健康领域的跨期决策与健康行为

doi:10.3724/SP.J.1042.2020.01926

摘要/Abstract

摘要：

健康领域的跨期决策关系着个体和国民的健康和福祉。目前学界对该领域的研究主要停留在参考传统金钱领域的相关理论模型和方法的阶段, 但健康跨期决策具有领域特异性, 沿袭金钱领域理论模型和方法, 导致该领域在研究方法和结果上存在较大的不一致性。健康跨期决策的行为后果是该领域关注重点, 多数研究均报告个体的低时间折扣率、高未来时间取向与其健康保护行为正相关, 与健康风险行为呈负相关。该领域也关注健康跨期决策的影响机制, 如决策对象和决策主体的核心特征等因素。未来研究亟需发展适用于健康领域的跨期决策模型和研究范式, 明确健康行为与跨期决策偏好的关系, 深入探讨健康跨期决策的内在选择机制, 并在健康行为干预和医疗卫生政策应用方面进行更多的尝试和探索。

关键词: 跨期决策, 健康行为, 领域特异性, 时间取向

Abstract:

Time preference for health is omnipresent and important at both individual and national levels. For a long time, research in this field has been limited to following inter-temporal choice models and methods in the traditional monetary domain of time preference studies. Given the domain-specificity of time preference in the health domain, these indiscriminately theoretical models led to inconsistent measures and results in the field. In the past few decades, researchers in this field have focused on the behavioral consequences of time preference for health. Most studies reported that lower temporal discount rates and higher future time perspectives are positively related to health protection behaviors and negatively related to health risk behaviors. Researchers also found that features of both decision-making objects and decision makers are key impact factors for time preference for health. Future studies should develop theoretical models and measurements that are more suitable to the time preferences for health domain, identify the relationship between healthy behaviors and time preference, and investigate the mechanism underlying the decision-making process. Future researchers should also explore interventions for health behaviors and their application to formulation of healthcare policies.

Key words: intertemporal decision making, health behavior, domain specificity, time perspective

中图分类号:

B849:C91

吴小菊, 陈俊芳, 符佳慧, 李纾, 梁竹苑. (2020). 健康领域的跨期决策与健康行为. 心理科学进展 , 28(11), 1926-1938.

WU Xiao-Ju, CHEN Jun-Fang, FU Jia-Hui, LI Shu, LIANG Zhu-Yuan. (2020). Time preferences for public health and health behavior. Advances in Psychological Science, 28(11), 1926-1938.

图/表 2

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健康保护行为	预测变量及测量	样本	两者关系	研究者
			正相关
锻炼	时间取向(财务计划时间期限)	英国老年居民	未来财务规划正向预测锻炼行为	Adams, 2009
锻炼	金钱时间偏好(假设的节省问题)	美国居民	未来时间偏好正向预测女性参加各种强度体育活动的时间, 以及男性参加高强度体育活动的时间	Kosteas, 2015
锻炼、蔬菜水果次摄入	时间取向(未来时间洞察力量表)	德国居民	量表得分正向预测全部健康行为	Gellert et al., 2012
锻炼、饮食习惯(BMI)	津巴多时间洞察力量表	希腊居民	未来和现在的享乐主义分量表得分正向预测锻炼行为。过去消极、现在的宿命论和现在享乐主义分量表得分正向预测饮食习惯(BMI)	Griva et al., 2015
锻炼、健康食品、安全驾驶、防晒霜使用、注射流感疫苗	时间取向(未来时间洞察力量表)	美国中学生	量表得分与全部健康行为正相关	Mahon et al., 2000
锻炼、安全带使用, 避孕套使用	时间取向(津巴多时间洞察力量表, 享乐、现在宿命、未来时间观分量表)	美国大学生	未来、现在享乐主义、现在宿命论分量表得分分别预测锻炼、避孕套使用和安全带使用行为	Henson et al., 2006
			负相关
锻炼	金钱跨期偏好(选择任务)	美国居民	体育活动干预可以促进时间折扣率降低	Sofis et al., 2017
			混合关系
锻炼、吃早餐、安全带使用、戴头盔、医疗检查、防晒	时间取向(津巴多时间洞察力量表, 享乐、现在宿命、未来时间观分量表, 未来后果量表), 金钱跨期偏好(选择任务)	美国大学生	在控制相关因素后, 除戴头盔、医疗检查、防晒外, 时间取向和时间折扣率提高了对其他健康行为的预测	Daugherty & Brase, 2010
锻炼、饮食、医疗检查、安全驾驶	金钱跨期偏好(选择任务)	美国吸烟者	除安全驾驶外, 时间折扣率负向预测其他健康行为	Snider et al., 2019
锻炼、蔬菜摄入、保健访问、癌症筛查	金钱跨期偏好(选择任务)	美国癌症者	时间折扣率负向预测保健访问行为, 未显著预测其他健康行为	Sheffer et al., 2018
改变锻炼习惯、饮食习惯、血压检查, 遵循医嘱	金钱跨期偏好(选择任务)	英国高血压患者	时间折扣率负向预测血压检查和遵循医嘱行为, 未显著预测改变锻炼习惯和饮食习惯行为	Axon et al., 2009
接种疫苗	金钱跨期偏好(匹配任务), 健康跨期偏好(匹配任务)	美国公司员工	接种疫苗的接受程度与金钱时间偏好与之间显著相关, 与健康时间偏好不相关	Chapman & Coups, 1999
锻炼、流感疫苗注射、健康检查(如乳房、前列腺、牙齿、胆固醇等)、其他健康习惯	金钱跨期偏好(选择任务)	美国居民	高时间折扣率与锻炼、流感疫苗注射、医疗检查(牙齿、胆固醇)其他健康习惯负相关, 与其他健康习惯不相关	Bradford, 2010
			不相关
锻炼	时间取向(津巴多时间洞察力量表, 享乐、现在宿命、未来时间观分量表)	美国居民	各分量表得分与锻炼行为不相关	Guthrie et al., 2009
锻炼	时间取向(津巴多时间洞察力量表)	美国居民	量表得分与锻炼行为不相关	Gulley, 2013
锻炼	时间取向(津巴多时间洞察力量表)	美国居民	量表得分未显著预测锻炼行为	Gulley & Boggs, 2014
锻炼、安全带使用、牙医检查	金钱跨期偏好(选择任务)	美国居民	时间折扣率未显著预测全部健康行为	Fuchs, 1982

