Jaylee Brown HL 250 W 14- Midterm Exam: Part II 1. You are hired as a health educator at NMU health center.

Local survey done among students revealed that Chlamydia is an issue among NMU students. There is a rise on incidence of Chlamydia at NMU. Using the constructs of Health Belief Model, develop an intervention to address this issue. Please makes sure to use all the constructs of HBM. (__________of 20 points) Introduction: Chlamydia is an infection caused by the bacteria chlamydia trachomatis. It can infect both men and women and cause serious and even permanent damage to the womans reproductive organs.(MedlinePlus, 2014) It is the most common sexually transmitted disease in the United States. Centers of Disease Control and Prevention (2014) found that in 2012, 1,422,976 cases of chlamydia were reported to CDC from 50 states and the District of Columbia, but an estimated 2.86 million infections occur annually. A large number of cases are not reported because most people with chlamydia do not have symptoms and do not seek testing. Statistics show that 25% of men and 75% of women have no signs of symptoms (U.S. National Library of Medicine, 2012). Adolescent women 25 and under are among the highest rates of contracting the infection of Chlamydia. Those who are sexually active and those with multiple sexual partners are at the highest possibility of obtaining STDs, such as Chlamydia. For this reason, it is very important for sexual partners that are or think as though they may be infected to get checked and treated for the prevention of passing the infection. If individuals are diagnosed early enough, treatment will go through easier, but if left untreated the consequences are severe. According to nursingschools.net, Its estimated that one in four college students will contract an STD during their time at school, with Chlamydia being a strong issue among those numbers. All in all, many factors are involved with the topic of Chlamydia and that is what we are here to figure out today. Perceived Susceptibility Susceptibility of individuals is related to beliefs of their chances of getting a disease. In study of STDs such as Chlamydia, Newby, Wallace, and French have reported the susceptibility of individuals beliefs: Respondents beliefs about their susceptibility to chlamydia were related to assessments of personal exposure to infection, and of the prevalence of infection amongst young adults. . . . Respondents knew that chlamydia transmission occurred through unprotected vaginal sex. The large majority of respondents reported that they were less likely to become infected with chlamydia than their peers. These judgments were based on assessments of the extent to which their sexual risk behavior, such as the frequency with which they had unprotected vaginal sex, and the number and type of their sexual partners, exposed them to infection. . . . Respondents referred to chlamydia as really common or the one that most people get. Although respondents referred to beliefs about prevalence when describing perceptions of personal

vulnerability to infection, at times it was clear that these perceptions had recently been altered. Change had occurred as a result of direct or indirect experiences of infection. (p. 149) Basing off the scholarly journal, students typically feel that they are not likely to get the disease and even if they are they have the ability to get it easily taken care of. But the lack of knowledge in aspects of Chlamydia such as symptoms, and how to protect against oral sex STD prevention, leaves individuals underestimating their vulnerability to the infection. It is also very important that women get tested for Chlamydia, for they are more prone to obtain substantial long-term effects from the infection. Perceived Severity Perceived severity is an individuals judgment as to the severity of the disease. Severity of the STD Chlamydia among college students does not seem to be a great issue. Individuals see Chlamydia as an easily taken care of infection. But at the same time, individuals also know that Chlamydia is the STD that is the most widely spread. This is evident when Katie V. Newby et al. research came to the conclusion All respondents were unclear about what symptoms individuals with chlamydia might expect, often guessing or seemingly drawing on knowledge of STIs in general. Individuals are not aware of what and when symptoms are known to be STIs. A report by Newby et al (n.d) described that this indicates that there hasnt been just one symptom of chlamydia that has previously stood out to be extremely unpleasant to inform severity reviews. When students dont perceive seriousness with the disease they are very unlikely to take precaution or prevention for the specific disease. Another factor that joins low severity beliefs of Chlamydia is the belief that condoms protect and prevent the individual from obtaining the infection. But when an individual does not use the form of protection such as condoms they perceive they are at higher risk of Chlamydia. Perceived Barriers Perceived barriers are individuals opinions as to what will stop them from adopting the new behavior. There are some perceived barriers for students perceptions on chlamydia that are correlated to clinical checkups and doctor appointments. One barrier that is quite frequently sought out is the feeling of embarrassment in the case of checkups/appointments. Discussing the matter of a sexual transmitted disease is quite personal and many people dont like to admit that theyve obtained such an infection. Other barriers have much to do with the lack of knowledge and evidence of chlamydia. These barriers are evident in C A M McNulty, E Freeman, J Bowen, et al study that stated that healthcare providers reported the greatest barriers to opportunistic testing and screening within primary car were lack of evidence of benefits of chlamydia testing, lack of knowledge of when and how to take specimens, and lack of time (p. 510). Perceived Benefits Perceived benefits are individuals conclusion as to whether the new behavior is better than what they are already doing. With women being among the highest rates of contracting chlamydia, it is seen by them to be beneficial to take all the correct precautions when dealing with sexual intercourse. When an individual comes to the conclusion that using protection, such as condoms, will reduce the risks of chlamydia, therefore reducing the risk of receiving long-term effects,

