Download Modles of Health psychology

Health Psychology
 According
to the basic tenets of attribution
theory people attempt to provide a causal
explanation for events in their world
particularly if those events are unexpected
and have personal relevance (Heider, 1958).
Thus it is not surprising that people will
generally seek a causal explanation for an
illness, particularly one that is serious.
 Taylor
et al. (1984) interviewed a sample of
women who had been treated for breast
cancer. They found that 95% of the women
had a causal explanation for their cancer.
These causes were classified as stress (41%),
specific carcinogen (32%), heredity (26%),
diet (17%), blow to breast (10%) and other
(28%).
Women’s causal explanations for breast cancer
 They
also asked the women who or what they
considered responsible for the disease and
found that 41% of the women blamed
themselves, 10% blamed another person, 28%
blamed the environment and 49% blamed
chance. The patients were also asked
whether they felt any control over their
cancer and they found 56% felt they had
some control.
The women’s attribution of responsibility
for their cancer
 Weiner
et al. (1972) suggested that we can
classify attributional dimensions along three
dimensions:

1 Locus: the extent to which the cause is
localized inside or outside the person.
2 Controllability: the extent to which the person
has control over the cause.
3 Stability: the extent to which the cause is
stable or changeable.
 Health
locus of control, like attribution
theory, also emphasises attributions for
causality and control.
 Wallston
and Wallston (1982) developed a
measure of the health locus of control, which
evaluates whether individuals regard their
health as controllable by them or not
controllable by them or they believe their
health is under the control of powerful
others.
 Health
locus of control is related to whether
individuals changed their behaviour and to
the kind of communications style they
require from health professionals.
 There
are several problems with the concept
of a health locus of control:

Is health locus of control a fixed traits or a transient
state?

Is it possible to be both external and internal?

Going to the doctor could be seen as external (the
doctor is a powerful other) or internal (I am looking
after my health).
 Unrealistic
optimism focuses on
perceptions of susceptibility and risk.
 Weinstein
(1984) suggested that one of the
reasons why people continued to practice
unhealthy behaviours is due to inaccurate
perceptions of risk and susceptibility - their
unrealistic optimism.
 He
asked subjects to examine a list of health
problems and displayed what "compared to
other people of your age and sex, are your
chances of getting the problem greater than,
about the same, or less than theirs?" Most
subjects believed they were less likely to get
the health problem.
 Weinstein
(1987) described four cognitive
factors that contribute to unrealistic
optimism:

