase perceived
5:01susceptibility.
5:04Our evaluations of perceived benefits
5:06and perceived barriers combined to
5:08determine our response.
5:10On some level, we evaluate the pros and
5:13cons and determine whether there would
5:14be a net gain associated with this
5:16action.
5:17Do the benefits of this action outweigh
5:20the costs?
5:21This points to other tasks for health
5:23promotion programs based upon this
5:25model. To ensure the benefits of the
5:28recommended action are clearly
5:29communicated and relevant for the target
5:32population. And to develop strategies to
5:34minimize the barriers people may
5:36experience. There are two other
5:38important components of the health
5:40belief model. Cues to action and
5:42self-efficacy.
5:45Cues to action serve as a trigger for
5:48behavior.
5:49Seeing a media campaign might serve as a
5:51cue to action.
5:53Others might be receiving advice,
5:55receiving a reminder from a clinic,
5:58becoming aware of bodily sensations such
6:00as feeling overly tired or experiencing
6:02dizziness,
6:03or something like illness, your own
6:05illness or that of someone you know.
6:08Exposure to these sorts of cues to
6:10action increase a person's readiness to
6:12take action.
6:16Self-efficacy is a concept originally
6:18introduced by Albert Bandura, one of the
6:20most influential psychologists of all
6:22time and a UBC grad.
6:25This concept, which is a key element of
6:27Bandura's social cognitive theory, has
6:30been incorporated into many health
6:31behavior theories because of the clear
6:33evidence of its importance in
6:35determining behavior.
6:37Self-efficacy refers to the belief that
6:39one can successfully undertake a
6:41particular behavior and persist with
6:44that behavior in the face of challenges.
6:47The belief that you can perform a task
6:49or take an action at a particular level
6:51of competence is important in both
6:53initiating and maintaining behavior
6:55change.
6:56You know that theories explain and
6:59predict.
7:00Let's look at a couple of examples of
7:02how the health belief model has been
7:03used in this regard. In a study of 75
7:06American women between the ages of 18
7:09and 45 who were diagnosed with
7:11gestational diabetes during their last
7:13pregnancy,
7:14participants a survey examining their
7:17perceptions of susceptibility and
7:19severity for type 2 diabetes and for the
7:22benefits and barriers to healthy eating
7:25to prevent type 2 diabetes.
7:28Being diagnosed with gestational
7:29diabetes, that is diabetes that's first
7:32detected during pregnancy, is a notable
7:34risk factor for the subsequent
7:36development of type 2 diabetes.
7:38So, the researchers thought that the
7:40women who had been diagnosed with
7:42gestational diabetes during their last
7:44pregnancy would have quite high
7:46perceived threat for type 2 diabetes.
7:49They found that the women were actually
7:51evenly split in this regard. Half of the
7:54women perceived that they had a low
7:55chance of developing type 2 diabetes in
7:57the next 10 years, whereas the other
8:00half thought they had a moderate or high
8:02chance of developing type 2 diabetes.
8:05These results showed that having been
8:07diagnosed with gestational diabetes
8:09during pregnancy did not increase
8:11perceived risk for developing type 2
8:14diabetes for all women. So, that
8:16experience was not a cue to action for a
8:19healthier lifestyle for everyone.
8:21This points to a potential gap in terms
8:23of education regarding risk for type 2
8:26diabetes, something that could be filled
8:28with a nutrition education initiative.
8:30Current dietary quality in this sample
8:32of women was moderate, not awful, but
8:35not great, either.
8:37Interestingly, the researchers found
8:39that the only variables which were
8:41significant predictors of a healthier
8:42eating pattern were higher levels of
8:45self-efficacy for healthy eating and
8:47higher education.
8:49The importance of self-efficacy for
8:51healthy eating in predicting healthy
8:53eating underscores the significance of
8:55self-efficacy and also highlights
8:58something that health promotion
8:59initiatives could aim to affect.
9:02Dietary self-efficacy can be increased
9:04through strategies such as education,
9:06problem-solving, observational learning,
9:09and so on.
9:10So, increasing self-efficacy for healthy
9:12eating among women with a previous
9:14diagnosis of gestational diabetes would
9:17likely support the adoption of healthier
9:19eating habits and thereby reduce the
9:21risk for developing type 2 diabetes.
9:24Let's consider an example of how the key
9:26constructs of the health belief model
9:28were applied to develop an intervention
9:31which aimed to increase the frequency of
9:34toothbrushing among unemployed adults
9:36between 18 and 24 years old living in
9:39New Zealand.
9:40The Keep On Brushing project sent
9:43motivational text messages created
9:45according to the constructs of the
9:46health belief model to participants once
9:49per week for a 10-week time period.
9:52These messages highlighted some of the
9:54benefits of toothbrushing, one's
9:57susceptibility to tooth decay, or the
9:59severity of cavities.
10:01Of 171 people who provided baseline
10:04data, 51% reported that they brushed
10:07their teeth two or more times per day,
10:10which corresponds to New Zealand's
10:11recommendations.
10:13And when the frequency of toothbrushing
10:15was reassessed at the end of the text
10:17messaging intervention,
10:18the proportion who reported brushing
10:20their teeth two or more times per day
10:22increased to 73%.
10:25But interestingly, only 26% of the
10:28original participants, that's 44 of the
10:31171 who provided information at the
10:33beginning of the study, were still
10:35participating in the study and answered
10:37the question about how many times they
10:38brushed their teeth on the previous day.
10:41The researchers conducting this trial
10:43concluded that motivational text
10:45messages based upon the health belief
10:47model constructs increased toothbrushing
10:50frequency in a population that can be
10:52hard to reach through traditional
10:54channels. And they further noted that
10:56the increase in toothbrushing frequency
10:59primarily occurred by week three of the
11:01intervention and remained stable after
11:03that point. These examples illustrate
11:06just two ways that this model has been
11:08applied to explain and predict
11:10health-related behavior. And how various
11:13health behavior theories can be key
11:15tools in our efforts to understand and
11:17change people's actions. As you learn
11:20about some of the key health behavior
11:22theories used in public health, consider
11:24these questions. What are the main
11:26strengths and limitations of each model?
11:29How are the models similar to and
11:32different from each other?
11:34How have the models been used to develop
11:36health promotion interventions in the
11:38past?
11:39Overall, you need to critically evaluate
11:42the various theories and consider how
11:45they've been used by others to explore
11:47which theories might be the best fit for
11:49the particular context in which you are
11:52working. Having a good working knowledge
11:54of health behavior theories will be
11:56tremendously useful in designing
11:58evidence-based public health nutrition
12:01interventions and make it more likely
12:03that your health promotion goals will be
12:05achieved.

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