Conscious knowledge of one's own character, feelings, motives, and desires.
What do we need for behavioral change?
Basic counseling skills
Knowledge of behavioral change theory
Keys to emotional intelligence
The ability to accurately perceive emotions in the face or voice of
others. Also includes the ability to identify one's own emotions.
a set of statements or principles devised to explain a group of facts
or phenomena, especially one that has been repeatedly tested or is
widely accepted and can be used to make predictions about natural phenomena.
Define a model
A model is a composite, a mixture of ideas or concepts taken from any
number of theories and used together. Models help us understand a
specific problem in a particular setting
What is the relationship between models and theories?
Theories and models help us explain, predict, and understand health
behavior. Understanding the determinants of health
Three separate levels of influence of models and theories
Theories and models can be separated into three different levels of
influence: intrapersonal, interpersonal, and community.
What do intrapersonal theories focus on?
At the intrapersonal or individual level, theories focus on factors
within the person that influence behavior, such as knowledge,
attitudes, beliefs, motivation, self-concept, developmental history,
past experience, and skills
What are examples of models that support the intrapersonal theory?
These theories and models include, among others, the Health Belief
Model, Theory of Reasoned Action, Self-Efficacy Theory, Attribution
Theory, and the Transtheoretical Model.
Interpersonal theory focus
Theories addressing factors at the interpersonal level operate on the
assumption that other people influence our behavior. Other people
affect behavior by sharing their thoughts, advice, and feelings and by
the emotional support and assistance they provide. These other people
may be family, friends, peers, health care providers, or co-workers
Common interpersonal theory
Social Cognitive Theory is a very commonly used theory addressing
behavior at this level.
Community-level theory focus
Community-level models and theories focus on factors within social
systems (communities, organizations, institutions, and public
policies), such as rules, regulations, legislation, norms, and
policies. These theories and models suggest strategies and initiatives
that can be used to change these factors.
Examples of community-level theories
A commonly used community-level theory is Diffusion of Innovation.
More recent additions to this category are ecological models and
Social Capital Theory.
What is the process of inductive reasoning?
inductive reasoning starts with specific observations or evidence and
moves to a conclusion.
What is the process of deductive reasoning?
In deductive reasoning we start with the conclusion and seek the
observations to support the conclusion.
How was the health belief model created?
Observation, inductive reasoning, and qualitative research methods
are what led to the development of the Health Belief Model.
Define health behavior
Health behavior includes all of those things we do that influence our
physical, mental, emotional, psychological, and spiritual selves.
The factors we have been discussing not only influence health
behavior, they are also the concepts of the theories we use to explain behavior.
What factors influence health behavior decisions
Some of these factors are socioeconomic status, skills, culture,
beliefs, attitude, values, religion, and gender.
Influence of socioeconomic status on health behavior
Socioeconomic status (SES) makes a significant contribution to health
since it encompasses education, income, and occupation. Of the SES
factors, education level seems to be the best predictor of good health
Influence of skills on health behavior
In the grand scheme of things, it is relatively easy to teach people
new information, thereby increasing their knowledge. But without the
skill or ability to use that knowledge, it is almost useless. So,
behavior is influenced by having both knowledge and skill.
Influence of culture on health behavior
behavior is significantly influenced by culture. In every culture
there are norms, or expected, accepted practices, values, and beliefs
that are the foundation for behavior.
Beliefs are intimately woven with culture. Beliefs are one�s own
perception of what is true, although they might not be viewed as being
true by others.
When there are a series of beliefs, you have an attitude.
Along with attitudes are values. Values are what people hold in high
regard, things that are important to them, such as nature, truth,
honesty, beauty, education, integrity, friendship, and family. What we
value influences the types of behaviors we adopt.
Influence of religion on health behavior?
Values and beliefs are often reflective not only of a culture, but of
a religion. Religion is another enormously important factor in health behavior.
Influence of gender on health behavior?
Gender is another important determinant of health behavior. Research
consistently shows that men engage in fewer health-promoting behaviors
and have less healthy lifestyles than women.
