Health CognitionsHealth Cognitions
Bill KleinBill KleinDepartment of PsychologyDepartment of PsychologyUniversity of PittsburghUniversity of Pittsburgh
Pittsburgh Mind-Body CenterPittsburgh Mind-Body CenterSummer InstituteSummer Institute
June 5, 2008June 5, 2008
OutlineOutline OutlineOutline Health Cognitions and Physical Health Cognitions and Physical
HealthHealth Health CognitionsHealth Cognitions
Attitudes and knowledgeAttitudes and knowledge Social cognitionsSocial cognitions Perceived vulnerabilityPerceived vulnerability Perceived control/efficacyPerceived control/efficacy Behavioral intentionsBehavioral intentions Mental representations of illnessMental representations of illness Attribution and blameAttribution and blame
Cognitions and Cognitions and BehaviorBehavior
Cognitions and Cognitions and BehaviorBehavior
Leading causes of death are Leading causes of death are behavioral (e.g., smoking, alcohol behavioral (e.g., smoking, alcohol use, nutrition, high risk sex)use, nutrition, high risk sex)
Need to understand cognitions Need to understand cognitions that underlie these behaviors in that underlie these behaviors in order to change themorder to change them
Health Behavior ModelsHealth Behavior Models Theory of Planned Behavior (Ajzen & Theory of Planned Behavior (Ajzen &
Madden, 1986)Madden, 1986) Health Belief Model (Janz & Becker, 1984)Health Belief Model (Janz & Becker, 1984) Protection Motivation Theory (Rogers, Protection Motivation Theory (Rogers,
1983)1983) Stage Models: Transtheoretical Model Stage Models: Transtheoretical Model
(Prochaska, DiClemente, & Norcross, (Prochaska, DiClemente, & Norcross, 1992); Precaution Adoption Process Model 1992); Precaution Adoption Process Model (Weinstein et al., 1998)(Weinstein et al., 1998)
PBC
Subjective Norms
Attitudes
Intentions Behavior
Theory of Planned Theory of Planned BehaviorBehavior
Theory of Planned Theory of Planned BehaviorBehavior
Problems with ModelsProblems with Models Problems with ModelsProblems with Models Cross-sectionalCross-sectional Role of environmental constraints Role of environmental constraints
and temptationsand temptations Past behaviorPast behavior Interactions and paths often not Interactions and paths often not
specifiedspecified
Attitudes and Attitudes and KnowledgeKnowledge
Attitudes and Attitudes and KnowledgeKnowledge
KnowledgeKnowledge Perceived costs and benefitsPerceived costs and benefits
Framing health messages (Rothman & Framing health messages (Rothman & Salovey, 1997)Salovey, 1997)
Affective orientation toward Affective orientation toward behaviorbehavior
Cognitive dissonanceCognitive dissonance Induced hypocrisy (Stone et al., 1994)Induced hypocrisy (Stone et al., 1994)
Defensive processing of health Defensive processing of health messagesmessages Fear appeals (Hovland et al., 1953)Fear appeals (Hovland et al., 1953) Perceived threat (Croyle et al., 1993)Perceived threat (Croyle et al., 1993) Perceived credibility (Liberman & Chaiken, Perceived credibility (Liberman & Chaiken,
1992)1992) Self-affirmation (Sherman et al., 2000)Self-affirmation (Sherman et al., 2000)
Social CognitionsSocial Cognitions Social CognitionsSocial Cognitions Subjective normsSubjective norms
Injunctive vs. descriptive normsInjunctive vs. descriptive norms
Perceived prevalence/social Perceived prevalence/social comparisoncomparison False consensus and false uniqueness (Suls False consensus and false uniqueness (Suls
et al., 1988)et al., 1988) Norm misperception (Prentice & Miller, Norm misperception (Prentice & Miller,
1993)1993) Threatening social comparisons (Klein & Threatening social comparisons (Klein &
Kunda, 1993)Kunda, 1993)
