Topic health communication summary
Lecture 1 – Theories of Planned Behaviour
Theory can:
• Help identify reasons why people do (not) take health-promoting actions
• Explain behaviour and suggest HOW to achieve behaviour change
• Help pinpoint WHAT you need to know before developing or organizing an intervention program
• Provide insight into HOW you can shape effective programs
• Identify WHAT should be monitored, measured, and/or compared in program evaluation
Article 1: Montano DE & Kasprzyk (2002). The theory of reasoned action and the theory of planned behaviour
Theory of reasoned action and theory of planned behaviour is to explain and/or predict behaviour.
The theory of reasoned action
Theory of planned behaviour: human behaviour is guided by three kinds of considerations
Behavioural beliefs: Beliefs about the likely outcomes of the behaviour and the evaluation of these outcomes
Normative beliefs: Beliefs about the normative expectations of others and motivation to comply (voldoen) with these
expectations
Control beliefs: Beliefs about the presence of factors that may facilitate or impede (belemmeren) performance of the
behaviour and the perceived power of these factors
Behavioral beliefs produce a favourable or unfavourable attitude toward the behaviour
Normative beliefs result in perceived social pressure or subjective norm
Control beliefs give rise to perceived behavioral control.
In combination, attitude toward the behaviour, subjective norm, and perception of behavioral control lead to the
formation of a behavioral intention. If they are high the intention is stronger for the person to perform the behaviour in
question.
Article 2: Smit, E.S., de Vries, H., Hoving, C. (2012). The effects of a web-based multiple tailored smoking cessation
programme: a randomized controlled trial,
The I-Change Model
,Intention state
Precontemplation: not going to change your behaviour in short time span
Contemplation: considering changing in about 6 months
Preparation: going to change the behaviour in the next month
Ability factors: are more objective. Some overlap with predisposing factors and may influence motivation factors
Barriers may prevent you from the intention to the behaviour.
Motivation factors: are more subjective (the beliefs)
Intention: The most important predictor of behaviour and the result of a conscious consideration of
Pros and cons
Important others’ opinion
Perceived control
Online computer-tailoring
- Online questionnaire (or activity tracker, or mobile survey)
- Relevant feedback
o Behaviour
o Pros and cons
o Self-efficacy
- Automatic process
o Questionnaire -> data file -> software program -> tailored feedback
{
Feedback library
Working mechanics
Effective behaviour change strategy
o Personal relevance ↑
o Information processing ↑
o Use & engagement ↑
o Behaviour change ↑
Application
Different types of health behaviours
Different target groups
o General population
o Older people
Different settings
o Municipal health centres
o General practices
Formats
Different formats
o Single vs. multiple
, o Text vs. video
o eHealth (electronic) vs. mHealth (mobile)
Experiment
The intervention Personal advice in stopping smoking (PAS) = an online multiple computer-tailored intervention
for smoking cessation.
Experiment with 2 groups, one control and one with intervention and tailored feedback letter
The results presented suggest significant effects of the intervention on short-term abstinence: at the 6-week
follow-up, respondents who received the intervention were more likely to report being abstinent for the past 24
hours, for the past 7 days, and since the previous measurement (i.e., 2 days after their quit date) than those
who did not receive the intervention. Despite incorporating goal and relapse prevention strategies (action and
coping plans), however, we found no effect of the intervention on abstinence measures assessed after 6
months.
We chose a negative scenario to replace missing values (70%) (i.e., we considered respondents lost to follow-up
to still be smoking)
Respondents who dropped out of the study were relatively more addicted and relatively younger than those
who remained in the study.
The screening instrument
Computer-tailored feedback
Article 3: Ajzen, I. (2006). Constructing a TpB Questionnaire. Conceptual and Methodological Considerations.
TACT (Target, Action, Context, Time) principle
E.g. Walking on a treadmill in a physical fitness centre for at least 30 minutes each day in the
forthcoming month.