1. Lack of personal experience with the problem

2. The belief that the problem is preventable by
individual action

3. The belief that if the problem has not yet
appeared, it will not appear in the future

4. The belief that the problem is infrequent.
 The
transtheoretical model of change
emphasises the dynamic nature of beliefs,
time, and costs and benefits.
 1.
Precontemplation: not intending to make
any changes
 2.
Contemplation: considering a change
 3.
Preparation: making small changes
 4.
Action: actively engaging in a new
behaviour
 5.
Maintenance: sustaining change over time
 Individuals
would go through these stages
in order but might also go back to earlier
stages.
 People
in the later stages, e.g.
maintenance, would tend to focus on the
benefits (I feel healthier after giving up
smoking), whereas people in the earlier
stages tend to focus on the costs (I will be
at a social disadvantage if I give up
smoking).
A
relationship has been found between level
of education and the stage of change
reached when contemplating taking regular
exercise.
 Those
people with lower levels of education
tended to be at an earlier stage of change
(Booth et al. 1993), and therefore it could be
argued that the model could be improved by
taking account educational attainment in
order to help predict the length of time a
person is likely to remain at the earlier
stages.
 Support
for individual components of the
model.
 Norman
and Fitter (1989) examined health
behaviour screening (for example breast
cervical cancer) and found that perceived
barriers (the costs of attending) were the
greatest predictors of whether a person
attended the clinic.
 Several
studies have examined breast selfexamination (BSE) behaviour and report that
barriers (Lashley 1987; Wyper 1990) and
perceived susceptibility (the likelihood of
having the illness) (Wyper 1990) are the best
predictors of healthy behaviour.
 The
role of giving information as a cue to
action has been researched. Information in
the form of fear-arousing warnings may
change attitudes and health behaviour in
such areas as dental health, safe driving and
smoking (e.g. Sutton 1982; Sutton and
Hallett 1989).
 Giving
information about the bad effects of
smoking is also effective in preventing
smoking and in getting people to give up
(e.g. Sutton 1982; Flay 1985). Several studies
report a significant relationship between
people knowing about an illness and their
taking precautions.
 Rimer
et al. (1991) report that knowledge
about breast cancer is related to having
regular mammograms. Several studies have
also indicated a positive correlation between
knowledge about BSE (Breast Selfexamination) and breast cancer and
performing BSE (Alagna and Reddy 1984;
Lashley 1987; Champion 1990).
 Showing
subjects a video about pap tests for
cervical cancer was related to their actually
having the pap test (O'Brien and Lee 1990'.)
 Janz
and Becker (1984) found that
healthy behavioural intentions are related
to low perceived seriousness - not high as
predicted (e.g. healthy adult having a flu
injection) - and several studies have
suggested an association between low
susceptibility (not high) and healthy
behaviour (e.g. many students recently
have agreed to be inoculated against
meningitis) (Becker et al. 1975; Langlie
1977).
 Hill
et al. (1985) applied the HBM to cervical
cancer, to examine which factors predicted
cervical screening behaviour. Their results
suggested that benefits and perceived
seriousness were not related.
 Janz
and Becker (1984) carried out a study
using the HBM and found the best predictors
of health behaviour to be perceived barriers
and perceived susceptibility to illness.
 However,
Becker and Rosenstock (1984), in a
review of 19 studies using a meta-analysis
that included measures of the HBM to predict
compliance, calculated that the best
predictors of compliance are the costs and
benefits and the perceived seriousness. So
there is lack of agreement over what really
does help to predict health behaviour.
 Is
health behaviour that rational? (Is toothbrushing really determined by weighing up
the pros and cons?).

Its emphasis on the individual (HBM ignores
social and economic factors)

The measurement of each component

The absence of a role for emotional factors
such as fear and denial.

It has been suggested that alternative factors
may predict health behaviour, such as
outcome expectancy (whether the person
feels they will be healthier as a result of
their behaviour) and self-efficacy (the
person’s belief in their ability to carry out
preventative behaviour) (Seydel et al. 1990;
Schwarzer 1992).

Schwarzer (1992) has further criticized the
HBM for saying nothing about how attitudes
might change.

Leventhal et al. (1985) have argued that
health-related behaviour is related more to
the way in which people interpret their
symptoms (e.g. if you feel unwell and you
feel it is not going to cure itself then you
would probably do something about it).
 Becker
and Rosenstock (1987) have revised
the HBM and have described their new model
as consisting of the following factors:



the existence of sufficient motivation;
the belief that one is susceptible or vulnerable to a
serious problem;
and the belief that change following a health
recommendation would be beneficial to the individual
at a level of acceptable cost.
 Rogers
(1975, 1983, 1985) developed
protection motivation theory (PMT) which
expanded the HBM to include additional
factors.
 Components of the PMT
 Health-related behaviours are a product of
five components:
 Coping
Appraisal
 self-efficacy (e.g. 'I am confident that I
can change my diet');
 Response effectiveness (e.g. 'changing my
diet would improve my health');
 Threat Appraisal
 Severity (e.g. 'bowel cancer is a serious
illness');
 Vulnerability (e.g. 'my chances of getting
bowel cancer are high').
 Fear
 According
to the PMT, there are two
sources of information:
 1.
environmental (e.g. verbal
persuasion, observational learning) and
 2.
intrapersonal (e.g. prior
experience).
 This information elicits either an
'adaptive' coping response (i.e. the
intention to improve one's health) or a
'maladaptive' coping response (e.g.
avoidance, denial).
 Rippetoe
and Rogers (1987) gave women
information about breast cancer and
examined the effect of this information on
the components of the PMT and their
relationship to the women's intentions to
practise breast self-examination (BSE).
 The
results showed that the best predictors
of intentions to practise BSE were response
effectiveness (believing that BSE would
detect the early signs of cancer), severity
(believing that Breast cancer is dangerous
and difficult to treat in it's advanced stages)
and self-efficacy (belief in one's ability to
carry out BSE effectively).
 In
a further study, the effects of
persuasive appeals for increasing exercise
on intentions to exercise were evaluated
using the components of the PMT. The
results showed that vulnerability (ill
health would result from lack of exercise)
and self-efficacy (believing in one's ability
to exercise effectively) predicted
exercise intentions but that none of the
variables were related to self-reports of
actual behaviour.
 In
a further study, Beck and Lund (1981)
manipulated dental students' beliefs
about tooth decay using persuasive
communication. Their results showed that
the information increased fear and that
severity (tooth decay has disastrous
consequences) and self-efficacy (I can do
something about it) were related to
behavioural intentions (flossing and
brushing regularly especially after
eating).
 The
PMT has been less widely criticized
than the HBM; however, many of the
criticisms of the HBM also relate to the
PMT. For example, the PMT assumes that
individuals are rational information
processors (although it does include an
element of irrationality in its fear
component), it does not account for
habitual behaviours, such as brushing
teeth, nor does it include a role for social
(what others do) and environmental
factors (eg opportunities to exercise or
eat properly at work).
 Schwarzer
(1992) has also criticized the PMT
for not tackling how attitudes might change
(a problem with the HBM as well).
 Communication
between health professional
and patient would be redundant if the
patient held beliefs about their health that
were in conflict with those held by the
professional.
 Pill
and Stott (1982) reported that
working-class mothers were more likely to
see illness as uncontrollable.
 In a recent study, Graham (1987) reported
that although women who smoke are
aware of all the health risks of smoking,
they report that smoking is necessary to
their well-being and an essential means
for coping with stress.
 Blaxter
(1990) analysed the definitions of
health provided by over 9000 British
adults in the health and lifestyles survey.
She classified the responses into nine
categories:

