Learning

out come Up on completion of this module, learners are able to

• Differentiate theory and model

• Understand the purpose of theory and model
• Recognize intrapersonal level theories and model

1
Theory
• is “A set of interrelated concepts, definitions, and proposition that
present a systematic view of phenomena by specifying relations
among variables with the purpose of explaining and predicting the
phenomena”

2
Theory o Theories explain why, what, how and when a particular behavior
occurs.

o They are by nature, abstract, and don’t have a specified content or

topic area.

o Like empty coffee cups. [theories have shapes and boundaries,

but nothing inside]

3
Model o Models “… is a subclass of theory”

o Semantic/diagrammatic representation of a
phenomenon.
o it results from an effort to best represent or
explain a specific problem by 100 %. At least a
model should explain in part (50%).

4
Purpose of Lung cancer
theory and 1. Describe-the behavior (what) : e.g. As event, as process

model 2. Explain- the causes of behavior (why)------factors

Smoking cigarette
3. Predict- we predict the behavior (when) --- hierarchy

4. Control/change-then we change the behavior (how) --steps

-knowledge
5. Focus -to limit options and reduce waste of effort -Attitude
-Peer pressure
-Accessibility
6. Simplify- untangle and simplify the complexity of nature -Affordability

-Residence/family
-School/college
-Policy/taxation
5
Level of
o Communication Theory
influence o Diffusion of Innovation
o Community Mobilization

o Social Cognitive Theory

o Social Network and social
support theory

o Health Belief Model

o Theory of planned
Behaviour
o Theory of Reasoned
Action
o Trans theoretical Model

6
Health
Belief
Model • The HBM was developed initially in the 1950s in the
(HBM) U.S. PHS to explain the widespread failure of people to
participate in programs to prevent and detect disease.
(Hochbaum, 1958; Rosenstock, 1960,
1974).

7
 • The HBM contains primary concepts that predict why
HBM people will take action to prevent, to screen for, or to control
illness conditions Based the 6 constructs of the model

o The constructs are:

1. Perceived susceptibility
2. perceived severity
3. perceived benefits
4. perceived barriers
5. Cues to action
6. Self efficacy

8
1.
Perceived
susceptibil
ity
- The subjective probability (individual perception) that ‘I’
could get the disease rather than other people or society
as a whole.

E.g. A women must be believe there is a possibility of getting

breast cancer before she will be interested in obtaining
Mammography

9
2. Perceived
severity
The subjective perception about the potential seriousness
of the condition in terms of pain or discomfort, disability,
death, economic difficulties, etc. if action was not taken.

Notice
Perceived Susceptibility+ severity= perceived threat of the
disease.

E.g. Common cold/flu Vs HIV/AIDS

10
3. Perceived
Benefits
The subjective perception about the benefits of taking
health action and its effectiveness.

o Other non-health-related perceptions, such as:

- Financial saving related to quitting smoking

- Benefits frequent hand washing in COVID-19 infection prevention

- Benefits of facemask in COVID-19 infection prevention

11
4.Perceive The barriers such as cost, side effects, culture, and
d convenience also influence the likely hood of taking
Barriers action.
E. g. It could help me, but…….

- Expensive, not available, it is not comfortable,

- Using face mask outside [Discomfort, frequency, appropriate use]

- Frequent hand washing [ unavailability of water, negligence,

inappropriate ]

Increased likely hood of Less/No likely hood of

performing recommend performing recommend
action action
Perceive Perceive
d d
Barriers Benefits
Perceive Perceive
d d
Benefits Barriers

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5. Self-
Efficacy
- One’s confidence in one’s ability to take action and the belief in
being able to successfully execute the behavior required to
produce the desired outcomes

13
 6. Cues to
take action
• Strategies to activate one’s readiness and events,
• either bodily or environmental that motivate people to take action
as well as individual's perception of the levels of susceptibility and
severity provide the force to act.

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 Construct Definitions Potential Change Strategies
sKey Concepts and Definitions of the HBM
Perceived Belief about the •Define population(s) at risk, risk
susceptibi chances of levels
lity experiencing a •Personalize risk based on a
risk or getting a person’s characteristics or
condition
behavior
•Make perceived susceptibility
more consistent with
individual’s actual risk
Perceived Belief about how •Specify consequences of risks
severity serious a and conditions
condition
Perceived Belief in efficacy •Define action to take: how,
benefits of the advised where, when; clarify the
action to reduce
risk or seriousness
positive effects to be
of impact expected
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 Constructs
,, Definitions

Perceived Belief about the •Identify and reduce

barriers tangible and perceived barriers through
psychological costs
of the advised
reassurance, correction of
action misinformation, incentives,
assistance
Cues to Strategies to •Provide how-to information,
action activate promote awareness,
“readiness”
use appropriate reminder
systems
Self Confidence in one’s •Provide training and
efficacy ability to take guidance in performing
action
recommended action
•Use progressive goal setting
•Give verbal reinforcement
•Demonstrate desired
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behaviors
 Health Modifying Individual Beliefs
belief Action
model and
Factor
linkage Perceived
susceptibility Perceived
and severity threat
Age
Gender Perceived Individua
Ethnicity benefits l
Personalit Behaviou
y r
Socio
economic Perceived
Knowledg barriers
e

Cues to
Perceived self- action
efficacy
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 Exercise on HIV testing related measures

Perceived susceptibility: (Likert 5 point scale )

example -1. strongly agree, 2. agree, 3. neutral, 4. disagree and
5. strongly disagree)

 I am not confident that I might have not get HIV/AIDS still.