Prototype perceptionPrototype perception Adolescent prototypes (Gibbons et al., Adolescent prototypes (Gibbons et al.,
1998)1998) Stereotypes (Weinstein, 1980)Stereotypes (Weinstein, 1980)
Self-presentationSelf-presentation Appearance vs. health (Mahler et al., 2003)Appearance vs. health (Mahler et al., 2003)
Perceived Vulnerability Perceived Vulnerability II
Perceived Vulnerability Perceived Vulnerability II
ConceptualizationConceptualization Perceived risk (absolute and comparative), Perceived risk (absolute and comparative),
perceived probability, perceived likelihood, perceived probability, perceived likelihood, unrealistic optimismunrealistic optimism
Role of affect (e.g., “feeling at risk” and Role of affect (e.g., “feeling at risk” and regret)regret)
Lay problems with risk estimationLay problems with risk estimation Use of probability (e.g., small vs. large, Use of probability (e.g., small vs. large,
50/50 ≠ 50%)50/50 ≠ 50%)
Perceived Risk of Breast CancerPerceived Risk of Breast CancerPerceived Risk of Breast CancerPerceived Risk of Breast Cancer
0
10
20
30
40
50
60
70
0 10 20 30 40 50 60 70 80 90 100
(Lipkus, Klein, Skinner, & Rimer, 2005)
Perceived Vulnerability Perceived Vulnerability II
Perceived Vulnerability Perceived Vulnerability II
ConceptualizationConceptualization Perceived risk (absolute and comparative), Perceived risk (absolute and comparative),
perceived probability, perceived likelihood, perceived probability, perceived likelihood, unrealistic optimismunrealistic optimism
Role of affect (e.g., “feeling at risk” and Role of affect (e.g., “feeling at risk” and regret)regret)
Lay problems with risk estimationLay problems with risk estimation Use of probability (e.g., small vs. large, Use of probability (e.g., small vs. large,
50/50 ≠ 50%)50/50 ≠ 50%) Use of heuristics (availability heuristic, Use of heuristics (availability heuristic,
base rate fallacy)base rate fallacy)
Illusory CorrelationIllusory Correlation Illusory CorrelationIllusory Correlation
Breast Breast CancerCancer
No Breast No Breast CancerCancer
High High Antibiotic Antibiotic
UseUse
88 44
Low Low Antibiotic Antibiotic
UseUse
44 22
Perceived Vulnerability Perceived Vulnerability II
Perceived Vulnerability Perceived Vulnerability II
ConceptualizationConceptualization Perceived risk (absolute and comparative), Perceived risk (absolute and comparative),
perceived probability, perceived likelihood, perceived probability, perceived likelihood, unrealistic optimismunrealistic optimism
Role of affect (e.g., “feeling at risk” and Role of affect (e.g., “feeling at risk” and regret)regret)
Lay problems with risk estimationLay problems with risk estimation Use of probability (e.g., small vs. large, Use of probability (e.g., small vs. large,
50/50 ≠ 50%)50/50 ≠ 50%) Use of heuristics (availability heuristic, Use of heuristics (availability heuristic,
base rate fallacy)base rate fallacy) Matching percentages to labelsMatching percentages to labels
EC Verbal LabelsEC Verbal Labels EC Verbal LabelsEC Verbal Labels
VERBAL VERBAL DESCRIPTORDESCRIPTOR
EC EC ASSIGNMENTASSIGNMENT
AVERAGE LAY AVERAGE LAY ESTIMATEESTIMATE
Very CommonVery Common > 10%> 10%
CommonCommon 1-10%1-10%
UncommonUncommon 0.1-1%0.1-1%
RareRare 0.01-0.1%0.01-0.1%
Very rareVery rare < .01%< .01%
(Berry, Raynor, & Knapp, 2006)
EC Verbal LabelsEC Verbal Labels EC Verbal LabelsEC Verbal Labels
VERBAL VERBAL DESCRIPTORDESCRIPTOR
EC EC ASSIGNMENTASSIGNMENT
AVERAGE LAY AVERAGE LAY ESTIMATEESTIMATE
Very CommonVery Common > 10%> 10% 65%65%
CommonCommon 1-10%1-10% 45%45%
UncommonUncommon 0.1-1%0.1-1% 17%17%
RareRare 0.01-0.1%0.01-0.1% 8%8%
Very rareVery rare < .01%< .01% 4%4%
(Berry, Raynor, & Knapp, 2006)
Perceived Vulnerability Perceived Vulnerability IIII
