PS370 Unit 2 Health Behavior Theory Paper Example

Why the Captain Still Smokes at Sea: A PS370 Unit 2 Health Behavior Theory Paper

[Student Name]

Purdue University Global

PS370: Health Psychology

Unit 2 Health Behavior Theory Paper

[Instructor Name]

[Date]

The captain, his crew and his family are composite; the theories and studies cited are real.

The Behavior

Paul is a 51-year-old scallop boat captain from New Bedford, Massachusetts, who had a heart attack at sea fourteen months ago and now has a stent in one coronary artery. He started smoking at seventeen and smoked about a pack a day for thirty-three years. In the hospital he promised his cardiologist and his wife, Ana, that he would quit, and on land he largely has. He has not bought a pack at home since the stent was placed. At sea, though, he smokes eight to twelve cigarettes a day, most of them between midnight and dawn while the crew sorts scallops on deck and he keeps watch in the wheelhouse.

Smoking matters more for Paul than for most smokers. People who keep smoking after a heart attack face a substantially higher risk of a second event than those who quit, and quitting is among the most effective steps available to him. This paper applies two health behavior models to his smoking, judges which one predicts his behavior better, and then uses a third framework to identify what might help.

The Health Belief Model

Rosenstock's framework predicts protective action from four judgments: that one could get a condition, that the condition is grave, that acting makes a difference, and that the benefits of acting outweigh its barriers, with a cue to action prompting the move (Rosenstock, 1974). Self-efficacy was added later as a further factor.

Each part fits Paul's decision to quit. His perceived susceptibility changed overnight; before the heart attack he thought his father's early death was bad luck, and afterward he thought it was his own future. Perceived severity was never in doubt after a helicopter ride to Boston. Perceived benefits were explained to him clearly by a cardiac nurse who told him that quitting would do more for his heart than any of his pills. The cue to action was the event itself.

The model also explains the barriers at sea. On a trip, cigarettes keep him awake through four-hour watches, they fill the hours when the boat steams to the grounds, and three of his five crew members smoke. Quitting on the boat would cost him sleep he cannot spare and the one break he takes on long nights. In Health Belief Model terms, the barriers at sea outweigh the benefits even though the threat has not changed.

The Health Belief Model explains why Paul decided to quit, but not why the same man with the same beliefs keeps smoking every night on the boat.

That is the model's limit.

The gap is not a matter of knowledge. Paul's beliefs about his heart are identical on land and at sea. The model treats behavior as the result of a weighing of beliefs, and it has little to say about habit, nicotine dependence or the setting in which a choice is made.

The Stages of Change

The transtheoretical model, developed from studies of people who quit smoking on their own, describes five stages a quitter moves through, beginning with precontemplation, when no change is intended, and ending with maintenance, when a new pattern has held for months (Prochaska & DiClemente, 1983). People use different processes of change in different stages, such as consciousness raising early and stimulus control and reinforcement later.

Paul's history fits the stages better than a single decision. Before his heart attack he was in precontemplation; he knew smoking was harmful and had no plan to stop. The heart attack moved him straight to action on land, without the preparation stage in which most successful quitters plan for triggers. He had no nicotine replacement, no plan for the boat and no conversation with his crew. On his first trip back, he smoked on the second night.

The model's processes of change explain the difference between settings. At home, Ana removed ashtrays and his brother-in-law, also a former smoker, checked on him, which provided stimulus control and helping relationships. On the boat, cigarettes were in reach, the cues of night watch were unchanged and the only people around were smoking. Paul's own description is that he quit at home and never started quitting at sea. In stage terms, he is in maintenance in one setting and has slipped back to contemplation in another.

Which Model Predicts Better

The transtheoretical model predicts Paul's behavior better because it treats change as a process that can be uneven and setting-specific. The Health Belief Model would have predicted that a man who believes he is at high risk of a fatal event would quit everywhere. The stages model would have predicted that someone who skipped preparation would relapse where his triggers were strongest, which is what happened.

Both models have weaknesses. The stages are partly arbitrary divisions of a continuous process, and research matching interventions to stages has produced mixed results. The Health Belief Model is useful for explaining why people start trying but is weaker at predicting whether they succeed. Neither model describes the specific ingredients that would help Paul quit at sea.

Choosing Techniques With the Behavior Change Wheel

Michie et al. (2011) proposed the behavior change wheel to link an analysis of behavior to the kinds of intervention most likely to change it. At its center is the COM-B model: behavior depends on capability, opportunity and motivation. Interventions are chosen to address whichever of the three is lacking.

Paul's motivation is strong. His capability is limited by nicotine dependence; he has never tried to quit with medication and gets intense cravings on the second and third nights at sea. His opportunity is the bigger problem: physical opportunity, with cigarettes on board, and social opportunity, with three crew members smoking around him.

Several techniques follow from that analysis. A plan made before each trip would add the preparation stage he skipped, naming the times he expects cravings and what he will do instead. Nicotine replacement, such as a patch combined with gum or lozenges for night watches, would address capability; combining two forms is more effective than one. Changing the environment, by not packing cigarettes and asking the crew to smoke on the stern rather than in the wheelhouse, addresses physical and social opportunity. Self-monitoring, with a simple count of cigarettes per trip, would let him see progress. His cardiac rehabilitation program can arrange the medication through his cardiologist and check in by phone between trips.

Conclusion

Paul's smoking shows the value and limits of health behavior models. The Health Belief Model explains why he wanted to quit. The stages of change explain why he quit in one setting and not another. The behavior change wheel turns that analysis into techniques, from a trip plan to combination nicotine replacement to a smoke-free wheelhouse. For a man with a stent and a family history like his, the gap between land and sea is the most important health problem he has left.

References

Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, Article 42. https://doi.org/10.1186/1748-5908-6-42

Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390-395. https://doi.org/10.1037/0022-006X.51.3.390

Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education Monographs, 2(4), 328-335. https://doi.org/10.1177/109019817400200403