Motivation and emotion/Book/2013/Health behaviours

Health behaviours:
What are they and how can they be fostered?

Multimedia presentation (5 min)

Overview

The root of all health is in the brain. The trunk of it is in emotion. The branches and leaves are the body. The flower of health blooms when all parts work together.

- Kurdish Saying.

Do you ever feel like you aren't in the best health you can be because of your lifestyle, habits and excuses you make? Do you want to live you life as long and disease free as possible? Do you want to kick the smoking (or cupcake) habit, hit the gym more often or just generally look after you health better?

If you answered yes then you have come to the right wiki to help yourself not only become more motivated but also to teach you how to be healthy and commit to long term habits to improve your health. This wiki will teach you about what health behaviours are, what inhibits health behaviours, what motivates them, the major theorists behind health motivation and how to apply this to yourself and any situation where you need help with motivating and improving your health behaviour.

Do you practice healthy behaviours?

Did you score 4? Perfect! You practice great health behaviour to eliminate you from most major risks! Less than 4? Then you have identified areas where you need to improve you health behaviour, keep reading to find out how.

Health behaviours

Health means being in a state of physical, social and mental well being. A health behaviour is any activity undertaken which consequences are to improve or maintain the individuals health (Nutbeam, 1998). This means any activity that is done to foster, improve, restore or maintain a healthy condition or to prevent diseases; including any activity from diet and exercise, washing your hands, wearing a condom, taking prescribed medication or eating an apple everyday (Xu, 2009). The Australian Institute of Health and Welfare (AIHW) identifies that tobacco use, alcohol consumption, physical activity, dietary behaviour, use of illicit drugs, sexual practices and vaccinations are the key risk factors that contribute to chronic disease for Australians (AIHW, 2012), somewhat the opposite of a health behaviour. A health behaviour could even be considered as not participating in any of these behavioural risks.

A balanced diet should be full of colourful fruit and vegetables

Promoting positive health habits in your own life is important because not only will it increase your chance of survival but you will have an overall better wellbeing, mental health, self-esteem and general better quality and longer life (AIHW, 2012). Good nutrition through a balanced diet and sufficient physical activity will lead to increased immunity, better physical and mental development, greater productivity, improved bone, functional and mental health, aid in weight control and greatly reduce your chance of preventable disease and associated medical costs.
Poor health behaviours, or behavioural risks, can cause high blood pressure, excess weight, impaired glucose regulation and high blood cholesterol which all may lead to a number of preventable diseases. Twelve of these diseases are listed by AIHW (2012) as;

Ischaemic heart disease	Lung Cancer	Arthritis	Chronic obstructive pulmonary disease (COPD)
Stroke	Depression	Osteoporosis	Chronic kidney disease
Colorectal Cancer	Type 2 diabetes	Asthma	Oral disease

These examples of preventable disease are responsible for an increased cost to Australia well over $13 billion from 2005-2006 (AIHW 2010). Poor health also leads to increased levels of mental health problems such as stress, anxiety or depression as well as low self-esteem, poor immunity and sleep problems (AIHW,2012). Some of these preventable diseases are even in the top 10 leading causes of death in Australia (AIHW, 2012)

What motivates such behaviour?

It is important to understand what motivates good and bad health behaviours and to be able to predict health behaviour when developing interventions to change behaviour. There are four historically prominent theories of health behaviour motivation in psychology. These have been used to predict changes of general and health-protective behaviour. These four theories specify what determines the likelihood of an individual undertaking a ‘health-protective action’ or a health behaviour instead of their current behaviour. These theories assume that the ‘benefits’ of the new behaviour must outweigh the ‘costs’ of current behaviour (Weinstein, 1993). These benefits and costs include time, effort, money, convenience and satisfaction. These theories are known as motivational models for health behaviour; their primary focus is on what induces performance or lack thereof health behaviours. Most of these models focus on intention and are designed to predict behaviour at single points in time for example; next week. These models include the health belief model, protection motivation theory, social cognitive theory and the theories of reasoned action/ planned behaviour.

A good example is a smoker wanting to cease smoking, benefits of stopping would include all round better health and greater longevity, more money, less social stigma, more convenience by not smoking, paying for cigarettes, smoking around others and finding places you can smoke or buy cigarettes, but what are the costs of stopping smoking? This could include agitation, anxiety, depression, anger, increased appetite, drowsiness, headaches, nausea, the list goes on (Fiore, et al., 2008).

