HEIL - Próf 1 (Kaflar: 1-2,7 & aukaefni)
Risk perception
People hold beliefs about their own susceptibility to a given problem and make judgments concerning the extent to which they are "at risk". Smokers, for example, may continue to smoke because although they understand that smoking is unhealthy, they do not consider themselves to be at risk of lung cancer. ég með lyft, segi svona
Motivation
(intrinsic and extrinsic) - Self-determination theory
Health Action Process Approach (HAPA)
- Stage model - Socio, cognition - Motivation & action stage - Self efficacy (!)
Attribution theory
- When applied to health, "health locus of control" - Controllable vs uncontrollable - Internal vs external (my failure vs the others)
Social cognition based group interventions
Step 1: Identify target behaviour and target population Step 2: Identify the most salient beliefs about the target behaviour in the target population using open-ended questions Step 3: Conduct a study involving closed questions to determine which beliefs are the best predictors of behavioural intention - Choose the best belief as the target belief Step 4: Analyse the data to determine the beliefs that best discriminate between intenders and non-intenders - These are further target beliefs Step 5: Develop an intervention to change these target beliefs
The stages of change model
The Stages of Change model was developed by Prochaska and DiClemente (1982) to describe the processes involved in eliciting and maintaining change. It is based upon the following stages: 1 Pre-contemplation: not intending to make any changes 2 Contemplation: considering a change 3 Preparation: making small changes 4 Action: actively engaging in a new behavior 5 Maintenance: sustaining the change over time *do not always occur in a linear fashion *how the individual weighs the costs and benefits of a particular behavior which is referred to as decisional balance. * has been applied to several health-related behaviors, such as smoking, alcohol use, exercise, and health screening behavior.
The Biomedical Model
The biomedical model can be understood in terms of its answers to the following 5 questions:
4) Who is responsible for treatment? (The Biomedical Model)
The responsibility for treatment rests with the medical profession
Determinants of health
Many health determinants - influencing both individuals and groups: •External determinants •Internal determinants
Perceived control and gender differences
Some research suggests that men may believe that they have less control over their health than women, which may account for why men behave in less healthy ways than women.
What would NOT increase contraception use in young people:
Teach young people that sex is private and should not be talked about
Tertiary prevention
• Actions taken to contain damage once a disease or disability has progressed beyond its early stages • Radiation therapy • Chemotherapy - Less cost-effective and less beneficial than primary or secondary prevention -However, the most common form of health care!
Primary prevention
• Health-enhancing efforts to prevent disease or injury from occurring -Wearing seatbelts, practicing good nutrition, exercising, avoiding smoking, obtaining regular health screening
Blocking
•People BLOCK emotional information •Develop resistance •Denial •Preserve integrity •'What do you know, experts are always changing their minds, that leaflet is badly designed, the font is too small'
Quantitative studies
Quantitative studies are the mainstay of more traditional forms of empirical research and involve collecting numerical data through questionnaires, experiments (or trials) or computer tasks
Strategies from learning theory
Reinforcement •Smiling, pleasure, sticker charts, praise Incentives •Getting money, saving money Associative learning •Pavlov´s dogs, Pairing healthy food with smiling people, unhealthy food with disease Modelling •Peer led videos, parents behaviour, "food dudes", social network behaviour Exposure •Past behaviour predicts future behaviour, habit formation, forced change -> Reinforcement / incentives / modelling / associative learning / exposure are behaviour change approaches from learning theory
Health beliefs and gender differences
Research indicates that men and women may have different beliefs about their health, which in turn influence their behaviors.
Models of behavior
Researchers have pulled together different beliefs to develop models of health beliefs and their impact on health behaviors as a means to frame research and interventions. - The stages of change model (Prochaska and DiClemente) - The health belief model (Rosenstock) - The protection motivation theory (Rogers) - The theory of planned behavior
Beliefs about control
Attribution theory states that people want to understand what causes events because this makes the world seem more predictable and controllable. - Health locus of control with people showing either an internal or external locus of control. Such beliefs will influence behavior.
Who is responsible for illness? (Health psychology)
Because illness is regarded as a result of a combination of factors, the individual is no longer simply seen as a passive victim. For example, the recognition of a role for behavior in the cause of illness means that the individual may be held responsible for their health and illness.
Whats involved in being critical?
Being critical involves asking questions about all aspects of methodology.
CBT: Cognitive Restructuring
Changing cognitions Disfunctional beliefs •Selective abstraction: "Eating cake is the only way I can unwind after work" •Dichotomous reasoning: "If I am not in complete control I will lose all control" •Overgeneralization: "I failed last night so I will fail today as well" •Magnification: "Cutting out cake will push me over the brink" •Superstitious thinking: "If I do exercise I will have another heart attack' •Personalization: "They were laughing, they must be laughing at me"? Socratic questions Searching for evidence •"What evidence do you have to support your thoughts?"; •"How would someone else view this situation?"; •"When you say 'everyone' who do you mean?"; •"When you say 'all the time' can you think of times when this is not the case?"
