Behavior change (public health)

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Behavior change, in the context of public health, refers to efforts put in place to change people's personal habits and attitudes, to prevent disease. [1] Behavior change in public health is also known as social and behavior change communication (SBCC). [2] More and more, efforts focus on prevention of disease to save healthcare care costs. [3] This is particularly important in low and middle income countries, such as Ghana, where health interventions have come under increased scrutiny because of the cost. [4]

Public health preventing disease, prolonging life and promoting health through organized efforts and informed choices of society and individuals

Public health has been defined as "the science and art of preventing disease, prolonging life and promoting human health through organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the health of a population and the threats it faces is the basis for public health. The public can be as small as a handful of people or as large as a village or an entire city; in the case of a pandemic it may encompass several continents. The concept of health takes into account physical, psychological and social well-being. As such, according to the World Health Organization, it is not merely the absence of disease or infirmity.

Disease abnormal condition negatively affecting organisms

A disease is a particular abnormal condition that negatively affects the structure or function of part or all of an organism, and that is not due to any external injury. Diseases are often construed as medical conditions that are associated with specific symptoms and signs. A disease may be caused by external factors such as pathogens or by internal dysfunctions. For example, internal dysfunctions of the immune system can produce a variety of different diseases, including various forms of immunodeficiency, hypersensitivity, allergies and autoimmune disorders.

Developing country nation with a low living standard relative to other countries

A developing country is a country with a less developed industrial base and a low Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is also no clear agreement on which countries fit this category. A nation's GDP per capita compared with other nations can also be a reference point.

Contents

Background

The 3-4-50 concept [5] outlines that there are 3 behaviors (poor diet, little to no physical activity, and smoking), that lead to four diseases (heart disease/stroke, diabetes, cancer, pulmonary disease), that account for 50% of deaths worldwide.This is why so much emphasis in public health interventions have been on changing behaviors or intervening early on to decrease the negative impacts that come with these behaviors. With successful intervention, there is the possibility of decreasing healthcare costs by a drastic amount, as well as general costs to society (morbidity and mortality). A good public health intervention is not only defined by the results they create, but also the number of levels it hits on the socioecological model [6] (individual, interpersonal, community and/or environment). The challenge that public health interventions face is generalizability: what may work in one community may not work in others. However, there is the development of Healthy People 2020 that has national objectives aimed to accomplish in 10 years to improve the health of all Americans.

Healthy People is a program of a nationwide health-promotion and disease-prevention goals set by the United States Department of Health and Human Services. The goals were first set in 1979 "in response to an emerging consensus among scientists and health authorities that national health priorities should emphasize disease prevention". The Healthy People program was originally issued by the Department of Health, Education and Welfare (DHEW). This first issue contained "a report announcing goals for a ten-year plan to reduce controllable health risks. In its section on nutrition, the report recommended diets with fewer calories; less saturated fat, cholesterol, salt, and sugar; relatively more complex carbohydrates, fish and poultry; and less red meat." Though this recommended diet consisted of more processed foods rather than fresh produce, the report advised for consumers to "be wary of processed foods". The goals were subsequently updated for Healthy People 2000, Healthy People 2010, and Healthy People 2020.

Health conditions and infections are associated with risky behaviors. Tobacco use, alcoholism, multiple sex partners, substance use, reckless driving, obesity, or unprotected sexual intercourse are some examples. Human beings have, in principle, control over their conduct. Behavior modification can contribute to the success of self-control, and health-enhancing behaviors. Risky behaviors can be eliminated including physical exercise, weight control, preventive nutrition, dental hygiene, condom use, or accident prevention. Health behavior change refers to the motivational, volitional, and action based processes of abandoning such health-compromising behaviors in favor of adopting and maintaining health-enhancing behaviors. [7] [8] [9] Addiction that is associated with risky behavior may have a genetic component. [10]

Risk is the possibility of losing something of value. Values can be gained or lost when taking risk resulting from a given action or inaction, foreseen or unforeseen. Risk can also be defined as the intentional interaction with uncertainty. Uncertainty is a potential, unpredictable, and uncontrollable outcome; risk is an aspect of action taken in spite of uncertainty.

