Hbhe 600: Psychosocial Factors In Health-related Behavior: Dr. Vic Strecher Kate Hsieh Sarah Lillie

HBHE 600: Psychosocial Factors in Health-Related Behavior Dr. Vic Strecher Kate Hsieh Sarah Lillie

Final Review Session

Sample Question for concept, construct, variable • When a concept is adopted into a model or theory, it becomes a _________________, which in the operational form (i.e. you can measure it) becomes a __________________. A. variable, construct B. construct, variable C. question, belief D. belief, question

Sample Question for HBM • Which of the following is NOT true for Health Belief Model? A.It is a disease-focused model. B.It has been shown in much research to successfully predict changes. C. It is also good to predict lifestyle changes without an addition of the self-efficacy construct. D. It best predicts screening behaviors such as tuberculosis screening.

Perceived benefits

Demographics, Social support, Personality Traits

minus

Perceived barriers

Susceptibility and Severity of Disease

Perceived threat of disease

Cues to action

Likelihood of behavior change

Sample Question for TPB • A doctor is conducting an elicitation interview with his patient who is ready to quit smoking. The doctor asks, “Who are the people or groups you would listen to who are either in favor or opposed to your tobacco use? What TPB construct is the doctor trying to assess? A. Behavioral beliefs. B. Evaluation of behavioral outcomes. C. Normative beliefs. D. Motivation to comply.

Behavio

Sample Question for SCT Kate believes that getting a mammogram will lead to early detection of breast cancer. This is an example of: A. efficacy expectations. B. perceived severity. C. outcome expectations. D. perceived susceptibility.

Person

Behavior

Efficacy expectations

Outcome

Outcome expectations

Sample Question for TTM • Which of the following are TRUE for the Transtheoretical Model (TTM)? A. TTM conceptualizes behavior change as a single event. B. TTM suggests that move people to “action stage” is the single most effective outcome. C. TTM suggests a “one size fits all” approach for individuals in different stages. D. A person can get stuck in a stage in TTM for years. Pro/cons

Temptations

Pro/cons

Pro/cons

Precontemplation

Temptations

Contemplation

Preparation

Temptations

Action

Maintenance

MOTIVATIONAL INTERVIEWING “client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence”

Rollnick and Miller, 2001

MOTIVATIONAL INTERVIEWING “an egalitarian, empathetic, and clientcentered way of being that manifests through specific techniques and strategies, e.g. reflective listening, shared agenda setting”

Resnicow et al, 2002

Sample Question • Which of the following is NOT a principle of Motivational Interviewing (MI)? A. Determining the treatment plan for clients B. Client-centered C. enhancing intrinsic motivation to change D. exploring and resolving ambivalence E. reflective listening

Eliciting Change Talk Stage 1: Diagnosis Strategy 1: Willing and Able Willingness On a scale of 0 to 10, with 10 being very willing, how willing (interested/motivated) are you to ...... (quit smoking, eat more F & V, exercise more, take your meds)? 0 12 34 56 78 910 Not at all Somewhat Very Confidence On a scale of 0 to 10, with 10 being very confident, assuming you decided to ....... (quit smoking, begin exercising) how confident are you that you could succeed ? 0 12 Not at all

34

56

78 910 Somewhat Very

Eliciting Change Talk: “The Three Probes”

1) Could have been Lower 2) Could have been Higher 3) What would it take

Reflective Listening  Statement, not a question  Ends with a down turn  Hypothesis testing (If I understand you correctly, it sounds like..)

 Affirms and validates  Keeps the client thinking and talking

Sample Questions You are working with a patient who said he was a 7 on the scale of 1 to 10 for willingness to exercise 3 times a week. • What would you ask using the scale to assess his barriers? • What would you ask to assess his perceived benefit?