CLINICAL PSYCHOLOGY VS. HEALTH PSYCHOLOGY
Clinical psychologists - mental health with an emphasis on mental health conditions such as anxiety, depression, psychosis, eating disorders, self-harm and obsessive compulsive disorder (OCD). CP can also be trained in health psychology. Treatment: CBT, family therapy, psychotherapy Health psychology - addresses physical health problems such as obesity, diabetes, cancer, heart disease, asthma and HIV/AIDS. Treatment: sense making, illness cognitions, appraisal, social support, beliefs and behaviour change to understand illness onset and progression and to develop interventions to improve patient health
Protection motication theory
Cognisocial theory self efficacy extension to health belief model
Transtheoretical Model
Core constructs: - Stages of Change (5 steps - (if termination = 6) - Processes of Change (10 factors) - Decisional Balance (2 factors) - Self-Efficacy (2 factors)
What best describes our current focus on sex research?
Sex is a risk for pregnancy and STDs
What's NOT a problem when trying to do research into sexual behaviour?
Sexual behaviour is an interaction between people - much research focuses on individual cognitions
The Example of Eating Behavior
Eating behavior has been studied using three key theoretical approaches which can also be applied to all other health behaviors - Cognition models - The developmental model - Social learning - Associative learning
What are health behaviors?
Health behaviors are regarded as any behavior that is related to the health status of the individual. These can be behaviors that have a negative impact on health
Who is responsible for treatment? (Health psychology)
- Because the whole person is treated, as compared to just their physical illnesses, the patient is in part responsible for their treatment. - This may take the form of responsibility to take medication and responsibility to change beliefs and behavior. They are not seen as a victim.
In summary of behavior change
- Behavior is central to health and illness and is clearly linked to the beliefs we hold. - Psychology has identified a number of beliefs to predict behavior and then pulled these together into models which can be used for research and to design behavior change interventions. - Eating behavior is a key behavior.
Health psychology
- Biological, psychological, social factors - Health as a continuum - Holistic approach - Health promotion - Behaviour change interventions - Focus on individuals, small groups
Health promotion (Public health)
- Biological, psychological, social factors - including physical environmental factors - Health as a continuum - Holistic approach - Health promotion - Behaviour change interventions - Focus on larger-scale population and community levels - Health Promotion is the process of enabling people to increase control over, and to improve their health
A focus on variability (The Four Key Theoretical Frameworks)
- Biomedicine tends to focus on knowledge as a predictor of behavior ("I know smoking kills") and disease as a predictor of health outcomes ("I have cancer and therefore will die"). - Health psychology argues = more variability between people than this and this variability is our focus. For example, two people might both know that smoking is bad for them but only one stops smoking. Similarly, two people might find a lump in their breast but only one goes to the doctor.
Self- efficacy
- Confidence / skills - Personal belief that they manage a health behaviour change
Social norms and gender differences
- Each society has social norms of masculinity and femininity which relate to the ways in which people behave. - In contemporary societies concern for health is often considered a feminine characteristic while "men are positioned as naturally strong, resistant to disease, unresponsive to pain and physical distress, and unconcerned with minor symptoms" (Lee and Owens, 2002)
Health psychology evaluation?
- Evaluating the role of behaviour on illness for example coronary heart disease is related to behaviours such as smoking, food intake and lack of exercise. - Predicting unhealthy behaviors - Evaluating the interaction between psychology and physiology - Understanding the role of psychology in the experience of illness. - Evaluating the role of psychology in the treatment of illness - Theory into practice
Health and illness as a continuum (The Four Key Theoretical Frameworks)
- Health Psychology emphasizes health and illness as being on a continuum and explores the ways in which psychological factors impact health at all stages.
What is the role of psychology in health and illness?
- Health psychology regards psychological factors not only as possible consequences of illness, but as contributing to it at all stages along the continuum from healthy to ill.
