Precaution Adoption Process Model Analysis

Health Behavior

The “Theories At A Glance” manual discussed a variety of healthy behaviors. Select two theories that can be used to explain why people behave the way they do. Discuss the basic premise and constructs of the theories you choose. Cite two examples of how each theory could be used to explain a health behavior.

Theory of Planned Behavior (TPB)

The relationship that exists between behavior and attitudes, beliefs and intention is studied under TPB (Theory of Planned Behavior). TRA (Theory of Reasoned Action) is also associated with TPB. According to TRA and TPB, behavior is mainly determined by behavioral intention. These models show that the attitude of an individual affects behavioral intention. Hence, the behavior of a person towards the performance of some particular behavior is also influenced. In addition to this, beliefs concerning individuals who have close association (these people have the decision making power of approving or disapproving the exposed behavior) also affects behavioral intention. In view of TRA and TPB, all other relevant social or behavioral factors cannot work in the absence of models’ constructs. Moreover, these models do not provide any explanation about the possibility of an individual’s action in a particular situation (NCI, 2011).

TRA and TPB are not similar. TPB is comprised of perceived behavioral control construct too. According to this construct, people have the belief and power to control certain behavioral actions or responses. This construct was included by Azjen and Driver when they observed individuals in certain situations when they were unable to control their behavior. The reason for such behavioral intention or people’s behavior was attributed to factors not in control. According to them, if people think that they can control a specific behavior, they tend to perform it more often (refer to Table 4). Situations cannot restrict the applicability of this model; nevertheless, it is clear that behavior is also affected by the people’s perception of controllability (NCI, 2011).

According to surveillance data, there is a higher possibility that acculturated Hispanic women would undergo Pap tests, in comparison to the older, less acculturated ones. A cervical cancer screening program was initiated by the health department, targeting older Hispanic women. This would include a survey, via which the intentions, attitudes and beliefs of the population would be figured out. The survey asked when had the women taken their Pap test last (behavior); the likelihood of them taking one (intention); the general attitude about the test (attitude); whether we’d recommend this test to someone we know (subjective norm); and whether the choice to get the test or not, is under the individual’s control (perceived behavioral control). All this would be considered, when carrying out the survey, so that the intentions, attitudes, beliefs could be noted. This would enable the researchers to identify the ones seeking a Pap test (NCI, 2011).

The TPB’s explanation for the intention behind any determined behavior is shown in Figure 3 (above). It also shows the way, perceived behavioral control, subjective norm and behavior influence behavioral intention. The model states that the attitudes of behavior are molded via the belief of motivation and social standards which are derived from the outcome and the performance of the behavior itself and that they comply with the subjective norms affect. The ease of performing any behavior would depend on the presence or lack of things, when talking about the perceived behavioral control. Thereby, behavior is derived from a chain of intentions, attitudes and beliefs (NCI, 2011).

Precaution Adoption Process Model

Seven distinct stages of the journey are specified in the Precaution Adoption Process Model (PAPM). This ranges from the lack of awareness of maintenance and/or adoption of a behavior. This is a newer model that has been applicable to various health behaviors, including: home testing for radon gas, hepatitis B vaccination, mammography, colorectal cancer screening and osteoporosis prevention (NCI, 2011).

There are a number of stages through which an individual goes through as far as the process of PAMP is concerned. Stage one is the phase of ignorance, when the person does not have any knowledge about the danger (for example he is not aware of hazards like HIV, radon exposure and sex without protections being used). Within the second phase the individual gets aware of the hazard but is not engaged in it. The next four stages (i.e. from stage three to six) are concerned with acting, stage 3 includes the decision of acting, and then they decide whether they have to act (stage 5) or they do not have to take any action (stage 4). Stage six is also concerned with acting but primarily the act of maintenance (See figure 4). Individuals go step-by-step and walk through each step with safety measures. After the completion of the first two phases the individuals never move back, like for instance an individual cannot move from an all knowing stage to the age of ignorance. But apart from the starting two stages, people can move form a forward stage to the previous one (NCI, 2011).

