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Choose a health issue for the Connecting Theory to Practice assignment. Research scholarly articles related to the health issue. Choose three scholarly articles and complete an annotated bibliography that includes those three articles.  Quiz Study Guide: Individual and Interpersonal
Models/Theories of Health Behavior
This study guide will help students prepare for the quiz, which consists of 30 multiple-choice
questions on individual and interpersonal theories of behavior. Topics covered by the quiz
include key constructs and characteristics of theories and models, examples of their application,
strengths and limitations, and future directions.
Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2015). Health behavior: Theory, research,
and practice (5th ed.). San Francisco, CA: Wiley/Jossey-Bass. ISBN: 9781118628980
Theories and Models of Individual Health Behavior – Textbook Chapters 4-7
a. Health Belief Model (HBM)
i. Key constructs
The Health Belief Model contains several primary components (or constructs) that
predict whether and why people will take action to prevent, detect, or control illness
conditions. These constructs include perceived susceptibility, perceived severity,
perceived benefits and barriers to engaging in a behavior, cues to action, and selfefficacy.
1. Perceived susceptibility – This refers to a person’s subjective perception of the
risk of acquiring an illness or disease. There is wide variation in a person’s
feelings of personal vulnerability to an illness or disease.
2. Perceived severity – This refers to a person’s feelings on the seriousness of
contracting an illness or disease (or leaving the illness or disease untreated). There
is wide variation in a person’s feelings of severity, and often a person considers
the medical consequences (e.g., death, disability) and social consequences (e.g.,
family life, social relationships) when evaluating the severity.
3. Perceived benefits – This refers to a person’s perception of the effectiveness of
various actions available to reduce the threat of illness or disease (or to cure
illness or disease). The course of action a person takes in preventing (or curing)
illness or disease relies on consideration and evaluation of both perceived
susceptibility and perceived benefit, such that the person would accept the
recommended health action if it was perceived as beneficial.
4. Perceived barriers – This refers to a person’s feelings on the obstacles to
performing a recommended health action. There is wide variation in a person’s
feelings of barriers, or impediments, which lead to a cost/benefit analysis. The
person weighs the effectiveness of the actions against the perceptions that it may
be expensive, dangerous (e.g., side effects), unpleasant (e.g., painful), timeconsuming, or inconvenient.
5. Cue to action – This is the stimulus needed to trigger the decision-making process
to accept a recommended health action. These cues can be internal (e.g., chest
pains, wheezing, etc.) or external (e.g., advice from others, illness of family
member, newspaper article, etc.).
6. Self-efficacy – This refers to the level of a person’s confidence in his or her ability
to successfully perform a behavior. This construct was added to the model most
recently in mid-1980. Self-efficacy is a construct in many behavioral theories as it
directly relates to whether a person performs the desired behavior.
ii. Gaps, strengths, and limitations
There are several limitations of the HBM which limit its utility in public health.
Limitations of the model include the following:

It does not account for a person’s attitudes, beliefs, or other individual determinants that
dictate a person’s acceptance of a health behavior.
It does not take into account behaviors that are habitual and thus may inform the
decision-making process to accept a recommended action (e.g., smoking).
It does not take into account behaviors that are performed for non-health related reasons
such as social acceptability.
It does not account for environmental or economic factors that may prohibit or promote
the recommended action.
It assumes that everyone has access to equal amounts of information on the illness or
It assumes that cues to action are widely prevalent in encouraging people to act and that
“health” actions are the main goal in the decision-making process.
The HBM is more descriptive than explanatory, and does not suggest a strategy for
changing health-related actions. In preventive health behaviors, early studies showed that
perceived susceptibility, benefits, and barriers were consistently associated with the
desired health behavior; perceived severity was less often associated with the desired
health behavior. The individual constructs are useful, depending on the health outcome of
interest, but for the most effective use of the model it should be integrated with other
models that account for the environmental context and suggest strategies for change.
iii. Application in practice
b. Theory of Reasoned Action (TRA)
i. Key constructs
ii. Gaps, strengths, and limitations
iii. Application in practice
c. Theory of Planned Behavior (TPB)
i. Key constructs
The Theory of Planned Behavior (TPB) started as the Theory of Reasoned Action in 1980 to
predict an individual’s intention to engage in a behavior at a specific time and place. The theory
was intended to explain all behaviors over which people have the ability to exert self-control.
The key component to this model is behavioral intent; behavioral intentions are influenced by the
attitude about the likelihood that the behavior will have the expected outcome and the subjective
evaluation of the risks and benefits of that outcome.
The TPB has been used successfully to predict and explain a wide range of health behaviors and
intentions including smoking, drinking, health services utilization, breastfeeding, and substance
use, among others. The TPB states that behavioral achievement depends on both motivation
(intention) and ability (behavioral control). It distinguishes between three types of beliefs behavioral, normative, and control. The TPB is comprised of six constructs that collectively
represent a person’s actual control over the behavior.
1. Attitudes – This refers to the degree to which a person has a favorable or unfavorable
evaluation of the behavior of interest. It entails a consideration of the outcomes of
performing the behavior.
2. Behavioral intention – This refers to the motivational factors that influence a given
behavior where the stronger the intention to perform the behavior, the more likely the
behavior will be performed.
3. Subjective norms – This refers to the belief about whether most people approve or
disapprove of the behavior. It relates to a person’s beliefs about whether peers and people
of importance to the person think he or she should engage in the behavior.
4. Social norms – This refers to the customary codes of behavior in a group or people or
larger cultural context. Social norms are considered normative, or standard, in a group of
5. Perceived power – This refers to the perceived presence of factors that may facilitate or
impede performance of a behavior. Perceived power contributes to a person’s perceived
behavioral control over each of those factors.
6. Perceived behavioral control – This refers to a person’s perception of the ease or
difficulty of performing the behavior of interest. Perceived behavioral control varies
across situations and actions, which results in a person having varying perceptions of
behavioral control depending on the situation. This construct of the theory was added
later, and created the shift from the Theory of Reasoned Action to the Theory of Planned
ii. Gaps, strengths, and limitations
Limitations of the Theory of Planned Behavior
There are several limitations of the TPB, which include the following:

