BEHAVIOUR AND HEALTH

CHARACTERISTICS OF HEALTH BEHAVIOUR

Background-

During 19th century modern medicine was established.

In 1865, Darwin wrote “Origin of species” which identified a place for man in
nature, suggesting that we are biological entities.
Darwin’s idea was in accord with the Biomedical model (which described
humans as biological entities and health and illness as pure biological
phenomenon.
20th Century brought significant developments- emergence of psychosomatic
medicine, behavioural health, behavioural medicine and most recently the
health psychology.
These developments challenged the mind body split and suggested a role of
mind in both cause and treatment of illness.
Now this opened the door for the study of health related beliefs and
behaviours.
The need of studying health behaviours:
The role of behaviour:
Over the past century health behaviours have played an increasingly important role in
health and illness. This relationship has been studied extensively by McKeown (1979)
throughout the twentieth century). He mentioned that illness is caused by the way in
which the individual determines his own behaviour (smoking, eating, exercise, and the
like). He also mentioned that, heath primarily depends on modification of such personal
habits (McKeown 1979).

Behaviour and mortality:

It has been suggested that 50 per cent of mortality from the ten leading causes of death
is due to behaviour. This indicates that behaviour and lifestyle have a potentially major
effect on longevity (though longevity differs cross culturally).

Longevity:
Belloc and Breslow (1972) worked on health behaviour that increases longevity. They
found out 7 such behaviours-
1 Sleeping 7–8 hours a day.
2 Having breakfast every day.
3 Not smoking.
4 Rarely eating between meals.
5 Being near or at prescribed weight.
6 Having moderate or no use of alcohol.
7 Taking regular exercise
As health behaviours are seen to be related to mortality and longevity, health
psychologists have therefore concentrated on studying health related behaviours.

Main Concept:
Health behaviour is any activity people perform to maintain or improve their health,
regardless of their perceived health status or whether the behaviour actually achieves
that goal. Kasl and Cobb (1966) defined three types of health-related behaviours. They
suggested that:
A health behaviour /well behaviour is a behaviour aimed to prevent disease (e.g. eating
a healthy diet)
An illness behaviour/ symptom based behaviour is a behaviour aimed to seek remedy
(e.g. going to the doctor)
A sick role behaviour is any activity aimed to get well (e.g. taking prescribed medication,
resting).

Health behaviours were further defined by Matarazzo (1984) in terms of:

■ health-impairing habits, which he called ‘behavioural pathogens’ (e.g. smoking, eating
a high fat diet), or
■ health protective behaviours, which he defined as ‘behavioural immunogens’ (e.g.
Attending a health check).
 Characteristics of Health Behaviour

We shall try to analyze the characteristics of health behaviours, how they operate, what
factors influence them to change using the idea of determinants of health behaviours.

GENERAL CHARACTERICTICS OF HEALTH-RELATED BEHAVIOURS:

1. Learning tend to influence health behaviours-
one feature of health behaviours is that they follow the general principles of learning.
Using the principles of reinforcement and punishment, that is by providing consequences,
such as praise or complaints, for a behaviour; or by modeling it; and conveying a value for
good health, health behaviours can be instilled in children which , if exercised regularly
will become health habits.

2. Health behaviours are also influenced by social and personality factors-

Many health-related behaviours are affected by social factors (Thirlaway & Upton, 2009).
Friends and family can encourage or discourage children’s practice of health-related
behaviours, such as smoking and exercising. Two other factors that are associated with
health behaviour are the person’s personality and emotional state, particularly stress. For
example, Conscientiousness which is a personality characteristic (the tendency of a
person to be dutiful, planful and organized,) is associated with practicing many health
behaviours.
3. Health behaviours are product of individual’s perception and cognition-
A general trend that happens is that when perceived symptoms are severe, people
usually seek immediate intervention, but when symptoms are not so severe, many
people often tend to ignore. This reaction of ignoring the problem to seeking/practising
health behaviours depends on the perception of that individual. Cognitive factors also
plays a role here. People who have correct knowledge/awareness about health issues
usually adheres to good health habits.

