Social Cognition And Health Belief Behaviours

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2nd May 2017 Psychology Reference this

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The definition of health behaviours are, any activity done by a person who believes himself as healthy so that he will prevent himself from disease or find it in the stage when it is asymptomatic (Kasl and Cobb 1966).The health behaviours study based on two premises, in nations who are industrialized the main causes of deaths are some behaviour patterns which can be changeable (Stroebe and Stroebe, 1995). People give much contribution in their health by adapting health improving behaviours like exercise and stay away from health loss behaviours like alcoholism. Social cognition is the sense made by individuals regarding social situations. The way targets on persons thoughts as process which takes place in seen stimulus and response given in those situations(Fiske and Taylor 1991).In recent years ‘social cognitive’ approach becomes dominant in the field of social psychology(Schneider 1991). Most of the work ,in social cognition divided into two types: person perception (how the peoples think about others) and self regulation (how they think about themselves) (Fiske and Taylor 1991).

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Self regulation includes the goal setting, cognitive planning, continuous monitoring and valuation of activities of goal direction. There are two common phases: motivational and volitional (Gollwitzer1990). The motivational phase involves the calculation of bonus and expectations to choose in between goals and consequent actions. This stage finishes with a decision regarding pursuing the goal. The volitional phase involves plan and action to achieve the goal which is already set.

Social cognition models (SCMs) depicts the essential cognitions and relationships in-between them to understand health behaviours. Social cognition models analyse factors which are predicting behaviour or intentions and analyse why persons not able to maintain a committed behaviour. Bandura (1977, 1986) developed social cognition theory and proposed that behaviour is controlled by expectancy, incentive and social cognition. There are five commonly used social cognition models: Health belief model, Protection motivation theory, Theory of planned behaviour, Theory of reasoned action and Transtheoretical model.

Health belief model: This is the oldest and mostly used model in the field of health psychology; developed formerly by Rosenstock (1966), and afterwards by Becker (1974).They developed this model to explain why few people don’t use prophylactic health behaviours such as immunization and screening and the particular behavioural reaction for the betterment of their health. The health belief model is the conclusion of four specified core beliefs. The primary core beliefs are the person’s perceptions of: risk to get ill, its severity, the cost and benefits for carrying that behaviour, and cues to that action which are either external or internal. After criticism the HBM has been revised and health motivation is added and recently perceived control was also added in this model (Becker and Rosenstock, 1987).

In health related behaviour like cervical cancer screening, the HBM anticipate screening test if a person thoughts that she is highly sensitive to cervical cancer, it is severe threat to her health, the screening benefits are high and cost of that action is low and she is subjected to cues to action if she got reminder from GP or read a leaflet in GP’s waiting room. According to new amended HBM, the model also hypothese that a lady go for screening if she is aware of health motivation and is confident that she has to do this. Norman and Fitter (1989) analyze health behaviours in screening and establish that perceived barriers are the major causes of attendance in clinics. Many studies analyzed self examination of breast behaviour and shows that barriers (Lashley, 1987, Wyper, 1990) and perceived susceptibility (Wiper, 1990) are the known predictors of behaviour which is healthy. Research shows that safer sex, taking vaccinations, regular dental checkups and regular exercise are the person’s perception of susception to relative health problem, his belief in severity of problem and his hypotheses that benefits of prevention dominates the cost.(Becker 1974,Becker et al.1977,Becker and Rosenstock 1984)

Protection Motivation Theory (PMT): The Protection motivation theory was initially proposed by Rogers (1975) to state how persons responded to fear originating threats to health. There are four main components of the protection motivation theory:

The severity of the threatened disease(If a person thought Cervical cancer is critical disease then she is afraid of this then she think to do screening test this will change her health behaviour)

The probability of the disease (e. g .If she thought her chances of getting cervical cancer are more, she will be more aware of screenings)

Response effectiveness ( Screenings and following the instructions of GP improve my health)

The perceived self efficacy like person’s own confidence.

Rogers (1985) also suggested a fifth component, which is fear (emotional response to health behaviour).

The protection motivation theory depicts susceptibility, severity and fear related to threat appraisal, and response effectiveness and self efficacy related to coping appraisal. According to PMT sources of information are of two types: environmental (Observational and verbal learning) and intrapersonal (previous experience). This information affects five components of this theory. This creates ‘adaptive’ coping response or ‘maladaptive’.

In case of change in diet, the PMT gives following hypotheses: telling the fact that taking diet of high fat, cause coronary disease and this would raise fear; knowing how critical is this disease (perceived severity) and raises the belief of the person about having heart attack (susceptibility). If the person is confident in change his diet (self efficacy) and this would have useful results (response effectiveness), they would have more aims for changing their behaviours. All this is adaptive coping response to the given knowledge.

