Health Behavior Models

Personal Reflection Module 2

     Public health promotion and prevention are more successful when interventions are developed with an explicit theoretical foundation (Glanz, 2015).   Individual health behaviour models and theories attempt to explain behavior and how to influence and change behavior that have negative effects on our overall health and economics (Rootman et al., 2012).   The models studied are broad theories of explanatory and change models, each having its own intervening strengths to help different public health issues and behaviors (Glanz, 2015).  For example, the health behavior model is a value expectancy model used to evaluate or influence an individual’s behavior change demonstrating an ontological view that relies heavily on an individual’s freewill (Scotland, 2012).  The Social cognitive theory (SCT) can be argued in a more epistemological view that emphasizes activity of the mind in the construction of knowledge or the individual acquired and justified knowledge for a behavior (Scotland, 2012).  

      The theories have been rooted around the social determinants of health and the effects of health behavior and largely ignore the social context in which the behavior is enacted. The interventions of social, cultural and economic factors at an individual level are not the only target in behavior change, but interventions should be made to include interpersonal, organizational and environmental factors (Triandis,1999).  As explained by Harper and et al (2014), when examining the health behaviors of the Inuit with gastrointestinal illness, not only do the SDOH such as food quality/preparation and health literacy play a role in prevention and promotion, practitioners must also consider interpersonal aspects especially with the elder’s role in healing or use of traditional medicine and access to health care.  Although Harper et al. (2014) recommends considering the environment as an issue to health promotion it is an aspect of population health.  Another aspect of consideration is that of a sustainable environment. Trevor Hancock (Ch8, Rootman et al., 2012), clearly suggests the environment is more concerned with protecting ecosystems that will prevent the decline of societies and health as a prospective of Global Health.  Our excessive pollution and waste not only destroy other ecosystems but contribute to the prevalence of disease in people, crops, water supply (McDonald, 2010).

      The theories rely on self efficacy for a positive behavior change (Glanz, 2015).  Some theories lack focus on the social contexts and its effects on behavior. The Trans theoretical model (TTM) has a greater emphasis on the individual’s needs and motivation in that the interventions can be tailored to meet them. The TTM model as per Kushnir et al. (2016) states that autonomous motivation such as a high level of self efficacy is a great determinant in an individual’s willingness to change and move along the continuum of the TTM stages to quit gambling compared to external factors.  Although, it should be noted that many external factors can influence the addiction to gambling such as friends that gamble or ease of accessibility with online gambling. The SCT and Theory of Reasoned action model extends its focus to include how coping mechanisms and emotions can affect self efficacy and social norms that may ultimately deter a change for positive health behavior (Glanz, 2015). The one draw back of the individual behavior models studied in relation to social contexts is the lack of cultural awareness, sensitivity and health literacy (Wells, 2010).  

      The greatest challenge as a health professional is understanding and implementing the theories to apply to the issue and the individual as children, teens, adults, communities or on a global scale (Abramson, 2013). The practitioner must also realize that the theory used must best represent the individual’s present knowledge, interests, attitudes and readiness to learn (Abramson, 2013).  Self evaluation is considered a priority for the individual to move towards goal settings and behavior change (Glanz, 2015).  The practitioner must also continue to re-evaluate the individual’s attitude towards new knowledge that may require implementing a different theory or parts of many theories (Abramson, 2013).   New challenges are emerging in Canadian public health today in a complex social aspect with health behavior change due to cultural and economic inequalities from individual to global health (Eisen, 2015).   I have experienced in my work as a primary care nurse, with the influx of immigrants to Winnipeg, a lot of the visits in clinic is learning the cultural beliefs and teaching in a context that supports the cultural and still promotes healthy behaviors.

      The idea of social networking as a barrier or positive influence in health behaviour is first introduced in the SCT stating behaviour and social networking can act in a reciprocal manner (Glanz, 2015). Social support with networking includes real or perceived resources provided by others that enable a person to feel cared for, valued, and part of a network of communication and mutual obligation  (Glanz, 2015).  A strong social network with health care practitioners can enhance communication regarding chronic disease and unhealthy behaviours.  With a developed sense of trust, a person is more likely to accept knowledge received and act on it.   Individuals also benefit from a strong relationship with friends, family and support groups to help with coping and stress management (Glanz, 2015).  An individual’s social supports are an important counterpart to behaviour and change, a practitioner and individual must also consider and reassess the influences of social networks.   The strength of social networking is evident in B.C. with the supervised injection clinics as people have created better lifestyles for themselves with employment and homes with clinics that help with coping due to addiction (CBC Radio Broadcast, 2017), with the fentanyl crisis expanding in Winnipeg, the possibility of safe injection sites may be beneficial, although most fentanyl overdoses I have experienced in ER and ICU are  in first time users such as teens and early 20 something individuals.  Education has increased about fentanyl in Manitoba mostly through non-government programs such as police and doctors to health care workers. The public has opposed the idea of safe injection sites based.  Public programs may have a greater health effect if they build on positive social interactions at a community level to build empowerment within the community and the individual.