Constructs are the ways concepts are used in each specific theory.
Each theory is composed of what?
Each theory, then, has at least one concept at its heart, and a
series of constructs that indicate how the concept is used in that theory.
A variable is the operationalized concept, or how the concept is
going to be measured
Essence of transtheoretical model
Behavior change is a process that occurs in stages.
Stages of change in the transtheoretical model
Pre-contemplation, contemplation, preparation, action, maintenance
Decision balance in transtheoretical model
Weighting the pros and cons of the change
Name processes of chang
Consciousness raising, dramatic relief or emotional arousal,
environmental reevaluation, social liberation, self-reevaluation,
stimulus control, helping relationships, counter conditioning,
reinforcement management, and self-liberation
One�s belief in one�s own ability to do something
Theoretical concept of transtheoretical model
The Transtheoretical Model proposes that behavior change is a process
that occurs in stages. As people attempt to change their behavior,
they move through a variety of stages using different processes to
help them get from one stage to the next until the desired behavior is
attained. Thus, the theory is also known as Stages of Change.
Theoretical constructs of transtheoretical model
The constructs of the theory include not only the stages of change,
but also the processes of change and self-efficacy.
How are the stages of change related?
Each has its own distinct characteristics and timeframe and builds
upon the preceding stage.
What is the pre-contemplation stage?
People are in this stage from 6 months prior to the point they begin
thinking about making a change in their behavior to when they actually
begin thinking about changing. People in this �pre-thinking stage�
either don�t recognize they have a behavior needing change or are just
not ready to change a behavior they know they should.
Why is identifying those in the pre-contemplation stage important?
Knowing why people might be in the pre-contemplation stage is useful
when trying to understand why unhealthy behaviors are not changed. The
goal is to take this information and assist them in moving forward
from not thinking about changing their behavior to contemplating, or
thinking about, changing.
What does it take to transition from the pre-contemplation to
When people move from pre-contemplation to contemplation it means
they recognize there is a problem and they are starting to think about changing.
In order to move out of the �thinking� mode, a decision has to be
made to either proceed with the change or not. This is decisional
balance, the process of weighing the perceived pros and cons or costs
and benefits of the new behavior against the old
Define decisional balance
Decisional balance is the process of weighing the perceived pros and
cons or costs and benefits of the new behavior against the old
How long does it take for someone to begin moving from contemplation
to the next stage of change?
Typically, once people start thinking about changing their behavior,
they usually make a decision and plan to make the change within 6
months. However, this does not hold true for everyone in all situations.
The preparation stage begins once the decision to change the behavior
is made. Preparation is a short stage, lasting only about 1 month,
since once people decide to change a behavior, they are often anxious
to get started. This preparation time is used to make a plan, obtain
any tools needed, learn new skills, and whatever else is necessary for
the change to occur.
Once preparation is complete, the action stage begins. Action is when
people are in the active process of modifying their behavior to
address the problem they identified in earlier stages. These
modifications tend to be observable changes and to be recognized and
rewarded by others
How do you know if action is successful?
Just because there is action does not necessarily mean the behavior
will change. Action and change are not the same thing.
In order for action to be successful, it needs to be measured
against criteria previously determined to reduce the risk of disease.
Maintenance is the final stage of change. During this stage, people
work (and sometimes struggle) to prevent relapsing to the old
behavior. In general, maintenance begins after 6 months of being in
the active stage of changing and continues for at least 6 months. With
some behavior changes, maintenance goes on for years.
Which construct is self-efficacy in the TTM?
The second construct of the TTM is self-efficacy.
How is self-efficacy related to behavioral change?
Self-efficacy plays a major role in how successful people are in
changing their behavior and maintaining the change. Remember,
self-efficacy is one�s confidence in one�s own ability to do
something. In the context of maintaining a behavior change, it has to
do with one�s confidence in coping with situations in which there is a
high risk of relapse.
What are the processes of change and how many are there?
