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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Serie: Jossey-Bass Public Health
- Sprache: Englisch
The essential health behavior text, updated with the latest theories, research, and issues
Health Behavior: Theory, Research and Practice provides a thorough introduction to understanding and changing health behavior—important facets of the public health role. Since the publication of the first edition, this comprehensive book has become the gold standard of health behavior texts. This new sixth edition has been updated to reflect the most recent changes in the public health field, including findings from real-world interventions based on the theories described in the book. Offering perspective applicable at the individual, interpersonal, group, and community levels, this essential guide gives public health students and practitioners an authoritative reference for both the theoretical and practical aspects of health behavior.
- Explore the link between culture, health, and the importance of community
- Get up to date on emerging theories of health behavior and their applications
- Examine the push toward evidence-based interventions and focus on diverse populations
- Learn how e-health and social media factor into health communication
Written and edited by leading theorists and researchers in the field, Health Behavior builds a solid understanding of how to analyze and improve health behaviors and health.
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Veröffentlichungsjahr: 2024
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Table of Contents
COVER
TABLE OF CONTENTS
TITLE PAGE
COPYRIGHT PAGE
DEDICATION PAGE
TABLES AND FIGURES
FOREWORD
PREFACE
ABOUT THE EDITORS
ABOUT THE CONTRIBUTORS
ABOUT THE COMPANION WEBSITE
PART ONE: HEALTH BEHAVIOR: THE FOUNDATIONS
CHAPTER 1: THE SCOPE OF HEALTH BEHAVIOR
What is Health Behavior?
Health, Disease, and Health Behavior: Global Needs and Goals
Health Behavior and Health Behavior Change
Settings and Audiences for Health Behavior Change
Health Behavior Foundations for Theory, Research, and Practice
References
CHAPTER 2: THEORY, RESEARCH, AND PRACTICE IN HEALTH BEHAVIOR
Theory, Research, and Practice: Interrelationships
What is Theory?
Paradigms for Theory and Research in Health Behavior
Trends in Use of Health Behavior Theories and Models
Selection of Theories for this Book
Fitting a Theory or Theories to Research and Practice: Building Bridges and Forging Links
Limitations of this Book
References
CHAPTER 3: ECOLOGICAL MODELS OF HEALTH BEHAVIOR
Ecological Models of Health Behavior: Introduction
History
Key Components of Ecological Models
Ecological Models in Practice
Applications
Discussion
Summary
Acknowledgments
References
PART TWO: MODELS OF INDIVIDUAL HEALTH BEHAVIOR
CHAPTER 4: INTRODUCTION TO HEALTH BEHAVIOR THEORIES THAT FOCUS ON INDIVIDUALS
Health Belief Model (HBM)
Reasoned Action Approach Models
The Transtheoretical Model (TTM)
Similarities and Differences in the Theories’ Constructions
Other Considerations
Conclusion
References
CHAPTER 5: THE HEALTH BELIEF MODEL
Introduction
Applications of the Health Belief Model
Discussion and Summary
References
CHAPTER 6: THEORY OF REASONED ACTION, THEORY OF PLANNED BEHAVIOR, INTEGRATIVE BEHAVIORAL MODEL, AND REASONED ACTION APPROACH
Introduction and History
Key Constructs
Measurement of TRA, TPB, IM, and RAA Constructs
Analyzing TPB, TRA, IM, and RAA Data
Supporting Evidence
Applications
Critiques
Future Directions
Summary
References
CHAPTER 7: THE TRANSTHEORETICAL MODEL AND STAGES OF CHANGE
Overview
Key Components
Critical Assumptions
Empirical Evidence
Applications of TTM
Limitations
Future Research
Summary
References
PART THREE: MODELS OF INTERPERSONAL HEALTH BEHAVIOR
CHAPTER 8: INTRODUCTION TO MODELS OF INTERPERSONAL INFLUENCES ON HEALTH BEHAVIOR
Social Cognitive Theory
Models of Social Support and Health
Social Networks and Health Behavior
Stress, Coping Adaptation, and Health Behavior
Future Directions
References
CHAPTER 9: SOCIAL COGNITIVE THEORY AND HEALTH BEHAVIOR
Background
Major Constructs
Case Study 1: Healthy Eating Living (HEAL)
Case Study 2: Catch My Breath
Discussion
Summary
Acknowledgments
References
CHAPTER 10: SOCIAL SUPPORT AND HEALTH
Definition and Conceptualizations of Social Support
Historical Perspectives
Theoretical Models
Empirical Evidence of the Health Effects of Social Support
Health Behavior Applications
Future Directions for Research and Practice
Summary
References
CHAPTER 11: SOCIAL NETWORKS AND HEALTH BEHAVIOR
Introduction
Social Network Theory
Social Media
Applications
Discussion and Conclusion
References
CHAPTER 12: STRESS, COPING, ADAPTATION, AND HEALTH BEHAVIOR
Historical Overview of Stress and Coping Research
Pathways Through Which Stress Influences Health
Transactional Model of Stress and Coping
Frameworks that Inform Strategies to Foster Adaptive Coping, Resilience, and Well‐Being
Stress, Coping, Adaptation, and Health Behavior: Applications to Current and Emerging Research
Critiques and Knowledge Gaps in Stress and Coping Research
Summary
References
PART FOUR: COMMUNITY AND GROUP MODELS OF HEALTH BEHAVIOR CHANGE
CHAPTER 13: INTRODUCTION TO COMMUNITY AND GROUP MODELS OF HEALTH BEHAVIOR CHANGE
Perspectives on Community, Group, and Organizational Interventions
Multiple Levels of Influence and Action
Adoption of Models from Outside the Health Field
Future Directions
References
CHAPTER 14: RACE, HEALTH, AND EQUITY
Race and Racism in Health Behavior: Definitions and Theoretical Foundations
Integrating Racism‐Focused Constructs into Health Behavior Models
Applications of PHCRP and CRT to Public Health
Discussion and Conclusions
References
CHAPTER 15: IMPROVING HEALTH THROUGH COMMUNITY ENGAGEMENT: RESEARCH AND PRACTICE
Overview
Concept of Community
Historical and Recent Developments
Concepts and Principles
Community Engagement in Practice
Measurement, Evaluation, and Research Designs
Application: Pasifika Prediabetes Youth Empowerment Program
