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Midterm Exam

HSCI 6240: Midterm Exam

Stephanie Sandoval
Department of Health Science and Human Ecology, California State University San Bernardino
HSCI 6240: Advanced Study of Health Promotion 
Professor Tom Hernandez
October 18, 2022
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Midterm Exam
1. Discuss how structural bias, social inequities and racism undermine health and
create challenges to achieving health equity at organizational, community and
societal levels.
Health inequities arise from structural bias, social inequities, and racism that impact the
health outcomes within communities. The factors that contribute to health inequities are
diverse and complex in nature; however, it is important to understand these factors so
appropriate public health interventions can promote health equity. Although inequities
exist based on socioeconomic status, gender, or other factors, race and ethnicity continue
to be a persistent issue. Negative attitudes and stereotypes about people of color
contribute to health care and health outcomes; physicians may have implicit biases about
people of color and treat them differently and even make assumptions about their lifestyle
based on their skin color. Communities of color continuously face housing discrimination
and do not have access to the best quality of care or nutritional services.

2. Discuss the 3 parts to a theory and explain those parts in relation to a specific model
or theory (such as the HBM, SCT, TTM, TPB, etc.). Use only one model or theory
to explain the parts. (Hint HBM-SCT)
The Health Belief Model and Social Cognitive Theory (HBM-SCT) is a theoretical model
that used to explain and predict individuals’ behaviors; going into detail as to how we act,
why we act the way we do, and most importantly, who and what impact our behaviors.
Theories are what help explain what happens and why; this can be interactions between
people, within people, and even at a community level. There are three main parts that
construct a theory: concept, construct, and variable. A concept is a certain belief in
something. For example, an individual can have a concept or belief about vaccines. A
Construct explains the perceived severity of that belief. For example, this same individual
may believe that vaccines can cause harm to their child. A variable would be a
measurable assessment of these beliefs. For example, this individual would take a health
literacy exam and score low because of her incorrect perceptions about vaccines. Within
public health the HBM-SCT is used to guide health promotion and disease prevention
programs. This model can take multiple concepts and constructs from theories and create
a guideline for applying these programs.
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Midterm Exam

3. What is a basic assumption from Bandura's Social Cognitive Theory?

Bandura’s Social Cognitive Theory (SCT) emphasizes that learning occurs within a
social context; people are considered acting agents that can influence others but are also
influenced by their own environment. One basic assumption about SCT that as humans
we learn socially by observing others’ behaviors and the consequences of those
behaviors. As the name suggests, this is a cognitive understanding of human behavior
based on several key characteristics: observation, self-control, self-efficacy, and
reinforcement (rewards or incentives). During the observation process, the individual
must pay attention to the behavior and the consequences that occur from it. These
behaviors are also not immediate or successful the first time; they require a degree of
self-control to maintain and self-efficacy to believe that they can maintain this behavior.
If a behavior is associated with positive emotions, it is more likely to be retained than a
behavior associated with negative emotions. Reinforcement plays an important role I this
motivation. The individual must expect to receive the same positive reinforcement that
they observed making it more likely that they will imitate the behavior, this is called
vicarious reinforcement.

4. Describe how one person can influence self-efficacy in others. (Hint HBM-SCT and
TTM)
Self-efficacy measured the level of an individuals’ confidence to perform a behavior
successfully; it is used within many behavioral theories because it directly related to
whether a person performs a behavior. There are many factors that influence self-
efficacy: mastery experience, vicarious experience (modeling), somatic or emotional, and
verbal persuasion. Mastery experience is when past success influences future successes.
This is a form of positive reinforcement because the success can be reproduced multiple
times and breed the same positive feeling. Vicarious experience is allowing the success of
others influence your own success. This is a cognitive observational behavior mainly
achieved socially because it is modeled by others. Somatic or emotional factors are the
physical or emotional state that influence self-confidence. Emotions have a strong effect
on the behavior; it can mean the difference between making a change or simply staying
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Midterm Exam
stagnant. Verbal persuasion is providing others with support. This is crucial because
family, peer, school, and work support all offer motivation and confidence; it is also a
great support system and keeps a person accountable for their actions.

5. Describe 3 factors that influence behavioral change decisions. (Hint Intro to HB

Theory)
The overall goal of health promotion is to enable individuals to take control of their
health behaviors and improve their quality of life. There are three factors that influence
any behavioral change decision: predisposing factors, enabling factors, and reinforcing
factors. Predisposing factors are the knowledge, beliefs, values, attitudes, or cultures that
an individual may have. This directly connects with their age, sex, race, income, or even
educational levels; this can mean the difference between having access to low- or high-
quality health care. Enabling factors are the availability of these health resources; this
encompasses the support that may or may not be offered and the commitment that the
community/government may have to achieving equitable health care for this specific
population. It is also important if this population has the economic resources available
and the time to seek quality health care services. Reinforcing factors encompass the
positive support; this includes family support, peer support, encouragement, or even
incentives or rewards. The workplace also influences an individual’s behavioral decisions
mainly based on the policies they may have in place that permit access to health care;
health provider costs may be very high and discourage people from seeking care.