It assumes the person has acquired the opportunities and resources to be successful in
performing the desired behavior, regardless of the intention.
It does not account for other variables that factor into behavioral intention and
motivation, such as fear, threat, mood, or past experience.
While it does consider normative influences, it still does not take into account
environmental or economic factors that may influence a person’s intention to perform a
It assumes that behavior is the result of a linear decision-making process, and does not
consider that it can change over time.
While the added construct of perceived behavioral control was an important addition to
the theory, it doesn’t say anything about actual control over behavior.
The time frame between “intent” and “behavioral action” is not addressed by the theory.
The TPB has shown more utility in public health than the Health Belief Model, but it is still
limiting in its inability to consider environmental and economic influences. Over the past several
years, researchers have used some constructs of the TPB and added other components from
behavioral theory to make it a more integrated model. This has been in response to some of the
limitations of the TPB in addressing public health problems.
iii. Application in practice
d. Integrated Behavioral Model (IBM)
i. Key constructs
ii. Gaps, strengths, and limitations
iii. Application in practice
e. Transtheoretical Model and Stages of Change (TTM-SC)
i. Key constructs
The Transtheoretical 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 Transtheoretical 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: precontemplation,
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.
1. Precontemplation – 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
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.
To progress through the stages of change, people apply cognitive, affective, and evaluative
processes. Ten processes of change have been identified with some processes being more
relevant to a specific stage of change than other processes. These processes result in strategies
that help people make and maintain change.
1. Consciousness Raising – Increasing awareness about the healthy behavior.
2. Dramatic Relief – Emotional arousal about the health behavior, whether positive or
negative arousal.
3. Self-Reevaluation – Self reappraisal to realize the healthy behavior is part of who they
want to be.
4. Environmental Reevaluation – Social reappraisal to realize how their unhealthy
behavior affects others.
5. Social Liberation – Environmental opportunities that exist to show society is supportive
of the healthy behavior.
6. Self-Liberation – Commitment to change behavior based on the belief that achievement
of the healthy behavior is possible.
7. Helping Relationships – Finding supportive relationships that encourage the desired
8. Counter-Conditioning – Substituting healthy behaviors and thoughts for unhealthy
behaviors and thoughts.
9. Reinforcement Management – Rewarding the positive behavior and reducing the
rewards that come from negative behavior.
10. Stimulus Control – Re-engineering the environment to have reminders and cues that
support and encourage the healthy behavior and remove those that encourage the
unhealthy behavior.
ii. Gaps, strengths, and limitations
Limitations of the Transtheoretical 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:

