MODULE I

INTRODUCTION TO HEALTH

 Historical Backgrounds: Aims and Objectives of Health Psychology, Challenge for the
Future
 Significance of Health Behaviour, Theory of Planned Behaviour: Attributive Theory,
Health Locus Control

HEALTH PSYCHOLGY

Health psychology is a specialty area that focuses on how biology, psychology,

behavior, and social factors influence health and illness. Other terms such as medical
psychology and behavioral medicine are sometimes used interchangeably with the term
health psychology. Health and illness are influenced by a wide variety of factors. While
contagious and hereditary illnesses are common, many behavioral and psychological factors
can impact overall physical well-being and various medical conditions.

Health psychology is a field of psychology focused on promoting health as well as the

prevention and treatment of disease and illness. Health psychologists also focus on
understanding how people react to, cope with, and recover from illness. Some health
psychologists work to improve the health care system and the government's approach to
health care policy.

The field of health psychology emerged in the 1970s to address the rapidly changing
field of healthcare. Today, life expectancy in the U.S. is around 80 years, and the leading
causes of mortality are chronic diseases often linked to lifestyle.2 Health psychology helps
address these changes in health.

Because health psychology emphasizes how behavior influences health, it is well-

positioned to help people change the behaviors that contribute to health and well-being.
Examples of health psychology in action would be researchers conducting applied research on
how to prevent unhealthy behaviors such as smoking or to find new ways to encourage
healthy actions such as exercising.
For example, while most people realize that eating a diet high in sugar is not good for their
health, many people continue to engage in such behaviors regardless of the possible short-
term and long-term consequences. Health psychologists look at the psychological factors that
influence these health choices and explore ways to motivate people to make better health
choices.

Current Issues in Health Psychology

Health psychologists work with individuals, groups, and communities to decrease risk
factors, improve overall health, and reduce illness. They conduct research and provide
services in areas including:
• Stress reduction
• Weight management
• Smoking cessation
• Improving daily nutrition
• Reducing risky sexual behaviors
• Hospice care and grief counselling
• Preventing illness
• Understanding the effects of illness
• Improving recovery
• Teaching coping skills

The Biosocial Model in Health Psychology

Today, the main approach used in health psychology is known as the biosocial model.
According to this view, illness and health are the results of a combination of biological,
psychological, and social factors.5
• Biological factors include inherited personality traits and genetic conditions.
• Psychological factors involve lifestyle, personality characteristics, and stress levels.
• Social factors include such things as social support systems, family relationships, and
cultural beliefs.

Health psychology is a rapidly growing field. As increasing numbers of people seek to take
control of their own health, more and more people are seeking health-related information
and resources. Health psychologists are focused on educating people about their own health
and well-being, so they are perfectly suited to fill this rising demand.
HISTORICAL BACKGROUND

Health psychology emerged as a distinct subfield of psychology when the American

Psychological Association’s (APA) Task Force on Health Research was com- missioned in
1976 to address concerns over increasing rates of “preventable” diseases in the United
States he term health psychology has been acknowledged formally as a sub discipline of the
field of psychology since 1978, with the formation of the American Psychological
Association’s Division of Health Psychology (Division 38). Psychology’s interest in general
health and illness, however, extends to the very beginning of the discipline itself. Many of
the earliest “psychologists,” for example, Wilhelm Wundt, William James, and Hermann
von Helmholtz. Were trained in medicine; understandably, the study of behavior and
physiology were closely linked.

To understand the evolution of health psychology within the context of psychology,

one can reach back to ancient Chinese medicine, Hippocrates (550 BCE). Galen (second
century CE) and William Harvey (1628) to appreciate the continuing debate over holistic
versus mechanistic approaches to health and disease. Over the years, advances in medical
technology have perpetuated the Cartesian dualism separating mind and body, affecting the
field of psychology as well, for example, the notion of behaviourism. Although the
behaviourist viewpoint had internal integrity and scientific foundation in establishing,
modifying, and maintaining behavior. It paid scant attention to the reciprocal influences that
mind and body exert over one another and that affect health status.

As the discipline of psychology developed its professional as well as scientific

identity, psychology’s role in health was primarily concerned with “mental health.” in
keeping with trends of medical specialization and the consequent mechanistic approach to
physical health, illness, and disorder. The development and success of vaccines and
antibiotics in addressing acute infectious diseases further reinforced this perspective,
leading to increased separation between the mental and physical domains. During this
period, the development of clinical psychology established the professional role of the
psychologist in the diagnosis and treatment of mental disorders.

In many ways, psychology’s proliferation of new sub disciplines allowed the field to keep
abreast of changes in the political, economic, and social landscape that accompanied the
extraordinary technological revolution of the twentieth century. A similar revolution
occurred in the study of behavior. Space and medical technology breakthroughs created the
instrumentation necessary to observe the inner workings of the human organism, thus
enabling us to better comprehend the body’s response to environmental and behavioral
challenges. Our understanding of the interplay between the brain and behavior has allowed
us to comprehend better how the brain can, over time, directly and indirectly affect health
status through metabolic, endocrine, and electrical pathways.
 As breakthroughs in medical research in the industrialized world led to effective
treatment and prevention strategies to overcome most of the acute infectious diseases,
chronic degenerative diseases became the number one source of morbidity and mortality.
The single factor, mechanistic approaches so effective in conquering the acute infectious
diseases were notably unsuccessful in addressing cardiovascular disease, cancer, stroke,
diabetes, and HIV/AIDS, among others. Although technology provided increasingly
sophisticated diagnostic and treatment strategies, little success in preventing such diseases
resulted from such efforts.

By the late 1960s and early 1970s, it had become evident that a more comprehensive
approach to diagnosis, treatment, and prevention would be necessary if we were to make
serious progress in controlling the growing epidemic of chronic disease and the dramatically
escalating costs associated with “high-tech” medicine. Although psychologists were
employed in medical schools beginning in the early years of the twentieth century, it was
not until the 1960s and 1970s that significant numbers (over 2.500. or 5% of the APA
membership at that time) became employed as medical school faculty. Psychologists
became increasingly involved in consulting with various medical subspecialties, for
example, paediatrics, geriatrics, surgery, obstetrics and gynaecology, rehabilitation,
cardiology, and neurology, as physicians became increasingly aware of the broader needs
of their patients and the capabilities of their psychologist colleagues to respond to these
needs. The psychologist’s research training proved particularly helpful in attempting to
explore the multifactorial nature of chronic disease and the necessity to employ more
sophisticated multivariable research paradigms (for example. time-series analyses,
structural equation modelling) to address issues concerning ethology, diagnosis, treatment,
and prevention.

Although there was growing interest in the role of behavioral factors in the
development, treatment, and prevention of disease, the science base supporting this interest
was very thin; funds to support basic and clinical behavioral research were needed. The
growing concerns over the rapidly escalating national health costs associated with the rising
prevalence of chronic disease prompted the U.S. Congress to broaden the mandate of the
National Institutes of Health to include “the prevention and control” of chronic disease. As
the principal source of funding for health research in the United States (over $15 billion in
1999), the NIH exerted enormous influence over the scope, direction, and content of basic,
clinical, and public health research in this country and throughout the world.

At the time of the expanded mandate, less than 0.5% of the NIH budget was devoted to
behavioral re­search (as of 1999, that figure approximates 10%). However, during this same
period, the federal Centre for Disease Control proclaimed “lifestyle” to be the principal culprit
in the 10 leading causes of death in the United States. “Lifestyle” translated into what people
did (for example, what and how much they ate, smoked, drank; how physically active they
were; how “connected” they were with others; how they coped with environmental
demands; and what their living conditions were like). Based on this analysis, changing health-
related behaviors became the major focus of the emergent behavioral research enterprise
within the NIH. The establishing of relevant programs, review committees, and advisory
panels stimulated the growth of “biobehavioral” research, principally undertaken by
psychologists in collaboration with physicians, physiologists, biologists, and epidemiologists.
This coincided with the emerging interest within psychology itself to establish a separate
“health psychology” entity within the American Psychological Association.