The health belief model

The Health Belief Model (HBM) was conceived by Rosentock in the 60’s to understand why people were failing to use disease preventatives and compliance to treatment. The health belief model has since been considered the most widely used theoretical frameworks in health behaviour today (Janz & Becker 1984).

Clemow, (2008) succinctly outlines the HBM as consisting of:

Perceived threat
- Susceptibility: the individuals risk of developing the condition. This can include general health problems, existing illnesses and complications or recurrent diseases.
- Perceived severity: how serious the individuals sees the illness, as well as the costs if left untreated. This can include physical consequences such as money, pain, death or social consequences like stigmatisation.
Perceived benefits: the what good will be gained from taking action, this can include reducing the disease threat as well as other benefits like saving money or becoming more aesthetically attractive.
Perceived barriers: anything that will impede the action, this includes discomfort or inconvenience from changing behaviour as well as expense or danger. Another perceived barrier can be competition, this includes with other more pleasurable activities or even other information. For example the common competing information of weather eating fatty food is good or bad for you. Strength or pleasure of bad habits are often barriers that impede health behaviours.
Cues to action: these can be either internal cues, like thoughts or emotions, or external such as reminders for screening tests on your calender or advertisments on TV. External cues can also be in social settings where friends or family are participating in health behavior.

It was also identified that social and psychological variables like health motivation, education or socioeconomic status may also be important modifiers of other variables listed. In a meta-anaylsis it was found that the most influential of these foundations in health motivation is the perceived barriers (Janz & Becker 1984) and although the effect sizes are small for all of the constructs they are all still statistically significant (Janz & Becker 1984). Critics of the HBM identify that the models foundations are poorly defined (Armitage & Conner, 2000) is based on the foundation that there is an abundance of cues to action which is most often not the case (Janz & Becker 1984). It also assumes that that health is a high priority for most people (Janz & Becker 1984).

Protective motivation theory

Protective motivation theory (PMT) was also developed in 1975 and its foundations are based on that the function of engaging in health behaviors is a result of motivation to protect yourself (Rogers, 1975). Protective motivation theory specifies what characteristics of a message will influence to arouse, sustain and direct behaviour and what processes motivate health behaviours (Rogers, 1975). These processes are:

- Severity of threat
- Vulnerability to threat
- How effective the alternate behaviour is to averting threat
- How effective the person is at implementing alternate behaviour

Rogers (1975) proposed that when one encounters a health threat from the environment two routes are taken to through the aforementioned processes. These routes are either; threat appraisal or coping appraisal, and from these routes it is determined weather a person will or will no express a maladaptive response (Rogers, 1975). A maladaptive response is a behavioural risk to health, as mentioned in detail above; this includes anything from substance abuse to not washing your hands. It was suggested that intrinsic and extrinsic rewards are what determine the chance of participation in these behavioural risks (Rogers, 1975). Critics of the protection motivation theory point out that the theory does not account for people’s individual differences and that if a person is uncertain about themselves and their environment to implement health behaviours they are less motivated than their more confident counterparts (Brouwers & Sorrentino, 1993)

Theory of reasoned action and theory of planned behaviour

The theory of reasoned action or (TRA) was developed in 1975 to explain the influence of action by beliefs and attitudes (Fishbein & Ajzen, 1975). It is identified that intention of action is the best forecast to behaviour, defined as an individuals cognitive readiness to perform and divided into three beliefs;

Behaviour; conviction of the consequences of a behaviour.
Attitudes; value of placed on self-performance of the particular behaviour.
Subjective norms; how others in their life view the behaviour

Criticisms of the TRA identify that the theory lacks in identifying if people believe they have the ability to perform an action (Armitage & Conner, 2001).

An example of TRA implemented would be if a person wishes to execute a physiotherapy plan of 3x 30 minutes daily stretching routine given to rehabilitate a sprained ankle. According to the TRA the individual must believe the plan will be effective, want to have a rehabilitated ankle and have their social network believe that’s how they will be rehabilitated. Here, some faults are identified in the TRA already the person could just as easily not implement the 90 minute daily physiotherapy plan and still see some improvement in their condition.

