Theoretical Models for Improving

Disease Management

Martanty Aditya
 Outline
•  A. Social Cognition Models (SCM)
•  B. Self-Regulatory Model (SRM)
•  C. Stages of Decision Making
 Social Cognition Models (SCM)
•  Beliefs are the key factors influencing behaviour in
response to health threats (e.g. experiencing
symptoms) or recommendations (e.g. being told to
follow medical advice).

•  Individual make an active decision.

 Social Cognition Models (SCM)
•  Two type of cognition involved in SCM:
•  Expectancy and Value.
•  Expectancy: beliefs about the probability that a specific
health-related behaviour/ action (e.g. attending diabetic clinic)
will lead to a set of outcome (e.g. optimisation of insulin
dose).
•  Value: appraisal of the worth or importance of the outcome

•  e.g. good control of diabetes will prevent long-term

complication
 Social Cognition Models (SCM)
•  Health Belief Model (HBM)
•  Theory of Reasoned Action (TRA) and Theory of
Planned Behaviour (TPB)
•  Other theories:
1. Causal attribution theory
2. Self-Efficacy
3. Health locus of control (HLOC)
 (A1) Health Belief Model
•  Developed in 1974 (Rosenstock)
•  to explain why people fail to take up disease
prevention measures or screening tests before the
onset of symptoms.
•  Has been used as the basis of AIDS awareness
campaign in 1980s in the UK.
(A1)  Health  Belief  Model    
(A1)  Health  Belief  Model    
(A1)  Health  Belief  Model    
•  Perceived seriousness/ severity: breast cancer can be
fatal if not treated promptly
•  Perceived susceptibility : “I am susceptible to breast
cancer because my mother had breast cancer when she
was my age”
•  Perceived benefit: attending breast cancer screening may
stop me worrying about breast cancer
•  Perceived barriers: fear of experiencing pain during
mammogram procedure)
•  Cues to action (media campaign, illness of friend, advice
from others)
•  Useful: behaviour which involves a single behaviour.
•  e.g. attendance at a clinic
•  Less useful: behaviour which involves sustaining the
action over a long period of time or more complex
behaviour.
•  e.g. stop smoking
 HBM limitation
•  Does not account a person’s emotional response to
illness.
•  Fail to recognise the importance of other people or
social pressure.
Theory of Reasoned Action (TRA) &
Theory of Planned Behaviour (TPB)
•  Individual Intention:
•  Attitude towards the behaviour Social or cultural
context
 TRA  
•  The person’s intention to behave in a particular way
will be influenced by their own views about it and
also by the views of important others.
•  It does not explain avoidance behaviour due to
emotional responses
•  E.g delay in seeking consultation with a physician
•  Emotional responses: fear, anxiety, denial.
TRA/TPB  
 Causal Attribution Theory (A3)
•  Beliefs about the cause of an illness or health
problem.
•  A person may be less motivated to change their
lifestyle after a heart attack if they do not believe
that lifestyle factors caused their heart disease.
•  Attribution theory is too simplistic to explain all the
variations in people’s health-related behaviour.
 Self-Efficacy (A3)
•  A person’s belief that just knowing what to do is not sufficient
for one to behave; instead one must also be confident that
one is capable of performing the specific behavior. (Bandura)
•  Efficacy expectancy:
•  belief that an individual can succeed at a particular task or
behaviour (e.g. exercise).
•  Outcome expectancy:
•  belief or expectancy that the particular behaviour will result in
a valued outcome (consequences).
•  e.g. increasing exercise will help me lose weight, increase my
fitness and health in general.
 (A3) HLOC
•  HLOC = Health locus of control
•  A person’s behaviour is influenced by a person’s
perception of control over health or illness.
•  Three basic group in HLOC:
1. internal expectancies
2. powerful others
3. chance
 HLOC
•  Internal expectancies believes that situations and event
related to health are under their own personal control.
•  The powerful others dimension assumes controllability
over health lies predominantly with other people (e.g.
doctors or healthcare professionals).
•  People in the chance locus of control believe that