Similarities can be seen between PAPM and Stages of Change in Model but there exist huge differences as well. Changes in the model focus on bringing change in the behavior of the individuals, like for instance it asks for quitting smoking and overeating. But this kind of an approach is less meaningful when handling a newly detected danger and precautions that are lately accessible. According to PAMP, the individuals who are at the starting stage of unawareness undergo hurdles of different nature as compared to those persons who are on the acting decision making stage and have decided not to respond. PAPM appeals the practitioners to work on the strategies relating to the starting phase i.e. prior to the active decision making stage (NCI, 2011).

2. A variety of factors (determinants) that influence healthy behavior were outlined on the videos. Discuss the determinants of healthy behavior in general and describe the three determinants you believe are most influential in shaping the behaviors of adults.

A number of factors in combination affect the health of people and communities. There are numerous factors that affect the health of an individual; a few factors are as follows; the area in which people live, the state of environment, genetics, the income and educational level, and the relationships with friends and family. Through this we get to know that the health of an individual is greatly affected by the atmosphere in which he lives and the situations which surround him. If we compare the above factors with the health care services, we acknowledge that, there is rather a lesser degree of impact of health care service on an individual. Health can be determined by the following factors:

Individual behaviors and characteristics of the people

Nature of physical environment

Economic and social system (NCI, 2011)

An individual’s health is largely the function of his lifestyle hence he should be appreciated for good health (Eddy, Module 1). On the same note, he should not be blamed for poor health either. There are many factors which directly or indirectly affect the individual’s health and not all the factors fall in his controllable domain. In addition to above mentioned factors, there are many other determinants as well.

Culture – beliefs, traditions and customs prevailing in the family and society at large affect general health of the people in that society

Supportive social networks – the degree of health is directly related with level of support from family members, friends and social circle

Physical environment – clean air and safe water, congenial workplace, safe housing and transportation infrastructure add to better health.

Working conditions and environment – employed people enjoy good health especially the ones having authority at workplace as compared to the unemployed people

Education – people with high education levels enjoy good health, more confidence and less stress.

Social status and income group – upper class generally enjoy better health conditions. The degree of health disparity is directly proportional to income disparity.

Coping skills and personal behavior – drinking, smoking, stress management, balanced diet and challenges largely affect the health conditions.

Genetics – healthiness, probability of disease and lifespan are the function of inherited characteristics.

Gender – both genders are prone to different diseases at different ages

Health services – use and access of health services determine the health of individual particularly prevention and treatment of diseases (NCI, 2011)

3. Describe the Social Ecology of Health Promotion approach to addressing a health problem. How would this model reduce victim blaming in Health Promotion? How would this model assist you with the design of a particular health issue / problem that you identify? Review possible interventions and applicable theories on all levels of the model.

The behavior of physical activity is a complex mechanism and the influencing factors are also multifaceted. At times these factors and behaviors lead to blocking physical activity. There are many models explaining such factors and their roles. They throw light upon the particular problem taking place in a specific background. The detailed study of the problem and related factors in the light of particular settings help the experts to design interventions accordingly. The intervention is in the form of policy, strategy and program that can have an impact over physical activity. The development of the intervention, its implementation and finally the evaluation depend largely upon the used model or framework (NCI, 2011).

Not all individuals take part in physical activities. There are many policies, social and physical environmental variables which determine an individual’s habit of participating in physical activity. The change in habit is possible through change in these environmental factors. If environment does not support change, habits will remain the same. In order to increase physical activity, the need is to work upon individual’s tendencies and the factors influencing those tendencies. The model of social ecology is a tool to achieve this goal. It throws light upon multiple factors that determine the individual’s behavior. Simultaneous focus on multiple points of influence increases the possibility of change in behavior (Eddy, Module 1).

There are certain theoretical models related to self-efficacy and stages of change which throw light upon inculcating habit of physical activity. These two models are based on psychology of the individual involving himself in the process of change. These models lack consideration of public policy, physical setup and social environment that at times are extremely important variables. The Study Design of VCE Physical Education (2011-2014) is working on the model of social ecology to critically analyze the process and technique of identifying the multiple points of influence so that a greater degree of change can be brought in (NCI, 2011).

There are many varieties of model of social ecology based on environmental factors. These factors are classified according to their influence. In the particular case of VCE Physical Education, the factors that it uses for studying the model of social ecology are based on social environment, policy components, physical environment and the characteristics of individual (NCI, 2011).

