The document summarizes several prominent health behavior theories that are relevant for nursing practice and research. It describes theories such as the health belief model, social cognitive theory, transtheoretical model, and theories of reasoned action. Key concepts discussed include an individual's perceptions, self-efficacy, environmental influences, and how behavior change is best understood as a process rather than a single event. The theories provide guidance for nurses to enhance patient motivation and effectively support individuals through the various stages of behavior change.

1. Chapter 11
Health Behavior
Theories

2. Introduction
• Health behavior is central to disease
prevention and management.
• Nurses play a pivotal role in health behavior
change due to their credibility as patient
educators.
• Nurses may provide intensive patient
counseling in a variety of settings, including
clinics, work sites, and communities.

3. Evolution of Health Behavior Theory
• Theories reflect an amalgamation of
approaches, methods, and strategies from social
and health sciences.
• Many professionals contribute to and conduct
health behavior and education research and
programs.
• Nurses bring unique expertise for working with
individuals and families to teaching about change
and quality of life.

4. Trends in Use of Theories and Models
• The most dominant theories of health behavior
therapy are the social cognitive theory, the
transtheoretical model, and the health belief
model.
• Importance of individual worldview, behavior
change as a process, and motivation versus
intention cut across many theories.
• In recent years, behavior change has focused on
obstacle reduction and empowerment.

5. The Health Belief Model (HBM)
• Posits that beliefs about susceptibility and
perceptions about the benefits of prevention
influence patients’ readiness to act.
• Readiness based on six criteria:
– Perceived susceptibility
– Perceived severity
– Perceived benefits
– Perceived barriers
– Cue to action
– Self-efficacy

6. Examples of Application of the HBM
• An extensive HBM research project sought to
develop a preconceptual counseling program for
teens with type 1 diabetes.
• Focused on teen’s perceptions of reproductive
problems due to diabetes and their adherence to
safe sex practices.
• Led to development of a reproductive health
program to aid decision making by diabetic teens.

7. The Theories of Reasoned Action (TRA)
and Planned Behavior (TPB)
• TPB evolved from TRA.
• Posits that health decisions are influenced by a
person’s view of actions and whether
important others would approve.
• Useful for explaining why some people change
behavior and others do not after completion of
health education programs.
• Good fit for predicting behaviors like
exercise, and health services utilization.

8. The Integrated Behavior Model (IBM)
• IBM is a combination of TPB, TR, and other
behavioral theories.
• Developed in response to criticism that TPB
ideas were too far removed from individuals
to accurately predict behavior.
• Identifies specific belief targets for behavior
change interventions based on
attitudes, norms, control, and self-efficacy.

9. Examples of Application of TPB
• A study of condom use by male South Korean
college students sought to establish a TPB link
between condom self-efficacy and parent-
adolescent relationships.
• Revealed that good mother-son relationships
yielded higher condom use intention and self-
efficacy.
• Illustrated how cultural practices in parenting can
influence intention and behaviors.

10. The Transtheoretical Model and Stages
of Change(1 of 2)
• Posits that people are at different stages of
readiness to adopt healthful behaviors.
• Describes a sequence of steps in successful
behavior change:
– Pre-contemplation
– Contemplation
– Preparation
– Action
– Maintenance

11. • Ability to advance through stages and need to
repeat stages is based on patient level of
motivation and self-efficacy.
• Useful for explaining why patients are not ready
to change and helps improve the success of
patient education.
The Transtheoretical Model and Stages
of Change(2 of 2)

12. Examples of Application of the
Transtheoretical Model
• A study of individuals with co-occurring conditions
sought to understand the way people undergo
change.
• Revealed that one disorder can make it difficult to
recognize the need for assistance with the other
disorder.
• Suggested that individuals with co-occurring
conditions need different interventions than
individuals with only a single condition.

13. Social Cognitive Theory (SCT)(1 of 2)
• Developed from the social learning theory.
• Explains behavior in terms of a three-
way, dynamic, reciprocal model in which
personal factors, environmental influences, and
behavior continually interact.
• Posits that people learn through their own
experiences and by observing the actions of
others.

14. Social Cognitive Theory (SCT)(2 of 2)
• Focuses on self-efficacy and deliberate efforts to
increase self-efficacy in patients via three strategies:
– Setting small, incremental goals
– Using formalized behavior contracts
– Monitoring and reinforcing behavior
• Environmental changes, role models, and
reinforcement can be used to promote good
behavior.
• Useful for nutritional interventions.

15. Examples of Application of SCT
• A study of self-monitoring via paper and
electronic diaries sought to understand the
ways in which feedback acts as a behavioral
reinforcement.
• Revealed that electronic diaries with built-in
feedback messages related to progress added
an extra reinforcement element that improved
patient success.

16. Social Ecological Models
• Posits that behaviors both shape and are shaped by
the social environment.
• Focuses on factors affecting behavior and provides
guidance for developing successful programs
through social environments.
• Suggests that creating an environment conducive
to change is important for making it easier to adopt
healthy behaviors.

17. The Representational Approach (RA)
• Posits that linking health psychology to
educational theory aids patient-centered
interventions.
• Relies on seven elements:
– Representational assessment
– Misconception exploration
– Condition creation for conceptual change
– Introduction of new information
– Goal setting and maintenance
– Summary
– Evaluation and revision

18. Examples of Application of RA
• A study of symptom management in ovarian
cancer patients sought to understand the
success of written interactions between
patients and nurses.
• Revealed that written interactions were more
effective than face-to-face interactions because
of the greater time and flexibility allowed in
communication.

19. Cross-Cutting Concepts: Patient’s
View of the World
• Behavior change depends on sound understanding
of the patient’s worldview.
• Poor adherence arises because patients lack
behavioral skills to make lifestyle changes.
• Relationships between
knowledge, awareness, intention, and actual
change are complex.
• Attention to group patterns combined with
individual understanding is key.

20. Cross-Cutting Concepts: Behavior
Change as a Process
• Behavior change is a process, not an event.
• Sustained health behavior change involves
multiple actions and adaptations over time.
• Four concerns are important to this process:
– Motivation vs. intention
– Intention vs. action
– Changing behavior vs. maintaining change
– The role of biobehavioral factors

21. Control Over Behavior and Health:
Control Beliefs and Self-Efficacy
• Control beliefs and self-efficacy are common
deterrents to positive health behavior change.
• Found in both the SCT and TPB models.
• Important to enhance perceived behavioral
control and increase self-efficacy to improve
patient motivation and persistence in the face of
obstacles.

22. Applications in Nursing and Nursing
Research
• Nurses should use theory to guide research and
theory application.
• Theory framework shapes the research process
and data interpretation, and influences
intervention design.
• Theory functions as a thread consistently
interwoven with a study and is not merely a
statement.

23. Summary
• Health behavior theories are important for
understanding patient actions and the success or
failure of nursing interventions.
• Many theories exist, and common themes cut
across these theories and suggest that change is
largely based on a patient’s worldview and
treatment of change as a process.
• Research design and application are closely tied
to theoretical frameworks.