HEALTH BEHAVIORAL MODELS

CONTENTS

• INTRODUCTION

• DEFINITION OF KEY TERMS

• MODELS OF INDIVIDUAL HEALTH BEHAVIOUR

• MODELS OF INTERPERSONAL HEALTH BEHAVIOR

• COMMUNITY & GROUP MODELS OF HEALTH BEHAVIOR CHANGE

• USING THEORY IN RESEARCH AND PRACTICE

• CONCLUSION

• REFERENCES
INTRODUCTION

• Health psychology is the study of psychological and behavioural processes in health,

illness, and healthcare

• Health education and behaviour change professionals once might have relied on intuition,
experience, and their knowledge of the literature, increasingly we expect professionals to
act on the basis of evidence.

• Theory and practice should coexist in a healthy dialectic; they are not dichotomies.

MODEL / THEORY

• Description , often presented as a

MODELS figure ,of the factors associated with in
the case.

• Theory of the model describe the

THEORIES nature and strength of the relationship
between these factors and confirms
these relationship in a scientific way

DEFINITION OF KEY TERMS

• Health behaviour as any activity undertaken by

people in order to protect , promote , or maintain
HEALTH BEHAVIOUR health and to prevent disease’- Steptoe et al 1994

SICK-ROLE RISK BEHAVIOUR

ILLNESS BEHAVIOUR
Any activity undertaken by
an individual who perceives
himself to be ill, to define the
state of health, and to
discover a suitable remedy
(Kasl and Cobb, 1966a)
BEHAVIOUR
Any activity undertaken by
an individual who
considers himself to be ill,
for the purpose of getting
well. It includes receiving
treatment from medical
providers, generally
involves a whole range of
Specific forms of
behaviour which are
proven to be associated
with increased
susceptibility to specific
disease or ill- health.
WHO health promotion
Glossary 1998
WHY HEALTH BEHAVIOR STUDY?

• Developing effective health education intervention needs to be directed at a specific

behavior and/or group.

• Analysis of health behavior helps to identify which behavior and which group to target
with the programme

• To understanding cognitive processes involved in translating the health education into

health behavior, and factors which might mitigate against success.

• We understand existing behavior , this will help determine how things can be made
different (Changing behavior).

HEALTH BEHAVIOR MODELS

1) MODELS OF INDIVIDUAL HEALTH BEHAVIOUR

 Health Belief model

 Theory of reasoned action, theory of planned behaviour, and the integrated
behavioural model
 Trans theoretical model and stages of change
  Precaution adoption process model (PAPM)

2) MODELS OF INTERPERSONAL HEALTH BEHAVIOR

 Social cognitive theory

 Social network and Social support
 Transactional model of stress and coping

3) COMMUNITY AND GROUP MODELS

 Community Organization And Community Building

 Diffusion Innovations
 Theories Of Organizational Change
 Communication Theory And Health Behaviour Change

HOW PEOPLE FEEL ABOUT HEALTH

ATTRIBUTION THEORY

 Heider (1944) worked on the theory

 Psychologists are interested in beliefs. Attribution theory deals with person’s own
attributions for the causes for different behavior.
 Distinctiveness , Consenses , consistency over time , over modality
 Internal Vs External – Iam not selected for job because I had not given good
performance Vs person took interviewed didn’t like my gender
 Stable Vs Unstable – My failure always follows me Vs I was just fail for that job only

LOCUS OF CONTROL

• Health Locus of Control has been developed from social learning theory (Julian B Rotter,
1954).
• Rotter's view was that behaviour was largely guided by reinforcements which include
rewards and punishments.
• Individual beliefs guide what kinds of attitudes and behaviors people adopt.
• Wallston et al, 1978 - Health Locus of Control measures the extent to which individuals
believe that their health is influenced by own behaviour or by external causes.
 • External locus of control and Internal locus of control.

SENSE OF COHERENCE

• Sense of coherence is based on the concept of Salutogenesis (saluto = health; genesis =

origin) which was proposed in 1979 by Aaron Antonovsky.