Health in a wider perspective
- Interplay between people and the environment - We do not live in this world as individuals, we belong to a community, both micro- and macro-environment ... groups of some sort ... - We have to consider things in context, coherence - Policy making has influence on our health - Actions in one place can influence living beings and the environment elsewhere - Advertisements ... social media ... intended to influence and change norms and behaviour - Laws and regulations can also change norms
Health behavior
- Kasl and Cobb (1966) defined 3 types of health-related behavior. - A health behavior aimst to prevent disease (diet) - Illness behavior aims to seek remedy (going to the doctor) - A sick role behavior aims at getting well - Health impairing habits: smoking, unhealthy food etc - Health protective behaviors: attending a health check
Knowledge vs beliefs
- Knowledge is important and plays a role in how we behave - But, to change a behaviour, knowledge is not enough - What people belief is more important - Health beliefs are the key predictors of behaviour - Included in most theories/models of health
Cognitive theory
- Leads to cognitive behaviour therapy (CBT) and relapse prevention Emphasises: •Links between thoughts and feelings •Therapy, a collaboration between patient and therapist •Patient as scientist, the role of experimentation •Self monitoring •Regular measurement •Setting an agenda each session •Treatment is learning a set of skills •Therapist is not the expert who will teach the patient how to get better •Regular feedback by patient and therapist
Finding differences in our theories
- Many theories also look for differences between populations (e.g. men versus women; old versus young; doctor versus patient). - Are the variables that we use to explore differences (men versus women; old versus young) really dichotomous variables or artificially created as binary variables - The answer depends on the question asked and the statistical test used.
Why study health behaviors?
- McKeown (1979) examined health and illness throughout the twentieth century and argued that contemporary illness is caused by 'influences - More recent data support this emphasis on chronic illnesses which are related to behaviour.
The intention-behavior gap
- Models predict 40-50% of variance in intentions - Models predict only 19-38% of actual behaviour => Intention-behaviour gap - If added, narrows gap:, Past behaviour, Habit •Bridging gap by -Implementation intentions = make a plan! -The plan describes the 'what' and 'when' of a behaviour -I will have a healthy lunch tomorrow at 12.30' (an example of a part of a plan)
What is a theory?
- Most health promotion theories come from behavioural and social sciences - Systematically organised knowledge applicable in a relatively wide variety of circumstances devised to analyse, predict, or otherwise explain the nature or behaviour of a specified set of phenomena that could be used as the basis for action
When choosing a theory
- No single theory dominates health promotion practice, and nor could it ... or should it - Consider the „area of change" - individual, community, communication strategy, organisations, public policy
Coping mechanisms and gender differences
- One central component to current social norms of masculinity is the focus on men not sharing their emotions or asking for help when they are feeling upset - whereas women are permitted to cope in more emotional ways. - men express more anger and hostility than women. - negative emotions may be linked to cardiovascular disease
How was health psychology developed?
- Over the twentieth century = the mind and body were more connected than assumed by the biomedical model - As a result, health psychology was developed, which can be understood in terms of the same 5 questions that were asked of the biomedical model: what causes illness, who is responsible, how should illness be treated, who is responsible for treatment, What is the role of psychology in health and illness?
Health belief models
- Overcoming perceived barriers to successful action = most important element of HBM - Perceived susceptibility and perceived benefits are also important elements - Limitations; HBM is a psychosocial model which accounts for variance in individual´s health behavior explained by their attitudes and beliefs, but other forces influence health as well! - HBM most useful when applied to behaviours for which it was orginally developed, screening and immunisation - Useful to improve knowledge and change beliefs
Individual beliefs about behavior
- People hold many different types of beliefs which influence their behavior. - Here are some of the key ones.: attitudes, beliefs about control, risk perception, beliefs about confidence
Gender Differences in Physical Symptoms
- Research has also highlighted gender differences for physical symptoms and shows that women are more likely to suffer from feeling tired, headaches, constipation, fainting and dizziness, and kidney or bladder problems - no gender differences in eye problems, ear problems, colds and flu, catarrh, coughs, and palpitations..
Conclusion - gender differences
- Research indicates consistent gender differences in physical illness and symptoms. But the data is not always straightforward with women experiencing more symptoms and illness than men, yet they tend to live longer. - explanations for these differences including biology, health behaviors, help-seeking behavior, health beliefs, social norms, and coping. - All factors illustrate the role of psychology in health and illness and indicate that although men and women are biologically different, psychological factors also play a key role in their health.
Gender differences in illness
- Research indicates several gender differences in disease. In particular, women are more likely to be obese than men and diagnosed with arthritis, piles, back problems, depression, migraines, varicose veins, and high blood pressure. - In contrast, men are more likely to be diagnosed with lung cancer, HIV / AIDS, and digestive disorders - women tend to live longer than men, but that over recent years the gap between men and women is gradually closing - Research also suggests that there are no gender differences in diabetes, hernia, epilepsy, respiratory problems, asthma, and CHD
The Protection Motivation Theory
- Rogers (1975, 1985) developed the Protection Motivation Theory - expanded the HBM to include additional factors, particularly fear as an attempt to include an emotional component into the understanding of health behaviors. The PMT describes health behaviors as a product of five components: 1 Severity (e.g. "Bowel cancer is a serious illness"). 2 Susceptibility (e.g. "My chances of getting bowel cancer are high"). 3 Response effectiveness (e.g. "Changing my diet would improve my health"). 4 Self-efficacy (e.g. "I am confident that I can change my diet"). 5. Fear (e.g. an emotional response "I am scared of getting cancer")
Integrating the Individual with their Social Context
- Social epidemiology (i.e. the exploration of class, gender and ethnicity) - social psychology (i.e. subjective norms) or social constructionism (i.e. qualitative methods). - Therefore health psychologists access either the individual's location within their social world via their demographic factors or ask individuals for their beliefs about the social world.
