Health Education Models
Cathy Hollister, RDH, MSPH, PhD
Nashville Area Dental Support Center Director
United South and Eastern Tribes, Inc.
615-872-7900
[email protected]
Health Belief Model
First model that recognized a social
component to health
See Nathe, C.N. (2001). Dental public
health: contemporary practice for the
dental hygienist. Upper Saddle River, NJ:
Prentice-Hall, Inc.
Theoretical Base
Better informed people will make better choices
HBM: Key Points
Individuals must believe they are
susceptible to the problem
Example: Mothers must believe their children
are susceptible to caries
Individuals must believe the condition is
serious
Mothers must believe baby teeth are important
HBM: Key Points- Con’t.
Individuals must believe the intervention will
work
Mothers must believe sleeping with the bottle
contributes to ECC
Mothers must believe reducing exposure to sugars will
reduce risk of ECC
Individuals must overcome barriers
Parents must be willing to endure crying
Parents must have strategies to overcome “grandma
overindulgence”
Limitations of HBM
Information alone rarely leads to a behavior
change
Behavior changes are not linear
Doesn’t provide the tools needed for
behavior change
New Diseases or Threats
TSA
Susceptible
• Global threat from terrorists
• Airlines have been targets
Serious
Interventions work
• Effective screening techniques
• Complaints about male/female screeners
Overcome barriers
• Accommodate male/female travelers
• More screening stations
• Consider flight times
Stages of Change
Behavior is change happens in stages
Change is predictable and follows a pattern
Stages
Precontemplation
No interest in change
Contemplation
Ready to change but no change has started
Preparation
Arranging elements necessary for change
Stages
Action
Change has started
Maintenance
Change has been sustained for 6 months
Termination
As if the previous behavior never existed
Smoking Cessation
Pre-contemplation
No interest in quitting tobacco use
Contemplation
Interested in quitting but not yet ready.
• Gather information
• Consider heatlh consequences
• Discuss personal experiences of experiences of
others
Smoking Cessation
Preparation
Set a quit date
Enroll in a smoking cessation program
Purchase quit aids
Plan strategies for quitting and triggers
Action
Quit using tobacco
Actively work on behavior change
Devise strategies for maintaining behavior
Smoking Cessation
Maintenance
No tobacco use for 6 months
Termination
No desire for tobacco
Theory of Reasoned Action
People make rational decisions based on
knowledge, values and attitudes
Intentions predict behavior
Limited value because intentions change
quickly
Theory of Reasoned Action
Social Norms influence behavior
Social norms formed within a family,
community or society
More use of Bottled water
Oral health habits formed in families, Head
Start
Reasoned Action: What is Missing?
Information
Facts
Personal assessment
Readiness to change
Social Learning Theory
LOC and Self Efficacy are Modifications of
Social Learning Theory
Behavior
Environment
Knowledge
Locus of Control
Refers to an individual’s beliefs about
control over health or health actions
External
Health status is influenced by fate, luck, chance
or other people
Locus of Control
Internal
Health status is controlled by personal behavior
One of several factors that determine health
behaviors
LOC is an indirect measure of health status
Locus of Control
LOC and Self-efficacy were associated with
ECC in studies of Head Start children
Reisine & Litt, 1993
Increased risk of ECC
External LOC
Lower income
More knowledge about dental health
Higher stress
Self Efficacy
High SE means an individual has
confidence their actions will affect outcome
Involves forethought, preplanning, sense of
control
Higher self efficacy is frequently associated
with better health status
Self Efficacy
Attained by:
Enactive Attainment (Success breeds success)
Vicarious Learning
Verbal persuasion
Associated with oral health in multiple
studies
Confidence vs Self-Efficacy
Confidence: I can do it
Self-Efficacy: If I do it, my life will change
Sense of Coherance
Salutagenesis
What keeps people well?
Continuum of “ease to dis-ease”
dis-ease -----------------------------------------ease
↑
Sense of Coherence
Network of resources creates system for
managing stress
Health status is predictable
Adequate resources to manage health
Health is important enough to spend resources
Higher SOC associated with better oral
health (Friere, Hardy & Sheiham, 2002)
Sense of Coherence
Oral Health Network
Access to care
Trusted dentist
Access to healthy foods
Belief that oral health is important
Source of accurate information
HPV Vaccinations
UNC Researchers
Interviewed Parents of young girls about the
vaccine
Likely to get vaccine
Expressed regret at the thought that their
daughter might develop later cervical cancer
Barriers
Less likely to get vaccine if:
Didn’t know where to get it
Insurance didn’t cover vaccine
Health care providers didn’t have the vaccine
Born again Christians less likely to get vaccine
HPV Vaccine Health Message
“You have hopes and dreams
for your daughter,
and they don’t include
cervical cancer”