BMS 361 Principles of Learning and Health Education

BMS 361 Principles of Learning and Health Education THEORIES OF INTRAPERSONAL CAPACITY 1 Dr. Fatmah Almoayad

Outline ■ Theories and models and their importance for HE. ■ Main streams for HE theories. ■ Main models of intrapersonal capacity

Main streams of Health Education ■ Models of Intrapersonal capacity (individual health behavior). ■ Models of Interpersonal relationships and support (social influence). ■ Models of environmental support and context.

Models of Intrapersonal capacity These models attempt to modify individuals’ characteristics: 1. Awareness and knowledge. 2. Beliefs. 3. Opinions and attitudes. 4. self-efficacy. 5. Intentions. 6. Skills and personal power.

The Rational Model Also known as the knowledge, attitudes, practices model (KAP). Target population of this model are individuals and groups. Aim to encourage positive and prevent negative health behaviour choices. Approach: presenting relatively unbiased information.

The Rational Model Change in knowledge Change in attitudes and beliefs Change in behavior

The Rational Model It assumes that the only obstacle to acting “responsibly” and rationally is ignorance, and that information alone can influence behaviour by “correcting” this lack of knowledge. It assumes that the ignorance is the only reason for unhealthy behaviors.

Examples of using the Rational Model.

The Rational Model weaknesses. ■ It focuses only on improving knowledge which is important but alone does not change behaviours. ■ It ignores other factors such as motivations, social pressure…etc

The Health Belief Model (HBM) ■ Explains human health decision-making and subsequent behavior. ■ Helps predict whether people will take action to prevent, screen for, and control illness.

The Health Belief Model (HBM) This is one of the earliest models in behaviour change it was developed in the 50 s to explain why people are refusing free chest x-ray to detect TB. They founded that people’s perceptions about severity and susceptibility influenced their willingness to take preventive actions.

Perceived susceptibility Beliefs about the chances of getting a condition (Likelihood). Ex. No one in my family got breast cancer, so I don’t think I am at risk why should I have a mammogram. I know people who are not wearing seat belts get injured in accidents but I drive well, so I am not susceptible to accidents.

Strategy to be used ■ Define what population(s) are at risk and their levels of risk ■ Tailor risk information based on an individual’s characteristics or behaviour ■ Help the individual develop an accurate perception of his or her own risk

Perceived severity Beliefs about the seriousness of a condition and its consequences (Magnitude or seriousness). Ex. I know I have diabetes but that’s fine it is not going to kill me. Influenza is not a serious condition so why would I bother my self with vaccines.

Strategy to be used Specify the consequences of a condition and recommended action.

Development of HBM ■ The model was expanded after its initial development to include ore concepts.

The Health Belief Model (HBM) Perceived Benefits VS Perceived barriers Perceived susceptibility Perceived severity Perceived threat Self-Efficacy Cues to action Likelihood of engaging in a behavior

Perceived benefits Beliefs about the effectiveness of taking action to reduce risk or seriousness. Ex. I have smoked for more than 20 years would it make any difference now?

Strategy to be used Explain how, where, and when to take action and what the potential positive results will be

Perceived barrier Beliefs about the material and psychological costs of taking action. Exercising is not for women it builds muscles. Breastfeeding in public is exposing and is inappropriate.

Strategy to be used Offer reassurance, incentives, and assistance; correct misinformation

Cues to action Factors that activate “readiness to change” – a trigger mechanism. Ex. ■ Reminder letters of mammogram and pap smear. ■ Sinks near patients rooms.

Strategy to be used Provide “how to” information, promote awareness and employ reminder systems.

Self-efficacy Confidence in one’s ability to take action. Ex. ■ I know loosing weight will improve my health but I cannot commit to a diet.

Strategy to be used ■ ■ Provide training and guidance in performing action Use progressive goal setting Give verbal reinforcement Demonstrate desired behaviour

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The extended parallel process model (EPPM) ■ Based on the health belief model. ■ Strategies may use reasoning, urging and inducement, and base their message on rational and/or emotional appeals to make people feel more susceptible.

The extended parallel process model (EPPM) Susceptibility Severity Threat Response efficacy Self efficacy Efficacy Health decision

Response efficacy Perceived effectiveness in averting threat

Appraisal processes ■ First, they perceive whether they are susceptible to an identified threat and whether the threat is severe. ■ If the threat is perceived as minor or irrelevant, they generally ignore the risk message and the urging to take the recommended action.

Appraisal processes ■ Second, if people believe they are susceptible to a severe threat and their level of fear is aroused, they are motivated to assess whether the recommended action can reduce that threat (i. e. response efficacy) and whether they can perform the recommended action (i. e. self-efficacy). ■ When they feel capable of taking action, they will control the risk accordingly. However, when they doubt their ability to minimize threat, perhaps because of personal, social or physical barriers, they focus instead on controlling their fear. They will also go into a state of

Appraisal processes In sum, perceived threat (i. e. , perceived susceptibility and severity) motivates action. Perceived efficacy (i. e. recommended response efficacy and self-efficacy) determines whether individuals control the danger and make behavioural changes or control their fear through psychological defence mechanisms.

Example of EPPM (Threat)

Transtheoretical model of change ■ Behavior change is viewed as a progression through a series of five stages. ■ People’s needs depend on their stage. ■ Effective educational interventions should target individuals’ needs. ■ Self-efficacy and balanced decision-making are central to theory.

Transtheoretical model of change Precontemplation Maintenance Action Contemplation Preparation

1 - Precontemplation At this stage a person has no intention to of taking action within the next six months. Usually a person at this stage cannot see a problem and as a result does not seek a change.

Potential change strategies (precontemplation) ■ Increase awareness of need for change ■ Personalize information about risks and benefits

2 - Contemplation At this stage a person starts to recognise the problem and intends to take action in the next six months

Potential change strategies (Contemplation) Motivate , encourage making specific plans.

3 - Preparation At this stage a person Intends to take action within the next 30 days and has taken some behavioural steps in this direction.

Potential change strategies (Preperation) Motivate , encourage making specific plans.

4 - Action At this stage a person has changed behaviour for less than six months.

Potential change strategies (Action) Assist with: ■ Feedback. ■ Problem-solving. ■ Social support and reinforcement.

5 - Maintenance At this stage a person has changed behaviour for more than six months

Potential change strategies (Maintenance) Assist with: ■ ■ Coping. Reminders. finding alternatives. Avoiding slips/relapses.

ANY QUESTIONS?