Social ecology model is the idea of Bronfenbrenner who has classified the influences in the layers. Each layer provides input to the next layer. In his view, the layers are similar to Russian dolls put in sequence. The core level comprises of the individual himself while respective outer layers represent varying degree of environmental influences on the individual (Bronfenbrenner 1994). Each layer is like an overlapping circle having a specific portion of the model. All the levels have considerable impact on the personality and attitude of an individual (Stokols 1996, p. 291). For instance, government level agencies and institutions form the broader level of environment in the light of policy implications. These implications affect the community facilities and geographical environment which put strong impact upon the lives of organizations and social structure in the society.

There is a need to customize the model of social ecology as per the population groups present in the society. It is mandatory to adjust it with the different behaviors prevailing in the society. The behavior varies because of the age factor mainly. The expected level of participation by the young adults will be quite different from the elderly group; hence the strategies and policy defined as intervention to change participation level will also be different. The population group will also affect the examples related to each layer of model of social ecology even though the same version of the model is used (Elder 2007, p. 156).

Finally, it can easily be estimated that the social-ecological model is a very vibrant and conducive structure with regards to understanding of the impacts of creating and analyzing intercessions on physical activities and behavioral changes. Many researchers have devotedly worked on the issue and their long-tailed reports indicate their individual impression about the model. Few citations might help one identify and understand various different divisions of the same model and its components.

The design for the VCE Physical Education (2011-2014) categorizes the following four elements in the social-ecological model:


Social environment

Physical Environment

Policy (NCI, 2011)

Here, it will be the responsibility of the researcher or practitioner to recognize and provide the examples of the social-ecological model. Moreover, they will also be analyzing the actual application of the social-ecological model by the public and private enterprises for the promotion of physical activity for targeting their respecting niche.

4. Discuss upstream and downstream approaches to health behavior change. Cite three examples

The case of Health Promotion is special as it is an upstream activity with the objective of helping people secure them. While, in the downstream, secondary activity (for detection of the illness for proper treatment ahead of any avoidable harm like screening) and also tertiary healthcare plans; (these plan of actions are made for proved diseases to minimize their complications and problems, like special steps for diabetes patients) (Eddy, Module 1a).

In the mid-level, the healthcare providers pursue certain health care and impediment measures on the individual front, like the awareness programs for smokers to help people understand the risks of the disease. While in the upstream level, healthcare development programs, policy initiatives etc. can be seen as options. Imposing tax on tobacco, ban on smoking related advertisement and implementing smoking free laws are few examples of policy initiatives. Furthermore, healthcare education by increasing people’s awareness about healthcare, and changing their attitudes and lifestyles is another tool. Hence, the Health Promotion element has a double role to play: one, preventing bad health and two promoting the activist health lifestyle (Eddy, Module 1a)

Health Promotion is a method of empowering people to enhance their control over their lives and maintain positive health. So that, they can reach a state of bodily and rationally sound health where they enjoy social goodwill by recognizing their needs, wants and desires while cooperating and integrating with the environment. Fitness is and should never be taken as aim of life; instead, it’s a tool to spend a sound and joyful life. The concept of health is not restricted to just physical capabilities; it also includes positive utilization of personal and communal resources. Hence, we can’t say that healthcare management is the sole responsibility of the health departments, but this is a collective responsibility of society and all the sectors for the combined well-being (Eddy, Module 1a).

In other words, we can define the Health Promotion structure as a process of empowering individuals and societies for enhancing their capabilities to develop their system of healthcare for improving their collective societal health. One of the main points in the definition is that we need to analyze the efforts for health promotion and in doing so, evidence collection on the progress and results, is an important factor. This process should be aimed at not only strength of healthcare status but also weakness of the negative health. It also notes that the evaluation process should be used as a means to improve overall personal as well as collective health and process of community health empowerment (Eddy, Module 1a).

Why We Need Upstream Investments

When you look at the spending of the global communities on transferable and non-infectious diseases, the balance has drastically changed. As per the expected statistics of 2010, their joint weight will reach 60%. Non-infectious diseases have to be dealt with a long-term perspective of sustainable health with unique approach. In the developed countries, the cost of healthcare has been reduced due to inexpensive solutions. Simple and basic healthcare measures can avoid many individual habitual and environmental pitfalls (Eddy, Module 1a).