The theory ignores the social context in which change occurs, such as SES and income.
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.
There is no clear sense for how much time is needed for each stage, or how long a person
can remain in a stage.
The model assumes that individuals make coherent and logical plans in their decisionmaking process when this is not always true.
The Transtheoretical Model provides suggested strategies for public health interventions to
address people at various stages of the decision-making process. This can result in interventions
that are tailored (i.e., a message or program component has been specifically created for a target
population’s level of knowledge and motivation) and effective. The TTM encourages an
assessment of an individual’s current stage of change and accounts for relapse in people’s
decision-making process.
iii. Application in practice
Theories and Models of Interpersonal Health Behavior – Textbook Chapters 8-12
a. Social Cognitive Theory (SCT)
i. Key constructs
Many theories of behavior used in health promotion do not consider maintenance of behavior,
but rather focus on initiating behavior. This is unfortunate as maintenance of behavior, and not
just initiation of behavior, is the true goal in public health. The goal of SCT is to explain how
people regulate their behavior through control and reinforcement to achieve goal-directed
behavior that can be maintained over time. The first five constructs were developed as part of
the SLT; the construct of self-efficacy was added when the theory evolved into SCT.
1. Reciprocal Determinism – This is the central concept of SCT. This refers to the dynamic
and reciprocal interaction of person (individual with a set of learned experiences),
environment (external social context), and behavior (responses to stimuli to achieve
2. Behavioral Capability – This refers to a person’s actual ability to perform a behavior
through essential knowledge and skills. In order to successfully perform a behavior, a
person must know what to do and how to do it. People learn from the consequences of
their behavior, which also affects the environment in which they live.
3. Observational Learning – This asserts that people can witness and observe a behavior
conducted by others, and then reproduce those actions. This is often exhibited through
“modeling” of behaviors. If individuals see successful demonstration of a behavior, they
can also complete the behavior successfully.
4. Reinforcements – This refers to the internal or external responses to a person’s behavior
that affect the likelihood of continuing or discontinuing the behavior. Reinforcements can
be self-initiated or in the environment, and reinforcements can be positive or negative.
This is the construct of SCT that most closely ties to the reciprocal relationship between
behavior and environment.
5. Expectations – This refers to the anticipated consequences of a person’s behavior.
Outcome expectations can be health-related or not health-related. People anticipate the
consequences of their actions before engaging in the behavior, and these anticipated
consequences can influence successful completion of the behavior. Expectations derive
largely from previous experience. While expectancies also derive from previous
experience, expectancies focus on the value that is placed on the outcome and are
subjective to the individual.
6. Self-efficacy – This refers to the level of a person’s confidence in his or her ability to
successfully perform a behavior. Self-efficacy is unique to SCT although other theories
have added this construct at later dates, such as the Theory of Planned Behavior. Selfefficacy is influenced by a person’s specific capabilities and other individual factors, as
well as by environmental factors (barriers and facilitators).
ii. Gaps, strengths, and limitations
Limitation of Social Cognitive Theory
There are several limitations of SCT, which should be considered when using this theory in
public health. Limitations of the model include the following:

The theory assumes that changes in the environment will automatically lead to changes in
the person, when this may not always be true.
The theory is loosely organized, based solely on the dynamic interplay between person,
behavior, and environment. It is unclear the extent to which each of these factors into
actual behavior and if one is more influential than another.
The theory heavily focuses on processes of learning and in doing so disregards biological
and hormonal predispositions that may influence behaviors, regardless of past experience
and expectations.
The theory does not focus on emotion or motivation, other than through reference to past
experience. There is minimal attention on these factors.
The theory can be broad-reaching, so can be difficult to operationalize in entirety.
Social Cognitive Theory considers many levels of the social ecological model in addressing
behavior change of individuals. SCT has been widely used in health promotion given the
emphasis on the individual and the environment, the latter of which has become a major point of
focus in recent years for health promotion activities. As with other theories, applicability of all
the constructs of SCT to one public health problem may be difficult especially in developing
focused public health programs.
One of the strengths of the social cognitive theory is that it offers the ability to relate to real life
examples. It also has the ability to be quickly and easily put to use. Another strength is that the
theory was very comprehensive. It takes human behavior, cognition, and the environment into
consideration as a whole. The next strength is that it addresses reinforcement and punishment
along with self-efficacy, motivation, Cognitive Personality Theories and the ways in which an
individual works towards obtaining their goal. The last strength is that it places focus on
learning and self-regulation.
iii. Application in practice
b. Stress-Buffering Model
i. Key constructs
ii. Gaps, strengths, and limitations
iii. Application in practice
c. Direct-Effect Model
i. Key constructs
ii. Gaps, strengths, and limitations
iii. Application in practice
d. Social Network Theory
i. Key constructs
ii. Gaps, strengths, and limitations
iii. Application in practice
e. Transactional Model of Stress and Coping
i. Key constructs
ii. Gaps, strengths, and limitations
iii. Application in practice

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