HEALTH PSYCHOLOGY 3 rd Edition Marks Murray Evans

HEALTH PSYCHOLOGY 3 rd Edition Marks Murray Evans Estacio Chapter 6 Theories, Models and Interventions Applied to Sexual Health Los Angeles | London | New Delhi Singapore | Washington DC

Chapter 6 Theories, Models and Interventions Applied to Sexual Health ● ● ● ● Incidence and Prevalence of STIs, HIV and AIDS Knowledge, Awareness and Condom Use Individual-Level Theories and Models The Health Belief Model Protection Motivation Theory of Reasoned Action Theory of Planned Behaviour The Information–Motivation–Behavioural Skills Model The Common Sense Model The Transtheoretical Model or Stages of Change Model Social Cognitive Theory Meta-Analyses Critique of Individual Level Approaches Summary Health Psychology (3 rd edition) Marks Murray Evans Estacio Los Angeles | London | New Delhi Singapore | Washington DC

Incidence and Prevalence of STIs, HIV and AIDS ● In the UK, the incidence of STIs has been steadily rising since the 1990 s. ● 399, 738 new cases of STIs were reported in 2008. ● More than half of STIs diagnosed in the UK occur in people aged 16– 24. ● Until 2009, over 102, 000 people in Britain have been diagnosed with HIV. ● Prevalence of HIV across the globe has been rising steadily with the majority (67%) in Sub-Saharan Africa. Health Psychology (3 rd edition) Marks Murray Evans Estacio Los Angeles | London | New Delhi Singapore | Washington DC

Knowledge, Awareness and Condom Use ● A National AIDS Trust (2008) survey showed widespread ignorance about STIs and HIV, for example, 1 in 5 people in the UK couldn’t identify how HIV is transmitted. However, there was an increase in the number of people using condoms in a relationship until ‘we’ve both been tested for STIs and HIV’. ● Other research has showed that 57% of young people in south-east Asia know little about HIV and AIDS as compared to 74. 3 % of young Africans. ● Randrianasolo (2008) suggested barriers to using modern contraceptives were: gaps in knowledge; misinformation and negative perceptions; concern about social opposition. Health Psychology (3 rd edition) Marks Murray Evans Estacio Los Angeles | London | New Delhi Singapore | Washington DC

Individual-Level Theories and Models ● Use theoretical concepts and models as a basic for studying people’s actions and choices – ‘top-down’ approach. ● Eight main theories which have informed interventions targeted at individual sexual risk taking: • • Health Belief Model Protection Motivation Theory of Reasoned Action Theory of Planned Behaviour The Information–Motivation–Behaviour Skills Model The Common Sense Model The Transtheoretical Model Social Cognition Theory Health Psychology (3 rd edition) Marks Murray Evans Estacio Los Angeles | London | New Delhi Singapore | Washington DC

The Health Belief Model (Rosenstock, 1966) ● A cognition model which examines the predictors and precursors to health behaviour. ● The model contains 4 constructs: 1) Perceived susceptibility; 2) Perceived severity; 3) Perceived barriers; 4) Perceived benefits. ● Cues to action (prompts to take action consistent with intention) also influence the likelihood of behaviour. ● More recently, additional factors such as demographic, psychosocial and structural factors have been added to the model. Health Psychology (3 rd edition) Marks Murray Evans Estacio Los Angeles | London | New Delhi Singapore | Washington DC

Protection Motivation Theory (Rogers, 1983) ● Describes coping with a health threat in light of threat appraisal and coping appraisal. ● According to PMT, behaviour change is best achieved by appealing to an individual’s fears. ● Poses four constructs: 1) Perceived severity of a threatened event; 2) Perceived probability of occurrence (vulnerability); 3) Efficiency of the preventative behaviour; 4) Perceived self-efficiency. ● Takes account of both costs and benefits of behaviour in predicting the likelihood of change. Health Psychology (3 rd edition) Marks Murray Evans Estacio Los Angeles | London | New Delhi Singapore | Washington DC

Theory of Reasoned Action (Fishbein & Ajzen, 1975) ● Includes three constructs: 1) Behavioural intention; 2) Attitude; 3) Subjective norm. ● Based on the assumption that a person is likely to do what (s)he intends to do. ● Assumes that a person’s behavioural intention depends on the person’s attitude about the behaviour and subjective norms. Health Psychology (3 rd edition) Marks Murray Evans Estacio Los Angeles | London | New Delhi Singapore | Washington DC

