File Name: health behavior and health education glanz .zip
Methods: A narrative review was conducted. Results: Traditionally, models and theories used to either predict or change health behaviors in aging have not viewed the mind as encompassing embodied and relational processes nor have they given adequate attention to multi-level, in-the-moment determinants of health behavior. Discussion: Future theory and research in aging would benefit from a broader integrative model of health behavior.
The effects of adverse life experience and changes in biological systems with aging and chronic disease on health behavior warrant increased attention.
Keywords: health behavior, models, theories, interventions, aging. The health care of older adults is complex requiring varying degrees of commitment on the part of patients to follow prescribed regimens of treatment. These regimens include behaviors such as dietary intake, physical activity, prescription drug use, taking preventive health screenings, and adherence to behavior protocols for physical rehabilitation.
As a field, Behavioral Medicine has come to recognize that health behaviors are determined by multiple levels of influence. Of critical importance is that, while theories often conceptualize health behaviors as intentional and under conscious control, this is often not true as is evident in the biological and environmental determinants of addictive behaviors. We then present a contemporary definition for the concept of mind and review support for an integrative model based on this perspective.
We believe this model will help to advance intervention development in aging research and foster an interdisciplinary science of health behavior and health behavior change.
As theory has advanced, scientists have adopted increasing specificity in the conceptual definition and measurement of constructs while becoming more interested in behavior change over understanding why individuals engage in particular health behaviors. Additionally, there has been increased interest in affect as well as the physiological and environmental input to health behavior and health behavior change.
The HBM first appeared in the s as a guide to research on tuberculosis screening. HBM is an expectancy-value model. As an example, people take medication to control their cholesterol because they value avoiding cardiovascular disease.
Core constructs include perceived threat of a given disease state, which is the product of perceived susceptibility to the disease and perceived disease severity. The model also emphasizes decisional balance: the relative weight of perceived benefits as compared to perceived barriers to engaging in a behavior.
As shown in Figure 1 , health behavior results from the combined effect of perceived threat and decisional balance over anticipated outcomes.
Of note, HBM practitioners have long recognized the limited scope of the model. Figure 1 The health belief model. Health Ed Quart. While there is continued emphasis on the concept of expectancy-value, a chief advancement of SCT is its focus on personal agency and the importance of context as a determinant of health behavior.
Moreover, while SCT has been useful in understanding why people perform a specific health behavior, it has also had a major effect on interventions for behavior change. Efficacy beliefs are dynamic, affecting and being affected by several downstream constructs highlighted in SCT see Figure 2.
Individuals with higher self-efficacy for a behavior are likely to have higher expectations for associated outcomes. They also perceive greater support from the social and physical environment and engage in more favorable self-regulatory behaviors than those with low self-efficacy. Success with the behavior fuels self-efficacy, especially when success occurs in the face of challenge. In addition, encouragement from others and observing relatable peers or those less skilled having success with a given behavior also enhances self-efficacy.
For example, Bandura calls forth the image of preparing for a public speaking event. As anxiety mounts in preparing to deliver a talk, some individuals become hypersensitive to physical symptoms such as rising heart rate, increasingly sweaty palms, and a queasy stomach. The result is that they experience a sharp, in-the-moment decline in their speech-related self-efficacy.
Figure 2 Social cognitive theory. Note: Aadapted from Bandura A. Health promotion by social cognitive means. Health Educ Behav. In part, the appeal of SCT arises from its specificity. Unfortunately, these key considerations are typically lost in implementation, with the focus constrained to individual-level perceptions and the influence of proximal social connections.
The third model of health behavior that we chose for inclusion is RP for addictive behavior. As an outgrowth of SCT, the intent behind RP was to describe the process of relapse for addictive behavior, emphasizing the importance of early intervention. They conceptualized relapse as an expected and transitional process; a key aim is to avoid or to learn how to cope with high-risk situations.
RP identified two categories of factors that contribute to a risk for relapse: immediate determinants and covert antecedents. They are immediate in-the-moment determinants of addictive behavior.
These range from social and physical environments, to internal states such as depression or negative affect. Another immediate determinant, coping, captures how an individual responds to a high-risk situation. Outcome expectancies are a third determinant, in that individuals who expect short-term benefits such as reduced anxiety from the behavior are more likely to relapse.
The fourth immediate determinant is the abstinence violation effect, which refers to the feeling of guilt or lack of control accompanying a single lapse. Covert antecedents of relapse are a partial determinant of whether an individual successfully negotiates immediate determinants.
More recent iterations of the model 11 specify both trait-like—tonic — influences on relapse, which are thought to dictate initial susceptibility to a relapse, and more dynamic and transient influences—phasic. Phasic influences include momentary mood states, urges and cravings, and in-the-moment changes in self-efficacy or outcome expectations.
These phasic influences represent the most proximal determinants of a relapse. Although not explicitly stated in RP, an interesting feature is the awareness that conscious goals related to recovery often succumb to the physiological symptoms of withdrawal, negative affective states, and the emotional tipping point created by the abstinence violation effect. Moreover, the ways in which these goal-driven behaviors are regulated are given importance in SDT. An intrinsically motivated behavior is one that brings about feelings of interest, enjoyment, or satisfaction, and it is theorized that this produces self-motivated, or self-determined behavior that is likely to last.
When the behavior is motivated by factors aside from the merits of the behavior itself, it is said to be externally regulated. There are several important conclusions to be drawn from research on SDT and health behavior.
