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Summary HEP4211_Changing Health Behaviour
- Instelling
- Maastricht University (UM)
Summary of all literature, mini lectures and summary lectures for the cases of HEP4211 Changing Health Behaviour
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Voorbeeld 4 van de 59 pagina's
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Voorbeeld van de inhoud
HEP4211 – Changing Health BehaviourLecture 1: Introduction to ‘Changing Health Behaviour’
The overall goal of health promotion is to achieve the definitions stated for health;
physical, mental and social Motivate and support people in the adoption and
maintenance of healthy behaviours.
In order to change behaviour, you must understand what drives behaviour. You need
insight in the determinants of behaviour and how to change these.
Motivational factors (cognitive. Motivation ≠ directly good behaviour;
intentions don’t always lead to the wanted behaviour).
Post-motivational factors (the methods to actually go from intentions to the
wanted behaviour – e.g. planning strategies).
Automatic processes (habits, automaticity; cues leading to certain behaviour).
Environmental factors (micro level (parenting, social support, nudging) and
macro level (national policy).
In order to change drivers/determinants of behaviour, you can use methods for
change. A method isn’t the same as an application.
A theoretical method is a general technique or process to induce change in a
determinant.
A practical application is a form in which the theoretical method can be
applied in practice in an intervention.
Cognitive variables can be changed through the methods of attitude, risk perception,
and self-efficacy. In order to change automatic and habitual behaviours, you need to
address certain cues that lead to behaviour.
Case week 2: How to modify risk perception?
A case of excessive alcohol consumption
Risk perception is incorporated in many (health) behaviour change theories, such as
the Protection Motivation Theory, Health Belief Model, I-Change Model, Health
Action Process Approach, etc. It is seen as a precondition for motivation and
informed decision making. People are more motivated to behave healthily if they
perceive themselves to be at risk. You need adequate knowledge of the risk to be able
to make an informed decision. Risk perception = severity + susceptibility.
- Behaviour isn’t only based on cognitive judgements (what people think), but
even more on affective likelihood beliefs (what people feel).
The perception of risk likelihood can guide (health-protective) behaviour. People are
often unrealistically optimistic about their vulnerability and underestimate their
likelihood, especially when the risk is partly controllable. Therefore, risk information
is often included in health interventions to influence individuals’ risk perception.
The communication of risk information is a fundamental aspect of nearly all health
promotion interventions. However, no consensus exists regarding the most effective
way to provide people with risk information. Two approaches to risk communication:
Numerical probability-based approach = presentation of numerical
information regarding the probability of a risk/health problem occurring.
1
, o Provides precise information regarding probabilities.
o Effectiveness is limited, since people have difficulty understanding and
using quantitative data cognitive (misunderstanding of information)
and motivational (people mostly engage with favourable information)
barriers. It can increase public awareness of potential health problems,
but it doesn’t affect perceptions of personal risk that much.
Contextualized approach = presentation of informational context (antecedents
and/or consequences of a health problem) in which to understand and
interpret individual risk. This appears to have a more consistent influence on
perceptions of personal risk than only numerical information.
o Several ways: provide people with specific risk information (link
between health problem and their own behaviour), narrative
techniques (sharing stories of people who have had the health problem
and let them tell about how the problem developed and/or how), or
fear appeal (give information/images about negative consequences).
An effective strategy might lead people to be better informed about probability of a
health problem, could appropriately alter people’s perceptions of personal or
comparative risk, and could be one that heightens people’s interest in relevant
primary prevention behaviours, independent of changes in risk perceptions.
Risk communication = Conveying or transmitting information between parties about
a range of areas, including:
Levels of health or environmental risks.
The significance or meaning of health or environmental risks.
Decisions, actions or policies aimed at managing or controlling health or
environmental risk.
The goals of risk communication are:
Behaviour change (when people perceive their risk too low/no risk).
Provide reassurance when people are outraged/far more concerned than
expected based on a scientific point of view (they overestimate their risk).
To inform people so that they can make informed decisions.
You want to reach accurate/realistic perceptions of risk, not necessarily a higher (as
high as possible) perceived risk! If you ‘just tell people about the risk’, they can all
interpret your message in a different way. Reference classes influence the way that
people interpret a certain risk, when you tell them. It can give people the wrong idea.
- For instance: ‘You have a 30 to 50% chance of developing a sexual problem
when you take Prozac’. This can be unfairly be interpreted as: ‘in 30 to 50% of
my sexual encounters, I will experience a problem’.
General lesson: communicating risk is complicated! It needs to be accurate and
understandable. Research develops very fast, showing different results. You can’t give
a general indication of effect/rule of thumb, since effects depend on various factors.