they are more likely to undergo protection measures. This could be seen in women the most, as for they are more prone to suffering greater consequences from the infection. Some long-term consequences for women are pelvic inflammatory disease, and infertility. For many women infertility is a crucial aspect of perceived benefits. Women were put on earth with the bodies to reproduce, and many would like to have a child of their own. When they see the bigger picture that protection is more important than the cost and/or consequences, they are likely to follow through with it. Self-Efficacy The personal belief in an individuals own ability to do something. Often times people do not try to pursue something new unless they think they can do it. I believe that self-efficacy also plays a role in the topic of Chlamydia. Individuals perceptions of their ability to protect themselves against STDs are usually rather confident. For example, some are in the mindset that they believe they can use condoms during sexual activity to protect them from the infection. One a different note, if they feels as though they can engage in sexual activity without condoms due to having an easy access of treatment, then they are more likely to have unprotected sex. Some problems do arouse with self-efficacy and they would vary among situational contexts. Some of these contexts would include being under the influence of drugs/alcohol and high levels of sexual arousal (Downing-Matibag& Geisinger, 2009). Being both, under the influence and high levels of sexual arousal, has likelihood of blocking out the thought process of the brain. When the thought process is unstable it causes decisions to be poorly brought out. Some poor decisions could be not using protection during sex, to decrease spreading STDs, and It is likely to say that our students believe they have control or believe they can perform tasks such as protection to lessen their chances of obtaining this infection. Construct of Priority Through the constructs address previously, my priority would be to work on perceived severity. I believe that is the main source of the problem. Students do not perceive chlamydia as a serious issue, due to the infection being easily treated. But many students are unaware of are signs and symptoms, and seriousness of the untreated infection. My goal would be to get programs started on Northern Michigan Universitys campus to advertise what exactly STDs are and there tolls they make on the human body. These programs would be interactive and informational setups to get students involved, hands on. Such hands on activities could include what I would call an STD bar graph percentage pair-share activity. Let me explain how this activity would work. First off, I would create a bar graph with all sorts of percentages of STDs but not have the STDs labeled next to them. This is where the activity comes into play because the STDs would be labeled scrambled up on top of the page. Students would then label the diseases to with percentage they believe they belong to. After each student has labeled there bar graph, they are to meet up with a partner and compare answers for a short period of time, and choose the bar graph that they believe is correct. Once theyve come to a conclusion on a bar graph, the two partners will pair up with two more people and once again compare bar graphs and choose whose is most likely to be correct. Then the same process will

occur to meet up with another group of four and so on until we have around two or three overall winners (depending on how many students are attending). Once overall winners have been selected they will come up and present in front of the other groups and give an explanation to as why they have matched what STDs with what percentage. After all the groups have given their explanations, I will then present the answers of the correct STDs with their correct percentages. Once Ive shown the answers, I will then discuss the facts of the major STDs and how one can protect themselves from them. My intention is to make the activity difficult because it will allow the students to critically think and also to give reason for my presentation because the facts are often different from what people actually believe or have been told. I would also bring forth more education through college courses that offer much knowledge on the topic. A course I have specifically in mind is Health Promotions (HP200), which all students from NMU must partake in. At this moment in time, HP200 is offered anytime and any year, freshman through senior. I would strive for changing HP200 to being a mandatory freshman class, for students to become aware of health and health issues from the start. But most importantly they will be more conscious of STD information and knowledge that will hopefully stay with them through their remainder years of college. Another change I would make to the HP200 class is to have an entire section be based solely on the topic of STDs that lasts a couple weeks to help increase the knowledge of what exactly they are, and how they affect the body. I would not only have this STD section be read from a textbook, but also through presentations, and through guest speakers that have experienced it first hand, so students can try to relate with it.

