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Individual-level models
of health behavior
Caitlin Kennedy
Health Behavior Change at the Individual,
Household and Community Levels
224.689
Individual-level models
of health behavior
National Cancer Institute. Theory at a Glance. US Dept of Health and Human Services, 2005.
Individual-level models
of health behavior
Dozens of models exist we do not
attempt to present the full range of models
in this course
Our aims:
Make you an informed consumer of
models
Understand range of applications of
models
HBM
Constructs in the
Health Belief Model
Perceived susceptibility to the
health problem
Perceived severity of the health
problem
Perceived benefits of the
recommended solution
Perceived barriers to adopting the
recommended solution
Cues to action
Self-efficacy
Present
in the
original
model
Later
additions
Applying HBM
(Similar considerations
for other models)
Applying HBM
Qualitative research
Quantitative surveys
Intervention design
Qualitative methodologies
Model-based
Take a HBM or other
model as basis for:
Questions to ask
and/or
Coding
and/or
Presentation of
results
Model-free approach
No starting model:
Elicit local (emic)
model or develop your
own (etic) model
based on the data
Examples:
Ethnography
Grounded Theory
Phenomenology
Model-based examples
Downing-Matibag & Geisinger 2009
Study on hooking up among college
students
HBM guided questions asked, coding,
presentation of findings
Phuanukoonnon et al. 2006
Study on dengue fever in Thailand
HBM guided questions asked &
presentation of findings, role in coding
unclear
Coding
Codes identifies the topic addressed in a
piece of text
Way of organizing textual information by
topic/theme
Codes inserted manually or with software
for textual analysis like NVivo, Atlas.ti
Subsequent analysis may bring together all
statements on that topic, then compare
and summarize these findings
Coding
Example from Downing-Matibag 2009: Here
the code may be Perceived susceptibility
or perceived risk corresponding to the
HBM construct
Like I think [midwest state] has maybe
as low as 2% population-wise of people
with HIV compared to the nation. Of
course that doesnt mean I cant get it.
But I feel like its a risk thats not nearly
as high as if I lived somewhere else. So
I dont think about HIV.
Weaknesses
Not considered real
qualitative research by
many
Categories are predefined: Do you really
learn what people are
thinking?
Crucial local concerns not
fitting into model may be
ignored
Applying HBM
Qualitative research
Quantitative surveys
Example: Lindsay and Strathman 1997
on recycling behavior
Intervention design
Applying HBM
to flossing behavior
Construct: Exposure to
information
I am very well informed about tooth brushing and
dental flossing as part of hygiene
Construct: Self-efficacy
Flossing my teeth is hard to do
Construct: Self-efficacy
I am confident I can floss my teeth once a
day
Behavioral outcome
During the last week, how often did you
floss your teeth?
Not at all 21.1%
Once a week 28.2%
Every second day 23.9%
Once a day 25.4%
More than once a day 1.4%
(Better than dental patients in Australia:
only 16% flossed once a day)
Applying HBM
Qualitative research
Quantitative surveys
Intervention design
National Cancer Institute. Theory at a Glance. US Dept of Health and Human Services, 2005.
TRA/TPB constructs
National Cancer Institute. Theory at a Glance. US Dept of Health and Human Services, 2005.
National Cancer Institute. Theory at a Glance. US Dept of Health and Human Services, 2005.
What people
think the
situation is
TRA/TPB:
#1. Behavioral intentions
National Cancer Institute. Theory at a Glance. US Dept of Health and Human Services, 2005.
TRA/TPB:
#1. Behavioral intentions
The best predictor of actual behavior
Best measured by linking the behavior to
specifically defined:
Action
Target
Context
Time
TRA/TPB:
#2. Attitude toward the behavior
National Cancer Institute. Theory at a Glance. US Dept of Health and Human Services, 2005.
TRA/TPB:
#3. Subjective norms
National Cancer Institute. Theory at a Glance. US Dept of Health and Human Services, 2005.
Norms
Norms are everywhere
What should I wear?
What should I eat?
Should I smoke?
How many children should a couple
have?
Subjective norms
Adding on normative/social dimension to HBM
Two parts:
Normative beliefs: What do I think people I
know think I should do?
My sexual partner thinks I should use a
condom
My family thinks I should breastfeed
Motivation to comply: How important is it to
me to do what others think I should do?
It is very important to me to do what my
partner/family thinks I should do
TRA/TPB:
Combining #2 and #3 into the
cognitive structure
for the behavior
Cognitive
structure
National Cancer Institute. Theory at a Glance. US Dept of Health and Human Services, 2005.
Specific to Action,
Target, Context, Time.
I think wearing a
helmet is good.
Wearing
Helmet
My friends think wearing
a helmet is not cool.
I care a lot about what
my friends think of me.
If I wear a helmet
my friends will think
I am not cool.
Specific to Action,
Target, Context, Time.
I think using a
bednet is good.
Using
Bednet
My family thinks using a
bednet is for people who
are weak.
I care a lot about what
my family thinks of me.
If I use a bednet
my family will think
I am weak.
TPB:
#4. Perceived behavioral control
National Cancer Institute. Theory at a Glance. US Dept of Health and Human Services, 2005.
Markus HR, Kitayama S. Culture and the self: Implications for cognition, emotion, and motivation. Psychological Review 1991;98:224-253
Thursday
8:30-9:00: Lecture here on Social Cognitive
Theory
9:00-10:20: Discussion groups
Be sure to read Markus & Kitayama pp
224-230 n.b. Figure 1 and Table 1