An important part of health psychology is to put theory into practice in health promotion. Psychologists assume that one way to change unhealthy behaviours is to change attitudes and beliefs. The main goal in prevention programs is to encourage people to change their health-threatening behaviours, or to prevent people from developing health-threatening behaviours in the first place. This is not as easy as it sounds because the exact link between beliefs and behaviours is not known. Another problem is that at the time that health-threatening behaviours develop, people often have very little immediate incentive to change their behaviours. For example, problems related to smoking occur many years after people have taken up smoking, not when they start the habit.

There are several strategies to try to change the health behaviours of either an individual or a whole population. As you can probably guess, these models do not work for everyone, but in order to be effective, they should be able to produce a noticeable and enduring change in a significant percentage of the population.

Health psychologists often base interventions on theories and empirical research related to decision making, in order to understand what factors contribute to people’s decisions to change. Two important theories on decision making that have guided interventions are the Health Belief Model (HBM) and Social Cognitive Theory.

 Teacher only box

There are two aspects of this promotion and students tend to focus only on one - the people in the video who get the note from the children.  Could this have an effect on these people? Potentially.  However, as the people in this video clearly know that smoking is bad for them, it is not clear that they will necessarily change their behaviour.  What increases the potential for change is that in that moment of doubt about their behaviour brought on by the child's note, there is a phone number where they can get help.  The sooner they call the number, the greater the chance of change.  Planning to "call later" will allow for rationalization and most likely not result in any change in behaviour.

But this campaign was designed to change the viewers' behaviours.  This aspect of the campaign is often lost on the students.  To be frank, we cannot know from watching the video that the people in the video are not actors!  (By the way, they weren't.) Watching this video at home may mean that people are more likely to call the number - they are in the privacy of their home and their phone is easily available.  

The Health Belief Model

The HBM and is one of the oldest social cognition models. The HBM predicts that individuals will take a health-related action if they think that a negative health problem - for example, developing lung cancer or type 2 diabetes  - can be avoided by taking the recommended action and that they will be successful in doing so.

It is based on the assumption that for a behavioural change to succeed, individuals must have the incentive to change, feel threatened by their current behaviour, and feel that a change will be beneficial and be at an acceptable cost. They must also feel competent to implement that change.

The HBM sees people as rational and suggests that the likelihood that a person will engage in healthy behaviour depends on a number of factors, such as:

Evaluation of threat  - for example, being overweight may result in developing a heart condition; smoking may result in lung cancer. The person will probably recognize this as a serious condition, but may also believe that it does not happen to people like them, for example, people their age. The model claims that people only act if they perceive a threat - for example, a physical symptom like chest pains, death of somebody from heart disease or lung cancer, or information from a mass media campaign.

Cost-benefit analysis - the person will evaluate whether the perceived benefits will be higher than the perceived barriers - for example, if you have to buy healthy food, this is more expensive than chips and burgers.

The HBM model also includes self-efficacy beliefs - that is, the belief that you can perform adequately in a particular situation. This feeling of competence will influence perception, motivation, and performance. Bandura (1977) suggested that self-efficacy beliefs are important predictors of what people believe they are capable of. People make judgments of self-efficacy primarily on the basis of previous achievements. Other sources of judgment include:

• Observations of the performance of others - If he can do it, so can I!
• Social and self-persuasion - You can do it! 
• Monitoring emotional states - for example, feeling anxious suggests low expectations of efficacy.

A problem in the HBM is the focus on individual cognitions. It does not include emotional, social, and economic factors, which are known to influence health behaviours as well. It seems difficult to make standard measurements of many of the concepts - for example, perceived vulnerability.

The HBM is also criticized for assuming that people are rational, which is not always the case. Research has found that awareness of health risks alone does not necessarily inhibit people from engaging in potentially risky behaviour. Studies have found that people are quite optimistic about their health. Weinstein (1987) asked people to rate their risk of developing various disorders compared to people like them. Individuals usually rate their chances of illness as lower than for other people. This is the case in smokers, to a large extent. Weinstein suggested that the following factors affect “unrealistic optimism”.

• People tend to believe that if a problem has not appeared yet, then it is unlikely to happen in the future.
• People tend to think that personal action can prevent the problem.
• People believe that the problem is rare.
• People have little or no experience of the problem.

Social Cognitive Theory

Social Cognitive Theory suggests that health promoters act as ‘change agents’, facilitating change through modification of the social environment and the development of skills and capacities that enable individuals to make healthy changes. If you remember from the core, there are several important components of Social Cognitive Theory.

Health promotion campaigns that are based on Social Cognitive Theory include an informational component to increase perceptions of the risks and benefits associated with a particular behavior, teaching social and cognitive skills that can be used to initiate behavior change, building self-efficacy to promote behavior maintenance, and building social support to sustain change.

The first attempt at applying the Sabido Method was in a soap opera called Acompáñame ("Accompany Me"). The results of Acompáñame, as reported by the Mexican government's national population council (CONAPO), were:

• Phone calls to the CONAPO requesting family planning information increased from zero to an average of 500 a month. Many people calling mentioned that they were encouraged to do so by the television soap opera.
• More than 2,000 women registered as voluntary workers in the national program of family planning. This was an idea suggested in the television soap opera.
• Contraceptive sales increased 23 percent in one year, compared to a seven percent increase in the preceding year.
• More than 560,000 women enrolled in family planning clinics, an increase of 33 percent (compared to a one percent decrease the previous year).

The Sabido method is based on several of the factors that promote social learning:

• Because viewers are committed to watching the show, they pay attention and retain the plot.
• They observe both the rewards and punishments that are received by the characters for the choices that they make – that is, vicarious reinforcement.
• They identify with the characters and feel connected to them. This serves as motivation to replicate the behavior.
• The characters in the soap opera are “average people”- many viewers will see them as part of their in-group.

The Sabido method has been successfully applied in other countries. For example, from 1993 to 1997 there was a serial in Tanzania to promote AIDS prevention behavior, the ideal age of marriage for women, and the use of family planning. In order to test the effectiveness of the program, a nationwide program was set up with the assistance of the University of New Mexico. The experiment used an independent samples design. In the area near the capital city of Dodoma, a music program was played. This was the control. The rest of the country heard the serial broadcast by Radio Tanzania. The program ran for two years.

Nationwide surveys showed a significant increase in the percentage of listeners in the broadcast areas who believed that they were vulnerable to HIV infection; an increase in the belief that audience members, rather than their God or fate, can determine how many children they will have; and an increase in the percentage of respondents who approve of family planning. Importantly, the research showed a very significant increase in family planning use and a reduction in fertility rate only where the program was broadcast (Vaughan et al, 2000).

 Teacher only box

This campaign plays to one's emotions - especially about the love between a parent and child. This is the focus of the potential change for the parents in the video who realize that they are not acting in the best interest of their children by not requiring them to wear a hat or sun cream.

However, it is the viewer of the campaign that is influenced by SCT.  Watching the video, they observe the negative experience of the parents, realizing that they are potentially endangering their children. This leads to a sense of "vicarious punishment", where the viewer feels that same sense of shame if they are engaging in the same behaviour.  In addition, the campaign is memorable (retention) and catches one's attention.  Finally, the people in the campaign are relatable - that is, the people in the audience can identify with them. The people in the video also represent the diversity of the population.