Behavior change (public health)

Last updated

Behavior change, in 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]

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.

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]

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]

Individual and interpersonal

Community

List of behavior change strategies

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 behaviour is a theory that links one's beliefs and behaviour.

Transtheoretical model integrative theory of therapy that assesses an individuals readiness to act on a new healthier behavior, and provides strategies, or processes of change to guide the individua

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".

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.

Self-care necessary human regulatory function which is under individual control, deliberate and self-initiated

In health care, self-care is any necessary human regulatory function which is under individual control, deliberate and self-initiated.

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.

Health belief model

The health belief model (HBM) is a social psychological health behavior change model developed to explain and predict health-related behaviors, particularly in regard to the uptake of health services. The HBM 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 HBM 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.

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.

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..

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.

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.

References

  1. WHO 2002: "World Health Report 2002 – Reducing Risks, Promoting Healthy Life". Retrieved February 2015.
  2. "Why Social and Behavior Change Communication? – Health Communication Capacity Collaborative – Social and Behavior Change Communication". Health Communication Capacity Collaborative – Social and Behavior Change Communication. Retrieved 2016-06-17.
  3. US Center for Disease Control and Prevention. "National Prevention Strategy". Retrieved February 2015.
  4. Jamison DT, Breman JG, Measham AR, et al., (eds) (2006) Disease Control Priorities in Developing Countries. 2nd edition Chapter 2: Intervention Cost-Effectiveness Retrieved February 2015.
  5. "SD County".
  6. "American College Health Association".
  7. "SAID project". Private Sector Partnerships. SAID project focused on increasing the private sector's role in providing high-quality health products and services in developing countries.
  8. "Barrier Analysis website". Barrier Analysis website.
  9. "Designing for Behavior Change Curriculum". Designing for Behavior Change Curriculum.
  10. Biliński P, Wojtyła A, Kapka-Skrzypczak L, Chwedorowicz R, Cyranka M, Studziński T (2012). "Epigenetic regulation in drug addiction". Ann. Agric. Environ. Med. 19 (3): 491–496. PMID   23020045.
  11. "Theory of Planned Behavior – The Health COMpass". www.thehealthcompass.org.
  12. "Diffusion of Innovations – The Health COMpass". www.thehealthcompass.org.
  13. Ryan, Polly (2009). "Integrated Theory of Health Behavior Change: Background and Intervention Development". Clinical Nurse Specialist. 23 (3): 161–172. doi:10.1097/NUR.0b013e3181a42373. PMC   2778019 . PMID   19395894.
  14. Prochaska, James; Velicer, Wayne (1997). "The Transtheoretical Model of Health Behavior Change". American Journal of Health Promotion. 12 (1): 38–48. doi:10.4278/0890-1171-12.1.38. PMID   10170434.
  15. Janz, Nancy K.; Becker, Marshall H. (2016-09-04). "The Health Belief Model: A Decade Later" (PDF). Health Education Quarterly. 11 (1): 1–47. doi:10.1177/109019818401100101. hdl:2027.42/66877. PMID   6392204.
  16. Rogers, Ronald W. (1975-09-01). "A Protection Motivation Theory of Fear Appeals and Attitude Change1". The Journal of Psychology. 91 (1): 93–114. doi:10.1080/00223980.1975.9915803. ISSN   0022-3980. PMID   28136248.
  17. "Brazil: Behavior Change Communication for More Effective Tuberculosis Control". John Snow Inc. 2010–2011. Retrieved 2 August 2016.
  18. "Behaviour Change Communication (BCC)for HIV/AIDS a Strategic Framework" (PDF). HIVPolicy.org. September 2002. Retrieved 2 August 2016.
  19. "Johns Hopkins Center for Communication Programs".
  20. "DMI – Where we work". Archived from the original on 2015-08-31. Retrieved 2015-09-06.
  21. "Evidence Action Beta".
  22. "Science Of Behavior Change Research Network Website".
  23. "Media For Social Change – Chocolate Moose Media – Social Innovator". www.chocmoose.com.
  24. "LOOKAHEADE".
  25. "Shape Up Somerville". City of Somerville, Mass.
  26. "National Institute of Diabetes and Digestive and Kidney Diseases".
  27. "Truth Initiative".
  28. "Campaign for Tobacco-Free Kids". 2017-04-21.
  29. "National Institutes of Health".