TPB in contrast to the HBM and the PMT
- TPB attempts to address the problem of social and environmental factors (in the form of normative beliefs). - It also includes a role for past behavior within the measure of perceived behavioral control. - the TPB has also been subjected to criticisms in terms of its constructs, the methods used to test the TPB and the extent to which it can predict behavior
More about SOC
- The five steps are not necessarily linear, people can jump back and forward between stages - Accounts for individual differences; some are more ready than others to change behavior - Different approaches at different stages
How should illness be treated? (Health psychology)
- The whole person should be treated, not just the physical illnesses that have taken place. - This can take the form of behavior change, encouraging changes in beliefs and coping strategies, and compliance with medical recommendations.
Why use a theory?
- Theory can help achieve a better fit between problem and program - Help us understand better the nature of the problem being addressed - Describe and explain the needs and motivations of the target population - Explain or make propositions concerning how to change health status, health-related behaviours and their determinants and - Inform the methods and measures used to monitor the problem and the program
The study of psychology of health and illness has the following aim
- To assess the role of behavior in the development of illness - To predict unhealthy behaviors - To change unhealthy behaviors - To understand the experience of illness - To improve the experience of illness - To understand the predictors of illness outcomes - To improve illness outcomes
Salutogenesis
- Views health and disease as a continuum and focuses on the conditions leading to wellness (Antonovsky, 1996) - Designed to reduce entropy (chaos) and generate a sense of coherence - Three main elements: Comprehensibility, Manageability and Meaningfulness - Sense of coherence = to find harmony and purpose with life and have the feeling of belonging to a group, community
Theory of planned behavior
- Was extensively used to examine predictors of behavior and was central to the debate within social psychology concerning the relationship between attitudes and behavior - Ajzen and colleagues
Do men and women show different mortality rates ?
- Yes. - Men and women show different mortality rates and vary in terms of specific illnesses and physical symptoms. - women seem to get more symptoms and illnesses than men, but yet live longer. - men die younger, less contact with health care services, less likely to see a doctor, have fewer hospital admissions, and are less likely to have a screening test or a general health check. - women are more likely to be diagnosed with depression, men are about four times more likely to die from suicide than women - possible reasons for these gender differences including biological factors, health behaviors, risk behaviors, help-seeking behavior, social norms and coping mechanisms.
The biopsychosocial model (The Four Key Theoretical Frameworks)
- biopsychosocial model was developed by Engel (1977) - and represented an attempt to integrate the psychological (the "psycho") and the environmental (the "social") into the traditional biomedical (the "bio")
Basics of the Theory of Planned Behavior
- developed from theory of reasoned action emphasizes behavioral intentions as the outcome of a combination of several beliefs. - The theory proposes that intentions should be conceptualized as "plans of action in pursuit of behavioral goals" - relationships among attitudes and behavior
Biological factors (gender differences)
- estrogen improves lipid profiles and can protect against cardiovascular disease, and the general robustness of females illustrated by the higher neonatal death rate of male babies compared to female babies - in evolutionary terms, women may need to be stronger than men to survive childbirth and whereas maternal mortality reduced women's life expectancy in the past, now the risk of dying during labor is much reduced.
The mind-body split
- holistic approach to health - it challenges the traditional medical model of the mind-body split and provides theories and research to support the notion of a mind and body that are one. - For example, it suggests that beliefs influence behaviour, which in turn influences health; that stress can cause illness and that pain is a perception rather than a sensation.
Risk perception and gender differences
- men appear to underestimate their risk for illness or injury compared to women - believe that they are less at risk from smoking, drug or alcohol use, skin cancer from sun damage, and HIV from unsafe sex. - Men also rate the risks of dangerous driving lower than women do.
Risk-Taking behaviors (gender differences)
- men show more risky behaviors. - Men also have more sexual partners than women, are more likely to take part in high-risk sports and leisure activities such as rugby, snowboarding, sky diving, bungee jumping, and rally driving. These risky behaviors are reflected in higher rates of accidental injury and death amongst men.
Role of health behaviors in gender differences
- much research indicates that men are more likely to carry out unhealthy behaviors than women - Men also show less motivation to engage in lifestyle changes than women and many older men believe it is "too late" to change - following divorce or widowhood, men show a greater deterioration in their diet, and increased use of alcohol and drugs, than women. - the only health-related behavior that men consistently perform more than women is physical activity.
Theory of planned behavior results of what beliefs?
