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BIOPSYCHOSOCIAL HEALTH
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Theories on Health
Behaviors
by Shaheen E Lakhan, MD, PhD, MEd, MS, FAAN | March 19, 2006

In behavioral medicine, professionals base their

interventions on a few models that attempt to explain people’s health-related behavior:
the health belief model, reasoned and planned behavior theory, learning theories/classical
conditioning, and social cognitive theory. These models are termed continuum theories,
for they aim to recognize variables that influence people’s behavior, and using the sum of
variables, how likely the person will engage in a particular behavior (Weinstein,
Rothman, & Sutton, 1998). They are often criticized on their narrow focus on outcome
behavior of interest (e.g. smoking cession) and its non-inclusion of race, gender, and
socioeconomic status — all features known to have a somewhat strong influence on
health behavior. Nonetheless, the model dynamics are useful to describe particular types
of behavior.

Health Belief Model

As the one of the earliest frameworks for understanding human behavior, the health belief
model declares that individuals will take health related actions based on six types of
factors and associated beliefs:

Perceived Susceptibility: the condition may hurt the individual on any aspect of the
biopsychosocial model.

Perceived Severity: the condition is severe enough to have a negative consequence.

Perceived Benefits: the advised actions may stop, lower, or lessen the affect, risk, and
consequences of the condition, respectively.

Perceived Barriers/Costs: the corrective/preventive benefits outweigh the psychological

and physical harms of abiding to the advised behavior.

Cues to Action: there is an internal or external cue, or both, that trigger the individual to
finally act.

This model is better for predicting simple, one-time or limited behaviors (e.g.
immunizations) than habitual behaviors.
 Reasoned Action & Planned Behavior Theory

This theory recognizes that individuals act rationally and emphasizes the power of
individual’s intention to induce behavior governed by three principles:

Attitudes: the individual’s positive or negative feelings about engaging in a given

behavior.

Subjective Norms: standards or influences established by the individual’s larger context,

for instance, familial beliefs, media conceptions, and societal models.

Perceived Behavioral Control: the degree to which the individual could perform a
behavior.

The theory is limited to discrete sample populations and does not incorporate profiles of
previous behaviors nor does it address when positive intentions are not enough to enact
behaviors (e.g. cues of action).

Learning Theories/Classical Conditioning

Based on the principles of classical conditioning, learning theories takes into account the
previous responses individual’s had “learned” due to similar stimuli. Desired behaviors
stem from positive experiences, associations, and thus responses to stimuli.
Consequently, this theory allows reinforcing behaviors by way of rewards, but they are
dependent on continual rewards – the precise problem in drug addiction and abuse.

Social Cognitive Theory

Through a variety of mediums, the social cognitive theory states that individuals
observations affect behavior by two modes of modeling:

Direct Modeling: Observing others in their social network engaging in a particular

behavior (i.e. vicarious learning)

Symbolic Modeling: Individuals more likely model behaviors by others they identify
with as portrayed in the media.

Importantly, the modeled learning governed behavioral execution by the individual’s

belief in their ability to engage in the behavior (self-efficacy) and consequences of
carrying it out (expectancies).

This theory has proven successful in a variety of health-related behaviors, including,

smoking cessation, condom use, and regular exercise.

Specialists have also mapped the traditional transtheoretical model or the newer
precaution adoption process model in order to stop or reduce unhealthy traits and develop
or enhance healthy actions (see table below). These two models categorize the changes
individuals go through in the process of behavioral alteration in discrete stages.

Transtheoretical Model

Change is process divided into five stages:

Precontemplation – Unaware or ignorant of the problem, or underestimate its

consequences or personal applicability.
Contemplation – Considering making a change to their behavior, often due to an
increased awareness or realization of the issue.

Preparation – Commits to change, and organized steps to enact change within a specific
time period.

Action – The behaviors are publicly modified to provoke change.

Maintenance – Sustains change, usually over six months

[At the action and maintenance stages, the individual is most prone to relapse.]

The model posits that change occurs in a spiral linear pattern, that is, the individual may
move forward or backward until the change is complete.

Precaution Adoption Process Model

Change is process divided into seven stages:

Stage 1 – Now aware of the problem.

Stage 2 – Limited awareness, however, not appreciative of personal risk.

Stage 3 – Acknowledges personal susceptibility of hazard, but fails to make a decision on

acting.

Stage 4 – Decides the action is unwarranted.

Stage 5 – Decides the action is warranted.

Stage 6 – The behaviors are publicly modified to provoke change.

Stage 7 – Sustains change, usually over six months

This new model of change further differentiates personal risk profiles and whether the
person decides to act.

Further studies must evaluate the effectiveness of each model on predicting health
behavioral change; however, it is likely that they are each best for specific types of
individuals or behaviors.