Question

Ms. Thom, age 46, works as an RN in the intensive care unit at a large busy medical center. Over the last three years she has gained 30 lbs and quit attending the fitness classes at the local recreation center. Her co-workers keep trying to get her to come back to fitness class, but she says that she is too tired after work and just wants to go home. She has smoked for 15 years, but says that she is trying to cut back on the number of cigarettes each day because she watched her mother die from emphysema. She has picked up some literature from Employee Health on smoking cessation. She was recently diagnosed with hypertension.

1. Using the health belief model, identify the modifying factors impacting Ms. Thom's likelihood of taking a preventive health action.

2. Which primary intervention activities are important for Ms. Thom?

3. Using the transtheoretical model of change, in which stage is Ms. Thom most likely related to her smoking? Explain your answer.

Answer 1

1. Health Belief Model

The Health Belief Model (HBM) was developed in the early 1950s by social scientists at the U.S. Public Health Service in order to understand the failure of people to adopt disease prevention strategies or screening tests for the early detection of disease. Later uses of HBM were for patients' responses to symptoms and compliance with medical treatments. The HBM suggests that a person's belief in a personal threat of an illness or disease together with a person's belief in the effectiveness of the recommended health behavior or action will predict the likelihood the person will adopt the behavior.

The HBM derives from psychological and behavioral theory with the foundation that the two components of health-related behavior are-

1) the desire to avoid illness, or conversely get well if already ill.

2) the belief that a specific health action will prevent, or cure, illness.

Factors

1. Perceived susceptibility - This refers to a person's subjective perception of the risk of acquiring an illness or disease. There is wide variation in a person's feelings of personal vulnerability to an illness or disease.
2. Perceived severity - This refers to a person's feelings on the seriousness of contracting an illness or disease (or leaving the illness or disease untreated). There is wide variation in a person's feelings of severity, and often a person considers the medical consequences (e.g., death, disability) and social consequences (e.g., family life, social relationships) when evaluating the severity.
3. Perceived benefits - This refers to a person's perception of the effectiveness of various actions available to reduce the threat of illness or disease (or to cure illness or disease). The course of action a person takes in preventing (or curing) illness or disease relies on consideration and evaluation of both perceived susceptibility and perceived benefit, such that the person would accept the recommended health action if it was perceived as beneficial.
4. Perceived barriers - This refers to a person's feelings on the obstacles to performing a recommended health action. There is wide variation in a person's feelings of barriers, or impediments, which lead to a cost/benefit analysis. The person weighs the effectiveness of the actions against the perceptions that it may be expensive, dangerous (e.g., side effects), unpleasant (e.g., painful), time-consuming, or inconvenient.
5. Cue to action - This is the stimulus needed to trigger the decision-making process to accept a recommended health action. These cues can be internal (e.g., chest pains, wheezing, etc.) or external (e.g., advice from others, illness of family member, newspaper article, etc.).

2. Primary Intervention activity for Ms. Thom is health promotion. Complete stop of the smoking because she is having high BP. She should go to fitness centre and deaddiction centre.

3.

The stages of change within the TTM are:

Precontemplation: At this stage the person is not even thinking about the behavior change. The person may be unaware of the need for change, or the person may be in denial. He or she has not personally considered making a change in lifestyle or behavior. In the case of smoking, the person has no thoughts of quitting. He or she has never considered quitting and has never thought about the harmful effects of smoking. There is no motivation to quit since the person has never seriously entertained the thought.

Contempation: Once a person reaches contemplation, he or she begins to seriously consider the pros/cons associated with the change. The person may do some research and may learn more about the aspects of the behavior change. The individual may ask certain questions and read some books about successful quitting techniques. Eventually, he or she considers actually making the change. Many smokers are in this stage because they hear about the health hazards associated with smoking and they begin to wonder whether they should try quitting. They don’t have any set plans to quit, but they consider what their life might be life if they were to quit.

Preparation: At this stage, the person begins to make plans and prepares for the necessary change. Most of this is mental and psychological preparation, but there may be some lifestyle changes that also take place as the person begins to prepare for action. For smokers, this may involve a mental preparation of quitting. They may plan ahead by setting a quit date and marking it on the calendar. They may also tell others about their quit date so that they have some accountability from others.

Action: This is where the individual implements the change in behavior. This is when the quit date arrives and the smoker stops smoking. If the action stage occurs and the behavior change isn’t maintained, then people fall back into a previous stage. Some people give up while others get motivated to prepare and plan for another quit date. Others are able to maintain their behavior change for a while, but then they may relapse and have to go through the stages of change again.

Maintenance: This is where one maintains the changed behavior and incorporates the new behavior as a way of life. Some people do not include this as a stage of change since at this point the person has already made the change. However, since people often revert back to original behaviors, this maintenance stage is a necessary step for many. Most smokers who quit for the first time relapse at some point. Hence, it often takes many efforts to get smokers to quit permanently.

Miss Thom is in Contmpation stage