4. Unrealistic Optimism influences Health behaviours-

Another characteristic of health behaviour is that it is impaired by what is called
unrealistic optimism, that is, an inaccurate perception of risk and susceptibility, or in
other words, the belief of people that they are less likely to get the health problem.
Weinstein (1982) described four cognitive factors that contribute to unrealistic
optimism: (1) lack of personal experience with the problem; (2) the belief that the
problem is preventable by individual action; (3) the belief that if the problem has not yet
appeared, it will not appear in the future; and (4) the belief that the problem is
infrequent.
5. Motivational Factors determines health behaviours-
People’s desires and preferences influence the judgments they make of the validity
and utility of new information through a process called motivated reasoning (Kunda,
1990). Health behaviours are often performed according to the motivated reasoning
that we form. In one form of motivated reasoning, individuals often use biased
cognitive processes to support their unhealthy behaviours (for e.g. In case of eating
fatty foods or smoking cigarettes, people tend to use biased cognitive processes, they
search for reasons to accept supportive information and discount disconfirming
information. The reasons they choose seem ‘‘reasonable’’ to them, even if the logic is
actually faulty .

6. Health behaviours are often performed according to False Hope and Willingness-
It has been seen that sometimes individuals who don’t maintain a healthier behaviour,
try again. But why do they try in spite of the previous failure? The reason may be that
they develop false hopes, believing without rational basis that they will succeed (Polivy
& Herman, 2002). They form false hopes
because they did succeeded for a while, which is reinforcing to them, but then they fail
to sustain as they expect too large a change within a too short time. But they do not
understand it and instead think that they failed because they did not tried enough.
Also, sometimes people have a willingness to engage in a risky
behaviour. The reasons include- firstly, the positive subjective norms and attitudes
toward the behaviour (which we covered as part of the theory of planned
Behaviour). Secondly, if the individual has been engaged in the behaviour previously
and have a favourable social image of the type of person who would perform the
behaviour.

7. Health behaviours are often product of Emotional Factors-

Stress affects the cognitive processes people use in making decisions. Conflict
theory explains both rational and irrational decision making process under
stress.(Janis & Mann, 1977). According to this theory, the cognitive sequence that is
used in decision making starts when an event challenges their current situation. The
challenge can be either a threat or an opportunity. This produces an appraisal of
risk: if the person sees no risk, the behaviour stays the same, and the decision-
making process ends; but if a risk is seen, the process continues with a survey of
alternatives for dealing with the challenge and consequently the health behaviour
changes.
 THEORIES OF HEALTH BEHAVIOUR
The Health Belief Model:
According to the health belief model (Rosenstock 1966), health behaviours are result of
a set of core beliefs, which are the individual’s perception of:
 susceptibility to illness (e.g. ‘my chances of getting lung cancer are high’)
 the severity of the illness (e.g. ‘lung cancer is a serious illness’)
 the costs involved in carrying out the behaviour (e.g. ‘stopping smoking will make me
irritable’)
 the benefits involved in carrying out the behaviour (e.g. ‘stopping smoking will save me
money’)
cues to action, which may be internal (e.g. the symptom of breathlessness), or external
(e.g. information in the form of health education leaflets).
This model suggests that these core beliefs predict the likelihood of occurance of a
health behaviour.

The Protection Motivation Theory:

