THE O R I E S I N

LT H E D U C A T I O N
H EA
LEARNING OBJECTIVES:
• AT THE END OF THE DISCUSSION THE LEARNER WILL BE ABLE TO:

1. DEFINE HEALTH PROMOTION

2. DISCUSSES THE HEALTH PROMOTION AND DISEASE PREVENTION
THEORIES AND MODEL
3. DESCRIBES THE THEORIES IN HEALTH EDUCATION.
HEALTH PROMOTION
•  IS "THE PROCESS OF ENABLING PEOPLE TO INCREASE CONTROL OVER THEIR 
HEALTH AND ITS DETERMINANTS, AND THEREBY IMPROVE THEIR HEALTH",
(WHO) 2005 

Health promotion involves public policy that addresses health determinants such as income,

housing, food security, employment, and quality working conditions. More recent work has
used the term Health in All Policies to refer to the actions to incorporate health into all public
policies.
Health promotion is aligned with health equity and can be a focus of NGOs dedicated to
social justice or human rights. 
Health literacy can be developed in schools, while aspects of health promotion such as 
breastfeeding promotion can depend on laws and rules of public spaces.
Health promotion is focused on preventative healthcare rather than a medical model of
curative care.
HEALTH PROMOTION AND DISEASE PREVENTION THEORIES AND MODELS

• 1. ECOLOGICAL MODELS
• 2. THE HEALTH BELIEF MODEL
• 3. RELAPSE PREVENTION MODEL
• 4. STAGES OF CHANGE MODEL (TRANSTHEORETICAL MODEL)
• 5. SOCIAL COGNITIVE THEORY
• 6. THEORY OF REASONED ACTION/PLANNED BEHAVIOR
1. ECOLOGICAL MODELS
•THEORY AT A GLANCE: A GUIDE FOR HEALTH PROMOTION AND
PRACTICE FRAMES THE ECOLOGICAL PERSPECTIVE AS
“...the interaction between, and
interdependence of, factors within and across
all levels of a health problem. It highlights
people’s interactions with their physical and
sociocultural environments.”
ECOLOGICAL MODELS OF HEALTH BEHAVIOR RECOGNIZE MULTIPLE
LEVELS OF INFLUENCE ON A PERSON'S HEALTH, INCLUDING:

1. INTRAPERSONAL/INDIVIDUAL FACTORS, WHICH INFLUENCE BEHAVIOR

SUCH AS KNOWLEDGE, ATTITUDES, BELIEFS, AND PERSONALITY.

2. INTERPERSONAL FACTORS, SUCH AS INTERACTIONS WITH OTHER

PEOPLE, WHICH CAN PROVIDE SOCIAL SUPPORT OR CREATE BARRIERS TO
INTERPERSONAL GROWTH THAT PROMOTES HEALTHY BEHAVIOR.
ECOLOGICAL MODELS OF HEALTH BEHAVIOR RECOGNIZE MULTIPLE
LEVELS OF INFLUENCE ON A PERSON'S HEALTH, INCLUDING:
3. INSTITUTIONAL AND ORGANIZATIONAL FACTORS, INCLUDING THE
RULES, REGULATIONS, POLICIES, AND INFORMAL STRUCTURES THAT
CONSTRAIN OR PROMOTE HEALTHY BEHAVIORS.
4. COMMUNITY FACTORS, SUCH AS FORMAL OR INFORMAL SOCIAL NORMS
THAT EXIST AMONG INDIVIDUALS, GROUPS, OR ORGANIZATIONS, CAN LIMIT
OR ENHANCE HEALTHY BEHAVIORS.
5. PUBLIC POLICY, INCLUDING LOCAL, STATE, AND FEDERAL POLICIES AND
LAWS THAT REGULATE OR SUPPORT HEALTH ACTIONS AND PRACTICES FOR
DISEASE PREVENTION INCLUDING EARLY DETECTION, CONTROL, AND
MANAGEMENT.
2. THE HEALTH BELIEF MODEL

• THE HEALTH BELIEF MODEL IS A CONCEPTUAL

FRAMEWORK THAT CAN BE USED TO GUIDE HEALTH
PROMOTION AND DISEASE PREVENTION PROGRAMS.
• IT EXPLAINS CHANGES IN HEALTH-RELATED
BEHAVIOR. KEY ELEMENTS OF THE HEALTH BELIEF
MODEL FOCUS ON INDIVIDUAL BELIEFS ABOUT
HEALTH CONDITIONS, WHICH PREDICT INDIVIDUAL
HEALTH-RELATED BEHAVIORS.
THE HEALTH BELIEF MODEL

