Difficulty: Intermediate | Prerequisites: Chapter 1 notes (biopsychosocial model, research methods).
Chapters 3 through 5 shift from anatomy to behaviour. Chapter 3 introduces the theoretical models health psychologists use to understand and change health habits. Chapter 4 covers exercise adherence and injury prevention. Chapter 5 deals with specific health-compromising behaviours: obesity, eating disorders, alcohol use disorder, smoking and opioid use disorder. Together, these chapters answer the question: if we know what makes people sick, how do we get them to change?
Health habits are shaped by demographics, social factors, values and cognitive beliefs, and they are unstable over time. Several models (health belief model, theory of planned behaviour, transtheoretical model, social cognitive theory) explain why people do or do not adopt healthy behaviours. Cognitive-behavioural techniques (self-monitoring, conditioning, stimulus control) are the main tools for change, and relapse prevention is built into every serious intervention. Obesity, eating disorders, alcohol, smoking and opioids are the major health-compromising behaviours covered, each with its own treatment landscape.
Health promotion
Helping people gain more control over their health and improve it. Includes practising good health behaviours and avoiding or eliminating bad ones.
Health habits
Behaviours that affect health. Determined by demographic factors (SES), social factors (family socialisation), values, cultural background, perceived symptoms, access to medical care and cognitive factors (health beliefs). They are only modestly related to each other and can be unstable over time.
Health belief model (HBM)
A model predicting health behaviour based on perceived severity of the threat, perceived benefits of action, perceived barriers to action and self-efficacy. In simple terms, you are more likely to change if you believe the risk is real, the change will help, the obstacles are manageable and you can pull it off.
Theory of planned behaviour (TPB)
Behaviour is predicted by attitudes toward the behaviour, subjective norms (social pressure) and perceived behavioural control. Think of it as: do I want to do it, do people around me think I should, and do I believe I can?
Transtheoretical model (stages of change)
Behaviour change happens in stages, not all at once. Relapse is common and expected. Interventions work best when matched to the person's current stage.
Social cognitive theory
Learning occurs through observation. Behaviour, personal factors (including self-efficacy) and the environment interact reciprocally.
Self-efficacy
Belief in one's ability to perform the behaviour needed to achieve a desired outcome. Central to multiple models.
Response efficacy
Belief that the recommended behaviour will be effective in overcoming the health threat.
Cognitive-behavioural therapy (CBT)
An approach to behaviour change using self-monitoring, classical conditioning, operant conditioning, modelling and stimulus control. Brings clients into the treatment process through self-control and self-reinforcement.
Self-monitoring
Tracking one's own behaviour (e.g. recording everything eaten). A core CBT technique.
Stimulus control
Modifying environmental cues that trigger a target behaviour. For example, removing junk food from the house to reduce overeating.
Social engineering
Changing behaviour through policy or structural changes rather than individual persuasion. Examples: mandated childhood immunisations, workplace smoking bans.
Caplan's model (prevention by disease stage)
Primary = prevent disease before it happens. Secondary = early detection (e.g. screenings). Tertiary = reduce impact of existing disease (treatment/rehabilitation).
Institute of Medicine model (prevention by risk level)
Universal = targets entire population. Selective = targets at-risk groups. Indicated = targets high-risk individuals showing early signs.
Relapse prevention
A CBT component that prepares people for setbacks and teaches strategies to recover from them rather than abandoning change entirely.
Obesity
Linked to cardiovascular disease, kidney disease, diabetes, some cancers and other chronic conditions. Contributors include genetics, family history, lack of exercise and high-calorie diet. Dieting itself may contribute to the propensity for obesity.
Anorexia nervosa / bulimia / binge eating
Major eating disorders. Family-based treatment can be effective.
Alcohol use disorder
Accounts for thousands of deaths annually through cirrhosis, cancer and drunk-driving injuries. Treatment typically uses CBT with relapse prevention, most commonly on an outpatient basis.
Opioid use disorder
Contributing factors include opioid access, social conditions, family history of substance use, depression and anxiety. Medications can treat it effectively, but nonadherence and relapse are high.
