Health Behavior Models for Understanding and Improvement

Inaugural Arizona Rock 'n' Roll 2001

According to Ganz, Rimer, & Viswanath (2008) there have been over three hundred theories and models in psychology to date where the top five most influential are the Health Belief Model, Social Cognitive Theory, Theory of Reasoned Action, Theory of Planned Behavior, and the Transtheoretical Model / Stages of Change. The intention of these models it to understand behavior change and promote healthy behaviors. The health belief model (HBM) is one of the first theories in health psychology developed in the 1950s. The theorists were S. Stephen Kegeles, Godfrey M. Hochbaum, Irwin M. Rosenstock, and Howard Leventhal who worked for the U.S. Public Health Service as social psychologists. 

HBM is one of the most widely used models of behavioral change and is used in research, to understand the change process, health interventions and programs. Developed by these social scientists, it was directed toward determining the reasoning behind why individuals would fail to participate in health programs to prevent and detect disease. It is a model that still is in use today.

 

The key constructs of the model include: perceived susceptibility, severity, benefits, and barriers along with cues to action, and self-efficacy.  Champion & Skinner (2008) discuss its application to two scenarios: breast cancer screening and risky sexual behaviors.  One of their findings was that perceived barriers was the most powerful indicator for mammography and perceived susceptibility is necessary before behavioral change will occur in regards to risky sexual behaviors. Self-efficacy, added later, was the most significant indicator for specific behavioral changes.  The HBM constructs have been combined with The Transtheoretical Model (TTM) (Prochaska, Redding & Evers, 2008)  and its staging methodology for behavior outcome. 

Theorist James O. Prochaska from the University of Rhode Island along with his associates are the originators of the transtheoretical model, which was introduced in the mid 1970’s. Its basis is on theories of psychotherapy and introduces the construct of intention combined with actual behavior. There exists fifteen core constructs across ten stages of change.  Though the constructs between the HBM and TTM models vary, it is believed that the conceptualization across the theories within them is similar. 

The constructs of TTM include: conscious raising, environmental reevaluation, dramatic relief, social liberation, self reevaluation, self-liberation, helping relationships, counter conditioning, reinforcement, management, stimulus control, changing increasing, cons of changing decreasing and self-efficacy increasing. TTM uses stages of change as the method to integrate processes and principles across several theories while HBM is a continuous model.  It was introduced in the attempt to integrate the over 300 theories of psychotherapy. As such, the model is more complex than HBM with more methodological refinement. This provide a better application to cognitive computational algorithms. While HBM provides the meta-structure.

The TTM and HBM both have some degree of notoriety within the health psychology industry and have had much application. Their importance lies within the foundational work that has been built upon them.  Combined they represent a stepwise progress of deeper understanding into the potential mechanisms involved in health behavior change, intervention, and education programs.  The application of these models to cognitive computation provides a new perspective and approach for artificial intelligent systems and learning systems.

In attempting to understand a high level aspect of health behavior change, the HBM would be more appropriate.  Its simplicity and design provide more of a meta-model framework or environment to work within.  In computation of big data, this model would provide the paradigm or viewpoint to support the organization of underlying algorithms. Its simplicity can also be seen as a weakness though. As a researcher, it is best used in conjunction with other models and so combining it with TTM provides a logical approach to the application of research the author is pursuing in cognitive computation and learning systems in artificial intelligence.

Understanding the perceived barriers to change not only can be applied to development of educational material or intervention approaches in health psychology, but also to the understanding and implementation of machine learning algorithms used in our virtual reality environment for providing rapid data to decisions and learning systems within high-dimensional data space. Intention, motivation, bias are also influential.

The ten processes of change within TTM can be applied to the application of our cognitive-based learning algorithm (patent pending). It would provide the ability to step participants through the phases of data assimilation that lead to a change in perception, and understanding, of underlying meaning hidden within complex, big data analyses.

In summary, both models have been is use for fifty years or more. Much research and foundational work has been done based upon their constructs. They have evolved, developed and refined over time and continue to show value to researcher. Not only do these models hold importance directly in health psychology, they have application to computational methods and other adjacent fields.  They provide a meaning metaphor for complexity reduction in computational methods.

