How can risk behavior be prevented

Health behavior, illness behavior, health behavior

Health behavior

Health behavior is understood to mean all behaviors of healthy people that, according to scientific (epidemiological) findings, increase the likelihood that diseases will be avoided or health will be preserved (Faltermaier, 2017). The term is therefore often used as the opposite of risk behavior, which includes all behaviors or habits that have been scientifically proven to increase the likelihood of developing a specific disease.

Today we have relatively good knowledge about these behavior-related risk factors: In addition to the somatic (e.g. high cholesterol, high blood pressure) and psychosocial risk factors and risk factor model (e.g. stress, risky personality traits), they play an important role in explaining serious and chronic illnesses (e.g. coronary heart disease, diabetes, cancer). Risk behaviors such as B. Smoking, excessive alcohol consumption, lack of exercise, high-fat and high-calorie diet, excessive sunbathing or risky sexual behavior (risk factors and risk factor model).

Conversely, experts classify behaviors as health behaviors that avoid these risky habits, e.g. B. adequate exercise or sport, a balanced diet, adequate sleep, "safer sex" or the use of preventive and early diagnosis examinations. However, it is much more difficult to empirically prove which behaviors, to what extent and for what duration, can maintain health. Statistically speaking, multiple risk behavior increases the risk of developing a disease; conversely, several health behaviors can be combined into a healthy lifestyle (lifestyle / lifestyle). Better health or lower disease and mortality rates can then be proven empirically.

Disease behavior

Illness behavior comprises the behavior of people who are already aware of symptoms of an illness and who make an effort to clarify them, make a diagnosis and obtain suitable treatment (Faltermaier, 2017). It can be about attempts to understand the meaning of complaints z. B. to assess by communicating with others, to get information about the illness, to understand an illness and its consequences, to find social support and help in one's social environment or to seek professional help (doctors, advice centers).

Disease behavior can be distinguished from Role behavior ("Sick role behavior"), which describes the behavior of people who have already received a medical diagnosis of an illness and have therefore usually assumed the role of a patient or are perceived as such (Faltermaier, 2017). This includes all efforts to receive suitable treatment and to prevent the progression of an illness, social interaction and cooperation ("compliance" = adherence to therapy / following medical instructions) with treating experts as well as dealing with treatment measures (e.g. surgery or chemotherapy) and its consequences.

Health action

Health action is understood to be the subjectively meaningful action of healthy or sick people that occurs more or less consciously with the aim of maintaining health and in an everyday social context (Faltermaier, 2017). The construct was introduced by Faltermaier (1994) in a critical departure from the concept of health behavior, in order to counter the normative requirement of a limited behavior, defined only by experts, with a subject-oriented concept that assumes that medical laypeople are also competent to act. Health action is a sociological construct and is seen in the context of salutogenesis (salutogenesis) and its health-disease continuum; There is therefore no need to clearly classify people as healthy or sick, but can assume a health motive for all people.

Health acting is based on that Health awareness (Health Literacy / Health Competence), i.e. on the everyday knowledge of people or social groups and their everyday ideas of health and illness (Subjective Health: Everyday Concepts of Health) (Faltermaier, 2005). Depending on the subjective point of view, health action can combine several levels of behavior (exercise, nutrition, dealing with perceived risks and stresses, building and maintaining personal and social resources) and combine them into a healthy lifestyle; however, it follows a subjective logic and therefore does not have to be in line with expert knowledge. Depending on the social context and the phase of life, health actions can change and manifest differently.

Importance for health promotion

For health promotion, the reference to health and illness behavior or health actions means that people can significantly influence their health through their everyday behavior and lifestyles as well as their changes and that professionals can support them in a variety of ways: It can be about dismantling a specific risk behavior (e.g. smoking), the development of a health behavior (e.g. an exercise behavior), the support of an illness behavior (e.g. better compliance in a diabetic patient), but also the Further development of health behavior or a healthy lifestyle among target groups or individuals.

As a basis for these professional measures of prevention and health promotion, scientific knowledge about the conditions of health and illness behavior and the possibilities of their change are to be used (cf. Kohlmann, Salewski, & Wirtz, 2018). These conditions include people's motivation, their subjective beliefs and their social framework (health literacy / health literacy, subjective health: everyday concepts of health, social inequality and health / illness).

Extensive research on the Conditions of health behavior were carried out in health psychology and led to empirically founded models; medical psychology is more concerned with disease behavior (cf. Bengel, & Jerusalem, 2009). Relevant research and practical approaches can also be found in medical sociology, social medicine and public health. While psychological disciplines or behavioral medicine traditionally work more with the concept of behavior, the concept of health action is more firmly anchored in the tradition of social and subject-scientific health research.

