Sarah Bouw 2025
Summary Health promotion: complete + made for flash card format
1: introduction
Def prevention science
Interdisciplinary specialty to prevent psycho and physical ills + promote overall
health and wellbeing through evidence base practice at individual and systemic
levels
Goals prevention science
1. Advancing health and individual + societal levels by
2. Informing policymakers
What are more aims of prevention?
1. Reduce preventable deaths
2. Reduce number lost years
3. Increase healthy life years
4. Increase QoL
5. Reduce economic impact diseases
Def preventable death
Potentially prevented by prevention or medical intervention (treatable)
Def premature Death
Deaths before 75 (number of deaths as % of total deaths)
Def Years of life lost
Number of years lost due to death/illness
Def Years lost to Disability YLD
Number of years that persons lives with limitation
Def healthy life expectancy
Life expectancy in good health
Def Disability-Adjusted life Years (DALY)
Years lost being sick (living with disability YLD) or premature death (YLL)
DALY = YLL + YLD
Def Quality-Adjusted Life Years (QALY)
Improvement in QoL after intervention
Def disability
Complex – interaction features persons body and society they live in
1. Impairments: prob body function/structure
2. Activity limitations: executing task/action
3. Participation restrictions: in involvement life sits
1
, Sarah Bouw 2025
Def QoL
Individual perception of their position in life in context of culture/value systems
they live in and in relation to their goals
How to implement change?
1. Types of prevention (CD: Caplans def)
2. Target groups (GD: Gordons def)
3. Psychological theories
Primary prevention CD
To prevent prob from ever occurring across pop or within subgroup or system
(eg. Vaccinations)
Secondary prevention CD
Targets groups at risk for developing a prob (eg. Mammograms for woman with
family history cancer)
Tertiary prevention CD
Limit impact on prob that has occurred (eg. AA programs)
Universal prevention GD
Interventions that offer value to entire group/pop (eg. Seat belts)
Selective prevention GD
Interventions targeted to individuals/subgroups above average risk (eg. Head
start program)
Indicated prevention GD
Interventions targeted to individuals/subgroups at high risk or showing
symptoms of problem (eg. Support groups widowers experiencing dep)
2: determinants of behavior and behavior change
Types of health behaviors
1. Health behavior: aimed to prevent disease
2. Illness behavior: aimed to seek remedy
3. Sick role behavior: any activity aimed to get well
What are the determinants of behaviour: risk and protective factors
1. Biological (eg genetics, predisposition)
2. Personal determinants (personality, learning history, knowledge,
impulsivity)
3. Environmental determinants (socio-cultural norms, economic conditions,
family)
2
, Sarah Bouw 2025
What can you conclude about experiments about health behaviors
1. Health recs more likely to be adopted by individuals who invest more in
their health in other ways
2. Health behaviors are correlated (due to common determinants)
3. Observational findings can be misleading (confounds)
Example study of genetics, behavior, environment
Smoking behavior in Vietnam veterans vs non-veterans: Veterans smoke 9
additional cigs/day
Interaction with genetic risk score (+1SD genetic risk, +8 cigs in veterans)
Risk in veterans attenuated by college education
What are possible interventions per determinant?
1. Environmental: housing conditions, health services
2. Personal: health education, sogn cogn theories
3. Choice architecture (nudging): built environment, inequity
What is nudging
Choice architecture: organizes context where ppl make decisions
People’s behavior gets altered in predictable way without forbidding opinions or
chancing economic incentives (eg. Reminder doctor’s appointment)
What are the theories for behavioral change?
1. Fear drive model (naïve + common sense approach)
2. Social Cogn Theory SCT
3. Health Belief model HBM
4. Transtheoretical model of change TMM: stage of changes model
5. Protection motivation theory
6. Theory of planned behavior
1: What is the Fear drive model?
Common sense/implicit theories: knowledge + neg feelings: inform, disgust,
shame, fear (can change behavior – but short lasting without repetition or
habituation (fear < bcs of exposure)
Punishment/reward
Effects of lifestyle changes are not obvious and certain
2: What are cognitive models of behaviour change?
Derived from subjective expected utility theory -> ppl weigh potential costs and
benefits of behavior (emphasis role individual cognitions > social context)
Focus on attitudes/beliefs: about risk (anchoring and automatic thinking) and
efficacy, personal control, social beliefs (perceived norm)
3
, Sarah Bouw 2025
Cognitive model: how can risk perception be influenced?
1. Unrealistic optimism
2. Availability of info
3. Personal experience
4. How risk is framed
Cognitive model: risk perception: What is unrealistic optimism?
1. Lack personal experience w prob
2. Egocentric perspective
3. Belief that if prob hasn’t appeared, it wont
4. Belief that prob is infrequent
Problem with Cognitive model
risk beliefs > only cognition? ignored emotional aspects + social components
(and bias)
1. Anxiety and fear
2. Social component of risk (family, peers, school)
3. Also risk perception importance varies across behaviours: not crucial for
all
4. Can be important to motivate change but not necessarily trigger it
Cognitive model: belief about personal control
Internal locus -> individual changes in behaviour (eg. Quit smoking)
Beliefs = crucial element in predicting health behaviours (Beliefs patient <->
perceived sympt <-> belief health prof)
Self-efficacy: belief about capability to produce designated levels of performance
with influence over life (determine how people feel, think, motivate themselves
and behave)
3: What is the Health belief model
What is the diagram of the Health behavior?