The Theories of reasoned action (TRA): This model was majorly used for analysing predictors of behaviours. It was debateable model within social psychology dealing the relationship between attitudes and behaviour (Fishbein 1967, Ajzen and Fishbein 1970, Fishbein and Ajzen 1975). The TRA advised that the proximal cause of willing behaviour is the person’s intention to follow that behaviour. Intentions show individuals motivation of his conscious decision for doing that behaviour. Attitude towards behaviour show their affect on performance of the behaviour through their affect on intentions.

According to the study done by Cochran et al. (1992) with 297 men by using theory of reasoned action to find the attitude-behaviour relationship in relation to safe sex. They noticed that like TRA prediction, the result give a positive attitude regarding safe sex and this helps in lowering the HIV infection.

The TRA extensively used in oral contraceptive use (Davidson and Jaccard 1979, Werner and Middlestadt 1979, Doll and Orth 1993) and other types of contraception’s (McCarty 1981, Pagel and Davidson 1984), and specifically in the use of condoms regarding threat of HIV in case of heterosexuals (Chan and Fishbein 1993, Terry et al., 1993a) and homosexuals ones (Fishbein et ak., 1992).

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So, in TRA attitude and subjective norm used as instant intention and behaviour predictors. The impact of previous behaviour is not included by subjective norm and attitudes in Theory of reasoned behaviour. In 1982, Bentler and Speckart suggest to add past behaviour in this model.

Theory of planned behaviour (TPB): The theory of planned behaviour is the further extension of theory of reasoned action (Fishbein and Ajzen1975, Ajzen and Fishbein 1980).The theory of planned behaviour shows a model which is developed by social psychologists which is used to understand different behaviours (Ajzen1988, 1991; Conner and sparks).Theory of planned behaviour has three actions:

Attitude towards a behaviour, having both positive and negative evaluations and its outcomes (like exercise is sport and it will make my life better. With this thought person change his/her health behaviour and start doing exercise for good health).

Subjective norm, hypothese of social norms and pressure for a particular behaviour (like people who are important for me, will say to me to lose weight and I want their words. Because he didn’t care other people and only these are the people who were important for him and going to change his behaviour).

Perceived behaviour control, is made of a particular belief for a particular behaviour on basis of internal (skill, ability) and external (obstacles, opportunities) control factors, those related to past behaviour.

According to theory of planned behaviour, the above 3 factors predict behavioural intentions, which associate to behaviour.

As in case of consumption of alcohol theory of planned behaviour make the given predictions: If a person thought that alcohol reduction makes his life productive and good for his health (attitude towards behaviour) and thought that persons who are valuable in his life wants him to cut down (subjective norm), and believe that he was able to drink less because of his past behaviour and analyzation of internal and external control factors, then this gives high intentions to reduce the intake of alcohol and changes his health behaviour.

Transtheoretical Model: It is developed by Prochaska and DiClemente (1982) showing the processes involved in creating and maintaining the behavioural changes. These are five in number: Precontemplation- person not even think to change the behaviour, Contemplation-person’s mind is thinking to change the behaviour, Preparation- small changes happened, Action- start moving in new behaviour, Maintenance- keeping the changed behaviour with time. These stages applied in so many health behaviours like smoking, use of alcohol, exercise and screening behaviour (DiClemente et al, 1991, Marcus et al, 1992).

People changes their behaviour according to these stages or some time revert to primary stage.50-80% persons who stops smoking relapse in one year because of their weak maintenance stage. In this particular stage person target on profits (after quitting smoking he feel good).In primary stages people mostly targets on cost. If person will power is not good then he is unable to maintain the maintenance stage and revert back to the smoking behaviour. For quit smoking his internal locus of control will be strong (DiClemente et al., 1991, Marcus et al., 1992).