• HEALTH BELIEF MODEL CAN BE USED TO DESIGN

SHORT- AND LONG-TERM PROGRAMS. THE MODEL'S
PREDICTIVE ABILITY VARIES DEPENDING ON THE
ABILITY TO GAUGE THE PRESENCE OF PERCEIVED
SUSCEPTIBILITY, PERCEIVED SEVERITY, PERCEIVED
BENEFITS OF ACTION, PERCEIVED BARRIERS TO
ACTION, CUES TO ACTION, AND THE SENSE OF SELF-
EFFICACY AMONG THE TARGET POPULATION.
THE FIVE KEY ACTION-RELATED COMPONENTS THAT DETERMINE
THE ABILITY OF THE HEALTH BELIEF MODEL TO IDENTIFY KEY
DECISION-MAKING POINTS THAT INFLUENCE HEALTH
BEHAVIORS ARE:

1. GATHERING INFORMATION BY CONDUCTING A HEALTH 

NEEDS ASSESSMENTS AND OTHER EFFORTS TO DETERMINE WHO IS AT RISK
AND THE POPULATION(S) THAT SHOULD BE TARGETED.
2. CONVEYING THE CONSEQUENCES OF THE HEALTH ISSUES ASSOCIATED
WITH RISK BEHAVIORS IN A CLEAR AND UNAMBIGUOUS FASHION TO
UNDERSTAND PERCEIVED SEVERITY.
THE FIVE KEY ACTION-RELATED COMPONENTS THAT DETERMINE
THE ABILITY OF THE HEALTH BELIEF MODEL TO IDENTIFY KEY
DECISION-MAKING POINTS THAT INFLUENCE HEALTH
BEHAVIORS ARE:
3. COMMUNICATING TO THE TARGET POPULATION THE STEPS THAT ARE
INVOLVED IN TAKING THE RECOMMENDED ACTION AND HIGHLIGHTING THE
BENEFITS TO ACTION.
4. PROVIDING ASSISTANCE IN IDENTIFYING AND REDUCING BARRIERS TO
ACTION.
5. DEMONSTRATING ACTIONS THROUGH SKILL DEVELOPMENT ACTIVITIES
AND PROVIDING SUPPORT THAT ENHANCES SELF-EFFICACY AND THE
LIKELIHOOD OF SUCCESSFUL BEHAVIOR CHANGES.
 3. RELAPSE PREVENTION MODEL

• THE RELAPSE PREVENTION THERAPY MODEL PROVIDES A STRATEGY FOR

ANTICIPATING BARRIERS AND OTHER FACTORS CONTRIBUTING TO PARTICIPANT
RELAPSE. THE MODEL PROVIDES PROGRAM PARTICIPANTS WITH COPING
SKILLS. ONCE PROGRAM PARTICIPANTS PROCESS THE NECESSARY KNOWLEDGE
TO ADAPT AND COPE WITH CHALLENGES DURING AND FOLLOWING THE
PROGRAM, PARTICIPANTS ARE LESS LIKELY TO RETURN TO PRIOR NEGATIVE
BEHAVIORS.
KEY CONCEPTS ARE:

• SKILLS TRAINING
• COGNITIVE REFRAMING
• LIFESTYLE REBALANCING
4. STAGES OF CHANGE MODEL (TRANSTHEORETICAL MODEL)

• THE STAGES OF CHANGE MODEL, ALSO CALLED THE

TRANSTHEORETICAL MODEL, EXPLAINS HOW AN
INDIVIDUAL OR ORGANIZATION INTEGRATES NEW
BEHAVIORS, GOALS, AND PROGRAMS AT VARIOUS
LEVELS.
• AT EACH STAGE, DIFFERENT INTERVENTION STRATEGIES
WILL HELP PEOPLE PROGRESS TO THE NEXT STAGE.
 4. STAGES OF CHANGE MODEL (TRANSTHEORETICAL MODEL)

THESE STAGES INCLUDE:

STAGE 1. PRE-CONTEMPLATION: THERE IS NO INTENTION OF TAKING ACTION.
STAGE 2. CONTEMPLATION: THERE ARE INTENTIONS TO TAKE ACTION AND A PLAN
TO DO SO IN THE NEAR FUTURE.
STAGE 3. PREPARATION: THERE IS INTENTION TO TAKE ACTION AND SOME STEPS
HAVE BEEN TAKEN.
STAGE 4. ACTION: BEHAVIOR HAS BEEN CHANGED FOR A SHORT PERIOD OF TIME.
STAGE 5. MAINTENANCE: BEHAVIOR HAS BEEN CHANGED AND CONTINUES TO BE
MAINTAINED FOR THE LONG-TERM.
STAGE 6. TERMINATION: THERE IS NO DESIRE TO RETURN TO PRIOR NEGATIVE
BEHAVIORS.
 5. SOCIAL COGNITIVE THEORY

SOCIAL COGNITIVE THEORY (SCT) FOCUSES ON HOW PEOPLE

LEARN FROM INDIVIDUAL EXPERIENCES, THE ACTIONS OF OTHERS,
AND THEIR INTERACTION WITH THEIR ENVIRONMENT.