Although there was strong interest in establishing a “health” identity within APA, the
general reluctance to establish new divisions during the mid-1970s resulted in the creation of
a “health” section within Division 18. Within only 2 years, however, it was obvious that a more
visible testament to psychology’s commitment to “health” was necessary to press the federal
scientific research establishment to commit much needed resources for research, as well as
to respond to the increasing demands for psychological research and services from the health
establishment itself.

While the formal recognition of the APA Division of Health Psychology occurred in
1978, several earlier events related to psychology’s role in health and well-being took place
that helped shape the scope and direction of the field. “The Role of Psychology in the Delivery
of Health Care,” a paper on psychology and health (Schofield, 1969), stimulated the APA’s
Board of Scientific Affairs in 1973 to appoint a Task Force on Health Research under the
leadership of William Schofield to address the role of psychology on health issues other than
“mental health.” This group published its formal report in the American Psychologist, which
concluded, “there is probably no specialty field within psychology that cannot contribute to
the discovery of behavioral variables crucial to a full understanding of susceptibility to
physical illness, adaptation to such illness, and prophylactically motivated behaviors” (APA
Task Force on Health Research, 1976, p. 272).

Late one evening in mid-1977, a small group of psychologists met in Bethesda,

Maryland, following an NIH study section meeting, to consider how to create a more
substantive presence for bio-behavioral research concerned with health and illness. The need
for a separate APA division exclusively devoted to “health” was agreed upon by all present.
Duties were assigned to each person in the room: obtaining the necessary signatures of 10%
of the active membership of the APA, establishing a committee to draw up charter and
bylaws, contacting influential members of the APA Council of Representatives to enlist their
support, developing a dialogue with officers of existing divisions to assure them that the
presence of a division of health psychology would not adversely affect their programs.
Surprisingly, there was essentially no opposition, and the division became a reality the
following year, with an initial membership of 600 psychologists. As testament to the need for
such an entity, within 3 years, 2.000 additional psychologists had joined Division 38, a tribute
to the dedication of the half-dozen “founder” psychologists drawn together and motivated
by a common vision.

The story would not be complete without reference to two related streams of activity
that directly affected the momentum of health psychology’s development. During this period
(actually beginning in the late 1960s), a growing dissatisfaction with the dominance of the
psychoanalytic orientation in “psychosomatic medicine” lead to a “separatist movement”
among more behaviourally inclined researchers and clinicians, guided principally by the work
of Neal Miller (considered the father of “behavioral medicine”). This group saw “biofeedback”
and the application of behavioral principles to problems of health and illness as a more
scientifically credible effort to understand and intervene upon mind-body interactions.

In 1977 and 1978, the Yale Conference on Behavioral Medicine and the Academy of
Behavioral Medicine Research meeting at the Institute of Medicine. National Academy of
Sciences formally defined the multidisciplinary field of “behavioral medicine” as “the
interdisciplinary field concerned with the development and integration of behavioral and
biomedical science knowledge and techniques and the application of this knowledge and
these techniques to prevention, diag­nosis, treatment and rehabilitation” (Schwartz & Weiss,
1978, p. 250).

Advances within the field of behavioral medicine have come primarily from health
psychologists working with primary care and specialty physicians, as well as epidemiologists,
virologists, physiologists, and molecular biologists, among others. Parenthetically, many have
erroneously equated health psychology and behavioral medicine; clearly, behavioral
medicine is an “umbrella” under which representatives from many disciplines can collaborate
on health-related issues. The scope of behavioral medicine extends, by definition, well
beyond the boundaries of any one discipline—it requires participation of two or more
disciplines to address the relevant issues at the multiple levels: genetic, physiological,
psychosocial, behavioral, environmental— involved in understanding the complexity and
interactions of the diagnostic, treatment, and prevention issues of chronic disease.

A second parallel development was initiated by Joseph Matarazzo, first president of

Division 38, in his conceptualization of “behavioral health,” which he defined as an
interdisciplinary field “that stresses individual responsibility in the application of behavioral
and biomedical knowledge and techniques to the maintenance of health and the prevention
of illness and dysfunction” (1980, p. 807).
 In light of the aforementioned Center for Disease Control report targeting lifestyle as
the single most important factor in the 10 leading causes of death, psychologists appeared
uniquely qualified to make a major contribution to “disease prevention and health
promotion.” Over the past 20 years, health psychologists have been conducting research
essential to the development of scientifically grounded intervention and prevention
strategies—and clinical health psychologists are implementing these strategies.

Both of these developments created internal pressures within health psychology to

establish overall professional objectives, education and training standards, research domains,
and associated policy and ethical guidelines. The 1983 Arden House Conference on Education
and Training in Health Psychology provided critical curricular guidelines to the many
departments of psychology that were establishing health psychology programs. It also
confirmed the commitment of health psychology to the professional path enunciated by the
Boulder “scientist-practitioner” model and provided guidelines for the relationship of health
psychology to other subdisciplines of psychology and to other health professions. The Harpers
Ferry Conference on Research in Health and Behavior established biobehavioral research
priorities in cardiovascular disease, cancer, AIDS, psychoneuroimmunology, smoking, child
health, and health policy.

Health psychology has been fortunate to have articulate spokespersons who promoted the
field through quality science. Dissemination of research findings, however, required avenues
to share these findings with the broader scientific community. Several new journals were
launched in health psychology and the companion area of behavioral medicine. Health
Psychology (the APA Division journal) was followed by Psychology and Health (European
Society of Health Psychology) and the Journal of Health Psychology. The Journal of Behavioral
Medicine, Annals of Behavioral Medicine, Behavioral Medicine, and the International Journal
of Behavioral Medicine all came into being within the same time frame, which permitted
substantive outlets for scientific productivity in both areas.
AIMS 0F HEALTH PSYCHOLOGY

Health psychology emphasizes the role of psychological factors in the cause, progression and
consequences of health and illness. The aims of health psychology can be divided into
Understanding, explaining, developing and testing theory and Putting this theory into
practice. 1Health psychology aims to understand, explain, develop and test theory by:

(a) Evaluating the role of behavior in the etiology of illness.

For example:
• Coronary heart disease is related to behaviors such as smoking, food intake, and
lack of exercise.
• Many cancers are related to behaviors such as diet, smoking, alcohol and failure to
attend for screening or health check-ups.
• A stroke is related to smoking, cholesterol and high blood pressure. An often
overlooked cause of death is accidents.
• These may be related to alcohol consumption, drugs and careless driving

(b) Predicting unhealthy behaviors.

For example:
• Smoking, alcohol consumption and high fat diets are related to beliefs.
• Beliefs about health and illness can be used to predict behavior.

(c) Evaluating the interaction between psychology and physiology.

For example:
• The experience of stress relates to appraisal, coping and social support.
• Stress leads to physiological changes which can trigger or exacerbate illness.
• Pain perception can be exacerbated by anxiety and reduced by distraction.

(d) Understanding the role of psychology in the experience of illness.

