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.