This is where the Theory of Planned Behaviour (TPB) (Ajzen, 1985) identified the need for perceived behaviour control, the difficulty of performing the particular behavior, this component links the intention to the capacity to perform. Further critics of the TRA and TPB pointed out that although attitudes, beliefs and behavioural control can predict behaviour often subjective norms are less effective at contributing to behaviour motivation. Examples of the TPB in health behaviours are listed below

Smoking (Norman, Conner & Bell, 1999)
Dieting (Armitage & Conner, 1999, Ellis Gardener, 2003),
Exercise (Atsalakis & Sleap, 1996, Budden & Sagarin, 2008, (Ellis Gardener, 2003)
Safe sex (Rye, Fisher & Fisher, 2001, Armitage & Talibudeen, 2010)

A meta analysis conducted in 2011 revealed that the type of behaviour moderated the effecicy of TPB. It was found that approximately 20% of variance could be predicted with physical activity and diety behaviours while only 15% of variance would be predicted for behaviors like detection, safe sex and drug abstinence (Robin, McEachan, Conner, Taylor & Lawton, 2011).

Social cognitive theory

The social cognitive theory proposed by Bandura (1986) is what he based on his 1998 motivation model of health behaviour on. The foundations are self-efficacy and situational and action expectations of outcomes. It predicts that behaviours are performed if you merely have confidence, control and few obstacles.

Outcome: the results
- Situation: some results are out of control.
- Action: actions are instrumental to results.
Self-efficacy: confidence in ability to implement action
Self-regulatory control: observation and conscious influence to change habits

Social Cognition theory will account for small to medium variance between behaviours and the strongest predictor of behaviour is again, self-efficacy (Armitage & Conner, 2000). The self-efficacy component is similar to what has been describes in PMT and TPB

Intrinsic

Intrinsic motivation is naturally occurring, when you enjoy something and you do it and you receive no reward a lot of people experience it when explaining their reasoning for an activity is 'for fun'. The reward for the behaviour is the behaviour itself (Ryan & Deci, 2000). Intrinsic motivation cannot be created but it can be facilitated through environments which support autonomy and competence (very similar to self-efficacy), or knowing actions are under your own control and you have the skills to reach and master your goals (Ryan & Deci, 2000).

Reading this self-help book would be an indication of perhaps having some intrinsic motivation to practice health behaviours, but not enough to foster behaviour without a little help. Your motivation may lie in the extrinsic category of motivation.

Extrinsic

Extrinsic motivation is participating in an action due to its outcome. This includes naturally occurring benefits or threats which have been explained above, practising good health for a better mind and body or to avoid illness. Other extrinsic motivation are rewards or punishments, which you can implement.(Ryan & Deci, 2000).

A good example of extrinsic motivation is giving yourself a new pair of shoes for every 5cm off your waist to motivate yourself to a healthy size through good nutrition and activity.

How can such behaviour be fostered?

As you can probably see, many of these aforementioned theories overlap in their foundations. By applying the knowledge you have learnt from the above theories you help can motivate yourself to participate in positive health behaviours. You will need to write the following down in application to your chosen behaviour in a dedicated notebook or journal- buy one with a calendar or weekly timetable to help.

Current maladaptive behaviour: By identifying what maladaptive, negative health behaviour or threat you want to address you can then appraise the following:

- Risks: how likely are you succumb to the costs of your negative health behaviour? Find some facts applicable to you and the behaviour you're addressing

- Costs: the costs of your negative health behaviour.

Keep all this information written down in the back of your journal, keep it simple and motivating.

A good example of identifying a maladaptive behaviour and addressing the risks and costs of such behaviour is demonstrated in the infamous and controversial scare campaign known as the Grim Reaper AIDS ad. The advertisement identifies the health behaviour of using condoms and practising safe sex; the risks of getting aids, is real to everybody and 50,000 people are now affected by the virus; and identifies the costs of the maladaptive behaviour by saying "if not stopped it could kill more australians than WWII"

Goal health behaviour: This should be the opposite of your maladaptive behaviour. If that is smoking, this should be not smoking; if your maladaptive behaviour is a bad diet then your goal health behaviour is good nutrition.
Knowing where you want to be, how you want to get there and how you have gotten to where you are are key to staying motivated. Just like climbing a mountain!