Upstream Investments Brings Downstream Results

Investment in intervention initiatives like smoking, higher BP, cholesterol etc. can help a lot in securing societies and empowering them to deal with the cardiovascular diseases that are causing the highest rates of deaths globally. At the same time, the inexpensive but reliable measures can improve their viability by reducing the cost and saving a great amount of money that was to be spent when dealing with the problem (Eddy, Module 1a).

If we focus on reducing the risks of the major diseases, we can save around 4 million untimely deaths annually. Every year, around five million people die because of tobacco, while soaring BP causes over 7 million deaths. However, it’s extremely necessary to say how important it is to invest in upstream interventions but it’s equally difficult as well. The most important thing here is an unending political will to make sure a reliable success rate exists while simultaneously reduce the inequality in basic necessities of life like health facilities (Eddy, Module 1a).

5. Discuss how you would use the Health Belief Model to assist with the design of a health promotion program to increase breast cancer screenings or cholesterol screenings in adult populations.

Health Belief Model (HBM)

Health Belief Model is one of the premier ideas in healthcare and health activities and still considered one of the most reputed theories of the field. A group of U.S. Public Health Service social psychologists developed this theory in the 1950s. They just aimed to help people understand as how they could help themselves remain protected from diseases like breast cancer amongst women by regular self-inspections and awareness of symptoms. Similarly, the same unit used to offer free X-Rays in the surrounding areas for awareness development. However, it’s a sad fact that despite being free of cost, this program didn’t go so successful. But one must ask why?

In order to understand this ‘why’, behavioral scientists conducted a research, which was aimed at finding the factor that discourages or encourages people to take part in such programs. They came up with the idea that people’s belief that whether a certain disease will attack them or not and their perceived benefits of such preventive measures influenced their mindset the most while reacting to the call of attention (NCI, 2011).

In the following years, the psychologists enhanced their research domain and eventually came up with 6 influencers that ultimately help people make up their minds about their illness and its control and take decisive steps thereof.

According to them, people act only if they;

Have a belief that they are vulnerable to the condition

Think that this disease will have serious ramifications

Are sure that their actions will reduce the severity of the disease and their vulnerability

Perceive that benefits of the action are higher than the cost

Are made aware of the facts that motivate actions (TV programs, advertisements, reminder from doctor etc.)

Have self-confidence to win and acquire positive results (NCI, 2011)

As health incentives are the central idea of the HBM, so it becomes very reasonable for addressing habitual problems that remind health concerns like, higher sexual behavior might lead to HIV or lumps in the breasts are indicative of breat cancer cells. The listed combination of 6 HBM elements provides a helpful framework for designing both temporary and long-standing behavior transforming strategies. Health practitioners should be very careful when they apply HBM to their program as it’s important to understand and analyze the vulnerability of the given targeted niche and how serious it takes a certain disease. It must be noted by practitioners that in case of using HBM in planning health programs, they must understand the mental level and emotional understanding of target population towards health problem. Do these people consider it seriously or do they believe that the cost incurred will help them in reducing the threat. It is not as easy to influence the changes in these factors as it seems to be (NCI, 2011).

People who have high-blood pressure and/or cholesterol are more vulnerable to a heart disease or / and at a risk for a heart-attack/stroke and it is also a possibility that they already had such experience. Moreover, sometimes people do not try to lose their fatty weight (which leads to increased cholesterol) and/or do not follow any prescribed medications just because they do not feel any sickness related to high-blood pressure or cholesterol. HBM can play a very important part in terms of dealing with the non-cooperation of people by developing relevant behavior modification strategies (NCI, 2011).

As HBM defines, the people with no signs of the sickness (Asymptomatic people) will never follow any prescribed routine treatment unless until they accept their problem, as physically they may be fit but mentally they may be facing hypertension (possible vulnerability) and this hypertension may lead them to strokes and attacks (a harsh reality). A proper following of cholesterol screening program and prescribed medicines will not destroy the problem completely but will definitely reduce the risk (perceived benefit) without any side-effects (a possible barrier). There are many ways which can encourage these people to positively follow the doctor’s medication and recommendation. These can also be called the “signs of actions” such as print materials, pill calendars and/or reminders (letters, alarms, etc.). A behavioral contract can be developed for those who have been finding it hard to follow instructions in decreasing cholesterol, which can help them in building confidence by achieving short-term goals (self-efficiency) (NCI, 2011).