References

Champion, V.L. & Sugg Skinner, C. (2008) The Health Behavior Model. In Health behavior and health education: Theory, research, and practice (4th Ed ed., pp. 169 - 188). John Wiley & Sons.

McAlister, A., Perry, C. & Parcel, G. (2008). How Individuals, Environments, and Health Behaviors Interact – Social Cognitive Theory. In Health behavior and health education: Theory, research, and practice (4th Ed ed., pp. 169 - 188). John Wiley & Sons.

Montaño, D. E. & Kasprzyk. (2008) Theory of Reasoned Action, Theory of Planned Behavior, and the Integrated Behavioral Model. In Health behavior and health education: Theory, research, and practice (4th Ed ed., pp. 67 - 96). John Wiley & Sons.

Prochaska, J.O., Redding, Colleen A., & Evers, K.E. The Transtheoretical Model and Stages of Change. (2008) In Health behavior and health education: Theory, research, and practice (4th Ed ed., pp. 67 - 96). John Wiley & Sons.

Schwarzer, R., Lippke, S., & Luszczynska, A. (2011). Mechanisms of health behavior change in persons with chronic illness or disability: the Health Action Process Approach (HAPA). Rehabilitation Psychology, 56(3), 161.

Spahn, J. M., Reeves, R. S., Keim, K. S., Laquatra, I., Kellogg, M., Jortberg, B., & Clark, N. A. (2010). State of the evidence regarding behavior change theories and strategies in nutrition counseling to facilitate health and food behavior change. Journal of the American Dietetic Association, 110(6), 879-891.

Sun, R. (2008). Introduction to computational cognitive modeling. Cambridge handbook of computational psychology, 3-19.

Weinstein, N. D., Sandman, P. M. & Blalock, S. J. (2008) The Precaution Adoption Model. In Health behavior and health education: Theory, research, and practice (4^th Ed, pp. 67 - 96). John Wiley & Sons.

Additional Reference

Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2008). Health behavior and health education: theory, research, and practice. (3^rd Ed) John Wiley & Sons.

The Big Engine that Couldn't

It's monsoon here in the desert southwest. Every summer from about July 4th to Mid-October, that's the season we're in. We expect rain; lots of it. Last week both Tucson and Phoenix were hit by the remnants of storms in the gulf and a hurricane in the Pacific.  The place flooded and even a few people were killed.  Yesterday, the city of Tucson nearly closed down.  Schools were closed. Businesses closed. People actually decided to NOT earn a dollar rather than risk being in a thunderstorm. People kept their children home from schools that weren't closed. Sandbags were being handed out AND on a limited basis.  You could get only five.  All of this, because of the remnants of the storm that hit Cabo San Lucas, Odile, that was heading our way.

Well,  it was the big engine that couldn't.

There were isolated downpours but no flooding and no washes overflowing. No streets were turned into rivers. No panic in the streets, looting and mass hysteria.

There are hundreds of theories and models to try to understand human behavior.  There have been numerous attempts to unify models to get better, more representative models.  But, there is no Grand Unified Theory of human behavior. The human psyche is complex. Using the Integrated Behavioral Model (Glanz, Rimer, & Viswanath, (Eds.), 2008) the reaction that was displayed yesterday had everything to do with beliefs - behavioral, normative, control and efficacy.  Beliefs that there was a severe risk, they had control, were able to take measures to mediate the risk and the attitudes that lead to the intention to do something.  John Meyer has a song, Belief.

"Is there anyone who ever remembers
Changing their mind
From the paint on a sign?
Is there anyone who really recalls
Ever breaking rank at all
For something someone yelled real loud
One time

Oh, everyone believes
In how they think it ought to be
Oh, everyone believes
And they're not going easily

Belief is a beautiful armor
But makes for the heaviest sword
Like punching under water
You never can hit who you're trying for

Some need the exhibition
And some have to know they tried
It's the chemical weapon
For the war that's raging on inside

Oh, everyone believes
From emptiness to everything
Oh, everyone believes
And no one's going quietly

We're never gonna win the world
We're never gonna stop the war
We're never gonna beat this if belief is what we're fighting for

(Is there anyone who you can remember
Who ever surrendered
With their life on the line?)