IT CAN BE APPLIED IN DIFFERENT SETTINGS AND POPULATIONS.

SCT PROVIDES OPPORTUNITIES FOR SOCIAL SUPPORT THROUGH
INSTILLING EXPECTATIONS, SELF-EFFICACY, AND USING
OBSERVATIONAL LEARNING AND OTHER REINFORCEMENTS TO
ACHIEVE BEHAVIOR CHANGE.
 KEY COMPONENTS OF THE SCT RELATED TO INDIVIDUAL
BEHAVIOR CHANGE INCLUDE:
1. SELF-EFFICACY: THE BELIEF THAT AN INDIVIDUAL HAS CONTROL OVER AND IS ABLE TO
EXECUTE A BEHAVIOR.
2. BEHAVIORAL CAPABILITY: UNDERSTANDING AND HAVING THE SKILL TO PERFORM A
BEHAVIOR.
3. EXPECTATIONS: DETERMINING THE OUTCOMES OF BEHAVIOR CHANGE.
4. EXPECTANCIES: ASSIGNING A VALUE TO THE OUTCOMES OF BEHAVIOR CHANGE.
5. SELF-CONTROL: REGULATING AND MONITORING INDIVIDUAL BEHAVIOR.
6. OBSERVATIONAL LEARNING: WATCHING AND OBSERVING OUTCOMES OF OTHERS
PERFORMING DESIRED BEHAVIOR.
7. REINFORCEMENTS: PROMOTING INCENTIVES AND REWARDS THAT ENCOURAGE BEHAVIOR
CHANGE.
 6. THEORY OF REASONED ACTION/PLANNED BEHAVIOR
 PREDICT A PERSON'S HEALTH BEHAVIOR BY THEIR ATTITUDE TOWARDS
PERFORMING A BEHAVIOR.

 A PERSON'S INTENTION TO PERFORM A BEHAVIOR (BEHAVIORAL INTENTION)

IS PREDICTED BY
1) A PERSON'S ATTITUDE TOWARD THE BEHAVIOR, AND
2) SUBJECTIVE NORMS REGARDING THE BEHAVIOR.
= SUBJECTIVE NORMS ARE THE RESULT OF SOCIAL AND ENVIRONMENTAL
SURROUNDINGS AND A PERSON'S PERCEIVED CONTROL OVER THE BEHAVIOR.
GENERALLY, POSITIVE ATTITUDE AND POSITIVE SUBJECTIVE NORMS RESULT IN
GREATER PERCEIVED CONTROL AND INCREASE THE LIKELIHOOD OF INTENTIONS
GOVERNING CHANGES IN BEHAVIOR.
THEORIES IN HEALTH EDUCATION

•PENDER’S HEALTH PROMOTION THEORY

•BANDURA’S SELF-EFFICACY THEORY
•HEALTH BELIEF MODEL
•GREEN’S PRECEDE-PROCEED MODEL
NOLA PENDER - NURSING
THEORIST

HEALTH PROMOTION
MODEL
THE HEALTH
PROMOTION
MODEL

NOLA PENDER
 MAJOR CONCEPTS
HEALTH PROMOTION IS DEFINED AS BEHAVIOR MOTIVATED BY THE DESIRE TO INCREASE WELL-BEING AND
ACTUALIZE HUMAN HEALTH POTENTIAL. IT IS AN APPROACH TO WELLNESS. 

ON THE OTHER HAND, HEALTH PROTECTION OR ILLNESS PREVENTION IS DESCRIBED AS BEHAVIOR MOTIVATED
DESIRE TO ACTIVELY AVOID ILLNESS, DETECT IT EARLY, OR MAINTAIN FUNCTIONING WITHIN THE CONSTRAINTS
OF ILLNESS.

INDIVIDUAL CHARACTERISTICS AND EXPERIENCES (PRIOR RELATED BEHAVIOR AND PERSONAL FACTORS).

BEHAVIOR-SPECIFIC COGNITIONS AND AFFECT (PERCEIVED BENEFITS OF ACTION, PERCEIVED BARRIERS TO

ACTION, PERCEIVED SELF-EFFICACY, ACTIVITY-RELATED AFFECT, INTERPERSONAL INFLUENCES, AND
SITUATIONAL INFLUENCES).

