(Behavioral) Theories of Health &

Physical Activity
KNES 400
Session 5
Instructor: Dr. Shannon Jette

Learning Objectives
Discuss the purpose of theoretical frameworks
Discuss behavioral theories that provide
insight into the mechanisms underlying the
relationship between intra- and inter-personal
factors and health-related behaviors
Discuss shortcomings of such theories
!

Theoretical Frameworks
Help us to interpret or understand a
situation or problem; often abstract and
applicable to a broad range of situations
Help us to answer why?
What can be changed?

Socio-ecological model

What are factors influencing health? Determinants, correlates

Where/how can we intervene?
Dahlgren!&!Whitehead,!1991!

Socio-Ecological Model
Poli4cal/Macro8
economic!!
Environmental!
Organiza4onal!
Interpersonal!

Intrapersonal!

Ecological Framework
multiple levels of influence
Concept

Deni+on

Intrapersonal!level

Individual!characteris4cs!that!inuence!behaviors!such!
as!knowledge,!aFtudes,!beliefs!and!personality!traits

Interpersonal!level

Interpersonal!processes!and!primary!groups,!including!
family,!friends,!and!peers!that!provide!social!iden4ty,!
support!and!role!deni4on

Organiza4onal!
level

Rules,!regula4ons,!policies,!and!informal!structures!that!
may!constrain!or!promote!recommended!behaviors

Environmental!
level

Aspects!of!the!social!(networks,!norms),!built!
(infrastructure!&!community!design)!and!natural!
(weather,!topography)!that!inuence!behaviors

Poli4cal!(policy)!
level

Local,!state,!federal!policies!and!laws!that!regulate!or!
support!un/healthy!ac4ons
Adapted!from!DHHS,!2005!

Adapted ecological model of correlates

of physical activity

Bauman et al., Lancet, 2012, 380: 258-71

But in addition to this broad model

Have theories that help to explain behavior (PA or
health-related) at various levels of the socioecological model
For many years, theories focused on intra- and
inter-personal levels, and aimed to
Identify the influential variables that predict PA behavior
(i.e., correlates)
Develop strategies to manipulate variables and bring
about changes in PA levels

Dominant theories: Cognitive-Behavioral!

1. Behavior is mediated by cognitions; that is,
what people know and think affects how they
act
2. Knowledge is necessary for, but not sufficient
to produce, most behavior changes
3. Perceptions, motivations, skills (& the social
environment) are key influences on behavior
!

Key Cognitive Behavioral Theories

Health Belief Model (HBM)
Stages of Change (Transtheoretical) Model
Theory of Planned Behavior
Precaution Adoption Process Model
Social Cognitive Theory (SCT)

Health Belief Model (HBM)

Six main constructs

Perceived susceptibility
Perceived severity
Perceived benefits
Perceived barriers
Cue to action
Self-efficacy (later added)
Health Motivation is central focus why people take action
to prevent, screen for or control illness conditions

HBM Components and Linkages

Modifying Factors

Age
Gender
Personality
Socioeconomics
Knowledge

Individual Beliefs
*Perceived
susceptibility to
& severity of
disease

Perceived
threat

Perceived benefits

Action

Individual
behaviors

Cue to action

*Perceived barriers
Perceived self efficacy

Adapted from Glanz et al., 2008

Theory of Planned Behavior

Belief about
what
behavior
entails
Evaluation of
behavior
outcome

Normative
beliefs

Attitude
toward
behavior

Subjective
norm

Behavioral
Intention

Behavior

Motivation to
comply

Control
beliefs

Perceived
Power

Perceived
behavioral
control

Behavioral Intention is viewed as most

important determinant
Adapted from Glanz et al., 2008

Qualitative study of barriers to concussive symptom

reporting in high school athletics (Chrisman et al., 2013)
young ppl knew that they should
take themselves out the game

didnt want to let down teammates

or seem weak

Interventions premised upon Intrapersonal

Cognitive Behavioral Theories
Some level of success but questions about
effectiveness
Gap between peoples intentions and behaviors; b/n
feelings of self efficacy and behaviors

Premised on notion of rational

public health: getting ppl to deny things that

makes them feel good

What about AFFECT/EMOTIONS, including pleasure?

Reductionist

dont consider behavior in the wider context:

ex: single low income mothers have higher
levels of smoking; interviews show
that smoking is a huge stress relief/social
norm (other factors)

tend to describe behavior in isolation of

social and cultural context

Thurston,!Behavior!Change,!2014!

At interpersonal level
Theories of health behavior assume
individuals exist within and are influenced by
a social environment
Individual has reciprocal effect on social
environment
Emphasis on human capacity for learning and
adaptation

Key Concepts in SCT

individuals not just impacted by env. but also
can shape their environment

Reciprocal determinism: Personal, behavioral and

environmental factors act as mutual causes of each
other
Self-efficacy: situation specific self-confidence
(beliefs one can execute behavior, overcome
barrier)
Outcome expectances: beliefs that behavior will
result in salient outcomes (esp. how person feels
about him or herself)

Interaction of Self Efficacy

with Environment
Responsive
Environment

Low self efficacy

High self efficacy

Unresponsive
Environment

Putting theory to practice?!

Targeted Interventions
Many work on improving self efficacy for desired
behavior
Mastery experience
Social modeling : someone similar who achieved the task
down context as to explain behavior
Self monitoring techniques :(ex:writedepressed=
smoking)
Goal setting and self-reward

Group change (social support in community

settings)
Policies to change environment to make healthy
choice easier
:change social norms in the group

Cognitive-Behavioral Models - Critiques

Constructs based on white, middle class norms
Created by and tested upon

Dominant Values: Independence, choice, control

in other words AGENCY, but a particular version of
agency

Stephens et al. (2009) Why did they

choose to stay?
Study 1: how observers perceived survivors who
evacuated (leavers) or stayed (stayers)
Leavers described positively (as agentic, independent
and in control)
Stayers described negatively (passive and lacking
agency)
Observers perceptions reflect disjoint model of agency
prevalent in white, mc contexts = good action are those
that emanate from within individual and act upon
environment

Stephens et al. (2009) Why did they

choose to stay?!
Study 2: interviews with survivors and found that
leavers and stayers relied on divergent models of
agency
Leavers emphasized independence, choice and control
Predominantly white, middle class

Stayers emphasized interdependence, strength and

faith
Predominantly black, lower income
Conjoint model of agency: good actions as those that adjust
to the environment and promote interdependence with
others

Cognitive-Behavioral Models - Critiques!

Insufficient attention to manner in which social structure
is internalized and normalized in an individuals
unconscious?
Manner in which unequal distribution of resources leads to
reproduction of unequal life chances and limitations of
choice? Varying forms of CAPITAL
(more to come on this )

Might behavior change interventions lead to widening

of health inequalities as those born into privilege
experience themselves as agents of their own destiny?

Socio-Ecological Model
Poli4cal/Macro8
economic!!
Environmental!
Organiza4onal!
Interpersonal!

Intrapersonal!

Additional theories or frameworks

Critical race theory

Structural discrimination
Intersectionality
Habitus (lifestyle as a reflection of social structure)
Political economy
Disciplinary power and Biopower