Health promotion and disease prevention has always been in the forefront in the health care system. Focus has been always on the physical factors that contribute to the birth and progress of a disease. Very few researches and studies are carried out on the psychological factors that influence the adoption of health improving behaviors. Many psychological theories and models have been proposed to explain patient’s health behavior.
The two studies that I have read and I use in my daily clinical practice are the health locus control (HLC) theory and health belief model (HBM).
The study which uses HLC is on managing diabetic foot ulcers and the second study is about using HBM for weight management. Both the studies focus on factors that would lead a patient to adopt changes in his behavior to promote health.
I usually come across male patients in my unit within the age group of 45 – 65years admitted with acute coronary syndrome. Their health assessment mostly reveal unhealthy lifestyles such as smoking, high cholesterol, unhealthy diet, lack of exercise and sedentary life which are all modifiable factors along with non-modifiable factors such as age, family history and gender.
Rotter in 1966 proposed the HLC and the internal –external locus scale. According to Rotter internal locus of control is the belief that positive/ negative life changes are a consequence of one’s own action whereas external locus of the control is the belief that positive/ negative life events are unrelated to one’s own behavior and so are beyond one’s own control. In my daily clinical practice I use HLC to give insight to patients that unhealthy life styles are creating the negative trend in their health. Patients with high health values and high internal HLC’s request more information about the disease and are more receptive towards health education, they are more compliant with treatments and they make use of the support system. Health belief model (HBM) was propounded by Baranowski, Cullen, Nicklas, Thomas and Baranowski (2003). Table 1.Health Belief Model applied to above mentioned scenario.
Perceived susceptibility| A person’s perceived risk for contracting an illness or health condition of concern to the researches. Inform patients that poor life styles make them prone to acquire diseases such as heart attacks, strokes , atherosclerotic conditions, peripheral vascular diseases etc.| Perceived severity| A person’s perception of the personal impact (clinical or social) of contracting the illness.Informing patients the seriousness and co morbidities associated with the conditions like heart attack, strokes, PVD’s etc.| Perceived benefits| A person’s perception of good things that could happen from undertaking specific behaviors, especially in regards to reducing the threat of the disease.
Benefit in this case would be leading a long disease free life unless family history, gender and age take controls which are non-modifiable factors.| Perceived barriers| A motivated person would look at the perceived benefits and thereby outweigh the perceived barriers that he/she may come across when adopting healthy life style choices | Self- efficacy| A person’s belief or confidence that he or she can perform a specific behavior. Self-determination and confidence inside the person helps him to make the changes in life to follow a healthy life style.|
Health education ( audio + video demonstration), educative materials in regards to the condition such as pamphlets, internet downloaded printed material, booklets all can guide patients to commit themselves to adopt life style changing behaviors. Family education, information about support systems and group activity can also contribute to the increased awareness towards one’s health and the behavioral changes that one should adopt to achieve a disease free life.
Baranowski, T., Cullen, K., Nicklas, T., Thompson, D., & Baranowski, J. (2003). Are current health behavioral change models helpful in guiding prevention of weight gain efforts? Obesity Research, 11(10), 23-42. Daddario, D.K. (2007). A review of the use of the health belief model for weight management. Medsurg Nursing, 16 (6), 363-366. Przybylski, M. (2010). Health locus of control theory in diabetes: a worthwhile approach in managing diabetic foot ulcers? Journal of Wound Care, 19 (6), 228-233. Rotter, J.B. (1966). Generalized expectations for internal versus external control of reinforcement. Psychol Monogr. 1966; 80: 1 1-28.