Benefits and Challenges of Community Engagement
Discussion and Conclusion
References
CHAPTER 16: IMPLEMENTATION, DISSEMINATION, AND DIFFUSION OF PUBLIC HEALTH INNOVATIONS
Introduction to Dissemination and Implementation Science
Conceptualizing Dissemination and Implementation
Introduction to Key Dissemination and Implementation Frameworks
Diffusion of Innovations Theory
The Consolidated Framework for Implementation Research
Study Designs and Methodological Approaches in Dissemination and Implementation Science: Some Considerations
Challenges and Future Directions
Summary
Acknowledgments
References
CHAPTER 17: COMMUNICATION AND MEDIA EFFECTS ON HEALTH BEHAVIOR
Introduction
Communication and Media Effects Theories
Applications
Discussion and Conclusions
Summary
References
PART FIVE: USING THEORY IN RESEARCH AND PRACTICE
CHAPTER 18: INTRODUCTION TO USING THEORY IN RESEARCHAND PRACTICE
Theory‐Based Planning Models
Behavioral Economics
Social Marketing
Social Media
Cross‐Cutting Propositions About Using Theory
Moving Forward
References
CHAPTER 19: PLANNING MODELS FOR THEORY‐BASED HEALTH PROMOTION INTERVENTIONS
Introduction
PRECEDE‐PROCEED Model
Applying the PRECEDE‐PROCEED Model: Case Study
Intervention Mapping
Applying the Intervention Mapping Framework
Summary
References
CHAPTER 20: BEHAVIORAL ECONOMICS AND HEALTH
Introduction
Theories of Human Behavior: From Standard Economics to Behavioral Economics
Applications
Discussion and Conclusions
Summary
References
CHAPTER 21: SOCIAL MARKETING
Introduction
Definition of Social Marketing
Basic Principles of Social Marketing
The Role of Social Marketing Within a Strategic Communication Framework
The Role of Theory and Research in Social Marketing
International Social Marketing Applications
Summary
References
CHAPTER 22: SOCIAL MEDIA AND HEALTH
Introduction
Social Media Use and Health Inequities
Effects of Social Media on Health
Methodology and Measurement in Research on Social Media and Health
Health Behavior Interventions that Use Social Media
Social Media Interventions and Health Inequities
Applications of Social Media for Health Behavior Interventions
Future Directions
References
NAME INDEX
SUBJECT INDEX
END USER LICENSE AGREEMENT
List of Tables
Chapter 1
Table 1.1 Settings for Health Behavior Interventions
Table 1.2 Features of Audiences for Health Behavior Interventions
Chapter 2
Table 2.1 Definitions of Theory
Table 2.2 Trends in Use of Health Behavior Theories and Models
Chapter 3
Table 3.1 Ecological Models: Key concepts
Chapter 5
Table 5.1 Summary of Patterns of Association for Health Belief Model Constr...
Chapter 6
Table 6.1 Constructs and Pathways for TRA, TPB, IM, and RAA
Table 6.2 RAA Construct Definitions, Measures, and Example Wording
Table 6.3 Measures and Descriptive Statistics for RAA Proximal Determinants...
Table 6.4 Audience Segmentation Analysis for Women: Enrolling in Brain Heal...
Chapter 7
Table 7.1 Transtheoretical Model Constructs
Chapter 9
Table 9.1 Major Constructs from Social Cognitive Theory
Table 9.2 Operationalization of Individual‐Level SCT Constructs in the Heal...
Chapter 10
Table 10.1 Measurement Approaches Used to Assess Social Relationships
Table 10.2 Definition and Examples of Dimensions of Functional Support
Chapter 11
Table 11.1 Social Network Analysis Terms
Chapter 12
Table 12.1 Transactional Model of Stress and Coping, with Extensions: Defin...
Chapter 14
Table 14.1 Ecosocial Theory
Table 14.2 Principles of Public Health Critical Race Praxis (PHCRP)
Chapter 15
Table 15.1 Key Concepts/Principles in Community Engagement
Table 15.2 Strategies Used to Inform the Development of the Pasifika Predia...
Table 15.3 Modular Components of the Pasifika Prediabetes Youth Empowerment...
Chapter 16
Table 16.1 Core Terms and Definitions in Dissemination and Implementation S...
Table 16.2 Diffusion of Innovations: Concepts, Definitions, and Application...
Table 16.3 Consolidated Framework for Implementation Research Domains, Thei...
Chapter 17
Table 17.1 Selected Communication Theories and Approaches at the Individual...
Chapter 19
Table 19.1 PRECEDE‐PROCEED Model as a Structure for Using Theories and Cons...
Table 19.2 Behavioral Outcomes, Environmental Outcomes, and Performance Obj...
Table 19.3 Student Outcome: Partial Example Methods and Practical Applicati...
Chapter 20
Table 20.1 Standard Economic Theory Versus Behavioral Economics
Table 20.2 Relevance of Selected Behavioral Economics Principles to Health...
Chapter 21
Table 21.1 Applications of Major Theories and Research in Social Marketing...
Table 21.2 Core Social Marketing Principles Reflected in the ICMM Project
Chapter 22
Table 22.1 Broad Categories of Social Media
List of Illustrations
Chapter 3
Figure 3.1 Ecological Models of Health Behavior: General and Behavior Specif...
Figure 3.2 Reciprocal Determinism in Ecological Models: Example of the Impac...
Chapter 5
Figure 5.1 Components of the Health Belief Model
Chapter 6
Figure 6.1 Visual Depictions of TRA and TPB
Figure 6.2 Visual Depictions of IM and RAA
Figure 6.3 Conceptual Model with RAA and Precursor for Intention to Use PrEP...
Chapter 7
Figure 7.1 Processes of Change that Mediate Progression Between the Stages o...
Chapter 9
Figure 9.1 Reciprocal Determinism
Chapter 10
Figure 10.1 Social Connection as a Continuous Multifactorial Risk Factor wit...
Figure 10.2 Theoretical (Stress Prevention, Direct Effect, and Stress Buffer...
Figure 10.3 Benchmark Data Comparing the Magnitude of Effect of Social Suppo...
Chapter 11
Figure 11.1 Network of Who Knew Whom in One Organization, Shapes Indicate De...
Figure 11.2 Friendships Ties Between Students in One High School with Vaping...
Figure 11.3 (a) Student 191 is a Nonvaper at Time One with Three Reciprocate...
Chapter 12
Figure 12.1 Transactional Model of Stress and Coping and Its Major Extension...
Figure 12.2 Applied Identity Vitality‐Pathology Framework to Describe the In...
Chapter 15
Figure 15.1 The Community‐Based Participatory Research (CBPR) Conceptual Mod...