• The theory explains that factors that promote health are different from those that modify
the risk for specific diseases.

• It is more important to focus on resources and the capacity to generate health -

salutogenesis – rather than the causes of the disease - pathogenesis.
SHIS - Salutogenic Health Indicator Scale – Measurements of Health Indicator

It is related to a Salutogenic and holistic description of health , which has been developed with
support of theories linked to concepts such as health and well-being.

• It reflects a person's view of life and capacity to respond to stressful situations in a health-
promoting manner.

• Acts as a promising approach for health promotion for the following reasons:

– It focuses on pathways and mechanisms leading to health.

– It addresses the "upstream" underlying social determinants, instead of focusing

mainly on changing health behaviours.

– Interventions based on an understanding of what sustains health in conditions of

chronic adversity.

Components of Sense of coherence

1. Comprehensibility (cognitive component)

2. Manageability (instrumental/behavioural component)
3. Meaningfulness (motivational component)
OPTIMISM

• Optimism is regarded as the generalized expectation of positive outcomes in the future.

• A disposition or tendency to look on more favourable side of events or conditions and to

expect the most favourable outcome.

• The belief that good ultimately predominates over evil in the world.

1) HEALTH BELIEF MODEL (HBM)

• In 1950's by Social psychologists in the U S public health service to explain the widespread
failure of people to participate in programs to prevent and detect diseases -HOCHBAUM

• Extended to study people’s responses to symptoms and their behaviors in response to a

diagnosed illness , adherence to medical regimens - ROSENSTOCK, 1966

• If individuals regard themselves as susceptible to a condition , believe that condition

would have potentially serious consequences, believe that a course of action available to
them would be beneficial in reducing either their susceptibility to or severity of the
condition , and believe the anticipated benefits of taking action outweigh the barriers to
action , they are likely to take action that they believe will reduce their risks
MODELS GIVEN BY CORE STEPS IMPLICATION
CONCEPTS

HBM HOCHBAUM, Value and Threat , Benefits , Dental Diseases

ROSENSTOCK, expectancy barriers , cues of
1966 beliefs guide action , Self
behavior. efficacy
 DENTAL

Demographic socio Benefits of dental health Preventive dental

psychological ( Education and outweighing cost of dental health behaviour
past dental behavior) disease.

Perceived seriousness of dental

ill health Perceived threat of dental
disease
Perceived susceptibility to poor
dental health

Cues of action
(Oral health education)
HBM SCALES FOR BREAST CANCER SCREENING

• In 1984 - champion developed , 1993 – self efficacy were added

• Benefits - Self examination & Mammography , would have in reducing the chance of death
from breast cancer.
• Barriers – Fear of findings a lump , time for screening , fear of radiation associated with
mammography ,memory of keep an appointment , pain.

ASSOCIATION OF HBM CONSTRUCTS WITH MAMMOGRAPH BEHAVIOR

• HBM predict women will be more likely to adhere to screening mammography

recommendation if they feel susceptible to breast cancer , think breast cancer is a severe
disease, perceive barriers to screening as lower than perceived benefits, have higher
self-efficacy for obtaining mammogram , and receive cue of action ( Health care
providers).
• Different group – different beliefs about cause for breast cancer – may ultimately
affect susceptibility.
• Older african – american believe that breast cancer is due to injury – if less frequency
of injury , susceptibility is quite low.
• Beliefs about lower perceived benefits like , surgery cause spread of cancer and lead
to death.
• MODESTY - special barrier in asian –american womens (And also fear ,
embarrassment & cost are barriers to adherence).

COMPARISON OF HBM WITH OTHER THEORIES

• HBM constructs have been combined with the Transtheoritical Model (TTM) component
of staging outcome behavior.

• Saywell and others stated that more intensive intervention is needed for women who are
not considering mammogram for screening than women who consider for screening.