- results of the following beliefs: * Attitude towards a behavior, which is composed of either a positive or negative evaluation of a particular behavior and beliefs about the outcome of the behavior (e.g. "exercising is fun and will improve my health"). * Subjective norm, which is composed of the perception of social norms and pressures to perform a behavior and an evaluation of whether the individual is motivated to * Perceived behavioral control, which is composed of a belief that the individual can carry out a particular behavior based upon a consideration of internal control factors (e.g. skills, abilities, information) and external control factors -> these three factors predict behavioral intentions, which are then linked to behavior. TPB also states that perceived behavioral control can have a direct effect on behavior without the mediating effect of behavioral intentions.
What theories does health psychology use?
- stages of change model (SOC) - theory of planned behavior (TPB) - COM-B
The health belief model
-Rosenstock and further by Becker and colleagues 70s-80s. - Over recent years, the Health Belief Model has been used to predict a wide variety of health-related behaviors. - Result of core beliefs, HBM suggests that it should be used to predict the likelihood that a behavior will occur - Criticism: the absence of the role for past behavior and habit; and the absence of a role for emotional factors such as fear and denial. But the HBM has been a useful approach for carrying out research and designing interventions.
Why do health psychologists consider health and illness to be on a continuum?
-They emphasize health and illness being on a continuum and explores the ways in which psychological factors impact health at all stages - Continuum psychology is involved in illness onset (e.g. beliefs and behaviours such as smoking, diet, alcohol intake and stress). -Once a person becomes ill, psychology is also involved in illness adaptation (e.g. help seeking, coping, pain, social support, behaviour, illness beliefs and adherence) and then as illness progresses towards illness outcomes psychology also plays a role & also plays a role in quality of life, longevity, behaviour and adherence.
What methods are used in health psychology?
-qualitative and quantitative - and range of research designs; cross sectional, experiments, cohort studies
The direct and indirect pathways between psychology and health (The Four Key Theoretical Frameworks)
Health psychologists consider both a direct and indirect pathway between psychology and health. Direct pathway = the way a person experiences their life (I am feeling stressed) has a direct impact on their body, through changes in their physiology which can change their health status Indirect pathway = the ways a person thinks ("I am feeling stressed") influences their behavior ("I will have a cigarette") which in turn can impact upon their health.
SOC
1.Precontemplation: no intention to take action within the next 6 months - this step describes individuals who are not even considering changing behaviour, or are consciously intending not to change 2.Contemplation: intends to take action within the next 6 months - the stage at which a person considers making a change to a specific behaviour 3.Preparation (determination): intends to take action within the next 30 days and has taken some behavioral steps in this direction - the stage at which a person makes a serious commitment to change 4.Action: Changed overt behavior for less than 6 months - the stage at which behaviour change is initiated 5.Maintenance: Changed overt behavior for more than 6 months - sustaining the change and achievement of predictable health gains. Relapse may also be the fifth stage. 6.Termination: No temptation to relapse and 100% confidence - not many that belief in this stage!
Health beliefs
Health psychologists have therefore attempted to understand and predict health-related behaviors by studying health beliefs. For example the belief that exercise is beneficial should be associated with increased physical activity - Health psychologists study what people believe and whether this relates to how they behave and if it can be changed
What percentage of bisexual men reported always using a condom with their current male partner?
25%
Working in health psychology
A clinical health psychologist has been defined as someone who merges 'clinical psychology with its focus on the assessment and treatment of individuals in distress ... and the content field of health psychology'
Theory of reasoned action
A theory suggesting that the decision to engage in a particular behavior is the result of a rational process in which behavioral options are considered, consequences or outcomes of each are evaluated, and a decision is reached to act or not to act. That decision is then reflected in behavioral intentions, which strongly influence overt behavior.
Health psychology is the study of
A) psychological influences on why some people stay healthy and others don't. B) interventions to help people stay healthy or become healthier. C) why some people respond to illness in healthy ways and others, when they become ill, do not behave healthily.
Does health psychology challenge the assumptions of the biomedical model of health and illness?
Health psychology challenges the mind-body split by suggesting a role for the mind in both the cause and treatment of illness, but differs from psychosomatic medicine and behavioural medicine in that research, within health psychology is more specific to the discipline of psychology.
What is health psychology aim, explanation and development ?
Health psychology emphasizes the role of psychological factors in the cause, progression and consequences of health and illness. The aims of health psychology can be divided into (1) understanding, explaining, developing and testing theory, and (2) putting this theory into practice.
Stage models
Health psychology uses a number of stage models such as the SOC. We need to ask: Are the different stages qualitatively separate from each other? Are stages real or a product of statistic? Are stages an artefact of labelling them as such?
Qualitative studies
Health psychology uses a range of qualitative methods such as focus groups and interviews and applies different data analysis approaches such as thematic analysis, interpretative phenomenological analysis (IPA) or narrative analysis. - Larger samples
The academic health psychologists
An academic health psychologist usually has a first degree in psychology and then completes a master's in health psychology and a PhD in a health psychology-related area.