For example:
• Understanding the psychological consequences of illness could help to alleviate
symptoms such as pain, nausea and vomiting.
• Understanding the psychological consequences of illness could help alleviate
psychological symptoms such as anxiety and depression.
e) Evaluating the role of psychology in the treatment of illness.
For example:

• If psychological factors are important in the cause of illness they may also have a role
in its treatment.
• Changing behavior and reducing stress could reduce the chances of a further heart
attack.
• Treatment of the psychological consequences of illness may have an impact on
longevity. Health psychology also aims to put theory into practice. This can be
implemented by: Promoting healthy behavior. For example:

• Understanding the role of behavior in illness can allow unhealthy behaviourist be targeted.

• Understanding the beliefs that predict behaviors can allow these beliefs to be targeted.

• Understanding beliefs can help these beliefs to be changed. Preventing illness. For example:
• Changing beliefs and behavior could prevent illness onset.

• Modifying stress could reduce the risk of a heart attack.

• Behavioral interventions during illness (e.g. stopping smoking after a heart attack) may
prevent further illness.

• Training health professionals to improve their communication skills and to carry out
interventions may help to prevent illness.
OBJECTIVES

Health psychology emphasizes the role of psychological factors in the cause, progression
and consequences of health and illness (Ogden, 2004).

1. Evaluating the role of behaviour in the aetiology of illness (heart disease is related to
behaviours such as smoking, food intake, lack of exercise. Many cancers are related to
behaviours such as diet, smoking, alcohol).

2. Predicting unhealthy behaviours (smoking, alcohol consumption and high fat diets are
related to beliefs. Beliefs about health and illness can be used to predict behaviour).

3. Evaluating the interaction between psychology and physiology (The experience of stress
relates to coping and social support. Stress leads to physiological changes which can trigger
or exacerbate illness. Pain perception can be exacerbated by anxiety and reduced by
distraction).

4. Understanding the role of psychology in the experience of illness (Understanding the

psychological consequences of illness which could help to alleviate symptoms such as pain,
nausea, vomiting, anxiety and depression).

5. Evaluating the role of psychology in the treatment of illness (If psychological factors are
important in the cause of illness, they may also have a role in its treatment. Changing
behaviour and reducing stress could reduce the chances of a further aggravation).

6. Promoting healthy behaviour (Understanding the role of behaviour and beliefs in

illness helps in targeting unhealthy behaviours and beliefs).

7. Preventing illness (Changing beliefs and behaviour could prevent onset of illness).
1. Understanding, explaining, developing and testing theory.
1. Evaluating the role of behaviour in illness. Ex- Coronary heart disease is related
to behaviours- smoking, food intake, lack of exercise.
2. Predicting unhealthy behaviours. Ex- Smoking, alcohol consumption and high
fat diets are related to beliefs.
3. Evaluating the interaction between psychology and physiology. Ex- The
experience of stress relates to appraisal, coping and social support.
4. Understanding the role of psychology in the experience of illness. Ex-
Understanding the psychological consequences of illness could help to
alleviate symptoms such as pain, nausea, vomiting, anxiety and depression.
 5. Evaluating the role of psychology in the treatment of illness. Ex- Changing
behaviour and reducing stress could reduce the chances of a further heart
attack.

2. Aim of health psychology is to Put this theory into practice.

1. Promoting healthy behaviour. Ex- 1. Understanding the role of behaviour in

illness can allow unhealthy behaviours to be targeted. 2,understanding the
beliefs that predict behaviors and make necessary changes.
2. Preventing illness. Ex- 1. Behavioural interventions during illness (e.g. stopping
smoking after a heart attack) may prevent further illness.2. Changing beliefss
and modifying stress.

CHALLENGES

The evidence about the effectiveness of behaviour change approaches—what works

and what does not work—is unclear. What we do know is that single interventions that target
a specific behavioural risk have little impact on the determinants that actually cause poor
health, especially for vulnerable people. This has not prevented health promoters from
continuing to invest in behaviour change interventions which are widely used in a range of
programs. The future of behaviour change and health promotion is through the application
of a comprehensive strategy with three core components: (1) a behaviour change approach;
(2) a strong policy framework that creates a supportive environment and (3) the
empowerment of people to gain more control over making healthy lifestyle decisions. This
will require the better planning of policy interventions and the coordination of agencies
involved in behaviour change and empowerment activities at the community level, with
government to help develop policy at the national level.

1. Behaviour Change and Health Promotion

The behaviour change approach promotes health through individual changes in

lifestyle that are appropriate to people’s settings [1]. The assumption is that, before people
can change their lifestyle, they must first understand basic facts about a particular health
issue, adopt key attitudes, learn a set of skills and be given access to appropriate services.
The simple logic is that some behaviour leads to ill-health, and so persuading people directly
to change their behaviour must be the most efficient and effective way to reduce illness. This
reasoning is attractive to decision-makers because it promises quantifiable results within a
short time frame, can deal with high prevalence health problems, is relatively simple and
offers savings in health care services, especially for people suffering from chronic diseases [2].
The evidence about the effectiveness of behaviour change approaches is unclear, for
example, about handwashing among children [3] and cooking and food skills among adults
[4]. However, this has not prevented health promoters from continuing to extensively invest
in this approach. Behaviour change communication is a widely-used intervention manifested
through approaches such as communication for development (C4D), water, sanitation and
hygiene (WASH) and social behaviour change communication. These approaches attempt to
provide new knowledge and skills that people need to adopt a healthier lifestyle. They use a
range of techniques including interactive communication technologies, motivation,
counselling, persuasion, influencing social norms and coercion. Health promotion has also
relied on pre-packaged, top-down programs especially for health education and multi-risk
factor reduction interventions. These have not guaranteed a change in behaviour and has led
to a “blaming of the victim”, for example, for drinking too much alcohol or continuing to
smoke even though people know the behaviour is harmful. This can create feelings of mistrust
between “expert” practitioners and the public [5], further exasperated by changes in health
messaging, for example, on the safe levels of alcohol consumption.

Fundamentally, people do not resist change, but they do resist being changed. This is
a situation made worse by health promotion programs that have an over-reliance on didactic
styles of communication, inadequate audience segmentation, and inappropriate message
content and weak material development [6]. The art of health promotion is knowing when
and how to use the science to produce a desired outcome but many practitioners lack the
competence and confidence to achieve this in different contexts [7].
Behaviour change and health promotion can be made more effective and sustainable if the
following elements are included (1) a strong policy framework that creates a supportive
environment and (2) an enablement of people to empower themselves to make healthy
lifestyle decisions.

2. Behaviour Change and Policy Frameworks

Despite decades of acknowledging the direct influence of poverty, unemployment and

housing on people’s health, the policy problems often end up being defined as a behavioural
risk such as physical inactivity. We know that diseases are caused by a complex interaction of
factors; in particular, those that are driven by political, social and economic determinants.
The importance of a broader determinants approach is recognised in health promotion work
that moves beyond the individual behavioural model. However, this requires an
understanding that health is determined by how societies themselves are structured and the
political nature of health policy agendas [8].

Health promotion interventions that directly address behavioural risks can, at best,
support policy to promote health and, at worse, maintain inequalities in society. This is
because behaviour change approaches have little impact on the broader conditions that
create poor health, especially for vulnerable people such as migrants, low socio-economic
and indigenous groups. Behaviour change approaches are better implemented as part of a
wider, comprehensive policy framework and not as a single intervention that relies on top-
down, communication strategies to target a specific disease or behaviour.
Comprehensive, multicomponent interventions are more appropriate to change behaviours
that can lead to negative health effects. In particular, a strong policy framework is
empowering because it gives people more control over their lives, rather than simply telling
them what to do. Behaviour change interventions must therefore be supportive of a strong
policy framework.