BEHAVIORAL OUTCOMES (COMMITMENT TO A PLAN OF ACTION, IMMEDIATE COMPETING DEMANDS AND

PREFERENCES, AND HEALTH-PROMOTING BEHAVIOR).
 SUB-CONCEPTS
1. PERSONAL FACTORS 
PERSONAL FACTORS CATEGORIZED AS BIOLOGICAL, PSYCHOLOGICAL AND SOCIO-CULTURAL. THESE FACTORS ARE
PREDICTIVE OF A GIVEN BEHAVIOR AND SHAPED BY THE NATURE OF THE TARGET BEHAVIOR BEING CONSIDERED.
A. PERSONAL BIOLOGICAL FACTORS 
INCLUDE VARIABLE SUCH AS AGE GENDER BODY MASS INDEX PUBERTAL STATUS,
AEROBIC CAPACITY, STRENGTH, AGILITY, OR BALANCE.

B. PERSONAL PSYCHOLOGICAL FACTORS

INCLUDE VARIABLES SUCH AS SELF ESTEEM SELF MOTIVATION PERSONAL COMPETENCE
PERCEIVED HEALTH STATUS AND DEFINITION OF HEALTH.

C. PERSONAL SOCIO-CULTURAL FACTORS

INCLUDE VARIABLES SUCH AS RACE ETHNICITY, ACCULTURATION, EDUCATION AND
SOCIOECONOMIC STATUS.
 SUB-CONCEPTS
2. PERCEIVED BENEFITS OF ACTION 
ANTICIPATED POSITIVE OUTCOMES THAT WILL OCCUR FROM HEALTH BEHAVIOR.

3. PERCEIVED BARRIERS TO ACTION 

ANTICIPATED, IMAGINED OR REAL BLOCKS AND PERSONAL COSTS OF UNDERSTANDING A GIVEN BEHAVIOR.
4. PERCEIVED SELF EFFICACY
JUDGMENT OF PERSONAL CAPABILITY TO ORGANIZE AND EXECUTE A HEALTH-PROMOTING BEHAVIOR.
PERCEIVED SELF EFFICACY INFLUENCES PERCEIVED BARRIERS TO ACTION SO HIGHER EFFICACY RESULT
IN LOWERED PERCEPTIONS OF BARRIERS TO THE PERFORMANCE OF THE BEHAVIOR.
5. ACTIVITY RELATED AFFECT
SUBJECTIVE POSITIVE OR NEGATIVE FEELING THAT OCCUR BEFORE, DURING AND FOLLOWING BEHAVIOR
BASED ON THE STIMULUS PROPERTIES OF THE BEHAVIOR ITSELF. 
6. ACTIVITY-RELATED AFFECT INFLUENCES PERCEIVED SELF-EFFICACY, WHICH MEANS THE MORE POSITIVE
THE SUBJECTIVE FEELING, THE GREATER THE FEELING OF EFFICACY. IN TURN, INCREASED FEELINGS OF
EFFICACY CAN GENERATE FURTHER POSITIVE AFFECT.
 SUB-CONCEPTS
•INTERPERSONAL INFLUENCES 
COGNITION CONCERNING BEHAVIORS, BELIEFS, OR ATTITUDES OF THE OTHERS. 

INTERPERSONAL INFLUENCES INCLUDE: NORMS (EXPECTATIONS OF SIGNIFICANT OTHERS), SOCIAL SUPPORT

(INSTRUMENTAL AND EMOTIONAL ENCOURAGEMENT) AND MODELING (VICARIOUS LEARNING THROUGH OBSERVING
OTHERS ENGAGED IN A PARTICULAR BEHAVIOR). 

PRIMARY SOURCES OF INTERPERSONAL INFLUENCES ARE FAMILIES, PEERS, AND HEALTHCARE PROVIDERS.

•SITUATIONAL INFLUENCES
PERSONAL PERCEPTIONS AND COGNITIONS OF ANY GIVEN SITUATION OR CONTEXT THAT CAN FACILITATE OR
IMPEDE BEHAVIOR. INCLUDE PERCEPTIONS OF OPTIONS AVAILABLE, DEMAND CHARACTERISTICS AND AESTHETIC
FEATURES OF THE ENVIRONMENT IN WHICH GIVEN HEALTH PROMOTING IS PROPOSED TO TAKE PLACE. SITUATIONAL
INFLUENCES MAY HAVE DIRECT OR INDIRECT INFLUENCES ON HEALTH BEHAVIOR.
STRENGTHS/WEAKNESSES
• STRENGTHS:
IT IS SIMPLE TO UNDERSTAND YET IT IS COMPLEX IN STRUCTURE.

