psych Health
How can adherence be improved?
Effective programs frequently include clearly written as well as clear verbal instructions, simple medication schedules, follow-up calls for missed appointments, prescriptions tailored to the patient's daily schedule, rewards for complaint behavior, and cues to signal the time for taking medication.
What type of training do health psychologists receive, and what kinds of work do they do?
Health psychologists receive doctoral-level training psychology and often receive at least 2 years of postdoctoral work in a specialized area of health psychology. Health psychologists are employed in a variety of settings, including universities, hospitals, clinics, private practice, and health maintenance organizations.
health psychology background:
Health psychology uses the science of psychology to enhance health, prevent and treat disease, identify risk factors, improve the health care system, and shape public opinion with regard to health.
What factors are related to seeking medical attention?
How people determine their health status when they don't feel well depends not only on social, ethnic, and demographic factors but also on the characteristics of their symptoms and their concept of illness. In deciding whether they are ill, people consider at least four characteristics of their symptoms
Control group
In an experiment or clinical trial, the group of participants who do not receive an active treatment. The control group serves as a comparison to the experimental group.
Experimental group
In an experiment or clinical trial, the group of participants who receive an active treatment.
Dependent variable
In an experiment or clinical trial, the variable that represents the effect or outcome of interest.
Independent variable
In an experiment or clinical trial, the variable that represents the presumed cause of an effect or outcome.
Motivational phase
In the health action process approach, the stage in which a person develops an intention to pursue a health-related goal.
Volitional phase
In the health action process approach, the stage in which a person pursues a health-related goal.
Randomized controlled trials
Randomized control trials are similar to experimental designs in psychology. In these studies, researchers manipulate the independent variable to determine its effect on the dependent variable. Randomized controlled trials are capable of demonstrating cause-and-effect relationships. The most common randomized controlled trial is the clinical trial , which is frequently used to measure the efficacy of medications. The statistical technique of meta-analysis allows psychologists and epidemiologists to combine the results of many studies to develop a picture of the size of an effect.
Negative reinforcement
Removing an unpleasant or negatively valued stimuli from a situation, thereby strengthening the behavior that precedes this removal.
Longitudinal studies
Research designs in which one group of participants is studied over a period of time.
Cross-sectional studies
Research designs in which subjects of different ages are studied at one point in time.
Case-control studies
Retrospective epidemiological studies in which people affected by a given disease (cases) are compared with others not affected (controls).
Chronic diseases
Long-lasting diseases that can be controlled but not cured.
Prospective studies
Longitudinal studies that begin with a disease-free group of subjects and follow the occurrence of disease in that population or sample.
Experimental design
With experimental designs, researchers manipulate the independent variable so that any resulting differences in the dependent variable between experimental and control groups can be attributed to their differential exposure to the independent variable.
Health psychologists
who are researchers typically collaborate with others, sometimes as part of a multidisciplinary team, to conduct research on behaviors related to the development of disease or to evaluate the effectiveness of new treatments.
Clinical trial
A research design that tests the effects of medical treatment. Many clinical trials are randomized controlled trials that allow researchers to determine whether a new treatment is or is not effective.
Ex post facto design
A scientific study in which the values of the independent variable are not manipulated but selected by the experimenter after the groups have naturally divided themselves.
Meta-analysis
A statistical technique for combining results of several studies when these studies have similar definitions of variables.
The variety of research methods used in psychology include
1. correlational studies 2.cross-sectional studies & longitudinal studies 3. Experimental design 4. ex-post facto design
cross-sectional studies& longitudinal studies
-Cross-sectional studies investigate a group of people at one point in time, -Whereas, longitudinal studies follow the participants over an extended period of time. -Longitudinal studies are more likely to useful and specific results, but they are more time consuming and expensive than cross-sectional studies.
How has epidemiology contributed to health knowledge?
