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Chapter
Three:
Health
Behaviors
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Education.
•An introduction to health behaviors
•Health promotion: An overview
•Changing health habits
•Cognitive-behavioral approaches to health
behavior change
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•The transtheoretical model of behavior
change
•Changing health behaviors through social
engineering
•Venues for health-habit modification
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•Idea that good health, or wellness, is a
personal and collective achievement
•Health behaviors: Undertaken by people to
enhance or maintain their health
•Health habit: Firmly established and
performed automatically without awareness
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•Taking measures to combat risk factors for
illness before it has a chance to develop
•Strategies
• Getting people to alter their problematic
health behaviors
• Keeping people from developing poor health
habits in the first place
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•Demographic factors
•Age
•Values
•Personal control
• Health locus of control scale: Measures the
degree to which people perceive their health
to be under personal control
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•Social influence
•Personal goals and values
•Perceived symptoms
•Access to the health care delivery system
•Knowledge and intelligence
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•Emotional factors may lead to unhealthy
behaviors
•Instability of health behaviors
• Different factors control different health
habits
• Different factors may control the same health
behavior for different people
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• Factors controlling a health behavior change:
• Over the history of the behavior
• Across a person’s lifetime
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•Socialization: Influence of parents as both
teachers and role models
•Teachable moment: Better times for
modifying health practices
• Window of vulnerability: Time when students
are first exposed to bad habits
• Not confined to childhood and adolescence
• Precautions taken in adolescence may affect
disease risk after age 45
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Benefits
• Efficient use of health
promotion dollars
• Diseases may be
prevented altogether
• Makes it easier to
identify other risk
factors
Problems
• Risks are not perceived
correctly
• Testing positive for a
risk factor leads people
into a hypervigilant
behavior
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•Choosing the right time to alert people
•Instilling risk reduction behaviors may cause
psychological stress
•No effective intervention may be available
for cases with genetic risk factors
•Emphasizing risks that are inherited can raise
complicated issues of family dynamics
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Maintain a healthy, balanced diet and an exercise regimen
Take steps to reduce accidents
Control alcohol consumption and eliminate smoking
Reduce inappropriate use of prescription drugs
Obtain vaccinations against influenza
Remain socially engaged
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•Health promotion efforts should take the
social norms of a group into account
• Health practices in the community
• Informal networks of communication and
language
• Co-occurring risk factors in ethnic groups
• Combined effects of low socioeconomic status
and a biologic predisposition to particular
illnesses
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Educational appeals
• People change their health habits if they have good
information about their habits
Fear appeals
• People change their behavior if they fear that a particular
habit is hurting their health
Message framing
• Depends on:
• Type of message
• People’s own motivation
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•Factors influencing health behavior practices
• Perceived health threat
• Perceived threat reduction
•Used to increase perceived risk and
perceived effectiveness of steps to modify
health habits
•Leaves out self-efficacy
• Self-efficacy: One’s ability to control his or
her practice of a particular behavior
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(Sources: Ajzen & Fishbein, 1980; Ajzen & Madden, 1986)
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•People are actively motivated to pursue their
goals
•Components fundamental to behavior change
• Autonomous motivation
• Perceived competence
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•Interventions may not always provide the
impetus to take action
•Assume that behavior changes are guided by
conscious motivation
•Ignores the fact that behavior changes occur
automatically and are not subject to
awareness
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•Integrates conscious processing with
automatic behavioral enactment
•Control of goal-directed responses can be
delegated to situational cues
•Changes in intentions lead to changes in
behavior
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•Health behavior change in response to
persuasive messages can occur outside of
awareness
•Change can be reflected in patterns of brain
activation
• Medial prefrontal cortex (mPFC)
• Posterior cingulate cortex (pCC)
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•Cognitive-behavior therapy: Uses
complementary methods to intervene in the
modification of a target problem and its
context
•Self-monitoring: Understanding the
dimensions of one’s poor health habit before
change can begin
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• Assesses the frequency of a target behavior
and its consequences
• Stages
• Learning to discriminate the target behavior
• Charting the behavior - Helps in identifying the
discriminative stimulus
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•Classical conditioning: Pairing of an
unconditioned reflex with a new stimulus
• Produces a conditioned reflex
• Heavily depends on the client’s willingness
•Operant conditioning: Pairs a voluntary
behavior with systematic consequences
• Reinforcement and its schedule are important
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•Modeling: Learning that occurs from
witnessing another person perform a
behavior
•Stimulus-control interventions:
• Ridding the environment of discriminative
stimuli that evoke the problem behavior
• Creating new discriminative stimuli, signaling
that a new response will be reinforced
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•CBT emphasizes self-control
•People learn to control the antecedents and
consequences of the target behavior
•Cognitive restructuring: Trains people to
recognize and modify their internal
monologues to promote health behavior
change
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•Self-reinforcement: Systematically
rewarding oneself to increase or decrease
the occurrence of a target behavior
• Contingency contracting: Effective selfpunishment in behavior modification
•Behavioral assignments: Home practice
activities that support the goals of a
therapeutic intervention
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Client becomes involved in the treatment process
Client produces useful analysis in planning further interventions
Client becomes committed to the treatment process
Responsibility for behavior change is slowly shifted to the client
Homework assignments increase client’s sense of self-control
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•Social skills training or assertiveness
training: People are trained in methods that
help them deal effectively with social
anxiety
•Relaxation training: Deep breathing and
progressive muscle relaxation
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•Interviewer adopts a nonjudgmental,
nonconfrontational, encouraging, and
supportive style
•Goal - To help clients express their positive
or negative thoughts regarding the behavior
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•Abstinence violation effect: Feeling of loss
of control that results when a person has
violated self-imposed rules
•Reasons for relapse
• Vigilance fades
• Negative affect
•Should be integrated into treatment
programs from the outset
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(Source: Larimer, Palmer, & Marlatt, 1999)
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•Techniques
• Asking people to identify the situations that
may lead to relapse
• Engaging participants in constructive self-talk
•Lifestyle rebalancing: Promotes a healthy
lifestyle and reduces the likelihood of
relapse
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•A carefully selected set of techniques help
deal with all aspects of a problem
•Therapeutic plan can be tailored to each
individual’s problem
•Skills imparted by multimodal interventions
help to modify several health habits
simultaneously
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Analyzes the stages and processes people go
through in bringing a change in behavior
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(Source: Prochaska et al., 1992)
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•Social engineering: Modifies the
environment in ways that affect people’s
ability to practice a health behavior
•Venues for health habit modification
• Private therapist’s office
• Health practitioner’s office
• Family
• Self-help groups
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• Schools
• Workplace interventions
• Community-based interventions
• Mass media
• Cellular phones and landlines
• Internet
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