HER THEORY GAVE MUCH FOCUS ON HEALTH PROMOTION AND DISEASE PREVENTION MAKING IT
STAND OUT FROM OTHER NURSING THEORIES.

IT IS HIGHLY APPLICABLE IN THE COMMUNITY HEALTH SETTING.

IT PROMOTES THE INDEPENDENT PRACTICE OF THE NURSING PROFESSION BEING THE PRIMARY
SOURCE OF HEALTH PROMOTING INTERVENTIONS AND EDUCATION.
STRENGTHS/WEAKNESSES
• WEAKNESSES:
THE MODEL OF PENDER WAS NOT ABLE TO DEFINE THE FOUR MOST IMPORTANT CONCEPTS
THAT A NURSING THEORY SHOULD HAVE, MAN, NURSING, ENVIRONMENT AND HEALTH.

THE CONCEPTUAL FRAMEWORK CONTAINS MULTIPLE CONCEPTS WHICH MAY INVITE

CONFUSION TO THE READER.

ITS APPLICABILITY TO AN INDIVIDUAL CURRENTLY EXPERIENCING A DISEASE STATE WAS

NOT GIVEN EMPHASIS.
 ALBERT BANDURA
IS AN INFLUENTIAL SOCIAL COGNITIVE
PSYCHOLOGIST WHO IS PERHAPS BEST-KNOWN FOR
HIS SOCIAL LEARNING THEORY, THE CONCEPT OF
SELF-EFFICACY AND HIS FAMOUS BOBO DOLL
EXPERIMENTS. HE IS A PROFESSOR EMERITUS AT
STANFORD UNIVERSITY AND IS WIDELY REGARDED
AS ONE OF THE GREATEST LIVING PSYCHOLOGISTS.
ONE 2002 SURVEY RANKED HIM AS THE FOURTH
MOST INFLUENTIAL PSYCHOLOGIST OF THE
TWENTIETH CENTURY.
 ALBERT BANDURA

"PEOPLE WITH HIGH ASSURANCE IN THEIR

CAPABILITIES APPROACH DIFFICULT TASKS AS
CHALLENGES TO BE MASTERED RATHER THAN AS
THREATS TO BE AVOIDED."
--ALBERT BANDURA
 AN OVERVIEW OF BANDURA'S LIFE

• BORN DECEMBER 4, 1925.

• 1949 – GRADUATED FROM THE UNIVERSITY OF BRITISH COLUMBIA WITH A DEGREE IN
PSYCHOLOGY.

• 1952 – RECEIVED HIS PH.D. IN CLINICAL PSYCHOLOGY FROM THE UNIVERSITY OF IOWA.
• 1953 – BEGAN TEACHING AT STANFORD UNIVERSITY.
• 1974 – SERVED AS PRESIDENT OF THE APA.
• 1980 – RECEIVED THE APA’S AWARD FOR DISTINGUISHED SCIENTIFIC CONTRIBUTIONS.
• 2004 - OUTSTANDING LIFETIME CONTRIBUTION TO PSYCHOLOGY, 
AMERICAN PSYCHOLOGICAL ASSOCIATION.
BEST KNOWN FOR:
• BOBO DOLL STUDIES
• OBSERVATIONAL LEARNING
• SOCIAL LEARNING THEORY
• SELF-EFFICACY
BY KENDRA CHERRY • ARE AGGRESSION AND VIOLENCE LEARNED
UPDATED APRIL 15, 2016 BEHAVIORS?

• IN A FAMOUS AND INFLUENTIAL EXPERIMENT

KNOWN AS THE BOBO DOLL EXPERIMENT, 
ALBERT BANDURA AND HIS COLLEAGUES
DEMONSTRATED ONE WAY THAT CHILDREN
LEARN AGGRESSION. ACCORDING TO
BANDURA'S SOCIAL LEARNING THEORY,
LEARNING OCCURS THROUGH OBSERVATIONS
AND INTERACTIONS WITH OTHER PEOPLE.
ESSENTIALLY, PEOPLE LEARN BY WATCHING
OTHERS AND THEN IMITATING THESE ACTIONS.
VIDEO PRESENTATION
BANDURA'S PREDICTIONS

• THE EXPERIMENT INVOLVED EXPOSING CHILDREN TO TWO

DIFFERENT ADULT MODELS; AN AGGRESSIVE MODEL AND A NON-
AGGRESSIVE ONE. AFTER WITNESSING THE ADULT'S BEHAVIOR, THE
CHILDREN WOULD THEN BE PLACED IN A ROOM WITHOUT THE
MODEL AND WERE OBSERVED TO SEE IF THEY WOULD IMITATE THE
BEHAVIORS THEY HAD WITNESSED EARLIER.
 BANDURA MADE SEVERAL PREDICTIONS ABOUT WHAT WOULD OCCUR:

1.HE PREDICTED THAT CHILDREN WHO OBSERVED AN ADULT ACTING AGGRESSIVELY WOULD
BE LIKELY TO ACT AGGRESSIVELY EVEN WHEN THE ADULT MODEL WAS NOT PRESENT.