Chapter 16
Figure 16.1 Simplified, Illustrative Process for Identifying and Implementin...
Figure 16.2 Key Constructs from the Consolidated Framework for Implementatio...
Chapter 17
Figure 17.1 Typology of Planned and Unplanned Approaches to Communication fo...
Chapter 19
Figure 19.1 PRECEDE‐PROCEED Planning Model
Figure 19.2 Logic Model of the Problem
Chapter 21
Figure 21.1 ICMM Family Planning (FP) Advocacy Framework
Chapter 22
Figure 22.1 Social Media and Health in the Broader Ecosystem of Information,...
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
Dedication Page
Tables and Figures
Foreword
Preface
About the Editors
About the Contributors
About the Companion Website
Begin Reading
Name Index
Subject Index
WILEY END USER LICENSE AGREEMENT
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HEALTH BEHAVIOR
THEORY, RESEARCH, AND PRACTICE
Sixth Edition
EDITED BY
Karen Glanz
University of Pennsylvania
Philadelphia
PA, USA
Barbara K. Rimer
University of North Carolina
Durham
NC, USA
K. Viswanath
Harvard University
Boston
MA, USA
Copyright © 2024 by John Wiley & Sons, Inc.All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies.
Published by John Wiley & Sons, Inc., Hoboken, New Jersey.Published simultaneously in Canada.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per‐copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, (978) 750‐8400, fax (978) 750‐4470, or on the web at www.copyright.com. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748‐6011, fax (201) 748‐6008, or online at http://www.wiley.com/go/permission.
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Library of Congress Cataloging‐in‐Publication Data applied for:
ISBN 9781394211302 (Hardback)
Cover Design: WileyCover Image: © AniGraphics/Getty Images
With warm appreciation to Howard Weitz, who has supported me so steadfastly on this journey and made me laugh when I needed to.
K.G.
With thanks to my husband, Bernard Glassman, whose support has enabled me accomplish more than I could achieve alone, and to all the colleagues who have been there along the way.
B.K.R.
To my parents and their parents who modeled a life of honesty, industry and kindness to their children and grandchildren, and to my teachers and mentors who taught me what pay it forward means.
K.V.
TABLES AND FIGURES
Tables
1.1
Settings for Health Behavior Interventions
1.2
Features of Audiences for Health Behavior Interventions
2.1
Definitions of Theory
2.2
Trends in Use of Health Behavior Theories and Models
3.1
Ecological Models: Key concepts
5.1
Summary of Patterns of Association for Health Belief Model Constructs and COVID‐19 Vaccine Intentions or Uptake
6.1
Constructs and Pathways for TRA, TPB, IM, and RAA
6.2
RAA Construct Definitions, Measures, and Example Wording
6.3
Measures and Descriptive Statistics for RAA Proximal Determinants of Enrolling in a Brain Health Registry, by Racial and Ethnic Subgroups
6.4
Audience Segmentation Analysis for Women: Enrolling in Brain Health Registries for Alzheimer’s Research
7.1
Transtheoretical Model Constructs
9.1
Major Constructs from Social Cognitive Theory
9.2
Operationalization of Individual‐Level SCT Constructs in the Healthy Eating Active Living (HEAL) Program
10.1
Measurement Approaches Used to Assess Social Relationships
10.2
Definition and Examples of Dimensions of Functional Support
11.1
Social Network Analysis Terms
12.1
Transactional Model of Stress and Coping, with Extensions: Definitions and Applications
14.1
Ecosocial Theory
14.2
Principles of Public Health Critical Race Praxis (PHCRP)
15.1
Key Concepts/Principles in Community Engagement
15.2
Strategies Used to Inform the Development of the Pasifika Prediabetes Youth Empowerment Program
15.3
Modular Components of the Pasifika Prediabetes Youth Empowerment Program
16.1
Core Terms and Definitions in Dissemination and Implementation Science, in Alphabetical Order
16.2
Diffusion of Innovations: Concepts, Definitions, and Applications to Public Health and Health Care Delivery
16.3
Consolidated Framework for Implementation Research Domains, Their Definitions, and Their Application to Implementation Research
17.1
Selected Communication Theories and Approaches at the Individual Level and Societal Level
19.1
PRECEDE‐PROCEED Model as a Structure for Using Theories and Constructs
19.2
Behavioral Outcomes, Environmental Outcomes, and Performance Objectives for
Me & You: Building Healthy Relationships
Program
19.3
Student Outcome: Partial Example Methods and Practical Applications
20.1
Standard Economic Theory Versus Behavioral Economics
20.2
Relevance of Selected Behavioral Economics Principles to Health
21.1
Applications of Major Theories and Research in Social Marketing
21.2
Core Social Marketing Principles Reflected in the ICMM Project
22.1
Broad Categories of Social Media
Figures
3.1
Ecological Models of Health Behavior: General and Behavior Specific Models
3.2
Reciprocal Determinism in Ecological Models: Example of the Impact of Built Environment Interventions on Health Behavior and Planetary Outcomes
5.1
Components of the Health Belief Model
6.1
Visual Depictions of TRA and TPB
6.2
Visual Depictions of IM and RAA
6.3
Conceptual Model with RAA and Precursor for Intention to Use PrEP (Case Study 1)
7.1
Processes of Change that Mediate Progression Between the Stages of Change
9.1
Reciprocal Determinism
10.1
Social Connection as a Continuous Multifactorial Risk Factor with Components Related to Structure, Function, and Quality.