3. Behaviour Change, Participation and Empowerment

Health promotion programs are often dependent on the participation of targeted people.
People also want to participate and will do so in large numbers if they are properly engaged
and have a shared interest in the program. Successful participation should be congratulated;
for example, the “walking for health” project recruited 8300 volunteer walk leaders [10] and
the Heritage Lottery Fund [11] recruited 5900 park friends and user groups across the UK (up
1100 from the previous year). However, participation is insufficient to help people to
empower themselves and to take the necessary actions to have a healthier lifestyle.
If the health promotion approach gives the practitioner the authority to control the
situation— for example, through setting the agenda or releasing specific resources—it is less
likely to be empowering. If it facilitates a process of needs assessment, capacity building and
local action it has a much better chance of being empowering. In practice, an empowerment
approach involves helping people to work together to gain more control over their lives and
health [12] such as by organising exercise classes or self-help groups. The behaviour change
approach can be paternalistic and often disregards the individual’s own perception of what is
important. Furthermore, the behaviour change approach can lead to stigmatization and to
increased inequalities in health, as its focus is on individual behaviours instead of the “causes
of the causes” of poor health. The empowerment approach does not have these problems
but can lead to empowering some groups over others, as the focus is not primarily on health
and empowered people might still choose to behave in ways that can damage their health
because this is secondary to other personal goals. However, the empowerment approach, on
the whole, has been considered to be superior to the behaviour change approach [13].
In practice the key question is: “Do I want to help others to empower themselves or to
simply change their behaviour?”. The added value of empowerment is that it gives the
individual, group, or community greater control, in achieving healthier, sustainable lifestyles.
The “Altogether Better project”, for example, was established in 2008 and has engaged over
18,000 volunteers as community “health champions” who have in turn reached over 104,000
other participants. The project aims at building capacity to empower communities to improve
their own health and well-being largely by extending the skills and expertise of local
volunteers. The project approach has demonstrated effectiveness in supporting positive
behaviour change, improving health, the use of health care services and by decreasing
hospital admissions [14].

4. The Future of Behaviour Change and Health Promotion

In reality, the modest success of behaviour change in health promotion programs has
been with those at the top of the social gradient and may even, at least temporarily, have led
to an increase in health inequalities [15]. The future of behaviour change and health
promotion is through the application of a comprehensive strategy to better enable people to
have a healthy lifestyle. A comprehensive strategy includes the points raised in this
commentary: (1) a behaviour change approach; (2) a strong policy framework that creates a
supportive environment; and (3) the empowerment of people to gain more control over
making healthy lifestyle decisions. A comprehensive strategy will require the better planning
and coordination of policy frameworks so that they systematically include both community
empowerment and behaviour change communication opportunities. The agencies involved
in delivering behaviour change and empowerment interventions at the community level will
have to work closely together as well as with government to help develop policy at the
national level.
SIGNIFICANCE OF HEALTH BEHAVIOUR

Health-related behavior is one of the most important elements in people's health and well-
being. Its importance has grown as sanitation has improved and medicine has advanced.
Diseases that were once incurable or fatal can now be prevented or successfully treated, and
health-related behavior has become an important component of public health. The
improvement of health-related behaviors is, therefore, central to public health activities.

DEFINITIONS OF HEALTH BEHAVIOR

There are many questions about health-related behavior, or health behavior that are
not yet well understood. Therefore, both public health workers and scientific researchers
continue to attempt to understand the nature and causes of many different health
behaviors. Health behavior encompasses a large field of study that cuts across various fields,
including psychology, education, sociology, public health, epidemiology, and anthropology.

In the broadest sense, health behavior refers to the actions of individuals, groups, and
organizations, as well as the determinants, correlates, and consequences, of these actions—
which include social change, policy development and implementation, improved coping skills,
and enhanced quality of life. This is similar to the working definition of health behavior that

Gochman's definition is consistent with the definitions of specific categories of overt health
behavior proposed by S. Kasl and S. Cobb. In two seminal 1966 articles, Kasl and Cobb define
three categories of health behavior:

• Preventive health behavior involves any activity undertaken by individuals who believe
themselves to be healthy for the purpose of preventing or detecting illness in a
asymptomatic state. This can include self-protective behavior, which is an action
intended to confer protection from potential harm, such as wearing a helmet when
riding a bicycle, using seat belts, or wearing a condom during sexual activity. Self-
protective behavior is also known as cautious behavior.
• Illness behavior is any activity undertaken by individuals who perceive themselves to
be ill for the purpose of defining their state of health, and discovering a suitable
remedy.
• Sick-role behavior involves any activity undertaken by those who consider themselves
to be ill for the purpose of getting well. It includes receiving treatment from medical
providers, generally involves a whole range of dependent behaviors, and leads to
some degree of exemption from one's usual responsibilities.
 •
These classic definitions have stood the test of time, and continue to be used by students and
public health workers alike. However, the lines between these three categories have blurred
somewhat over time, and there are also several categories of behavior that warrant specific
definitions.

Behavior versus Lifestyle

Health behavior can be something that is done once, or something that is done periodically—
like getting immunizations or a flu shot. It can also be something that one does only to oneself,
such as putting on sunscreen, or a behavior that affects others, like putting up a shade cover
so that children at a playground are protected from the sun. Other health behaviors are
actions that are performed over a long period of time, such as eating a healthful diet, getting
regular physical activity, and avoiding tobacco use. It is these latter types of behaviors, which
are sustained patters of complex behavior, that are called "lifestyle" behaviors. A composite
of various healthful behaviors is often referred to as "healthy lifestyle." However, most people
do not practice either healthful or risky behaviors with complete consistency—someone
might get regular, health-promoting exercise several times a week but be a cigarette smoker
who seldom brushes his or her teeth; or someone might quit smoking, only to begin eating
chocolate as a substitute. In the ideal, the person who practices a variety of behaviors in a
health-enhancing manner can be described as living a healthy lifestyle. More realistically,
though, many people practice some, but not all, lifestyle behaviors in a consistently healthful
manner

Health-Related and Health-Directed Behavior.

Health-related behavior is any action that is related to disease prevention, health

maintenance, health improvement, or the restoration of health. This type of behavior can be
either voluntary or involuntary, and can be undertaken explicitly for health purposes, as a
matter of habit, or to comply with a law or requirement. For example, a child who runs 800
meters in a physical education class is performing a health-related behavior, but only because
the teacher requires it to get a passing grade. In contrast, an adult who exercises to reduce
the risk of heart disease is engaging in that behavior for the express purpose of restoring,
maintaining, or improving his or her health. This type of action is called "health-directed
behavior." Sometimes these two types of health behavior coexist—a toddler buckled into a
safety seat is participating in health-related behavior, but for the parent this is a health-
directed behavior.
Self-Care Behavior

Self-care behavior involves taking actions to improve or preserve one's health. Self-care is
often thought of in terms as prevention or self-treatment of definable health problems or
conditions, but it can also include primary prevention in the absence of any symptoms. Self-
care includes the actions taken to treat symptoms before (or instead of) seeking professional
medical attention, such as eating chicken soup, drinking liquids, or taking over-the-counter
medications for cold or flu-like symptoms. It also includes treating minor injuries such as
bruises, scrapes, and twisted ankles when a person does not think a health care professional
is needed. Self-care is also a continuum whereby a patient may complete home treatments
such as changing a bandage or wound dressing, doing rehabilitation exercises, or avoiding
foods that inflame an allergic reaction. The use of alternative and complementary medical
treatments, without medical supervision, is also self-care behavior. An important feature of
self-care behavior is that it involves active participation in the health care process.