2.THE CHILDREN WHO OBSERVED THE NON-AGGRESSIVE ADULT MODEL WOULD BE LESS
AGGRESSIVE THAN THE CHILDREN WHO OBSERVED THE AGGRESSIVE MODEL; THE NON-
AGGRESSIVE EXPOSURE GROUP WOULD ALSO BE LESS AGGRESSIVE THAN THE CONTROL
GROUP.
3.CHILDREN WOULD BE MORE LIKELY TO IMITATE MODELS OF THE SAME-SEX RATHER THAN
MODELS OF THE OPPOSITE-SEX.
4.BOYS WOULD BEHAVE MORE AGGRESSIVELY THAN GIRLS.
 WHAT WERE THE RESULTS OF THE BOBO DOLL EXPERIMENT?

• THE RESULTS OF THE EXPERIMENT SUPPORTED THREE OF THE FOUR ORIGINAL PREDICTIONS.

1. CHILDREN EXPOSED TO THE VIOLET MODEL TENDED TO IMITATE THE EXACT BEHAVIOR THEY
HAD OBSERVED WHEN THE ADULT WAS NO LONGER PRESENT.

2. BANDURA AND HIS COLLEAGUES HAD ALSO PREDICTED THAT CHILDREN IN THE NON-
AGGRESSIVE GROUP WOULD BEHAVE LESS AGGRESSIVELY THAN THOSE IN THE CONTROL GROUP.
THE RESULTS INDICATED THAT WHILE CHILDREN OF BOTH GENDERS IN THE NON-AGGRESSIVE
GROUP DID EXHIBIT LESS AGGRESSION THAN THE CONTROL GROUP, BOYS WHO HAD OBSERVED
AN OPPOSITE-SEX MODEL BEHAVE NON-AGGRESSIVELY WERE MORE LIKELY THAN THOSE IN THE
CONTROL GROUP TO ENGAGE IN VIOLENCE.
 WHAT WERE THE RESULTS OF THE BOBO DOLL EXPERIMENT?

• THE RESULTS OF THE EXPERIMENT SUPPORTED THREE OF THE FOUR ORIGINAL PREDICTIONS.
3. THERE WERE IMPORTANT GENDER DIFFERENCES WHEN IT CAME TO WHETHER A SAME-SEX
OR OPPOSITE-SEX MODEL WAS OBSERVED. BOYS WHO OBSERVED ADULT MALES BEHAVING
VIOLENTLY WERE MORE INFLUENCED THAN THOSE WHO HAD OBSERVED FEMALE MODELS
BEHAVING AGGRESSIVELY. INTERESTINGLY, THE EXPERIMENTERS FOUND IN THE SAME-SEX
AGGRESSIVE GROUPS, BOYS WERE MORE LIKELY TO IMITATE PHYSICAL ACTS OF VIOLENCE
WHILE GIRLS WERE MORE LIKELY TO IMITATE VERBAL AGGRESSION.

4. THE RESEARCHERS WERE ALSO CORRECT IN THEIR PREDICTION THAT BOYS WOULD BEHAVE
MORE AGGRESSIVELY THAN GIRLS. BOYS ENGAGED IN MORE THAN TWICE AS MANY ACTS OF
AGGRESSION THAN THE GIRLS.
 WHAT DO BANDURA'S RESULTS SUGGEST?

• THE RESULTS OF THE BOBO DOLL EXPERIMENT SUPPORTED BANDURA'S SOCIAL LEARNING THEORY.
BANDURA AND HIS COLLEAGUES BELIEVED THAT THE EXPERIMENT DEMONSTRATES HOW SPECIFIC
BEHAVIORS CAN BE LEARNED THROUGH OBSERVATION AND IMITATION. THE AUTHORS ALSO SUGGESTED
THAT "SOCIAL IMITATION MAY HASTEN OR SHORT-CUT THE ACQUISITION OF NEW BEHAVIORS WITHOUT
THE NECESSITY OF REINFORCING SUCCESSIVE APPROXIMATIONS AS SUGGESTED BY SKINNER."