Empirical Research: Hill et al. (1985) done a comparison between Health Belief Model (HBM) and Theory of reasoned action (TRA) regarding the breast self examination and cervical screening test. The two models were found predicting aims explaining in between 17 and 20% of discrepancy in self breast examination and 26-32% in cervical screening test intentions. In the health belief model the more number of constructs were measured that’s why it is found more predictable of discrepancy in every case (Hill et al, 1985).Mullen et al.(1987) examined the power of TRA and HBM to predict changes in health behaviour over the period of eight months. Both models found to create significant changes in health behaviours. Mullen et al. (1987) also found that HBM was economical in prediction of behaviour change and it needs average of 23 items for measure its construct as compare to32 items required in TRA. The studies showed HBM slightly superior model in comparison to TRA while some other studies suggested reversed conclusion. As an e.g., Oliver and Berger (1979) suggest TRA as a superior predictor of inoculation behaviour whereas Rutter (1989) found it better in AIDS preventive behaviour. Conner and Norman (1994) examined the causal factor in attendance at the health checks and got all the models at similar level in predictions and health behaviour. According to Bakker et al. (1994) TPB is much predictive in case of condom use in heterosexuals. S

According to American cancer society 1 out of 9 ladies develop cancer of breast in her life (American Cancer Society, 1993). Breast carcinoma cannot be prevented because its aetiology is not understood properly. In early detection that is by, breast self examination through manual palpation for any abnormal breast lumps, chances of survival is more (Hill et al., 1988, GIVO Interdisciplinary Group for Cancer Care Evaluation, 1991) . Even so, this is noticed that even after motivation mostly ladies didn’t do breast self examination. According to Clarke et al. (1991) even 61% of ladies who visits Breast self examination (BSE) sessions thinks to do BSE and only 22% actually do that.

Now a days, cervical cancer is major cause of mortality in ladies is always fatal when it is cancer in situ (World Health Organization, 1986, 1987). It is evaluated that if ladies were regularly screened after 3 years, the mortality rate could be decreased to 70-95 %( Greenwald and Sondick, 1986).In cervical smear test microscopic examination of cells of cervix done for detecting any abnormalities which if not treated may turn to cancerous. According to National Audit Office (1998) survey 10-32% women unscreened who are eligible for cervical cancer screening. Same figures found in USA (Hayward et al., 1988, Lantz et al., 1997, Ruchlin, 1997). The longitudinal study in cervical screening (Orbell and Sheeran, 1998) found that 43% of women actually done screening even after invitations got from their GP.

Conclusion:

These models and theories can used to adopt certain health related behaviours according to the situation. Either the models provide clear theoretical framework to understand health behaviour, these models direct us to neglect the variables which are very important in understanding health behaviour. Another thing is that these models provide us targets designed for behaviour change, they don’t define how such cognitions are changed. Every model has some limitations but they are somewhat reliable for adopting health behaviour and improve from risk behaviour and live healthy life style. They help people to protect from sickness and try to keep them healthy.

The definition of health behaviours are, any activity done by a person who believes himself as healthy so that he will prevent himself from disease or find it in the stage when it is asymptomatic (Kasl and Cobb 1966).The health behaviours study based on two premises, in nations who are industrialized the main causes of deaths are some behaviour patterns which can be changeable (Stroebe and Stroebe, 1995). People give much contribution in their health by adapting health improving behaviours like exercise and stay away from health loss behaviours like alcoholism. Social cognition is the sense made by individuals regarding social situations. The way targets on persons thoughts as process which takes place in seen stimulus and response given in those situations(Fiske and Taylor 1991).In recent years ‘social cognitive’ approach becomes dominant in the field of social psychology(Schneider 1991). Most of the work ,in social cognition divided into two types: person perception (how the peoples think about others) and self regulation (how they think about themselves) (Fiske and Taylor 1991).

Self regulation includes the goal setting, cognitive planning, continuous monitoring and valuation of activities of goal direction. There are two common phases: motivational and volitional (Gollwitzer1990). The motivational phase involves the calculation of bonus and expectations to choose in between goals and consequent actions. This stage finishes with a decision regarding pursuing the goal. The volitional phase involves plan and action to achieve the goal which is already set.

Social cognition models (SCMs) depicts the essential cognitions and relationships in-between them to understand health behaviours. Social cognition models analyse factors which are predicting behaviour or intentions and analyse why persons not able to maintain a committed behaviour. Bandura (1977, 1986) developed social cognition theory and proposed that behaviour is controlled by expectancy, incentive and social cognition. There are five commonly used social cognition models: Health belief model, Protection motivation theory, Theory of planned behaviour, Theory of reasoned action and Transtheoretical model.

Health belief model: This is the oldest and mostly used model in the field of health psychology; developed formerly by Rosenstock (1966), and afterwards by Becker (1974).They developed this model to explain why few people don’t use prophylactic health behaviours such as immunization and screening and the particular behavioural reaction for the betterment of their health. The health belief model is the conclusion of four specified core beliefs. The primary core beliefs are the person’s perceptions of: risk to get ill, its severity, the cost and benefits for carrying that behaviour, and cues to that action which are either external or internal. After criticism the HBM has been revised and health motivation is added and recently perceived control was also added in this model (Becker and Rosenstock, 1987).