6. Explain the Trans-theoretical Stages of Change Model. How would you apply this model to an intervention to increase physical activity?

Change of Behavior is not an event rather it’s a process, a main and basic concept of the Change Model, developed by DiClemente and Prochaska (1992). The phase of this model which evolved from the studies compares the experiences of the smokers who quit smoking by themselves with the ones who received professional treatment. According to this model, a person moves through different phases when he attempts to change his behavior, these are; Pre-contemplation, contemplation, action, preparation and maintenance. Depending on the behavior at hand the stages may differ slightly and people having different needs can be benefited from doing interventions in these stages.

People experience the same stages of change whether they employ self-management methods or take part in professional programs. Nevertheless, depending on the type of behavior change, the overall experiences that the individual has in these stages may vary. For instance, an individual who wishes to forsake smoking habits may go through the stages of change in a different manner than an individual who wants to improve his/her dietary habit (NCI, 2011).

In addition to its application to individual behaviors, this Stages of Change Model has also been applied to changes in organizations. Because it is linear, the model suggests that instead of progressing step-by-step from one stage to the other, people may enter the process of change at any stage, go back to a previous stage and start the process once again. They might circulate through this process again and again and the entire process can stop anytime (Perko, Module 2).

Take for instance, the employment of a smoke cessation program by a large organization for its employees who are involved in smoking amount to a total of about 200 people. The program manager offers smoking cessation clinics in groups to the employees at different points in time at different locations. After various months, only 50 of the smokers sign up for the clinics. Now, the dilemma faced by the health educator is how the 150 non-participating smokers can be reached effectively (NCI, 2011; also see Perko, Module 2).

Perspectives on various ways to approach this problem can be offered by the Stages of Change Model. Firstly, the model can be used to comprehend why the non-participating smokers are not attending the clinics. Secondly, the model can help establish a better smoking program so that current and former smokers can better cope with forsaking their habit. There are certain levels of the process of quitting smoking. The smoker may be on any of these levels. In order to find out the level of a smoker, certain questions can be asked (NCI, 2011). These questions identify the phase on which the smoker actually is and can be recognized as:

Pre-contemplation (when a person says he/she is willing to quit smoking).

Contemplation (when a person says he/she is willing to quit smoking as quick as possible).

Preparation (when a person says he/she wants to take measures to quit smoking).

Action (when a person is already taking measures to quit smoking).

Maintenance (when a person has quit smoking and wants to remain as he is) (NCI, 2011)

Once the phase of smokers will be known, then it will be easier to find out their level and intensity towards quitting smoking. Moreover, it will also be helpful to design programs and strategies accordingly; because addressing a smoker with an irrelevant message will not work at all. For instance, if a person is in the phase of “pre-contemplation,” the strategies and programs of “contemplation” or “preparation” will not work upon him/her. Initially he/she is supposed to be brought to the contemplation stage through relevant programs, such as, using carbon monoxide testing to exhibit the hazardous impact that smoking can have on his/her health (NCI, 2011; also see Perko, Module 2).

7. Thoroughly discuss how theories of health behaviors can be used to 1) explain health behavior and 2) design a health promotion intervention. Cite examples to support your response.

In order to make relevant improvements, either in an individual or in the society as a whole, the attitude must be changed first. Different programs can be used to change the behavior and attitude of a person. These programs include effective public health, health promotion, and chronic disease management. Moreover, these programs are applicable on individuals, families, organizations, and communities (Naggy, Module 2; NCI, 2011).

There are certain factors that also play a crucial role in the success and failure of a certain program. These factors include the extent to which the desired objective is clear and the environment in which the application of program takes place. In order to improve the efficacy of a particular program, the program must be assessed on continual basis through using strategic planning models and health behavior theory (Naggy, Module 2; NCI, 2011).

What Is Theory?

A theory caters with an organized method of comprehending situations or events. It is a combination of propositions, concepts and definitions explaining and predicting the situations or event. It also illustrates the relationships among various variables. Theories need to be implementable to a wide range of events. They are abstract by nature and are not specific to a particular topic. The analogy of a theory can be compared to empty coffee cups, which are bounded by boundaries yet empty from inside (Naggy, Module 2; NCI, 2011). They are beneficial when practical goals, topics and problems fill them up.