Health Care Utilization Behavior

Health care utilization is the use of health services, whether it be clinical public health
services or the services of medical care professionals. Health care utilization behavior is a
continuum that ranges from using preventive services, such as getting immunizations or early
detection and screening tests, to elective surgery or involuntary hospitalization after an
injury. Health care utilization is influenced by many different factors, and therefore the study
of utilization behavior includes examining who uses medical services, when and why they use
these services, and how satisfied they are with the services. Because health care utilization
behaviors, like lifestyle behaviors, are quite complex, various factors need to be examined to
understand them. A framework for understanding these factors that has been widely used is
the model devised by R. Andersen and L. A. Aday. According to their model, among the factors
influencing health care utilization are: characteristics of individuals and populations at risk,
the availability and quality of availability services, economic factors such health insurance,
and additional access factors such as the location of health services and the availability of
transportation. In addition, the level of "health need" is very important in terms of motivation
and/or choice about using medical care. This approach provides an important and robust
model for studying health care utilization behavior.

Dietary Behavior

Dietary behavior refers to eating patterns that people engage in, as well as behaviors
related to consuming foods, such as shopping, eating out, or portion size. Dietary behavior
differs from some other types of health behavior in that it is, in its basic forms, essential for
life. Of course, some dietary behaviors, such as drinking alcoholic beverages or smoking
cigarettes, are not necessary to sustain life. It is recognized that dietary behaviors influence
the development of many chronic diseases, including coronary heart disease, some cancers
(e.g. breast, colon, prostate, stomach, and cancers of the head and neck), type II diabetes
mellitus, and osteoporosis. Recommendations for healthful dietary behavior include limiting
consumption of high-fat foods, having a high intake of fruit and vegetables, increasing fiber,
and controlling caloric intake to prevent obesity. Although most Americans know about the
health consequences of unhealthful diets, many of the public health goals for dietary behavior
have not been met. The prevalence of obesity and type II diabetes mellitus increased
markedly in the United States and Canada during the last decade of the twentieth century.
Dietary behaviors play a role in preventing or managing disease when they are sustained over
the long term. Behavioral considerations are key to any attempts to promote healthful dietary
behavior. Several core issues about dietary behavior have been recognized. First, most diet-
related risk factors are asymptomatic and do not present immediate or dramatic symptoms.
Second, health-enhancing dietary changes require qualitative charge, not just changes in the
amount of food consumed. Third, both the act of making changes and self-monitoring dietary
behaviors require knowledge about foods. Thus, information acquisition and processing may
be more complex for dietary change than for changes in some other health behaviors, such
as smoking and exercise.

Substance-Use Behavior

Substance-use behavior focuses on the use of both licit and illicit mood-altering
substances. This category of substances, typically referred to collectively as "drugs," includes
tobacco, alcohol, caffeine, marijuana, cocaine, heroin, "designer drugs," and prescription
medications taken improperly. These substances are ingested for various reasons, but they
are similar in that they are all taken without the advice of a physician. Substance abuse, which
occurs when substance use behavior is at an extreme and unsafe level, is sometimes
associated with addiction, which makes it difficult to stop using the substance. Substance use
and abuse are responsible for many social and health problems, and for an enormous burden
of avoidable injuries in the United States each year.

Sexual Behavior

Sexual behavior may or may not involve sexual intercourse. Sexual behaviors have
health implications that range from reproduction and childbearing to sexually transmitted
diseases and, the most serious of these, HIV/AIDS. Taking precautions or avoiding sexual
contact with multiple partners can help prevent sexually transmitted diseases (STDs) and
prevent unwanted pregnancies. Sexual freedom due to social changes, a broadening of
women's participation in society, and the availability of effective birth control has increased
the prevalence of sexual behavior in the United States, bringing with it significant health and
social problems. Attention toward this area of health behavior has increased greatly over the
last two decades of the twentieth century, especially due to the AIDS epidemic.

Reckless Behavior

Reckless behavior involves individuals putting themselves in situations not normally

required in daily living that substantially increase their chances of illness, injury, or death. It
is often used synonymously with the terms "risk taking behavior" and "risky behavior."
Reckless or risky behavior is observed in adolescents and young adults, especially young
males, more often than in other demographic groups. Examples of behaviors considered risky
or reckless include drinking and driving, drag racing, substance use, carrying a concealed
weapon, engaging in unprotected sex, and playing extreme sports. Reckless behaviors have
been shown to be strongly related to an individuals' tendency toward impulsivity and
sensation-seeking.

IMPORTANT CROSS-CUTTING ISSUES AND CONSTRUCTS

The various theories of health-related behavior often overlap. Not surprisingly, these
explanations for behavior and models for change share several constructs and common
issues.

• Behavior Change as a Process. One central idea that has gained wide acceptance is
the simple notion that behavior change is a process, not an event, which is the major
tenet of the stages of change model. It is important to think of the change process as
one that occurs in stages. It is not a question of someone deciding one day to stop
smoking and the next day becoming a nonsmoker for life. Likewise, most people won't
be able to dramatically change their eating patterns all at once. The idea that behavior
change occurs in a number of steps is not particularly new. In fact, various multistage
theories of behavior change date back to the 1940s. This theory gained wider
recognition toward the end of the twentieth century, however. One example is the
diffusion of innovations theory, which distinguishes the diffusion or spread of new
behaviors from their adaptation or use by increasing numbers of people.

• Changing Behaviors versus Maintaining Behavior Change. Even where there is good
initial compliance to a health-related behavior change, a relapse to previous behavior
patterns is very common. Undertaking a behavior change and maintaining the change,
therefore, require different types of programs and self-management strategies. For
 example, someone could quit smoking by going "cold turkey," but he or she will
probably be tempted again, perhaps at a party where friends are smoking.
Maintaining cessation involves developing self-management and coping strategies, as
well as establishing new behavior patterns that emphasize perceived control,
environmental management, and improved confidence in one's ability to avoid
temptation. A model called the relapse prevention model focuses very specifically on
this issue.

• Barriers to Actions and Decisional Balance. The concept of barriers to action, or

perceived obstacles, is often mentioned in theories of health behavior. An extension
of this concept involves what is known as "decisional balance." This idea is called the
"net benefits of action" in the health belief model and "pros minus cons" in the stages
of change model. These terms all reflect the idea that individuals engage in a relative
weighing of the pros and cons of a prospective behavior change. This notion is basic
to models of rational decision making, in which people intellectually think about the
advantages and disadvantages of engaging in a particular action.

IMPLICATIONS FOR PUBLIC HEALTH

Understanding and improving health-related behavior is critical to the future of public health
and to the well-being of individuals, and has become central to public health activities. While
policies, laws, and regulations can affect health behaviors, there are also many individual
factors that must be considered in these public health efforts.
Change is incremental. Many people have practiced a lifetime of less than optimal health
behaviors of one sort or another. It is unreasonable to expect that significant and lasting
changes will occur during a short period of time. Public health programs need to identify and
maximize the benefits of positive change, pull participants along the continuum of change,
and consider changes in educational programs and environmental supports to help people
maintain changes over the long term.
THEORY OF PLANNED BEHAVIOUR

The theory of planned behavior (TPB) is a cognitive theory by Azjen (1985) that
proposes that an individual’s decision to engage in a specific behavior, such as gambling or
stopping gambling, can be predicated by their intention to engage in that behavior.