Behavior modification • Observing/monitoring • Task analysis • Reinforcement • Shaping • Modeling • Contracting • Action planning

Reinforcement: Types • All reinforcement results in increases in behavior frequency or likelihood – Positive reinforcement – applying something positive following a behavior – Negative reinforcement – removing something aversive following a behavior

Reinforcement: Schedules and Size • Continuous vs. intermittent – Continuous: Behavior is reinforced each time it occurs – Intermittent: Behavior is reinforced on some occasions but not others – Variable vs. fixed schedule

• Immediate vs. delayed • Large vs. small

Reinforcement: types • Unconditioned reinforcer: function as reinforcers the first time they are presented to most human beings • Conditioned reinforcer: a stimulus that was once neutral but became established as a reinforcer by being paired with an unconditioned reinforcer or an already established conditioned reinforcer

Miltenberger R. Behavior Modification: Principles and Procedures (3rd Edition). Thomson, Belmont, CA. 2004.

Putting it all together Something is given Behavior increases

Something is taken away

Positive Negative reinforcement reinforcement (give good) (take away bad)

Modeling: The art form of imitation • Conditions that enhance effectiveness of modeling – – – –

Similarity of model to subject Higher status model Multiple models Coping vs. mastery models

RECAP • When a behavior increases because I took something bad away, it’s called a ___? • When I give someone something good to increase a behavior, it’s a ____? • Should a reinforcement be: – – – –

Continuous or intermittent? Immediate or delayed? Large or small? Consistent or irregular?

•

Sample Question

Jean gets into her car and does not put her seatbelt on. When she starts her car, she hears a loud beeping noise. This loud beeping noise is: A. to decrease her barriers to putting on her seatbelt. B. to change her perceived severity about getting into a car accident. C. a cue to action. D. annoying. E. I cannot tell from the information provided. •

After Jean puts on her seatbelt, the loud beeping noise stops. This is a ___________ for Jean to buckle up her seatbelt. A. Positive reinforcement B. Negative reinforcement

Sample Question • Sue is trying to quit smoking. Sue was told by her doctor to keep a daily log of her smoking behavior including what time of day Sue smokes and how Sue feels after smoking. What behavior best describes what Sue’s doctor is encouraging her to do? A. self-regulation B. behavior contracting C. action planning D. self-monitoring E. reinforcing

Relationship between goal difficulty and goal commitment

Behavior change

High goal commitment

Medium goal commitment

Low goal commitment Low

Medium

Goal difficulty

High

Causal attributions Internal/ external Stable/ unstable Uncontrollable/ controllable

Definition of Relationships among Variables • Antecedent-background factors that precede expected relationships. • Mediating-variables that come between predictor and outcome variables. • Moderating-relationship between the predictor and outcome is influenced by different levels of another variable.

Predictor

Dependent

Variable

Variable

Predictor

Dependent

Variable

Variable

Predictor

Dependent

Variable

Variable

Types of Relationships between Variables

Elaboration Likelihood Model (ELM)

central route

Cognitive elaboration

peripheral route

Little/no elaboration

Message

Central processing: Quality of arguments crucial Motivation can depend upon e.g.; personal relevance need for cognition Ability can depend upon e.g.; prior knowledge, message comprehensibility amount of distraction, repetition Attitude change following central processing is likely to be more enduring, resistant to further change and more likely to be correlated with behaviour

Peripheral processing: Involves inferring likely correctness / usefulness of the message from non-issue characteristics or cues Cues include: attractive and expert sources number of messages inability to process centrally (e.g. unclear message or distraction)

Some conclusions regarding attitude change… If strong arguments are available…. provide many repeat a few times ensure appropriate prior knowledge emphasise personal relevance ensure distraction-free presentation If not….. distract the receiver use acceptance cues (more messages & source credibility)

Sample Question • You are creating a new commercial to encourage young women to wear sunscreen. You are using Hillary Duff as your spokeswoman for sunscreen. What type of processing are you trying to achieve?

