Lecture 2: Changing health behaviour

The main questions during this lecture are Can everyone become motivated to change?, How can motivations be influenced? and When are you motivated to perform behaviour X?

Two answer these questions, theories have been placed into four categories:

• Early theories: “It could happen to you”
• Later theories: “You can do it”
• Newer theories: “If only you want to”
• Newest theories: “Stick to your plans”

Early theories: It could happen to you

The Health Belief Model is an example of an early theory. According to this model, chances of someone changing their behaviour is determined by demographic variables like age, culture and SES. View the previous lecture for a more detailed description of this model.

According to the Parallel Process Model fear can have two consequences. When fear arises, someone can have the urge to control the fear or to control the danger. Fear control is about the need to reduce the emotion of fear and can be done by denial, avoidance or distraction. Danger control is about the need to reduce the negative consequences of the danger.

However, fear only works in combination with response-efficacy and self-efficacy. Response-efficacy is the possibility of reducing the threat and self-efficacy is the ability to control your behaviour and to perform certain behaviour.

Later theories: I can do it

Bandura’s Social Learning Theory describes how performance accomplishments, vicarious experience, social persuasion and physiological and emotional states can influence self-efficacy judgements (believing you can do it), which ultimately influences behaviour/performance. Self-efficacy can be increased by performance accomplishments & social coaching/training (step-by-step mastery, instructions, they have to be specific and realistic, giving evaluative feedback) and vicarious experience/modelling, which has to be reliable, identifiable and attractive. Self-efficacy is effective when motivation is always high. However, motivation fluctuates. It is better to have a motivational state rather than a motivational stage. An overview of this model is shown on slide 19. For an example of this model, check the workgroup notes of workgroup 2.

The Protection Motivation Theory is a theory based on fear. Including fear can be done by information/persuasion, like messages on cigarettes, and  by modelling, for example showing a commercial or a photo of someone dying from lung cancer. According to this theory, there are two types of responses in cognitive mediating processes which influence protection motivation:

• Maladaptive responses
  Starts with intrinsic and extrinsic rewards and a high perceived vulnerability (“This could happen to me”) and a high perceived severity (“.. and that would be terrible”). These factors add up to threat appraisal. Fear plays a role in the development of perceived vulnerability and perceived severity.  
• Adaptive responses
  Starts with response efficacy (possibility to reduce threat) and self-efficacy (ability to control your behaviour) which lead up to response costs. These add up to coping appraisal.

Newer theories: if only you want to

Newer theories suggest that behaviour should be connected to one’s own values and/or identity. Self-regulation is the ability to direct our behaviour to meet standards, achieve goals, or reach ideals. This involves goal-setting, monitoring behaviour, evaluative outcomes and adjusting behaviour until goals are achieved. People select goals that support the definition of the self. The key message of self-regulation is behaviour can be understood only by identifying the goals to which behaviour is linked.

The Control Theory (also named cybernetic theory or cybernetics) is about performing certain behaviour(s) to achieve your goal by receiving feedback. Either the goal can be achieved or you can disengage from the goal. An overview of this model is shown on slide 28.

The Health Behaviour Goal Model focusses on personal goals. The model assumes that goal approximation is influenced at all stages by personal goal structure of the individual. The model includes predictors from the health behaviour changes. It also differentiates between health- and affect-related cognitions and the model represents a process of change that takes into account personal and environmental sources. An overview of this model is shown on slide 29.

The self-discrepancy theory says there are three future possible selves:

• Desired self: who would I wish to be?
• Feared self: who do I fear to become?
• Ought self: who do I ought to be?

Your current self describes where you are at at the moment. The person needs to me motivated to get the current self to the desired self as quickly as possible. Differences between these two selves, or changing too slowly can excite emotions.

The self-determination theory focusses on the basic needs of autonomy, competence and relatedness. The more the goal of a certain behaviour fulfils these basic needs, the more intrinsic this certain behaviour is. The violation effect describes how someone can relapse, for example by having thoughts like “I don’t like it at all, it doesn’t suit me”, “Is it worthwhile all the fuss and effort?”, “I can’t do it”, “I behave so well and healthy in all other aspects, I may allow myself one vice”. An overview of this model is shown on slide 34.

Newest theories: stick to your plans

The newest theories are about identifying the action that you’re going to take to achieve your goal, and how you’ll know when to take it, and about identifying possible obstacles to goal-achievement and how you’ll deal with them. An example to illustrate this is if you feel sluggish in the afternoon you usually walk over to the vending machine to get a chocolate bar, because when you feel stressed you have a tendency to overeat. Implementation intentions can help you change this. These describe how you can bring your good intentions into practice. For example, instead of getting a chocolate bar you can drink a glass of water and eat a handful of almonds. However, self-generated plans are often low in quality and effectiveness of implementation plans is at least partially dependent on plan commitment.

You can change many things in the environment to influence health behaviour. Healthy options in the environment should be easy to make (like offering fruit instead of candy) and unhealthy options should be deleted from the environment (not selling cigarettes or candy).