• Women who are contemplating being screened have an increased perception of threats
and benefits to action and fewer barriers to action than women in pre-comtemplation.
 • Identifying subgroups of women who are in precomtemplation or comtemplation for
mammography allowed greater tailoring of interventions

CHALLENGES IN FUTURE HBM RESEARCH

• HBM has been used for over half a century to predict health related behaviours and to
frame interventions to change behavior.

• It simplicity , however also creates some of its major limitations.

• Several challenges,

• First perceived threats is a construct , has greater relevance in health related behaviors.

• However , the relationship between risk and severity in forming threat is not clear.

• Perceived susceptibility is stronger predictors when severity is perceived as higher

versus lower.

• Perceived benefits and barriers may be stronger predictors of behavior change when
perceived threat is high than when it is low.

• HBM is limited , in that it is a cognitively based model and does not consider the
emotional component of behavior.

• Cues of action are one component of HBM often missing from research.

• Cues of action will have greater influence on behavior when perceived threats and benefits
are high and perceived barriers are low.

• Cancer screening reminders letters or post cards as an intervention found may be a cue of
action.

LIMITATIONS OF HBM

It does not take into account:

• A person' s attitudes, beliefs, or other individual determinants

• Environmental or economic factors.
• It assumes that everyone has access to equal amounts of information on the illness or
disease.
• It assumes that cues to action are widely prevalent in encouraging people to act and that
“health” actions are the main goal in the decision-making process.
2) THEORY OF REASONED ACTION & PLANNED BEHAVIOUR

• FISHBEIN 1967 , The Theory of Reasoned Action (TRA) and Theory of Planned
Behavior (TPB) focus on theoretical constructs concerned with individual motivational
factors as determinants of the likelihood of performing a specific behavior.

• TRA - Attitude towards behavior and Social normative perceptions

• TPB – Additionally Perceived control over behavior

• Fishbein distinguished between attitude toward an object & attitude toward a behavior
with respect to the object.

• For example ,most theorists said , Attitude towards object ( Breast Cancer) in trying to
predict a behavior ( Mammography) , but fishbein stated , attitude towards the behavior (
Mammography) is much better predictor of behavior (Obtaining mammography) than
attitude towards the object (Cancer).

CONSTRUCT A MODEL

• TRA asserts that the most important determinants of behavior is behavioral intention.

• TRA - Attitude towards behavior and Social normative perceptions

• TPB – Additionally Perceived control over behavior where one may not have complete
volitional control over behavior.

ATTITUDE

It determined by the individual’s beliefs about outcome or attributes of performing the behavior
(Behavioral beliefs ), weighted by evaluations of those outcomes and attributes.

Positive beliefs that positively valued outcomes will result from performing the behavior will
have a positive attitude toward the behavior.
SUBJECTIVE NORMS

• It is determined by his or her normative beliefs , that is whether important referent

individuals approve or disapprove of performing the behavior , Weighted by his or her
motivation to comply with those referent

• A person who believes that certain referent think she should perform a behavior and is
motivated to meet expectations of those referents will hold a positive subjective norm

• TPB - AJZEN and Colleagues - Add perceived control in TRA component account for
factors outside individual control that may affect intentions and behavior.

• Perceived control is determined by Control beliefs concerning the presence or absence

of facilitators and barriers to behavioral performance , weighted by their perceived
power or the impact of each control factor to facilitate or inhibit the behavior.

• Ajzen’s inclusion of perceived control was based in part on the idea that behavioral
performance is determined jointly by motivation (Intention) and ability ( Behavioral
control) . A person’s perception of control over behavioral performance , together with
intention , is expected to have a direct effect on behavior ,
MODELS GIVEN CORE CONCEPTS STEPS IMPLICATION
BY

TRA& FISHBEIN Rationally motivated , Attitude , Tooth brushing

TPB 1967 intentional health and Subjective norms ,
non-health behaviors Perceived control of
AJZEN
behavior.