In the real (working) life, you have to study specific literature of the risk issue, risk
context, target group, and take into account the goal of the risk communication.
Assessment of risk communication strategies
Fundamental issues to assess risk communication strategies, when you want people
both to understand information and recognize its implications for own risk status:
How do people think about and form judgments of/process health risks?
2
, o People think about health problems in relation to their causes and
consequences. Therefore, perceptions of risk are not simply a function
of probability information but are affected by the beliefs people hold
about both the antecedents of the problem and its consequences.
o Antecedent information helps people think about how a health problem
could develop. It renders specific factors that promote or prevent the
development of a health problem, and it helps people recognize the
links between the things that they do (not do) and unwanted health
outcomes. Information about the consequences emphasizes what it
would be like to actually have the health problem. This could help
people to recognize the severity of what could happen to them.
o People are more likely to base their judgment on concrete, case-based
information than on abstract, statistical information. They rely on the
dimensions of cause and consequences to structure their mental models
of health problems. Therefore, a contextualized approach could be
effective; they have proven to be capable of influencing perceptions of
risk, but they lack the precision afforded by a numerical estimate of the
probability that an event will occur.
What is the most appropriate way to assess the impact of an intervention?
o Evidence that people are aware of the risks posed by a particular
behaviour may indicate the successful communication of health risk
information, but it cannot tell whether people recognize the risk as
personally relevant; direct measures of personal risk are needed.
o It is not clear whether the criterion for an effective intervention should
be based on changing absolute levels of personal risk or in modifying
comparative risk optimistic bias: people systematically
underestimate important personal health risks, which is considered a
barrier to the adoption of precautionary behaviours.
Probability information in risk information
Probability information can be communicated in different formats (frequencies,
percentages, verbal expressions). There are two factors that seem to determine how
probability information is understood and how it influences risk perception.
Content: the exact content of presentation format may determine its effect.
Situation or context: more important than the content in explaining the
format’s effect. Processing risk information can be done two ways:
o Heuristic information processing entails people using schemata or
simple inferential rules to come to an evaluation of a risk.
o Systematic information processing represents in-depth processing of
the information and is more deliberate and time consuming. Using this,
the presentation format has the strongest effect (preferred).
The person’s situation determines which type of processing prevails. The
presentation format hardly has an impact on people in situations where they have
time, motivation, and cognitive capacity to process information systematically.
However, in many situations, people are not motivated or do not have the ability to
process information systematically, so they rely on heuristic processing. Then the
presentation format of the probability information is crucial.
3
, Probability estimates are affected by: cognitive capacities and characteristics of the
person who is receiving the message (e.g. numeracy, graph literacy), the context,
and risk presentation methods (e.g. formats, framing).
Presentation of risk information
There are different formats for communicating risk information.
Numerical:
o Percentages
o Rates (2 in 100)
o Proportion (1 in 50)
o Number needed to treat, relative and absolute risk reduction, etc.
Graphical:
o Pictograms
o Paling perspective scale (graphical presentation that depicts risks
covering different orders of magnitude on a logarithmic scale. It also
presents information for other risks. The presentation of comparative
risk information should help patients to evaluate a particular risk).
Verbal expressions:
o Use a verbal statement to express a probability to others.
Disadvantage Advantage
Numerical People can’t compare the risk, Studies has shown that numerical
so they don’t know if the risk if information is more trustful and
high or low + people need to better understandable than verbal
have time to process this. information.
Graphical There is not a clear type of It is more likely to draw people’s
graph that influences people’s attention to a probability of harm
risk perception most, it differs. than other formats.
Verbal It might be difficult to develop They can provide information about
verbal probability expressions a graph that people will use to
that all people interpret in the express a probability to others.
same way.
Numerical risk information
What is the higher risk? 1286 of 10.000, or 24,14 of 100. Most people choose for
option 1, but the probability of option 2 is (much) higher. People tend to remember
higher numbers more and perceive the risk to be higher. They usually focus on the
first number (1286 and 24,14). When people must compare different risks, the
misunderstanding among rates (always … in 100) is lower than in proportions.
There are two ways of representing the same statistical information …
Probabilities: “The probability that a woman has breast cancer is 1%. If a
woman has breast cancer, the probability is 80% that she will have a positive
mammogram. If a woman does not have breast cancer, the probability is 10%
that she will still have a positive mammogram. Imagine a woman who has a
positive mammogram in your breast cancer screening. What is the probability
that she actually has breast cancer? _____%”
Natural frequencies: “Ten out of every 1,000 women have breast cancer. Of
these 10 women with breast cancer, 8 will have a positive mammogram. Of the
remaining 990 women without breast cancer, 99 will still have a positive
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