Summary HEP4210
Understanding Health Behavior
Lecture 1: Definitions & models 1
Case 1: ‘Too many obese workers’ 6
Lecture 2: Attitude, social influence and self-efficacy 16
Case 2: ‘Confiding about confidence to quit’ 20
Lecture 3: Self-determination theory 33
Case 3: ‘I determine whether I’m motivated’ 38
Lecture 4: Automatic behavior 46
Case 4: ‘Automaticity or control?’ 49
Lecture 5: Mediators, Moderators and Monsters: Dual-processes and interactions 57
Case 5: The ball and the fence 60
Response lecture 69
,Lecture 1: Definitions & models
Public health = “the science and art of preventing disease, prolonging life, and promotion health
through the organized efforts of society” – WHO (1988)
Development of public health
• Personal and societal hygiene (antiquity)
• Isolation and quarantine (middle ages)
• Vaccination (18th/19th century)
• Sanitation (19th century) London
• Targeted prevention (newborn care, youth care, school health care, work health care, elderly
care) (20th century)
• Integrated care (21st century)
Definitions of health
• The first definition had a strong biomedical perspective mainly stressing: “the absence of
disease”
• New definition of the WHO (1948): “physical, mental and social well-being, and not merely
the absence of disease and infirmity”
Impact on our field
• At first, prevention of disease was most important
• Different types of prevention: primary, secondary, tertiary prevention
• Then, the promotion of health was strongly emphasized = health promotion = “the process
of enabling people to increase control over, and to improve, their health (WHO)
Health promotion
• In 1989 there was an editorial in the American Journal of Health System Pharmacy:
“Health promotion is the science and art of helping people change their lifestyle to move
toward a state of optimal health.”
• Optimal health is defined as a balance of physical, emotional, social, spiritual, and intellectual
health. Lifestyle change can be facilitated through a combination of efforts to enhance
awareness, change behavior and create environments that support good health
practices. Of the three, supportive environments will probably have the greatest impact in
producing lasting change.
Tools for health promotion
• Health communication: raising awareness about healthy behaviors for the general public
• Health education: communication of information, but also fostering the motivation, skills
and confidence (self-efficacy) necessary to take action to improve health
• Policy, systems and environment: making systematic changes – through improved laws,
rules, and regulations (policy), functional organizational components (systems), and
economic, social, or physical environment – to encourage, make available, and enable
healthy choices
→ Changing the environment is the most efficient.
1
,The Ottawa Charter
• The 1st international conference on health promotion, held
in Ottawa, 1986
• Goal: Health for All in 2000
• Develop personal skills → health education
• Create supportive environments → policy, systems and
environment
• Reorient health services → health communication
• Build healthy public policy → policy, systems and
environment
Ottawa Charter
• Health is not just the responsibility of the health sector, but
goes beyond healthy life styles to well-being →
multidisciplinary
• It aims at making political, economic, social, cultural, environmental, behavioral and
biological factors favourable through advocacy for health
• Focuses on achieving equity in health (enable)
• Demands coordinated action by all concerned: by governments, by health and other social
organizations (mediate)
Important principles
• Advocate: political, economic, social, cultural, environmental, behavioral and biological
factors can all favour health or be harmful to it. Health promotion aims at making these
conditions favourable through advocacy for health
→ Knowledge on these factors is imperative!
• Enable: health promotion focuses on achieving equity in health. Health promotion action
aims at reducing differences in current health status and ensuring equal opportunities and
resources to enable all people to achieve their fullest health potential.
o Equality = give the same chances to everybody → is not always the best strategy,
because not everybody requires the same.
o Equity = give everybody what they actually need.
→ Policy should pay attention to not making the differences bigger.
• Mediate: health promotion demands coordinated action by all concerned: by governments,
by health and other social and economic sectors, by nongovernmental and voluntary
organizations, by local authorities, etc.