Perceived threat -
o Perceived susceptibility
o Perceived severity
Perceived effectiveness of behaviour +
4
Summary Health promotion: complete + made for flash card format
1: introduction
Def prevention science
Interdisciplinary specialty to prevent psycho and physical ills + promote overall
health and wellbeing through evidence base practice at individual and systemic
levels
Goals prevention science
1. Advancing health and individual + societal levels by
2. Informing policymakers
What are more aims of prevention?
1. Reduce preventable deaths
2. Reduce number lost years
3. Increase healthy life years
4. Increase QoL
5. Reduce economic impact diseases
Def preventable death
Potentially prevented by prevention or medical intervention (treatable)
Def premature Death
Deaths before 75 (number of deaths as % of total deaths)
Def Years of life lost
Number of years lost due to death/illness
Def Years lost to Disability YLD
Number of years that persons lives with limitation
Def healthy life expectancy
Life expectancy in good health
Def Disability-Adjusted life Years (DALY)
Years lost being sick (living with disability YLD) or premature death (YLL)
DALY = YLL + YLD
Def Quality-Adjusted Life Years (QALY)
Improvement in QoL after intervention
Def disability
Complex – interaction features persons body and society they live in
1. Impairments: prob body function/structure
2. Activity limitations: executing task/action
3. Participation restrictions: in involvement life sits
1
, Sarah Bouw 2025
Def QoL
Individual perception of their position in life in context of culture/value systems
they live in and in relation to their goals
How to implement change?
1. Types of prevention (CD: Caplans def)
2. Target groups (GD: Gordons def)
3. Psychological theories
Primary prevention CD
To prevent prob from ever occurring across pop or within subgroup or system
(eg. Vaccinations)
Secondary prevention CD
Targets groups at risk for developing a prob (eg. Mammograms for woman with
family history cancer)
Tertiary prevention CD
Limit impact on prob that has occurred (eg. AA programs)
Universal prevention GD
Interventions that offer value to entire group/pop (eg. Seat belts)
Selective prevention GD
Interventions targeted to individuals/subgroups above average risk (eg. Head
start program)
Indicated prevention GD
Interventions targeted to individuals/subgroups at high risk or showing
symptoms of problem (eg. Support groups widowers experiencing dep)
2: determinants of behavior and behavior change
Types of health behaviors
1. Health behavior: aimed to prevent disease
2. Illness behavior: aimed to seek remedy
3. Sick role behavior: any activity aimed to get well
What are the determinants of behaviour: risk and protective factors
1. Biological (eg genetics, predisposition)
2. Personal determinants (personality, learning history, knowledge,
impulsivity)
3. Environmental determinants (socio-cultural norms, economic conditions,
family)
2
, Sarah Bouw 2025
What can you conclude about experiments about health behaviors
1. Health recs more likely to be adopted by individuals who invest more in
their health in other ways
2. Health behaviors are correlated (due to common determinants)
3. Observational findings can be misleading (confounds)
Example study of genetics, behavior, environment
Smoking behavior in Vietnam veterans vs non-veterans: Veterans smoke 9
additional cigs/day
Interaction with genetic risk score (+1SD genetic risk, +8 cigs in veterans)
Risk in veterans attenuated by college education
What are possible interventions per determinant?
1. Environmental: housing conditions, health services
2. Personal: health education, sogn cogn theories
3. Choice architecture (nudging): built environment, inequity
What is nudging
Choice architecture: organizes context where ppl make decisions
People’s behavior gets altered in predictable way without forbidding opinions or
chancing economic incentives (eg. Reminder doctor’s appointment)
What are the theories for behavioral change?
1. Fear drive model (naïve + common sense approach)
2. Social Cogn Theory SCT
3. Health Belief model HBM
4. Transtheoretical model of change TMM: stage of changes model
5. Protection motivation theory
6. Theory of planned behavior
1: What is the Fear drive model?
Common sense/implicit theories: knowledge + neg feelings: inform, disgust,
shame, fear (can change behavior – but short lasting without repetition or
habituation (fear < bcs of exposure)
Punishment/reward
Effects of lifestyle changes are not obvious and certain
2: What are cognitive models of behaviour change?
Derived from subjective expected utility theory -> ppl weigh potential costs and
benefits of behavior (emphasis role individual cognitions > social context)
Focus on attitudes/beliefs: about risk (anchoring and automatic thinking) and
efficacy, personal control, social beliefs (perceived norm)
3
, Sarah Bouw 2025
Cognitive model: how can risk perception be influenced?
1. Unrealistic optimism
2. Availability of info
3. Personal experience
4. How risk is framed
Cognitive model: risk perception: What is unrealistic optimism?
1. Lack personal experience w prob
2. Egocentric perspective
3. Belief that if prob hasn’t appeared, it wont
4. Belief that prob is infrequent
Problem with Cognitive model
risk beliefs > only cognition? ignored emotional aspects + social components
(and bias)
1. Anxiety and fear
2. Social component of risk (family, peers, school)
3. Also risk perception importance varies across behaviours: not crucial for
all
4. Can be important to motivate change but not necessarily trigger it
Cognitive model: belief about personal control
Internal locus -> individual changes in behaviour (eg. Quit smoking)
Beliefs = crucial element in predicting health behaviours (Beliefs patient <->
perceived sympt <-> belief health prof)
Self-efficacy: belief about capability to produce designated levels of performance
with influence over life (determine how people feel, think, motivate themselves
and behave)
3: What is the Health belief model
What is the diagram of the Health behavior?
Perceived threat -
o Perceived susceptibility
o Perceived severity
Perceived effectiveness of behaviour +
4