- Target: On a treadmill
- Action: Walking for at least 30 minutes each day
- Context: In a physical fitness centre
- Time: in the forthcoming month
Compatibility principle
Walking on a treadmill in a physical fitness centre for at least 30 minutes each day in the forthcoming month
Intention to walk on a treadmill in a physical fitness centre for at least 30 minutes each day in the forthcoming
month
Attitude towards walking on a treadmill in a physical fitness centre for at least 30 minutes each day in the
forthcoming month
, The attitude is the behaviour towards walking
The subjective norm is the perceived social pressure to do so
Perceived behaviour control refers to control over performing the defined behaviour
We must assess the intention to perform this behaviour
Don’t be too general and don’t be too specific
Behavioural beliefs, Attitude toward the behaviour
For me to walk on a treadmill for at least 30 minutes each day in the forthcoming month is
harmful:_____:_____:_____:_____:_____:_____:_____: beneficial
pleasant:_____:_____:_____:_____:_____:_____:_____: unpleasant
good:_____:_____:_____:_____:_____:_____:_____: bad
Normative beliefs, Subjective norm:
Most people who are important to me think that
I should:_____:_____:_____:_____:_____:_____:_____: I should not
walk on a treadmill for at least 30 minutes each day in the forthcoming month
Control beliefs, Perceived Behavioral Control
For me to walk on a treadmill for at least 30 minutes each day in the forthcoming month would be
impossible:_____:_____:_____:_____:_____:_____:_____: possible
Injunctive norms: Whether other people think you should perform the behaviour
Descriptive norms: Whether other people actually perform the behaviour
……………………………………………………………………………………………………………………
Online health communication
Public health impact = Effect * reach
Digital health communication = high effect * high reach
Digital health communication
Mass media communication = low effect * high reach
Health counselling = high effect * low reach
Article 4: Kohl, L.F.M., Crutzen, R. de Vries, N.K. (2013). Online Prevention Aimed at Lifestyle Behaviors: A Systematic
Review of Reviews
The major challenge In digital health communication
41 reviews of internet-delivered interventions (dietary behaviours and physical activity 20/41, alcohol use,
smoking 9, condom use 1)
Effectiveness: positive, but small effects
Possible effective elements:
o 1. Tailored feedback
o 2. Use of theory
o 3. Interactivity
o 4. Goal setting
o 5. Combined online and in-person contact
Reach: female, young, white, high-income countries
Use: low use, high drop-out
Public health impact = effect * reach
Internet is less costly than face-to-face
Face-to-face leads to more effectiveness but has negative implications for reach.
You need to find a balance between face-to-face and self-guided internet-delivered material
Article 5: Schneider, van Osch, L., Schulz, D.N., Kremers, S.P.J., de Vries, H. (2012). The Influence of User Characteristics
and a Periodic Email Prompt on Exposure to an Internet-Delivered Computer-Tailored Lifestyle Program
Lecture 1 – Theories of Planned Behaviour
Theory can:
• Help identify reasons why people do (not) take health-promoting actions
• Explain behaviour and suggest HOW to achieve behaviour change
• Help pinpoint WHAT you need to know before developing or organizing an intervention program
• Provide insight into HOW you can shape effective programs
• Identify WHAT should be monitored, measured, and/or compared in program evaluation
Article 1: Montano DE & Kasprzyk (2002). The theory of reasoned action and the theory of planned behaviour
Theory of reasoned action and theory of planned behaviour is to explain and/or predict behaviour.
The theory of reasoned action
Theory of planned behaviour: human behaviour is guided by three kinds of considerations
Behavioural beliefs: Beliefs about the likely outcomes of the behaviour and the evaluation of these outcomes
Normative beliefs: Beliefs about the normative expectations of others and motivation to comply (voldoen) with these
expectations
Control beliefs: Beliefs about the presence of factors that may facilitate or impede (belemmeren) performance of the
behaviour and the perceived power of these factors
Behavioral beliefs produce a favourable or unfavourable attitude toward the behaviour
Normative beliefs result in perceived social pressure or subjective norm
Control beliefs give rise to perceived behavioral control.
In combination, attitude toward the behaviour, subjective norm, and perception of behavioral control lead to the
formation of a behavioral intention. If they are high the intention is stronger for the person to perform the behaviour in
question.
Article 2: Smit, E.S., de Vries, H., Hoving, C. (2012). The effects of a web-based multiple tailored smoking cessation
programme: a randomized controlled trial,
The I-Change Model
,Intention state
Precontemplation: not going to change your behaviour in short time span
Contemplation: considering changing in about 6 months
Preparation: going to change the behaviour in the next month
Ability factors: are more objective. Some overlap with predisposing factors and may influence motivation factors
Barriers may prevent you from the intention to the behaviour.