As with research on incentives and affective valence described below, SDT highlights the importance of maximizing behaviors that produce positive bodily states such as enjoyment. It also provides a useful framework for considering appropriate incentives. Namely, by emphasizing incentives that are intrinsic as opposed to extrinsic. Lastly, it underscores the value of leveraging the group as a tool of behavior change; a notion we will highlight in the final section of this manuscript.
Although the motivational significance of incentives and affective valence that people associate with particular outcomes of a health behavior are evident in the concept of expectancy-value, within contemporary theoretical frameworks it is frequently assumed that people value their health and the focus of most research has been on self-efficacy, outcomes expectation, and behavioral intention.
There has been a surge of interest in the affective determinants of health behavior, including work on both reflective and reflexive affect. Rhodes and Gray 19 recently note that most research on affect and health behavior has focused on reflective as opposed to reflexive affect.
Although not conducted on older adults, reviews of the exercise literature have shown that reflexive affect may be more important in predicting future exercise behavior than reflective affect or social cognitive variables. Given the growing interest in reflexive affect 17 and the importance of incentives to health behavior, there are important lessons to be learned from work in the biology of addiction.
The central axis for desire begins in the ventral tegmental area VTA of the midbrain. Activation of this region of interest provides the fuel for desire—dopamine!
Other key areas of the brain involved in impulsive behavior—the initiation of an addictive behavior—include the ventral and dorsal striatum, amygdala, hippocampus, and prefrontal cortex PFC. In the early stages of desire for a substance or behavior, both nonconscious and conscious processing are involved.
The amygdala acquires and maintains emotional sensations and communicates with the hippocampus, a structure that stores explicit memories of experience. The ventral striatum is responsible for feelings of attraction, desire, and craving.
It is the main driver for impulsivity, getting its fuel from the VTA. The PFC creates conscious, context-specific interpretations of highly motivating situations and is key to executive function, planning, bringing memories into consciousness, sorting and comparing memories, and making decisions.
Once a person has been repeatedly exposed to a desired substance or behavior, involvement of the PFC in the reward network weakens to the point where conscious processing is no longer involved—the dorsal lateral region of the striatum has led to addiction, a compulsive act.
The substance or behavior is now a habit: stimuli lead to a response S-R in the absence of conscious thought. We believe this model describing the biology of desire is important for several reasons. First, desire—or the incentive value of a behavior—is applicable to both functional and dysfunctional health behaviors.
Second, as this model illustrates, intervention development would benefit from integrating concepts from neuroscience into the study of health behavior change. Third, as we will see later, there may be important neural phenotypes that could assist in tailoring treatment.
Fourth, we believe this model is applicable to understanding incentives or desire more generally; habits vary in their strength! If we hope to promote health behaviors among older adults, there is little question that we need to discover the motivational levers that operate for different people in varied contexts.
Fifth, we believe a focus on desire has wide application to the design of behavioral interventions and should give pause to health scientists implementing aversive interventions such as highly popular high-intensity physical activity training regimens. Finally, it is important to note the growing popularity of ecological models of health behavior.
A key assumption of these models is that researchers can study individuals at various levels of influence, including the individual, community, state, or national level. However, effective health behavior change likely needs to consider the individual as affected by these various levels of influence.
For instance, the likelihood an individual sets a goal to eat better, engage in exercise, commute in an active manner, or reduce sitting will be influenced by their built eg, are there bike paths and healthy food options? That is, people engage in health behaviors because of the belief that the behavior will yield outcomes of value. It is interesting to note that, with the emergence of SCT, the focus has been on self-efficacy even though it is one of the several core constructs alongside incentives and outcome expectations.
Although the role of affect and physiological states on health behavior is apparent in SCT, the theory posits that self-efficacy mediates these effects. In addition, it is surprising that researchers have paid so little attention to the incentives underlying health behaviors, how incentives and goals benefit from being linked to core needs central to SCT, and how the affect associated with the incentive value of health behavior may be tempered by the sacrifices that older adults are often required to make when changing their behavior.
Of note is the fact that, as models and theories of health behavior have evolved, there has been an increasing conceptual focus on behavior change.
This study is quasi-experimental research with an aim to examine the effects of a health belief model program on complication preventive behavior in hypertensive older persons. The target group was 50 elderly people with hypertension at the Elderly Club of Amphoe Wiset Chai Chan, Angthong, who met the eligibility criteria. The first 25 subjects were assigned to the control group and the next 25 subjects were assigned to the experimental group. They were pair-matched based on their similar characteristics in terms of gender, age, and educational attainment. The control group received routine nursing care, whereas the experimental group participated in the health belief model program for elderly people with hypertension.
Understanding the theoretical basis of health behavior and evaluating their use has been a mainstay of Dr. Glanz's work. Please refer to the publications and resources below to learn more about this work. PDF copies of articles are available for download by clicking the citation. Any copies downloaded are for personal use only. Glanz K, Bishop D. The role of behavioral science theory in development and implementation of public health interventions.
Health behavior change is our greatest hope for reducing the burden of preventable disease and death around the world. Tobacco use, sedentary lifestyle.
Many professionals who work in health promotion and health education would agree that health behavior research is a core foundation for both research and practice. If this is so, then the short answer to the question of whether health behavior research is relevant to health promotion and health education is simple: It is highly relevant, pervasive, and almost always woven into work in the field. This short answer, however, does not convey a complex story very well. Health promotion and health education are eclectic, rapidly evolving, and reflect a conglomeration of approaches, methods, and strategies from social and health sciences. Unable to display preview.
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Health behavior and health education: theory, research, and practice Karen Glanz and Marc D. Schwartz Michelle C. Kegler and Karen Glanz [http://stpetersnt.org].Reply
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