Health behavior discussion post on ted talk

(formerly known as TRA) “Our attitudes control our lives. Attitudes are a secret power working twenty-four hours a day, for good or bad. It is of paramount importance that we know how to harness and control this great force.” – Irving Berlin – Main Points Levels of Influence Individual Health Behavior Theory Theory of Planned Behavior • Discuss the historical development of the TRA/TPB. • Present the key components of the TRA/TPB. • Give examples of applications of the TRA/TPB. Focus and Key Concepts Theory of Reasoned Action • The TRA was developed in 1967 to understand the relationship between people’s attitudes and their behavior. • The logic of the TRA is: • behavior is predicted by intentions • intentions are predicted by attitudes • and attitudes are made up of beliefs TRA • Example • behavior (exercise) is predicted by intentions (dedication, hard work) • intentions (hard work, dedication) are predicted by attitudes (positive, I CAN do this) • and attitudes (positive) are made up of beliefs (if I exercise, I will lose weight, gain muscle, be healthy) TRA: Behavioral Intention • Attitude towards a behavior results from: 1. A person’s belief about what will happen if they do it (behavioral beliefs). 2. A person’s assessment of whether the outcome is good or bad. TRA • TRA assumes the best predictor of behavior is a person’s behavioral intention – – perceived likelihood of performing the behavior. • Behavioral intention is influenced by: • attitude toward performing the behavior • subjective norm associated with the behavior TRA: Behavioral Intention • Subjective norms (normative beliefs) results from: • A person’s beliefs about what other people in his or her social group will think about the behavior, combined with • their motivation to conform to these social norms. • A person who holds strong beliefs that positive outcomes will result from performing a behavior, will have a positive attitude toward that behavior. • A person who believes that others think he/she should perform a behavior, and who is motivated to meet the expectations of those people, will hold a positive subjective norm. TRA TRA • There is a link between behavioral and normative beliefs to behavioral intention and the behavior itself. • EX: Candace believes if she quits smoking she is likely to gain weight. If the peer social norm for females is not to gain weight and the behavior of quitting smoking itself is viewed as physically unpleasant, she may have a low intent to quit smoking. EX: Patient compliance with antibiotics http://www.biomedcentral.com/1471-2458/7/104/figure/F6?highres=y Applications of TRA in HE & HP Colorectal cancer screening Sunscreen use behavior Condom use Violence prevention Exercise/physical activity behavior Promoting milk with 1% or less fat Promoting healthy diet Prostate cancer genetic screening Mammography behavior & intention Teaching TSE by nurse practitioners Osteoporosis prevention Predicting mothers’ infant feeding intentions Patient compliance during orthodontic Tx HIV Prevention program in adolescent mothers Predicting problem gambling Acceptance of a diagnosis of depression Physician intention to prescribe emergency contraception Attitudes about genetically modified foods The Reformulation • Jane is concerned about breast cancer, she has a favorable attitude about getting a mammogram, and she was not going to be influenced by the skepticism of her social group. She works on a small farm and lives very far from the nearest place to get a mammogram. • She has intent, but doesn’t feel that she can get a mammogram given circumstances out of her control. Consequently, behavioral intention alone is not a sufficient predictor of behavior. Perceived Behavioral Control • Control Beliefs • Refers to the presence or absence of facilitators and barriers to performing the behavior. • Jane thinks she can get a ride (facilitating control belief). Or Jane thinks she can’t get a ride (constraining belief). • Perceived power of each of these factors to facilitate or inhibit the behavior. • If Jane felt that getting a ride was the only possible way she can get to the screening facility, this would have a lot to do with how much of a determining factor her facilitating control belief was in predicting her behavior. The Reformulation • TRA does not account for external factors that may prevent someone from taking a specific action. • An individual can go through the process of assessment and have a behavioral intention, but still not be able to do the behavior! The Reformulation • Perceived Behavioral Control was added • Refers to the degree to which someone believes they have control over whether they can take the action and the strength of that belief. • Separated in two parts • Control Beliefs • Perceived Power TPB • NOW under the TPB, a person’s perception of how much they can control their behavior is combined with intention, attitude and norms to determine or predict