The Theory of Planned Behavior (TPB) started as the Theory of Reasoned Action in
1980 to predict an individual's intention to engage in a behavior at a specific time and place.
The theory was intended to explain all behaviors over which people have the ability to exert
self-control. The key component to this model is behavioral intent; behavioral intentions are
influenced by the attitude about the likelihood that the behavior will have the expected
outcome and the subjective evaluation of the risks and benefits of that outcome.
The TPB has been used successfully to predict and explain a wide range of health behaviors
and intentions including smoking, drinking, health services utilization, breastfeeding, and
substance use, among others. The TPB states that behavioral achievement depends on both
motivation (intention) and ability (behavioral control). It distinguishes between three types
of beliefs - behavioral, normative, and control. The TPB is comprised of six constructs that
collectively represent a person's actual control over the behavior.

1. Attitudes - This refers to the degree to which a person has a favourable or

unfavourable evaluation of the behavior of interest. It entails a consideration of the
outcomes of performing the behavior.

2. Behavioral intention - This refers to the motivational factors that influence a given
behavior where the stronger the intention to perform the behavior, the more likely
the behavior will be performed.

3. Subjective norms - This refers to the belief about whether most people approve or
disapprove of the behavior. It relates to a person's beliefs about whether peers and
people of importance to the person think he or she should engage in the behavior.

4. Social norms - This refers to the customary codes of behavior in a group or people or
larger cultural context. Social norms are considered normative, or standard, in a group
of people.

5. Perceived power - This refers to the perceived presence of factors that may facilitate
or impede performance of a behavior. Perceived power contributes to a person's
perceived behavioral control over each of those factors.
 6. Perceived behavioral control - This refers to a person's perception of the ease or
difficulty of performing the behavior of interest. Perceived behavioral control varies
across situations and actions, which results in a person having varying perceptions of
behavioral control depending on the situation. This construct of the theory was added
later, and created the shift from the Theory of Reasoned Action to the Theory of
Planned Behavior.

Limitations of the Theory of Planned Behavior

There are several limitations of the TPB, which include the following:
• It assumes the person has acquired the opportunities and resources to be successful
in performing the desired behavior, regardless of the intention.

• It does not account for other variables that factor into behavioral intention and
motivation, such as fear, threat, mood, or past experience.

• While it does consider normative influences, it still does not take into account
environmental or economic factors that may influence a person's intention to perform
a behavior.

• It assumes that behavior is the result of a linear decision-making process, and does
not consider that it can change over time.

• While the added construct of perceived behavioral control was an important addition
to the theory, it doesn't say anything about actual control over behavior.
 • The time frame between "intent" and "behavioral action" is not addressed by the
theory.

The TPB has shown more utility in public health than the Health Belief Model, but it is still
limiting in its inability to consider environmental and economic influences. Over the past
several years, researchers have used some constructs of the TPB and added other
components from behavioral theory to make it a more integrated model. This has been in
response to some of the limitations of the TPB in addressing public health problems.

ATTRIBUTION THEORY

Attribution theory, proposed by Fritz Heider (1958), is a social psychology theory that
deals with how individuals relate and make sense of the social world. More specifically, it is
concerned with how people translate events around them and how their translations affect
their thinking and behavior.

How does Attribution Theory Work?

The Attribution Theory is concerned with how individuals perceive the information
they receive, interpret events, and how these form causal judgements.
No individual would take an action or decision without attributing it to a cause or factor.

According to Heider, this is aimed at assessing the explanation that people give to
certain behaviors, it considers how individuals interpret their behaviors.
The theory of attribution posits that attribution, whether done internally or externally, has
great influence on how people feel and relate to others.
Heider says that all behavior is considered to be determined by either internal or by external
factors:

• External Attribution (Situational Attribution): Causality is assigned to an outside

factor, agent or force. Outside factors fall outside your control. You perceive you have
no choice. So your behavior is influenced, limited or even completely determined by
influences outside your control. Therefore you feel not responsible. A generic example
is the weather.
• Internal Attribution (Dispositional Attribution): Causality is assigned to an inside
factor, agent or force. Inside factors fall inside your own control. You can choose to
 behave in a particular way or not. So your behavior is not influenced, limited or even
completely determined by influences outside your control. Therefore you feel
responsible. A typical example is your own intelligence.

There is a three-stage process underlying attribution:

1. Perception. Observe. The person must perceive or observe the behavior.

2. Judgment. Determine deliberateness. The person must believe that the behavior was
intentionally performed.

3. Attribute. The person must determine if he believes the other person was forced to
perform the behavior (in which case the cause is attributed to the situation) or not (in
which case the cause is attributed to the other person).

Dispositional Vs Situational Attribution

1. Dispositional Attribution

Dispositional attribution assigns the cause of behavior to some internal characteristic

of a person rather than to outside forces.

When we explain the behavior of others, we look for enduring internal attributions,
such as personality traits. This is known as the fundamental attribution error.
For example, we attribute the behavior of a person to their personality, motives, or beliefs.

2. Situational Attribution

The process of assigning the cause of behavior to some situation or event outside a
person’s control rather than to some internal characteristic.

When we try to explain our behavior, we tend to make external attributions, such as
situational or environmental features.
Attribution theory examples

Psychologists have come up with a variety of theories to explain the attribution

process. The two most accredited theories are Kelley's covariation model and the
correspondent inference theory. Read below to learn more about the theories:

Kelley's Covariation Model

This is one of the most well-known examples. It decides whether situational or

dispositional factors explain certain actions. Kelley suggests people observe three different
pieces of evidence to uncover the cause of certain behaviour:
• Consensus: How other people behave in a similar situation.
• Distinctiveness: The extent to which the person behaves the same in similar
situations.
• Consistency: How often the person shows this behaviour every time the situation
occurs.

To illustrate this theory, we can apply it to drinking alcohol in a restaurant. If it's high in
consensus, then other people are also doing it. If someone only drinks in restaurants, the
behaviour is high in distinctiveness. If they drink all the time, then it's low. Finally, if the person
drinks in a restaurant every time, then consistency is high.

Correspondent Inference Theory

First put forward by Edward Jones and Keith Davis in 1965, the two introduced this theory
to explain how we make internal attributions. It suggests people are more likely to judge
voluntary behaviour instead of accidental behaviour. During the attribution process, we see
a clear correspondence between personality and behaviour to make an internal attribution,
for example, when we see a link between something behaving unkindly and being an unkind
person. Jones Davis claimed we can base correspondence inference on five factors

• Choice: If the behaviour is voluntary, then it is likely internal.

• Accidental or intentional behaviour: In this case, accidental is situational and

intentional is personality-based.

• Social desirability: We are more sensitive to making inferences based on socially

unacceptable behaviours.
 • Hedonistic relevance: Whether the behaviour is likely to benefit or harm us.

• Personalism: If we see the behaviour as directly affecting us, then it is personal and
not part of the situation.

Attribution theory: Biases and errors

Sometimes, the process of attribution is our own attempt to explain certain behaviour.
It is often prone to natural biases. These can vary depending on whether they involve
ourselves or other people, or whether the behaviour is dispositional or situational. Realising
these biases is the first step to combat them in our daily and professional lives and ensure our
relationship with colleagues improves. Below are three of the most common biases.