Concepts serve as a stepping stone in building up a theory, so they are the primary elements of it.

Constructs are the adoption or development of concept by a specific theory. Construct are the key concepts of the theory.

Variables form the operational perspective of constructs. They define the measurement of a construct in a particular situation. The evaluation of a program based on a theory requires matching variables to the constructs in order to identify the needs.

Models are based on various theories and cater to the understanding of a particular problem in a certain context and are less specific in comparison to theory (NCI, 2011).

Majority of health behavior and health promotion theories were derived from behavioral and social sciences. The application of these theories to health issues necessitates the familiarity with the biological sciences and epidemiology. Health promotion and health behavior theories attract several domains like sociology, psychology, consumer behavior, anthropology and marketing. Most of these are not developed to a great extent and are not tested thoroughly. Due to this reason the terms theoretical frameworks and conceptual frameworks are used interchangeably (Green, Module 2).

How Can Theory Help Plan Effective Programs?

Theory caters the understanding of behavior, designing and evaluation of health promotion interventions and health behavior through the use of planner tools. It gives the healthcare planners the opportunity to step back and view the larger picture. The program planner, as if he is an artist, creates innovation in addressing certain circumstances by including health interventions. They are independent of the “paint-by-numbers” approach and make use of outdated ideas. Instead they tailor unique and innovative solutions to the problems by the skillful usage of a palette of behavior theories (NCI, 2011).

Program planning and development based on theory works consistently with evidence based interventions in behavioral medicine, medicine and public health, which are being emphasized greatly in the current era. Theory gives a clear cut idea for identifying and studying problems, evolving suitable interventions and the evaluation of their success. It caters with a great deal of information in all the stages with a deep insight that ultimately results in a durable and resilient program. Health behaviors are amicably explained by theory. This includes the processes responsible for changing them and the consequences of forces affecting health behaviors considering physical and social environment. Theory lends a hand to the planners in identifying the appropriate target audiences, ways of bringing about change and the evaluation of the consequences (NCI, 2011).

The questions of “what,” “why” and “how” can be well investigated by researchers and practitioners using theory. The answers to these questions help instigate the nature of health behaviors set as target by the researcher. This implies that theory helps in reasoning out the facts behind people’s engagement in certain health behaviors. They help the planners to find out the things needed essentially for carrying out a particular public health program. It provides the guidelines for formulating program strategies to reach the target audiences and cast upon positive consequences. Due to these key factors, implementation, program planning, and monitoring processes founded on theory have a higher probability of success as compared to those grounded without considering the profits of theoretical perspective (NCI, 2011).

Explanatory Theory and Change Theory

The root cause to a problem can be identified with the help of explanatory theory. Some of these root causes include; self-efficacy, inadequate information, supply resources, self sufficiency. These causes tend to change. Some of the explanatory theories include; Theory of Planned Behavior, Precaution Adoption Process Model, and Health Belief Model (NCI, 2011).

Figure 1 depicts the usage of change theory and explanatory theory in planning and evaluating programs. Change theory gives direction to progress of health interference. It suggests the pattern through which certain ideas can result in the development of communication and related strategies. It also defines the essential factor needed for program evaluation. The individual, who is planning, can take help from change theory to verify the authenticity of their assumptions regarding the working of a program. Diffusion of Innovations and Community Organization are two examples of change theories (NCI, 2011).

8. Describe how Social Learning Theory and Relapse Prevention constructs can be used to design health promotion interventions.

The theory that focuses on interpersonal behavior is Social Cognitive Theory, also known as Social Learning Theory. The health behavior theories believe that social environment influence the individual at a large extent. Their actions, beliefs, attitude is greatly affected by their social circle. And similarly the individual has his own effect on other people. This social environment also affects physical condition. This social circle consists of family, friends, health consultants, etc. Social Cognitive Theory is one of the many other theories that focus on health. It analyses the simultaneous effects of people on each other in a social circle and psychosocial determinants of health behavior (Eddy, Module 2).

A continuous and dynamic process, in which factors like personal, environmental and human conducts are influential on one another, is known as Social cognitive Theory. Social Cognitive Theory (SCT) mentions three main aspects which affect human health activities namely: Self-efficacy under which humans show effectiveness in their behavior even while facing hindrances. Second are Goals and then comes Outcome Expectancies. If ones’ desire subsides to fight with his/her health, he or she cannot endure the challenges of life and no motivation is observed (Eddy, Module 2c).