The Theory of Planned Behaviour (Ajzen, 1985) ● Acknowledges that not all behaviour is under volitional control as implied by the Theory of Reasoned Action (TRA). ● Added the variable of ‘perceived behavioural control’ to the TRA model. ● Proposes that perceived behavioural control can influence intentions and behaviour directly. ● Reviews of this model suggest that important factors are missing, for example, culture and religion. Health Psychology (3 rd edition) Marks Murray Evans Estacio Los Angeles | London | New Delhi Singapore | Washington DC

The Information–Motivation–Behavioural Skills Model (Fisher and Fisher, 1992, 2000) ● Focuses on informational, motivational and behavioural skills found to be associated with sex-related behaviours. ● Suggests that the learning of sexuality-related information is a prerequisite to action in these areas. ● Assumes that having the motivation to practise specific sex-related behaviours is necessary for the production of problem-prevention or wellness promotion. ● Sexuality-related behavioural skills are a fundamental determinant of acting effectively to avoid sexual problems. ● Fits well with successful intervention strategies such as motivational interviewing. Health Psychology (3 rd edition) Marks Murray Evans Estacio Los Angeles | London | New Delhi Singapore | Washington DC

The Transtheoretical Model or Stages of Change Model (Prochaska & Di. Clementi, 1982) ● A highly influential model in the literature on health behaviour change. ● Hypothesizes six discrete stages of change people progress through: 1) Precontemplation – no action intended; 2) Contemplation – intention to change in the next 6 months; 3) Preparation – intention to change in the immediate future; 4) Action – making specific overt modifications; 5) Maintenance – working to prevent relapse; 6) Termination – zero temptation, 100% self-efficiency OR Relapse – reverting back to original behaviour. Health Psychology (3 rd edition) Marks Murray Evans Estacio Los Angeles | London | New Delhi Singapore | Washington DC

The Common Sense Model (Leventhal et al. , 1980, 2003) ● Aka The Self-Regulatory Model. ● A key construct is the idea of illness representations or ‘lay’ beliefs about illnesses. ● Five components of illness representations: 1) Identity; 2) Cause; 3) Time-line; 4) Consequences; 5) Curability/controllability. ● Offers no guidance for the design of interventions. Health Psychology (3 rd edition) Marks Murray Evans Estacio Los Angeles | London | New Delhi Singapore | Washington DC

Social Cognitive Theory (Bandura, 1986) ● Examines the social origins of behaviour in addition to the cognitive thought processes that influence human behaviour and functioning. ● Bandura posed two basic constructs of SCT: • Observational learning: Suggests that people can learn by observing others. May or may not be demonstrated in behaviour; • Perceived self-efficacy: people’s beliefs about their capabilities to produce levels of performance that exercise influence over events in their lives. Determines how people think, feel, motivate themselves and behave. Health Psychology (3 rd edition) Marks Murray Evans Estacio Los Angeles | London | New Delhi Singapore | Washington DC

Meta-Analyses ● Albarracín, Johnson, Fishbein and Muellerleile (2001) metaanalysed data on the ability of the TRA and TPB to predict condom use. Consistent with the TRA and TPB, condom use was correlated with intentions. However contrary to the TPB, it did not correlate significantly to condom use. ● Albarracín, Gillette, Earl, Glasman, Durantini and Ho (2005) tested the main theoretical assumptions in models of behaviour change in contrasting ‘passive’ and ‘active’ HIV-prevention interventions. ● Findings showed that perceived behavioural control correlated significantly with condom use intentions however not with condom use. Health Psychology (3 rd edition) Marks Murray Evans Estacio Los Angeles | London | New Delhi Singapore | Washington DC

Critique of Individual-Level Approaches ● Individualistic bias ● Lack of ecological validity: most samples used are too small to make generalizations. ● Neglect of culture, religion and gender ● Tautological and unfalsifiable ● Unsupported assumptions: stage definitions are logically flawed ● Procedural issues: use of questionnaires ● Neglect of motivation. Health Psychology (3 rd edition) Marks Murray Evans Estacio Los Angeles | London | New Delhi Singapore | Washington DC

Summary ● Sexual activity is associated with STI and HIV risks. ● Incidence and prevalence of STIs and HIV is increasing. ● Individual-level theories are based on universal constructs concerning behavioural adoption, maintenance and change. ● Meta-analyses have tested individual-level theories and models with mixed success. ● Critics have suggested that individual-level theories and models are fundamentally flawed. ● An alternative approach is the community level of analysis, which is bottom-up and flexible. ● The community-level approach is difficult to evaluate using traditional evaluation methods and designs. Health Psychology (3 rd edition) Marks Murray Evans Estacio Los Angeles | London | New Delhi Singapore | Washington DC