Health as not-ill: the absence of
physical symptoms.

Health despite disease.

Health as reserve: the presence of
personal resources.

Health as behaviour: the extent of
healthy behaviour





Health as physical fitness.
Health as vitality.
Health as social relationships.
Health as function.
 It
was found that there was considerable
agreement in the emphasis on behavioural
factors as causes of illness. There was
however limited reference to structural
or environmental factors, especially
among those from working-class
backgrounds. Gender differences were
also found. The women were more likely
to define health in terms of personal
relationships. Murray and McMillan (1988)
also found that working class women
made repeated reference to their families
when describing cancer.
 Chamberlain
(1997) noted a series of
social class differences in his review of
several studies of lay people’s perceptions
of health. Lower social economic status
people emphasise the role of health in
their ability to work whereas higher social
economic status people referred more to
their ability to participate in leisure
activities. Four different lay views of
health emerged:
 1.
Lower social economic status
participants only reported a view that
emphasised physical aspects.
 2.
Both lower and higher social
economic status participants gave a
dualistic view in which physical and
mental aspects of health were combined.
 3.
Predominantly higher social
economic status gave a complimentary
view of health, which integrated both
physical and mental dimensions.
 4.
Higher social economic status
participants gave a multiple view of health,
which included physical, mental, emotional,
social and spiritual directions.
 Stainton-Rogers
(1991) used Q-sort
methodology to identify the concepts
used by a sample of British adults to
explain health. She identified eight
different accounts of health and illness:

The ‘body as machine’ account
which considered illness as naturally
occurring and ‘real’ with biomedicine
considered the main form of treatment.

The ‘body under siege’ account
which considered illness as a result of
external influences such as germs or
stress.

The ‘inequality of access’ account
which emphasized the unequal access to
modern medicine.

The ‘cultural critique’ account
which was based upon a sociological
worldview of exploitation and oppression.

The ‘health promotion’ account
which recognized both individual and
collective responsibility for ill health.

The ‘robust individualism’ account
which was concerned with every
individual’s right to a satisfying life.

The ‘willpower account’ which
defined health in terms of the individuals
ability to exert control.
 1.
Humans are rational in their
information processing. It is the role of
perceived factors (e.g. risk, rewards,
costs, etc) rather than actual risks.
 2.
Different cognitions are separate
from and perform independently from
each other. Could be because the
researchers ask questions relating to each
'type' of cognition.
 3.
The types of cognition may not really
exist nor play a part in the patient's
thinking about their health; they could
just be an artefact of the way the
research was carried out.
 4.
Cognitions are not placed within a
context. For example, actual social
pressure and environment are not taken
into account, only the individual's
interpretation of social pressure and
environmental influences.