In health related behaviour like cervical cancer screening, the HBM anticipate screening test if a person thoughts that she is highly sensitive to cervical cancer, it is severe threat to her health, the screening benefits are high and cost of that action is low and she is subjected to cues to action if she got reminder from GP or read a leaflet in GP’s waiting room. According to new amended HBM, the model also hypothese that a lady go for screening if she is aware of health motivation and is confident that she has to do this. Norman and Fitter (1989) analyze health behaviours in screening and establish that perceived barriers are the major causes of attendance in clinics. Many studies analyzed self examination of breast behaviour and shows that barriers (Lashley, 1987, Wyper, 1990) and perceived susceptibility (Wiper, 1990) are the known predictors of behaviour which is healthy. Research shows that safer sex, taking vaccinations, regular dental checkups and regular exercise are the person’s perception of susception to relative health problem, his belief in severity of problem and his hypotheses that benefits of prevention dominates the cost.(Becker 1974,Becker et al.1977,Becker and Rosenstock 1984)

Protection Motivation Theory (PMT): The Protection motivation theory was initially proposed by Rogers (1975) to state how persons responded to fear originating threats to health. There are four main components of the protection motivation theory:

The severity of the threatened disease(If a person thought Cervical cancer is critical disease then she is afraid of this then she think to do screening test this will change her health behaviour)

The probability of the disease (e. g .If she thought her chances of getting cervical cancer are more, she will be more aware of screenings)

Response effectiveness ( Screenings and following the instructions of GP improve my health)

The perceived self efficacy like person’s own confidence.

Rogers (1985) also suggested a fifth component, which is fear (emotional response to health behaviour).

The protection motivation theory depicts susceptibility, severity and fear related to threat appraisal, and response effectiveness and self efficacy related to coping appraisal. According to PMT sources of information are of two types: environmental (Observational and verbal learning) and intrapersonal (previous experience). This information affects five components of this theory. This creates ‘adaptive’ coping response or ‘maladaptive’.

In case of change in diet, the PMT gives following hypotheses: telling the fact that taking diet of high fat, cause coronary disease and this would raise fear; knowing how critical is this disease (perceived severity) and raises the belief of the person about having heart attack (susceptibility). If the person is confident in change his diet (self efficacy) and this would have useful results (response effectiveness), they would have more aims for changing their behaviours. All this is adaptive coping response to the given knowledge.

The Theories of reasoned action (TRA): This model was majorly used for analysing predictors of behaviours. It was debateable model within social psychology dealing the relationship between attitudes and behaviour (Fishbein 1967, Ajzen and Fishbein 1970, Fishbein and Ajzen 1975). The TRA advised that the proximal cause of willing behaviour is the person’s intention to follow that behaviour. Intentions show individuals motivation of his conscious decision for doing that behaviour. Attitude towards behaviour show their affect on performance of the behaviour through their affect on intentions.

According to the study done by Cochran et al. (1992) with 297 men by using theory of reasoned action to find the attitude-behaviour relationship in relation to safe sex. They noticed that like TRA prediction, the result give a positive attitude regarding safe sex and this helps in lowering the HIV infection.

The TRA extensively used in oral contraceptive use (Davidson and Jaccard 1979, Werner and Middlestadt 1979, Doll and Orth 1993) and other types of contraception’s (McCarty 1981, Pagel and Davidson 1984), and specifically in the use of condoms regarding threat of HIV in case of heterosexuals (Chan and Fishbein 1993, Terry et al., 1993a) and homosexuals ones (Fishbein et ak., 1992).

So, in TRA attitude and subjective norm used as instant intention and behaviour predictors. The impact of previous behaviour is not included by subjective norm and attitudes in Theory of reasoned behaviour. In 1982, Bentler and Speckart suggest to add past behaviour in this model.

Theory of planned behaviour (TPB): The theory of planned behaviour is the further extension of theory of reasoned action (Fishbein and Ajzen1975, Ajzen and Fishbein 1980).The theory of planned behaviour shows a model which is developed by social psychologists which is used to understand different behaviours (Ajzen1988, 1991; Conner and sparks).Theory of planned behaviour has three actions:

Attitude towards a behaviour, having both positive and negative evaluations and its outcomes (like exercise is sport and it will make my life better. With this thought person change his/her health behaviour and start doing exercise for good health).

Subjective norm, hypothese of social norms and pressure for a particular behaviour (like people who are important for me, will say to me to lose weight and I want their words. Because he didn’t care other people and only these are the people who were important for him and going to change his behaviour).