References Centers for Disease Control and Prevention. (2014, January 14). Chlamydia-CDC Fact Sheet. Retrieved by http://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm. Downing-Matibag, T. M., & Geisinger, B. (2009). Hooking Up the Sexual Risk of Taking Among College Students: A Health Belief Model Perspective. Qualitative Health Research. 19. 1196-1209. doi: 10.1177/1049732309344206. Retrieved from http://qhr.sagepub.com/content/19/9/1196.full.pdf+html Elaridi, F. (2012, March 30). College Students Overshare STDs. Campus Times. Retrieved from http://laverne.edu/campus-times/2012/03/college-students-overshare-stds/. McNulty, C. A. M., Freeman, E., Bowen, J., Shefras, J., & Fenton, K. A. (2004, July 1). Barriers to opportunistic chlamydia testing in primary care. British Journal of General Practice. 54. 508-514. Retrieved by http://bjgp.org/content/54/504/508.full.pdf+html. Newby, K.V., Wallace, L.M., & French, D.P. (2012). How do young adults perceive the risk of chlamydia infection? A qualitative study. British Journal of Health Psychology. 17. 144154. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.20448287.2011.02027.x/pdf U.S. National Library of Medicine. (2012, May 31). Chlamydia. Retrieved by http://www.nlm.nih.gov/medlineplus/ency/artivle/001345.htm

2. Behavior change is a difficult process; however we have learned in a theory class that it can be addressed using different theories. Please select a theory you like and apply it to a selected behavior you want to change. For example, I want to improve my fruits and vegetable consumption using the constructs of Theory of Planned Behavior (TPB). Explain all the constructs of TPB, give examples, and provide rationale how you are going to use it. Please use a theory in which you feel comfortable. (________20 points) I want to improve my thought process during track races to, in turn, better my overall results using the Self-Efficacy Theory. Mastery experience I would say that I am quite an experienced runner. Ive been running ever since I can remember. I ran for my school throughout my middle and high school years. So you could say I have a lot of wisdom in the area of running. Switching from high school to college, I will say, was quite the struggle. In college you run more miles, have longer practices, and competing against more competitive athletes. My freshman year, 2012-2013, I ran races I had never ran in high school so it was crucial for me to keep a positive mindset to work my way up. My event freshman year was the 800 meter run. Every meet we had I continued to see better and better results, and reaching a personal record every race. This helped me reach my best running time of the season at the last meet. Then it was onto sophomore year. Coming into this season it helped for me to think upon my previous track season. My goal was to utilize all of my previous training/practices obtain the results I wish to see. Using my training will increase my confidence to master struggles, internally and externally, to be able to go through races and know how to deal with those situations. Knowing that my last season I was able to show successful results, I am more prone to realizing that in similar situations I will be able to do so again. Vicarious Experience Vicarious experience would play a factor in my behavior change as well. On the track team there are many girls to train alongside with. I train with a specific group due to our similar time ranges. Some girls in my group run in the same events at meets as me as well and are successful in running the times that I am striving to achieve. Many of them are able to maintain a positive mindset throughout the duration of their races. But there are many factors that come into play. All runners are different by having more endurance, tolerance of pain, and speed thresholds. This makes it rather difficult to gage off their particular performances and compare them to my own because all athletes have different aspects they excel at. Another way I can better improve my thought process is by watching YouTube videos of other college runners training and races to see how they establish their plan or strategy of action. This would allow me to practice/try out different mind sets or different strategies to use during my running. Verbal Persuasion Verbal persuasion plays a role in my improving of thought process. My entire team is very encouraging when it comes to anything from practices, to academics, to races. There is always a constant support to keep anyone, especially myself, pushing it to their limit. But the best support,

