Health+and+Behavior

=**Health and Behavior**=


 * 1. Define health behavior.**

Health Behavior as defined by Kasl and Cobb is any activity undertaken by an person believing himself to be healthy for the purpose of preventing disease or detecting it in an asymptomatic stage.

This is different from illness behavior and sick role behavior. Illness behavior is any activity undertaken by a person who feels ill to define the state of health and find a suitable remedy. Sick role behavior is an activity undertaken by a person who considers themselves ill for the purpose of getting well and usually involves seeking treatment from appropriate therapists, a range of dependent behaviors, and some degree of neglect of one's usual duties.


 * 2. Describe the health belief model.**

The health belief model is a model that attempts to explain health behavior and adherence. It suggests that individual perceptions of perceived susceptibility and severity to a disease are modified by demographic and sociopsychological variables and cues to action. These modifications are used to estimate the benefits and barriers to preventive action which determine the likelihood of taking recommended preventive health actions against the perceived threat of health issue.

Demographic variables include age, sex, race, ethnicity, etc. Sociopsychological variables include personality, social class, peer and reference group pressure, etc. Cues to action include mass media campaigns, advice from others, reminder postcards from health professionals, illness in family member/friend, articles in newspaper/magazines, etc.

Modifying factors may include a patient-practitioner relationship with good communication, a regular physician, social pressure and social group conformity, influence of friends and family are all correlated with following health regimens.


 * 3. Discuss adherence within a health behavior paradigm.**

The health behavior paradigm is useful in predicting health behavior before illness (e.g. screening for cancer). It is also useful in predicting health behavior during an illness (adherence/compliance to medical regimens). There is a positive correlation between higher levels of subjective vulnerability to disease and the adherence to various health behaviors against the disease. Conversely, very low levels of perceived severity are not sufficient to motivate patients to adhere to health behaviors. However, very high levels of perceived severity can be inhibiting because patients are so afraid they may avoid or deny their susceptibility to the disease. Nonetheless, generally, patient estimates of seriousness are predictive of adherence.


 * 4. Describe changes in health regimen and elements of health delivery that are important to modifying health behavior.**

Factors that predict adherence behavior include the patients attitudes and perception of illness, environmental factors, therapeutic regimen, and the physician-patient interaction. To facilitate adherence, a physician may alter the educational approach between being active (doctor tells you to do...) or passive (interact and work with patient in partnership). A physician may also accommodate the gender, culture, or personality of the patient or modify environmental and social factors by utilizing social support or disease support groups. Changes to simplify the therapeutic regimen and enhancing the physician-patient relationship may also help boost adherence.

The following health regiment and delivery considerations may be helpful to maximize adherence:

(1) Provide continuity of personalized care (2) Change the patient's expectations of treatment or attempting to meet them (3) Simplifying the health regimen (4) Providing health knowledge that operationalizes the recommended behavior (give patients an active role) (5) Communication the importance of health behaviors and motives (6) Maximizing rewards for prescribed behaviors (7) Minimizing the costs for being a patient (8) Easing the patient into a regimen (9) Instilling a sense of personal responsibility for health maintenence


 * 5. Describe Prochaska and Diclemente's transtheortical model of stages of change.**

Under the transtheroetical model of stages of change, the change of a habit or behavior does not occur in just one try. Change requires movement through discrete motivational stages over time and these stages require different processes to help the learner "move" through the stages. Relapse is common and to be expected. These stages represent a continuum of readiness of behavior change:

Precontemplation - not intending to change in the near future Contemplation - intending to change within 6 months Preparation - actively planning change and experimenting with limited action Action - actually making overt changes; less than 6 months of success Maintenance - sustaining change over time and taking steps to resist relapse


 * 6. Discuss behavioral issues and interventions in coronary heart disease.**

A study of Type A behavior pattern is correlated with double the risk of coronary heart disease in 8.5 year follow-up of a study of 3,154 men. Type A behavior includes ambitiousness, aggressiveness, competitiveness and impatience, alertness and muscle tension, rapid and emphatic speech stylistics, enhanced irritiation and expressed signs of anger/hostility. The anger/hostility dimension appears to be most predictive of CHD.

To modify Type A behavior, a physician can have a patient start progressive muscle relaxation training, rational emotive therapy, communication skills training, problem skills training, and stress inoculation. These programs can reduce systolic blood pressure, serum cholesterol, and time pressure.


 * 7. Discuss health issues and interventions for smoking.**

Smoking is estimated to be responsible for about 419,000 deaths per year and $50 billion annually is spent on direct medical care for smoking related illnesses. 90% of former smokers say they quit on their own but the majority of former smokers are not successful on first try.

The more intense the treatment, the more likely for long term abstinence. Some policies suggested include implementing a tobacco user identification system in every clinic, provide education, resources and feedback to promote provider intervention, promote hospital policies that support and provide smoking cessation services, include smoking cessation treatments as paid services in all health benefits packages, and address effective smoking cessation treatment in clinical compensation agreements.

Other recommendations include offering treatment to all smokers, determining and documenting all patients tobacco use status, at least minimal intervention should be provided to every tobacco user, nicotine replacement therapy, social support, and/or skills training/problem solving training should be provided.

In the clinic, use "ask, assess, advise, assist and arrange" for all smoker patients. Implement a system that ensures tobacco use status is obtained and recorded for every patient at every visit. Advise users to quit and be clear, strong, and personal in your advice. Assist the patient with a quit-plan by advising the patient to set a quit date, inform family/friends/co-workers of plans and ask for support, remove cigarettes, review previous quit meetings, and anticipate challenges. Encourage nicotine replacement therapy.


 * 8. Discuss behavior issues in HIV infection prevention.**

Risk factors for HIV and AIDS include unprotected sexual activity with multiple sexual partners and intravenous drug use with shared needles. HIV risk is large with comparatively low rates of risk taking behavior and success in prevention requires making and maintaining consistent behavioral changes (consistent condom use when non-monogamous, not engaging in i.v. drug use with dirty needles).

Physicians should provide behavior-specific risk education by clearly identifying the behavior practices that create risk and practical advice on behavior changes needed to reduce risk while taking into account the realities of the patient's lifestyle and relationships. Physicians should also accurately discuss the patient's risk level, encourage patient self-appraisal of risk, and induce a realistic perception of threat.

Patients should then be given skills training such as condom use if sexually active, assertiveness to resist coercion to engage in unsafe sexual practices, negotiation to discuss commitment to safer sex practices with new/high-risk partners, and self-management to identify and neutralize patterns, habits, or activites that increase vulnerability to risk.

Follow-up counseling should be considered to reinforce change efforts, discuss problems encountered, and encourge patient self-commendation of risk-reduction change.