- Benefits: Think about, what current benefits do you get from your current maladaptive or risky behaviour; is it connivence, perhaps pleasure? Then do some research, what benefits do you get from changing the maladaptive behaviour to a positive health behaviour? Do they outweigh the current benefits?

- Value What is the value that you place on these benefits? For example, perhaps smoking currently gives you the immediate pleasure which you do value but growing old free of illness and watching your children grow up would be placed at a higher value than the immediate pleasure from cigarettes.

- Action Determine what actions you are going to set to change your behaviour. This may or may not be to a schedule and the schedule may be predesigned or one that you've made for yourself. See Goal setting for tips on where to begin.

- Results What do you want to achieve? Is is as simple as being able to eat better or do you want more energy or a smaller pant size? Results are like the benefits that you are aiming for but should be measurable for you.

Create a page in your journal for each of these, include pictures and information to help you achieve your goal. This could be anything from relaxation techniques if you are overcoming smoking to exercises and recipes if you want to practise better activity and nutrition

The Australian Governments initiative Swap It, Dont Stop It is a great example of giving a goal, demonstrating the benefits, proposing a value and potential results of a health behaviour, in this case good nutrition. The website has lots of resources including a 12 week schedule and tailored fact sheets that are customised to gender, season and region. This particular initiative could be adapted to nearly any health behaviour. "

Social support: most negative health behaviours will already be viewed as detrimental socially but make sure you tell your friends, family and significant others that you are planning on behaviour change (and are serious) and they should support you. Unfortunately in some cases such as smoking and alcohol cessation, social groups can have a negative effect on your behaviour change. Identify these situations early, or before they happen and assert your behaviour change firmly.
Cues to action: Social support can often naturally give you cues to action as well, friends asking how you have been with your behaviour change or pointing out your lapses. You still need to ensure that you have your own cues to action; your action schedule will help with this but ensure that you come into contact with it frequently. Good cues to action are reminders on your desk or calendar, apps on your smart phone and eliminating temptation of maladaptive behaviour. For example, don't keep large quantities of junk food at home or keep your gym bag in view at home.
Self-regulation: This again ties into action, cues to action and the schedule that you have planned. Make sure that you keep to your schedule, have realistic goals and maintain motivation through small rewards. If you have a bad day, there is always new opportunity the next morning. Stick to it!

Examples of health promotion campaigns

Physical health promotion campaigns

The Australian National Preventive Health Agency
Binge Drinking

Sexual Health
Sun Protection

Promotion of healthy eating

The Australian guide to healthy eating
Swapping bad for good
Shape up
The Australian dietary guidelines:

Choose amounts of nutritious food and drinks to meet your energy needs
Enjoy a wide variety of nutritious foods from these five groups every day:
1. Plenty of vegetables, including different types and colours, and legumes/beans
2. Fruit
3. Grain (cereal) foods, mostly wholegrain and/or high cereal fibre varieties, such as breads, cereals, rice, pasta, noodles, polenta, couscous, oats, quinoa and barley
4. Lean meats and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans
5. Milk, yoghurt, cheese and/or their alternatives, mostly reduced fat (reduced fat milks are not suitable for children under the age of 2 years)
6. And drink plenty of water.
Limit intake of foods containing saturated fat, added salt, added sugars and alcohol
Encourage, support and promote breastfeeding
Care for your food; prepare and store it safely

Promotion of exercise

The Australian physical activity guidelines:

Think of movement as an opportunity, not an inconvenience.
Be active every day in as many ways as you can.
Put together at least 30 minutes of moderate intensity physical activity on most, preferably all, days.
If you can, also enjoy some regular, vigorous activity for extra health and ﬁtness.

Mental and social health

There are no official mental health guidelines. But the Department of health offers several Mental Health programs such as Headspace which features information about

Similarly there are also no social health guidelines, and even less information about social health problems. Fortunately there are many independent programs in schools to address bullying. Headspace also offers information about

Relationships

Conclusion

Health is as a state of physical, social and mental well being. A health behaviour is anything done to improve or maintain your health or any activity that is done to restore health or prevent diseases. This can include nearly anything; no matter how small, or when, as preemptive or reactive to a health issue. Promoting positive health habits is important to it increase longevity, wellbeing, mental health, self-esteem and life quality. Activities that are detrimental to health are often referred to as maladaptive behaviours or health risks, these can lead to a number of preventable diseases.