TOOTH BRUSHING MODEL

Behaviour Beliefs
Outcome beliefs Attitude regarding tooth
If I brush my teeth I will improve my brushing
dental health and make my smile more Tooth brush would be a
attractive good thing for me to do

Behavioral
Intention
I am going to
start
brushing my
teeth
Normative beliefs
Beliefs about others opinion
My family and friends think I should
brush my teeth Subjective norm for
Motivation to comply with others tooth brushing
opinions Tooth brushing is an
I want to do , what they want me to do appropriate thing to do
TBA MODEL

LIMITATIONS OF TPB

• It does not take into account environmental or economic factors that may influence a
person' s intention to perform a behavior.

• It assumes that behavior is the result of a linear decision-making process, and does not
consider that it can change over time.

• It doesn’t say anything about actual control over behavior.

• The time frame between "intent" and "behavioral action" is not addressed by the theory.
3) TRANSTHEORETICAL MODEL [STAGES OF CHANGE MODEL] PROCHASKA
AND VELICHER 1994

• The trans theoretical model (TTM) uses stages of change to integrate processes and
principles of change across major theories of intervention , hence the name trans
theoretical.
• It emerged from a comparative analysis of leading theories of psychotherapy and behavior
change in an effort to integrate a field that had fragmented into more than 300 theories of
psychotherapy.
MODELS GIVEN BY CORE STEPS IMPLICATIO
CONCEPT N
S

TRANSTHEORITIC PROCHASK Focusing on 6 stages Smoking

AL MODEL A AND changes in .Precomtemplatio Cessation
VELICHER behavior, n, comtemplation
1994 less on , preparation
cognitive ,action ,
(Perceived maintenance ,
risk and termination
barriers)

Within next 6
months

Within next 6
months

Next 30 days

Less than 6 months

More than 6 months

Life time
APPLICATION OF THE TRANSTHEORETICAL MODEL TO SMOKING

CESSATION

• Applying TTM like theory to entire at risk population , like smokers , requires a
systematic approach that begins with recruiting and retaining a high percentage of the
eligible population.
RECRUITMENT

• High recruitment rates provide Population impacts .

• Population impact has been defined as participation rate × the rate of efficacy of action.

• For example if a program produced 30% efficacy to be better than a program that
produced 25% abstinence.

• So achieve high impact , shift from reactive recruitment ,( where we advertise and react
when people reach us) to proactive recruitments ,where we reach out to interact with all
potential participants, including those not yet ready to change behavior.

• Physicians spent 5 min , Nurse 10 min , 12 min videotape and health educator.

RETENTION

• Psychotherapy and behavior change intervention poor retention rates.

• Promote retention – Match strategies – pre-contemplation stage highly retained then

preparation stage.

• Relapse prevention strategies would be indicated for smokers who are taking action.

PROGRESS

It depends upon , stages they started Contemplation > precontemplation.

PROCESSES

Classical conditioning processes like counter conditioning , stimulus control and contingency
control can highly successful strategies for participants taking action ,but create resistance in
precontemplation stage individuals. For those people ,dramatic relief and consciousness raising is
used for move from this stage.

OUTCOME

• Smokers in contemplation stage could begin taking small steps (Like delaying their first
cigarette in the morning for an extra thirty minutes) – it increases the self efficacy and
motivate for preparation stage.
 • Compare proactive and reactive recruitment of participants outcome .

• Reactive is more successful compare to proactive recruitment.

MAINTENANCE

• The person is more likely to focus on the advantages of behavior change ( I feel better
having stopped smoking) rather than on disadvantages in the earlier stages.

LIMITATIONS OF TRANS-THEORETICAL MODEL

• The theory ignores the social context in which change occurs, such as SES and income.

• The lines between the stages can be arbitrary with no set criteria of how to determine a
person' s stage of change.

• The questionnaires that have been developed to assign a person to a stage of change are
not always standardized or validated.

• There is no clear sense for how much time is needed for each stage, or how long a person
can remain in a stage.
4) PRECAUTION ADOPTION PROCESS MODEL

• Given by Neil D. Weinstein, Peter M. Sandman, and Susan J. Blalock , Initial work

On the PAPM was stimulated by Irving Janis and Leon Mann.