 My sexual behavior is safe and didn’t expose me to

HIV/AIDS.

 I might have been susceptible to HIV due to lack of my

partner faithfulness.

 I will not be infected with HIV come whatever.

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 Perceived severity

 HIV/AIDS is a disease that has neither cure nor vaccine.

 One will die of a painful death if infected with HIV/AIDS.
 HIV/AIDS is probably the worst disease one can get.
 HIV/AIDS is a life threatening disease.
Perceived barrier
 If I undergo testing, the test result will never escape from being known by
significant others in some way.
 Health care providers who offer HIV testing will never keep results really
confidential.
Perceived benefit
 HIV testing helps to decide reducing risky behaviors that expose to HIV infection.
 HIV testing is the first step to confidently start to have safer sex with ones
partner.

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 cues to action

 I have heard from media about HIV testing few days before
visiting health institution.
 My friends/partners/etc were discussing with me to get HIV
testing few days before visiting health institution.
 I encountered my friends who get HIV in near past.
Self efficacy
 If I get HIV positive result in a test, I can achieve my goals in
a life.
 I can freely continue my daily routine activities as previous
in spite of HIV positive test result.
 I am confident to undergo HIV testing whenever needed.

02/15/2025
Theory of Reasoned Action(TRA)
&
Theory Planned Behavior (TPB)

21
Theory of
reasoned Developed by Fishbein & Ajzen in 1970’s.
action
• Basically rooted in cognitivism theory in
which

o Human beings are usually very rational & make systematic

decisions based on available information.

o Most behavior are under volitional control.

o focus on theoretical constructs concerned with individual

motivational factors as determinants of the likelihood of
performing a specific behavior
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Theory of
reasoned
action
o TRA asserts that the most important determinant of behavior is
behavioral intention

o Direct determinants of individuals’ behavioral intention are their

attitude toward performing the behavior and their subjective
norm associated with the behavior.

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 TRA and
its
Behavioral belief
constructs & Attitude
Outcome Evaluation

INTENTION
Normative
Evaluation beliefs: :belief about what a specific

BEHAVIOR
Behavioral beliefs
of outcome:The person’s
his beliefs
or her that
evaluations
referent
the person
behavior
of those thinks
leads
outcomes one should
to certain or should not
outcomes
do regarding the behavior

Normative beliefs of
referents
Subjective norms
&
Motivation to comply

24
 TRA and
its
constructs
1. Behavioral beliefs : The person’s beliefs that the
behavior leads to certain outcomes

2. Evaluation of outcome: his or her evaluations of

those outcomes

25
 TRA and
its
constructs
o An attitude toward a behavior can be predicted by
the product of the outcome evaluation and belief
strength

 Implications of this approach:

Two people may have the same set of beliefs about

a behavior but a totally different attitude because of
different outcome evaluations or belief strengths

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 TRA and
its
constructs
I. Normative beliefs
II. Motivation to comply

1. Normative beliefs: belief about what a specific

referent person thinks one should or should not do
regarding the behavior

Referent: specific individual or group who may

influence one’s behavior

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 TRA and
its
constructs
o For each referent, we have a normative belief, what
we think that referent would want us to do

o For each referent, we have a specific level of

motivation to comply with their wishes for us

28
Theory
of
planned
Behavio
Extensions Theory of Reasoned Action
ur

Theory of Planned Behavior

29
Perceive
d
behavior
al control - is a perceived ease or difficulty in performing a
(PBC) behavior

- It Cover non volitional factors which interfere with ones

attempt to perform a behavior

- Made up of control beliefs and perceived power of a control

30
 TPB predicts two possible effects of perceived
PBC behavioral control (PBC)on behavior:

1. PBC reflects motivational factors that have an indirect effect on

behavior through intentions, also

2. PBC reflects actual control and has a direct link to behavior not
mediated by intentions

31
 Behavioral belief
Behavioral belief
If I exercise, It will takes me away
If I exercise,
from my my family
heart will get
healthier
If I exercise, I will get sweaty and sore
If I exercise, I will gain muscle strength
Outcome Evaluation
OutcometoEvaluation
It is important me that I spent
It ismuch
important to
time with memythat I have
family
stronggetting
I hate absolutely Heart sweaty an
I value being
sore strong Negative Attitude
Positive Attitude