It is important to understand what motivates good and bad health behaviours and to be able to predict health behaviour when developing interventions to change behaviour. There are four historically prominent theories of health behaviour motivation, which can predict changes of general and health-protective behaviour. These four theories specify what factors determine the likelihood of an individual participating in a health behaviour instead of their current behaviour. These theories assume that the ‘benefits’ of the new behaviour must outweigh the ‘costs’ of current behaviour and are include; health belief model, protection motivation theory, social cognitive theory and the theories of reasoned action/ planned behaviour.

Each have their own positives and negatives and they mostly have very similar components. By applying the knowledge of these theories behaviour you help can motivate yourself and organisations and implement interventions for the public to participate in positive health behaviours.

Other Related Book Chapters

External links

[1] Diet as a medicine: TED Talk by Dean Ornish
[2] World Health Organisation
[3] Department of Health
[4] Australian Insitute of Health and Welfare

References

AIHW 2010. Australia’s Health 2010. Australia’s health series no. 12. Cat. No. AUS 122. Canberra: AIHW

AIHW 2012. Risk factors contributing to chronic disease. Cat. no. PHE 157. Canberra: AIHW. Viewed 17 October 2013 http://www.aihw.gov.au/publication-detail/?id=10737421466

Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211

Armitage, C. J., & Conner, M. (2000). Social cognition models and health behaviour: A structured review. Psychology & Health, 15, 173-189.

Armitage, C. J., & Talibudeen, L. (2010). Test of a brief theory of planned behaviour-based intervention to promote adolescent safe sex intentions. British Journal of Psychology (London, England : 1953), 101(Pt 1), 155.

Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Prentice-Hall.

Bandura, A. (1998). Health promotion from the perspective of social cognitive theory. Psychology & Health, 13(4), 623-649.

Brouwers, M. C., & Sorrentino, R. M. (1993). Uncertainty orientation and protection motivation theory: The role of individual differences in health compliance. Journal Of Personality And Social Psychology, 65(1), 102-112. doi:10.1037/0022-3514.65.1.102

Clemow, L. (2008). Health Belief Model. In S. Boslaugh, & L. McNutt (Eds.), Encyclopedia of Epidemiology. (pp. 464-466). Thousand Oaks, CA: SAGE Publications, Inc. doi: 10.4135/9781412953948.n195

Ellis Gardner, R. (2003). Exercise and diet motivation of overweight women: An application of the theory of planned behavior. ProQuest, UMI Dissertations Publishing).

Fishbein, M., & Ajzen, I. (1975). Belief, Attitude, Intention, and Behavior: An Introduction to Theory and Research. MA: Addison-Wesley.

Fiore, M., Jaén, C., Baker, T., Bailey, W., Benowitz, N., Curry S., et al. (2008) A Clinical Practice Guideline for Treating Tobacco Use and Dependence: 2008 Update. A U. S. Public Health Service Report Am J Prev Med, 35 (2), pp. 158–176

Nutbeam, D. (1998) Health promotion glossary, Health Promotion International

Janz, N. K.; Becker, M. H. (1 January 1984). "The Health Belief Model: A Decade Later". Health Education & Behavior 11 (1): 1 47.doi:10.1177/109019818401100101

Norman, P., Conner, M., & Bell, R. (1999). The theory of planned behavior and smoking cessation. Health Psychology, 18(1), 89-94. doi:10.1037/0278-6133.18.1.89

Rogers, R. W. ( 1975). A protection motivation theory of fear appeals and attitude change. Journal of Psychology, 91, 93– 114

Ryan, R. M., & Deci, E. L. (2000). Intrinsic and extrinsic motivations: Classic definitions and new directions. Contemporary Educational Psychology, 25, 54-67. doi:10.1006/ceps.1999.1020

Rye, B. J., Fisher, W. A., & Fisher, J. D. (2001). The theory of planned behavior and safer sex behaviors of gay men. AIDS and Behavior, 5(4), 307-317.

Xu, X. (2009). Health motivation in health behavior: Its theory and application. ProQuest, UMI Dissertations Publishing

Weinstein, N. D. (1993). Testing four competing theories of health-protective behavior. Health Psychology,12(4), 324-333. doi:10.1037/0278-6133.12.4.324

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