Health promotion helps people take control of their health by practising good behaviours and eliminating bad ones. Health habits are determined by:
Demographic factors (socioeconomic status)
Social factors (early family socialisation)
Values and cultural background
Perceived symptoms
Access to medical care
Cognitive factors (health beliefs)
Health habits are only modestly related to each other and can be unstable over time. Promotion efforts target children and adolescents before unhealthy habits form, focus on at-risk populations, and increasingly target older adults to contain late-life healthcare costs.
Health belief model: a person is more likely to change when they perceive the health threat as severe, believe they are personally susceptible, feel they can perform the needed response (self-efficacy), believe the response will work (response efficacy), and perceive that social norms support the behaviour.
Theory of planned behaviour: behaviour is predicted by three factors: attitudes, subjective norms (social pressure) and perceived behavioural control.
Transtheoretical model (stages of change): change happens in stages (precontemplation, contemplation, preparation, action, maintenance). Relapse is common and expected. Interventions matched to the person's current stage are more effective.
Social cognitive theory: behaviour, personal factors and the environment interact. Self-efficacy is central. Learning happens through observation and modelling.
Attitudinal approaches (education, motivation) can shift knowledge but produce limited behaviour change on their own.
Cognitive-behavioural approaches use:
Self-monitoring: tracking behaviour systematically
Classical conditioning: associating cues with behaviour
Operant conditioning: reinforcing desired behaviour
Modelling: learning from observing others
Stimulus control: modifying environmental triggers
CBT brings clients into the process through self-control and self-reinforcement. Change happens in stages, not all at once.
Caplan's model (by disease stage):
Primary: prevent disease before it happens
Secondary: early detection (screenings)
Tertiary: reduce impact of disease (treatment/rehab)
Institute of Medicine model (by risk level):
Universal: entire population
Selective: at-risk groups
Indicated: high-risk individuals showing early signs
Some habits are best changed through social engineering: mandated childhood immunisations, workplace smoking bans, legislation. Individual methods are giving way to cheaper group methods (self-help groups, school/workplace interventions). Mass media, telephone, internet and texting interventions are all promising delivery channels.
Cognitive-behavioural interventions with relapse prevention have been moderately successful in helping people stick to regular exercise programmes. Unintentional injuries are a major cause of preventable death among children and adolescents. Publicity, legislation, parent training and child safety interventions have reduced these risks.
Obesity is linked to cardiovascular disease, kidney disease, diabetes, some cancers and other chronic conditions. Contributors include genetic predisposition, family history, lack of exercise, high-calorie diet and, paradoxically, dieting itself.
Treatment approaches:
Diets
Surgical procedures
CBT: monitoring eating behaviour, modifying environmental stimuli, reinforcing new habits
Relapse prevention is essential
CBT can produce weight losses of about 2 pounds per week for 20 weeks, maintained over a 2-year period. Prevention efforts increasingly focus on unhealthy eating before obesity develops.
Anorexia nervosa, bulimia and binge eating are major health problems. Family-based treatment can be effective.
Accounts for thousands of deaths annually through cirrhosis, cancer and drunk-driving injuries. Residential treatment begins with an inpatient "drying out" period, followed by CBT with relapse prevention. Most programmes are outpatient and use CBT principles.
Smoking causes more than 480,000 deaths annually in the US from heart disease, cancer and lung disorders.
Contributing factors: opioid access, adverse social conditions, family history of substance use, depression and anxiety. Medications can treat it effectively, but nonadherence and relapse rates are high.
Students think giving people information is enough to change behaviour. Attitudinal/educational approaches shift knowledge and motivation but produce limited behaviour change on their own. CBT techniques are needed for lasting change.
Students confuse Caplan's model (by disease stage: primary, secondary, tertiary) with the Institute of Medicine model (by risk level: universal, selective, indicated). Both classify prevention, but along different dimensions.
Students assume relapse means failure. In the transtheoretical model, relapse is expected and treated as a normal part of the change process, not a sign that treatment has failed.
