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Quiz: Social and Behavioral Health

Test your understanding of health behavior theories, social determinants, structural racism, and behavioral economics with these review questions.

1. The Health Belief Model predicts that an individual will adopt a health behavior when they perceive:

  1. High social norms in favor of the behavior combined with self-efficacy
  2. Sufficient threat (susceptibility and severity) and believe the benefits of action outweigh the barriers
  3. A positive outcome expectancy reinforced by observational learning
  4. Strong intentions formed through attitude and subjective norm
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The correct answer is B. The Health Belief Model (HBM) posits that behavior change requires perceiving oneself as susceptible to a condition, viewing the condition as serious, believing the recommended action is beneficial, and believing the benefits outweigh the barriers. Cues to action (reminders or prompts) and self-efficacy (added later) also facilitate action. Option C describes Social Cognitive Theory; option D describes the Theory of Planned Behavior.

Concept Tested: Health Belief Model

2. The Transtheoretical Model (Stages of Change) proposes that behavior change is:

  1. A single decision point triggered by a sufficiently powerful incentive
  2. A linear progression through five sequential stages from precontemplation to maintenance
  3. A non-linear process moving through stages where relapse is a normal part of the cycle
  4. Driven primarily by unconscious motivational factors that cannot be directly influenced
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The correct answer is C. The Transtheoretical Model (TTM) describes behavior change as a process through five stages: precontemplation, contemplation, preparation, action, and maintenance. Importantly, the model explicitly recognizes that relapse — returning to an earlier stage — is common and part of the natural change process, not a treatment failure. This non-linear conceptualization shifted counseling approaches toward meeting people where they are in the change process.

Concept Tested: Transtheoretical Model / Stages of Change

3. Social Cognitive Theory's concept of "self-efficacy" refers to:

  1. A person's belief in their ability to successfully perform a specific behavior
  2. The degree to which a person's behavior is reinforced by social rewards
  3. The internal motivation to maintain health behaviors without external prompts
  4. The capacity to learn health behaviors by observing others
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The correct answer is A. Self-efficacy, central to Bandura's Social Cognitive Theory, is a person's belief in their own capability to successfully execute the behavior needed to produce a specific outcome. It differs from outcome expectancy (belief that the behavior will lead to the desired outcome). High self-efficacy predicts initiation and persistence of health behaviors; low self-efficacy is a key barrier to change. Self-efficacy is built through mastery experiences, vicarious learning, verbal persuasion, and physiological states.

Concept Tested: Self-Efficacy (Social Cognitive Theory)

4. The social-ecological model (SEM) of health behavior emphasizes that:

  1. Individual beliefs are the only modifiable determinants of health behavior
  2. Health behaviors are influenced by multiple nested levels: individual, interpersonal, community, and policy
  3. Social networks are the primary driver of health behavior regardless of individual psychology
  4. Economic incentives operate independently from social influence on health decisions
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The correct answer is B. The social-ecological model conceptualizes health behavior as shaped by factors at multiple interconnected levels: individual characteristics (knowledge, attitudes, self-efficacy), interpersonal relationships (family, peers, social networks), community settings (workplaces, schools, neighborhoods), and policy/societal environments (laws, regulations, cultural norms). Interventions that target multiple levels simultaneously are more effective than single-level approaches.

Concept Tested: Social-Ecological Model

5. "Default opt-out" organ donation policies are an example of which behavioral economics concept?

  1. Loss aversion — framing the absence of a donor card as a loss
  2. Choice architecture — using defaults to make the desired behavior the path of least resistance
  3. Social norms — showing that most people in the community are donors
  4. Commitment devices — binding people to future behavior through advance decisions
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The correct answer is B. Choice architecture refers to the design of environments in which people make choices — including which option is the default. Opt-out organ donation systems make donation the default (people are registered as donors unless they actively opt out), exploiting status quo bias (people tend to stick with defaults). Countries with opt-out systems consistently have higher donor rates than opt-in systems, without restricting individual choice.

