Brig Ali Nasre Alam

18.10.2015

Health Communication & Advocacy

Theories of Change
Individual Level
 1. Health Belief Model

 A psychological model that attempts to explain and predict

health behaviors by focusing on attitudes and beliefs of
individuals.

 Conceptual framework of health behavior stating that health

behavior is a function of both knowledge and motivation.

 Designed to explain why people did not participate in

programs to prevent diseases.
 Two major factors influence the likelihood that a person
will adopt a recommended preventive health action

 First they must feel personally threatened by the disease i.e.

they must feel personally susceptible to a disease with
serious or severe consequences

 Second they must believe that the benefits of taking the

preventive action outweigh the perceived barriers to (and/or
costs of) preventive action”
 Health Belief Model -- Revised
(Rosenstock, Strecher, & Becker, 1988)

BACKGROUND PERCEPTIONS ACTION

Cues to Action

•Media
Threat •Personal influence
•Reminders
•Perceived susceptability
(or acceptance of the
diagnosis)
•Perceived severity of
Sociodemographic ill-health condition
Factors “ Behavior
to reduce threat
(e.g., education, age,
sex, race, ethnicity) based on
Expectations Expectations ”
•Perceived benefits of
action (minus)
•Perceived barriers to
action
•Perceived self-efficacy
to perform action
 2. Stages of Change Model (Trans-theoretical Model)
 Model evolved out of studies comparing the experiences of
smokers who quit on their own with those of smokers
receiving professional treatment.
 Basic premise: Behavior change is a process, not an event.
 As a person attempts to change a behavior, he or she moves
through five stages:
 Precontemplation

 Contemplation

 Preparation

 Action

 Maintenance
Stages of Change Model (cont.)
Precontemplation

Maintenance Contemplation

Action Decision
Transtheoretical Model
(Prochaska & DiClemente, 1982, 1983)

Stages of Change in Which Particular Processes Are Emphasized

Precontemplation  Contemplation  Preparation  Action  Maintenance

Consciousness Raising
Dramatic Relief
Environmental Reevaluation

Self-Reevaluation

Self-Liberation

Reinforcement Management
Helping Relationships
Counterconditioning
Stimulus Control
 Whether individuals use self-management methods or
take part in professional programs, they go through the
same stages of change.

 Model is circular, not linear.

 They may enter the change process at any stage, relapse

to an earlier stage, and begin the process once more.
 3. Theory of Planned Behavior (TPB)

• The TPB and the associated Theory of Reasoned Action

(TRA) explore the relationship between behavior and
beliefs, attitudes, and intentions.

• Both the TPB and the TRA assume behavioral intention

is the most important determinant of behavior.

• Behavioral intention is influenced by a person’s attitude

toward performing a behavior, and by beliefs about
whether individuals who are important to the person
approve or disapprove of the behavior.
• The TPB differs from the TRA in that it includes one
additional construct, i.e. perceived behavioral control;

• This construct has to do with people’s beliefs that they

can control a particular behavior.

• People try harder to perform a behavior if they feel they

have a high degree of control over it.

• People’s perceptions about controllability may have an

important influence on behavior.
 4. Precaution Adoption Process Model (PAPM)

 The Precaution Adoption Process Model (PAPM) is a

relatively new model that has been applied to an
increasing number of health behaviors.

 This specifies seven distinct stages from lack of awareness

to adoption and/or maintenance of a behavior.

 In the first stage of the PAPM, an individual may be

completely unaware of a hazard (e.g. link between
unprotected sex and HIV)
 The person may subsequently become aware of the issue
but remain unengaged by it (Stage 2)

 The person faces a decision about acting (Stage 3)

 May decide not to act (Stage 4)

 May decide to act (Stage 5)

 Stage of action (Stage 6)

 Maintenance (Stage 7)
 People pass through each stage of precaution adoption
without skipping any of them.
 It is possible for people to move backwards from some later
stages to earlier ones, but once they have completed the first
two stages of the model they do not return to them.
 A person does not move from unawareness to awareness
and then back to unawareness.
 The people who are unaware of an issue, or are unengaged
by it, face different barriers from those who have decided
not to act.
 The PAPM prompts practitioners to develop intervention
strategies that take into account the stages that precede
active decision-making.
 Brig Ali Nasre Alam
26.10.2014

Interpersonal
Level
 Interpersonal Level
 The individuals exist within, and are influenced by, a
social environment.

 Opinions, thoughts, behavior, advice and support of the

people surrounding an individual influence his feelings
and behavior and vice versa

 The social environment includes family members,

coworkers, friends, health professionals, and others.

 The social environment also has impact on health

 5. Social Cognitive Theory (SCT)

 Many theories focus at the interpersonal level, but SCT is

one of the most frequently used and robust health behavior
theories.

 It explores the reciprocal interactions of people and their

environments, and the psychosocial determinants of health
behavior.

 One of the key concepts in SCT is the environmental

variable: observational learning.
 In contrast to earlier behavioral theories, SCT views the
environment as not just a variable that reinforces or
punishes behaviors, but one that also provides a milieu
where an individual can watch the actions of others and
learn the consequences of those behaviors.

 Social Cognitive Theory (SCT) describes a dynamic,

ongoing process in which personal factors, environmental
factors, and human behavior exert influence upon each
other.
Processes governing observational learning include:

 • Attention—gaining and maintaining attention

 • Retention—being remembered

 • Reproduction—reproducing the observed behavior

 • Motivation—being stimulated to produce the behavior

 According to SCT, three main factors affect the likelihood
that a person will change a health behavior:
 (1) self-efficacy,
 (2) goals, and
 (3) outcome expectancies.

 If individuals have a sense of personal agency or self-

efficacy, they can change behaviors even when faced with
obstacles.

 If they do not feel that they can exercise control over their
health behavior, they are not motivated to act, or to persist
through challenges.
Social Cognitive Theory
Thank You