Application of Health Behavior Theories Toward Survey Development

Application of Health Behavior Theories Toward Survey

Development

Purpose of Notes

Provide students with knowledge on specific theories and develop survey questionnaire’s using theories as a framework.

Learning Objectives

By the end of the special topic seminar students will be able to:

1. Understand the importance of using theories when designing survey questionnaire’s on human behavior

2. Name three human behavior theories and the major components of each theory.

Learning Objectives (cont.)

3. Design a survey scale based upon Bandura’s self-efficacy scale.

4. Develop survey questions from several human behavior theories.

5. Teach one of the theories to colleagues.

6. Conduct an observational survey.

7. Develop a behavior modification program based on theory.

Key Definitions• Theory

• “a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by specifying relations among variables in order to explain and predict the events of the situations” (Glanz, Lewis, & Rimer, 1997, p. 21)

• Concepts• the primary elements of theories (Glanz, Lewis,

& Rimer, 1997)

Key Definitions (cont’d)

• Construct• a concept that has been developed,

created, or adopted for use with a specific theory (Kerlinger, 1986)

• Variable• “specify how a construct is to be measured

in a specific situation” (Glanz & Rimer, 1995, p. 11)

Key Definitions (cont’d)• Model

• “a subclass of a theory” (McKenzie & Smeltzer,

2001, p. 138); draws “on a number of theories to help people understand a specific problem in a particular setting or context” (Glanz, Lewis, & Rimer, 1997, p. 24)

How can theory be used?

Describe (event, behavior, etc.) Explain Predict Prescribe

Examples

• Concept

• Construct

• Variable

• Model

• Theory

• Personal beliefs

• Perceived benefit

• Rank order incentives

• Health Belief Model

• Social Cognitive Theory

Why use theory?

• Help guide the practice of health educators

• “…provides direction and justification for program activities…” (Cowdery et al., 1995, p. 248)

Behavior Change Theories / Models• First need to decide on what level to

intervene• Consider the ecological perspective (McLeroy et

al., 1988)

• Intrapersonal, or individual, factors• Interpersonal factors• Institutional, or organizational, factors• Community factors• Public policy factors

Behavior Change Theories / Models Health Belief Model (HBM) Self-efficacy Theory of Reasoned Action Transtheoretical Model (TTM)

– aka-Stages of Change Diffusion Theory Social Cognitive Theory

Assumptions of Behavior Change Models

Cognitive Ability/Inability is primary reason for behavior change.– N/A for children

Health is highly valued part of life. Behavioral is intentional. Behavior is rationale. People want to change behavior.

– Stages of Change– Self Efficacy

Health Belief Model

Four major components– Threat Components:

• Perceived severity• Perceived susceptibility

– Action Components• Benefits• Barriers

Mediating factors (Cues to Action)– Social, environmental, media, others

Health Belief Model

Perceived Severity

Perceived SusceptibilityOutcome

Benefits

Barriers

Self-Efficacy

Perceived Threat

Modifying Factors -Media -People -Other factors

5 Criticisms of HBM

Belief-Behavior connection has not yet been established– Why we don’t want to get vaccinated and

reason we don’t. Attempts to modify or change beliefs

are often unsuccessful.– Family or religious beliefs prevent us from

doing this change.

5 Criticisms of HBM cont.

Individual and Social Factors should be included in behavior change intervention.– Mental health issues (sometimes you just don’t

want to change)– Parents or Friends

Lack of quantification of HBM in past research.– Not enough evidence

5 Criticisms of HBM cont.

Focus on individual determinants for health behavior may lead to victim blaming.– Person gets cancer so we as a society

may blame them for not exercising, eating right, and using protection.

– Where it could be environmental or public policy to blame instead.

Self-Efficacy (Albert Bandura)

Definition: person’s confidence to perform a specific task.