behavior. • People might try harder to perform a behavior if they feel they have a high degree of control over it. • If two people have equally strong intentions to learn to ski, and both try to do so, the person who is confident that s/he can master this activity is more likely to persevere than is the person who doubts his/her ability. TRA/TPB Key Components of the TRA/TPB • Use this information for the next few slides: • Target population: high school students • Behavior targeted: The use of sunscreen TRA/TPB Construct Behavior Definition TRA/TPB Example •Single, observable •Sun Protection/ action performed by Sunscreen an individual, or a category of actions. How to Modify? •By influencing a behavioral intention, which is dependent on attitude toward the behavior and subjective norms Construct Behavioral Intention •The thought to perform the behavior. TRA/TPB Construct Definition Example Attitude toward the •Overall feeling of •I like putting on behavior like or dislike toward sunscreen because I any given behavior. like the smell – OR I don’t like putting on sunscreen because I don’t like the smell. Definition Example •Intent to put or not put on sunscreen. How to Modify? •By influencing attitude toward the behavior and subjective norms. TRA/TPB How to Modify? •By influencing behavioral beliefs and outcome evaluations Construct Behavioral Beliefs Definition •Beliefs that performing a given behavior leads to certain outcomes. Example How to Modify? •If I put on sunscreen, I believe it will reduce my chances of getting sunburned. Brainstorming all possible outcomes. TRA/TPB Construct Definition Example TRA/TPB How to Modify? Construct Subjective Norm Outcome Evaluations •The value a person •It would be great if I •Discussion about places on each don’t get sunburned positive outcomes. outcome resulting or cancer. from performance of the behavior. TRA/TPB Construct Normative Beliefs Definition • What a person thinks other people who are significant in his/her life would like him/her to behave. Example Definition How to Modify? • My friends think it’s •Role play cool (healthy) to put • Panel discussion on sunscreen. •Discussion – Construct Motivation to comply Helps a person think critically about the perception of significant others in their life. Example Example • One’s belief that most •If I put on sunscreen, of the significant my friends will be others in one’s life proud of me. thinks one should or should not perform the behavior. How to Modify? •By influencing normative beliefs and motivation to comply. TRA/TPB TRA/TPB Construct Definition Definition • Degree to which a person wants to act in accordance with the perceived wishes of those significant in his or her life. Example •I really want to make my friends happy, so I’ll put on sunscreen. How to Modify? • Role play • Discussion TRA/TPB How to Modify? Perceived behavioral •How much a person •The only way I’ll •By influencing control feels he/she is in remember to put on control beliefs and command of enacting sunscreen is if I buy perceived power. the given behavior. one. Construct Definition Control Beliefs •Beliefs about internal and external factors that may inhibit or facilitate the performance of the behavior. Example •The only way I’ll remember to put on sunscreen is if I put it in my bag. How to Modify? • Discussion about factors that facilitate behavior. • Incentives • Reduction of inhibiting factors TRA/TPB Construct Definition TRA/TPB Example How to Modify? EX: Sunscreen use behavior If I put sunscreen on, I believe it will reduce my chances of getting sunburned. It would be great if I don’t get sunburned or cancer. Perceived Power • Perception about how easy or difficult it is to perform the behavior in each condition identified in the control beliefs. •I brought the sunscreen, so I will be able to put it on. • Having role models model the behavior. • Removing barriers. • Breaking down the behavior into small steps. My friends think putting on sunscreen is cool (healthy). I’d really like to make my friends happy or proud of me, so I’ll put sunscreen on. The only way I will remember to put on sunscreen is if I buy one and bring it with me. If I bring the sunscreen, I will be able to put it on. Purpose of Theory • To account for factors outside individual control that may affect intentions and behaviors. • To identify how and where to target strategies for changing behavior. • To predict and understand intentions, behaviors, and outcomes of health related behaviors. • The objective of interventions based on TRA/TPB is to alter beliefs about the object or action and its consequences for the individual. This ad gives information that people are generally unaware of, and this knowledge will certainly create an attitude toward cocaine and hopefully, will lead to behavior away from the drug. • By altering beliefs that make up key attitudes it is possible to alter behavior. Limitations • Factors, such as personality and demographic variables are