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There is 2 part this Assignment and I downloaded my 3 week paper 
Assignment 9 details:
Please refer back to the personal health behavior you wanted to change earlier in the semester (In Week 3) and answer the following questions, which apply the concepts of behavioral economics to your selected personal health behavior:

What are TWO decision errors that may prevent people from adopting your selected personal health behavior? Please list the types of decision errors (present-based preferences, loss aversion, etc.) and then specify the ways in which these decision errors may be applied to your selected health behavior.
How can we apply these decision errors to an intervention to change the selected health behavior?

Please summarize your responses in a 1 page double spaced typed paper using 12-pt. Arial or Times Roman font.
Assignment 9 deadline: Sunday by 11:59 pm EDT
Grading Rubric for Individual Assignment: 
Participation Individual Assignment Grading Rubric-1.pdf

Assignment 10 details:
Please refer back to the personal health behavior you wanted to change earlier in the semester (In Week 3) and answer the following questions, which apply the concepts of patient and consumer activation and patient communication to your selected personal health behavior:
Assignment 10_Patient and Consumer Activation and Patient Communication.docx
Patient Activation Measure Tool:
Assignment 10_PAM.pdf

Personal Behavior Change

Personal Behavior Change
PUBH-520
Dr. Michael Reger
Group 4: Lara Roelofs, Jaipal Hooda, Maria Gonzalez

Personal Behavior Change
One of the personal health behaviors that we would aim to change in a rural population is alcohol dependency. Alcohol use has become a significant health behavior that has serious implications if not managed. Many people find it difficult to stop this behavior because it has become a way of forgetting their problems. From a personal standpoint, one of our members has had a previous experience with this issue and can provide insight into effecting personal behavior change. Effective health behavior intervention strategies rely on a theoretical foundation that combines social and behavioral theories and integrates the various levels of influence. Lastly, effective intervention strategies must take an ecological approach that considers how several factors, relationships, and environments have an impact (Hagger et al., 2020).
Successful behavior change involves incorporating the various levels of influence within an ecological framework such as the intrapersonal level. The intrapersonal level considers the “individual characteristics that influence behavior” (Hagger et al., 2020, p.11). To change alcohol dependence behavior at the intrapersonal level will involve understanding and changing the individual attitudes, beliefs, and knowledge about alcohol use. An intervention strategy that could be used is using education sessions that target children, young adults, and adults. This can involve conversations with children and young adults in school settings, as well as adults in public settings like libraries or churches within the rural populations. The focus of these conversations will be the detrimental effects of alcohol and techniques to decrease alcohol dependency such as self-discipline. For example, it is important to practice avoidance techniques that decrease the temptation to drink. It is also important to ensure that feelings that increase the urge to consume alcohol be controlled.
At the interpersonal level, it is important to combine forces with other healthcare professionals to provide education about the dangers of alcohol misuse. This can be based on offering insights, experiences, and life events. Because the interpersonal level is focused on the relationships and connections, our intervention strategy should be focused on the social networks that can influence alcohol use. An intervention strategy that could be used is providing education in community settings like churches about signs of alcohol dependency and concrete strategies to address it. This would provide family members and friends the tools to recognize alcoholism in their loved ones and methods to connect them to help.
In a rural setting, behavioral change will also involve understanding the socioeconomic and situational factors that contribute to alcohol dependence. Rural areas are more likely to have higher poverty and unemployment rates than metro areas (United States Department of Agriculture, 2019). This results in a higher percentage of young people participating in binge drinking (Marqués-Sánchez et al., 2020). At the environmental level, pursuing personal behavior change will involve studying drinking patterns among the ethnic and cultural communities. This enables all the stakeholders involved in the process of enacting policies that prevent alcohol dependency in the rural population (Hagger et al., 2020). This would involve building on the previous strategies discussed to first, raise awareness of programs that directly focus on the treatment of alcohol dependency, and second, promote programs that address the factors that contribute to alcoholism. Because young adults are particularly vulnerable, a social media campaign targeting the younger population could be helpful. The promotion of these strategies would fall under media advocacy as they would be carried out via social media and local advertising.
The health behavior model that we would incorporate into the intervention strategies is relapse prevention. This model is critical to the suggested interventions because it emphasizes the importance of early intervention. For the case of an alcohol addict, it is important to educate them about the benefits of abstaining from alcohol and ensure they are aware that relapse is a transitional process. This will require equipping our populations with coping strategies for dealing risky encounters (Rejeski & Fanning, 2019). The individuals can be trained on how to respond to experiences that induce depression or anxiety.
Another health behavior model could be used include is the self-determination theory which incorporates three areas including the need to experience competence, feeling meaningfully connected socially, and a feeling of autonomy over one’s life (Rejeski & Fanning, 2019). Therefore, this model would play a key role in helping the victims in refraining from their alcoholic behavior by helping them formulate goals that suit their immediate goals during the recovery process. Overall, these two models will complement each other along with the process of advocating for behavior change within the communities. This will involve the use of the ecologic model when helping the individual and it will allow us to focus on interventions that will promote abstinence. It is important to encourage the individuals to formulate goals that enable them to be successful and equip them with coping strategies to overcome barriers that might prevent them from achieving their goals.
The stakeholders identified as important to successful intervention programs include behavioral health practitioners so that they may provide counseling services and offer education to the members of the community on prevention and abstinence. It is important to work closely with the target population as they are one of the primary stakeholders at an intrapersonal level. At an interpersonal level we must consider those around our at-risk population to ensure they are aware of the interventions and strategies to help them avoid the prevailing community challenge. “Alcohol use has been identified as a major risk factor for acute and chronic health harms and imparts economic, health, and social costs to individuals, communities, and societies” (Flynn & Wells). This includes family, friends, church leaders, local officials, and other influencers. Relationships are fundamentally important and should not be underestimated when implementing personal behavior strategies. Finally, stakeholders like funding agencies will be important because they provide the funds necessary to run the program and they are vital to the ecological level of influence. Comment by Maria Gonzalez Chavez: Are we using this one or the first one then? I did incorporate some of Jaipal’s notes here Comment by Maria Gonzalez Chavez: @Jaipal S Hooda @Lara Roelofs