Students think obesity is purely a matter of willpower. Contributors include genetics, family history, environment and, paradoxically, repeated dieting. Treatment requires systematic behaviour change, not just motivation.
⚠️ Know the four components of the health belief model (perceived severity, perceived susceptibility, self-efficacy, response efficacy) and be able to apply them to a scenario.
⚠️ Be ready to compare the HBM, TPB, transtheoretical model and social cognitive theory. Exam questions often describe a programme and ask which model it reflects.
⚠️ Understand the difference between Caplan's model (disease stage) and the Institute of Medicine model (risk level).
⚠️ CBT techniques (self-monitoring, stimulus control, operant conditioning) are commonly tested. Know what each means and be able to give an example.
⚠️ Relapse prevention is a recurring concept across chapters 3, 4 and 5. Understand it as built into the change process, not as failure.
⚠️ Smoking = 480,000+ deaths annually in the US. This statistic appears regularly in exams.
True or False: The transtheoretical model treats relapse as a sign of treatment failure.
False. Relapse is expected and considered a normal part of the change process.
Fill in the blank: In the health belief model, ______ is the belief that one can successfully perform the needed behaviour.
Self-efficacy.
True or False: Social engineering changes behaviour through individual counselling.
False. Social engineering uses policy or structural changes (e.g. smoking bans, mandatory vaccinations).
Fill in the blank: Caplan's ______ prevention involves early detection through screenings.
Secondary.
True or False: CBT techniques for obesity include self-monitoring eating behaviour and modifying environmental stimuli.
True.
Q: Compare the health belief model and the theory of planned behaviour. What does each emphasise?
A: The HBM focuses on individual perceptions: perceived severity, susceptibility, benefits, barriers and self-efficacy. The TPB focuses on attitudes toward the behaviour, subjective norms (social pressure from others) and perceived behavioural control. The key difference is that the TPB explicitly includes social influence, while the HBM centres on the individual's own risk assessment.
Q: A university runs a campus-wide vaccination campaign aimed at all students, not just those at high risk. Which prevention model and level does this represent?
A: Institute of Medicine model, universal level (targets the entire population regardless of risk).
Q: Name three CBT techniques used in health-habit change and give an example of each.
A: (1) Self-monitoring: keeping a food diary to track daily calorie intake. (2) Stimulus control: removing alcohol from the home to reduce drinking cues. (3) Operant conditioning: rewarding oneself for completing a week of exercise.
Q: Why might dieting contribute to obesity rather than reduce it?
A: Repeated dieting can alter metabolism and increase the propensity for weight regain. The cycle of restriction and rebound eating can lead to higher overall weight over time.
Q: What is the difference between primary, secondary and tertiary prevention in Caplan's model?
A: Primary prevention stops disease before it happens (e.g. vaccination). Secondary prevention detects disease early through screenings (e.g. mammograms). Tertiary prevention reduces the impact of existing disease through treatment and rehabilitation.
The behaviour change models from Chapter 3 are the theoretical backbone for every intervention discussed in later chapters, whether for chronic pain management, adherence to medical regimens or coping with chronic illness. The stress physiology from Chapter 2 (sympathetic activation, cortisol) explains why stress drives the health-compromising behaviours in Chapter 5: eating, drinking and smoking often function as maladaptive coping strategies. Relapse prevention, introduced here, reappears in nearly every treatment context across the course.
health promotion, health habits, health belief model, HBM, theory of planned behaviour, TPB, transtheoretical model, stages of change, precontemplation, contemplation, preparation, action, maintenance, social cognitive theory, self-efficacy, response efficacy, CBT, cognitive-behavioural therapy, self-monitoring, classical conditioning, operant conditioning, stimulus control, modelling, social engineering, Caplan's model, primary prevention, secondary prevention, tertiary prevention, Institute of Medicine model, universal prevention, selective prevention, indicated prevention, relapse prevention, obesity, BMI, eating disorders, anorexia nervosa, bulimia, binge eating, alcohol use disorder, cirrhosis, smoking, lung cancer, opioid use disorder, PSY320 Chapter 3, Chapter 4, Chapter 5