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Is It Possible to Help People Change to a More Healthy Behavior?

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Is it possible to help people to change to more healthy behaviour?

Theories about changes in health behaviour tend to look at:

Ð'* Cognition: the way people define and think about what they do and how they change their minds in ways that can lead to changing the ways they act; and

Ð'* Context: the cultural, social, physical, emotional and psychological environments that shape people and the factors that can facilitate change. No one theory can sum up all the factors in health behaviour, but theories can be used to focus on particular aspects of behaviour and to choose the most appropriate programmes for cancer control.

Behaviour: what people do

Ð''Behaviour' is the general term covering all the physical acts performed by individuals. Examples of physical acts include walking, interacting with others, writing, reading and preparing to learn. Behaviour includes seeking or not seeking advice for health care and following or not following a prescribed medical regimen. It includes relationships with tobacco, food, alcohol and so on.

Cognition: what and how

people think

Ð''Cognition' is the term given to all the mental processes of an individual and includes not only aspects of thinking, such as knowledge, attitudes, motives, attributions and beliefs, but also perceptions, personal values, perceived cultural truths and memory. Cognition can be influenced by intelligence and past experience. Examples are religious convictions, wanting to be a good parent, distrusting modern medicine, knowing that smoking is dangerous for others but believing that it is not dangerous for one's own health, and so on.

Context: the setting of

behaviour and cognition

Ð''Context' is a general term that is more inclusive than the general perception of the environment. It includes not only the social, cultural and physical environment but also interpersonal influences on behaviour and the emotional and psychological

contexts of each act and cognition. These include laws, norms (socially defined and accepted cognition and behaviour) and social dynamics. Much healthy behaviour is not practised simply because, for instance, it is not defined as necessary by the community (e.g. skin protection), the appropriate choice is not available (e.g. healthy eating at work or school), other forces push society towards an unhealthy alternative

(E.g. the tobacco industry) or an unhealthy behaviour is reinforced by contingencies (e.g. pressures of time that reinforce driving rather than walking). These three dimensions may interact in various ways.

Relationship between

cognition and behaviour

The clearest evidence that cognition leads to new behaviour is the development of skills through formal and informal education. Cognition such as beliefs and attitudes can be translated into action if a change is perceived to be possible, if there is no opposition to or difficulty in performing the action or if the cognition is a central component of the person's teleological system, such as religious beliefs. Cognition that is forged from past experience often influences behaviour. For example, a patient who has been successfully treated in the past is likely to return for care when a new illness appears. Cognitive theories of behaviour attempt to predict what people will do in certain circumstances. The challenge is in identifying which cognition is most salient and the degree to which it can predict change. Many people know that they should exercise and eat a healthy diet, and they form an intention: they decide that they will begin to exercise regularly and limit their intake of sweets and fats. If a large proportion of people with this intention do indeed perform these behavioural

changes, intention is a good predictor. In many cases, however, behaviour can change thought patterns. In the case of exercise and diet, a person can desire to be healthy but stop working in this direction when he or she finds it difficult to make time to exercise and makes little progress in changing eating patterns. Diet and exercise then become less important. If this is true for many people, intention is not a strong predictor, or the wrong intention has been measured. Indeed, observations of human behaviour indicate that it is easier for people to find reasons for what they do than to change

The research should allow for refinement or new theories. Theories and strategies related to health behaviour generally give predominance to the connection between cognition and behaviour or to that between the context and behaviour. The measurements made in each type of theory fall into two main categories. Quantitative measurement involves the assessment of observable, objective behaviour, defined health states and contextual events, or countable scales for subjective variables such as cognition, and the relationships between them. Qualitative measurement involves the assessment of subjective accounts of cultural or social perceptions, which can indicate contextual elements, and the environmental changes required to facilitate alternative behaviour that corresponds to belief structures.

Cognitive theories

of health behaviour

Most models of behavioural change are based on an assumption of volitional, that is cognitively determined, behavior. For example, the health belief mode land its offshoots are based on the premise that attitudes and beliefs are the major determinants of health behaviour, and that any behaviour in response to a health threat is based on two major types of cognition: the expectation that a specific action will lead to improved health, and the subjective value that is placed on improved health. Any divergence in behaviour is thus related to the adequacy of cognition and how readily cognition is adapted tone experience. Cognitive theories have been used to investigate the roles of motivation, fear and misperception. In all, the basic premise is the same: preventive behaviour is a function of the perception of threat and of the belief that the best course of action includes new

behaviour. With the recognition that context also plays a role, evolving theory includes cues to action and general orientation to health as subjective cultural values. Stage models of behaviour have been developed from Rogers' concept



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