Perceived behaviour control, is made of a particular belief for a particular behaviour on basis of internal (skill, ability) and external (obstacles, opportunities) control factors, those related to past behaviour.

According to theory of planned behaviour, the above 3 factors predict behavioural intentions, which associate to behaviour.

As in case of consumption of alcohol theory of planned behaviour make the given predictions: If a person thought that alcohol reduction makes his life productive and good for his health (attitude towards behaviour) and thought that persons who are valuable in his life wants him to cut down (subjective norm), and believe that he was able to drink less because of his past behaviour and analyzation of internal and external control factors, then this gives high intentions to reduce the intake of alcohol and changes his health behaviour.

Transtheoretical Model: It is developed by Prochaska and DiClemente (1982) showing the processes involved in creating and maintaining the behavioural changes. These are five in number: Precontemplation- person not even think to change the behaviour, Contemplation-person’s mind is thinking to change the behaviour, Preparation- small changes happened, Action- start moving in new behaviour, Maintenance- keeping the changed behaviour with time. These stages applied in so many health behaviours like smoking, use of alcohol, exercise and screening behaviour (DiClemente et al, 1991, Marcus et al, 1992).

People changes their behaviour according to these stages or some time revert to primary stage.50-80% persons who stops smoking relapse in one year because of their weak maintenance stage. In this particular stage person target on profits (after quitting smoking he feel good).In primary stages people mostly targets on cost. If person will power is not good then he is unable to maintain the maintenance stage and revert back to the smoking behaviour. For quit smoking his internal locus of control will be strong (DiClemente et al., 1991, Marcus et al., 1992).

Empirical Research: Hill et al. (1985) done a comparison between Health Belief Model (HBM) and Theory of reasoned action (TRA) regarding the breast self examination and cervical screening test. The two models were found predicting aims explaining in between 17 and 20% of discrepancy in self breast examination and 26-32% in cervical screening test intentions. In the health belief model the more number of constructs were measured that’s why it is found more predictable of discrepancy in every case (Hill et al, 1985).Mullen et al.(1987) examined the power of TRA and HBM to predict changes in health behaviour over the period of eight months. Both models found to create significant changes in health behaviours. Mullen et al. (1987) also found that HBM was economical in prediction of behaviour change and it needs average of 23 items for measure its construct as compare to32 items required in TRA. The studies showed HBM slightly superior model in comparison to TRA while some other studies suggested reversed conclusion. As an e.g., Oliver and Berger (1979) suggest TRA as a superior predictor of inoculation behaviour whereas Rutter (1989) found it better in AIDS preventive behaviour. Conner and Norman (1994) examined the causal factor in attendance at the health checks and got all the models at similar level in predictions and health behaviour. According to Bakker et al. (1994) TPB is much predictive in case of condom use in heterosexuals. S

According to American cancer society 1 out of 9 ladies develop cancer of breast in her life (American Cancer Society, 1993). Breast carcinoma cannot be prevented because its aetiology is not understood properly. In early detection that is by, breast self examination through manual palpation for any abnormal breast lumps, chances of survival is more (Hill et al., 1988, GIVO Interdisciplinary Group for Cancer Care Evaluation, 1991) . Even so, this is noticed that even after motivation mostly ladies didn’t do breast self examination. According to Clarke et al. (1991) even 61% of ladies who visits Breast self examination (BSE) sessions thinks to do BSE and only 22% actually do that.

Now a days, cervical cancer is major cause of mortality in ladies is always fatal when it is cancer in situ (World Health Organization, 1986, 1987). It is evaluated that if ladies were regularly screened after 3 years, the mortality rate could be decreased to 70-95 %( Greenwald and Sondick, 1986).In cervical smear test microscopic examination of cells of cervix done for detecting any abnormalities which if not treated may turn to cancerous. According to National Audit Office (1998) survey 10-32% women unscreened who are eligible for cervical cancer screening. Same figures found in USA (Hayward et al., 1988, Lantz et al., 1997, Ruchlin, 1997). The longitudinal study in cervical screening (Orbell and Sheeran, 1998) found that 43% of women actually done screening even after invitations got from their GP.

Conclusion:

These models and theories can used to adopt certain health related behaviours according to the situation. Either the models provide clear theoretical framework to understand health behaviour, these models direct us to neglect the variables which are very important in understanding health behaviour. Another thing is that these models provide us targets designed for behaviour change, they don’t define how such cognitions are changed. Every model has some limitations but they are somewhat reliable for adopting health behaviour and improve from risk behaviour and live healthy life style. They help people to protect from sickness and try to keep them healthy.

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