The background to health psychology
An increasing role for psychology in the cause and treatment of illness: - Psychosomatic medicine; the first challenge to the biomedical model - Behavioural medicine; included prevention and intervention, challenged the separation of the mind and the body - Health psychology; the most recent development, research specific to health psychology
Key theories in health psychology to underping research and test interventions
Theories are used to underpin research and frame and test interventions. Health psychology 'steals' its theories from other psychological perspectives. - it uses learning theory with its emphasis on associations and modelling - social cognition theories with their emphasis on beliefs and attitudes - stage theories with their focus on change and progression - decision-making theory - highlighting a cost-benefit analysis - the role of hypothesis testing - and physiological theories with their interest in biological processes and their links with health - > it utilizes many key psychological concepts such as stereotyping, self-identity, risk perception, self-efficacy and addiction..
What is NOT a valid criticism of most school based sex education programmes:
They do not provide enough information about contraception
Mr.A: The example of lung cancer
This case illustrates many psychological constructs including health beliefs, peer pressure, reinforcement, benefits of a behavior, social norms, habit, illness beliefs, risk perception, help-seeking, delayed help-seeking, doctor decision making, adherence, Quality of Life, and health outcomes
The need to change behavior
To prevent illness - Primary prevention -obesity, CHD, HIV, diabetes, cancer To improve well being - Primary prevention -Pain, tiredness etc. To reduce physical symptoms - Secondary prevention -Pain, tiredness etc. To treat illness - Tertiary prevention -obesity, CHD, HIV, diabetes, cancer Effortful vs. Effortless -Individual - Public Health interventions
What is health behaviors generally regarded as, in health psychology?
In health psychology, health behaviours are generally regarded as any behaviour that is related to the health status of the individual.
Beliefs about confidence
Individuals also hold beliefs about their ability to carry out certain behaviors. Bandura (1977) has termed this self-efficacy to reflect the extent to which people feel confident that they can do whatever it is that they wish to do. A smoker, for example, may feel that she should stop smoking but has very little confidence that she will be able to do so
Subjective measures
It is acknowledged that self-report measures such as questionnaires and interviews are subjective. This raises problems such as: - Are participants just saying what they believe the researcher wants them to say? - Does the participant have the language and insight to express what they really feel? - Can people really differentiate their feelings, beliefs or behaviours into the level of detail expected by numerical scales with 5 or 7 or even 100 options
What is the WORST predictor of condom use:
Knowledge about pregnancy risk
Finding associations in our theories
Many of our theories argue that different constructs are associated with each other (e.g. self-efficacy predicts behavioural intentions; control-related illness cognitions predict coping). We need to ask: Are these associations true by definition? Are the associations true by observation?
The health psychology practitioner
Trained to an acceptable standard in health psychology and works as a health psychologist. - Within the UK, the term 'health psychologist' is now used and is managed by the Health Care Professions Council. Across Europe, Australasia and the USA, the term 'professional health psychologist' or simply 'health psychologist' is used.
Help seeking behavior & gender differences
Men = delayed help-seeking which could contribute to gender differences in life expectancy and causes of mortality if men wait until their illness has progressed before accessing medical care.
Objective measures
Most measures still involve the possibility of human error or bias through coding, choosing what to measure and when, and deciding how the data should be analysed.
Is the biopsychosocial model a useful perspective?
One reason why the biopsychosocial perspective is so useful is because it explains how some people who are seemingly "healthy" can get mental illnesses and why some are more prone to mental illness than others
Attitudes
We hold attitudes about many aspects of life. For example, we may have an attitude that exercise is boring, that smoking is relaxing, that eating vegetables is healthy, that using a condom takes the fun out of sex, that going to the doctor is embarrassing and that alcohol is good for stress. These attitudes will clearly change and shape how we behave. (dont be silly wrap your willy)
5) What is the role of psychology in health and illness? (The Biomedical Model)
Within traditional biomedicine, illness may have psychological consequences, but not psychological causes. For example, cancer may cause unhappiness, but mood is not seen as related to either the onset or progression of cancer.
Epidemic
a disease that affects a large number of people within a community, population, or region
Pandemic
an epidemic that is spread over multiple counties or continents •The Black Death - 1350 •Russian Flu - 1889 •Spanish Flu - 1918 •Asian Flu - 1957 •HIV/AIDS - 1981 •SARS - 2003 •COVID-19 - 2019
Health psychologists address the relationship between psychology and health by
both direct and indirect pathways that contribute to health status.
TPB has been used to predict wide range of behavior, including?
condom use in both gay and heterosexual populations - blood donation for blood transfusion and organ donation - smoking - exercise during pregnancy - walking - speeding behavior using a driving simulator - deliberate self-harm, and suicidality.