10.2
Theoretical (Stress Prevention, Direct Effect, and Stress Buffering) Models and Pathways Linking Social Support to Physical Health Outcomes
10.3
Benchmark Data Comparing the Magnitude of Effect of Social Support on Odds of Decreased Mortality Relative to Other Factors
11.1
Network of Who Knew Whom in One Organization
11.2
Friendships Ties Between Students in One High School with Vaping Behavior
11.3
(a) Student 191 is a Nonvaper at Time One with Three Reciprocated Friendships with 33% Exposure to Vapers. At Time Two He/She has Become a Vaper and Now has Named Five Friends who all Vape; (b) Student 133 is a Nonvaper at Time One with Four Friendships with 100% Exposure to Vapers. At Time Two He/She has Become a Vaper
12.1
Transactional Model of Stress and Coping and Its Major Extensions
12.2
Applied Identity Vitality‐Pathology Framework to Describe the Influence of Socially Constructed Identity on Stress Appraisal, Coping, and Health
15.1
The Community‐Based Participatory Research (CBPR) Conceptual Model
16.1
Simplified, Illustrative Process for Identifying and Implementing an EBI in Practice Settings
16.2
Key Constructs from the Consolidated Framework for Implementation Research
17.1
Typology of Planned and Unplanned Approaches to Communication for Health
19.1
PRECEDE‐PROCEED Planning Model
19.2
Logic Model of the Problem
21.1
ICMM Family Planning (FP) Advocacy Framework
22.1
Social Media and Health in the Broader Ecosystem of Information, Behavior, and Health
FOREWORD
The role of behavior in achieving healthy individuals, communities, and populations around the world is becoming ever clearer, and the need to understand behavior and how to enable change ever more urgent. This decade has seen a global pandemic that brought many governments and non‐governmental organizations to recognize the vital importance of people’s behavior in preventing infection and ameliorating its harms. Key behaviors included social distancing, ensuring ventilation and wearing facemasks in social situations to reduce transmission, being vaccinated to reduce harm, and communicating in ways that engage diverse communities.
Other global existential threats to health include the environmental and biodiversity crises, the dangers of antimicrobial resistance and concerns around cybersecurity and artificial intelligence. These issues and the related behaviors add to the large number that have influenced our health for centuries—for example, tobacco, alcohol, and other drug use; eating and physical activity; adherence to medication and other health interventions; delivery of healthcare; and implementation of evidence‐based practice more generally.
In all these global threats, human behavior is at the center of creating and exacerbating them—but also at the heart of reducing or eliminating them.
The harm caused by some behaviors affects not only the well‐being of people, their families, and communities, but also people’s contribution to society and therefore societal and economic strength. Harms are distributed unequally within and across societies, with those with fewest resources suffering the greatest harm. In recognition of this, in 2023 the World Health Assembly for the first time agreed to a resolution on Behavioral Sciences for Health.
It is in this context that I welcome the 6th edition of Health Behavior: Theory, Research, and Practice. The accessible knowledge packed within its pages is foundational for understanding the huge range of behaviors related to health across diverse contexts. This volume also enables the reader to learn about how to apply that understanding to research, public health and clinical practice and policy, communications, education, and training. Each chapter begins with a “vignette” to engage readers’ attention, introducing a contemporary problem that can be addressed with relevant theory or evidence.
It reflects advances in the last decade, updating applications and evidence, and two new chapters: Ch 14 on race, health, and health equity; and Ch 22 on social media and health.
The strengths of this outstanding book are many. Here are five that make this a comprehensive and compelling companion for anyone interested in health behavior.
It describes
theories of health behavior
and their importance in advancing research and practice in an accessible, compelling way.
Why is theory so important? First, good theories summarize what we know about a field at any point in time, bringing together research findings across diverse domains, populations, and settings. This is essential for accumulating knowledge and advancing the study and application of health behaviors. Second, they outline processes of change, that is how any intervention, policy, or program has an effect on desired outcomes. This enables those designing interventions to target mechanisms that are most likely to bring about change in the behavior of interest. Third, a good theory will also explain variation of effects across contexts, e.g. across populations, settings, and points in time. This is incredibly important as practitioners and policymakers want to be able to ascertain the relevance of research findings conducted in particular contexts for the setting and population they are concerned about. Thus, theories are essential for informing the development of interventions to change behaviors, both because this is likely to lead to more effective interventions, but also because whatever the findings, new knowledge will be generated that can be built on in the future.
It demonstrates the
connectedness of theory, research, and practice
.
Just as applying theoretical understanding leads to better policy and practice, feedback from applying theory in practice strengthens understanding. Research is the activity that connects theory and practice. By collecting data in an organized way, research studies can systematically test theoretical propositions and provide evidence to strengthen policy and practice. Well‐designed studies can do both of these simultaneously.
It recognizes
the importance of context
when considering health behaviors.
Major public health problems can only be successfully addressed by taking into account both local and global contexts, as outlined in Chapter 3 on ecological models. These represent examples of systems thinking and methods which are being increasingly used in considering health behaviors. Systems approaches, including ecological models, can combine population, community, and individual levels in research. They are strengthened by linking the general with the specific in terms of specifying intervention content and mechanisms of action.
The majority of research is conducted in the global North and among relatively advantaged populations, but the majority of health need is in the global South and among disadvantaged communities. This poses the challenge of knowing what evidence can be generalized from research populations to the culturally, socially, and racially diverse populations that health behavior interventions and policies seek to benefit. This edition addresses important issues in the areas of race, health, and health equity in Chapter 14, and of community engagement in Chapter 15.
It evaluates
evidence
about the application of theories and models and mechanisms of change.
Over the decade since the 5th edition of Health Behavior: Theory, Research, and Practice, there have been significant advances in study designs and methods of data collection. Behavioral interventions can be specified in terms of their component techniques, enabling the evaluation of the effectiveness of particular techniques, along with their links with theoretical processes. The last decade has also seen a digital revolution. Behavior can now be measured directly in real‐time, ecologically valid settings, for example via wearables, smartphones, physiological monitors, and environmental sensors. This provides a wealth of data about how behavior changes in response to environmental, physiological, and reported psychological processes. This has huge potential to advance our theories and models about how health behaviors can be changed. Complex data sets require complex analyses; harnessing the power of machine learning and artificial intelligence open up new horizons for the field.
It is
accessible and engaging
, aimed at a wide spectrum of readers.
The many groups that this book will interest and inform include health, education, and communication practitioners; intervention developers and policy planners; and researchers seeking to generate the best possible evidence and theoretical understanding. Chapters draw the reader in by beginning with a contemporary problem that can be addressed with the theory or model, followed by critiques and evaluation of evidence. This includes the all‐important issue as to how theoretical constructs are conceived in practice and measured. New topics that were not a “thing” 10 years ago are included, for example, social media and health in Chapter 22.
This book will be an invaluable resource for all those wanting an accessible and authoritative source to guide all aspects of the research process from conceptualizing problems in behavioural terms to writing protocols or research reports to synthesize evidence to consult with those wishing to use research findings in their work. The combination of rigorous thinking and methods with practical applications and case studies make this book shine out in an already sunny landscape.