health status is a function of luck or fate and is beyond
their own control or control of healthcare professionals.
 (A3) HLOC – example
•  Diabetic patient who perceives that control over
their diabetes is largely a matter of fate rather than
medical action, may be less motivated to self-
manage their diabetic treatment.
•  A patient who believes that their own action can
make a difference may be more likely to self-
manage their diabetes by monitoring blood glucose
and taking control of the insulin dose.
 (B) Self-Regulatory Model (SRM)
•  The way that people make sense of illness or health
threats.
•  Often called “common sense model”.
•  A person will be more likely to seek medical care if it
makes common sense in the light of their own
representations of the health threat.
 (B) Self-Regulatory Model (SRM)
•  How people respond to a threat? There are three
inter-related stages:
1. Cognitive representation.
2. Action Planning or coping.
3. Appraisal.
(B) Self-Regulatory Model (SRM)
(B) Self-Regulatory Model (SRM)
 1. Cognitive representation
•  Mental map or model of the illness. Comprises 5
components of beliefs:
1. identity (what is it?)
2. cause (what has caused it?)
3. time-line (likely duration)
4. consequences (what affect will it have?)
5. control or cure (what is the potential for the illness to
cured or controlled?)
 2. Action planning or coping
•  This action is based on their representation of
•  the threat, then the person decides on a coping
procedure for dealing with it.
•  Coping procedure can be behaviours, such as
taking a medicine or calling emergency service for
help.
 3. Appraisal
•  to evaluate how effective is the action plan after
implementing it.
•  The person may either decide to continue with the
coping strategy or adopt an alternative procedure.
In the SRM, there is an interaction between people’s
beliefs about the illness and the health-related
behaviour.
Kasus 1
Bu Rahma, 45 tahun, ibu rumah tangga, pergi ke Dr. Budi kemarin
malam dan didiagnosis menderita kencing manis. Ia mendapat
anjuran diet dan resep obat diabetes. Bu Rahma tidak membelikan
obat tersebut karena pernah mendengar dari tetangganya bahwa
harga obat diabetes sangat mahal, namun walau minum obat,
penyakit tidak sembuh-sembuh. Saat ini Bu Rahma bingung, tidak
tahu harus bertanya kepada siapa tentang penyakitnya. Akhirnya ia
memutuskan berkonsultasi kepada Eyang Saputri yang di desanya
dikenal sebagai dukun bayi yang berpengalaman mengobati
beberapa penyakit
Kasus 2
Bu Siti seorang pedagang emas yang sukses. Kemarin ia membawa
cucunya yang berusia lima tahun ke dokter spesialis anak. Sesuai
dengan pesan suaminya, Bu Siti minta dokter spesialis anak itu
meresepkan antibiotika terbaru dan termahal. Si cucu menderita
batuk pilek dengan panas sekitar 38 C selama 2 hari terakhir ini.
Dokter spesialis anak meresepkan obat sesuai permintaan Bu Siti. Bu
Siti pulang dengan puas.
Kasus 3
Pak Andi seorang pensiunan angkatan laut yang berobat ke dokter
praktek swasta dengan keluhan sering sakit kepala. Dokter menemukan
bahwa tekanan darah Pak Andi 160/100, dan ternyata menurut cerita
Pak Andi, kadang-kadang tekanan darah beliau memang naik. Dokter
memberikan resep obat antihipertensi dan menyarankan agar Pak Andi
menggunakan kartu ASKES untuk melanjutkan pengobatan di RSAL.
Alasan dokter, pengobatan Pak Andi akan berlangsung jangka panjang,
dan mungkin dibutuhkan pemeriksaan laboratorium untuk mengetahui
tanda-tanda komplikasi. Pak Andi menyampaikan akan mencoba resep
obat dokter terlebih dahulu, dan akan menyampaikan keputusannya
saat kontrol 2 minggu lagi.
Kasus 4
Wira adalah seorang programmer berusia 35 tahun. Saat melakukan
general check up, ia menemukan bahwa kadar cholesterol darahnya di
atas normal. Wira segera mencari informasi tentang obat untuk
menurunkan kadar cholesterol. Saat periksa ke dokter penyakit dalam,
ia membawa beberapa lembar print out informasi obat dari internet.
Setelah berdiskusi, dokter menyarankan diet untuk Wira, belum disertai
obat, diikuti dengan pemeriksaan darah ulang 1 bulan kemudian. Karena
Wira merasa kurang puas, Wira menghubungi temannya, seorang
apoteker, untuk meminta ‘second opinion’