-Epidemiology has contributed the concepts of risk factor, prevalence, and incidence. -A risk factor is any characteristic or condition that occurs with greater frequency in people with a disease. -Prevalence is the proportion of the population that have a particular disease at a specific time -Incidence measures the frequency of new cases of the disease during a specified time.
How can adherence be improved?
-Methods of improving adherence can generally be divided into educational and behavioral strategies. -Educational methods may increase patients' knowledge, but behavioral approaches are better at enhancing adherence. Strategies for enhancing adherence fall into four approaches:
The health action process approach proposes two stages: a motivational phase and a volitional phase.
-Perceived susceptibility, self-efficacy and outcome expectations are the important factors in the motivational phase. -Planning and self efficacy are important in the volitional phase. -The success of stage theories in predicting and changing behavior rests on having accurate and valid methods of assessing a person's stage of behavior change. All theories - continuum and stage theories, are useful for understanding adherence but limited by their omission of various social, economic, ethnic,and other demographic factors that also affect people's health behavior.
Health psychologists use a variety of measurement instruments to assess behaviors and theoretical concepts. To be useful, these psychometric instruments must be both reliable and valid:
-Reliability is the extent to which an assessment device measures consistently -Validity is the extent to which an assessment instrument measures what it is supposed to measure.
four characteristics of symptoms
-The obvious visibility of the symptoms -The perceived severity of the illness -The degree to which the symptoms interfere with their lives -The frequency and persistence of the symptoms. Once people are diagnosed as sick, they adopt the sick role that involves relief from normal social and occupational responsibilities and the duty to try to get better.
Researchers can measure adherence in at least six ways:
1.)Ask the practitioner 2.)Ask the patient 3.)Ask other people 4.)Monitor use of medicine 5.)Examine biochemical evidence 6.)Use a combination of these procedures Of these, physician judgement is the least valid, but each of the others also has serious flaws; a combination of procedures provides the best assessment. These different methods of assessment complicate the determination of the frequency of non-adherence. However, an analysis of more than 500 studies revealed that the average rate of nonadherence is around 25%, with people on medication regimens more adherent than those who must change health-related behaviors.
problems receiving medical care
1.)Physicians may not have a lot of time to devote to a patient, which may create communication problems that reduce patients' satisfaction 2.)Communication problems include using medical language that is unfamiliar to the patient, as well as focusing on determining and describing a diagnosis rather than allowing the patients to fully describe their concerns. 3.)Although hospital stays are shorter than they were 30 years ago, being in the hospital is a difficult experience for both adults and children. As a hospital patient, a person must conform to hospital procedures and policies, which include being treated as a "nonperson", tolerating lack of information, and losing control of daily activities. Children who are hospitalized are placed in an unfamiliar environment, may be separated from their parents, and may undergo surgery or other painful medical procedures. Interventions that help children and parents manage in this stressful experience may ease the distress, but cost is a factor that limits the availability of these services.
Many of the research methods used in epidemiology are quite similar to those used in psychology. Epidemiology uses at least three basic kinds of research methodology
1.Observational studies 2.Randomized controlled trials 3.Natural experiments
Five Stages in making changes in behavior
1.Precontemplation 2.Contemplation 3.Preparation 4.Action 5.Maintenance
Strategies for enhancing adherence fall into four approaches:
1.Providing prompts 2.Tailoring the regimen 3. Implementing the regimen gradually 4.Making a contingency contract
Epidemiology
A branch of medicine that investigates the various factors that contribute either to positive health or to the frequency and distribution of a disease or disorder.
Self-selection
A condition of an experimental investigation in which subjects are allowed, in some manner, to determine their own placement in either the experimental or the control group.
Single-blind design
A design in which the participants do not know if they are receiving the active or inactive treatment, but the providers are not blind to treatment conditions.
Dose-response relationship
A direct, consistent relationship between an independent variable, such as a behavior, and a dependent variable, such as an illness. For example, the greater the number of cigarettes one smokes, the greater the likelihood of lung cancer.
