Multiple choice, true/false, fill-in the blank [1 point each; please highlight AND bold the correct answer]

Multiple choice, true/false, fill-in the blank [1 point each; please highlight AND bold the correct answer]

1. A randomized intervention in Zimbabwe to promote regular condom use found both the intervention and the control groups reported similar decreases in unprotected sex. An evaluation based on the Integrated Behavior Model concluded:

a. The intervention group shared information with the control group, accounting for the similar outcomes

b. Behavioral, normative, and efficacy beliefs were not correlated with behavioral intention

c. The intervention was effective in changing the beliefs and intentions in the intervention group to a greater degree than in the control group

d. Observed changes were likely due to factors outside of the intervention, such as condom availability

e. The effectiveness of the intervention could not have been improved

2. One challenge to using the TTM for an intervention is:

a. It is only effective for drug and alcohol cessation and physical activity interventions

b. There are no applied studies, only theoretical studies, demonstrating effectiveness

c. It may be difficult to recruit individuals who are in the precontemplation stage

d. It is inappropriate with low-literacy populations

e. It requires that people in different stages of change receive the same intervention, which may be inappropriate for participants

3. Retention is notoriously difficult in behavior change programs. Which strategy helps increase retention?

a. Incentives to join the program

b. Carefully match tailored intervention to stage of change

c. Only enroll participants in the action stage

d. Require participants sign a contract to complete the entire program as part of their informed consent

e. Integrate additional Stages of Change models such as the Precaution Adoption Process Model

4. Reliance on commitments, conditioning, environmental controls, and support is most likely to happen among people in which stages of the TTM?

a. Precontemplation and contemplation

b. Action and maintenance

c. Consciousness raising and self-reevaluation

d. Decisional balance and self-efficacy

e. Temptation and termination

5. The Precaution Adoption Process Model (PAPM) was originally developed to explain the process by which people adopted precautions to detect carbon monoxide in their homes.

a. True

b. False

6. An individual who smoked for twenty years completed a smoking cessation program and reports not smoking for twelve months. She is in the maintenance stage.

a. True

b. False

7. Normative beliefs refer to whether important referent individuals approve or disapprove of performing the behavior.

a. True

b. False

8. The Theory of Reasoned Action and the Theory of Planned behavior both posit that demographic and environmental characteristics independently contribute to behaviors.

a. True

b. False

9. One benefit of the Transtheoretical Model is that effective intervention strategies are the same for individuals at different stages of the model.

a. True

b. False

10. The influence of a smoker’s partner in a smoking cessation intervention would likely be considered which construct of the Theory of Reasoned Action?

Construct: Subjective Norm

Short answer: [10 points, 5 points each]

Select One (either Question 11 or Question 12)

11. What is the one construct that HBM, EPPM, PMT and IBM have in common? Why do you think that all of these models contain this one construct? Do you think that adding this construct to these models improves the models’ effectiveness to explain/predict behavior? Why?

The HBM, EPPM, PMT, and IBM all have the common construct which is Self-efficacy. Self-efficacy definition is a confidence in one’s ability to make a behavior change. This construct reflects the degree of confidence individuals have in maintaining their desired behavior change in situations that often trigger relapse. It is also measured by the degree to which individuals want to return to their problem behavior in high-risk situations. Yes, I think adding this construct to these models will improve the model’s effectiveness to explain and predict the behavior because it is playing an important role in lifestyle changing decisions within some components such as motivation and achievement.


12. The PAMP was initially used to screen for environmental health issues. What other types of health behaviors have been attempted to be changed using the PAPM as a framework? Is this model effective?

PAPM model is also used to examine predictors of osteoprotective behavior in epilepsy. It can also be used to examine disaster-preparedness interventions among low-income people. The model is effective because it conceptualizes behavior as dynamic and occurring over time.

13. [Must complete] From a public health perspective, we know that we can reach the most people with policy-level changes. Some may even dismiss the use of individual-level models/theories in health promotion activities. Describe at least two merits of individual-level models/theories and explain why these models/theories still have a place in the field of public health promotion today. Provide evidence to support your claims.