Susan Michie
London, UKNovember 2023
PREFACE
Programs to influence health behavior, including health promotion and education programs and interventions, generally are more likely to benefit participants and communities when guided by a theory or theories of health behavior. Theories of health behavior can help program planners consider the sources of influence on particular health behaviors and identify the targets for behavior change and methods for accomplishing these changes. Theories also can inform the evaluation of change efforts by helping planners, evaluators, and others to specify the outcomes to be measured and the timing and methods of study. Although the evidence is not unequivocal, when they are developed and implemented thoughtfully and systematically, theory‐driven health promotion and education efforts stand in contrast to programs based primarily on precedent, tradition, intuition, or general principles.
Theory‐driven health behavior change interventions and programs require an understanding of the components of health behavior theories and operational or practical forms of the theories. The first edition of this book, published in 1990, was the first text to provide an in‐depth analysis of various theories of health behavior relevant to health education in a single volume. It brought together dominant health behavior theories, research based on those theories, and examples of health education practice derived from theory that had been tested through evaluation and research. The second (1996), third (2002), fourth (2008), and fifth (2015) editions of this book updated and improved upon the earlier volumes. People around the world are using this book. It has been translated into multiple languages, including, most recently, Japanese, Korean, and Chinese editions.
We are confident that the sixth edition of Health Behavior: Theory, Research, and Practice improves upon on the preceding edition, as each earlier edition has done. The main purpose of the book is the same: to advance the science of understanding health behavior and the practice of health behavior change through the informed application of theories of health behavior. Likewise, this book serves as the definitive text for students, practitioners, and scientists in these areas and education in three ways: by analyzing the key components of health behavior theories, by describing current applications of these theories in selected public health and health promotion programs and interventions, and by identifying important future directions for research and practice in health behavior change.
The sixth edition responds to new developments in health behavior theories and the application of theories in new settings, to new populations, and in new ways. This edition includes an enhanced focus on the application of theories for diverse populations and settings, and there are more chapters written by diverse authors. There is a corresponding integration of issues related to race and ethnicity in multiple chapters and a new chapter (Chapter 14) focused on theories of race and racism. Authors recognize the complexity of race/ethnicity; these are not mere variables. Rather, they are the lenses through which people experience the world. Issues of culture and health inequities are also integrated into many chapters. These issues are of broad and growing importance across many theories and models. We believe that these additions strengthen the book and increase its value for use in settings around the world. The world is more global than ever before, and professionals working on behavior change often will work in multiple countries. We have a heightened commitment to addressing health risks and threats in low‐ and middle‐income countries (LMICs). Thus, more global applications from both developing and developed countries are included.
As new information and communication technologies have opened up an unprecedented range of strategies for health behavior change, this edition integrates expanded coverage of social media and digital health behavior interventions examples throughout the book.
Audiences
This book is written for graduate students, practitioners, and scientists who spend part or all of their time in the broad arenas of health behavior change, public health, health promotion, and health education; the text will assist them both to understand the theories and to apply them in practical settings. Practitioners, as well as students, should find this text a major reference for the development and evaluation of theory‐driven health behavior change programs and interventions. Researchers should emerge with a recognition of areas where empirical support is deficient or inconclusive, helping set the research agenda for health behavior going forward.
This book is intended to assist all professionals who value the need to influence health behavior positively. Their fields include health promotion and education, health communication, medicine, nursing, public health, health psychology, behavioral medicine, health communications, nutrition and dietetics, dentistry, pharmacy, social work, exercise science, clinical psychology, and occupational and physical therapy.
Overview of the Book
The chapters, written expressly for this sixth edition, address theories and models of health behavior at the level of the individual, interpersonal, group, organization, and community and approaches that are integrated across multiple levels.
The book is organized into five parts. Part One defines key terms and concepts and introduces ecological models. The next three parts reflect important units of health behavior and education practice: the individual, the interpersonal or group level, and the community or aggregate level. Each of these parts begins with an introductory chapter to orient readers to the next chapters and their interrelationships, and has several chapters. Part Two covers theories of individual health behavior, and its chapters focus on variables within individuals that influence their health behavior and response to health promotion and education interventions. Three bodies of theory are reviewed in separate chapters: Health Belief Model; Theory of Reasoned Action/Theory of Planned Behavior/Integrated Behavioral Model and the Reasoned Action Approach, and The Transtheoretical Model. Part Three examines interpersonal theories, which emphasize elements in the interpersonal environment that affect individuals' health behavior. Four chapters examine Social Cognitive Theory: social support, social networks; and stress and coping. Part Four covers models for the community or aggregate level of change and includes chapters on race, health, and health equity; community engagement; implementation, dissemination, and diffusion of innovations; and media communications. Part Five explores “Using Theory,” which presents the key components and applications of overarching planning and process models and integrated models and approaches to health behavior change. It includes chapters on theory‐based planning models, behavioral economics, social marketing, and social media (new for this edition).
The major emphasis of this book is on the analysis and application of health behavior theories to public health and health promotion practice. The section introductory chapters in Parts Two, Three, Four and Five introduce the theories in their sections; summarize their potential application to the development of health behavior change interventions; and highlight strengths, weaknesses, gaps and areas for future development and research, and promising strategies. Each core chapter in Parts Two, Three, and Four begins with a discussion of the background of the theory or model and a presentation of the theory; reviews empirical support for it; and concludes with one or two applications.
Chapter authors are established, highly regarded researchers, and practitioners who draw on their experiences in state‐of‐the‐art research to critically analyze and apply the theories to health behavior and education. This text makes otherwise lofty theories accessible and practical, and advances both research and practice in the process.
No single book can be truly comprehensive and still be concise and readable. Decisions about which theories to include were made with both an appreciation of the evolution of the study of health behavior and a vision of its future (see Chapter 2). We emphasize theories and conceptual frameworks that encompass a range from the individual to the societal level. We acknowledge that there is substantial variability in the extent to which various theories and models have been codified, tested, and supported by empirical evidence. Of necessity, some promising emerging theories were not included.
The first five editions of this book grew out of the editors' own experiences, frustrations, and needs as well as their desire to synthesize many literatures and to draw clearly the linkages between theory, research, and practice in health behavior and education. We have sought to show how theory, research, and practice interrelate and to make each accessible and practical. In this sixth edition, we have attempted to respond to changes in the science and practice of public health and health promotion and to update the coverage of these areas in a rapidly evolving field. Substantial efforts have been taken to present findings from health behavior change interventions based on the theories that are described and to illustrate the adaptations needed to successfully reach diverse and unique populations. Through the preceding five editions, Health Behavior: Theory, Research and Practice has become established as a widely used text and reference book.
