Table 1.
Key elements of the common and important health behavior concepts
| Key developer or health behavior concepts | Key elements |
|---|---|
| Gonzalez et al99 | Diabetes self-management behaviors may be influenced by three psychosocial domains: 1. Knowledge, beliefs and related cognitive constructs 2. Emotional distress and well-being 3. Behavioral skills and coping Socioeconomic status, cultural beliefs and norms are important context for the above patient-level constructs |
| Empowerment100 | Empowerment is seen as a goal and as a means (process, method, approach) that consists of or leads to an increase in the: 1. Control of an individual’s (or community’s) own health 2. Ability to control their life 3. Ability to change the world Empowerment as a goal requires knowledge, consciousness raising, skills development, self-esteem, self-confidence or self-efficacy, ability, autonomy and freedom. The idea that empowerment is an approach suggests that the individual or group should take responsibility themselves for the change process, instead of relying on health care professionals |
| Mindfulness101 | Mindfulness involves intentionally bringing one’s attention to the internal (such as bodily sensations, thoughts and emotions) and external (such as sights, smells and sounds) experiences at the present moment with an attitude of nonjudgmental acceptance (not evaluated as good or bad, true or false, healthy or sick, important or trivial). It aims to detach or decenter one’s thoughts, including statements such as “thoughts are not facts” and “I am not my thoughts.” This decentered approach is also applied to emotions and bodily sensations |
| Self-Determination Theory (autonomy)102 | The theory posits that internalization of motivations (or self-regulation) is an active activity and it occurs to satisfy three innate needs: 1. Autonomy (free will and self-rule) 2. Competence (self-efficacy) 3. Relatedness (secure and supportive interpersonal relationships) Satisfaction of these psychological needs is necessary for successful integration (development), psychological and physical health and well-being |
| Theory of Planned Behavior103 | The theory of planned behavior is an extension of the theory of reasoned action. It emphasizes cognitive processing of information and decision making in goal-directed health behaviors. Affect and emotions serve as background factors that influence intentions and behaviors. Performance of a behavior is a joint function of: 1. Intention to perform a given behavior. Determinants of intentions: • Attitude toward the behavior • Subjective norm-perceived social pressure to perform or not to perform the behavior • Perceived ease or difficulty of performing the behavior – willpower 2. Salient information or beliefs relevant to the behavior: • Behavioral beliefs • Normative beliefs • Control beliefs |
| Moser et al104 | Self-management processes in people with T2DM: 1. Off-course (short term) – in facing with health problems caused by diabetes, becoming aware, reasoning, deciding, acting and evaluating 2. Daily activities (long term) – adhering, adapting and acting routinely 3. Preventive (long term) – experiencing, learning, being cautious and putting into practice Self-management is deeply embedded in one’s unique life situation; it is perceived as an important dimension of personal autonomy which requires competency. These processes are interwoven, recurring and complex. Support from health care providers and family caregivers is necessary |
| Lorig and Holman41 | Self-management behavior of five core skills: 1. Problem solving 2. Decision making 3. Resource utilization 4. Patient–health care provider partnership 5. Taking action |
| Corbin and Strauss105 | Self-management framework of three tasks: 1. Medical management – adhering to medication and recommended lifestyle change 2. Behavioral/role management – changes in social roles or routines as an adaptation to illness 3. Emotional management |
| Social Cognitive Theory (previously known as Social Learning Theory)106 | Behavior is determined by expectancies and incentives. Expectancies consist of: 1. Expectancies about environmental cues (beliefs about how events are connected – about what leads to what) 2. Outcome expectation 3. Efficacy expectation (self-efficacy) Incentive or reinforcement is defined as the value of a particular object or outcome. Behavior is also regulated by the (possible) consequences Cognitive behavioral therapy applies the principles of social cognitive theory in changing human behaviors. Directive and action-oriented approaches are used to help a person to become aware of own dysfunctional thoughts and actions. Strategies such as self-monitoring, problem solving, goal setting, contingency management, cognitive restructuring, social support, stimulus control, stress management and relapse prevention are skills that are taught to the participants |
| Health Belief Model106,107 | Health behavior depends on simultaneous occurrence of three factors: 1. Sufficient motivation 2. Perceived threat 3. Perceived benefit and perceived barriers in following health recommendation |
| Protection Motivation Theory and Self-efficacy Theory108 | A possible general model of attitude change. The probability of a threat’s occurrence (fear appeal) initiates cognitive appraisal of its severity and believing in possession of an effective coping response (self-efficacy expectancy); both have positive effects on attitudes and intentions to adopt a recommended preventive health behavior. Four basic components: 1. Outcome expectancy – current behavior 2. Outcome expectancy – alternative behavior 3. Self-efficacy (for the alternative behavior) 4. The relative value of the different sets of outcomes Two decision-making strategies that people use when confronted with a fear appeal: 1. A precaution strategy (a response is not necessary) 2. A hyperdefensiveness strategy (the danger cannot be avoided) A shift to positive emphasis/outcomes was argued to be possible with little modification of the basic components of the theory |
Abbreviation: T2DM, type 2 diabetes mellitus.