What factors could explain variability between people in terms of their behavior and health outcomes?
coping, social norms, social support, cognitions, emotions, peer pressure, expectations, learning
1) What causes illness? (The Biomedical Model)
diseases either come from outside the body, invading the body and causing physical changes within the body, or originate as internal physical changes. Such diseases may be caused by several factors such as chemical imbalances, bacteria, viruses, and genetic predisposition.
Doll and Peto (1981)
estimated the contribution of different factors as a cause of all cancer deaths and concluded that tobacco consumption accounts for 30% of all cancer deaths, alcohol for 3%, diet for 35%, and reproductive and sexual behavior for 7%. From this estimate, approximately 75% of all deaths from cancer can be attributed to behavior.
What is the focus of health psychology?
focuses on the role of psychology at all stages of health and illness. In particular, it draws upon the biopsychosocial model of health, health as a continuum, the direct and indirect pathways between psychology and health, and a focus on variability. = 4 theoretical theories
The 4 key theoretical frameworks
form the basis of health psychology and reflect the emphasis on psychology as having a role at all stages of being healthy and becoming ill. These frameworks can be illustrated by the case example of Mr. A.
The biopsychosocial model of health believes that:
health and illness are influenced by a variety of factors other than reductionistic explanations.
What is the study of Health psychology?
health psychology is the study of the role of psychology in any physical health problem including coughs and colds, cancer, coronary heart disease, HIV, obesity, and diabetes. It is best understood by comparing it to the more traditional biomedical model using 5 simple questions as follows: 1. What causes illness 2. Who is responsible for illness? 3. How should illness be treated? 4. Who is responsible for treatment? 5. What is the role of psychology in health and illness?
Health psychologists study:
how one achieves health through attention to biological, psychological and social needs.
The biopsychosocial model of health and illness
identifies (1) biological (genetics, virueses, bacteria) , 2) psychological (emotions, behavior) , and 3) social factors (norms) that combine in a continuous loop, resulting in health or illness
TPB applied to alcohol consumption
if an individual believed that reducing their alcohol intake would make their life more productive and be beneficial to their health (attitude to the behavior) and believed that the important people in their life wanted them to cut down (subjective norm), and they believed that they were capable of drinking less alcohol due to their past behavior and evaluation of internal and external control factors (high behavioral control), then this would predict high intentions to reduce alcohol intake (behavioral intentions).
The biomedical model of health believes that:
illness can be explained mainly on the basis of disordered cells and chemical imbalances.
2) Who is responsible for illness? (The Biomedical Model)
illness is seen as arising from biological changes beyond their control, individuals are not seen as responsible for their illness. They are regarded as victims of some external force causing internal changes.
Health behaviors
in terms of smoking, drinking alcohol, diet, sleep, and exercise are important predictors of health and illness.
Perceived health status and gender differences
men die younger than women and tend to seek help at a later stage of disease - research indicates that men rate their subjective health status as higher than women rate theirs -Men, therefore, show a profile of health beliefs which may contribute to behaving in less healthy ways and in turn having shorter life expectancy than women.
Health belief model (HBM)
model for explaining how beliefs may influence behaviors
The biopsychosocial model of health makes the relationship between patient and practitioner:
most important, since the patient is considered a team member in the decision-making processes
What causes illness? (Health psychology)
that human beings should be seen as complex systems and that illness is caused by a multitude of factors and not by a single causal factor. & attempts to move away from a simple linear model of health and claims that illness can be caused by a combination of biological (e.g. a virus), psychological (e.g. behaviors, beliefs) and social (e.g. social support) factors.
What problems are there with dividing up the pathways into indirect and direct pathways?
there is also variability between people
A leap of faits
this process involves an enormous leap of faith - that our measurement tool actually measures something out there. -> Likewise, a quality of life scale may not assess quality of life but simply how someone completes the questionnaire.
3) How should illness be treated? (The Biomedical Model)
treatment in terms of vaccination, medication, chemotherapy, and surgery, all of which aim to change the physical state of the body
Constructs in health psychology
uses a wide range of constructs such as coping, illness beliefs, perceived control, quality of life, depression and anxiety. We need to ask whether these constructs are meaningful and discrete. For example: Is 'I feel depressed' an emotion or a cognition? can it cause poor quality life?
Does TPB predict behavior with the influence of intentions?
yes
Secondary prevention
• Actions taken to identify and treat an illness or disability early in its occurrence -Monitoring symptoms, taking medication, dietary changes, following treatment regimens
Worldwide the following gender differences have been shown:
• World wide women live three years longer than men. This varies across regions • In Eastern Europe = 11 years longer than men • In the UK= 4 years more than men. It is 6 years more in the U.S.A. • In Australia, indigenous men live on average 23 years less than nonindigenous women and 19 years less than nonindigenous men • In Eastern Europe, women live on average 11 years more than men • In Afghanistan, men live on average 1 year longer than women • Men are twice as likely to develop and die from the ten most common cancers which affect both men and women • Although coronary heart disease is a leading cause of death for both men and women, men die younger from this illness than women • Of those who die from a heart attack in the U.S.A. under the age of 65, nearly 75% of these are men.
