Psychology of prevention and health promotion: Determinants of behavior
and behavior change (lesson2)
More theoretical (lesson2+3)
AIMS
What are behavioral determinants?
Theories and models (=> most famous!)
Explain how theories and models of behavior influence behavior change interventions
INTRODUCTION
DEFINING HEALTH BEHAVIORS
HEALTH PSYCHOLOGY PERSPECTIVE: what are health behaviors? Different kinds!
Health behavior – Behavior aimed to Go to gym, eat healthy, not smoke, get enough
gezondheidsgedrag prevent a disease. sleep
Illness behavior – Behavior aimed to seek Go to the doctor, extra rest
ziektegedrag remedy.
Sick role behavior – Behavior is any activity Taking a prescription/ medication, wearing a cast
ziekterolgedrag aimed to get well. for a broken leg, staying home during illness (flu)
Health impairing habits/ behaviors vs Health protecting behaviors
- Some behaviors are guided by habits (not addiction), more automatic/ difficult to target;
Cf. Start the day by studying with a cup of coffee, make it a habit to have a cup next to you.
Cf. Lesson1: Noncommunicable Diseases – 4 diseases, 4 modifiable shared risk factors
Tabacco use Unhealthy diets Physical inactivity Harmful use of alcohol
Cardiovascular X X X X
Diabetes X X X X
Cancer X X X X
Chronic respiratory X
(INTERACTIONS BETWEEN) DETERMINANTS OF BEHAVIOR Certain extent overlapping!
Biological determinants
- Metabolic traits (cf. nicotine metabolism, alcohol metabolism, hunger and satiety, reward
sensitivity,…)
- Genetics/ predisposition
Personal determinants
- Personality (cf. high reward sensitivity + impulsive => lead to addition behaviors)
- Learning history
- Attitudes, knowledge, expectations (cf. information distributed on posters in hospitals…)
• Knowledge one of the easiest targets to influence behavior
Environmental determinants
- Availability (cf. larger ability to cigarettes because of a low price, more likely to engage in smoking)
- Socio- cultural norms – family, school, peers, community (cf. socially acceptable to be a smoker)
• The norm of your social group: seen as negative or positive => has an impact.
- Financial/ economic conditions
• Higher education & better financial conditions ~ better health behavior
RISK & PROTECTIVE FACTORS (two faces of the same coin?)
Cf. resilience, skills, strengths, environmental advantages
BOTH: individual & systemic level
Cf. Zie extra document ‘Example: the vitamin E case’.
Interactions between all these factors: complex & often non-linear
- It is not necessarily the case that when at lower or higher risk for a certain disease, the amount of
(un)healthy behaviors leads to a linear decrease/increase in risk.
, 6 THEORIES FOR BEHAVIOR CHANGE
NOTE: research has been largely non-theory-based (1/3 of 193 were theory based) ➔ problematic!
HISTORICAL EVOLUTION AND OVERVIEW
Before ‘70s In ‘70s In ‘90s Now
Environmental Personal Health Choice architecture
determinants determinants promotion
Nowadays see some Health See paper: ‘The Suggestions, reminders.. in favor of certain healthy
things as common sense education role of a doctor is behavior (cf. attractive stairs in shopping centers,
(cf. not smoke during not only to cure, reminders doctors appointment);
pregnancy), was once not but also to ‘Choice architect’: organize context in people make
so common sense. prevent’. decisions;
Nudge1.
(1) FEAR DRIVE MODEL (along with naïve and common sense approaches)
= producing excessively frightening messages to preventively reduce behavior.
= common sense, implicit, folk, naïve theories
Inform/ educate: Fear appeals (cf. images on Disgust Repression Shame
important, not enough packs of cigarettes)
Not so effective:
Repetition leads to habituation: the fear Punishment/reward It is short lasting without
diminishes with exposure to it repetition
Work on knowledge, and negative feelings Fear might not evoke Effects of lifestyle changes
(which are short-term and not enough for a change in behavior are not obvious and certain
long-term change)
(2) (SOCIAL) COGNITIVE THEORY (SCT)
Cognitive models: derived from subjective expected utility theory
- People will wight potential costs and benefits for the behavior;
- Emphasize the role of individual cognitions rather than the social context.
• Decides for themselves, social context is ignored (does not matter).
Cognitive (and social cognitive) models: change focus on attitudes/ beliefs
- Beliefs about risk and efficacy: offering knowledge to change beliefs
- Beliefs about personal control: cf. excessive optimism
- Social beliefs: cf. perceived social norm
Beliefs about risk: the perception of risk is a crucial element
- Risk perception would be best approximated by experts (i.o.w.: ‘trust me’) cf. Covid: vaccinate…
- Several biases: - not completely rational thinkers cf. I smoke 2 packs of cigarettes a day and still
haven't died, just like my father who is still alive.
• Unrealistic optimism: 1) Lack personal experience, 2) Egocentric perspective: belief,
problem preventable by individual action, 3) Belief, if the problem has never appeared, it
won’t, 4) Belief, problem is infrequent
• Availability of info: In your context nothing happened, but you have to look it on a bigger scale
• Personal experience with the problem
• How the risk is framed
1
Nudge= any aspect of the choice architecture that alters people’s behavior in a predictable way without forbidding
opinions of changing economic incentives.
and behavior change (lesson2)
More theoretical (lesson2+3)
AIMS
What are behavioral determinants?