• ACCORDING TO BANDURA, THE VIOLENT BEHAVIOR OF THE ADULT MODELS TOWARD THE DOLLS LED
CHILDREN TO BELIEVE THAT SUCH ACTIONS WERE ACCEPTABLE. HE ALSO SUGGESTED THAT AS A RESULT,
CHILDREN MAY BE MORE INCLINED TO RESPOND TO FRUSTRATION WITH AGGRESSION IN THE FUTURE.

• IN A FOLLOW-UP STUDY CONDUCTED IN 1965, BANDURA FOUND THAT WHILE CHILDREN WERE MORE
LIKELY TO IMITATE AGGRESSIVE BEHAVIOR IF THE ADULT MODEL WAS REWARDED FOR HIS OR HER
ACTIONS, THEY WERE FAR LESS LIKELY TO IMITATE IF THEY SAW THE ADULT MODEL BEING PUNISHED OR
REPRIMANDED FOR THEIR HOSTILE BEHAVIOR.
HEALTH BELIEF MODEL
(HBM)
DEFINITION:

• THE HEALTH BELIEF MODEL (HBM) IS ONE OF THE MOST

WIDELY USED CONCEPTUAL FRAMEWORKS FOR
UNDERSTANDING HEALTH BEHAVIOR.
• DEVELOPED IN THE EARLY 1950S, THE MODEL HAS BEEN
USED WITH GREAT SUCCESS FOR ALMOST HALF A CENTURY
TO PROMOTE GREATER CONDOM USE, SEAT BELT USE,
MEDICAL COMPLIANCE, AND HEALTH SCREENING USE, TO
NAME A FEW BEHAVIORS.
• THE HEALTH BELIEF MODEL IS A FRAMEWORK FOR MOTIVATING PEOPLE TO
TAKE POSITIVE HEALTH ACTIONS THAT USES THE DESIRE TO AVOID A
NEGATIVE HEALTH CONSEQUENCE AS THE PRIME MOTIVATION.

For example, HIV is a negative health consequence, and the

desire to avoid HIV can be used to motivate sexually active
people into practicing safe sex.

Similarly, the perceived threat of a heart attack can be used

to motivate a person with high blood pressure into
exercising more often.
 Concept Definition Application
HEALTH 1. Perceived One's belief of the •Define population(s) at
BELIEF MODEL: Susceptibility chances of getting a risk and their risk levels
MAJOR condition
•Personalize risk based on
CONCEPTS a person's traits or
behaviors

•Heighten perceived
susceptibiity if too low
2. Perceived Severity One's belief of how •Specify and describe
serious a condition and its consequences of the risk
consequences are and the condition
3. Perceived Benefits One's belief in the •Define action to take —
efficacy of the advised how, where, when
action to reduce risk or
seriousness of impact •Clarify the positive
effects to expected

•Describe evidence of
effectiveness
 Concept Definition Application
HEALTH
BELIEF MODEL: 4. Perceived Barriers One's belief in the •Identify and reduce
MAJOR tangible and barriers through
psychological costs of the reassurance, incentives,
CONCEPTS advised behavior and assistance

5. Cues to Action Strategies to activate •Provide how-to

"readiness" information

•Promote awareness

•Provide reminders

6. Self-Efficacy Confidence in one's ability •Provide training,

to take action guidance, and positive
reinforcement
 Condom Use Education
Concept
Example
1. Perceived Youth believe they can get STIs or
Susceptibility HIV or create a pregnancy.
2. Perceived Youth believe that the consequences
Severity of getting STIs or HIV or creating a
pregnancy are significant enough to
try to avoid.
3. Perceived Benefits Youth believe that the recommended
action of using condoms would
protect them from getting STIs or
HIV or creating a pregnancy.
STI Screening or HIV
Testing
Youth believe they may have been
exposed to STIs or HIV.
Youth believe the consequences of
having STIs or HIV without knowledge or
treatment are significant enough to try
to avoid.
Youth believe that the recommended
action of getting tested for STIs and HIV
would benefit them — possibly by
allowing them to get early treatment or
preventing them from infecting others.
 Condom Use Education STI Screening or HIV
Concept
Example Testing
4. Perceived Barriers Youth identify their personal barriers to Youth identify their personal barriers to
using condoms (i.e., condoms limit the getting tested (i.e., getting to the clinic or
feeling or they are too embarrassed to talk being seen at the clinic by someone they
to their partner about it) and explore ways know) and explore ways to eliminate or
to eliminate or reduce these barriers (i.e., reduce these barriers (i.e., brainstorm
teach them to put lubricant inside the transportation and disguise options).
condom to increase sensation for the male
and have them practice condom
communication skills to decrease their
embarrassment level).
5. Cues to Action Youth receive reminder cues for Youth receive reminder cues for action in
action in the form of incentives (such the form of incentives (such as a key
as pencils with the printed message chain that says, "Got sex? Get tested!")
"no glove, no love") or reminder or reminder messages (such as posters
messages (such as messages in the that say, "25% of sexually active teens
school newsletter). contract an STI. Are you one of them?
Find out now").
6. Self-Efficacy Youth receive training in using a Youth receive guidance (such as
condom correctly. information on where to get tested) or
training (such as practice in making an
appointment).
 HOW THE HEALTH BELIEF MODEL WAS DEVELOPED