References
Flynn, A., & Wells, S. (n.d.). Community Indicators: Assessing the Impact of Alcohol Use on Communities. National Institute on Alcohol Abuse and Alcoholism,

Hagger, M. S., Cameron, L. D., Hamilton, K., Hankonen, N., & Lintunen, T. (Eds.). (2020). The handbook of behavior change. Cambridge University Press.
Marqués-Sánchez, P., Quiroga Sánchez, E., Liébana-Presa, C., Fernández-Martínez, E., García-Rodríguez, I., & Benítez-Andrades, J. A. (2020). The consumption of alcohol by adolescent schoolchildren: Differences in the triadic relationship pattern between rural and urban environments. PloS one, 15(11), e0241135.
Rejeski, W. J., & Fanning, J. (2019). Models and theories of health behavior and clinical interventions in aging: a contemporary, integrative approach. Clinical Interventions in Aging, 14, 1007.
United States Department of Agriculture. (2019, November). Rural America at a Glance. Retrieved from United States Department of Agriculture Economic Research Service: https://www.ers.usda.gov/webdocs/publications/95341/eib_212_printerspreads.pdf?v=6522.4

Contributions
Lara Roelofs: Group leader, Compiled draft, APA formatting
Jaipal Hooda: Research, Provided feedback on draft
Maria Gonzalez: Edited draft, Research

Participation Individual Assignment Grading Rubric
(Total # of points: 10)

Levels of Achievement

Criteria Exceeds
expectations

Proficient Competent Needs
Improvement

Understanding of
public health topic
(40%)

4 points

Provided
correct and
comprehensive
responses to
assignment
questions.

3 points

Provided
mostly correct
or adequate
responses to
assignment
questions.

2 points

Provided
somewhat
correct or
somewhat
adequate
responses to
assignment
questions.

1 point

Did not
address all
assignment
questions at
all.

Reflection or
application of
public health topic
(40%)

4 points

Demonstrated
extensive
reflection or
application of
assignment
topic, as
evidenced by
use of multiple
examples from
the following
sources:
student’s
personal or
professional
context;
textbook
reading;
course lecture
material;
supplemental
reading;
current events.

3 points

Demonstrated
adequate
reflection or
application of
assignment
topic, as
evidenced by
use of one
example from
the following
sources:
student’s
personal or
professional
context;
textbook
reading;
course
lecture
material;
supplemental
reading;
current
events.

2 points

Demonstrated
somewhat
adequate
reflection or
application of
assignment
topic, with no
use of
examples.

1 point

Did not
demonstrate
any reflection
or application
of assignment
topic.

Writing mechanics
(10%)

1 point

0.75 point

0.5 point

0.25 point

Consistently
used good
spelling and
grammar in the
paper.

Made 1-2
errors in
grammar or
spelling that
distract the
reader from
the content.

Made 3-4
errors in
grammar or
spelling that
distract the
reader from
the content.

Made more
than 4 errors
in grammar or
spelling that
distract the
reader from
the content.

Sources/citations
(10%)

1 point

Cited all
sources (e.g.
textbook,
supplemental
reading,
outside
sources,
lecture
material) using
correct APA
format.

0.75 point

Cited most
sources using
correct APA
format.

0.5 point

Cited
sources, but
did not use
APA format at
all.

0 point

Did not cite
any sources.

® Insignia Health, LLC � Proprietary and Confidential � © 2013 � For use with a valid copyright license only
3

Below are some statements that people sometimes make when they talk about their health.
Please indicate how much you agree or disagree with each statement as it applies to you
personally by circling your answer. Your answers should be what is true for you and not just what
you think others want you to say.

If the statement does not apply to you, circle N/A.