• Attempts to explain how a person comes to decisions to take action and how he or she
translates that decision into action.

• Refer to new precaution or cessation of risky behaviour and not the gradual development
of habit or commencement of risky behaviour

• Identifies seven stages along the path from lack of awareness to action

• Initial work on the PAPM , explain responses to threats by proposing discrete categories
determined by people’s beliefs about their capacity to cope with the threats.

• All PAPM stages prior to action are defined in terms of mental states , rather than in terms
of factors external to the person ,such as current or past behaviors.
MODELS GIVEN BY CORE STEPS IMPLICATION
CONCEPTS

PAPM NEIL D. Stages of 7 Stages - Health education

(PREACAUTION WEINSTEIN behavior Unaware. - Flossing
ADOPTION changes , Unengaged,
PROCESS) Focus more undecided ,
on increasing decided not to act ,
awareness decided to act ,
about risk. acting,
maintenance

• Stage 1 - People are unaware of the health issue

• Stage 2 – First learn something about the issue , no longer unaware , not yet engaged.

• Stage 3 - Decision making stage , become engaging with issue and considering responses.

• Stage 4 – If they decide to take no action moving to stage 4

• Stage 5 – If they adopt the precaution moving to stage 5

• Stage 6 – Initiate of behavior

• Stage 7 - The behavior has been maintained over time.

Never heard of taking calcium to prevent osteoporosis

Never thought about taking calcium

Decided
not to take
Undecided about taking calcium calcium

Decided to take calcium

Started taking calcium

Takes calcium regularly

Stage Transition Factor

Stage 1 to Stage 2 Media messages about the hazard and

precaution

Stage 2 to Stage 3 Media messages , Communications from

significant others , Personal experience with
hazard

Stage 3 to stage 4 or stage 5 Beliefs about hazard likelihood and severity ,

personal susceptibility , Perceived social norms

Stage 5 to stage 6 Time , effort and resources needed to act

Detailed how- to information

Reminders and cues of action

MODELS OF INTERPERSONAL HEALTH BEHAVIOR

1) SOCIAL COGNITIVE MODEL

• Social cognitive theory is a learning theory based on the operation of established
principles of learning within the human social context.
 • Also based on ideas that people learn by observing others with the environment,
behaviour and cognition, all as chief factors in influencing development in a reciprocal
triadic relationship.
• In this concept of cognitive psychology were integrated to accommodate the growing
understanding of human information processing capacities and biases that influence
learning from experience , observation and symbolic communication. (BANDURA
1977)

MODELS GIVEN BY CORE STEPS IMPLICATION

CONCEPTS

SOCIAL BANDURA Human agency Psychological , Smoking

COGNITIVE 1977 and environmental cessation
environment determinants,
interact – Observational
individual and learning , moral
social change disengagement , self
regulation

CONCEPT DEFINITION

Reciprocal determinism Environmental factors influence

individuals and groups , vice versa

Outcome expectations Beliefs about the likelihood and value of

the consequences of behavioral choices

Self -efficacy Beliefs about personal ability to perform

behaviors that bring desired outcomes
Collective efficacy Beliefs about the ability of a group to
perform concerted actions that brings
desired outcomes

Observational learning Learning to perform new behavior by

exposure Interpersonal or media displays
of them , peer modeling.

Incentive Motivation The use and misuse of rewards and

punishments to modify behviour

Facilitation Providing tools , resources or

environmental changes that make new
behaviors easier to perform

Self -regulation Controlling oneself through self regulation

( 6 STEPS)

Moral disengagement Ways of thinking about harmful behaviors

and the people who are harmed that make
infliction of suffering acceptable by
disengaging self regulatory moral
standards
 Psychological
determinant
self efficacy
belief ,
outcome
Mass expectations
communication,
attention, Observational
retention, learning
production,
motivation.