• THE HBM WAS FIRST DEVELOPED IN THE 1950S BY SOCIAL

PSYCHOLOGISTS GODFREY HOCHBAUM, IRWIN ROSENSTOCK, AND
STEPHEN KEGELS WORKING IN THE U.S. PUBLIC HEALTH SERVICES.

• THE MODEL WAS DEVELOPED IN RESPONSE TO THE FAILURE OF A FREE

TUBERCULOSIS (TB) HEALTH SCREENING PROGRAM.

The model was first presented with only four key concepts: Perceived Susceptibility,
Perceived Severity, Perceived Benefits, and Perceived Barriers. The concept of Cues for
Action was added later to "stimulate behavior." Finally, in 1988, the concept of Self-
Efficacy was added to address the challenges of habitual unhealthy behaviors such as
smoking and overeating.
 THE HEALTH BELIEF MODEL AND SEXUALITY EDUCATION
• THE HEALTH BELIEF MODEL (HBM) HAS BEEN APPLIED TO A VARIETY OF HEALTH
EDUCATION TOPICS INCLUDING SEXUALITY EDUCATION. SINCE THE HBM IS BASED
ON MOTIVATING PEOPLE TO TAKE ACTION, (LIKE USING CONDOMS) IT CAN BE A
GOOD FIT FOR SEXUALITY EDUCATION PROGRAMS THAT FOCUS ON:
1.PRIMARY PREVENTION — FOR EXAMPLE, PROGRAMS THAT AIM TO PREVENT
PREGNANCY, SEXUALLY TRANSMITTED DISEASES (STIS) AND HIV BY INCREASING
CONDOM USE, AND
2.SECONDARY PREVENTION — FOR EXAMPLE, PROGRAMS THAT AIM TO INCREASE
EARLY DETECTION OF STIS OR HIV TO REDUCE THEIR SPREAD VIA UNPROTECTED
INTERCOURSE AND TO ENSURE THE EARLY TREATMENT OF THE CONDITIONS.
PRECEDE/PROCEED MODEL
PRECEDE/PROCEED MODEL
• THE PRECEDE-PROCEED MODEL IS A COMPREHENSIVE STRUCTURE
FOR ASSESSING HEALTH NEEDS FOR DESIGNING, IMPLEMENTING,
AND EVALUATING HEALTH PROMOTION AND OTHER PUBLIC
HEALTH PROGRAMS TO MEET THOSE NEEDS.

• PRECEDE PROVIDES THE STRUCTURE FOR PLANNING A TARGETED

AND FOCUSED PUBLIC HEALTH PROGRAM.

• PROCEED PROVIDES THE STRUCTURE FOR IMPLEMENTING AND

EVALUATING THE PUBLIC HEALTH PROGRAM.
• PRECEDE STANDS FOR PREDISPOSING, REINFORCING, AND
ENABLING CONSTRUCTS IN EDUCATIONAL DIAGNOSIS AND
EVALUATION. IT INVOLVES ASSESSING THE FOLLOWING
COMMUNITY FACTORS:

1. Social assessment: Determine the social problems and needs of a given

population and identify desired results.
2. Epidemiological assessment: Identify the health determinants of the
identified problems and set priorities and goals.
3. Ecological assessment: Analyze behavioral and environmental determinants
that predispose, reinforce, and enable the behaviors and lifestyles are identified.
•Identify administrative and policy factors that influence implementation
and match appropriate interventions that encourage desired and expected
changes.
4. Implementation of interventions.
• PROCEED STANDS FOR POLICY, REGULATORY, AND
ORGANIZATIONAL CONSTRUCTS IN EDUCATIONAL AND
ENVIRONMENTAL DEVELOPMENT. IT INVOLVES THE IDENTIFICATION
OF DESIRED OUTCOMES AND PROGRAM IMPLEMENTATION:
1. Implementation: Design intervention, assess availability of
resources, and implement program.
2. Process Evaluation: Determine if program is reaching the
targeted population and achieving desired goals.
3. Impact Evaluation: Evaluate the change in behavior.
4. Outcome Evaluation: Identify if there is a decrease in the
incidence or prevalence of the identified negative behavior or an
increase in identified positive behavior.
*** END***