We're never gonna win the world
We're never gonna stop the war
We're never gonna beat this if belief is what we're fighting for

What puts a hundred thousand children in the sand?
Belief can
Belief can
What puts the folded flag inside his mother's hand?
Belief can
Belief can"

Beliefs are held deeply.  They lead to intention. But intention alone doesn't change behavior. I could get hit by a bus if I leave my house.  That doesn't keep me indoors. In fact, I could get hit by a bus, every 20 minutes.  What was it that made people jump the intention-behavior gap yesterday and would they do it again?  I hear another hurricane is coming.

There are many more and far more risky things in the world where health psychologists hope to change behavior for the better and cannot.  We're trying to understand how to help make effective, enduring, positive change. For myself, how many times do I need to watch Forks Over Knives, or Sick, Fat, and Nearly Dead to really jump that intention-behavior gap and change my diet to truly become vegan?  Does it have to take cancer to do it?

Well, The sky did not fall yesterday and recently I WAS diagnosed with cancer.

Time to get out the juicer and read the instruction manual again. Time to make that jump.

What positive change will you do?

References:

Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2008). Health behavior and health education: theory, research, and practice. John Wiley & Sons

 

"By the pricking of my thumbs, something wicked this way comes." - MacBeth, Shakespeare

Mindfulness and Stress Reduction

Living in the moment along the path.

Abstract

Since the early 60’s and 70’s there has been a growing interest in alternative and integrative medicine and in particular mindfulness as a practice. The merging of Eastern and Western thought has brought about new approaches and theories on psychological health. (Keng et al., 2011) Leaders in the field like Jon Kabat-Zinn (1990) and Thich Nhat Hanh (1991) established a connection between Western and Eastern though. Both have worked in this area and have established many years of data. Others have since come along with additional research and focus. (Carlson & Garland, 2005; Hayes et al., 2005) This paper will briefly describe the theoretical basis from empirical literature and studies on the effects and benefits of mindfulness as a stress reduction technique, pain management, and improvements in mood and behavior for improving psychological health.

Mindfulness, as a concept has been around for thousands of years in Buddhist tradition as part of the path to enlightenment through the understanding of the existence of suffering, the cause of suffering and its cessation. Western thought on mindfulness is integrated with medicine and psychological health. (Keng, et al., 2011) The focus on laboratory and experimental research has been on the impact and effects of mindfulness on emotional and psychological functioning, and behavior. Both schools of thought, and the research supported, has demonstrated increased sense of well-being, improved balance of emotions and psychological mood.

Current research (Carlson, 2005) and (Keng, 2011) points to two of the seven main principles defined by Kabat-Zinn (1994) as the most effective; self-awareness and being non-judgmental about what comes up in your life.  Indications are that they are “potentially effective antidotes against common forms of psychological distress—rumination, anxiety, worry, fear, and anger” (Kayes, 2004). These destructive emotions lead a person to avoid, suppress, or intensely focus on distressing situations, illusions, thoughts, and emotions. 

The empirical data provided across multiple studies and methodologies (Keng, 2011), has concluded that mindfulness improves adaptive psychological functioning. Mindfulness can take the form of guided meditations, silent meditation, body scans, mindful walking, eating, speech, breathing exercises and loving-kindness.  Each of these help an individual to adopt a more accepting attitude about their personal experiences and how they integrate them and interpret them in their lives.  It helps elevate mood, manage chronic pain, create greater states of calmness, and a more responsive approach to external stimuli rather than reactive and impulsive behaviors that only aggravates the stress cycle.

It does not take extensive training or guidance to begin a mindfulness practice.  Many programs are for about 6-8 weeks.  Oftentimes, during mindfulness meditation, the practitioner may become so relaxed as to fall asleep.  My instructor, Natasia Korsack (Korsack, in conversation) at the Tucson MBSR Program, often said, “I’ve spent half of my life in mindfulness meditation and half of that has been asleep.”  She suggests that sleep is what the body is requiring at the time.  Staying in the present moment and allowing yourself to enjoy that moment of rest is exactly what is needed. 