Self Efficacy Theory

Behavior Outcome

Efficacy Expectation

Outcome Expectations

Can I Do Activity? If I Do It, What Will Happen?

Person

Response Efficacy

(Does it work?)

Effort expended

Performance attainment

Vicarious learning

Verbal persuasion

Physiological monitoring

Decision to perform

Perceived Self-Efficacy

Persistence

Sources of Self-Efficacy Behavior

Self-Efficacy

Development of scale to determine efficacy level:

Examples:– Likert Scale Items– How confident are you in….

Theory of Reasoned Actionaka

Theory of Planned Behavior Intentions predict behaviors

– “Do you intend to…..” Three factors that affect a person’s

intention to do a specific behavior:– Personal attitudes– Social norm (what others think)

• Good to use in assessment bc you ask about social norms.

– “Do your friends….”

– Perceived behavioral control

Theory of Planned Behavior

Attitudes

Social Norm

Inentions Behavior

Attitudes

Social Norm

Intentions Behavior

Perceived Control

Stages of Change Theory(Prochaska and DiClemente)

Best to use for Behavior Change 6 stages of behavior change

– Precontemplation– Contemplation– Preparation– Action– Maintenance– Termination

Stages of Change Theory

Precontemplation– Person is not aware that they have a problem and

does not see how unhealthy behavior is effecting their life or health.

– Process of change: • Consciousness raising- media report• Social liberation- no smoking signs• Helping relationships

– Identify on survey-not ready for change in next 6 months.


Contemplation– Person knows that change would be good, but

does not have the confidence to change and needs more information.

– Process of change:• Self-reevaluation- Self liberation

– Does this behavior fit in with your current lifestyle?

• Dramatic relief (emotional arousal)• Helping relationships

– Identify-will change in next 6 months


Preparation– Person begins preparing for changing

unhealthy behavior for new healthy behavior.

– Process of change• Self-liberation (commitment)• Helping relationships

– Identify-Ready for change in next month


Action– Person begins the new healthy behavior.– Process of change

• Reinforcement management (Reward)– Stop smoking and get some taste back

• Helping relationships• Stimulus control

– Controlling your environment» Example- Limit activity where behavior is prevalent

• Counter conditioning– Chew gum instead of smoking

– Identify-currently changing


Maintenance– Person is practicing healthy behavior but

may need feedback and a booster to avoid obstacles and temptations.

– Process of change• Helping Relationships

– Identify-have made change in past 6 months.


Termination– Persons feels that new behavior is a part of

their life and they never look back and think about the unhealthy behavior.

• Helping Relationships

– Example:• You feel “naked” with out your Seat Belt now…

Diffusion Theory(Everett Rogers) Definition: spread of ideas (tangible or

intangible) and innovations over time through communication channels( interpersonal most important) among members of a social system.– Fast Diffusers- IPOD– Slow Diffusers- Helmet with Bicycle

Used to predict best channels to communicate health information in hopes of behavior change.

Diffusion Theory

Adopter categories– Innovators (1.3%)- developers– Early adopters (16%)- Mass Media – Early majority (33%)- Word of Mouth– Late majority (33%)- Word of Mouth– Laggards (16%)- Late Bloomers

• Think your grandparents and computers!

– Never get 100% compliance rate

Diffusion Theory

Innovation- Decision Process: Knowledge Persuasion Decision Implementation Confirmation Decide to Adopt or Reject Product

Diffusion Theory

Example:– Knowledge

• Gain information of new product or idea

Persuasion– Marketing Campaign to persuade you to change over

Decision– Make the decision to use the product or idea

Implementation– Actually using the product

Confirmation– Use product and Like it

Diffusion Theory

Types of Innovation- Decisions– Optional- individual choice– Collective- group– Authority- powerful group– Contingent- combination

Diffusion Theory

Characteristics of Innovations– Relative Advantage

• Ipod vs. Radio

– Compatibility• How compatible are helmets with hair?

