Ch09: Health Behavior — Theory, TTM & Interventions（健康行为）

Preparatory Mindset

Health behavior = actions that directly affect health outcomes. The two health-behavior lectures (Peng, 18KB + 15KB) + the 医学心理学笔记 cover the Transtheoretical Model (TTM/stages of change), socioecological framework, habits and lifestyles, and tobacco control. The exam tests: TTM stages (precontemplation → contemplation → preparation → action → maintenance → relapse), theory in action, and the risk factors of obesity/alcohol/smoking.

Exam mindset: know the 5-6 stages of behavior change (TTM), the 10 processes of change (consciousness raising, dramatic relief, etc.), the 5 levels of the socio-ecological framework (intrapersonal → interpersonal → organizational → environmental → public policy), and case-study application (e.g., the 50-year-old smoker with a granddaughter).

Core Concepts

1. Definition (MUST KNOW)

• Health behavior: actions that can directly affect health outcomes
• Theory: an individual-level effort to prevent diseases, prolong life, and promote the dimensions of health
• Examples: smoking, diet, exercise, alcohol use, adherence, vaccination

2. Why health behavior matters (MUST KNOW)

• People's lifestyles can be a strong determinant of the diseases they will suffer
• Tobacco use, poor diet, and physical inactivity are causally associated with multiple diseases
• Many factors influence behavior: age, gender, socioeconomic status, skills, beliefs, attitudes, values, culture, religion

3. Risk factors (MUST KNOW)

• Overweight/obesity: ↑ hypertension, ↑ LDL, ↓ HDL → atherosclerosis, coronary heart disease, stroke; type 2 diabetes
• Alcohol: liver damage → cirrhosis; stomach/duodenal ulcer; cancer (oral, esophageal, liver, breast)
• Smoking: lung damage → COPD, lung cancer, pulmonary disease; vascular disease; many cancers
• WHO: overweight/obesity has nearly tripled since 1975; 4 million deaths/year worldwide (GBD)

4. Theory in health behavior (MUST KNOW)

• Theory: a way to put together a set of ideas that helps us understand how, why, and what might happen next
• Important aspects: describes current relationships among concepts; explains how concepts work together; predicts future behavior
• Why theory matters: interventions that apply theoretical principles are more more effective than those that do not
• Application: target behavior, factors, population, sociocultural fit

5. Transtheoretical Model (TTM) — stages of change (MUST KNOW)

1. Precontemplation — no intention to change in the next 6 months; denial, ignorance of problems 2. Contemplation — intends to change in the next 6 months; ambivalent; aware of benefits; conflicted 3. Preparation — intends to change in the next 30 days; making small changes; collecting information 4. Action — actively modifying behavior, but <6 months 5. Maintenance — sustained behavior change >6 months; avoiding temptation; the new behavior is the habit 6. Relapse — return to the old behavior; common; not failure — restart at an earlier stage

• Integrative, biopsychosocial model to conceptualize the process of intentional behavior change
• 5 stages (with the 6th — relapse):

6. 10 processes of change (MUST KNOW)

• Consciousness raising
• Dramatic relief
• Environmental reevaluation
• Self-reevaluation
• Self-liberation
• Counterconditioning
• Reinforcement management
• Stimulus control
• (Plus 2: helping relationships, social liberation)

7. Other health behavior theories

1. Intrapersonal (individual) 2. Interpersonal (family, friends) 3. Organizational (school, workplace) 4. Environmental (community) 5. Public policy (laws, regulations)

• Health Belief Model (HBM): perceived susceptibility, severity, benefits, barriers; cues to action; self-efficacy
• Theory of Planned Behavior (TPB): attitudes, subjective norms, perceived behavioral control → intention → behavior
• Social Cognitive Theory (Bandura): reciprocal determinism (person, behavior, environment); self-efficacy
• Socio-ecological framework (5 levels):

8. Tobacco control (MUST KNOW)

• MPOWER (WHO): Monitor tobacco use, Protect people, Offer help, Warn about dangers, Enforce bans, Raise taxes
• Interventions: taxation, plain packaging, smoke-free laws, cessation support (NRT, varenicline, CBT), media campaigns

9. Case study: the 50-year-old smoker

• Stage: contemplation (intends to quit in next 6 months — cough 3 months)
• Interventions: motivational interviewing (elicit change talk), explore ambivalence, discuss pros/cons, encourage support from family (granddaughter)
• Strategies: distraction (play with granddaughter), substitute (lollipop), nicotine replacement, brief counseling

10. Adherence (MUST KNOW)

• Adherence dimensions: taking medication, following diet, lifestyle changes, screening
• Predictors of non-adherence: complex regimen, side effects, cost, lack of understanding, depression, lack of perceived benefit
• Interventions: simplify regimen, patient education, motivational interviewing, reminder systems, family involvement

11. Lifestyle medicine

• 6 pillars: nutrition, physical activity, sleep, stress management, avoidance of risky substances, social connection
• Integrate with primary care for chronic disease prevention & management

High-Yield Points

• TTM stages: precontemplation → contemplation → preparation → action → maintenance → relapse
• Contemplation: intends in next 6 months (the 50-year-old smoker)
• Preparation: intends in next 30 days; small changes
• Action: actively changing, <6 months; Maintenance: >6 months sustained
• Relapse: common — restart (not failure)
• Theory-based interventions are more effective than non-theory
• 5 levels of socio-ecological framework: intrapersonal → interpersonal → organizational → environmental → public policy
• Risk factors: obesity (CHD, DM), alcohol (cirrhosis, cancer), smoking (COPD, lung cancer)
• MPOWER (WHO tobacco control): Monitor, Protect, Offer, Warn, Enforce, Raise taxes
• MI for behavior change: evoke change talk (DARN), reduce resistance (RULE)
• Self-efficacy (Bandura): central to all behavior change

Topic Summary

Health behavior encompasses actions that directly affect health outcomes — influenced by age, gender, SES, beliefs, culture, and religion. Major risk factors include overweight (atherosclerosis, CHD, type 2 diabetes), alcohol (cirrhosis, cancer), and smoking (COPD, lung cancer). Health behavior change is best guided by theory. The Transtheoretical Model (TTM) describes six stages: precontemplation (no intent, denial), contemplation (intent in next 6 months, ambivalent — the 50-year-old smoker case), preparation (intent in next 30 days, small changes), action (active change <6 months), maintenance (>6 months sustained), and relapse (common — restart, not failure). Other theories include the Health Belief Model (susceptibility, severity, benefits, barriers), Theory of Planned Behavior (attitudes, norms, control), and Social Cognitive Theory (Bandura's self-efficacy). The 5-level socio-ecological framework spans intrapersonal, interpersonal, organizational, environmental, and public policy. WHO's MPOWER strategy provides the global tobacco control template. Health behavior interventions are most effective when theory-based and combine motivational interviewing, environmental support, and reinforcement.