It is our sincere hope that the sixth edition will continue to be relevant and useful, and to stimulate readers’ interest in theory‐based health behavior and health education. We aspire to provide readers with the information and skills to ask critical questions, think conceptually, and stretch their thinking beyond using formulaic strategies to improve health. Ultimately, we aim to encourage users to use, test, refine, and even develop theories with the goal of improving health for people around the world and to benefit especially those populations that have suffered disproportionately from the conditions that predispose to poor health.
Acknowledgments
We owe deep gratitude to all the authors whose work is included in this book. They worked diligently with us to produce an integrated volume, and we greatly appreciate their willingness to tailor their contributions to realize the vision of the book. Their collective depth of knowledge and experience across the broad range of theories and topics far exceeds the expertise that the editors can claim.
We acknowledge authors who contributed to the first five editions of this book; although some of them did not write chapters for this edition, their intellectual contributions form an important foundation for this volume.
We pay special tribute to Dr. James Prochaska and Dr. Kay Bartholomew, luminaries in our field whose work appeared in earlier editions of this book who passed away since the last edition was published. Their work is an influential foundation for chapters in this edition that were written by their colleagues.
The editorial team at Wiley provided valuable support to us for development, production, and marketing of this edition. We also are grateful to Terra Ziporyn for her exceptional technical editing support for this edition.
The editors are indebted to their colleagues and students who, over the years, have taught them the importance of both health behavior theories and their cogent and precise representation. They have challenged us to stretch, adapt, and continue to learn through our years of work at the University of Michigan, the University of North Carolina (UNC) at Chapel Hill, the University of Pennsylvania (UPenn), Emory University, Harvard University, the University of Minnesota, Ohio State University, Johns Hopkins University, Temple University, Fox Chase Cancer Center, Duke University, the University of Hawai'i, and the National Cancer Institute (NCI).
We thank Daniel Holman and Alisha Suhag from the University of Sheffield (UK), who collaborated on the umbrella review of theory‐behavior change intervention effectiveness that is described in Chapter 2. We also thank members of the Viswanath Lab at Harvard/Dana‐Farber and the Center for Health Behavior Research team at Penn, who respectively made it possible for Vish Viswanath and Karen Glanz to focus on the book while they ensured progress on active projects. Further, completion of this manuscript would not have been possible without the dedicated assistance of Lisa Warren and Ellie Bernstein at UNC, and Claudia Caponi at UPenn.
We also express our thanks to our colleagues, staffs, friends, and families, whose patience, good humor, and encouragement sustained us through our work on this book.
January 2024
Karen Glanz
Philadelphia, Pennsylvania
Barbara K. Rimer
Chapel Hill, North Carolina
K. Viswanath
Boston, Massachusetts
ABOUT THE EDITORS
Karen Glanz is George A. Weiss University Professor, Professor in the Perelman School of Medicine and the School of Nursing, and Director of the UPenn Prevention Research Center and the Center for Health Behavior Research at the University of Pennsylvania. She is Program Co‐Leader of the Cancer Control Program at the Abramson Cancer Center and has been Director of the Community Engagement and Research (CEAR) Core of the UPenn CTSA since 2011.
Glanz is a senior fellow of the Leonard Davis Institute of Health Economics and the Center for Public Health Initiatives, a distinguished fellow of the Annenberg Public Policy Center, and a fellow of the Penn Institute for Urban Research. She was previously at Emory University (2004–2009), the University of Hawaii (1993–2004), and Temple University (1979–1993). She received her MPH (1977) and PhD (1979) degrees in health behavior and health education from the University of Michigan.
A globally influential public health scholar whose work spans psychology, epidemiology, nutrition, and other disciplines, her research in community and healthcare settings focuses on obesity, physical activity, nutrition, and the built environment; cancer prevention and control; chronic disease management and control; reducing health disparities; and implementation science. Her research and publications about understanding, measuring, and improving healthy food environments, beginning in the 1980s, has been widely recognized and replicated. She served on the NHLBI Advisory Council from 2016 to 2021 and was a member of the US Task Force on Community Preventive Services from 2006 to 2016. Her scholarly contributions consist of more than 550 journal articles and book chapters.
Dr. Glanz has been recognized with local and national awards for her work, including being elected to membership in the National Academy of Medicine in 2013. She was elected to be a fellow of the College of Physicians of Philadelphia, named a fellow of the Society for Behavioral Medicine and received the Elizabeth Fries Health Education Award. She was designated a highly cited author by Clarivate (formerly ISI), in the top 0.5% of authors in her field over a 20‐year period, beginning in 2016.
Barbara K. Rimer is Dean Emerita and Alumni Distinguished Professor Emerita of Health Behavior at the University of North Carolina at Chapel Hill Gillings School of Global Public Health. In her 17 years of leading the Gillings School, she was known for her strong commitment to inclusive excellence.
Dr. Rimer received an MPH (1973) from the University of Michigan, with joint majors in health education and medical care organization, and a DrPH (1981) in health education from the Johns Hopkins School of Hygiene and Public Health. Previously, she served as Deputy Director for Population Sciences at UNC Lineberger Comprehensive Cancer Center at UNC‐Chapel Hill (2003‐2005), and as Director of the Division of Cancer Control and Population Sciences at the National Cancer Institute (part of the National Institutes of Health), from 1997 to 2002.
Dr. Rimer has conducted research in several areas, including informed decision‐making, long‐term maintenance of behavior changes (such as diet, cancer screening, and tobacco use), interventions to increase adherence to cancer prevention and early detection, dissemination of evidence‐based interventions, and use of new technologies for information, support, and behavior change.
Dr. Rimer is the author of over 270 peer‐reviewed articles, 55 book chapters, and six books, and serves on several journal editorial boards. She is the recipient of numerous awards and honors; in 2013, she was awarded the American Cancer Society’s Medal of Honor for her cancer research, which has guided national research, practice, and policy for more than 20 years. In 2024, she received the Welch‐Rose Award from the Association of Schools and Programs of Public Health.
Dr. Rimer was the first woman and behavioral scientist to lead the National Cancer Institute’s National Cancer Advisory Board, a presidential appointment. She was elected to the Institute of Medicine (now the National Academy of Medicine) in 2008 and appointed by President Obama to chair the President’s Cancer Panel in 2011, for which served as Chair through 2019.
K. Viswanath is Lee Kum Kee Professor of Health Communication in the Department of Social and Behavioral Sciences at the Harvard T. H. Chan School of Public Health (HSPH) and in the McGraw‐Patterson Center for Population Sciences at the Dana‐Farber Cancer Institute (DFCI). He is also the Director of Lee Kum Sheung Center for Health and Happiness, Harvard Chan, Director of the Center for Translational Communication Science, DFCI, Associate Director for Community Outreach and Engagement, Dana‐Farber/Harvard Cancer Center, and Director, Harvard Chan India Research Center.