健康保护行为	预测变量及测量	样本	两者关系	研究者
			正相关
锻炼	时间取向(财务计划时间期限)	英国老年居民	未来财务规划正向预测锻炼行为	Adams, 2009
锻炼	金钱时间偏好(假设的节省问题)	美国居民	未来时间偏好正向预测女性参加各种强度体育活动的时间, 以及男性参加高强度体育活动的时间	Kosteas, 2015
锻炼、蔬菜水果次摄入	时间取向(未来时间洞察力量表)	德国居民	量表得分正向预测全部健康行为	Gellert et al., 2012
锻炼、饮食习惯(BMI)	津巴多时间洞察力量表	希腊居民	未来和现在的享乐主义分量表得分正向预测锻炼行为。过去消极、现在的宿命论和现在享乐主义分量表得分正向预测饮食习惯(BMI)	Griva et al., 2015
锻炼、健康食品、安全驾驶、防晒霜使用、注射流感疫苗	时间取向(未来时间洞察力量表)	美国中学生	量表得分与全部健康行为正相关	Mahon et al., 2000
锻炼、安全带使用, 避孕套使用	时间取向(津巴多时间洞察力量表, 享乐、现在宿命、未来时间观分量表)	美国大学生	未来、现在享乐主义、现在宿命论分量表得分分别预测锻炼、避孕套使用和安全带使用行为	Henson et al., 2006
			负相关
锻炼	金钱跨期偏好(选择任务)	美国居民	体育活动干预可以促进时间折扣率降低	Sofis et al., 2017
			混合关系
锻炼、吃早餐、安全带使用、戴头盔、医疗检查、防晒	时间取向(津巴多时间洞察力量表, 享乐、现在宿命、未来时间观分量表, 未来后果量表), 金钱跨期偏好(选择任务)	美国大学生	在控制相关因素后, 除戴头盔、医疗检查、防晒外, 时间取向和时间折扣率提高了对其他健康行为的预测	Daugherty & Brase, 2010
锻炼、饮食、医疗检查、安全驾驶	金钱跨期偏好(选择任务)	美国吸烟者	除安全驾驶外, 时间折扣率负向预测其他健康行为	Snider et al., 2019
锻炼、蔬菜摄入、保健访问、癌症筛查	金钱跨期偏好(选择任务)	美国癌症者	时间折扣率负向预测保健访问行为, 未显著预测其他健康行为	Sheffer et al., 2018
改变锻炼习惯、饮食习惯、血压检查, 遵循医嘱	金钱跨期偏好(选择任务)	英国高血压患者	时间折扣率负向预测血压检查和遵循医嘱行为, 未显著预测改变锻炼习惯和饮食习惯行为	Axon et al., 2009
接种疫苗	金钱跨期偏好(匹配任务), 健康跨期偏好(匹配任务)	美国公司员工	接种疫苗的接受程度与金钱时间偏好与之间显著相关, 与健康时间偏好不相关	Chapman & Coups, 1999
锻炼、流感疫苗注射、健康检查(如乳房、前列腺、牙齿、胆固醇等)、其他健康习惯	金钱跨期偏好(选择任务)	美国居民	高时间折扣率与锻炼、流感疫苗注射、医疗检查(牙齿、胆固醇)其他健康习惯负相关, 与其他健康习惯不相关	Bradford, 2010
			不相关
锻炼	时间取向(津巴多时间洞察力量表, 享乐、现在宿命、未来时间观分量表)	美国居民	各分量表得分与锻炼行为不相关	Guthrie et al., 2009
锻炼	时间取向(津巴多时间洞察力量表)	美国居民	量表得分与锻炼行为不相关	Gulley, 2013
锻炼	时间取向(津巴多时间洞察力量表)	美国居民	量表得分未显著预测锻炼行为	Gulley & Boggs, 2014
锻炼、安全带使用、牙医检查	金钱跨期偏好(选择任务)	美国居民	时间折扣率未显著预测全部健康行为	Fuchs, 1982

