Leading onwards from the level 4 module of Communication Skills, this module further incorporates theoretical and communication models at an advanced level. Students will explore and evaluate these perspectives in the context of working at relational depth with clients in practice. This work will then be linked to the models and theories examined therein allowing students to examine the merits and challenges which those varied approaches have to offer connection to different clients.
Within the module learners will also identify and report upon models of advocacy and the impacts of employing these within practice. This will directly link with some of the strategic objectives which have been outlined in the Care Act 2014 and the Care Standards Certificate (or the latest reference for standards for practice).
- Critically analyse two models of communication linking these to underpinning theoretical perspectives.
- Critically evaluate the application of two selected models of communication and their effectiveness in practice.
- Evaluate the process of advocacy ormediation in regards to practice with reference to relevant communicative approaches.
- Analyse the process of self-efficacy for service users, making reference to approaches which support this and linking these to contemporary sector strategies.
Health practitioners and counselors have one of the most difficult tasks in the world as many depend on them for resolving their personal, emotional and physical issues. To approach a client in an effective manner, health practitioners need to develop a strong understanding of the various methods of communication (Golden and Earp 2012). They also have to utilize these in accordance with the situation of the client. Numerous theorists have developed different models of communication that are applied to various fields. The Theory of Planned Behavior (TBP), the Health Belief Model under Cognitive theories, the Transtheoretical model of communication (TTM), the Process of Behavior Change and so on under Stage theories are some of the communication theories and models that are applied to practice (Corcoran 2013).
The given report focuses mainly on two theories of communication- one from Cognitive and one from Stage theories and tries to analyze these two theories in regards to practical examples.
The two models or theories of communication selected for the report are the Theory of Human Behavior and the Transtheoretical model of communication.
Analyzing the selected models and linking those to theoretical perspectives
Ajzen and Fishbein proposed the Theory of Planned Behavior during the 1980s initially called the Theory of Reasoned Action that comes under the Cognitive theories of human behavior. Later, the theorists modified it in the early 90s where they added one more dimension to the previous theory- the perceived behavior control (Forestry.gov.uk 2017). The theory stresses on the fact that human behavior is influenced by three major activities. The first is one’s own attitude, second is external pressure or motivation from society and the third is the apparent behavioral control. These factors decide the consequent intention of the individual whether to accept and act upon that behavior or not. Ultimately, the behavioral intention leads to what the individual ends up doing that is the achieved behavior (Montano and Kasprzyk 2015). A close study at the TBP reveals its evident link with the Freudian concept of psychodynamic. According to Freud, human personality comprises three elements- the Id, Ego and the Superego. The Id is accountable for instincts and pleasure seeking. It urges the mind to want something obsessively; the Superego gives more importance to the obligations and rules imposed by parents and society; and the Ego tries to strike a balance between the Id and the Superego. It tries to mediate between the two and explore new ways to get what the Id wants without disturbing the societal rules and norms (Marmor 2012).
Now, one can clearly notice that Freud’s Id is closely linked to the first stage of TBP that is the attitude towards behavior. The second stage of TBP coincides with the Ego that pays more attention to what the society that is family and friends have to say. The third TBP stage- the apparent behavior control- can be associated with Freud’s third element, which is the Superego.
The next model of communication selected for the purpose of health communication is the Transtheoretical Model. Prochaska and Diclemente introduced the Transtheoretical Model (TTM) in 1983 that comes under the Stage-step theories (Prochaska 2013). This theory rejected the Cognitive views of human behavior and focused more on the stages of behavior not the ages. The TTM suggests that humans go through a cyclical process of behavior change. The process begins with pre-contemplation where humans do not intend to change their behavior as they think it does not cause any harm or danger. They tend to remain in this inactive phase of behavior. This stage is followed by the contemplation stage where humans start giving thoughts to change in behavior. They start thinking of the harms of being inactive and contemplate on changing it. The next is the preparation stage where they initiate the first steps towards change. It is then followed by the action stage where the individual has started acting on his contemplation and has been doing or planning to do it for a longer period. The action stage gives way to the stage of maintenance that involves continuation of the action. After a period of action and its continuation, the individual might decide to drop the idea and go back to the previous stages. This is the relapse stage in the behavior cycle (Sharma 2016).
Erikson’s psychosocial model comprises eight stages of human behavioral development- trust as opposed to mistrust, autonomy against doubt, initiative versus guilt, industry versus inferiority, identity opposed to role confusion and so on (Cragg 2013). The TTM mainly concerns the stage of indentify versus role confusion that involves individuals between the ages of 13 to 21 years. The reason for choosing this stage is its close link to the stages of the cyclical human behavior. According to Erikson, at this stage, the youngsters start to feel that they need to develop their own identity (Jones et al. 2014). Prior to this stage, they were not concerned about how they looked and what others might think of them. To say this in terms of TTM, they were in the pre-contemplation stage. When they passed that stage, they contemplated on developing their own identity. When the contemplation stage is over, the youngsters then give a thought whether they are prepared for the change or not.
Effectiveness of TBP and TTM in practice
In the field of health communication, these two theories have been largely utilized. Health practitioners are applying the Theory of Planned Behavior to promote healthy habits amongst adults like walking daily, dangers associated with smoking, motivating exercise and so on. However, it is imperative to realize the manners in which this theory can be applied while communicating with a service user.
As per the TBP, an individual’s intention is the main driving force behind the achievement of any behavior. In health sector, practitioners apply this theory to influence clients to take up healthy habits or behaviors. To cite an example, a person’s addiction to smoking can be reduced through the three phases prior to the attitude stage. At first, the person would question his own behavioral beliefs whether the outcomes of the decision would be positive or negative. The second phase is the normative beliefs that results in apparent pressure from the society that compels the person to consider the attitude of his family and friends towards his decision. The final phase involves the control beliefs of the person where he questions his own ability and knowledge. The TBP can be used in this case to design an intervention for the person addicted to smoking (Gault et al. 2016).