Dr. Viswanath’s work is driven by two fundamental concerns: (i) how to center equity in drawing on translational communication science to promote health and well‐being for all population groups and (ii) to involve community‐based organizations and stakeholders in promoting social change. His work has documented the relationship between communication inequalities, poverty and health inequalities, and knowledge translation to address health inequalities. He has written more than 320 journal articles, reviews, commentaries, and book chapters and coedited three books and monographs (in addition to co‐editing two earlier editions of this book): Mass Media, Social Control, and Social Change (Iowa State University Press, 1999), The Role of Media in Promoting and Reducing Tobacco Use (National Cancer Institute, 2008), and A Socioecological Approach to Addressing Tobacco‐Related Health Disparities (National Cancer Institute, 2017). He was the Editor of the Social and Behavioral Research section of the 12‐volume International Encyclopedia of Communication (Blackwell Publishing, 2008).
He served on and chaired several national committees for the US Government and the National Academy of Sciences, Engineering, and Medicine (NASEM) and currently Chairs the NASEM Consensus Study Committee on Understanding and Addressing Misinformation in Science.
In recognition of his academic and professional achievements, Dr. Viswanath received several awards including the Outstanding Health Communication Scholar Award from the International and National Communication Associations, and the Mayhew Derryberry Award from the American Public Health Association for contributions to health education research and theory. He is an elected fellow of the International Communication Association (2011), the Society for Behavioral Medicine (2008), and the Midwest Association for Public Opinion Research (2006).
ABOUT THE CONTRIBUTORS
Zinzi Bailey is an associate professor in the Department of Epidemiology and Community Health at the University of Minnesota School of Public Health.
Sara G. Balestrieri is the director of research at the National Resident Matching Program.
Mesfin A. Bekalu is a program officer at the National Institute of Mental Health at the National Institutes of Health.
Ganga Bey is an assistant professor in the Department of Epidemiology at Gillings School of Global Public Health at the University of North Carolina at Chapel Hill.
Amy Bleakley is a professor in the Department of Communication at the University of Delaware.
Noel T. Brewer is a professor in the Department of Health Behavior at Gillings School of Global Public Health at the University of North Carolina at Chapel Hill.
Tamara J. Cadet is an associate professor in the School of Social Policy and Practice at the University of Pennsylvania.
Jessica L. Cohen is a Beal associate professor in the Department of Global Health and Population at the Harvard T. H. Chan School of Public Health.
Casey Durand was an assistant professor at the University of Texas Health Science Center at Houston.
Shari Esquenazi‐Karonika is a senior program director in the Department of Integrative Health at New York University (NYU) Langone Health.
Kerry E. Evers is the co‐president and CEO of Pro‐Change Behavior Systems, Inc. in Rhode Island.
María E. Fernández is the vice president of Population Health and Implementation Science and Lorne Bain distinguished professor at the University of Texas Health Science Center at Houston.
Sarah E. Gollust is a professor in the Division of Health Policy and Management at the University of Minnesota School of Public Health.
Deanna M. Hoelscher is John P. McGovern professor in health promotion and the director of the Michael and Susan Dell Center for Healthy Living the University of Texas School of Public Health in Austin.
Julianne Holt‐Lunstad is a professor of psychology and neuroscience at Brigham Young University.
Shawnika Hull is an associate professor of communication in the School of Communication and Information at Rutgers University.
Ethan T. Hunt is an assistant professor of health promotion and behavioral sciences at the University of Texas School of Public Health.
Alejandra Jáuregui is the chair of the Department of Physical Activity and Healthy Lifestyles at the Mexican National Institute of Public Health.
Joseph Keaweʻaimoku (Keawe) Kaholokula is a professor and chair of the Department of Native Hawaiian Health at the John A. Burns School of Medicine, University of Hawaiʻi at Mānoa.
Steven H. Kelder is Beth Toby Grossman professor in spirituality and healing and professor of epidemiology, human genetics and environmental sciences at the University of Texas School of Public Health.
Racquel E. Kohler is an assistant professor in the Department of Health Behavior, Society, and Policy at the Rutgers University School of Public Health
Evelyn Kumoji is with the Johns Hopkins Center for Communication Programs.
Dale S. Mantey is an assistant professor of health promotion and behavioral sciences at the University of Texas School of Public Health.
Christine Markham is Alan King professor and chair of the Division of Health Promotion and Behavioral Sciences at the University of Texas School of Public Health.
Patricia Dolan Mullen is a professor of health promotion and behavioral sciences and Distinguished Teaching Professor at the University of Texas School of Public Health.
Rebekah H. Nagler is an associate professor in the Hubbard School of Journalism and Mass Communication at the University of Minnesota.
John G. Oetzel is a professor in the Department of Management Communication in the Waikato Management School at the University of Waikato in New Zealand.
Melissa Peskin is an assistant professor of health promotion and behavioral sciences and epidemiology at the University of Texas School of Public Health.
Sarah E. Piombo is a PhD candidate in the Department of Population and Public Health Sciences at Keck School of Medicine, University of Southern California.
Andrew Scot Proctor is a PhD candidate in social and health psychology at Brigham Young University.
Shoba Ramanadhan is an associate professor of social and behavioral sciences at the Harvard T.H. Chan School of Public Health.
Fred Rariewa is with the sustainability and social enterprise division at the Johns Hopkins Center for Communication Programs.
Serena A. Rodriguez is an assistant professor of health promotion and behavioral sciences at the University of Texas School of Public Health.
Deborah Salvo is an associate professor in the Department of Kinesiology and Health Education in the College of Education at the University of Texas at Austin.
Rachel C. Shelton is an associate professor of sociomedical sciences at the Columbia University Mailman School of Public Health.
Ka‘imi A. Sinclair (deceased) was an associate professor in the College of Nursing at Washington State University.
J. Douglas Storey is a professor emeritus and was director for Communication Science and Research at the Center for Communication Programs, in the Johns Hopkins University Bloomberg School of Public Health.
Celette Sugg Skinner is Parkland Community Medicine professor at the University of Texas Southwestern School of Public Health.
Harsha Thirumurthy is a professor in the Department of Medical Ethics and Health Policy at the University of Pennsylvania, Perelman School of Medicine.