Rogers (1975) developed the protection motivation theory which claimed that health-
related behaviours are a product of four components:
1 Severity (e.g. ‘Bowel cancer is a serious illness’).
2 Susceptibility (e.g. ‘My chances of getting bowel cancer are high’).
3 Response effectiveness (e.g. ‘Changing my diet would improve my health’).
4 Self-efficacy (e.g. ‘I am confident that I can change my diet’).
Later in 1985, Rogers suggested a fifth component, fear (e.g. an emotional response).
These components predict behavioural intentions which are related to behaviour.
Theory of Planned Behaviour:
According to the theory of planned behaviour (Ajzen, 1985), people decide their
intention in advance of most voluntary behaviours. The factors that operate in this
planning are-
Attitude towards a behaviour,
Subjective norm
Perceived behavioural control.
According to the TPB, these three factors predict behavioural intentions, which are
then linked to behaviour.
The Stages-of-Change Model:
Prochaska and DiClemente(1982) suggested a model of behaviour change based on
the following stages:
1 Pre-contemplation: not intending to make any changes.
2 Contemplation: considering a change.
3 Preparation: making small changes.
4 Action: actively engaging in a new behaviour.
5 Maintenance: sustaining the change over time.
These stages, however, do not always occur in a linear fashion that is people do not
simply move from 1 to 5,but rather behaviour change is dynamic.
The Health Action Process Approach:
The health action process approach (HAPA) developed by Schwarzer (1992) suggests
that -
individuals initially decide whether or not to carry out a behaviour (the motivation
stage)
 and then make plans to initiate and maintain this behaviour (the action phase).
According to the HAPA, the motivation stage is made up of :
■ Self-efficacy (e.g. ‘I am confident that I can stop smoking’)
■ Outcome expectancies (e.g. ‘stopping smoking will improve my health’)
■ Threat appraisal, which is composed of beliefs about the severity of an illness and
perceptions of individual vulnerability.
The action stage is composed of- cognitive , situational and behavioural factors.
The integration of these factors determines the extent to which a behaviour is initiated
and maintained through self-regulatory processes.
 Managing health behaviours and Prevention

Till here we discussed who practices healthful behaviour and why? Or what are the
components or determinants of them. Now, the next segment of discussion is the
barriers to the health behaviour, which prevents us from following them. But before
we move there, We should have the idea of management of health behaviours in
terms of its prevention. Usually we think of prevention as occurring before an illness
takes hold. There are three levels of prevention, called primary, secondary, and
tertiary prevention. Each level of prevention can include the efforts of oneself in our
well, symptom-based, and sick-role behaviours; one’s social network; and health
professionals. Though there are three level, only one of which applies before a
disease or injury occurs and that is Primary Prevention.
Health behaviour management and Primary Prevention:

Instilling good health habits and changing/modification of poor ones is the task of
primary prevention. If we take measures to combat risk factors of illnesses before it
actually occurs, it will definitely result in better management of our health.

There are two functional strategies of primary prevention:

1. The first one is to make individuals alter their problematic health behaviours, such
as, helping people to lose weight, to help smokers to quit smoking.

2. The second and more recent approach is to keep people from developing poor
health habits, such as smoking prevention programs with young adolescents are
an example of this approach.
 BARRIERS TO HEALTH BEHAVIOURS
Health habits usually develop during childhood and adolescence when most people
are healthy. During that time very few individuals are concerned about what their health
will be after, say,30 years. As unhealthy behaviours such as, poor diet, and lack of
exercise have no apparent effect on health for years, so often bad habit makes its way.
So, along with a proper understanding of health behaviours, we should also know the
barriers that inhibits individual to attain good health.

Intrapersonal Factors :
Unhealthy behaviours are, often at times, pleasurable, automatic, addictive, and
resistant to change. Moreover, threatening messages delivered to change health
behaviours can produce psychological distress as a result of which individuals can
respond defensively. In this situation individuals may perceive a health threat to be
less relevant than it really is and they may inaccurately see themselves as less
vulnerable than other people. In this way emotions can perpetuate unhealthy
behaviours. So, it is one of the important barrier to the practice of health behaviours.
Four other factors within the individual are also important.
First, adopting wellness lifestyles may require individuals to change longstanding
behaviours that have become habitual and may involve addictions,( such as
smoking).Habitual and addictive behaviours are very difficult to modify
Second, certain cognitive resources are needed (such as the knowledge and skills) to
know what health behaviours to adopt, to make plans for changing existing behaviour,
and to overcome obstacles to change, such as having little time or no place to exercise.

Third, individuals need sufficient self-efficacy regarding their ability to carry out the
change. Without self-efficacy, their motivation to change will be impaired.

Last, being sick or taking certain drugs can affect people’s moods and energy levels,
which may affect their cognitive resources and motivation.

Interpersonal Factors:

Many social factors influence people’s likelihood to adopt health-related behaviours.