Human nature changes by the time new actions and behaviors are adopted; change also occurs as the time passes. So, it is commonly said that surroundings of a man and his life do not really constitute human behavior and also the collaboration of behavior does not result in an environment. People learn from their surroundings and also from others’ experiences which are beneficial for them. This is evaluated by SLT (Social Learning Theory), which further expands into Social Cognitive Theory (SCT). Behavioral changes are studied in Social Cognitive Theory as an amalgamation of processes extracted from cognitive, behaviorist and expressive models of changes that undergo in human behavior. SLT was enhanced by Bandura who added the factor of self-efficacy and renamed it as Social Cognitive Theory (SCT). Hence, SCT is an upgraded version of SLT and is still sometimes known as SLT. Hence, SCT is used effectively to study behavioral changes constantly taking place in humans like how to relieve pain and control diet properly (Eddy, Module 2b).

Surroundings, personal aspects and human conducts are somehow or the other inter-related and do affect one another. This relationship is defined as Reciprocal Determinism. A behavior performed by a person is dependable on what he thinks to do and how he thinks he needs to complete it (Eddy, Module 2a; 2b).

A person who takes any action also expects some reaction in the form of an outcome. According to Bandura, self-worth is a very significant factor in an individual’s behavior. There are a number of ways through which an individual can increase his self-efficacy, such as developing a number of goals like exercise for ten minutes every day. Moreover, through behavioral contracting that consists of an official contract mentioning particular number of goals and incentives. Supervising and reinforcement also increases self-efficacy, such as receiving response on self checking and record maintaining. The concept of self-worth is always discussed in health behavior theories. Observational learning is also helpful where people learn from observing other people rather than their personal experiences (Eddy, Module 2d).

Reinforcement theory states that an individual’s behavior is a function of its consequences. Reinforcement is positive when a motivating factor is presented to make the behavior more likely to happen in future. Negative reinforcement occurs when you reward a person to remove the undesirable behavior. For instance, when an alarm rings in a car whenever the driver starts it, reminds him to fasten seatbelt. There are internal and external reinforcements. Internal is when the individual rewards himself while external rewards consist of incentives or other motivators that increases individual participation in programs having long duration. However, external rewards are not considered to strengthen a person’s own wish to change and they do not help in maintaining a long-term change (Eddy, Module 2).

An example of behavior can be: a university in a rural area built a church where worshippers could change their habits in order to take precautions against cancer. Example of personal factors include: worshippers in church having less income are also unhealthy, overweight etc. Environmental factors include when worshippers are supposed to drive long distances due to their far location.

The structured agenda trains the applicants about a healthy diet; like for instance, what a healthy life includes? And what type of eating habits and work out activities would be favorable for a good health? The health instructors set up a target and sign a binding agreement with the candidate. There are members who motivate the participants by acting as a role model. Moreover, the applicants receive T-shirts, recipe books, and many other attractive things. They are even allowed to give themselves a treat by soothing their bodies. As a result, the church members begin bringing healthier food to the church, thus strengthening their habits (Eddy, Module 2d; 2a).


Individuals do get aware of the modern health practices easily, but it is a very tedious task to abide by the rules of it, which require a complete scheduling procedure and commitment. Social marketing and PRECEDE-PROCEED are two scheduling methods which smooth the progress of a successful health governance agenda. These programs are successful due to the sole reason that they take the practitioner slowly and gradually along the process of fitness test that is conduct at numerous levels (NCI, 2011).

There are two approaches according to ecological perspective, which address the health problems and those are; modification in people’s actions or alteration in the environment. Therefore, constant conduct adjustment and high fitness promotions mix these two approaches and regard them both as most essential. There are certain community level theories which aim at the alteration of environment, therefore in the same way the change in people’s behavior is often derived from individual-level theories. Theories like Social Cognitive, which is considered as the community level theory, talks about the mutual relations linking community members and their atmosphere (NCI, 2011).