– Complexity• Is it to hard or difficult to make the change?

Diffusion Theory

Characteristics of Innovations– Try-ability-

• Try it before you buy it

– Observability-• Want to see other people doing the behaviors

Diffusion Theory

Diffusion Curve

Per

cent

ado

ptio

n

Time

at 20% adoption,Innovation takes off!

Social Cognitive TheoryAKA

Social Learning Theory(Albert Bandura)

Based on premise that an interaction exists between behavior, individual, and the environment.

Reciprocal Determinism

Behavior Individual

Environment

Social Cognitive Theory

Behavior change occurs in 4 phases:– Pre-Training

• Assessment on the first day of basketball tryouts

– Training-• Learning to dance example

– Initial Testing-• Building up confidence to perform task

– Continual Performance-• Practicing (really learning the skill)• Learning a new language example


Pre-Training Phase– Reciprocal Determinism– Behavioral Capability

• Is person capable of performing task?

– Example:• If you are afraid of water there is a possibility

you will not be able to learn to swim.


Training Phase– Trying to build of confidence to perform task.

• Expectations– What will the likely outcome be?– What do you consider the outcome or goal?

– Expectancies• Value placed on expected outcomes• Fitness Program Example:

– What do you consider goal?» Weight loss- benefit» Soreness- barrier


Training Phase– Self-Efficacy

• Doesn’t kick in until you are motivated and want to make a change.

– Emotional coping response• How will person deal with change?

– Emotions on giving up things we need:» Example: Giving up driving when you are older» Example: Wilson the volleyball on Castaway


Initial Testing Phase– Observational learning

• Game like conditions, think scrimmage• Observing others perform task/activity

– Taking a tour of a fitness facility before actually joining the gym.

– Self-control or self-regulation• Self commitment• Monitoring self progress


Continual Performance Phase– Reinforcement

• Reward for continuing performance/activity– Son put on helmet with out being told , so he got a candy

bar treat.

– Locus of control• Internal--self reward

– You reward yourself– Exercise and lose weight

• External--other reward– Needs others to help make them feel good– Verbal reinforcement from peers, coaches, friends

Social Marketing Theory

What is it?

Social Marketing Theory-– Applies the concept of traditional marketing

to the “sale” or promotion of healthy behaviors.

– Elements • market plan• carefully designed messages • employment of mass media • consensus building• appropriate packaging

SMT continued

SMT emphasizes the importance of specific target audiences and segmentation of the population when designing programs.– Gender, race, age, religion, education, etc.

Components

The eight components include but are not limited to: – consumer orientation– exchange theory – audience analysis and segmentation– formative research – channel analysis– marketing mix– process tracking– marketing management

1) Consumer orientation

This component consists of familiarizing the health educators and marketers to the needs of the consumers to better market towards them. – To discover the needs and wants of the

consumers, focus groups can be formed to represent the demographic being served.

2) The Exchange Theory

Tangible and non-tangible items that are given up to achieve health behavior goal.

• To achieve a lower triglyceride level and decrease your total cholesterol you might have to give up eating at McDonalds five times a week in exchange for two times a week.

3) Audience Analysis and Segmentation

Audience analyses, knowing your target populations.– what population you are working with– who is at risk

Segmentation, describes breaking down populations into more specific groups. This makes groups readily available for analysis, diagnosis, and treatment with new implementation of programs.

4) Formative Research

Documentation of development Extensive note taking Existing materials Materials that need to be made Continuous Evaluation

5) Channel Analysis

Channels refer to the lines of communication through which an individual is reached.– Billboards– TV– Internet– Print Media– Novelty Items– Radio– News Outlets

When trying to promote the Gardasil vaccination, concentrate on channels of media that young women are exposed to, such as teen magazine, MTV.

6) Marketing Mix

Based on the 4P’s: – product– price– place– Promotion

• And sometimes PARTNER

6) Marketing Mix cont.