Models of health behavior

Models of health behavior try to explain health behavior through cognitive, social and socio-demographic factors (explanatory and change models I: Attitude and behavior changes) (see Faltermaier, 2017). This tradition began in the 1970s with the “Health Belief Model” (HBM) (Faltermaier, 2017; Schwarzer, 2004), in which specific health beliefs (perceived risks, perceived benefits and costs of behavior) were formulated in order to describe health-related behaviors such as B. to explain the use of preventive medical examinations.

In criticism of the limited predictive power of these early models, new models emerged that were empirically better tested and conceptually more convincing due to their procedural relationships (see for an overview: Faltermaier, 2017; Schwarzer, 2004). Internationally well-known models today include the “Health Action Process Approach” model (HAPA) by the German health psychologist Schwarzer (2004) and the “Transtheoretical Model” (TTM) by the American psychologist Prochaska (1997).

These models usually distinguish between intentional and volitional processes as the central cognitive conditions of the actually realized health behavior. Whether a person intends (intention) trains them to change their behavior requires that they also perceive themselves as vulnerable (Risk perception) that she expects a positive effect on her own health (Expectation of results or conviction of control) and that she is convinced that she can implement the health behavior permanently (Competency or self-efficacy belief).

However, the formation of an intention alone is not enough for a change in behavior, rather it must be in the Volition (“Will”) the implementation of the behavioral goals are specifically planned and controlled, d. H. they have to be shielded from obstacles and resistance and their results have to be evaluated. In addition to cognitive processes, there are also social influences (normative beliefs and social support for health behavior in one's own reference group) and socio-structural factors (Gender, age, social status) effective (Faltermaier, 2017; Schwarzer, 2004); this indicates that specific forms of health behavior are embedded in social contexts and are built up over the long term through processes of socialization.

In addition to the perception of physical complaints and the creation of a "Lay diagnosis" in particular dealing with the disease in the lay health system (self-treatment, self-medication, seeking help) and in the professional system. Extensive research deals with attempts to cope with disease-related burdens (coping research, stress and stress management), the conditions for the use of and cooperation with professional services (compliance research) as well as the subjective ideas of illnesses of patients who deal with their own The disease and with the treating experts.

Health promotion and lay health system

It is increasingly recognized today that these processes of health and disease behavior to a large extent in "Lay health system" (“Lay health care system”) (see Faltermaier, 1994; 2017). Many preventive and illness-related activities are socially coordinated and organized, socially supported or inhibited - before, simultaneously and after contact with the professional system. Therefore, professional efforts in prevention and health promotion should ensure that they first perceive, explore and respect the individual and social health actions of target groups before professional interventions and thus interventions in the everyday life of healthy or sick people are undertaken.

The subject orientation in the social and health sciences is based on the competence and own logic of action of “laypeople” in all health issues and understands them as socially integrated processes. The subject perspective thus represents the basis for the participation required in health promotion: codecision of the citizens and for the processes of empowerment / enabling of target groups. Salutogenesis tends to remove the separation between health and disease processes and focuses health action by more or more less healthy or sick people based on their subjective and social conditions.

Literature:

Faltermaier, T. (1994). Health awareness and health action: About dealing with health in everyday life. Weinheim: Beltz.
Faltermaier, T. (2017). Health psychology. 2., revised and expanded edition, Stuttgart: Kohlhammer.
Prochaska, J. O., & Velicer W. F. (1997). The transtheoretical model of health behavior change. In: American Journal of Health Promotion 12, 1997, pp. 38-48.
Schwarzer, R. (2004). Health Behavior Psychology: Introduction to Health Psychology. Göttingen: Hogrefe.

Further sources:

Bengel, J., & Jerusalem, M. (Eds.) (2009). Handbook of Health Psychology and Medical Psychology. Göttingen: Hogrefe.
Faltermaier, T. (2005). Subjective concepts and theories of health and disease. In R. Schwarzer (ed.). Health psychology (Pp. 31-53). Göttingen: Hogrefe.
Kohlmann, C.-W., Salewski, C., & Wirtz, M.A. (Ed.) (2018). Health Promotion Psychology. Göttingen: Hogrefe.

References:

Empowerment / qualification, explanatory and change models I: Attitude and behavior changes, health-disease continuum, health literacy / health literacy, lifestyles / lifestyles, participation: co-decision of citizens, risk factors and risk factor model, salutogenesis, social inequality and health / illness , Stress and Stress Management, Subjective Health: Everyday Concepts of Health