Theories about changes in health behaviour tend to look at:
Cognition: the way people define and think about what they do and how they change their minds in ways that can lead to changing the ways they act; and
Context: the cultural, social, physical, emotional and psychological environments that shape people and the factors that can facilitate change. No one theory can sum up all the factors in health behaviour, but theories can be used to focus on particular aspects of behaviour and to choose the most appropriate programmes for cancer control.
Behaviour: what people do
Behaviour' is the general term covering all the physical acts performed by individuals. Examples of physical acts include walking, interacting with others, writing, reading and preparing to learn. Behaviour includes seeking or not seeking advice for health care and following or not following a prescribed medical regimen. It includes relationships with tobacco, food, alcohol and so on.
Cognition: what and how
Cognition' is the term given to all the mental processes of an individual and includes not only aspects of thinking, such as knowledge, attitudes, motives, attributions and beliefs, but also perceptions, personal values, perceived cultural truths and memory. Cognition can be influenced by intelligence and past experience. Examples are religious convictions, wanting to be a good parent, distrusting modern medicine, knowing that smoking is dangerous for others but believing that it is not dangerous for one's own health, and so on.
Context: the setting of
behaviour and cognition
Context' is a general term that is more inclusive than the general perception of the environment. It includes not only the social, cultural and physical environment but also interpersonal influences on behaviour and the emotional and psychological contexts of each act and cognition. These include laws, norms (socially defined and accepted cognition and behaviour) and social dynamics. Much healthy behaviour is not practised simply because, for instance, it is not defined as necessary by the community (e.g. skin protection), the appropriate choice is not available (e.g. healthy eating at work or school), other forces push society towards an unhealthy alternative (E.g. the tobacco industry) or an unhealthy behaviour is reinforced by contingencies (e.g. pressures of time that reinforce driving rather than walking). These three dimensions may interact in various ways.
cognition and behaviour
The clearest evidence that cognition leads to new behaviour is the development of skills through formal and informal education. Cognition such as beliefs and attitudes can be translated into action if a change is perceived to be possible, if there is no opposition to or difficulty in performing the action or if the cognition is a central component of the person's teleological system, such as religious beliefs. Cognition that is forged from past experience often influences behaviour. For example, a patient who has been successfully treated in the past is likely to return for care when a new illness appears. Cognitive theories of behaviour attempt to predict what people will do in certain circumstances. The challenge is in identifying which cognition is most salient and the degree to which it can predict change. Many people know that they should exercise and eat a healthy diet, and they form an intention: they decide that they will begin to exercise regularly and limit their intake of sweets and fats. If a large proportion of people with this intention do indeed perform these behavioural changes, intention is a good predictor. In many cases, however, behaviour can change thought patterns. In the case of exercise and diet, a person can desire to be healthy but stop working in this direction when he or she finds it difficult to make time to exercise and makes...