There are ten processes of change: consciousness raising, dramatic
relief or emotional arousal, environmental reevaluation, social
liberation, self-reevaluation, stimulus control, helping
relationships, counter conditioning, reinforcement management, and self-liberation
What's the difference between the processes of change and the stages
While the stages of change help us understand when people change
their behavior, the processes of change help us understand how change occurs.
What are the ten processes of TTM divided into and which processes
fit into each category?
The ten processes are divided into two groups: cognitive processes
and behavioral processes.
Consciousness raising, dramatic relief, self-reevaluation,
environmental reevaluation, and social liberation are cognitive and
stimulus control; helping relationships, counter conditioning,
reinforcement management, and self-liberation are behavioral
Define consciousness raising
Consciousness raising is the process whereby people obtain
information about themselves and the problem behavior. It is the
process of becoming aware of the problem and the causes and
consequences of continuing a particular behavior.
Define dramatic relief
Dramatic relief, also referred to as emotional arousal, is being able
to express feelings about or react emotionally to the behavior in
question and the possible solutions.
Define environmental reaction
The process of environmental reevaluation is looking at the behavior
being changed (old behavior) in light of its impact or effect on the
physical and social environments.
Define social liberation
Social liberation is the process whereby options or alternatives are
sought that support the new behavior.
Self-reevaluation is the process in which people look at themselves
with and without the problem behavior and assess the differences in
Define stimulus control
Stimulus control is when people remove the cues or triggers for the
problem behavior from their environment.
Define helping relationship
Helping relationships are relationships with people who act as a
support system for changing the unwanted, unhealthy behavior
Define counter conditioning
In counter conditioning, a healthier behavior is substituted for the
Define reinforcement of management
The process of reinforcement management has to do with rewards and
punishments. Although unwanted behavior can be changed through the
fear of punishment or negative consequences (as any child will tell
you), rewards for engaging in the targeted behavior are more natural.
The reward can be from the person to himself or herself, or from
When using the process of self-liberation, people choose to change
their behavior, believe they can, and commit to making the change. In
self-liberation, people free themselves from a behavior in which they
no longer choose to engage.
Essence of Social Cognitive Theory
Behavior, personal factors, and environmental factors interact with
each other, and changing one changes them all.
Social Cognitive Theory
Social Cognitive Theory (SCT) is based on the concept of reciprocal
determinism, that is, the dynamic interplay among personal factors,
the environment, and behavior. The way in which people interpret their
environment, and their personal factors, affect their behavior, their
behavior affects their personal factors, which can affect their
environment, and so on. The point being that changing one of these
three factors, changes all of them, and therefore changes behavior.
Theoretical constructs of social cognitive theory
Self-efficacy, expectations, self-regulation, observational learning,
expectancies, emotional arousal, behavioral capability, reinforcement,
locus of control.
Why is expectation important in social cognitive theory?
Behavior is influenced by expectations. This construct suggests that
people behave in certain ways because of the results they expect.
Observational learning (modeling)
Learning by watching others.
The likely outcome of a particular behavior.
The value placed on the outcome of the behavior
The emotional reaction to a situation and its resulting behavior.
The knowledge and skills needed to engage in a particular behavior.
The rewards or punishments for doing something
Locus of control
One�s belief regarding one�s personal power over life events
Meshing the previous two constructs, self-efficacy and expectations,
and adding goal setting gives rise to the construct of
self-regulation. Self-regulation occurs when people form beliefs about
what they can do, anticipate the likely outcome of their actions, set
goals, and plan a course of action that will result in the expected outcome
The construct of behavioral capability tells us that if people are to
perform a certain behavior, they must have knowledge of the behavior
and the skills to perform it. Simply put, before doing something, you
have to know what it is you�re going to do and know how to do it.
Internal control perspective
Internally controlled people believe that everything that happens to
them is a result of their own decisions and behaviors.They believe
they have control over all aspects of their lives and their destiny.
External control perspective
Externally controlled people believe that forces outside of their
control, such as fate, God�s will, or important or powerful others,
govern all aspects of their lives.