Keng (2011) says that, “despite existing methodological limitations within each body of literature, there is a clear convergence of findings from correlational studies, clinical intervention studies, and laboratory-based, experimental studies of mindfulness—all of which suggest that mindfulness is positively associated with psychological health, and that training in mindfulness may bring about positive psychological effects.”   Some of the results might be subjective well-being while others include reduced psychological symptoms, emotional reactivity, improvement in how a person regulates their behavior.

Further research is needed to generate more data and have an improved understanding of “the nature of mindfulness, how mindfulness can best be measured, fostered, and cultivated, and the mechanisms and specificity of effects of mindfulness-oriented interventions.”  But, based on the advantages seen so far, it is likely that we will continue to discover new paradigms in the application of mindfulness.  In both the Eastern and Western traditions, the goal is to understand and alleviate human suffering, physical or psychological and help others live a more fulfilling and joyful life.

References

Kabat-Zinn J., (1990) Full Catastrophe Living: How to Cope with Stress, Pain and Illness Using 
     Mindfulness Meditation. New York: NY: Bantam Dell;
 
Kabat-Zinn J. (1994) Wherever You Go There You Are: Mindfulness Meditation in Everyday Life.
     New York, NY: Hyperion.

Carlson, L. E., & Garland, S. N. (2005). Impact of mindfulness-based stress reduction (MBSR) on
     sleep, mood, stress and fatigue symptoms in cancer outpatients. International journal of
     behavioral medicine, 12(4), 278-285.

Keng, S. L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: A
     review of empirical studies. Clinical psychology review, 31(6), 1041-1056.

Hayes, A. M., Beevers, C. G., Feldman, G. C., Laurenceau, J. P., & Perlman, C. (2005). Avoidance and
     processing as predictors of symptom change and positive growth in an integrative therapy
     for depression. International Journal of Behavioral Medicine, 12(2), 111-122.

Hanh, T. N. (1991). Peace is every step. New York: Bantam Books.

Korshak, N. (2014). Mindfulness-Based Stress Reduction Program. . Retrieved July 11, 2014,
     from http://mbsrprogram.org/

Reset the Net

"One year ago, we learned that the internet is under surveillance, and our activities are being monitored to create permanent records of our private lives — no matter how innocent or ordinary those lives might be.

Today, we can begin the work of effectively shutting down the collection of our online communications, even if the US Congress fails to do the same. That’s why I’m asking you to join me on June 5th for Reset the Net, when people and companies all over the world will come together to implement the technological solutions that can put an end to the mass surveillance programs of any government. This is the beginning of a moment where we the people begin to protect our universal human rights with the laws of nature rather than the laws of nations.

We have the technology, and adopting encryption is the first effective step that everyone can take to end mass surveillance. That’s why I am excited for Reset the Net — it will mark the moment when we turn political expression into practical action, and protect ourselves on a large scale.

Join us on June 5th, and don’t ask for your privacy. Take it back.”  - Edward Snowden

Want to learn how you can take back your privacy?  Here's how:
Reset the Net

Watch this video:  http://youtu.be/qKk8MHFLNNE

The Stories We Tell

Lenda Brasileira da
Origem do Rio Amazonas  

Onça

Há muitos anos, existia na selva amazônica dois noivos apaixonados 
que sonhavam ser um casal. Ela vestia-se de prata e seu nome era Lua. 
Ele vestia-se de ouro e o seu nome era Sol. Lua era a dona da noite 
e Sol era dono do dia.
Havia porém, um obstáculo para aquele namoro: se eles se casassem 
o mundo se acabaria. O ardente amor de sol queimaria a terra toda 
e o choro triste da Lua toda a terra afogaria.

Apesar de apaixonados, como poderiam se casar? 
A Lua apagaria o fogo? O Sol faria toda a água evaporar?

Assim, eles se separaram. Eles nunca puderam se casar. 
Os noivos ficaram desesperados, a Lua de prata e o Sol de ouro.

No desespero da saudade, a Lua chorou durante todo um dia 
e toda uma noite. Suas lágrimas escorreram por morros sem 
fim até chegar ao mar. Mas o mar, com tanta água embraveceu-se, 
ele não queria aceitar tanta água.