Incentive
Environmental
motivation ,
determinant
Facilitation

6 steps Self regulation

Euphemistic
Moral labeling ,
Disengagement attribution of
blame
Key concepts:

– Psychological determinants : self efficacy belief, Social outcome expectations

– Outcome expectations – Belief about the likelihood of various outcomes that might
result from the behaviours that a person might choose to perform and the perceived
value of those outcomes – Maximize benefits and minimize cost

– Observational learning: Mass communication, attention, retention, production,

motivation.

– Access to family , peer , and media models determine what behaviours a person is
able to observe, while the functional value of the outcome expected from the
modelled behavior determines what they choose to attend closely.

– Environmental determinants : Incentive motivation (Reward and punishments ,

Financial incentives) , Facilitation (Provision new structures or resources that
enable behaviours or make them easier to perform.

– Self-regulation: Self control does not depend upon will-power but instead his
acquisition of concrete skills for managing himself.

– Self monitoring ( Systematic observation of own behaviour), goal setting

(Identification incremental long term changes can be obtained ), feedback
(Information about quality of performance) , self reward (Tangible or intangible
rewards for himself) , self instruction (self talking by themselves), enlistment of
social support (Find people who encourage her efforts to exert self-control).

Moral disengagement: how people can learn moral standards for self-regulation, which can lead
them to avoid violence and cruelty to others.

• Euphemistic labeling - Sanitizes Violent acts by using words that make them less
offensive

• Dehumanization and attribution of blame to victim by perceiving them as racially or

ethnically different and at fault for the punishment they will receive
CASE STUDIES

• AMERICAN CANCER SOCIETY TELEPHONE COUNSELLING FOR

SMOKING CESSATION

• Counselors – 140 hrs training by self regulatory approach

• Self monitoring - Simple records of their smoking , cues were present when they smoked
,

• Goal setting - Single day and three day

• Feedback – Unsuccessful performance should be corrective and framed in positive way –

Good try

• Self reward – Saving money not buying cigar , Immediate self reward – Feeling
satisfaction by weekly savings

• Self instructions - Multiple Rehearsals by deep breathing and self instruction to cope with
stress and reduce craving for tobacco.

• Enlistment of social support - Clients are asked to explicit sources of support ,

Counselors are short term support , Positive feedback and increase the self –efficacy.

LIMITATIONS OF SOCIAL COGNITIVE MODEL

• SCT is very broad and ambitious , in that it seeks to provide explanations for virtually all
human phenomena.

• The theory assumes that changes in the environment will automatically lead to changes in
the person, when this may not always be true.

• The theory does not focus on emotion or motivation, other than through reference to past
experience. There is minimal attention on these factors.

• All related factor need to be test , Ex – obesity related research , Incentive motivation and
facilitative environmental change is important compare to others
2) SOCIAL NETWORK AND SOCIAL SUPPORT
• Social Network - Web of social relationships that surround individuals , it refers
linkage between people that may or may not provide social support and that may serve
functions.
• Social Capital – Certain resources and norms arises from social network.
 • Social support – One of the important functions of social relationships.
• Social integration - Existence of social ties.

STRUCTURAL CHARACTERISTICS OF SOCIAL NEWORK

RECIPROCITY Extent to which resources and support are

both given and received in a relationship

INTENSITY Extent to which social relationship offer

emotional closeness

COMPLEXITY Extent to which social relationship serve

many functions

FORMALITY Extent to which social relationships exits in

the context of organizational or institutional
roles

DENSITY Extent to which network members know and

interact with each other

HOMOGENEITY Extent to which network ,members are

demographically similar.

GEOGRAPHIC DISPERSION Extent to which members live in close

proximity to focal person

DIRECTIONALITY Extent to which members of the dyad share

equal power and influence
FUNCTIONS OF SOCIAL NEWORK

SOCIAL CAPITAL Resources characterized by norms of

reciprocity and social trust

SOCIAL INFLUENCE Process by with thoughts and actions

are changed by actions of others

SOCIAL UNDERMINING Process by which others express

negative affect or criticism or hinder
one’s attainment of goals

COMPANIONSHIP Sharing leisure or other activities

with network members

SOCIAL SUPPORT Aid and assistance exchanged

through social relationships and
interpersonal transactions.