Fear appeals
•1. Fear arousal: •There is a threat: 'Heart disease' , 'diabetes' •You are at risk: 'being overweight puts you at risk of MI' •The threat is serious: 'MI kills' •2. Safety conditions: •A recommended protective action: 'eat less', 'do more exercise' •The action is effective: 'eating a healthy diet helps protect against MI' •The action is easy: 'healthy eating is easy and cheap'
Relapse prevention techniques from CBT
•Addictive behaviours are learned and therefore can be unlearned •Addictions are not "all or nothing" but exist on a continuum •Lapses from abstinence are likely and acceptable •Believing that "one drink - a drunk" is a self-fulfilling prophecy •Lapse (a minor slip) - Relapse (return to former behaviour) •The process from abstinence to lapse to relapse •Important to identify high-risk situations •External cues (someone else is smoking) •Internal cues (anxiety) •Most common high-risk situations are •Negative emotions •Interpersonal conflict •Social pressure •Important to have planned good coping strategies and •negative outcome expectancies (e.g., getting drunk will make me feel sick) •Will raise self-efficacy => No lapse
PER
•Background factors that predispose, enable and reinforce certain lifestyle and environment elements •Predisposing factors; personal factors that influence motivation to change, such as knowledge, beliefs, attitudes, values •Enabling factors; factors that support change in behaviour or environment, such as resources and skills, and also any barriers •Reinforcing factors; the feedback received from adopting the behaviour
Social cognition theory
•Emphasizes expectancies (beliefs), incentives (reinforcements) and social cognitions (subjective norms) •HBM and TPB are social cognition models •To change cognitions as a means to change subsequent behaviour and to close the intention-behaviour gap
Global warming
•Greenhouse gases from human activities are responsible for around 1.1 °C of the warming since 1850 •The warming differs •larger over land compared to the global average •> twice as high in the Arctic compared to the average •Will increase with additional warming •The effects •Increasing heat waves •Longer warm seasons •Shorter cold seasons
IPCC report 2021
•Intergovernmental Panel on Climate Change •Report: Climate Change 2021 - The Physical Science Basis •Changes seen in every region on Earth •Many have never been seen before •Some are irreversible •Emissions of carbon dioxide (CO2) and other greenhouse gases •Strong and sustained reductions would limit climate change •Short term benefits - Long term benefits
Helpful techniques from CBT
•Keep a diary - similar to the description tables and charts used in the project •Gradually try out new behaviours •Cue exposure - Define triggers and practice coping techniques (exposure) •Relaxation techniques - music, body scanning meditation - Reduces anxiety and negative thoughts •Distraction techniques - to manage anxiety or prevent a relapse •Distorted cognitions - a vicious cycle between thoughts and behaviour - replace them with more helpful ones - Cognitive restructuring •Awareness-Beliefs-Challenge-Delete-Evaluate - the ABCDE system - to change cognitions and promote behaviour change, for example in chronic illnesses
Preventing lapse turning into relapse
•Self-monitoring - what do I do in high-risk situations? •Relapse fantasies - what would it be like to relapse? •Relaxation training / Stress management •Skills training - how will I say NO to a drink? •Contingency contracts - when offered a cigarette I will ... •Cognitive restructuring - learning not to make internal attributions for lapses
The transition from a lapse to a relapse = AVE
•The transition is determined by dissonance conflict and self-attribution •Dissonance: a conflict between a self-image and current behaviour •Conflict maximized: disease model of addictions - emphasizes "all or nothing" •Conflict minimized: social learning model - likelihood of lapses is acknowledged •Important to understand the cause of the lapse •If a lapse is attributed to the self (e.g., I am useless, it´s my fault) => guilt, self-blame => lower self-efficacy => increasing changes of a full-blown relapse •If a lapse is attributed to the external world (e.g., situation, presence of others) => guilt and self-blame is reduced => increased chances of a lapse remaining a lapse
Definition of health
•To be without disease •Ability to tackle life; vitality, resilience •"A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (WHO, 1948) •Health is a resource for everyday life, not the object of living. It is a positive concept emphasizing social and personal resources as well as physical capabilities (WHO, 1986)
Changing behavior is a skill
•You can practice - train to get automatic - you will get better •Start small - most start too big - create tiny habits •Consistency - every day ... every other day ... •Concentrate on one thing, don´t try to change everything at once •Involve supportive people around you •Change the environment •Motivation - Ability - Trigger (call for action) •Turn a behaviour into a habit