A sofrida lua não conseguia misturar suas lágrimas às águas bravas
do mar. Algo estranho aconteceu. As águas escavaram um imenso vale, 
serras se levantaram. Um imenso rio apareceu. As lágrimas da lua 
formaram o rio Amazonas, o rio-mar da Amazônia.

Amazon Jungle

Roughly translated: 

"Once upon a time, a long time ago, there were two lovers. One dressed in silver called the moon. The other dressed in gold called the sun. The moon ruled the night while the sun ruled they day. They had a great love for each other but faced a terrible obstacle that kept them from marrying. If together, the moon would extinguish the fire and the sun would evaporate the water.  Thus they had to remain separate.  The moon in her sorrow cried and cried all day and night. Her tears flowed until they reached the sea and thus the Amazon was born."

Some things are just not meant to be. Some love is best when it it unrequited, unfulfilled...  its legend lives long and is the stuff of song, art,  and poetry.  A wise old Brazilian woman once told me, "It is not from our joys that great art is born, it is from seeing it contrasted against our greatest sorrows."   Use that to inspire yourself to great things but know that separateness is an illusion - even down to the subatomic level. Physical separation exists, spiritual does not.

That separateness we all feel... the desire and hunger to be touched, loved, admired... to be part of something that is larger than ourselves... that illusion of our separateness from God. We all share a piece of God whether we are brown, white, black, christian, hindu, jewish, French, American, Chinese, straight, gay, transgendered, Geminian, Martian...  What a huge legend of divisiveness it is to say God has been made into "a distinct, separate entity to which we must worship, humor, and please  - all in the hopes to get a reward at the end of life" or avoid the fires of hell. "This is not what God is. That is blasphemy."  Shame on you that try to keep us separate.  

"God must be greater than the greatest of human 
weaknesses and, indeed, the greatest of human skill. God 
must even transcend our most remarkable-to emulate 
nature in its absolute splendor. How can any man or 
woman sin against such greatness of mind? How can one 
little carbon unit on Earth-in the backwaters of the Milky 
Way, the boondocks-betray God almighty? That is 
impossible. The height of arrogance is the height of 
control of those who create God in their own image." 
-Ramtha

Saving the Crows

“Stan Gable: Those nerds are a threat to our way of life.” - Revenge of the Nerds.

Species Diversity

What do you do to promote compassion and common understanding when you mix a diverse group of people together in a situation where they must interact closely together, like in a dying spacecraft, a stuck elevator, on a long tour bus ride; like in the office, in a classroom, in a community and keep them interconnected?  It’s difficult and uncomfortable; people revert back to old patterns, cliques, and behaviors under perceived or real threats, different perspectives, change or scarcity.  But interconnectivity is a basic fact of our existence. We must be able to accept our difference to thrive together.

Often in these scenarios, someone, or some group, is cast as the nerds, put on ‘double secret probation’, or treated like the red headed stepchild.  There are the birds and then there are the crows.  The birds are beautiful, colorful, have a sweet song and draw your attention.  People venture on bird-watching trips just to see them. While, when people think about the crows, they liken them to Edgar Allen Poe’s The Raven, the harbinger of death, dark, black, big and scary with all the varied sounds they make.  They build scarecrows to keep them away. 

Did you know that recent research has found some crow species are capable of not only tool   use, but they also can construct tools and engage in meta-tool usage?  Crows are considered to be among the world's most intelligent animals. And according to The Berkeley Daily Planet in a 2003 article, “if any bird had the cognitive wherewithal to make its own tools, it would be some kind of crow. Crows, ravens, and their relatives are famous for their adaptability, resourcefulness, sociality, and curiosity. As a group, they have the highest encephalization quotient—ratio of brain size to body size—among birds.”

Crow and Gull

Well, I’ve always been a Lorax,  “I speak for the trees. I speak for the trees for the trees have no tongues. And I'm asking you sir, at the top of my lungs - that thing! That horrible thing that I see! What's that thing you've made out of my Truffula tree?”  Today I speak for the trees and all you crows out there too.  