Smoking practice in which a substance is burned and the resulting smoke breathed in to be tasted and absorbed into the bloodstream

Smoking is a practice in which a substance is burned and the resulting smoke breathed in to be tasted and absorbed into the bloodstream. Most commonly, the substance used is the dried leaves of the tobacco plant, which have been rolled into a small square of rice paper to create a small, round cylinder called a "cigarette". Smoking is primarily practiced as a route of administration for recreational drug use because the combustion of the dried plant leaves vaporizes and delivers active substances into the lungs where they are rapidly absorbed into the bloodstream and reach bodily tissue. In the case of cigarette smoking these substances are contained in a mixture of aerosol particles and gasses and include the pharmacologically active alkaloid nicotine; the vaporization creates heated aerosol and gas into a form that allows inhalation and deep penetration into the lungs where absorption into the bloodstream of the active substances occurs. In some cultures, smoking is also carried out as a part of various rituals, where participants use it to help induce trance-like states that, they believe, can lead them to spiritual enlightenment.

Alcoholism Broad term for problems with alcohol

Alcoholism, also known as alcohol use disorder (AUD), is a broad term for any drinking of alcohol that results in mental or physical health problems. The disorder was previously divided into two types: alcohol abuse and alcohol dependence. In a medical context, alcoholism is said to exist when two or more of the following conditions are present: a person drinks large amounts of alcohol over a long time period, has difficulty cutting down, acquiring and drinking alcohol takes up a great deal of time, alcohol is strongly desired, usage results in not fulfilling responsibilities, usage results in social problems, usage results in health problems, usage results in risky situations, withdrawal occurs when stopping, and alcohol tolerance has occurred with use. Risky situations include drinking and driving or having unsafe sex, among other things. Alcohol use can affect all parts of the body, but it particularly affects the brain, heart, liver, pancreas and immune system. This can result in mental illness, Wernicke–Korsakoff syndrome, irregular heartbeat, an impaired immune response, liver cirrhosis and increased cancer risk, among other diseases. Drinking during pregnancy can cause damage to the baby resulting in fetal alcohol spectrum disorders. Women are generally more sensitive than men to the harmful physical and mental effects of alcohol.


Theories

Behavior change programs tend to focus on a few behavioral change theories which gained ground in the 1980s. These theories share a major commonality in defining individual actions as the locus of change. Behavior change programs that are usually focused on activities that help a person or a community to reflect upon their risk behaviors and change them to reduce their risk and vulnerability are known as interventions. Examples include: "Transtheoretical (Stages of Change) Model of Behavior Change", "theory of reasoned action", "health belief model", "theory of planned behavior", [11] diffusion of innovation", [12] and the health action process approach. Developments in health behavior change theories since the late 1990s have focused on incorporating disparate theories of health behavior change into a single unified theory. [13] [14]

An intervention is an orchestrated attempt by one or many people – usually family and friends – to get someone to seek professional help with an addiction or some kind of traumatic event or crisis, or other serious problem. The term intervention is generally used when the traumatic event involves addiction to drugs or other items. Intervention can also refer to the act of using a similar technique within a therapy session.

The Theory of Reasoned Action aims to explain the relationship between attitudes and behaviors within human action. It is mainly used to predict how individuals will behave based on their pre-existing attitudes and behavioral intentions. An individual's decision to engage in a particular behavior is based on the outcomes the individual expects will come as a result of performing the behavior. Developed by Martin Fishbein and Icek Ajzen in 1967, the theory derived from previous research in social psychology, persuasion models, and attitude theories. Fishbein's theories suggested a relationship between attitude and behaviors. However, critics estimated that attitude theories were not proving to be good indicators of human behavior. The ToRA was later revised and expanded by the two theorists in the following decades to overcome any discrepancies in the A-B relationship with the Theory of Planned Behavior (TPB) and Reasoned Action Approach (RAA). The theory is also used in communication discourse as a theory of understanding.

Health belief model

The health belief model (HBM) is a psychological health behavior change model developed to explain and predict health-related behaviors, particularly in regard to the uptake of health services. The health belief model was developed in the 1950s by social psychologists at the U.S. Public Health Service and remains one of the best known and most widely used theories in health behavior research. The health belief model suggests that people's beliefs about health problems, perceived benefits of action and barriers to action, and self-efficacy explain engagement in health-promoting behavior. A stimulus, or cue to action, must also be present in order to trigger the health-promoting behavior.

Individual and interpersonal

Protection motivation theory is a theory that was originally created to help clarify fear appeals. The protection motivation theory proposes that people protect themselves based on four factors: the perceived severity of a threatening event, the perceived probability of the occurrence, or vulnerability, the efficacy of the recommended preventive behavior, and the perceived self efficacy. Protection motivation stems from both the threat appraisal and the coping appraisal. The threat appraisal assesses the severity of the situation and examines how serious the situation is. The coping appraisal is how one responds to the situation. The coping appraisal consists of both efficacy and self-efficacy. Efficacy is the individual's expectancy that carrying out recommendations can remove the threat. Self-efficacy is the belief in one's ability to execute the recommended courses of action successfully. PMT is one model that explains why people engage in unhealthy practices and offers suggestions for changing those behaviors. It is educational and motivational. Primary prevention: taking measures to combat the risk of developing a health problem.. Secondary prevention: taking steps to prevent a condition from becoming worse..