Motivation factors: are more subjective (the beliefs)
Intention: The most important predictor of behaviour and the result of a conscious consideration of
Pros and cons
Important others’ opinion
Perceived control
Online computer-tailoring
- Online questionnaire (or activity tracker, or mobile survey)
- Relevant feedback
o Behaviour
o Pros and cons
o Self-efficacy
- Automatic process
o Questionnaire -> data file -> software program -> tailored feedback
{
Feedback library
Working mechanics
Effective behaviour change strategy
o Personal relevance ↑
o Information processing ↑
o Use & engagement ↑
o Behaviour change ↑
Application
Different types of health behaviours
Different target groups
o General population
o Older people
Different settings
o Municipal health centres
o General practices
Formats
Different formats
o Single vs. multiple
, o Text vs. video
o eHealth (electronic) vs. mHealth (mobile)
Experiment
The intervention Personal advice in stopping smoking (PAS) = an online multiple computer-tailored intervention
for smoking cessation.
Experiment with 2 groups, one control and one with intervention and tailored feedback letter
The results presented suggest significant effects of the intervention on short-term abstinence: at the 6-week
follow-up, respondents who received the intervention were more likely to report being abstinent for the past 24
hours, for the past 7 days, and since the previous measurement (i.e., 2 days after their quit date) than those
who did not receive the intervention. Despite incorporating goal and relapse prevention strategies (action and
coping plans), however, we found no effect of the intervention on abstinence measures assessed after 6
months.
We chose a negative scenario to replace missing values (70%) (i.e., we considered respondents lost to follow-up
to still be smoking)
Respondents who dropped out of the study were relatively more addicted and relatively younger than those
who remained in the study.
The screening instrument
Computer-tailored feedback
Article 3: Ajzen, I. (2006). Constructing a TpB Questionnaire. Conceptual and Methodological Considerations.
TACT (Target, Action, Context, Time) principle
E.g. Walking on a treadmill in a physical fitness centre for at least 30 minutes each day in the
forthcoming month.
- Target: On a treadmill
- Action: Walking for at least 30 minutes each day
- Context: In a physical fitness centre
- Time: in the forthcoming month
Compatibility principle
Walking on a treadmill in a physical fitness centre for at least 30 minutes each day in the forthcoming month
Intention to walk on a treadmill in a physical fitness centre for at least 30 minutes each day in the forthcoming
month
Attitude towards walking on a treadmill in a physical fitness centre for at least 30 minutes each day in the
forthcoming month
, The attitude is the behaviour towards walking
The subjective norm is the perceived social pressure to do so
Perceived behaviour control refers to control over performing the defined behaviour
We must assess the intention to perform this behaviour
Don’t be too general and don’t be too specific
Behavioural beliefs, Attitude toward the behaviour
For me to walk on a treadmill for at least 30 minutes each day in the forthcoming month is
harmful:_____:_____:_____:_____:_____:_____:_____: beneficial
pleasant:_____:_____:_____:_____:_____:_____:_____: unpleasant
good:_____:_____:_____:_____:_____:_____:_____: bad
Normative beliefs, Subjective norm:
Most people who are important to me think that
I should:_____:_____:_____:_____:_____:_____:_____: I should not
walk on a treadmill for at least 30 minutes each day in the forthcoming month
Control beliefs, Perceived Behavioral Control
For me to walk on a treadmill for at least 30 minutes each day in the forthcoming month would be
impossible:_____:_____:_____:_____:_____:_____:_____: possible
Injunctive norms: Whether other people think you should perform the behaviour
Descriptive norms: Whether other people actually perform the behaviour
……………………………………………………………………………………………………………………
Online health communication
Public health impact = Effect * reach
Digital health communication = high effect * high reach
Digital health communication
Mass media communication = low effect * high reach
Health counselling = high effect * low reach
Article 4: Kohl, L.F.M., Crutzen, R. de Vries, N.K. (2013). Online Prevention Aimed at Lifestyle Behaviors: A Systematic
Review of Reviews
The major challenge In digital health communication
41 reviews of internet-delivered interventions (dietary behaviours and physical activity 20/41, alcohol use,
smoking 9, condom use 1)
Effectiveness: positive, but small effects
Possible effective elements:
o 1. Tailored feedback
o 2. Use of theory
o 3. Interactivity
o 4. Goal setting
o 5. Combined online and in-person contact
Reach: female, young, white, high-income countries
Use: low use, high drop-out
Public health impact = effect * reach
Internet is less costly than face-to-face
Face-to-face leads to more effectiveness but has negative implications for reach.
You need to find a balance between face-to-face and self-guided internet-delivered material
Article 5: Schneider, van Osch, L., Schulz, D.N., Kremers, S.P.J., de Vries, H. (2012). The Influence of User Characteristics
and a Periodic Email Prompt on Exposure to an Internet-Delivered Computer-Tailored Lifestyle Program
