health psychology jette hannibal - inthinking. health psychology health psychology is a relatively...

Health Psychology

Jette Hannibal - Inthinking

Health Psychology

Health psychology is a relatively new field. It attempts to integrate medicine and psychology.

Definition of health psychology (Matarazzo 1980) Health psychology is the “aggregate of the

specific educational, scientific and professional contribution of the discipline of psychology to the promotion and maintenance of health, the promotion and treatment of illness and related dysfunction.”


Definitions of Health

Health is a state of complete physical, mental and social well-being, and not merely the absence of disease and infirmity (WHO, 1946).

The Biopsychosocial Model of health and illness argues that different systems are linked together, e.g. the ecological system, social systems, psychological systems, biological systems and physical systems.


The Biopsychosocial Model

Integration of various factors in explanation of mental and physical health. • Employment (social)

• Social support (social)

• Perceptions of control and self-efficacy. Beliefs and attitudes among other cognitive factors.

• Illness - physiological and/or psychological disorders.


Culture and Health

Cross-cultural health psychology deals with how culture influences health – for example, how different cultures define illness and express it.

Chinese have a tendency to express psychological problems somatically

Horton (1971) described how traditional medical treatments in Africa focus on social factors even when diagnosing infectious diseases (e.g. casting spells).

Taylor et al. (2004) found that social support as a coping strategy was more used by American than Korean students.


Biomedical vs biopsychosocial

Biomedical model Reductionist: explains illness by

simplest possible process (e.g. disordered cells)

Single-factor causes: looks for the cause of illness rather than contributory factors (e.g. looking for a genetic explanation of alcoholism or smoking)

Focus on illness (not health) People not responsible for illness

Biopsychosocial model Holistic: looks at all levels of

explanation from micro-level (e.g. biochemical changes in the body) to macro-level (e.g. the culture that you live in).

Does not look for single-factor causes: multi-factorial model assumes that health and illness have many causes and can produce many effects.

Does not focus exclusively on illness: assumes that the continuum between health and illness must be analysed as a system (system theory approach).

People’s behaviour influences health (responsibility) and people can change behaviour.

This approach assumes that illness is to a large extent based on lifestyle factors which can be changed so that people can become healthier.

This approach assumes that illness is to a large extent based on lifestyle factors which can be changed so that people can become healthier.


The Health System

Biological factors Genetic Viruses Hormones & neurotransmitters

Psychological factors Cognitions (beliefs,

expectations) Emotions (e.g. fear of

treatment) Behaviours (smoking, alcohol

consumption, unsafe sex) Perception of Stress and

pain

Social and cultural factors Social norms of behaviour

(e.g. smoking/not smoking) Pressures to change (e.g.

peer group expectations, parental pressure)

Social values on health Social class /social status Cultural norms Ethnicity (culture) Employment

Integration of various factors provides a more holistic approach to understanding health issues such as smoking, stress and obesity

Integration of various factors provides a more holistic approach to understanding health issues such as smoking, stress and obesityJette Hannibal - Inthinking

The aim of health psychology

Evaluate the role of behaviour in the onset (etiology) of illness e.g. link between stress and coronary heart disease, smoking and cancer, lack of exercise and illness.

Explain how lifestyles such as smoking, excessive alcohol intake, high-fat diets and stress start, how they are related to health and develop models for behavioural change.

Understand the role of psychological factors in the experience of stress and illness: e.g. coping and depression

Evaluate the role of psychological factors in health behaviour. Promote health behaviour; e.g. change beliefs and behaviour

but also promote factors that encourage healthy lifestyles (e.g. remove escalators, ban tobacco advertising).

Prevent illness: e.g. interventions and health promotion


Addictive behaviour: smoking

Biological factors: nicotine is an addictive substance. People who are addicted to nicotine experience withdrawal symptoms if they don’t get nicotine. Nicotine stimulates the release of adrenaline and dopamine (arousal and pleasure). Di Franza et al. (2006) found that some adolescents were addicted after the first puff.

Biological factors: nicotine is an addictive substance. People who are addicted to nicotine experience withdrawal symptoms if they don’t get nicotine. Nicotine stimulates the release of adrenaline and dopamine (arousal and pleasure). Di Franza et al. (2006) found that some adolescents were addicted after the first puff.

Cognitive factorsBeliefs about smoking such as associating it with fun, pleasure and being ’cool’ can lead to smoking. The tobacco companies take advantage of this.

Cognitive factorsBeliefs about smoking such as associating it with fun, pleasure and being ’cool’ can lead to smoking. The tobacco companies take advantage of this.

Sociocultural factorsParents and peers can influence an adolescent chance of smoking. Low socio-economic status is associated with smoking (and drinking and being obese).

Sociocultural factorsParents and peers can influence an adolescent chance of smoking. Low socio-economic status is associated with smoking (and drinking and being obese).


Modeling in addictive behaviour (smoking)?

Social learning theory (modeling) can explain why parental influence and peer pressure may contribute to smoking.


Parental smoking and attitudes to smoking predict smoking in adolescents

Parental smoking is one of the most important predictors of smoking in adolescents.

Bauman et al (1990) found that 80% of adolescents (aged 12-14) whose parents did not smoke had never tried to smoke themselves.

Lader & Matheson (1991) found that children were twice as likely to smoke if their fathers smoked.

Murray et al. (1984) found that if parents were against smoking their children were up to seven times less likely to smoke themselves.