Community

List of behavior change strategies

[ citation needed ]

Tools

Behavior change communication (BCC)

Behavior change communication, or BCC, is an approach to behavior change focused on communication. It is also known as social and behavior change communication, or SBCC. The assumptions is that through communication of some kind, individuals and communities can somehow be persuaded to behave in ways that will make their lives safer and healthier. BCC was first employed in HIV and TB prevention projects. [17] [18] More recently, its ambit has grown to encompass any communication activity whose goal is to help individuals and communities select and practice behavior that will positively impact their health, such as immunization, cervical cancer check up, employing single-use syringes, etc.[ citation needed ]

Examples

Organizations, foundations and programs

Physical activity and diet

Quitting smoking

See also

Related Research Articles

Health psychology is the study of psychological and behavioral processes in health, illness, and healthcare. It is concerned with understanding how psychological, behavioral, and cultural factors contribute to physical health and illness. Psychological factors can affect health directly. For example, chronically occurring environmental stressors affecting the hypothalamic–pituitary–adrenal axis, cumulatively, can harm health. Behavioral factors can also affect a person's health. For example, certain behaviors can, over time, harm or enhance health. Health psychologists take a biopsychosocial approach. In other words, health psychologists understand health to be the product not only of biological processes but also of psychological, behavioral, and social processes.

Theory of planned behavior in psychology, a theory that links ones beliefs and behavior

In psychology, the Theory of Planned Behavior is a theory that links one's beliefs and behavior.

The transtheoretical model of behavior change is an integrative theory of therapy that assesses an individual's readiness to act on a new healthier behavior, and provides strategies, or processes of change to guide the individual. The model is composed of constructs such as: stages of change, processes of change, levels of change, self-efficacy, and decisional balance.

Self-efficacy is, according to psychologist Albert Bandura who originally proposed the concept, a personal judgment of "how well one can execute courses of action required to deal with prospective situations". Expectations of self-efficacy determine whether an individual will be able to exhibit coping behavior and how long effort will be sustained in the face of obstacles. Individuals who have high self-efficacy will exert sufficient effort that, if well executed, leads to successful outcomes, whereas those with low self-efficacy are likely to cease effort early and fail.

Behavioral medicine is concerned with the integration of knowledge in the biological, behavioral, psychological, and social sciences relevant to health and illness. These sciences include epidemiology, anthropology, sociology, psychology, physiology, pharmacology, nutrition, neuroanatomy, endocrinology, and immunology. The term is often used interchangeably, but incorrectly, with health psychology.. The practice of behavioral medicine encompasses health psychology, but also includes applied psychophysiological therapies such as biofeedback, hypnosis, and bio-behavioral therapy of physical disorders, aspects of occupational therapy, rehabilitation medicine, and physiatry, as well as preventive medicine. In contrast, health psychology represents a stronger emphasis specifically on psychology's role in both behavioral medicine and behavioral health.

Social cognitive theory (SCT), used in psychology, education, and communication, holds that portions of an individual's knowledge acquisition can be directly related to observing others within the context of social interactions, experiences, and outside media influences. This theory was advanced by Albert Bandura as an extension of his social learning theory. The theory states that when people observe a model performing a behavior and the consequences of that behavior, they remember the sequence of events and use this information to guide subsequent behaviors. Observing a model can also prompt the viewer to engage in behavior they already learned. In other words, people do not learn new behaviors solely by trying them and either succeeding or failing, but rather, the survival of humanity is dependent upon the replication of the actions of others. Depending on whether people are rewarded or punished for their behavior and the outcome of the behavior, the observer may choose to replicate behavior modeled. Media provides models for a vast array of people in many different environmental settings.

Behavioural change theories are attempts to explain why behaviours change. These theories cite environmental, personal, and behavioural characteristics as the major factors in behavioural determination. In recent years, there has been increased interest in the application of these theories in the areas of health, education, criminology, energy and international development with the hope that understanding behavioural change will improve the services offered in these areas. Some scholars have recently introduced a distinction between models of behavior and theories of change. Whereas models of behavior are more diagnostic and geared towards understanding the psychological factors that explain or predict a specific behavior, theories of change are more process-oriented and generally aimed at changing a given behavior. Thus, from this perspective, understanding and changing behavior are two separate but complementary lines of scientific investigation.