After Ottawa
• Jakarta Declaration (1997): partnerships, community capacity, social responsibility
• Bangkok Charter (2005): globalization
• WHO conferences
o Nairobi (2009) Implementation gap
o Helsinki (2013) Health in All Policies
o Sanghai (2016) Focus on healthy cities
Three main types of models
• Planning models
2
, • Models aimed at understanding behavior
o Precede-Proceed model
• Models illustrating change of behavior
o Precaution Adoption Process Model (PAPM)
o Stages of change (Transtheoretical model; TTM)
3
Understanding Health Behavior
Lecture 1: Definitions & models 1
Case 1: ‘Too many obese workers’ 6
Lecture 2: Attitude, social influence and self-efficacy 16
Case 2: ‘Confiding about confidence to quit’ 20
Lecture 3: Self-determination theory 33
Case 3: ‘I determine whether I’m motivated’ 38
Lecture 4: Automatic behavior 46
Case 4: ‘Automaticity or control?’ 49
Lecture 5: Mediators, Moderators and Monsters: Dual-processes and interactions 57
Case 5: The ball and the fence 60
Response lecture 69
,Lecture 1: Definitions & models
Public health = “the science and art of preventing disease, prolonging life, and promotion health
through the organized efforts of society” – WHO (1988)
Development of public health
• Personal and societal hygiene (antiquity)
• Isolation and quarantine (middle ages)
• Vaccination (18th/19th century)
• Sanitation (19th century) London
• Targeted prevention (newborn care, youth care, school health care, work health care, elderly
care) (20th century)
• Integrated care (21st century)
Definitions of health
• The first definition had a strong biomedical perspective mainly stressing: “the absence of
disease”
• New definition of the WHO (1948): “physical, mental and social well-being, and not merely
the absence of disease and infirmity”
Impact on our field
• At first, prevention of disease was most important
• Different types of prevention: primary, secondary, tertiary prevention
• Then, the promotion of health was strongly emphasized = health promotion = “the process
of enabling people to increase control over, and to improve, their health (WHO)
Health promotion
• In 1989 there was an editorial in the American Journal of Health System Pharmacy:
“Health promotion is the science and art of helping people change their lifestyle to move
toward a state of optimal health.”
• Optimal health is defined as a balance of physical, emotional, social, spiritual, and intellectual
health. Lifestyle change can be facilitated through a combination of efforts to enhance
awareness, change behavior and create environments that support good health
practices. Of the three, supportive environments will probably have the greatest impact in
producing lasting change.
Tools for health promotion
• Health communication: raising awareness about healthy behaviors for the general public
• Health education: communication of information, but also fostering the motivation, skills
and confidence (self-efficacy) necessary to take action to improve health
• Policy, systems and environment: making systematic changes – through improved laws,
rules, and regulations (policy), functional organizational components (systems), and
economic, social, or physical environment – to encourage, make available, and enable
healthy choices
→ Changing the environment is the most efficient.
1
,The Ottawa Charter
• The 1st international conference on health promotion, held
in Ottawa, 1986
• Goal: Health for All in 2000
• Develop personal skills → health education
• Create supportive environments → policy, systems and
environment
• Reorient health services → health communication
• Build healthy public policy → policy, systems and
environment
Ottawa Charter
• Health is not just the responsibility of the health sector, but
goes beyond healthy life styles to well-being →
multidisciplinary
• It aims at making political, economic, social, cultural, environmental, behavioral and
biological factors favourable through advocacy for health
• Focuses on achieving equity in health (enable)
• Demands coordinated action by all concerned: by governments, by health and other social
organizations (mediate)
Important principles
• Advocate: political, economic, social, cultural, environmental, behavioral and biological
factors can all favour health or be harmful to it. Health promotion aims at making these
conditions favourable through advocacy for health
→ Knowledge on these factors is imperative!
• Enable: health promotion focuses on achieving equity in health. Health promotion action
aims at reducing differences in current health status and ensuring equal opportunities and
resources to enable all people to achieve their fullest health potential.
o Equality = give the same chances to everybody → is not always the best strategy,
because not everybody requires the same.
o Equity = give everybody what they actually need.
→ Policy should pay attention to not making the differences bigger.
• Mediate: health promotion demands coordinated action by all concerned: by governments,
by health and other social and economic sectors, by nongovernmental and voluntary
organizations, by local authorities, etc.
After Ottawa
• Jakarta Declaration (1997): partnerships, community capacity, social responsibility
• Bangkok Charter (2005): globalization
• WHO conferences
o Nairobi (2009) Implementation gap
o Helsinki (2013) Health in All Policies
o Sanghai (2016) Focus on healthy cities
Three main types of models
• Planning models
2
, • Models aimed at understanding behavior
o Precede-Proceed model
• Models illustrating change of behavior
o Precaution Adoption Process Model (PAPM)
o Stages of change (Transtheoretical model; TTM)
3