Health psychology
A field of psychology that contributes to both behavioral medicine and behavioral health; the scientific study of behaviors that relate to health enhancement, disease prevention, and rehabilitation.
Implementation intentions
Detailed plans that link a specific situation with a goal that a person wants to achieve.
Incidence
A measure of the frequency of new cases of a disease or disorder during a specified period of time.
Adherence
A patient's ability and willingness to follow recommended health practices.
Absolute risk
A person's chances of developing a disease or disorder independent of any risk that other people may have for that disease or disorder.
Behavioral willingness
A person's motivation in a given situation to engage in a risky behavior, often as a reaction to social and situational pressures.
Conscientiousness
A personality trait marked by a tendency to be planful and goal-oriented, to delay gratification, and to follow norms and rules.
Neuroticism
A personality trait marked by a tendency to experience negative emotional states.
Biomedical Model
A perspective that considers disease to result from exposure to a specific disease-causing organism.
What are placebos, and how do they affect research and treatment?
A placebo is an inactive substance or condition that has the appearance of an active treatment and may cause the participants to improve or change because of a belief in the placebo's efficacy. In other words, a placebo is any treatment that is effective because patients' expectations based on previous experiences with treatment lead them to believe that it will be effective. The therapeutic effect of placebos is about 35%, but the rate varies with many conditions, including treatment setting and culture. Placebos including sham surgery, can be effective in a wide variety of situations, such as decreasing pain, reducing asthma attacks, diminishing anxiety, and decreasing symptoms of Parkinson's disease. Nocebos are placebos that produce adverse effects. The positive effects of placebos are usually beneficial to patients, but they create problems for researchers attempting to determine the efficacy of a treatment. Experimental designs that measure the effectiveness of a treatment intervention balance the intervention against a placebo so that people in the control (placebo) group have the same expectations as do the people in the experimental (treatment intervention) group. Experimental studies frequently use designs in which participants do not know which treatment condition they are in (single-blind design) or in which neither the participants nor the people administering the treatment know who receives the treatment intervention (double-blind design).
Subject variable
A variable chosen (rather than manipulated) by a researcher to provide levels of comparison for groups of subjects.
Validity
Accuracy; the extent to which a test or other measuring instrument measures what it is supposed to measure.
Positive reinforcement
Adding a positively valued stimulus to a situation, thereby strengthening the behavior it follows.
What is adherence, how is it measured, and how frequently does it occur?
Adherence is the extent to which a person's behavior coincides with appropriate medical and health advice. For people to profit from medical advice, first, the advice must be accurate and , second, patients must follow the advice. When people do nor adhere to sound health behaviors, they may risk serious health problems or even death. As many as 125,000 people in the United States die each year because of adherence failures.
Nocebo effect
Adverse effect of a placebo.
Double-blind design
An experimental design in which neither the subjects nor those who dispense the treatment condition have knowledge of who receives the treatment and who receives the placebo.
Behavioral medicine
An interdisciplinary field concerned with developing and integrating behavioral and biomedical sciences.
Risk factor
Any characteristic or condition that occurs with greater frequency in people with a disease than it does in people free from that disease.
Pathogen
Any disease-causing organism.
Correlation coefficient
Any positive or negative relationship between two variables. Correlational evidence cannot prove causation, but only that two variables vary together.
Reciprocal determinism
Bandura's model that includes environment, behavior, and person as mutually interacting factors.
behavioral medicine background:
Behavioral medicine is an interdisciplinary field concerned with applying the knowledge and techniques of behavioral science to the maintenance of physical health and to prevention, diagnosis, treatment and rehabilitation. Behavioral medicine which is not a branch of psychology, overlaps with health psychology, a division within the field of psychology
Social Support
Both tangible and intangible support a person receives from other people.
What are continuum theories of health behavior, and how do they explain adherence?