Product-– What we are trying to “sell”?– May be a tangible product or in our case

an intangible product, the idea of health.– Can be used to explore the consumer’s

perception of the problem or product and how to remedy it.


Price-– Price describes what the consumer has to

“pay” for the product. • Monetary• Time• Effort• Remembering to do it

– Behaviors will more likely be adopted if the benefits outweigh the costs.


Place-– Where will you promote?– Where will product be sold?

• shopping malls• mass media• fliers• brochures


Promotion-– Integrates the advertisements, public

relations, promotion, media, personal testimonials, and entertainment sources.

– The rationale for promotion is to create and sustain the product.

• a PSA may be used to increase awareness of breast cancer and give tips on self examination.

7) Process Tracking

Evaluations– surveys – Letters to the editors– Press release

• process (what you are doing right now) • impact (directly after the fact), and • outcome (after the program, ie. 6 months)

evaluations.

Partner

Teaming up with other organizations to better market to the desired consumer

Collaboration of time, resources, people, money, etc.

8) Marketing Management

Involves the specific aspects of the program you are trying to manage – Budget – Administration issues– Team building– Leadership

The Health Communication Process

Composed of 6 stages– Planning and Strategy Selection– Selecting Channels and Materials– Developing Materials and Pre-testing– Implementation– Assessing Effectiveness– Feedback to Refine Program

Step 1: Planning and Strategy Selection Review Available Data Identify Existing Activities and Gaps Write Goals and Objectives Gather New Data Determine Target Audience Establish Tracking System Assess Resources Draft Communication Strategies Write Program Plan and Timetable

Step 2: Selecting Channels and Materials

Identify Messages and Materials Decide whether to produce new materials Choose Channels

– Face to face– Group delivery– Organizational– Mass media– Community– Combo of above

Step 2: Selecting Channels and Materials cont.

Public Service Announcements– PSA’s are useful in creating awareness or

publics’ sensitivity to a health problem or issue, or reinforcing a newly established behavior.

– Their Role however is limited in behavior change

Step 3: Developing Materials and Pre-testing

Develop and Test Message Concepts Develop Draft Materials Pre-testing:

– Self administered surveys– Interviews– Focus groups interviews– Readability testing– Gatekeeper review– Combo of above

Step 3: Developing Materials and Pre-testing cont.

Plan and Conduct Pre-Test– Design survey– Recruit respondents– Identify interviewers– Facilities– Gatekeeper review

Stage 4: Implementation

Prepare to introduce program Tracking progress Establish process evaluation

Step 5: Assessing Effectiveness

Types of Evaluation:– Formative– Process– Outcome– Impact– Cost Effectiveness– Cost benefit

Step 5: Assessing Effectiveness

Elements of Evaluation Design– Statements of Objectives– Case Definitions of Data– Methodology– Data Collection– Data Processing/ Analysis– Reporting

Step 6: Feedback to Refine Program

Apply what has been learned Revise Program Disseminate findings to others

Evaluations:

Process Impact Outcome Formative Summative

Process

Description:– What

How to Measure:– Record Keeping

Example:– Number of people attending a lecture– Number of posters placed in residence halls– Number of meetings

Impact

Description:– Short term change (less than 6 months)

How to Measure:– Surveys, interviews, and observations

Example:– Change in attitudes, behavior and or

perception

Outcome

Description:– Long term change (from 1-10 years)

How to Measure:– Surveys, interviews, hospital records, and police

reports Example:

– Change in object of interest such as injuries related to motorcycles

– Decrease in homeless– Increase in fruit and vegetable consumption

Formative

Description:– Evaluations conducted throughout program

How to Measure:– All of above

Example:– Message development– Qualitative research (focus groups)

Summative

Description:– Final evaluations of program

How to Measure:– Similar to outcome

Example:– Final evaluation slips and records

Application of Health Behavior Theories Toward Survey Development

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