健康风险行为	预测变量及测量	样本	两者关系	研究者
			相关
吸烟	金钱跨期偏好(选择任务)	美国居民	时间折扣率正向预测吸烟行为	Fuchs, 1982
吸烟、酗酒	金钱跨期偏好(选择任务)	日本居民	时间折扣率正向预测吸烟、酗酒行为	Takagi et al., 2016
吸烟、酗酒、不防晒	金钱跨期偏好(选择任务)	美国癌症者	时间折扣率正向预测吸烟、酗酒、不防晒行为	Sheffer et al., 2018
吸烟、酗酒、吸毒	时间取向(津巴多时间洞察力量表, 享乐、现在宿命、未来时间观分量表), 未来后果量表, 金钱跨期偏好(选择任务)	美国大学生	在控制相关因素后, 时间取向和时间折扣率提高了对全部健康行为的预测	Daugherty & Brase, 2010
吸毒	金钱跨期偏好(选择任务)	美国吸烟者	时间折扣率显著正向预测吸毒行为	Snider et al., 2019
吸烟	时间取向(财务计划时间期限)	英国老年居民	财务规划时间反向预测吸烟行为	Adams, 2009
吸烟	金钱跨期偏好(选择任务)	加拿大精神病患者及正常人	在正常人群中, 现在吸烟者的时间折扣率高于过去曾经吸烟与从不吸烟者; 在精神病患者中, 现在和过去吸烟者的时间折扣率高于从不吸烟者	Wing, Moss, Rabin, & George, 2012
吸烟、酗酒、吸毒、不安全性行为	时间取向(津巴多时间洞察力量表, 享乐、现在宿命、未来时间观分量表)	美国大学生	现在享乐主义分量得分表显著正向预测全部行为, 未来分量表显著反向预测吸烟、酗酒, 吸毒行为; 现在宿命论分量表正向吸烟行为	Henson et al., 2006
			不相关
吸烟	时间取向(津巴多时间洞察力量表, 享乐、现在宿命、未来时间观分量表)	美国居民	各分量表得分都与吸烟不相关	Guthrie et al., 2009
吸烟	津巴多时间洞察力量表	希腊居民	量表得分与吸烟行为不相关	Griva et al., 2015

健康风险行为	预测变量及测量	样本	两者关系	研究者
			相关
吸烟	金钱跨期偏好(选择任务)	美国居民	时间折扣率正向预测吸烟行为	Fuchs, 1982
吸烟、酗酒	金钱跨期偏好(选择任务)	日本居民	时间折扣率正向预测吸烟、酗酒行为	Takagi et al., 2016
吸烟、酗酒、不防晒	金钱跨期偏好(选择任务)	美国癌症者	时间折扣率正向预测吸烟、酗酒、不防晒行为	Sheffer et al., 2018
吸烟、酗酒、吸毒	时间取向(津巴多时间洞察力量表, 享乐、现在宿命、未来时间观分量表), 未来后果量表, 金钱跨期偏好(选择任务)	美国大学生	在控制相关因素后, 时间取向和时间折扣率提高了对全部健康行为的预测	Daugherty & Brase, 2010
吸毒	金钱跨期偏好(选择任务)	美国吸烟者	时间折扣率显著正向预测吸毒行为	Snider et al., 2019
吸烟	时间取向(财务计划时间期限)	英国老年居民	财务规划时间反向预测吸烟行为	Adams, 2009
吸烟	金钱跨期偏好(选择任务)	加拿大精神病患者及正常人	在正常人群中, 现在吸烟者的时间折扣率高于过去曾经吸烟与从不吸烟者; 在精神病患者中, 现在和过去吸烟者的时间折扣率高于从不吸烟者	Wing, Moss, Rabin, & George, 2012
吸烟、酗酒、吸毒、不安全性行为	时间取向(津巴多时间洞察力量表, 享乐、现在宿命、未来时间观分量表)	美国大学生	现在享乐主义分量得分表显著正向预测全部行为, 未来分量表显著反向预测吸烟、酗酒, 吸毒行为; 现在宿命论分量表正向吸烟行为	Henson et al., 2006
			不相关
吸烟	时间取向(津巴多时间洞察力量表, 享乐、现在宿命、未来时间观分量表)	美国居民	各分量表得分都与吸烟不相关	Guthrie et al., 2009
吸烟	津巴多时间洞察力量表	希腊居民	量表得分与吸烟行为不相关	Griva et al., 2015