Those instructors who are aware of the mutual relations between the individuals and their environment are inclined to prepare programs which are multidimensional, and are focused to achieve outstanding health outcomes. It is a well experienced fact and is also illustrated in the individual level theory that the individuals’ characteristics and actions directly affect their surroundings. This illustration can be well explained by this example, where if in a university or a college the students get committed to have healthy food or in other words practice a healthy diet routine, then automatically the cafeteria would be having all the healthy eatables in it. Similarly, a scheme which is built on the foundation of community level theory also brings about changes in the health of the people. For example, a lady who is involved in a project, whose aim is to provide better admittance to fruits and vegetables to the community members, would definitely be stimulated to cook healthy food for her family as well (NCI, 2011).

The theoretical concepts are brought in to practice with the help of frameworks. The theories on behavioral changes and the scheduling methods make the instructors more prone to prepare creative as well as perfect resolutions. The theoretical approach enables practitioners to raise appropriate questions and undergo a systematic approach of planning and understanding. The instructors have brought a scientific and systematic structure into their work and they have advanced past their earlier practices. There are other elements as well through which the programs of the health instructors can become more affective, like by toning the program as per the need and the taste of the audience, or by bringing behavioral changes, by making information easily available to the participants, by making dynamic learning accessible to the audience and also by integrating factors for building skill and expertise (NCI, 2011).

Behavioral changes theory have been applied in academics and researches for a long time but now it can be used to solve health related issues as well. Via the help of the theories the practitioners become keener to understand the health related issues and then think to find possible solutions for them in innovative ways. By using this theory as a source one can believe the words of Winston Churchill (1898) that “I pass with relief from the tossing sea of Cause and Theory to the firm ground of Result and Fact” (as cited in NCI, 2011).


Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, N.J.: Prentice-Hall, 1986.

Bronfenbrenner, U 1994 ‘Ecological Models of Human Development’, International Encyclopaedia of Education, Vol 3, Oxford, Elsevier.

Eddy Module 2. Dr. James Eddy. Social Learning Theory (SLT/SCT): Reciprocal Determinism, Expectations, Value Expectancies. Accessed March 18th, 2012 from: mms://

Eddy Module 2a. Dr. James Eddy. SLT/SCT (cont’d): Observational Learning, Reinforcement, Self-Efficacy, Emotional Coping. Accessed March 18th, 2012 from: mms://

Eddy Module 2b. Dr. James Eddy. SLT & 4 phases of Behavior Change. Accessed March 18th, 2012 from: mms://

Eddy Module 2c. Dr. James Eddy. SLT/SCT Recommendations for Health Educators. Accessed March 18th, 2012 from: mms://

Eddy Module 2d. Dr. James Eddy. Recommendations continued. Accessed March 18th, 2012 from: mms://

Eddy, Module 1. Overview of Health Behavior- Dr. James Eddy. Accessed March 18th, 2012 from mms://

Eddy, Module 1a. Upstream / Downstream Approaches to Health Promotion- Dr. James Eddy. Accessed March 18th, 2012 from: mms://

Elder, JP, Lytle, L, Sallis, JF, Young, DR, Steckler, A, Simons-Morton, D, Stone, E, Jobe, JE, Stevens, J, Lohman, T, Webber, L, Pate, R, Saksvig, BI and Ribisl K. 2007, ‘A Description of the Social-Ecological Framework used in the Trial of Activity for Adolescent Girls’, Health Education Research, vol. 22, no. 2, pp. 155 — 165.

Green, Module 2. Interpersonal. Dr. Lee Green Accessed March 18th, 2012 from: mms://

Naggy, Module 2. Dr. Steve Nagy. An Evolving Perspective on Why People Behave the Way They Do. Accessed March 18th, 2012 from: mms://

National Cancer Institute. (NCI) (2011). Theory at A Glance: A guide for health promotion practice. U.S. Department Of Health And Human Services, National Institutes of Health

Perko, Module 2. Design and Evaluation in The Stages of Change Model – Dr. Mike Perko. Accessed March 18th, 2012 from: mms://

Prochaska JO, DiClemente CC, Norcross JC. In Search of How People Change: Applications to the Addictive Behaviors. American Psychologist 47:1102 — 1114, 1992.

Stokols, D 1996, ‘Translating Social Ecological Theory into Guidelines for Community Health Promotion’, American Journal of Health Promotion, vol. 10, no. 4, pp. 282 — 298.

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