TYPES OF SOCIAL SUPPORT

EMOTIONAL SUPPORT Expressions of empathy , love ,

trust and caring

INSTRUMENTAL Tangible aid and services

INFORMATIONAL Advice , suggestions and

information
 APPRASIAL Information that is useful for self -
evaluation

RELATIONSHIP OF SOCIAL NETWORKS & SOCIAL SUPPORT TO HEALTH

Reciprocal influence

Pathway 1 - Hypothesized direct effect of social networks and social support on health , By
meeting basic human needs for companionship , intimacy , sense of belonging , reassurance of
one’s worth as a person, supportive ties my enhance well-being and health.

Pathway 2 & 4 - Hypothesized effect of social networks and social support on individual
coping resources and community resources respectively.

Ex – SN & SS can enhance an individual’s ability to access new contacts and information and
to identify and solve problems.
 • On organizational and community competence are less well studied and it may increase
community’s ability to garner its resources and solve problems.

• Several community- level interventions have shown how intentional network building and
the strengthening of social support within communities are associated with enhanced
community capacity.

• Individual and community levels may have direct health enhancing effects

• Pathway 2a – 4a - If people experience stressors , individual and community resources

increases , stressors will be handled and coped with in a way that reduces adverse health.

• “Buffering effect’’

Ex – Research involving people going through major life transitions (Such as loss of a job or
birth of child) has shown how social networks and social support influence the coping process and
buffer the effects of the stressor on health.
 Pathway 3 - SN & SS may influence the frequency and duration of exposure to stressors,
Ex – Supportive supervisor may ensure that an employee is not given more work to do
than can be completed in the available time.
Social network provides information about new jobs may reduce the likelihood
that a person will suffer from long term unemployment.
Reduce exposure to stressors - Enhance mental an physical health
Pathway 5 - SN & SS supports on Health behaviors. Inter-personel exchanges within a
social network , individuals are influenced and supported in such health behaviors as
adherence to medical regimens , help seeking behaviors.
It may affect the incidence and recovery from disease.

FUTURE DIRECTIONS FOR RESEARCH AND PRACTICE

• Social network interventions enhance individuals' motivation and skills for performing
healthy behaviors while also enhancing health –promoting qualities of social networks
have great potential.

• Direction for future research is to develop and evaluate social network interventions that
include strategies across multiple units of practice .

Effective social network interventions evaluated through ,

• Carefully describing interventions activities ,

• Monitoring the effects of activities ,amount of quality of social support delivered and
received.

• Assessing changes in knowledge , health behaviors , community capacity or health status.

Effectively enhance the health-protective functions of Social network by

WHO – WHAT – WHEN - WHOM
 3) STRESS , COPING HEALTH BEHAVIOR
 Understanding stress and coping is essential for health education , promotion and
disease prevention.
 Stressors are demand made by internal or external environment , that upset balance or
homeostasis , thus affect physical and psychological well-being.
 Stress may be direct physiological effect or indirect maladaptive behaviour ( smoking
and poor eating habits)
 It is the process for evaluating coping for stressful events.
 Stress was considered to be a transactional phenomenon dependent on the meaning of
stimulus to the perceiver (Lazarus 1966, Antonovsky 1979)
 This is mediated by the person’s appraisal of the stressor and the social and cultural
resources at his/her disposal (Cohen 1984)

 Transactional model of stress and coping

 When faced with a stressor , a person evaluate potential threats or harms (Primary
appraisal)

 As well as his or her ability to alter the situation and manage negative emotional
reactions (Secondary appraisal)

 Problem management and Emotional regulation – Coping efforts

 Outcome - adaptation

STRESS

• Stress is defined as any circumstance that threatens or are perceived to threaten one’s well
being and thereby tax one’s coping abilities (Wayne Weiton)