Central Processing • • • • • •

Personal Relevance Quality of arguments Expertise Knowledge Need for Cognition Timing

Peripheral Processing • • • • • •

Personal Relevance Quality of arguments Expertise Knowledge Need for Cognition Timing

Cognitive Load Theory

Stimuli

Sensory Register

Working Memory Selective Attention

Long Term Memory Encoding

Sample Questions • A. B. C. D. E. •

Which statement(s) tells you that the client you are working with has a high need for cognition? (SELECT ALL THAT APPLY.) “When I am in a new city, I always rely on other people to figure out the logistics of what attractions we should see and where we should eat.” “I like it when my boss tells me what to do.” “My favorite thing to do on Sunday mornings is the New York Times crossword puzzle.” “I have to read the cereal box when I am eating my breakfast cereal.” “If someone tells me something cannot be done. I am likely to spend time trying to come up with a new way of doing it.” Using the Cognitive Load Theory, what mediates the sensory register and memory?

Common health behavior change models: Person

Behavior

Efficacy expectations

–Social Cognitive Theory

Outcome

Outcome expectations

–Transtheoretical (Stages of Change) Model Pro/cons

–Health Belief Model

Temptations

–Theory of Planned Behavior

Pro/cons

Pro/cons

Temptations

Temptations

Action

Preparation

Contemplation

Perceived benefits

Demographics, Social support, Personality Traits

minus Precontemplation Perceived barriers

Susceptibility and Severity of Disease

Perceived threat of disease

Likelihood of behavior change

Cues to action

Motivation

Behavioral Beliefs

Self-efficacy

Maintenance

Developing a Conceptual Model • Specify an outcome of interest. • Use an existing model as a starting point. • Select potential correlates of the outcome. • Determine the initial relationships among selected concepts using theory and empirical evidence, as well as personal knowledge. • Draw linkages among concepts.

Example 1 • This example encompasses a few theories but the TPB was used as a starting off point

Use of prescribed inhaler by teenage asthmatics Cue to Action

Attitudes Towards Inhaler Use Intention to use Inhaler

Inhaler Use

Subjective Norms Vicarious experience

Self-Efficacy

Coping Social Support Barriers (Actual/ Perceived)

Health Belief Model Cue to Action

Attitudes Towards Inhaler Use Intention to use Inhaler

Inhaler Use

Subjective Norms Vicarious experience

Self-Efficacy

Coping Social Support Barriers (Actual/ Perceived)

Theory of Reasoned Action Cue to Action

Attitudes Towards Inhaler Use Intention to use Inhaler

Inhaler Use

Subjective Norms Vicarious experience

Self-Efficacy

Coping Social Support Barriers (Actual/ Perceived)

Theory of Planned Behavior Cue to Action

Attitudes Towards Inhaler Use Intention to use Inhaler

Inhaler Use

Subjective Norms Vicarious experience

Self-Efficacy

Coping Social Support Barriers (Actual/ Perceived)

Social Support, Coping Cue to Action

Attitudes Towards Inhaler Use Intention to use Inhaler

Inhaler Use

Subjective Norms Vicarious experience

Self-Efficacy

Coping Social Support Barriers (Actual/ Perceived)

Self-Efficacy Cue to Action

Attitudes Towards Inhaler Use Intention to use Inhaler

Inhaler Use

Subjective Norms Vicarious experience

Self-Efficacy

Coping Social Support Barriers (Actual/ Perceived)

Example 2 • Here is another example. It is simpler than the conceptual models we have seen, but still includes theory. • What are the relationships you see? • Where are the theoretical constructs?

Safe contact lens-washing routine Perceived threat of eye infection

Verbal reinforcement

Ophthalmologistpatient communication

Understanding of contact lens washing routine Verbal reinforcement

Safe contact lens hygiene Perceived Behavioral Control

Barriers Benefits

Perceived threat of eye infection

Verbal reinforcement

Opthamologistpatient communication

Understanding of contact lens washing routine Verbal reinforcement

Safe contact lens hygiene Perceived Behavioral Control

Barriers Benefits

•

Culture-based

•

Accessible

•

Values-based

•

Acceptable

•

Literacy-based

•

Consumer-centric

•

Adaptive

•

Data-centric

•

Engaging