Such as, one partner’s exercising or eating unhealthfully before marriage can lead his or
her partner to adopt the same behaviour over time (Homish & Leonard, 2008). The
social influence probably involves individuals giving social support and encouragement
for the other person to change his or her lifestyle.
Instability of Health Behaviours:
 Health habits are often unstable and they are weakly related to each other. The
person who do regular exercises does not necessarily follow other health habits.
Therefore, health behaviours must be managed one at a time.
Health habits are unstable over time also. A person may stop smoking for a year but
again can start it during a period of high stress.
So the question naturally comes that why are health habits relatively independent of
each other and unstable? Four explanations have been offered-
First, different health habits are controlled by different factors. For example,
smoking may be related to stress or can simply be a imitated behaviour of a desired
person, whereas exercise depends heavily on one’s access to athletic facilities.
Second, different factors may control the same health behaviour for different
individuals. For example, one person’s overeating may be “social,” whereas another
person may overeat only when under stress.
Third, factors controlling a health behaviour may change over the history of the
behaviour .For example, smoking might be initiated by peer group pressure (social
factors), but over time, smoking may simply be maintained because it reduces
feelings of stress.
Fourth, factors controlling a health behaviour may change across a person’s
lifetime. In childhood, regular exercise is practiced because it is built into the school
curriculum, but in adulthood, the practice of it is totally dependent on the intention of
the individual.
Factors in the Community:
Individuals are more likely to adopt healthful behaviours if these behaviours are
promoted or encouraged by community organizations, such as governmental agencies
and the health care system. The larger community faces a multiple of problems in
trying to promote health behaviours and to prevent illness and injury.

These problems include- having insufficient funds for public health projects and
research, needing to adjust to and communicate with individuals of very different ages
and socio-cultural backgrounds, and providing health care for those who need it most.
So, it can be seen that health behaviours are elicited and maintained by different
factors for different individuals and these factors change over the lifetime as well as
over the course of the health habit. Consequently, health habit interventions have
focused heavily on those who may be helped the most—namely, children and
adolescents (Patton et al., 2012).

Intervening with Children and Adolescents:

Socialization: Development of proper health habits strongly depends upon the early
socialization process, specially on the influence of parents as they serve as both
teachers and role models. Basic health habits like brushing teeth regularly and
eating breakfast every day is instilled by parents. Although, in many families,
specially where parents are separated or there is highly stressful family situation.
Also, as children move into adolescence, they sometimes ignore these early training.
In addition, they might be exposed to alcohol consumption, smoking, drug use, and
sexual risk taking etc if their parents are not monitoring them very closely or their
peers practice these behaviours.

Using the Teachable Moment:

There are some teachable moments that arise through the course of development
when learning/modification is easier and better. Health Promotion often capitalize
on these teachable moments. For example, many such moments arise in early
childhood when parents can teach the basic safety behaviours.
Middle school is another important teachable moment. Several health related habits
(such as, food choices, dieting etc) crystallize around this time. There is also a window
of vulnerability for smoking and drug use during this time due to peer pressure.
Interventions through the schools may reduce these risks.
Pregnancy is another teachable moment for stopping smoking and improving diet.

Adolescent Health Behaviours and Adult Health:

An important to intervene with adolescents because , the health habits a person
practices as a teenager may determine his/her health status as adult, which chronic
diseases he/she will develops. For adults who make changes in their lifestyle, it may
already be too late. This is true for many diseases. Disorders such as coronary heart
disease may also be strongly affected by health habits in childhood and adolescence
as well.

Intervening with at risk people:

Another vulnerable group is who are at risk for particular health problems. For
example, individuals with family history of certain disorders. However there remains
some problem with intervening with at-risk people, as awareness of a risk factor
sometimes lead people to needless worry and hyper vigilant behaviours. People can
also become defensive, minimize the significance of their risk factor, and avoid using
appropriate services or monitoring their condition.
Health management and Older Adults:
Health management with older adults focus on several behaviours, such as-
•maintaining a healthy, balanced diet
•maintaining a regular exercise regimen
•taking steps to reduce accidents
•controlling alcohol consumption
•eliminating smoking
•reducing the inappropriate use of
prescription drugs
•obtaining some vaccinations
• remaining socially engaged and many more (Thomas, 2011).
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BOOKS TO REFER
THANK YOU