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Theories of
Health Behaviour
Health Psychology
• According to the basic tenets of attribution theory people
attempt to provide a causal explanation for events in their
world particularly if those events are unexpected and
have personal relevance (Heider, 1944,1958). Thus it is
not surprising that people will generally seek a causal
explanation for an illness, particularly one that is serious.
Attribution theory
• Taylor et al. (1984) interviewed a sample of women who
had been treated for breast cancer. They found that 95%
of the women had a causal explanation for their cancer.
These causes were classified as stress (41%), specific
carcinogen (32%), heredity (26%), diet (17%), blow to
breast (10%) and other (28%).
Attribution theory
Women’s causal explanations for breast cancer
• They also asked the women who or what they considered
responsible for the disease and found that 41% of the
women blamed themselves, 10% blamed another person,
28% blamed the environment and 49% blamed chance.
The patients were also asked whether they felt any
control over their cancer and they found 56% felt they
had some control.
Attribution theory
The women’s attribution of responsibility
for their cancer
• The transtheoretical model of change emphasises the
dynamic nature of beliefs, time, and costs and
benefits.
The transtheoretical model of behaviour change
(stages of change model)
• 1. Precontemplation: not intending to make any changes
• 2. Contemplation: considering a change
• 3. Preparation: making small changes
• 4. Action: actively engaging in a new behaviour
• 5. Maintenance: sustaining change over time
The transtheoretical model of behaviour change
(stages of change model)
• Individuals would go through these stages in
order but might also go back to earlier stages.
• People in the later stages, e.g. maintenance,
would tend to focus on the benefits (I feel
healthier after giving up smoking), whereas
people in the earlier stages tend to focus on the
costs (I will be at a social disadvantage if I give
up smoking).
The transtheoretical model of behaviour change
(stages of change model)
Health motivation
Perceived control
The Health Belief Model
Support for individual components of the model:
• Norman and Fitter (1989) examined health behaviour
screening (for example breast cervical cancer) and found
that perceived barriers (the costs of attending) were the
greatest predictors of whether a person attended the
clinic.
Health belief model
• Several studies have examined breast self-examination
(BSE) behaviour and report that barriers (Lashley 1987;
Wyper 1990) and perceived susceptibility (the likelihood
of having the illness) (Wyper 1990) are the best
predictors of healthy behaviour.
Health belief model
• The role of giving information as a cue to action has been
researched. Information in the form of fear-arousing
warnings may change attitudes and health behaviour in
such areas as dental health, safe driving and smoking (e.g.
Sutton 1982; Sutton and Hallett 1989).
Health belief model
• Giving information about the bad effects of smoking is
also effective in preventing smoking and in getting people
to give up (e.g. Sutton 1982; Flay 1985). Several studies
report a significant relationship between people knowing
about an illness and their taking precautions.
Health belief model
• Janz and Becker (1984) found that healthy
behavioural intentions are related to low
perceived seriousness - not high as predicted (e.g.
healthy adult having a flu injection) - and several
studies have suggested an association between
low susceptibility (not high) and healthy
behaviour (e.g. many students recently have
agreed to be inoculated against meningitis)
(Becker et al. 1975; Langlie 1977).
Evidence Against the HBM
• Hill et al. (1985) applied the HBM to cervical cancer, to
examine which factors predicted cervical screening
behaviour. Their results suggested that benefits and
perceived seriousness were not related.
Evidence Against the HBM
• Is health behaviour that rational? (Is tooth-brushing really
determined by weighing up the pros and cons?).
 Its emphasis on the individual (HBM ignores social and
economic factors)
 The measurement of each component
 The absence of a role for emotional factors such as fear
and denial.
Criticisms of the HBM
Rogers (1975, 1983, 1985) developed protection motivation
theory (PMT) which expanded the HBM to include
additional factors.
Protection motivation
theory
Coping Appraisal
• self-efficacy (e.g. 'I am confident that I can change
my diet');
• Response effectiveness (e.g. 'changing my diet would
improve my health');
Threat Appraisal
• Severity (e.g. 'bowel cancer is a serious illness');
• Vulnerability (e.g. 'my chances of getting bowel
cancer are high').
• Fear
Protection motivation
theory
According to the PMT, there are two sources of
information:
• 1.
environmental (e.g. verbal persuasion,
observational learning) and
• 2.
intrapersonal (e.g. prior experience).
This information elicits either an 'adaptive' coping
response (i.e. the intention to improve one's health)
or a 'maladaptive' coping response (e.g. avoidance,
denial).
Protection motivation
theory
• Rippetoe and Rogers (1987) gave women information
about breast cancer and examined the effect of this
information on the components of the protection
motivation theory (PMT) and their relationship to the
women's intentions to practise breast self-examination
(BSE).
Support for the PMT
• The results showed that the best predictors of intentions
to practise BSE were response effectiveness (believing
that BSE would detect the early signs of cancer), severity
(believing that breast cancer is dangerous and difficult to
treat in its advanced stages) and self-efficacy (belief in
one's ability to carry out BSE effectively).
Support for the PMT
• In a further study, the effects of persuasive
appeals for increasing exercise on intentions to
exercise were evaluated using the components of
the protection motivation theory (PMT). The
results showed that vulnerability (ill health would
result from lack of exercise) and self-efficacy
(believing in one's ability to exercise effectively)
predicted exercise intentions but that none of the
variables were related to self-reports of actual
behaviour.
Support for the PMT
The PMT has been less widely criticised than the
HBM; however, many of the criticisms of the
HBM also relate to the PMT. For example, the
PMT assumes that individuals are rational
information processors (although it does include
an element of irrationality in its fear component),
it does not account for habitual behaviours, such
as brushing teeth, nor does it include a role for
social (what others do) and environmental factors
(eg opportunities to exercise or eat properly at
work).
Criticisms of the PMT
• Schwarzer (1992) has also criticised the PMT for not
tackling how attitudes might change (a problem with the
HBM as well).
Criticisms of the PMT
Theory of Planned
Behaviour
• Attitude towards a behaviour – can be a positive or negative
evaluation of a particular behaviour and beliefs about the outcome of
the behaviour (e.g. exercising is fun and will improve my health)
• Subjective norm – composed of perception of social norms and
pressures to perform behaviour and an evaluation of whether the
individual is motivated to comply (e.g.) people who are important to
me will approve if I lose weight and I want their approval)
• Perceived behavioural control – self-efficacy can be dependent on
Internal factors – skills, abilities (relate to past behaviour)
External factors – obstacles and opportunities (relate to past behaviour)
Theory of Planned
Behaviour
• Pill and Stott (1982) reported that working-class
mothers were more likely to see illness as
uncontrollable.
• In a study, Graham (1987) reported that although
women who smoke are aware of all the health
risks of smoking, they report that smoking is
necessary to their well-being and an essential
means for coping with stress.
Lay theories about health
It was found that there was considerable
agreement in the emphasis on behavioural factors
as causes of illness. There was however limited
reference to structural or environmental factors,
especially among those from working-class
backgrounds. Gender differences were also
found. The women were more likely to define
health in terms of personal relationships
Lay theories about health
• Chamberlain (1997) noted a series of social class
differences in his review of several studies of lay
people’s perceptions of health. Lower social
economic status people emphasise the role of
health in their ability to work whereas higher
social economic status people referred more to
their ability to participate in leisure activities.
Four different lay views of health emerged:
Lay theories about health