not taken into consideration. • What about habit? • What about gender? • What about culture, educational level, income, or other demographic characteristics? Limitations • Assumption is made that perceived behavioral control predicts actual behavioral control. This may not always be the case. • What if someone has low self-esteem and regardless of the actual social or physical factors that may inhibit behavior, they will discount their “control” over what they do? Limitations • The longer the time interval between behavioral intent and behavior, the less likely the behavior will occur. • Monday may be good for Jane’s appointment, but what if the appointment is in 3 weeks? Will this affect intent and action? Limitations • The theory is based on the assumption that human beings are rational and make systematic decisions based on available information. Unconscious motives are not considered. • What about gut instincts or emotions as decision motivators? Limitations • Like the HBM, TRA/TPB assumes that behavior is the output of rational, linear decision making processes. • The TPB construct “perceived behavioral control” is very unclear, and so is its relationship to the actual control a person might have over his/her behavior. Application of TPB • Time between intent and action is not considered. Application of TPB to HPV Prevention Introduction • The Development of a Culturally Relevant, Theoretically Driven HPV Prevention Intervention for Urban Adolescent Females and Their Parents/Guardians • Nearly 6 million Americans contract HPV annually – – 74% are among 15-to 24-year olds • Brawner BM, Baker JL, Voyeck CD, Leader A, Cashman RR, Silverman RS, Peter N, Buchner BJ, Barnes CA, Jemmott LS, and Frank I. In Health Promotion Practice, July 2013, Vol. 14 No. 4, pages 625-636. • More than 100 types of HPV • HPV most common STI • 2 types cause 70% of cervical cancers • 2 types cause 90% of anogenital warts Background • Low-income and racial/ethnic minority populations are disproportionately affected. • HPV Risk Factors: sexual activity, early sexual debut, and multiple sex partners • 46% of adolescent females report having had sex • 36% are currently sexually active • 58% of Black adolescent females report having had sex Background • Two vaccines approved by the FDA. • Less than 50% of U.S. females aged 13-17 have received at least one dose of the HPV vaccine. • Despite increased rates of HPV awareness, knowledge about HPV is still relatively low among adolescents. • Black race and lower neighborhood educational attainment are associated with lower series completion. Aim • Since Black adolescent females are at heightened risk for HPV infection and are less likely to initiate and complete the HPV vaccine series. . . • Aim of study: Increase HPV prevention and vaccination among low-income urban adolescent females 9-18 years old. • Interventions targeted adolescent females and parents/ guardians of the girls. Theoretical Model Depicting the Impact of a Culturally Relevant, Theoretically Driven Intervention on HPV Vaccination Results: Attitudes • Favorable • toward HPV vaccination • Negative • vaccine’s inability to prevent all HPV types • fear of needles • uncertainty about side effects Background • Predictors of HPV Vaccines acceptance among Black adolescent females include: • • • • insurance coverage for vaccination belief that referent others endorse vaccinations increased perceived vulnerability to HPV fewer perceived barriers to vaccination • greater expectations of vaccine efficacy against cervical cancer • provider recommendations The Curricula’s Focus • Address underlying attitudes & beliefs that many young women, or their parents/guardians have about HPV and the vaccine; • Provide information and skills-based exercises that teach proper condom use techniques and how to negotiate vaccination with others important in their decision-making processes; • Provide strategies for participants to navigate within the health care system; • And develop two curricula. Results • Factors that would facilitate HPV Vaccination • more info about the vaccine & its side effects • social support for vaccination • a convenient location & process for vaccination • full financial coverage for the vaccine series r Fo ents sc ole ad F Pa or re nts For each student’s initial post, please complete the following: o Watch the TED TALK on Why Some People Find Exercise Harder than Others o Identify one construct from the Theory of Reasoned Action and explain how the construct is applied in this TED TALK. o Explain how you would use Why Some People Find Exercise Harder than Others to help a client/patient with increasing their amount and frequency of exercise. Make sure to use include one example from the TED TALK in your explanation. Participate and engage in the discussion o Each student is required to respond to two different students’ posts. Ted talk https://www.ted.com/talks/emily_balcetis_why_some_people_find_exercise_harder_than_others