HEALTH BEHAVIOUR THEORIES

1. TRANS THEORETICAL MODEL

2. TRANS THEORETICAL MODEL (STAGES OF CHANGE) 

The Trans theoretical Model (also called the Stages of Change Model), developed by Prochaska and DiClemente in the late 1970s, evolved through studies examining the experiences of smokers who quit on their own with those requiring further treatment to understand why some people were capable of quitting on their own. It was determined that people quit smoking if they were ready to do so. Thus, the Trans theoretical Model (TTM) focuses on the decision-making of the individual and is a model of intentional change. The TTM operates on the assumption that people do not change behaviors quickly and decisively. Rather, change in behavior, especially habitual behavior, occurs continuously through a cyclical process. The TTM is not a theory but a model; different behavioral theories and constructs can be applied to various stages of the model where they may be most effective. 

The TTM posits that individuals move through six stages of change: pre-contemplation, contemplation, preparation, action, maintenance, and termination. Termination was not part of the original model and is less often used in application of stages of change for health-related behaviors. For each stage of change, different intervention strategies are most effective at moving the person to the next stage of change and subsequently through the model to maintenance, the ideal stage of behavior. The stages are;

1. Pre contemplation - In this stage, people do not intend to take action in the foreseeable future (defined as within the next 6 months). People are often unaware that their behavior is problematic or produces negative consequences. People in this stage often underestimate the pros of changing behavior and place too much emphasis on the cons of changing behavior. 

2. Contemplation - In this stage, people are intending to start the healthy behavior in the foreseeable future (defined as within the next 6 months). People recognize that their behavior may be problematic, and a more thoughtful and practical consideration of the pros and cons of changing the behavior takes place, with equal emphasis placed on both. Even with this recognition, people may still feel ambivalent toward changing their behavior. 

3. Preparation (Determination) - In this stage, people are ready to take action within the next 30 days. People start to take small steps toward the behavior change, and they believe changing their behavior can lead to a healthier life. 

4. Action - In this stage, people have recently changed their behavior (defined as within the last 6 months) and intend to keep moving forward with that behavior change. People may exhibit this by modifying their problem behavior or acquiring new healthy behaviors. 

5. Maintenance - In this stage, people have sustained their behavior change for a while (defined as more than 6 months) and intend to maintain the behavior change going forward. People in this stage work to prevent relapse to earlier stages. 

6. Termination - In this stage, people have no desire to return to their unhealthy behaviors and are sure they will not relapse. Since this is rarely reached, and people tend to stay in the maintenance stage, this stage is often not considered in health promotion programs.

 LIMITATIONS OF THE TRANS THEORETICAL MODEL 

There are several limitations of TTM, which should be considered when using this theory in public health. Limitations of the model include the following: 

1. The theory ignores the social context in which change occurs.

2. The lines between the stages can be arbitrary with no set criteria of how to determine a person's stage of change. The questionnaires that have been developed to assign a person to a stage of change are not always standardized or validated. 

3. There is no clear sense for how much time is needed for each stage, or how long a person can remain in a stage. 

4. The model assumes that individuals make coherent and logical plans in their decision-making process when this is not always true. 

2. THEORY OF PLANNED BEHAVIOUR

THEORY OF PLANNED BEHAVIOUR

The Theory of Planned Behavior (TPB) developed by Icek Ajzen, 1991, is a psychological framework that predicts human behavior. It suggests that people's beliefs about whether they can perform a behavior (behavioral beliefs), their beliefs about the outcomes of the behavior (outcome beliefs), and their beliefs about what others think they should do (normative beliefs) influence their intentions, which in turn influence their actual behaviors. The theory was proposed by Icek Ajzen in 1985 as an extension of the Theory of Reasoned Action.

The Theory of Planned Behavior (TPB) is based on several key assumptions:

1. Behavioral Intention: The most immediate determinant of behavior is a person's intention to perform that behavior. Intentions are influenced by the person's attitude toward the behavior, subjective norms, and perceived behavioral control.

2. Attitude Toward Behavior: A person's attitude toward a specific behavior is determined by the individual's beliefs about the outcomes of performing the behavior and the evaluation of those outcomes.

3. Subjective Norms: Subjective norms refer to the perceived social pressure to perform or not perform a behavior. It is influenced by the individual's beliefs about what important others think they should do and the motivation to comply with these perceived expectations.

4. Perceived Behavioral Control: Perceived behavioral control reflects the individual's perception of the ease or difficulty of performing the behavior. It is influenced by factors such as resources, skills, and obstacles.

5. Behavioral Beliefs, Normative Beliefs, and Control Beliefs: These beliefs underlie attitude, subjective norms, and perceived behavioral control, respectively. They are the foundation of the TPB and shape the individual's overall intention to perform a behavior.

6. Behavioral, Normative, and Control Beliefs are Modifiable: According to the TPB, these beliefs can be influenced and changed through interventions, which can in turn affect behavioral intentions and behaviors.

These assumptions form the basis of the Theory of Planned Behavior and guide its application in predicting and understanding human behavior.

3. SOCIAL COGNITIVE THEORY

Social Cognitive Theory is a psychological theory, it was developed by Albert Bandura in 1970s and 1980s. It emphasized the interaction between people's thoughts, behaviors, and the environment. It posits that individuals learn and acquire new behaviours, attitude and knowledge through observation imitation and social interactions, the theory also posits that the consequences of those observed behaviors influence their own behavior, beliefs, and attitudes. It emphasises the dynamic interplay between personal, environmental and behavioural factors in shaping human actions. Key concepts include self-efficacy, observational learning, and reciprocal determinism, which refers to the dynamic interplay between personal factors, behavior, and the environment.

ASSUMPTIONS OF THE SOCIAL COGNITIVE THEORY 

1. Observational Learning (Modeling) – People learn new health behaviours by observing the behaviors of others and the consequences of those behaviors. 

2. Reciprocal Determinism – Human health behavior is influenced by a continuous interaction between personal factors (such as thoughts and emotions), environmental influences, and behavioral patterns.

3. Self-Efficacy – The belief in one’s ability to successfully perform a behavior influences motivation and persistence. A person with high self-efficacy is more likely to take on challenges and persist despite difficulties.

4. Reinforcement and Punishment – positive or negative health behaviors are strengthened or weakened based on the consequences they receive. Positive reinforcement encourages repetition, while punishment discourages certain actions.

5. Cognitive Processes – People do not simply react to stimuli but actively process information, reflect on experiences, and anticipate future outcomes before engaging in a behavior.