1. When all is said and done, I am the person
who is responsible for taking care of my
health

Disagree
Strongly

Disagree Agree Agree
Strongly

N/A

2. Taking an active role in my own health care
is the most important thing that affects my
health

Disagree
Strongly

Disagree Agree Agree
Strongly

N/A

3. I am confident I can help prevent or reduce
problems associated with my health

Disagree
Strongly

Disagree Agree Agree
Strongly

N/A

4. I know what each of my prescribed
medications do

Disagree
Strongly

Disagree Agree Agree
Strongly

N/A

5. I am confident that I can tell whether I need
to go to the doctor or whether I can take
care of a health problem myself

Disagree
Strongly

Disagree Agree Agree
Strongly

N/A

6. I am confident that I can tell a doctor
concerns I have even when he or she does
not ask

Disagree
Strongly

Disagree Agree Agree
Strongly

N/A

7. I am confident that I can follow through on
medical treatments I may need to do at
home

Disagree
Strongly

Disagree Agree Agree
Strongly

N/A

8. I understand my health problems and what
causes them

Disagree
Strongly

Disagree Agree Agree
Strongly

N/A

9. I know what treatments are available for
my health problems

Disagree
Strongly

Disagree Agree Agree
Strongly

N/A

10. I have been able to maintain (keep up with)
lifestyle changes, like eating right or
exercising

Disagree
Strongly

Disagree Agree Agree
Strongly

N/A

11. I know how to prevent problems with my
health

Disagree
Strongly

Disagree Agree Agree
Strongly

N/A

12. I am confident I can figure out solutions
when new problems arise with my health

Disagree
Strongly

Disagree Agree Agree
Strongly

N/A

13. I am confident that I can maintain lifestyle
changes, like eating right and exercising,
even during times of stress

Disagree
Strongly

Disagree Agree Agree
Strongly

N/A

Insignia Health. “Patient Activation Measure; Copyright 2003-2010, University of Oregon. All Rights reserved.”

Contact Insignia Health at www.insigniahealth.com

® Insignia Health, LLC � Proprietary and Confidential � © 2013 � For use with a valid copyright license only
4

Score Table for Patient Activation Measure, 13 Items

Instructions:
First, calculate a raw score: add up all of the responses to the 13 questions. For each “Strongly
Disagree” response give the person a 1, for each “Disagree” response give the person a 2, for
each “Agree” response give the person a 3, for each “Strongly Agree” response give the person a
4.

If there are no items with “not applicable” responses, use the total as the raw score.
If there are items with a response of “not applicable” or a question left blank, these items are
scored as “missing.” In this case divide the point total by the number of items completed with a 1-
4 response (exclude the missing) and multiply by 13 to get the raw score. For example, if two
questions were answered with a “not applicable” response, your denominator would be 11.

Second, convert the raw score into the activation score. If necessary, round off your raw score to
the nearest whole number. Then, using the table below, simply find the raw score in the column
marked “Raw Score,” then read across to find the person’s activation score.

Finally, we recommend that if any respondents who answer all 13 questions with a “strongly
agree” response, that you carefully consider their score. They are likely not responding in a
truthful or accurate way. The same is true for respondents who answer all 13 items with a
“strongly disagree” response.

Raw
Score Activation

Raw
Score Activation

13 0.0 33 41.7
14 8.2 34 43.4
15 13.3 35 45.2
16 16.5 36 47.4
17 18.9 37 49.9
18 20.9 38 52.9
19 22.7 39 56.4
20 24.3 40 60.0
21 25.7 41 63.2
22 27.1 42 66.0
23 28.4 43 68.5
24 29.7 44 70.8
25 31.0 45 73.1
26 32.2 46 75.3
27 33.5 47 77.5
28 34.7 48 80.0
29 36.0 49 82.8
30 37.3 50 86.3
31 38.7 51 91.6
32 40.1 52 100.0

® Insignia Health, LLC � Proprietary and Confidential � © 2013 � For use with a valid copyright license only
5

Cut Points and percentages by Activation Level Segment

LEVEL 1: May not yet believe that the patient role is important
(Having a PAM score of 47.0 or lower, 11.8%)

LEVEL 2: Lacks confidence and knowledge to take action
(Having a PAM score of 47.1 to 55.1, 29.3%)

LEVEL 3: Beginning to take action
(Having a PAM score of 55.2 to 67.0, 36.5%)

LEVEL 4: Has difficulty maintaining behaviors over time
(Having a PAM score of 67.1 or above, 22.3%)

Patient and Consumer Activation and Patient Communication: Application to Personal Health Behavior Change

Patient and Consumer Activation:

1. Please take the Patient Activation Measure (please see attached document in the Assignment Dropbox), score it and report back about the level of difficulty you fall under. You do not need to show me your specific responses.
2. Now, please ask a friend or family member who is NOT in the health field to take the PAM. Ask them to score their own responses and report back you about the level of difficulty he/she falls under. He/she does not need to show his/her specific responses.
3. Now compare the levels of difficulty between yourself and the other person. What factors do you think may have caused any differences there are?
4. How would you incorporate patient activation into an intervention to change your selected personal health behavior?

Patient Communication:

1. How are patient activation (score on PAM) and health literacy related? How might patient activation and health literacy affect the power differential in a physician-patient relationship?
2. What are some measures you would take to empower patients/clients and increase their health literacy if you developed an intervention to change your selected personal health behavior?

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