Diversity is important to survival, growth and learning. Being different is something to celebrate and aspire.  Bloomberg Business Week speaks about the importance of diversity in a company; it’s not just some HR slogan anymore.  It is “crucial to doing business in a world whose populations, by virtue of speedy air travel and even speedier Internet service, become more interconnected by the day.” Yet, it’s so difficult to integrate. Organizations and communities who do not find a way to bring their communities together will simply not succeed.

“Beanie: Because this is a very big idea, my friends. We're talking about a non-exclusive egalitarian brotherhood where community status and, more importantly, age have no bearing whatsoever.”  - Old School

There are approaches toward integrating diversity. But how can you ensure a positive experience for all?   Here’s advice from GE:  You can begin to acknowledge and appreciate that cultural differences exist.  Find ways of adapting, and introducing diversity into your culture rather than forcing others to adapt to your traditional office culture. Allow your culture to change and grow. Encourage communication about differences. Be alert for both verbal and nonverbal cues that might indicate tension. Consider that the root causes of tension could be cultural or generational. Also, examine how your diversity strategy aligns with or differs from your expectations. And don’t neglect the bottom line: Look at how diversifying affects your organization’s or your community’s performance in terms of sales, efficiencies, and customers gained or lost” or relationships built, connections, cooperation and support gained.

Support the crows. Learn from each other. It is the way of the future.  Your only other option is to refuse to grow and embrace the thought that ‘high-school ever ends.’  

High School Never Ends – Bowling for Soup

What are your thoughts?

The State of Zero

Ho'oponopono

Hawaiian historians documented a belief that illness was caused by breaking spiritual laws and atonement was needed for this transgression. A Kahuna, healing priest, would assist by praying for forgiveness from the gods or from the person injured. Ho'oponopono is such a tradition. 

It is a Hawaiian word where no’o makes a noun into a verb, like “to”, and pono meaning “goodness, uprightness, morality, moral qualities, correct or proper procedure, excellence, well-being, prosperity”.  So Ho'oponopono is "to put to rights; to put in order or shape, correct, revise, adjust, amend, regulate, arrange, rectify”.  It is an ancient Hawaiian practice of reconciliation and forgiveness.

Others have written that hoʻoponopono is all about getting to the State of Zero, where there are zero limits, no memories no identity.  To reach this state, you must repeat this mantra over and over again, "I love you. I'm sorry. Please forgive me. Thank you." 

This praying or meditation is about taking responsibility for everyone's actions, not only your own. If one takes full responsibility for all actions, feelings, events, thoughts all around them, the focus of the problem would not be lie outside with their external reality, it would be within themselves.  Thus by healing yourself, you can heal others. We often hear, “to change our reality, we would have to change ourselves.” Getting to the zero state is that goal. This is forgiveness on the grandest scale.

So what makes the zero state so important? The etymology of zero comes from French zéro or from Venetian zero, which goes to the Italian zefiro from Arabic صفر, ṣafira and symbolizes "it was empty", ṣifr = "zero", "nothing".   "How can nothing, as symbolized by zero, be something?"

Emptiness

Zero is the pivotal point around which many things circulate.   It is the empty set.  It is the state of all possibility. The Dalai Lama says you must realize the emptiness of inherent existence before you may go on to higher levels; those of the subtlest form, innate mind of clear light where all "energy and mental processes are withdrawn or dissolved", so that all that what appears to the mind is "pure emptiness". Emptiness is “the creative Void”. It is the state of complete receptivity and perfect enlightenment, the merging of the
"ego with its own essence", which Buddhists call the "clear light".  

Taoism says this state of emptiness creates stillness and placidity that is the "mirror of the universe".  In the Tao Te Ching, emptiness is related to the "Tao, the Great Principle, the Creator and Sustainer of everything in the universe".  This still mind is that of the sage and it becomes the “mirror of heaven and earth, the glass of all things” and the "pure mind"; heaven on earth.

Through forgiveness and the state of zero, you can reach the empty set of all possibility and create heaven on earth, enlightenment, nirvana. Isn’t that what the Passion Play, the story of Easter, is all about?  Clearing the slate clean of past wrong doing; atonement, resurrection; “that He was buried; that He rose to life again on the third day in accordance with the Scriptures” and generated a world of all possibility?