Health determinants can predict behavioural change (Lewenthal et al. 1985)

Health professionals’ beliefs in efficacy of intervention and treatment

Health professionals’ beliefs in efficacy of intervention and treatment

Perceived symptomse.g. Breathlessness, fatigue, anxiety, pain

Perceived symptomse.g. Breathlessness, fatigue, anxiety, pain

Psychological factorsEmotions, stress, anxiety

Psychological factorsEmotions, stress, anxiety

Cognitive factorsBeliefs, attitudes, perception of control, e.g. Self-efficacy beliefs and unrealistic optimism

Cognitive factorsBeliefs, attitudes, perception of control, e.g. Self-efficacy beliefs and unrealistic optimism

Biological factorsGenetic inheritance, addictive substances and their interaction with neurotransmitters

Biological factorsGenetic inheritance, addictive substances and their interaction with neurotransmitters

Social factors Parental and peer norms, social and cultural norms, socioeconomic factors

Social factors Parental and peer norms, social and cultural norms, socioeconomic factors

But all this is very complex.....Jette Hannibal - Inthinking

Health Promotion

Health promotion is the process of enabling people to exert control over the determinants of health and thereby improve health.

Health promotion includes actions directed toward health determinants outside the control of individuals (socioeconomic and environmental factors) as well as individual health behaviours.


Models of behavioural change

The Health Belief Model is partly based on Social Cognitive theory

Becker & Rosenstock, 1984

HBM sees people as rational. It suggests that people will engage in health protective behaviour under certain conditions.


The Health belief model assumes that people:

Evaluate threat (perceived vulnerability): People only act if they have a cue to action, e.g. a physical symptom like chest pains, death of somebody from a heart disease or a mass media campaign – that is, no action if they don’t perceive a threat)

Make a cost-benefit analysis (perceived outcome of changing behaviour): People will only act if perceived benefits will be higher than the perceived barriers


HBM applied to Quist-Paulsen et al. (2003)

Field experiment with patients who had been treated for heart problems.

Smoking increases mortality with 50% and normally heart patients stop

Patients were randomly allocated to treatment group (fear arousal) or control to see if this influenced smoking cessation.

Nicotine replacement and counseling were offered to all.

57% in the treatment group had stopped smoking and 37% in the control group.

Persuasive communication

Persuasive communication

Perceived vulnerability and severity of health problem

Perceived vulnerability and severity of health problem

Perceived threatPerceived threat

Perceived barriers to action (cravings)

Perceived barriers to action (cravings)

Likelihood of taking preventive action (stop smoking) – not all stopped smoking!

Likelihood of taking preventive action (stop smoking) – not all stopped smoking!Jette Hannibal - Inthinking

Evaluation of HBM

Conflicting findings: healthy behavioural intentions seem related to low perceived seriousness - they are not as high as predicted in the model)- see Quist-Paulsen et al. (2003)

It seems difficult to make standard measurements of perceived seriousness - called perceived susceptibility..

The model assumes people are rational in their decision-making - instead of rationalising after the event - thus disregarding emotional and social factors.


Role of self-efficacy beliefs – a theory to take into consideration in health promotion

Self-efficacy beliefs

Belief in ability to engage in certain types of actions successfully → more likely to try and put effort into carrying them out → more likely to develop necessary skills.

Wulfert and Wan (1993) study on promotion of use of condoms in college students

Knowledge about HIV had little effect on sexual behaviour + inconsistent use of condoms

The best predictor of condom use was self-efficacy - whether the students felt they could use a condom and still have good sex.

Health promotion: does not concentrate on health risks of unprotected sex but encourages self-efficacy in potential condom users (damage control).

Self-efficacy beliefs are important but they are not the only factor in predicting health behaviour.

Self-efficacy beliefs are important but they are not the only factor in predicting health behaviour.


Unrealistic optimism - a factor in health psychology?

Kahneman (2002) demonstrated that people make decisions intuitively – that is, on the basis of what they believe is correct and not after deliberate calculations.

Wenstein (1987) asked people to rate their personal risk of developing various disorders compared to people like them. Individuals usually rate their chances of illness as less than that of other people.

Turner et al (1988) students judged their own risk of contracting AIDS to be less than that of their fellow students


Possible answers to optimism?

Weinstein (1987) People tend to believe that if a problem has

not appeared yet, then it is unlikely to happen in the future.

People tend to think that personal action can prevent the problem.

People believe that the problem is rare. People have little or no experience of the

problem.


Optimism and health?

Kubzanski et al. (2002) found that people with optimistic explanatory style were less likely to develop heart disease.

Longitudinal prospective study with 1306 participants

12% of pessimistic explanatory style developed some heart disease but only 8% of the optimists.

Indicates a possible link between psychological and physical health research is only correlational.


Health Promotion

Prevention: Combat risk factors to avoid illness and lifestyle related problems (e.g. Diabetes Type II or drug use)

Health education: Identify, prevent and slow down damage due to lifestyle or illness; develop health programmes

Health protection: Improve quality of life


Issues in health promotion

Limited knowledge about which behaviours threathen health. Remember, it took a long time before the dangers of tobacco were identified.

Limited knowledge about how people develop health-threatening behaviour.

Some health behaviours are learnt at home (e.g. smoking, drinking) and habits are difficult to change.

People have little incentive to change health-threatening behaviour once health issues have developed.

People are often unrealistically optimistic about their health Difficult to plan efficient health campaigns: fear appeals do not

really function unless combined with suggestions of how to change behaviour and promote self-efficacy.


health psychology jette hannibal - inthinking. health psychology health psychology is a relatively...

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