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Summary HEP4210_Understanding Health Behaviour
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HEP4210 – Understanding Health BehaviourLecture 1: Introduction to ‘Understanding Health Behaviour’
Primary questions of this course:
Why determinants research?
What are the most important (groups of) determinants of health behaviour?
What are the most changeable determinants of health behaviour?
How do determinants interrelate?
How to execute determinants research?
A systematic approach to health promotion is proven to be effective.
Causal mechanisms; what leads to what? Interrelated factors? Model/theory. Most
theories origin from behavioural sciences, for instance sociology, (developmental,
social and health) psychology, and health promotion (integration).
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,Case 1: Too many obese workers
What determinants are involved in health behaviour (and how)?
1 – What (personal) determinants are involved in health behaviour?
According to WHO, the determinants of health include:
Social and economic environment.
Physical environment.
A person’s individual characteristics and behaviours.
Determinants of health behaviour are:
Environmental physical, social, economic and political environment;
availability, neighbourhood characteristics, climate, culture, policies, examples
in social environment, etc.
Personal/Cognitive behavioural intention, attitude, perceived norms and
social influence, self-efficacy/perceived control, anticipated regret and moral
obligation, risk perception, personal characteristics/norms/preferences, health
locus of control, knowledge, awareness, etc.
The middle part of the Health Believe Model can be seen as an overview of the
(personal) determinants of health behaviour.
From ‘Gezondheidsvoorlichting en Gedragsverandering’ (van Assema & Lechner).
Intention The extent to which someone intends to execute a certain
behaviour (change or maintain current behaviour). This is
usually a result from several other determinants, like attitude
or social influence. A positive intention doesn’t always mean
the actual execution of a certain behaviour (barriers, habits);
positive intention is a prerequisite for behaviour change but
doesn’t guarantee it.
Attitude People’s attitude (point of view) towards certain topics or
(outcome behaviours. This is formed by previous learning experiences
expectation) and doesn’t change quickly. Attitude gives (co-) direction to,
but it doesn’t equal behaviour. Based on both logical reasoning
and intellectual considerations (cognitive), as well as habits
and irrational beliefs (affective). It’s also important to
distinguish between short- and long-term effects of behaviour.
Perceived norms Perceived norms are the perceived expectations of important
and social others (e.g. partner or friends). If someone doesn’t obey to
influence these expectations, they can expect (social) sanctions, like
feeling left out. Both the normative/injunctive beliefs (the
expected beliefs that others’ have) and motivation to comply
(the extent to which someone intends to ‘care’ about these
beliefs) are important.
Social influence exists of social support or pressure (direct
influence of others) and modelling/vicarious learning
(observing the behaviour of others).
Self-efficacy The expectation that people have about their own ability to
(perceived execute a certain behaviour. Self-efficacy and attitude are the
control) most important personal determinants.
Anticipated A more affective or moral/ethical determinant. Anticipated
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,regret and moral regret is the feelings of regret or guilt that people expect to
obligation experience if they don’t execute a certain health behaviour.
This is an important determinant of intention and behaviour.
Moral norm is the perception of an individual about the moral
correctness of a certain behaviour. People can feel a moral
obligation (a personal obligation or responsibility) to behave in
a certain way. This is strongly related to intention.
Risk assessment The decision of people to behave in a certain way is co-
determined by the perceived health threat and the estimation
people make about their chances of experiencing that risk. Risk
perception or perceived vulnerability has a more indirect
relation with health behaviour, e.g. via attitude.
The bigger and more serious people assess a risk, the bigger
then chances are that they want to avoid the risk and change
their unhealthy behaviour. There are two processes that can be
a consequence of the experience of a health threat: primary (a
process aimed at estimating the threat) and secondary
appraisal (a process aimed at estimating the possibilities to
cope with the threat).
Knowledge and Knowledge about health and disease, and specifically about the
awareness health risks of certain behaviours, is needed to achieve
behaviour change. Different types: knowledge that makes
people aware of the relation between behaviour and a risk,
knowledge about how you could change, and deeper theoretical
knowledge such as scientific knowledge. Knowledge is related
to health literacy; to what extent are people able to gain,
understand, evaluate and apply health information.
When people are aware of their behaviour, they have sufficient
knowledge and insight in their own unhealthy behaviour.
However, health behaviour is very complex, which makes that
awareness isn’t self-evident. A proper estimation of people’s
own health behaviour can be a prerequisite for behaviour
change, but it’s rarely enough.
Personal Personal characteristics that aren’t linked to a certain
characteristics behaviour can still (indirectly) influence the execution of a
(traits) health behaviour.
2 – What are important Health Models?
Lecture 1 – Models of health behaviour:
Socio-cognitive models health belief model, theory of reasoned action (case
2), theory of planned behaviour (case 2), self-determination theory (case 3).
Precede-Proceed Model, Intervention Mapping.
Habit theory, automaticity (case 4)
Ecological models ANGELO framework, EMPA (case 5)
Dual-process models, integrated models ELM, MODE, EnRG (case 5)
The Ottawa Charter for Health Promotion isn’t really a health model, but more a
framework that helps you to achieve effective health promotion It was the
beginning of ‘health promotion’. Health promotion entails both providing and
integrating (e.g. though skills training or enabling people) knowledge.
The Ottawa Charter for Health Promotion (1986)
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, The International Conference on Health Promotion in Ottawa was primarily a
response to growing expectations for a new worldwide public health movement. They
wanted to achieve a healthy/healthier world by the year of 2000.
Health promotion is the process of enabling people to increase control over, and to
improve, their health. To reach a state of complete physical, mental and social well-
being, an individual or group must be able to identify and to realize aspirations, to
satisfy needs, and to change or cope with the environment. Health is a positive
concept emphasizing social and personal resources, as well as physical capacities.
Therefore, health promotion is not just the responsibility of the health sector but goes
beyond healthy life-styles to well-being.
The fundamental conditions and resources for health are: peace, shelter, education,
food, income, a stable eco-system, sustainable resources, social justice and equity.
Improvement in health requires a secure foundation in these basic prerequisites.
Enable = health promotion focuses on
achieving equity in health. Health
promotion action aims at reducing
differences in current health status and
ensuring equal opportunities and
resources to enable all people to achieve
their fullest health potential. This includes
a secure foundation in a supportive
environment, access to information, life
skills and opportunities for making
healthy choices. People cannot achieve
their fullest health potential unless they
are able to take control of those things
which determine their health.
Mediate = The prerequisites and
prospects for health cannot be ensured by
the health sector alone. More importantly, health promotion demands coordinated
action by all concerned (governments, health and other social and economic sectors,
non-governmental and voluntary organizations, local authorities, industry and the
media). People is all walks of life are involved as individuals, families and
communities. Professional/social groups and health personnel have the responsibility
to mediate between differing interests in society for the pursuit of health.
Health promotion strategies and programmes should be adapted to the local needs
and possibilities of individual countries and regions to take into account differing
social, cultural and economic systems.
Advocate = Good health is a major resource for social, economic and personal
development and an important dimension of quality of life. Political, economic,
social, cultural, environmental, behavioural and biological factors can all favour
health or be harmful to it. Health promotion action aims at making these conditions
favourable through advocacy for health.
Health promotion action means:
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