Continuum theories of health behavior identify variables that should predict the likelihood a person will adhere to a healthy behavior. Continuum theories propose that the variable should predict adherence in the same manner for all individuals. The health belief model focuses on people's beliefs in perceived susceptibility to a health problem, perceived severity of the problem, perceived benefits of adhering to a behavior, and perceived barriers to adherence, as well as their beliefs about people's confidence that they can control adherence, as well as their beliefs that adherence will bring about good outcomes. The theory of planned behavior focuses on people's attitudes toward a behavior their beliefs about subjective norms, and their perceived behavioral control as predictors of intentions. Behavioral theory explains adherence in terms of reinforcement and habits that must be changed. Rewards and reinforcement can help a person to initiate a behavior, as well as maintain it over time. Behavioral theory also recognizes the importance of cues and contracts in improving adherence. Continuum theories generate a large amount of research across a wide variety of behaviors and are typically successful at predicting people's motivations to adhere to health behaviors.However, they neglect behavioral factors, so they are often better at predicting people's motivations and intentions than they are at predicting behavior.
correlational studies
Correlational studies indicate the degree of association or correlation between two variables, but by themselves, they cannot determine a cause-and-effect relationship.
Observational studies
Observational studies, which parallel the correlation studies used in psychology, are two types: retrospective and prospective Retrospective studies are usually case-control studies that begin with a group of people already suffering from a disease (the cases) and then look at characteristics of these people that are different from those people who do not have that disease (the controls). Prospective studies are longitudinal designs that follow the forward development of a population or sample.
What problems do people encounter in receiving medical care?
People encounter problems in paying for medical care, and those without insurance often have limited access to health care. The U.S. government's creation of Medicare and Medicaid had helped people over 65 and some poor people with access to health care, but many people have problems finding a regular practitioner and receiving optimal health care.
Stages of Contemplation & Preparation
People in the earlier stages of contemplation and preparation are thought to benefit more from techniques that raise their awareness of a health problem, such as education or motivational interviewing. In contrast, people in the later stages of action and maintenance should benefit most from strategies that directly address behaviors.
Where do people seek medical information?
Prior to seeking medical care and information from the health care system, people often turn to other people and the Internet. The lay referral network is people's family and friends, who often help interpret the meaning of symptoms as well as suggest possible causes and cures. In recent years, the Internet is a common source of health information, although the quality of health information on the Internet varies widely. When patients find accurate and relevant health information, it can benefit the patient-practitioner relationship. However, not all patients have access to health information through the Internet or are wary of bringing up cuh information with their providers.
How did psychology become involved in health care?
Psychology has been involved in health almost from the beginning of the 20th century. During those early years, however, only a few psychologists worked in medical settings, and most were not considered full partners with physicians. Psychosomatic medicine highlighted psychological explanations of certain somatic diseases emphasizing the role of emotions in the development of disease. By the early 1970s, psychology and other behavioral sciences began to play a role in the prevention and treatment of chronic diseases and in the promotion of positive health, giving rise to two new fields: behavioral medicine and health psychology:
How does psychology research contribute to health knowledge?
Psychology has contributed to health knowledge in at least five important ways Its long tradition of techniques to change behavior An emphasis on health rather than disease Development of reliable and valid measuring instruments Construction of useful theoretical models to explain health-related research Various research methods used in psychology ***(This chapter mostly dealt with the fifth contribution)
How can scientists determine if a behavior causes a disease?
Seven criteria are used for determining a cause-and-effect relationship between a condition and a disease: 1.A dose-response relationship must exist between the condition and the disease 2.Removal of the condition must reduce the prevalence or incidence of the disease 3.The condition must precede the disease 4.The casual relationship between the condition and the disease must be physiologically plausible 5.Research data must consistently reveal a relationship between the condition and the disease 6.The strength of the relationship between the condition and the disease must be relatively high 7.The relationship between the condition and the disease must be based on the well-designed studies
ex-post facto design
Similar to experimental designs in that researchers compare two or more groups and then record the differences on the dependent variable. However, in an ex post facto study, the experimenter merelt selects a subject variable on which two or more groups have naturally divided themselves rather than create differences through manipulation.