in my opinion, comes from my coaches and parents. When my coach tells me that Ive shown an abundant amount of improvement and have the potential of improving even more, it brings my morale soaring. In other words, its an empowering moment to have your coach express all this faith and confidence they have in you and your abilities. Lastly, my parents encouragement means the most to me. Theyve been supportive of me my whole life, and truly make it known that everyone has their share of bad days and you only learn from them therefore making you stronger. Their advice has gone a long way in my sport of running because I will have good days and I will have bad days its inevitable, but it all depends on my mindset during the process. They tell me if I am to have a bad day, make something good out of it. An example of this is if I ran a race and I did not end with the time I wanted, or was not mentally in the race, then I can leave with the positive mindset that I will do better next time, or I know what to work on to better myself for the next race. Somatic and Emotion States Somatic and emotional states, the physical and emotional states caused by thinking about undertaking a new behavior, take part in helping improve my thinking process behavior. When attending track meets, that first step on the track is always the most crucial. You see everything and everyone around you and it all comes rushing in at once. This occurring, I receive feelings of excitement and nerves, which is hard to distinguish between most of the time. Those emotions, many times, have major effects on my races. Most of the time, they give me more energy and adrenaline for the extent of my races. Other times the environment and situations Im put under during a track meet can become very overwhelming, bringing forth unwanted and unhelpful emotions to say the least. When this occurs, I will often leave the stressful environment for a quick time and stand alone. When leaving the environment, Im able to take deep breaths and think of the meet from different views. By this I will perhaps focus more on my teammates well-being and share more energy in supporting them, rather than focusing on the negative internally. Crucial Construct From the constructs Ive stated, mastery experience is the most crucial in changing my thought process behavior. If Ive gone through successful races, and have made personal records in the past, then I am more motivated and believe I have a better chance to meet this new behavior. Mastery experience is basically all internal factors, so once you are stable internally you can achieve much greater results than if you were unstable. Verbal persuasion peaked up into being crucial for me as well. I seem to always get more motivated and pumped up when I have others that believe in me too. When they give me positive feedback, I want to give it back to them in actions and show that I can follow through with what they believe in me for. But verbal persuasion doesnt surpass mastery experience because it can only go so far. You will, at some point, hit a moment when others encouragement will only go so far. But mastery being internal will continue to push you through, knowing that youve succeeded in the past.

3. You are interviewing for a position at a community center where you will be developing programming to address the health needs of community members. The interviewer asks, Why it theory important when you are developing programs intended to change behaviors? (______ of 10 points) Theory is very crucial part in developing programs intended to change behaviors. Theories are born from the need to solve a problem or find explanation in regards to repeated observed occurrences. Therefore, theories are used put forth in programs in hopes of helping explain, foresee, and better understand more thoroughly of particular parts of individuals and events, through studies and research experiments. Theories are divided into three separate levels of influence. These levels include intrapersonal, interpersonal, and community-level theories. Intrapersonal levels of theories focus on factors within an individual that is influencing the specific behavior. Interpersonal levels of theories state that other individuals influence our personal behaviors. Lastly, community-level theories deal with factors within our social systems such as organizations, businesses, and etc. These systems use strategies and initiative in hopes of changing individuals behaviors. (Hayden, 2014) Theories have the ability to help improve health, reduce disease risks, manage chronic illnesses and improve well-being. Glanz and Rimer (1997) studied that this ability is brought forth during the stages of program setup, which include planning (assessing a need, and producing measurable objectives), implementation, and evaluation. And the program is implemented throughout the different levels of influence, as stated previously. The main questions to be answered through theories are, what is to be changed, why does it need to be changed, and how can you change it. Throughout the different levels of influence in theories, there are an abundant amount of health issues that can be and have been addressed through them. A few of the health issues, out of the many, that can be addressed through theories are HIV prevention, breast cancer screening (to increase it), and helping solve issues with obesity (losing weight). An example of a successful theory used in a health issue is mothers intentions to vaccinate their daughters against HPV using the Theory of Planned Behavior, which was stated in Hayden (2014) Introduction to Health Behavior Theory. Theory of Planned Behavior states that health behavior results from intention influenced by attitude, norms and control (Hayden, 2014). In the article all the constructs were applied, and measured to see if they resulted in mothers intentions to vaccinate their daughters. Two of the constructs were to be successful in this study and they were attitudes and subjective norms. Out of the two constructs, attitudes seemed to have been the major factor of intention in mothers. If mothers had positive attitudes of the vaccinations health benefits and how easy it was to obtain the vaccination, they were more towards the idea of their daughters receiving the vaccination. Subjective norms were the second major factor within mothers intentions. The mothers decisions could be easily swayed by someone important to them in their lives or someone they can trust, such as a doctor, physician, or even their parents. (Hayden, 2014)

References: Glanz, K., & Rimer, B.K. (1997). Theory at a glance: a guide for health promotion practice. (pp. 1-24). Bethesda, MD: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, & National Cancer Institute. Gielen, A.C., & Sleet, D. (2003). Application of Behavior-Change Theories and Methods to Injury Prevention. Epidemiologic Reviews. 25. doi: 10.1093/epirev/mxg004. Hayden, J. (2014). Introduction to Health Behavior Theory. (pp. 1-8). Burlington, MA: Jones & Bartlett Learning. Yarbrough, S.S, & Braden, C.J. (2008, July 7). Utility of health belief model as a guide for explaining or predicting breast cancer screening behaviours. Journal of Advanced Nursing. 33(5). 677-688. doi: 10.1046/j.1365-2648.2001.01699.x.