• Coping refers to various efforts taken to reduce, control or tolerate the state of stress.
1) Smokeless tobacco users
having perceived
susceptibility of SCC
2) Perceived severity
(Complication of SCC)
3) Major impact on
person’s goals and concerns
4) Self causal focus
1) Perceives risk for SCC ,
hence motivated to obtain
screening procedure
(Problem focused coping) Outcome /
2) Social support to cope Adaptation
with concerns about threat
– (Emotion focused coping)

STRESSOR

Meaning based
Reappraisal ,
1) Perceived control
Spiritual beliefs ,
over threat
2) Perceived control
over feeling
Expectations about 1) Emotional and functional reaction to
the effectiveness of stressors.
one’s coping 2) Motivation by social support
resources ( Family & peer friends and health care
providers)
MODELS GIVEN BY CORE STEPS IMPLICATION
CONCEPTS

HBM HOCHBAUM, Value and Threat , Benefits , Dental Diseases

ROSENSTOCK, expectancy barriers , cues of
1966 beliefs guide action , Self
behavior. efficacy

TRA& TPB FISHBEIN 1967 Rationally Attitude , Tooth Brushing

AJZEN motivated , Subjective norms ,
intentional Perceived control
health and of behavior.
non-health
behaviors

TRANSTHEORITICAL PROCHASKA Focusing on 6 stages Smoking

MODEL AND changes in .Precomtemplation, cessation
VELICHER behavior, less comtemplation ,
1994 on cognitive preparation ,action
(Perceived , maintenance ,
risk and termination
barriers)

PAPM NEIL D. Stages of 7 Stages - Health education

(PREACAUTION WEINSTEIN behavior Unaware. - Flossing
ADOPTION changes , Unengaged,
PROCESS) Focus more undecided ,
on increasing decided not to act ,
awareness decided to act ,
about risk. acting,
maintenance
MODELS GIVEN BY CORE STEPS IMPLICATION
CONCEPTS

SOCIAL BANDURA Human agency and Psychological , Smoking

COGNITIVE 1977 environment environmental cessation
interact – individual determinants,
and social change Observational
learning , moral
disengagement , self
regulation

SOCIAL BARNES Social relationship , Social network and

NETWORK nature and degree of support – Stressors -
& SOCIAL interaction ,may Individual coping &
SUPPORT offer social support , organizational
perform social coping – Physical
control and manage mental , social
social conflict health

STRESS LAZARUS Interpersonal Stressors - Primary, Smokeless

AND & COHEN interaction and secondary appraisal tobacco - SCC
COPING 1977 communication - Coping effort –
plays crucial role in Outcome -
helping cope with adaptation
stress
CONCLUSION

• A majority of modern diseases have an underlying psychological factor.

• It is important for a healthcare professional to know the behaviour and underlying

psychology of individuals towards health and oral health before planning any treatment.

• The psychology of an individual determines behaviour which in turn can affect the overall
health and health seeking behaviour of individuals.

• Models like health belief model, transtheoretical model and many more are explained to
change the behaviour of individuals.

REFERENCES

1. Cynthia Pine and Rebecca Harris, Community Oral Health, 2nd Edition:
Quintessence publishers.

2. Park’s Texbook of Preventive and Social Medicine.23rd edition. Banarsidas Banot

3. Health promotion and health behaviour. Gary Glanz.4th edition

4. Glik DC1, Eisenman DP, Zhou Q, Tseng CH, Asch SM.Using the Precaution
Adoption Process model to describe a disaster preparedness intervention among low-
income Latinos; Health Educ Res. 2014 Apr;29(2):272-83. doi: 10.1093/her/cyt109.
Epub 2014 Jan 7.

5. B. S. Manoranjitha, Shwetha K. M., K. Pushpanjali A systematic review of health

education theories and approaches in improving the oral health behaviour among
adults , DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20170251