Individual factors in changing health beliefs — practice questions

(a) Stage and LOC:

• Colleague X: Contemplation stage — recognises problem but lacks confidence to act. External LOC tendency — "always fail" suggests outcome feels beyond personal control.
• Colleague Y: Precontemplation stage — does not intend to change; minimises problem. External/social LOC — social drinking controlled by team norms, not personal choice.

(b) Self-efficacy (Colleague X):

• X has low self-efficacy from repeated failed mastery experiences — past quit attempts reinforce belief that change is impossible.
• Bandura — without successful past experience or credible model, self-efficacy remains low despite recognising health risk.
• Verbal persuasion (leaflet alone) is the weakest source of self-efficacy — insufficient without supported behaviour attempt.

(c) Stage-matched interventions:

• Colleague X (contemplation): Motivational interviewing — explore ambivalence, build self-efficacy through small achievable goals (e.g. two alcohol-free days). Provide vicarious learning — colleague testimonials. Set preparation plan with specific dates.
• Colleague Y (precontemplation): Consciousness-raising — personalised feedback (audit score showing units consumed). Highlight subjective norms — not everyone drinks heavily. Avoid confrontation; decisional balance exercise weighing pros/cons. Do not push action-stage strategies (will fail).

(d) Evaluation of Stages of Change Model:

• Strengths:
  • Tailored interventions — prevents wasting resources on precontemplators with action-stage programmes.
  • Relapse normalised — not failure but part of spiral model; reduces dropout guilt.
  • Supported by Prochaska et al. meta-analyses — stage-matched interventions outperform mismatched.
  • Integrates with HBM (contemplation = weighing benefits/barriers) and TPB (preparation = forming intention).
• Limitations:
  • Stages may not be discrete — people oscillate between stages; model oversimplifies continuous process.
  • Difficult to classify — X and Y may shift stages within weeks.
  • Individual focus — ignores social and environmental barriers (workplace drinking culture).
  • Western bias — assumes autonomous individual decision-maker; less applicable in collectivist cultures.
  • Arbitrary time boundaries — no clear criteria for stage transition.

Judgement: Valuable practical framework for clinicians and health promoters, but should be combined with HBM/TPB and settings approach (3.5.2) for comprehensive intervention design.

(a) Percentage Reduction Calculation:

Formula: ((Initial Value - Final Value) / Initial Value) * 100%

• Participant A:

  • Initial = 20 cigarettes/day
  • Final = 18 cigarettes/day
  • Reduction = ((20 - 18) / 20) * 100%
  • Reduction = (2 / 20) * 100%
  • Percentage Reduction = 10%

• Participant B:

  • Initial = 15 cigarettes/day
  • Final = 5 cigarettes/day
  • Reduction = ((15 - 5) / 15) * 100%
  • Reduction = (10 / 15) * 100%
  • Percentage Reduction = 66.7% (or 67%)

(b) Explanation of Outcomes:

The significant difference in outcomes can be explained by the individual factors of locus of control and self-efficacy.

• Participant B (Successful Reduction):

  • High Internal Locus of Control (Score: 8/10): Participant B likely believes that their health outcomes are a direct result of their own actions. This internal LoC would motivate them to actively engage in the cessation programme, take responsibility for their behaviour, and persist despite difficulties.
  • High Self-Efficacy (Score: 18/25): According to Bandura, this high score indicates a strong belief in their own capability to quit smoking. This confidence would make them more likely to set challenging goals, put in effort, and view setbacks as temporary. The combination of believing change is within their control (LoC) and believing they have the skills to execute that change (self-efficacy) is a powerful predictor of success, as seen in their 66.7% reduction.

• Participant A (Limited Reduction):

  • External Locus of Control (Score: 3/10): Participant A has a more external LoC, suggesting they may believe quitting is down to luck, fate, or the power of the addiction itself, rather than their own efforts. This can lead to passivity and a lower level of engagement with the programme.
  • Low Self-Efficacy (Score: 10/25): This low score indicates a lack of confidence in their ability to stop smoking. They may have had past failures (poor mastery experiences) which reinforce this belief. When faced with cravings, they are more likely to give in, believing they don't have what it takes to succeed. The minimal 10% reduction is consistent with someone who lacks both the belief that their actions matter (LoC) and the confidence to perform the necessary actions (self-efficacy).