Fear appeal is a term used in psychology, sociology and marketing. It generally describes a strategy for motivating people to take a particular action, endorse a particular policy, or buy a particular product, by arousing fear. A well-known example in television advertising was a commercial employing the musical jingle: "Never pick up a stranger, pick up Prestone anti-freeze." This was accompanied by images of shadowy strangers (hitchhikers) who would presumably do one harm if picked up. The commercial's main appeal was not to the positive features of Prestone anti-freeze, but to the fear of what a "strange" brand might do.

Health coaching is the use of evidence-based skillful conversation, clinical interventions and strategies to actively and safely engage client/patients in health behavior change. Health coaches are certified or credentialed to safely guide clients and patients who may have chronic conditions or those at moderate to high risk for chronic conditions.

In psychology, the I-change model or the Integrated Model for explaining motivational and behavioral change derives from the Attitude – Social Influence – Self-Efficacy Model, integrates ideas of Ajzen's Theory of Planned Behavior, Bandura's Social Cognitive Theory, Prochaska's Transtheoretical Model, the Health Belief Model, and Goal setting theories. Previous versions of this model have been used to explain a variety of types of health behavior.

Health action process approach Theory of health behavior change

The health action process approach (HAPA) is a psychological theory of health behavior change, developed by Ralf Schwarzer, Professor of Psychology at the Free University of Berlin, Germany.

Peer education is an approach to health promotion, in which community members are supported to promote health-enhancing change among their peers. Peer education is the teaching or sharing of health information, values and behavior in educating others who may share similar social backgrounds or life experiences.

Social and behavior change communication

Social and behavior change communication (SBCC), often also only "BCC" or "Communication for Development (C4D)" is an interactive process of any intervention with individuals, group or community to develop communication strategies to promote positive behaviors which are appropriate to their settings and there by solve world's most pressing health problems. This in turn provides a supportive environment which will enable people to initiate, sustain and maintain positive and desirable behavior outcomes.

Audience segmentation is a process of dividing people into homogeneous subgroups based upon defined criterion such as product usage, demographics, psychographics, communication behaviors and media use. Audience segmentation is used in commercial marketing so advertisers can design and tailor products and services that satisfy the targeted groups. In social marketing, audiences are segmented into subgroups and assumed to have similar interests, needs and behavioral patterns and this assumption allows social marketers to design relevant health or social messages that influence the people to adopt recommended behaviors. Audience segmentation is widely accepted as a fundamental strategy in communication campaigns to influence health and social change. Audience segmentation makes campaign efforts more effective when messages are tailored to the distinct subgroups and more efficient when the target audience is selected based on their susceptibility and receptivity.

The PRECEDE–PROCEED model is a cost–benefit evaluation framework proposed in 1974 by Lawrence W. Green that can help health program planners, policy makers and other evaluators, analyze situations and design health programs efficiently. It provides a comprehensive structure for assessing health and quality of life needs, and for designing, implementing and evaluating health promotion and other public health programs to meet those needs. One purpose and guiding principle of the PRECEDE–PROCEED model is to direct initial attention to outcomes, rather than inputs. It guides planners through a process that starts with desired outcomes and then works backwards in the causal chain to identify a mix of strategies for achieving those objectives. A fundamental assumption of the model is the active participation of its intended audience — that is, that the participants ("consumers") will take an active part in defining their own problems, establishing their goals and developing their solutions.

A behavior change method, or behavior change technique, is a theory-based method for changing one or several psychological determinants of behavior such as a person's attitude or self-efficacy. Such behavior change methods are used in behavior change interventions. Although of course attempts to influence people's attitude and other psychological determinants were much older, especially the definition developed in the late nineties yielded useful insights, in particular four important benefits:

  1. It developed a generic, abstract vocabulary that facilitated discussion of the active ingredients of an intervention
  2. It emphasized the distinction between behavior change methods and practical applications of these methods
  3. It included the concept of 'parameters for effectiveness', important conditions for effectiveness often neglected
  4. It drew attention to the fact that behavior change methods are influence specific determinants.

The Johns Hopkins Center for Communication Programs (CCP) was founded over 30 years ago by Phyllis Tilson Piotrow as a part the Johns Hopkins Bloomberg School of Public Health's department of Health, Behavior, and Society and is located in Baltimore, Maryland, United States.

Dolores Albarracin is a psychologist, author and professor of psychology and business based in Illinois. She is Professor of Psychology at the University of Illinois at Urbana Champaign. She is known for her work in the fields of behavior, communication and persuasion. Her contributions have had implications for the scientific understanding of basic social psychological processes and communication policy, especially in the area of health.

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