Individual-level theories are important since they appeal to people’s need for autonomy or self-determination to improve their health while living their own lives the way they desire. In addition, people have needs that are unique to them. Unlike theories that are used at the policy levels, individual-level theories are applied to meet the distinct health needs for each person (DiClemente, Crosby & Kegler, 2009).  Most importantly, individual-level theories are often versatile and dynamic because they can be applied to numerous life contexts and in addressing many types of health problems.

Applied Exercise: [25 points]

14. You work at a local non-profit organization aimed at reducing cardiovascular disease among women living in the three poorest zip codes of your city. Your current funding is running out and if you don’t successfully design a fundable program, you will likely lose your job! The funding agency has put out a request for proposals (RFP) for up to $150,000 per year for three years. If you get this grant, you will get to keep your job for three years. You meet with your supervisor and she ask you to draft up a proposal using the Transtheoretical Model as the theoretical foundation of the programming that will be proposed.

a. Please design the questionnaire that will be used to “sort” people into the various stages of the model.


Questions Answer
1. Do you plan to change your behaviors in the next six months? Yes/ No
2. Do you have the self-drive to pursue health-seeking behaviors? Yes/ No
3. How do you perceive yourself in the coming twelve months?
4. What actions have you already taken to achieve this goal
5. What is your annual income?

a- Less than 10,000

b- 10,000 to 50,000

c- 50,000 to 80,000

d- More than 80,000

b. Briefly describe the components of each stage of your intervention, as it relates to cardiovascular disease among women of low socioeconomic status.

Each stage of the intervention had its components. For instance, at the pre-contemplation phase, subjects were not involved in physical exercises and did not plan to start in the next six months. In the contemplation stage, participants were not engaged in physical activities but planned to begin it in the next six months. In the preparation phase, the participants were exercising, but not on regular basis. In the action phase, subjects exercised on a regular basis but for only less than six months. Finally, the maintenance phase involved subjects a exercising on a regular basis for more than six months.

c. What format will you use to deliver your intervention? Face-to-face? Social media? Computer-based online learning module? Text-messaging? Or other? Why did you select this method for program delivery?

The main channel of communication that I would use is text messaging. This is because nearly all participants own mobile phones. Therefore, they can be reminded every morning to join behavior change programs against cardiovascular diseases. Although social media and computer-based channels are effective, not all participants have access to the internet due to their differences in socioeconomic statuses and age. However, more than 90 percent of participants own mobile phones. Therefore, text messages are most likely to have a wider outreach.

d. What is your strategy for reaching members of the target population and getting them to participate in your program?

There are various methods that will be employed to reach out to target population and encourage them to participate in the program. First, advocacy campaigns will be launched. Opinion leaders will be approached to persuade their followers to embrace this health program(Edberg, 2010). In addition, a participative and collaborative approach will be used that will make the participants feel as though they are part of the program. This will convince them to take part (Edberg, 2010). Finally, communication campaigns will be launched using channels such as social media, road shows, and social marketing to increase the number of participants.

e. How would you measure the success of your program?

The main method that will be used to examine the success of the program is outcome

evaluation. Outcome assessment seeks to examine the impacts of the program with respect to the degree to which the objectives have been met. This will require using certain metrics or indicators of success (Brownson, Deshpande & Gillespie, 2017). One of the most important metrics will be body mass index (BMI). The degree to which BMIs of the target population decrease in comparison with their initial levels prior to joining the program will be an important indicator of success.


Brownson, R. C., Deshpande, A. D., & Gillespie, K. N. (2017). Evidence-based public health.

Oxford: Oxford university press.

DiClemente, R. J., Crosby, R. A., & Kegler, M. C. (Eds.). (2009). Emerging theories in health

promotion practice and research. New Jersey: John Wiley & Sons.

Edberg, M. C. (2010). Essential readings in health behavior: Theory and practice. Burlington:

Jones & Bartlett Learning.

Bandura, A. (1995). Self-efficacy in changing societies, NY; Cambridge University Press.

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