Theories and models (=> most famous!)
Explain how theories and models of behavior influence behavior change interventions
INTRODUCTION
DEFINING HEALTH BEHAVIORS
HEALTH PSYCHOLOGY PERSPECTIVE: what are health behaviors? Different kinds!
Health behavior – Behavior aimed to Go to gym, eat healthy, not smoke, get enough
gezondheidsgedrag prevent a disease. sleep
Illness behavior – Behavior aimed to seek Go to the doctor, extra rest
ziektegedrag remedy.
Sick role behavior – Behavior is any activity Taking a prescription/ medication, wearing a cast
ziekterolgedrag aimed to get well. for a broken leg, staying home during illness (flu)
Health impairing habits/ behaviors vs Health protecting behaviors
- Some behaviors are guided by habits (not addiction), more automatic/ difficult to target;
Cf. Start the day by studying with a cup of coffee, make it a habit to have a cup next to you.
Cf. Lesson1: Noncommunicable Diseases – 4 diseases, 4 modifiable shared risk factors
Tabacco use Unhealthy diets Physical inactivity Harmful use of alcohol
Cardiovascular X X X X
Diabetes X X X X
Cancer X X X X
Chronic respiratory X
(INTERACTIONS BETWEEN) DETERMINANTS OF BEHAVIOR Certain extent overlapping!
Biological determinants
- Metabolic traits (cf. nicotine metabolism, alcohol metabolism, hunger and satiety, reward
sensitivity,…)
- Genetics/ predisposition
Personal determinants
- Personality (cf. high reward sensitivity + impulsive => lead to addition behaviors)
- Learning history
- Attitudes, knowledge, expectations (cf. information distributed on posters in hospitals…)
• Knowledge one of the easiest targets to influence behavior
Environmental determinants
- Availability (cf. larger ability to cigarettes because of a low price, more likely to engage in smoking)
- Socio- cultural norms – family, school, peers, community (cf. socially acceptable to be a smoker)
• The norm of your social group: seen as negative or positive => has an impact.
- Financial/ economic conditions
• Higher education & better financial conditions ~ better health behavior
RISK & PROTECTIVE FACTORS (two faces of the same coin?)
Cf. resilience, skills, strengths, environmental advantages
BOTH: individual & systemic level
Cf. Zie extra document ‘Example: the vitamin E case’.
Interactions between all these factors: complex & often non-linear
- It is not necessarily the case that when at lower or higher risk for a certain disease, the amount of
(un)healthy behaviors leads to a linear decrease/increase in risk.
, 6 THEORIES FOR BEHAVIOR CHANGE
NOTE: research has been largely non-theory-based (1/3 of 193 were theory based) ➔ problematic!
HISTORICAL EVOLUTION AND OVERVIEW
Before ‘70s In ‘70s In ‘90s Now
Environmental Personal Health Choice architecture
determinants determinants promotion
Nowadays see some Health See paper: ‘The Suggestions, reminders.. in favor of certain healthy
things as common sense education role of a doctor is behavior (cf. attractive stairs in shopping centers,
(cf. not smoke during not only to cure, reminders doctors appointment);
pregnancy), was once not but also to ‘Choice architect’: organize context in people make
so common sense. prevent’. decisions;
Nudge1.
(1) FEAR DRIVE MODEL (along with naïve and common sense approaches)
= producing excessively frightening messages to preventively reduce behavior.
= common sense, implicit, folk, naïve theories
Inform/ educate: Fear appeals (cf. images on Disgust Repression Shame
important, not enough packs of cigarettes)
Not so effective:
Repetition leads to habituation: the fear Punishment/reward It is short lasting without
diminishes with exposure to it repetition
Work on knowledge, and negative feelings Fear might not evoke Effects of lifestyle changes
(which are short-term and not enough for a change in behavior are not obvious and certain
long-term change)
(2) (SOCIAL) COGNITIVE THEORY (SCT)
Cognitive models: derived from subjective expected utility theory
- People will wight potential costs and benefits for the behavior;
- Emphasize the role of individual cognitions rather than the social context.
• Decides for themselves, social context is ignored (does not matter).
Cognitive (and social cognitive) models: change focus on attitudes/ beliefs
- Beliefs about risk and efficacy: offering knowledge to change beliefs
- Beliefs about personal control: cf. excessive optimism
- Social beliefs: cf. perceived social norm
Beliefs about risk: the perception of risk is a crucial element
- Risk perception would be best approximated by experts (i.o.w.: ‘trust me’) cf. Covid: vaccinate…
- Several biases: - not completely rational thinkers cf. I smoke 2 packs of cigarettes a day and still
haven't died, just like my father who is still alive.
• Unrealistic optimism: 1) Lack personal experience, 2) Egocentric perspective: belief,
problem preventable by individual action, 3) Belief, if the problem has never appeared, it
won’t, 4) Belief, problem is infrequent
• Availability of info: In your context nothing happened, but you have to look it on a bigger scale
• Personal experience with the problem
• How the risk is framed
1
Nudge= any aspect of the choice architecture that alters people’s behavior in a predictable way without forbidding
opinions of changing economic incentives.