Examples of biases and errors in the workplace

The biases and errors of a characteristic theory can create a culture of blaming and
irresponsibility within the workplace. To combat this, a good employee needs to be aware of
their tendency towards self-preservation and biases towards observing other people. Below
are some common workplace attribution biases and ways in which you can counterbalance
them:
• Being scolded by your manager for losing an important contract. In this situation, it
is natural to want to blame other people, but you benefit from balancing self-
reflection and genuine external factors that you can adjust for next time.
• A new employee doesn't speak to you when you greet them. You may attribute this
to their disposition and say they are just a rude person. It's a good idea to consider
external factors that may influence their behaviour, such as nerves in a new office or
maybe the fact you weren't speaking clearly.
• Constantly firing people for making mistakes. As a manager, over punishment for
mistakes can create an atmosphere of blaming within the workplace as people work
to save themselves. Instead, you can look at empathising with your employees and
encouraging them to self-reflect and admit their mistakes, giving them an opportunity
for improvement.
• Situational attribution towards a colleague's promotion. Attributing a colleague's
promotion to favouritism or luck is not conducive to the support network you want to
create within the office and maybe traits or behaviour they have you can shadow.
Putting your biases aside and discussing their success with them is a great opportunity
to create a friendlier office environment and help you in your career.
LOCUS OF CONTROL

Locus of control is the extent to which you feel you have control over events that
impact your life. Put another way, it is "a belief about whether the outcomes of our actions
are contingent on what we do (internal control orientation) or on events outside our personal
control (external control orientation)," explains psychologist Philip Zimbardo.1

In 1954, psychologist Julian Rotter suggested that our behavior was controlled by
rewards and punishments. The consequences of our actions helped determine our beliefs
about the likely results of future behaviors.2

Our anticipation of certain results influences our behaviors and attitudes. In other
words, an individual is more likely to pursue a goal if they have been rewarded for similar
efforts in the past and believe that they can influence their chances of future success.

In 1966, Rotter published a scale designed to measure and assess external and internal
locus of control.3 The scale utilizes a forced choice between two alternatives, requiring
respondents to choose just one of two possibilities for each item.
While the scale has been widely used, it has also been the subject of considerable criticism
from those who believe that locus of control cannot be fully understood or measured by such
a simplistic scale.4

Internal vs. External Locus of Control

If you believe that you have control over what happens, you have what psychologists
refer to as an internal locus of control. If you believe that you have no control over what
happens and that external variables are to blame, you have what is known as an external
locus of control.5
It is important to note that locus of control is a continuum. No one has a 100% external or
internal locus of control. Instead, most people lie somewhere on the continuum between the
two extremes.

These are characteristics of people with a dominant internal or external locus of control.6

Internal Locus of Control

• Are more likely to take responsibility for their actions
• Tend to be less influenced by the opinions of other people
• Often do better at tasks when they are allowed to work at their own pace
• Usually, have a strong sense of self-efficacy
• Tend to work hard to achieve the things they want
 • Feel confident in the face of challenges
• Tend to be physically healthier
• Report being happier and more independent
• Often achieve greater success in the workplace

External Locus of Control

• Blame outside forces for their circumstances

• Often credit luck or chance for any successes
• Don't believe that they can change their situation through their own efforts
• Frequently feel hopeless or powerless in the face of difficult situations
• Are more prone to experiencing learned helplessness

Internal locus of control is often used synonymously with "self-determination" and

"personal agency." Some research suggests that men tend to have a higher internal locus of
control than women7 while others suggest the opposite: that women have greater internal
locus of control in comparison.8 Other research reports a shift towards more internal locus of
control as people grow older.9

Experts have found that, in general, people with an internal locus of control tend to be
better off.6 However, it is also important to remember that internal locus of control does not
always equal "good" and external locus of control does not always equal "bad."
In some contexts, having an external locus of control can be a good thing—particularly when
a situation poses a threat to self-esteem or is genuinely outside of a person's control.

For example, a person who loses a sports game may feel depressed or anxious if they
have a strong internal locus of control. If this person thinks, "I'm bad at sports and I don't try
hard enough," they might allow the loss to affect their self-image and feel stressed in future
games.
However, if this person takes an external focus during such situations ("We were unlucky to
get matched with such a strong team," or "The sun was in my eyes!"), they will probably feel
more relaxed and less stressed.

Do You Have an External or Internal Locus of Control?

Where does your locus of control fall on the continuum? Read through the statements below
and select the set that best describes your outlook on life.
Outlook 1
• I often feel that I have little control over my life and what happens to me.
• People rarely get what they deserve.
• It isn't worth setting goals or making plans because too many things can happen that
are outside of my control.
• Life is a game of chance.
• Individuals have little influence over the events of the world.
If the statements above best reflect your view on life, then you probably tend to have an
external locus of control.

Outlook 2
• If you work hard and commit yourself to a goal, you can achieve anything.
• There is no such thing as fate or destiny.
• If you study hard and are well-prepared, you can do well on exams.
• Luck has little to do with success; it's mostly a matter of dedication and effort.
• In the long run, people tend to get what they deserve in life.
If the statements above best reflect your outlook on life, then you most likely have an internal
locus of control.

Public Health Behaviour by WHO

• Public health behavior plays a crucial role in promoting and maintaining the well-being
of individuals, communities, and societies at large. The World Health Organization (WHO), as
a leading international body in public health, recognizes the significance of public health
behavior in preventing diseases, improving health outcomes, and fostering a healthy
environment. This article delves into the concept of public health behavior, its importance,
and the role of the WHO in promoting and advocating for positive health behaviors.

• Public health behavior refers to the actions, choices, and habits individuals and
communities adopt to protect and promote their health. It encompasses a wide range of
behaviors, including personal hygiene practices, healthy eating habits, physical activity,
adherence to medical treatments, responsible sexual behavior, avoidance of risky substances,
and regular health check-ups. These behaviors are not only important for individual health
but also have a significant impact on the overall health of communities and societies.

• The importance of public health behavior cannot be overstated. Adopting and

maintaining healthy behaviors can prevent the onset of various diseases, such as
cardiovascular diseases, diabetes, obesity, respiratory illnesses, and certain types of cancer.
These behaviors also contribute to mental well-being, as physical activity and healthy eating
are linked to improved mood and reduced risk of mental health conditions. Public health
behavior is not only crucial for disease prevention but also for enhancing the quality and
longevity of life.

• The World Health Organization plays a vital role in promoting and advocating for
positive public health behaviors worldwide. The WHO recognizes that behavior change is a
complex process influenced by multiple factors, including individual, social, economic, and
environmental determinants. As a result, it implements a multifaceted approach to address
public health behavior, combining research, policy development, capacity building, and public
awareness campaigns.

• One of the key strategies employed by the WHO is the development and
dissemination of evidence-based guidelines and recommendations. These guidelines provide
individuals, healthcare professionals, and policymakers with scientifically sound information
on healthy behaviors and interventions. They cover a wide range of topics, such as nutrition,
physical activity, tobacco control, alcohol consumption, and sexual and reproductive health.
By providing reliable guidance, the WHO aims to empower individuals and communities to
make informed decisions about their health behaviors.

• Furthermore, the WHO actively collaborates with member states, non-governmental

organizations, and other stakeholders to implement and evaluate public health programs and
interventions. It supports countries in building their capacity to address health behavior
issues, including training healthcare professionals, establishing surveillance systems, and
developing effective communication strategies. Through technical assistance and knowledge
sharing, the WHO fosters the implementation of evidence-based interventions to promote
positive health behaviors globally.

• Public awareness campaigns are another important tool utilized by the WHO to
promote health behavior change. These campaigns are designed to educate the public, raise
awareness about health risks, and motivate individuals to adopt healthy behaviors. By
leveraging various communication channels, including traditional media, social media, and
community engagement, the WHO disseminates messages on topics such as disease
prevention, vaccination, safe sex, healthy lifestyles, and mental health. These campaigns aim
to empower individuals to take control of their health and make choices that contribute to
their well-being.

• In addition to promoting positive health behaviors, the WHO also addresses barriers
and challenges that hinder behavior change. It acknowledges that social, economic, and
environmental factors significantly influence individual choices and behaviors. Therefore, the
organization advocates for policies and interventions that create supportive environments
and facilitate healthy choices. This includes advocating for legislation on tobacco control,
promoting access to nutritious food, improving urban planning to encourage physical activity,
and addressing social determinants of health that impact behavior, such as poverty and
inequality.