Concept Tested: Choice Architecture / Default Effects

6. Health literacy is best defined as:

  1. The level of education required to understand a patient's medical record
  2. The ability of individuals to obtain, process, and understand health information needed to make appropriate decisions
  3. A healthcare provider's skill in communicating diagnoses clearly to patients
  4. The reading grade level at which public health materials should be written
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The correct answer is B. Health literacy encompasses an individual's capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Low health literacy is associated with poorer chronic disease management, more hospitalizations, less preventive care use, and worse health outcomes. It is not solely a patient characteristic — it reflects the interaction between individual skills and the demands placed by health systems and communication.

Concept Tested: Health Literacy Definition

7. The concept of "structural racism" in public health refers to:

  1. Explicit racial bias held by individual healthcare providers toward patients of color
  2. The totality of cumulative and compounding effects of an array of factors that systematically privilege white people and disadvantage people of color
  3. Legal racial segregation in healthcare facilities that existed before the Civil Rights Act
  4. The racial composition of public health department leadership and workforce
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The correct answer is B. Structural racism encompasses the historical and ongoing policies, institutional practices, cultural representations, and social norms that work in various, often reinforcing ways to perpetuate racial group inequity. It operates through housing policy (redlining), criminal justice, education funding, employment discrimination, and healthcare access — producing health disparities that cannot be fully explained by individual behavior or biology. It is distinguished from interpersonal racism (option A) and operates independently of explicit discriminatory intent.

Concept Tested: Structural Racism

8. The Theory of Planned Behavior adds which construct to the Theory of Reasoned Action?

  1. Self-efficacy, which influences whether intentions translate into action
  2. Perceived behavioral control, which reflects the perceived ease or difficulty of performing the behavior
  3. Outcome expectancy, which connects behavior to anticipated consequences
  4. Social norms, which reflect perceptions of others' approval or disapproval
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The correct answer is B. The Theory of Reasoned Action (TRA) posited that intentions (determined by attitude and subjective norm) predict behavior. Ajzen extended the TRA to the Theory of Planned Behavior (TPB) by adding perceived behavioral control — the person's perception of how easy or difficult it is to perform the behavior — which addresses behaviors not fully under volitional control. Perceived behavioral control is conceptually similar to Bandura's self-efficacy but measured differently.

Concept Tested: Theory of Planned Behavior

9. "Cultural humility" in public health practice is best described as:

  1. Memorizing the cultural norms of every ethnic group served by a health department
  2. A lifelong commitment to self-reflection and critique of one's own cultural assumptions in service of equitable care
  3. Translating all patient education materials into the patient's native language
  4. Hiring healthcare providers who share the same cultural background as the patients they serve
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The correct answer is B. Cultural humility, distinguished from cultural competence, emphasizes an ongoing process of self-reflection and willingness to acknowledge and correct cultural biases in oneself and one's institutions — rather than achieving a fixed level of "competence" about other cultures. It recognizes power imbalances in provider-patient relationships and involves institutional accountability for addressing inequity, not merely individual skill acquisition.

Concept Tested: Cultural Humility

10. "Nudges" as health interventions differ from traditional health education primarily because they:

  1. Target policymakers rather than individuals to achieve population-level change
  2. Change behavior by altering the choice environment rather than changing knowledge or attitudes
  3. Rely on financial penalties for unhealthy behaviors rather than positive reinforcement
  4. Focus exclusively on food environments and physical activity settings
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The correct answer is B. Nudges, as defined by Thaler and Sunstein, are any aspect of the choice architecture that alters people's behavior in a predictable way without forbidding options or significantly changing economic incentives. They work through the choice environment (defaults, salience, framing, social proof) rather than by increasing knowledge or changing attitudes — the mechanism assumed by traditional health education. Examples include placing healthy foods at eye level in cafeterias and sending appointment reminder texts.

Concept Tested: Nudges and Choice Architecture