Many have nonetheless argued against the application and effectiveness of the TBP in the modern technologically advanced era. The theory gives excessive attention to hypothetical behavioral tendencies or attitudes, point out critics that might or might not influence behavior. Moreover, the theory does not include health determinants that might lead to an incomplete or sometimes incorrect behavior determination (Sniehotta, Presseau and Araújo-Soares 2014).
Health communicators have widely used the Transtheoretical model of communication to interact effectively with their clients (Dray and Wade 2012). The TTM has received great popularity owing to its simple process. Known also as the Stages of Change Model, TTM has been successfully applied to achieve several health related targets. Specifically targeted towards intervention programs, the TTM has provided positive results in the sector. The model was initially designed for the purpose of intervening smoking habits; it began to be used in areas such as encouraging vegetable and fruit consumption, encouraging physical activity and injury avoidance.
The Transtheroretical Model has largely been criticized for its exclusion of priority-based intervention. To give an example, quitting smoking might not be seen as a priority by many and hence, the TTM stages may not be applicable to that person. Furthermore, to decide as to which stage the user belongs might cause conflict between the health practitioner and the client. Many critics have also pointed out to the weaknesses of the stages in TTM like the pre-contemplation and contemplation stage. They argue that there is hardly any behavioral change visible from the pre-contemplation to the contemplation stage. Some have limited the success of this model to short-term goals only.
Advocacy and mediation in relation to relevant communication approaches
An advocate or mediator has a very important role to play in an individual’s life. Advocacy generally refers to the process of helping someone and supporting someone. It allows people to express their views and get justice for them. People play the role of an advocate either knowingly or without knowing. Social workers, mental health experts, clergy, government officials and even a friend or a relative could be an advocate as per situations. Service users in particular could be empowered and protected through the utilization of advocacy effectively (Ncbi.nlm.nih.gov, 2017).
Mediation, on the other hand is a slightly different process than advocacy, as it does not involve supporting one side against the other. Mediation is a process where a person acts as the mediator for solving issues between conflicting groups by making them come together and have a conversation. This process works best when the two conflicting parties come into an agreement to resolve disputes through mutual understanding. In addition, the parties involved in mediation possess the capability to live up to their promises and discontinue the conflict in future.
Health practitioners especially counselors who look to resolve disputes between husband and wife, their families and so on widely use both advocacy and mediation. Communication strategies used by health professionals to advocate or mediate a service user must be as per the demand of the situation.
In the health sector, communication plays a vital role for both patients and practitioners. However, despite improved knowledge and training on patient communication, severity of communication still persist. Communication is a process of exchanging information and ideas and views and one cannot proceed further if the other feels inferior or low. Self-efficacy thus becomes an important parameter to establish a congenial relationship between the user and the practitioner. Self-efficacy refers to the capability of an individual to develop potential without anyone’s help (Schwarzer 2014). Self-efficacy is an individual’s belief that he or she can produce desired results or that he or she can control or influence any situation. In the field of health practices, this belief is very important especially for the service user. Possessing self-efficacy allows the service user to open up about their problems and freely discuss with the practitioner (Lee et al. 2012).
Studies have found that the Health Belief Model (HBM) is an ideal communication model that can be linked to the process of self-efficacy in service users. Health Belief Model (HBM) proposes certain principles that are supposed to influence behavior. According to HBM, behavior of people could change through an incentive; there must be vulnerability in them to act in a certain way and they must be assured that the change would bring advantages and that these advantages must overshadow the barriers. Lastly, people must possess that confidence or self-efficacy that they can overcome barriers to achieve a behavioral change (Montanaro and Bryan 2014).
The practical application of HBM supporting self-efficacy is evident in the health sector where service users are allowed to strengthen their own will to achieve behavioral change. To cite an example, a person meets with an accident and is bedridden for months. He is unable to walk and his counselor or health advisor pushes him to the extreme to make him believe that he can walk if he tries (Wang et al. 2014). The person then establishes that self-belief and confidence that he can achieve that change.
The contemporary health sector applies the HBM largely to help patients with Tay-Sachs disease, exercise and nutrition programs and so on. However, it needs to be mentioned that the applicability and effectiveness of the HBM is limited to certain areas of health sector (Eldredge et al. 2016). The model lacks the analytical worth for some of its vital views. To illustrate, a person would not just agree for a behavior change by looking at the severity of the illness. The illness might not be as serious to the person as it may seem to the health practitioner (Sundqvist et al. 2016)
One cannot deny the effectiveness of the various models of communication in the field of health services. In the past years, health communication through campaigns and advertisements used to be done on extemporary basis but the scenario has changed now. Health practitioners now prefer the practical implementation of the various theories and models in order to achieve maximum result. The report has critically explained the connection of the various models of communication to the theories of Freud and Erikson. Sigmund Freud and Erik Erikson were the two exponents of the psychodynamic theory and the psychosocial theory, both of which are applicable to behavioral change in humans. The report has highlighted the different models of communication along with their application and effectiveness in practice. The Theory if Planned Behavior (TBP), the Transtheoretical Model (TTM) and the Health Belief Model (HBM) have been discussed elaborately in the report. The report has also mentioned the critical aspects of the theories and has put forth their drawbacks as well. It however needs to be pointed out that these models of communications are apt in their own places but their effectiveness depends on the way these are utilized. It therefore can be suggested that the communicators or practitioners of health utilize the different models of communication through a deep understanding of the user’s needs and requirements.
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