• In conclusion, public health behavior plays a vital role in improving individual and
population health outcomes. The World Health Organization recognizes the significance of
positive health behaviors and actively promotes them through evidence-based guidelines,
capacity building, public awareness campaigns, and collaboration with member states

• . By addressing barriers to behavior change and advocating for supportive

environments, the WHO strives to empower individuals and communities to adopt and
maintain healthy behaviors, ultimately contributing to a healthier world.

Attributive Theory of Emotion

The Attributive Theory of Emotion, established by psychologist Fritz Heider in the

year 1958, provides insights into how individuals attribute causes and explanations to their
own and others' emotions. This theory offers a framework for understanding the cognitive
processes that underlie the perception, interpretation, and understanding of emotional
experiences.

According to the Attributive Theory of Emotion, individuals make attributions or

judgments about the causes of emotions based on two fundamental dimensions: internal-
external and stable-unstable. The internal-external dimension refers to whether the cause of
the emotion is perceived as stemming from within the individual (internal) or from external
circumstances (external). The stable-unstable dimension pertains to whether the cause of the
emotion is seen as enduring over time (stable) or as temporary and fleeting (unstable).

When individuals experience emotions, they seek to understand why those

emotions arise. The Attributive Theory proposes that people engage in a process of
attribution, where they evaluate potential causes or reasons for their emotional experiences.
These attributions can significantly influence how individuals interpret and respond to their
emotions.

For instance, imagine a person feeling sadness. Based on the attributive process,
they may reflect on the potential causes of their sadness. If they attribute the sadness to
internal factors such as their own personality traits or disposition (internal-stable attribution),
they might conclude that they are inherently prone to feeling sad. On the other hand, if they
attribute the sadness to external factors such as a recent loss or a challenging life event
(external-unstable attribution), they might view the sadness as a temporary response to
specific circumstances.

The Attributive Theory of Emotion suggests that the attributions individuals make
about their emotions can have important implications for their emotional experiences, coping
mechanisms, and subsequent behavior. The theory highlights the role of cognitive processes
in shaping emotional responses and how individuals make sense of their emotional states.

Furthermore, the Attributive Theory also extends to the perception and

interpretation of others' emotions. When observing someone else experiencing an emotion,
individuals may engage in a similar attributional process to understand the causes of that
person's emotional state. By attributing internal or external causes to others' emotions,
individuals make inferences about the other person's personality, disposition, or the specific
situation they are facing.

The Attributive Theory of Emotion has implications in various domains, including

psychology, social interactions, and clinical practice. It provides a framework for
understanding how individuals make sense of their own and others' emotions, which can have
implications for empathy, interpersonal relationships, and the assessment and treatment of
mental health conditions.

It is important to note that the Attributive Theory of Emotion is one of several

theories in the field of emotion psychology. Other theories, such as the Cognitive Appraisal
Theory and the Facial Feedback Hypothesis, also contribute to our understanding of how
emotions are perceived, experienced, and expressed.

In conclusion, the Attributive Theory of Emotion, established by Fritz Heider in

1958, explores how individuals attribute causes and explanations to their own and others'
emotional experiences. By considering the internal-external and stable-unstable dimensions
of attributions, this theory provides insights into how individuals perceive, interpret, and
understand emotions. The theory highlights the role of cognitive processes in shaping
emotional responses and emphasizes the influence of attributions on emotional experiences,
coping strategies, and behavior.

Attribution Theory of Achievement Motivation

The Attributional Theory of Achievement Motivation, also known as the Attribution

Theory of Achievement Motivation, was proposed by psychologist Bernard Weiner in the
early 1970s. This theory aims to explain how individuals attribute their successes and failures
in achievement-related situations and how these attributions influence their motivation and
subsequent behavior.

According to the Attributional Theory of Achievement Motivation, individuals tend to

attribute their successes and failures to three key dimensions: locus of causality, stability, and
controllability. These dimensions play a significant role in shaping individuals' perceptions of
their abilities, their expectations for future success or failure, and their motivation to engage
in achievement-related tasks.

1. Locus of Causality:
• Internal locus: Individuals attribute their achievement outcomes to internal factors
such as personal abilities, effort, or strategies.
• External locus: Individuals attribute their achievement outcomes to external factors
such as luck, task difficulty, or the influence of others.
• Points to consider:
• Internal attributions tend to enhance individuals' sense of self-efficacy and belief in
their abilities.
• External attributions may lead individuals to discount their own capabilities and
attribute outcomes to factors beyond their control.
• Internal attributions are generally associated with greater motivation and persistence
in achievement-related tasks.

2. Stability:

• Stable attributions: Individuals attribute their achievement outcomes to stable factors

that remain relatively consistent over time, such as inherent ability or lack thereof.
• Unstable attributions: Individuals attribute their achievement outcomes to temporary
or changeable factors, such as effort, mood, or specific circumstances.
• Points to consider:
• Stable attributions can lead individuals to develop long-term expectations about their
future performance based on past outcomes.
• Unstable attributions may foster a belief in the potential for improvement and
motivate individuals to exert effort to change their outcomes.
• Stable attributions for failure can lead to a fixed mindset, whereas unstable
attributions for failure can promote a growth mindset.

3. Controllability:
• Controllable attributions: Individuals attribute their achievement outcomes to factors
within their control, such as effort, study habits, or effective strategies.
 • Uncontrollable attributions: Individuals attribute their achievement outcomes to
factors beyond their control, such as luck, task difficulty, or external circumstances.
• Points to consider:
• Controllable attributions empower individuals by suggesting that they can influence
their outcomes through their actions and efforts.
• Uncontrollable attributions may lead to a sense of helplessness or reduced motivation
if individuals believe they have no control over their future performance.
• Encouraging controllable attributions can promote a sense of agency and increase
motivation and effort in achieving desired outcomes.

 These dimensions interact with each other, and the specific attributions
individuals make about their achievement outcomes can have a significant impact on their
motivation, beliefs, and subsequent behavior. Educators, parents, and individuals themselves
can benefit from understanding these dimensions to foster a positive achievement mindset
and support individuals' motivation and growth in various domains.
 The attributions individuals make about their achievement outcomes can have
significant implications for their motivation and subsequent behavior. For example,
individuals who attribute their successes to internal, stable, and controllable factors are more
likely to have a sense of self-efficacy and exhibit higher levels of motivation to tackle future
challenges. They believe that their abilities and efforts contribute to their achievements and
are more likely to persist in the face of obstacles.

 Conversely, individuals who attribute their failures to internal, stable, and

uncontrollable factors may experience feelings of helplessness, lower self-esteem, and
reduced motivation. They may believe that their abilities are fixed and that their efforts will
not make a difference, leading to decreased persistence and engagement in achievement-
related activities.

 The Attributional Theory of Achievement Motivation has important

implications for educational settings, where it can inform teaching practices, feedback
delivery, and the cultivation of a growth mindset. By understanding how individuals attribute
their successes and failures, educators can provide targeted feedback that promotes internal
locus attributions, emphasizes effort and controllability, and fosters a belief in the malleability
of abilities.

 In conclusion, the Attributional Theory of Achievement Motivation, proposed

by Bernard Weiner, explains how individuals attribute their successes and failures in
achievement-related situations. By considering dimensions such as locus of causality,
stability, and controllability, this theory sheds light on how these attributions influence
individuals' motivation, self-perceptions, and subsequent behavior. The theory has important
implications for understanding achievement-related motivation and can inform educational
practices aimed at fostering a growth mindset and enhancing student engagement and
persistence.