What are stage theories of health behavior and how do they explain adherence?
Stage theories propose that people progress through discrete stages in the process of changing their behavior and that different variables will be important depending on that stage a person is in. The transtheoretical model proposes that people progress in spiral fashion through five stages in making changes in behavior:
Correlational studies
Studies designed to yield information concerning the degree of relationship between two variables.
Biopsychosocial Model
The approach to health that includes biological, psychological, and social influences.
Self-efficacy
The belief that one is capable of performing the behaviors that will produce desired outcomes in any particular situation.
Optimistic bias
The belief that other people, but not oneself, will develop a disease, have an accident, or experience other negative events.
Outcome expectations
The beliefs that carrying out a specific behavior will lead to valued outcomes.
Life expectancy
The expected number of years of life that remain for a person of a given age.
Reliability
The extent to which a test or other measuring instrument yields consistent results.
What is the intention - behavior gap, and what factors predict whether intentions are translated into behavior?
The intention- behavior gap refers to the fact that intentions are imperfect predictors of adherence. Behavioral willingness refers to a person's motivation at a given moment to engage in risky behavior and is driven largely by social pressures in a specific situation. Poor planning can also explain why intentions are not always translated into behavior. Implementation intentions are effective planning exercises that help people identify the specific situations in which they will perform a specific behavior.
Lay referral network
The network of family and friends from whom a person may first seek medical information and advice.
Punishment
The presentation of an aversive stimulus or the removal of a positive one. Punishment sometimes, but not always, weakens a response.
Prevalence
The proportion of a population that has a disease or disorder at a specific point in time
Relative risk
The risk a person has for a particular disease compared with the risk of other people who do not have that person's condition or lifestyle.
What factors predict adherence?
The severity of a disease does not predict adherence, but unpleasant of painful side effects of medication do lower adherence. Some personal factors relate to adherence, but a nonadherent personality does not exist. Age shows a curvilinear relationship, with older adults and children and adolescents experiencing problems in adhering to medication regimens,but gender shows little overall effect. EMotional factors such as stress, anxiety, and depression lower adherence. Personal beliefs are a significant factor, with beliefs in a regimen's ineffectiveness lowering adherence and self-efficacy beliefs increasing adherence. A person's life situation also affects adherence. Lower income endangers adherence; people are not able to pay for treatment or medications. Higher income levels and greater social support generally increase adherence. Individuals with a cultural background that fails to accept Western medicine are less likely to adhere. Ethnicity may also affect the treatment that patients receive from practitioners, and people who feel discriminated against adherence, so researchers must consider a combination of factors.
How do theory and measurement contribute to health psychology?
Theories are important tools used by scientists to Generate research Predict and explain research dats Help the practitioner solve a variety of problems
Continuum theories
Theories that explain adherence with a single set of factors that should apply equally to all people.
Stage theories
Theories that propose that people pass through discrete stages as they attempt to change a health behavior. Stage theories propose that different factors become important at different times, depending on a person's stage.
Illness behavior
Those activities undertaken by people who feel ill and who wish to discover their state of health, as well as suitable remedies. Illness behavior precedes formal diagnosis.
Sick role behavior
Those activities undertaken by people who have been diagnosed as sick that are directed at getting well.
How have views of health changed?
Views of health are changing, both among health care professionals and among the general public. Several trends have prompted these changes, including (1) the changing pattern of disease and death in the United states from infectious diseases to chronic diseases, (2) the increase in medical costs, (3) the growing acceptance of a view of health that includes not only the absence of disease but also the presence of positive well-being and (4) the biopsychosocial model of health that departs from the traditional biomedical model and the psychosomatic model by including not only biochemical
Clinical health psychologists
provide services, often as a part of a healthcare team.