Normative beliefs
My parentNormative beliefsme to
doesn’t want
My Parent want me to exercise
exercise
My Friends want me to go to Gym no
NO
My teacher wants me to exercise Negative
Positive subjective not Intended to Behaviour/exercise
with them Intended
Intended to
to exercise
exercise Behaviour/exercise
Motivation
Motivation to
to comply
comply NORM
NORM exercise Behaviour/exercise
II want to comply with y parent
care what my parent want me to do
II don’t care
want to do want my teacher
want my Friends want
mewants
to do

Control beliefs
beliefs
Control Positive
II believe
don’t think I can go for Gym
Evenwhen
if I amI
am busy
I can go for Gym Negative PBC
busy withwith
a lotaoflotactivities
of activities
PBC
Perceived Power
Control frequency
I am a busy with schooltovery
I am always busy due many often 32
activities
 o is developed by James Prochaska and Carols Diclemente
TTM
(1979).
o It is a stage model and considers behavior change as
sequential

o The model’s basic premise is that behavior change is a

process that unfolds over time, not an event.

o change is a process with stages not just an event …

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Core
constructs of
the TTM
1. The stages of change
2. The process of change
3. Decisional balance (The pros and con)
4. Self-efficacy

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 Core
constructs

02/15/2025 35
1. Stage of
change
Stage of changes
• Trans theoretical model 1. Pre-contemplation
has 6 stages of changes 2. contemplation
3. preparation
4. Action
5. Maintenance
6. Termination

02/15/2025 36
Six stages
of change 1. Pre contemplation phase
o Who have no intention to change behavior (weather he/she
recognizes it or not).

2. Contemplation phase
o Who recognizes the problem and seriously thinking about
making changes. They are intended to change within six
months.

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 3. Preparation phase:
o Actively planning for change and intending to take action in the
next month.

4. Action phase
o Who are involved in consistent behavior changes for less than 6
months/overt making changes

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 5.Maintenance phase
o Who have been successful in maintaining or sustaining a change
for 6 months or more.

6. Termination phase
o It is the time when the individuals who have
zero temptation to return to their old behavior
and have 100% self –efficacy (lifetime
maintenance). E.g. Smokers becomes non-
smokers.
02/15/2025 39
o Note: relapse can occur at any stage except the termination phase
 Stages of Change Model
Precontemplation
Awareness of need to change

Contemplation
Increasing the Pros for Change
and decreasing the Cons

Preparation
Commitment & Planning
Relapse and
Recycling
Maintenance
Action
Integrating Change into
Implementing and
Lifestyle
Revising the Plan

02/15/2025
Termination 40
2.Process of
change • The processes of change allow understanding of
how changes occur

• Ten processes of change have been identified and

specific processes are associated with particular
stages of preparation for change

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 1. Consciousness raising
2. Dramatic relief Experiential set of
3. Self-reevaluation process

4. Environmental Reevaluation
5. Social Liberation reaffirm

6. Self-Liberation
Behavioral set of
7. Helping Relationships process
8. Counter conditioning
9. Reinforcement Management
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10. Stimulus Control 42
 1. Consciousness raising :
o finding & learning new facts, ideas, & tips that support
the healthy behavior change

2. Dramatic relief :
experiencing the negative emotions (fear, anxiety, worry)
that go with unhealthy behavioral risks

02/15/2025 43
2.Process of
change
3. Self-re-evaluation : realizing that the behavior change is
an important part of one’s identity as person

4. Environmental Re-evaluation : realizing the negative

impact of the unhealthy behavior, or the positive impact of
the healthy behavior, on one’s proximal social &/or
physical environment

5. Social Liberation: realizing that social norms are changing

in the direction of supporting the healthy behavior change.
02/15/2025 44
Behavioral set of 1. Self-Liberation:
process Making a firm commitment to change

2. Helping Relationships:
Seeking & using social support for the healthy
behavior change

3. Counter conditioning:
substitution of healthier alternative behaviors &/or
cognitions for the unhealthy behavior
02/15/2025 45
 4.Reinforcement Management:
o increasing the rewards for the positive behavior change
&/or decreasing the rewards of the unhealthy behavior

5. Stimulus Control:
o removing remainders or cues to engage in the unhealthy
behavior &/or adding cues to remainders to engage in the
healthy behavior

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Decisional
balance

o Refers to the pros and cons of the behavior change

o I.e. The individual decision to move from one stage to the

next is based on the relative importance (Pro) &
disadvantage(Con) of the behavior change for the
individuals.

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 • The pros of healthy behaviors are low in the early stages and
increase across the stages of change.

• The cons of the healthy behavior are high in the early stages
and decreases across the stages of change.

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4. Self-
efficacy

• Self-efficacy is an individuals confidence in

his/her ability to successfully perform a
particular task

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 Thank you

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