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Learn how to improve health behavior

This is an excerpt from Health and Physical Education for Elementary Classroom Teachers With Web Resource by Retta Evans & Sandra Sims.

Improving Health Behavior

Health behavior is simply the choices people make that influence health status. These choices can include negative or positive behaviors. Some positive behaviors might include eating fruits and vegetables, washing hands frequently, sleeping for 8 hours each night, and exercising regularly. All of these behaviors can impact health. Health education borrows theories from the field of psychology and education and applies them to health behavior.

When applying health behavior theory to young children, it is essential to consider that children are products of their environments. Many of their health choices are made for them, so be careful not to place blame or criticize. Children have little to no control over what foods are purchased, adult supervision, housing, neighborhood crime rates, bedtime, availability of appropriate car seats, and the scheduling of routine doctor or dentist appointments. Parents and caregivers typically control these factors.

How can positive health behavior change occur in a home environment that is not conducive to health? Families must be involved in the process. In order to gain support for positive health behavior change, elementary teachers and parents must be in a two-way partnership. Parents should be encouraged not only to meet their basic obligations but also to become involved in school health programs, home learning activities, health policy, and advocacy. Health behavior change is a collaborative and empowering process.

One essential factor that affects human behavior is self-efficacy. Self-efficacy is the extent of one's belief in one's own ability to complete tasks and reach goals. Self-efficacy plays a critical role in how people think, feel, and behave. Students with a strong sense of their own effectiveness are more likely to challenge themselves with difficult tasks and be intrinsically motivated. These students devote great time and energy into their commitments, and they often attribute failure to things that are in their control rather than blame others. Students with high self-efficacy recover quickly from setbacks, and they are able to achieve personal goals. Conversely, students with low self-efficacy tend to think they cannot be successful and are less likely to make the effort needed to accomplish a goal or task. Therefore, students in this category may have lower aspirations, which may result in poor academic performance. The school setting provides the perfect platform for learning academic and social skills, solving problems, communication, and relationship development. In a social setting, levels of self-efficacy become evident. Children are particularly sensitive to how their peers view them. A child with high self-efficacy likely has confidence in her relationship with peers, but a child with low self-efficacy might feel unaccepted and withdraw.

The four sources of self-efficacy are

• mastery experiences,
• vicarious experiences,
• verbal persuasion, and
• emotional states.

Teachers can use strategies to build self-efficacy in many ways. For example, having successful experiences with a presentation or exam boosts self-efficacy (an example of mastery experience), while failures tend to erode it. Observing a peer succeed at a task can strengthen beliefs in one's own abilities (an example of a vicarious experience). Teachers can boost self-efficacy with verbal persuasion - praise and feedback to guide the student through the task or motivate them to make their best effort. Using incentives to reward the achievement of health goals is another way to support self-efficacy among children. Lastly, a positive level of emotional stimulation (emotional state) can contribute to strong performances. Teachers can help by reducing stressful situations and lowering anxiety about events such as tests or presentations. Throughout school, parents and teachers can have a profound effect on self-efficacy. The goal of health education is to increase student self-efficacy by facilitating the acquisition of knowledge and developing the skills needed in order to achieve and maintain healthy behaviors.

So, you know that children with high self-efficacy are going to be more successful at achieving their goals - in this case, their health-related goals. Another important element to adopting health behaviors is through modeling behaviors they see. Social cognitive theory (SCT) refers to a psychological model that focuses on the idea that learning occurs in a social setting and that much of what is learned is gained through observation. SCT adheres to some basic assumptions about learning and behavior. One assumption is called reciprocal determinism, whereby personal, behavioral, and environmental factors influence one another in a bidirectional way. So, a person's behavior is a product of an ongoing interaction between cognitive, behavioral, and contextual factors. Another assumption is that people can influence their own behavior and the environment in a purposeful, goal-directed way. A third assumption within SCT is that learning can occur without an immediate change in behavior. A strength of SCT is that it provides a framework for classroom interventions designed to improve students' learning. So, if a student sees the teacher walking around the track during recess, then eating an apple and drinking water during lunchtime, the child is more likely to adopt those healthy behaviors.

Now that you can acknowledge the role of self-efficacy and the social environment (SCT) in successfully changing health-related behaviors, you can also characterize behavior change as occurring through a series of stages. The transtheoretical model of behavior change (TTM) is a way to categorize a person by stage based on readiness to change a particular behavior. The concept of readiness is important because if a person is not ready to change a behavior, then change is unlikely to occur. Table 3.1 lists the stages through which people progress during behavior change and the characteristics that accompany each stage. The stage helps to determine what kind of intervention would be most effective. For example, if smokers are not aware that smoking can lead to serious health problems, they are unlikely to attempt to give up smoking right away and an intervention aimed at providing information about the negative effects of smoking may help them move to the next stage.

Think about a health behavior that you would like to change. Would you like to exercise more, increase your fruit or vegetable intake, or reduce your consumption of salt? Use table 3.1 to determine what stage best describes your efforts. What would it take to move you to the next stage? Teachers can use the TTM as a way to engage their students in making behavior changes. For example, after staging your students, use table 3.1 as a guide in moving them to the next stage in increasing physical activity.

People are motivated at different times to perform positive health-related behaviors, and attitude can affect this phenomenon. The theory of planned behavior attempts to predict how a person's attitudes about a behavior may affect the intention to engage in that behavior. Health educators posit that behavior is often established by intention, which is determined by attitude toward the behavior (good or bad), subjective norm (perception of social pressures to perform or not perform behavior), and perceived behavioral control (perception of ease or difficulty in performing behavior). For example, the likelihood of John intending to change behavior in order to lose weight is based on three factors: his attitude toward the behavior change, subjective norms of friends and family, and whether or not John feels he has control over the process and outcome. If John is trying to lose weight, he must believe that healthy eating and exercise will result in weight loss. He must also have confidence that losing weight will result in him looking and feeling better. Another factor that will influence John's intention is how subjective norms affect his decision making and his perception that he must comply with them. If he has health-minded friends and family and believes that they want him to lose weight, he is more likely to comply with healthful eating and exercising. Lastly, John must think he is capable of accomplishing the tasks necessary to lose weight (self-efficacy). According to the theory of planned behavior, attitudes, intentions, subjective norms, perceived behavioral control, and self-efficacy are the main ingredients for health behavior change. These components are closely related to and overlap with constructs in other health behavior theories.

Lastly, the health belief model (HBM) is a psychological model that seeks to explain and predict health behaviors by focusing on people's attitudes and beliefs. The model suggests that people's beliefs about health problems, perceived benefits and barriers to the behaviors that will prevent the health problem, and self-efficacy explain whether they will engage in a health-promoting behavior. According to the model, a cue to action must also be present in order to trigger the health-promoting behavior. See table 3.2 for the components of the HBM.

Teachers can use constructs of the HBM to assist their students in making positive changes to their health. For example, you may aim to increase perceived susceptibility to and perceived seriousness of a health condition by providing education about prevalence and incidence of a disease, having students complete a family health history, and citing facts about the consequences of the disease. You could also have students complete an activity such as a cost - benefit analysis of engaging in a health-promoting behavior (benefits and barriers). The activity could include information about the various behaviors to reduce risks of the disease, identify common perceived barriers, and describe incentives to engage in health-promoting behaviors. In addition, you could provide cues to action to remind and encourage students to engage in health-promoting behaviors.

The fields of education and psychology have made important contributions in understanding and guiding health behavior change. Teachers with a sound understanding of human behavior and the theories that explain it are better armed with the skills needed to individualize health education instruction in the classroom.

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