Jasmin A. Tiro is a professor in the Department of Public Health Sciences at University of Chicago Medicine.
Ridvan (Riz) Tupai‐Firestone is an associate professor and associate dean at the Centre for Public Health Research at Massey University in New Zealand.
Thomas W. Valente is a professor of population and public health sciences at the University of Southern California Keck School of Medicine.
Yunita Wahyuningrum (deceased) was a project director at the Center for Communication Programs at the Johns Hopkins University.
Cheryl L. Woods‐Giscombe is Levine Family Distinguished professor in the School of Nursing at the University of North Carolina at Chapel Hill.
ABOUT THE COMPANION WEBSITE
This book is accompanied by a companion website:
www.wiley.com/go/glanz/healthbehavior6e
The website includes:
Test Bank
Power Points
Transition Guide
PART ONEHEALTH BEHAVIOR: THE FOUNDATIONS
CHAPTER 1THE SCOPE OF HEALTH BEHAVIOR
The Editors
In 2020–2022, the world experienced the COVID‐19 pandemic, which brought about the most profound changes globally since the influenza pandemic of 1918–1919. The SARS‐CoV‐2 virus spread across the world. Conservatively, almost 7 million people died, economies sputtered, governments faltered, and inequities were highlighted in searing ways. Quickly, COVID‐19, the disease caused by the virus, became one of the world’s worst killers in multiple countries, with most of those deaths coming from low‐ and middle‐income countries (LMICs). In tragedy, there also was dramatic progress and innovation as vaccines and treatments for COVID‐19 were developed at lightning speed. The pandemic underlined more acutely than any recent event the centrality of health behavior and the threats of health inequities. In the early days of the pandemic (winter/spring 2020), before there were vaccines and treatments, it was necessary to rely on what was learned in 1918 and since—the importance of masks, physical distancing, and good hygiene, such as handwashing. Unfortunately, these proven, common‐sense activities became highly politicized. Some countries, such as South Korea, were remarkably successful in applying interventions to prevent sickness and death early in the pandemic, though the country proved vulnerable in its later stages. Other countries had leaders who distrusted science and waited too long to adopt proven interventions. Millions became infected and died as a result, and the economies in these countries were hard‐hit. Then, a concerning pattern emerged with the adoption of vaccines: while overall vaccine uptake was relatively high, disadvantaged populations often did not get vaccinated due to mistrust and/or lack of access. COVID also drew attention to an emerging infodemic, or spread of information, often false, at a volume and great speed, affecting health behaviors and challenging people’s and systems’ capacities to cope with the pandemic.
The 2020 pandemic is one of the strongest historical cases of why understanding health behavior and applying science‐driven interventions is a matter of life and death. The pandemic also showed that we cannot separate health behaviors from communities and health systems, and that multiple levels of interventions, including policies, are needed to address a deadly viral threat. And it demonstrated that unprepared health systems and communities are not resilient when faced with a pandemic like COVID‐19. To prevent future infectious disease outbreaks on a global scale and improve population health, societal issues, including deeply embedded structural inequities, must be tackled (Lancet Editors, 2020).
There are many other examples to demonstrate why health behavior is so important to health. More than half the top 10 causes of death worldwide are attributed to unhealthy behaviors (World Health Organization, 2023b). 30–50% of cancers are preventable, mostly by behavioral means. With 18 million cancers projected in 2023, changing behavior could save millions of lives globally (Shiels et al., 2023). Infectious and chronic diseases and the factors that drive them—including failure to vaccinate and practice good hygiene, obesity, and physical inactivity, overuse of opioids, and underuse of proven methods to screen and treat diseases when they are early and curable—all contribute to avoidable illness and mortality. Globalization and westernization have accelerated the speed with which diseases of developed countries, such as diabetes and cancers, are increasing in the developing world. Life expectancy is falling for less‐educated groups and is eclipsing racial inequities (Case & Deaton, 2021). In many parts of the world, increasing affluence has made automobile accidents a growing threat. There is growing recognition that health behavior changes are needed across the world if population health is to improve.
Where professionals once might have seen their roles as working at a particular level of intervention (such as changing organizational or individual health behaviors) or employing a specific type of behavior change strategy (such as group interventions or individual counseling), evidence shows that multiple kinds of interventions at different levels often are needed to initiate and sustain behavior change effectively. This is true for tobacco use, physical activity, and obesity. During the pandemic, policy interventions were used to mandate masking and provide special funding and services, such as food assistance, for unemployed and low‐income families. Community interventions were developed for at‐risk groups. Media, pharmacy, and clinical interventions aimed to persuade people to be vaccinated. Environmental approaches, such as wastewater surveillance, were used to understand transmission and provide early warning systems. Any of these alone would have been insufficient to achieve maximal impact. The determinants of health behavior and health are multicomponent and multilevel, and the strategies to improve them are equally complex.
What is Health Behavior?
In the broadest sense, health behavior refers to the actions of individuals, groups, and organizations and the determinants, correlates, and consequences of actions, including social change, policy development and implementation, improved coping skills, and enhanced quality of life (Parkerson et al., 1993). This is aligned with the working definition of health behavior that Gochman proposed, although his definition emphasized individuals: it includes not only observable, overt actions but also the mental events and feeling states that can be reported and measured. Gochman defined health behavior as “those personal attributes such as beliefs, expectations, motives, values, perceptions, and other cognitive elements; personality characteristics, including affective and emotional states and traits; and overt behavior patterns, actions, and habits that relate to health maintenance, to health restoration, and to health improvement” (Gochman, 1982, 1997).
Gochman’s definition is consistent with and embraces the definitions of specific categories of overt health behavior proposed by Kasl and Cobb in their seminal articles. Kasl and Cobb defined three categories of health behavior along a continuum of health and illness: preventive health behavior (primary prevention), illness behavior (disease detection and care‐seeking); and sick‐role behavior (medical treatment, adherence, and self‐care) (Kasl & Cobb, 1966a, b).
Health, Disease, and Health Behavior: Global Needs and Goals
Substantial suffering, premature mortality, and medical costs can be avoided by positive changes in behavior at multiple levels. During the past 30 years, there has been a dramatic increase in public, private, and professional interest and investment in preventing disability and death through changes in lifestyle and increasing participation in screening programs. Much of the interest in disease prevention and early detection was stimulated by the growth of noncommunicable diseases around the world, while injuries and old and emerging infections continue to pose growing threats to health. Risks associated with the highest number of deaths worldwide now include behavioral risk factors such as