Perceived Vulnerability Perceived Vulnerability IIII
Relation to health outcomesRelation to health outcomes Mammography (McCaul et al., 1996): r Mammography (McCaul et al., 1996): r
= .16 across samples; r = .33 among = .16 across samples; r = .33 among women with a family history women with a family history
Condom use (Gerrard et al., 1996)Condom use (Gerrard et al., 1996) Processing health information (Radcliffe & Processing health information (Radcliffe &
Klein, 2002)Klein, 2002) Methodological concerns (Weinstein et al., Methodological concerns (Weinstein et al.,
1998)1998)
Perceived Perceived Control/EfficacyControl/Efficacy
Perceived Perceived Control/EfficacyControl/Efficacy
Control perceptions (Langer & Control perceptions (Langer & Rodin, 1977)Rodin, 1977)
Self-efficacy (Bandura, 1977)Self-efficacy (Bandura, 1977) Response efficacy (Rogers, 1983)Response efficacy (Rogers, 1983) Perceived behavioral control Perceived behavioral control
(Ajzen, 1991)(Ajzen, 1991) Health locus of control (Wallston, Health locus of control (Wallston,
1992) 1992) Biases in control perceptionsBiases in control perceptions
Illusion of control (Langer, 1975)Illusion of control (Langer, 1975) Comparative perceptions (Klein & Comparative perceptions (Klein &
Kunda, 1994)Kunda, 1994)
Drug Problem
Imagine you are making a choice between the following two drug treatments for reducing heart attack risk:
Drug A has lung-related side effects 1 out of every 100,000 times. However, when these side effects occur, they are instantly fatal. Overall, then, there is a 1 in 100,000 chance of a fatality if you take this drug.
Drug B has lung-related side effects 4 out of every 100,000 times. However, when they occur, there are measures you can take to avoid becoming a fatality. The side effects lead to death about 50% of the time. Overall, then, there is a 2 in 100,000 chance of a fatality.
Which drug do you prefer? ________
Klein & Kunda, 1994
Behavioral IntentionsBehavioral Intentions Behavioral IntentionsBehavioral Intentions Intentions (Ajzen & Madden, Intentions (Ajzen & Madden,
1986)1986) Protection motivation (Rogers, Protection motivation (Rogers,
1983)1983) Willingness (Gibbons et al., 1998)Willingness (Gibbons et al., 1998) Contemplation (Prochaska et al., Contemplation (Prochaska et al.,
1992)1992)
Illness Cognition IIllness Cognition I Illness Cognition IIllness Cognition I Illness Representations (Meyer, Illness Representations (Meyer,
Leventhal, & Guttman, 1985)Leventhal, & Guttman, 1985) Cause, consequence, timeline, Cause, consequence, timeline,
identity, controlidentity, control Acute vs. chronic illnessAcute vs. chronic illness Age differences (Gump et al., 2001)Age differences (Gump et al., 2001)
Unrealistic pessimism regarding Unrealistic pessimism regarding coping (Blanton et al., 2001); coping (Blanton et al., 2001); affective forecastingaffective forecasting
Illness Cognition IIIllness Cognition II Illness Cognition IIIllness Cognition II Attribution (Seligman, 1975)Attribution (Seligman, 1975)
Global, stable, internal attributions Global, stable, internal attributions for negative events associated with for negative events associated with earlier illness onset and mortality earlier illness onset and mortality (e.g., U. S. Presidents, Hall of Fame (e.g., U. S. Presidents, Hall of Fame baseball players)baseball players)
Characterological blame worse than Characterological blame worse than behavioral blame over time (e.g., behavioral blame over time (e.g., Glinder & Compas, 1999)Glinder & Compas, 1999)
Counterfactual thinking might Counterfactual thinking might promote less adaptive coping (Roese promote less adaptive coping (Roese & Olson, 1995)& Olson, 1995)