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Models of Health Psychology PSY5106 Malika Guruge BSc in Psychology and Counselling MSc in Clinical and Health Psychology  Table of contents 01 Health Behaviours 03 Criticisms 02 Health Theories  01 Health Beh...

Models of Health Psychology PSY5106 Malika Guruge BSc in Psychology and Counselling MSc in Clinical and Health Psychology  Table of contents 01 Health Behaviours 03 Criticisms 02 Health Theories  01 Health Behaviours Introduction  Health Behaviours Health Behaviours are actions taken by individuals that affect health or mortality (Short & Mollborn, 2015). Health behaviours, whether deliberate or accidental, can either enhance or undermine the well-being of the individual or those around them. ○ E.g. Smoking, substance use, dietary choices, engagement in physical activity, sleep patterns, adherence to medication etc.  Kasl and Cobb (1966) introduced a classification for health-related actions, identifying three distinct types of behaviors. They proposed that: 1. A health behavior encompasses actions taken with the intention of preventing illness or disease, such as adopting a nutritious diet. 2. An illness behavior refers to actions that are geared towards seeking remedies or treatment when one is already experiencing illness or health issues, such as visiting a doctor for medical advice. 3. A sick role behavior comprises any activities undertaken with the objective of recovering and returning to a state of well-being, such as adhering to prescribed medications and allowing oneself to rest.  Matarazzo (1984) provided a more detailed categorization of health behaviors, distinguishing between two main types: 1. Health-impairing habits, which he termed 'behavioral pathogens,' refer to actions or behaviors that have the potential to harm one's health. E.g: Examples of these habits include smoking and consuming a diet high in fat content, which are known risk factors for various health issues. 2. Health protective behaviors, described as 'behavioral immunogens' by Matarazzo, encompass actions taken with the intent of safeguarding and enhancing one's health. E.g: An instance of such behavior is attending regular health check-ups, which can aid in the early detection and prevention of health problems.  Predicting Health Behaviour Leventhal et al. (1985) outlined various factors they considered influential in predicting health behaviors. These factors encompass: 1. Social Factors: These factors involve aspects of the social environment that can influence health behaviors. They include elements such as learning, reinforcement, modeling (observing others' behaviors), and social norms (the accepted behaviors within a particular social group). 2. Genetics: The possibility of a genetic basis for certain health behaviors, particularly concerning alcohol use. This implies that genetic factors may play a role in an individual's susceptibility to or propensity for alcohol-related behaviors. 3. Emotional Factors: Emotional states can significantly impact health behaviors. Emotions like anxiety, stress, tension, and fear can either motivate or hinder certain health-related actions.  Predicting Health Behaviours Cont. 4 Perceived Symptoms: The presence of specific symptoms, such as pain, breathlessness, or fatigue, can influence an individual's health behaviors. These symptoms may prompt individuals to seek medical attention or engage in self-care behaviors. 5 Beliefs of the Patient: A person's personal beliefs, attitudes, and perceptions about their health and well-being can have a profound impact on their health behaviors. These beliefs can shape their choices regarding health-related actions and adherence to medical advice. 6 Beliefs of the Health Professional: The beliefs and recommendations of healthcare providers can also play a critical role in determining a patient's health behaviors. Patients often consider the advice and expertise of healthcare professionals when making decisions about their health.  Theories of Health Psychology Attribution Locus of Unrealistic Self-affirmation Stages-of-change Theory Control Optimism Theory Model  Attribution Theory Attribution theory was originally developed by Fritz Heider, one of the most important social scientists of the twentieth century. It focuses on an individual’s perception of the cause of events and behaviors (Schrader & Helmke, 2014). Causal Attribution: At the core of attribution theory is the concept of causal attribution. This refers to the process by which individuals assign causes or reasons to events or behaviors. People seek to understand why something happened or why someone behaved in a particular way. The most well-known attribution theory is Kelley’s Covariation model, developed by Harold Kelley in 1967. It seeks to explain how people make attributions or judgments about the causes of others' behavior. a. Consensus: It focuses on whether other people tend to react in a similar way to the same stimulus or situation. E.g.: If most people in a specific social group or environment smoke (high consensus), and an individual also smokes in that context, observers may attribute the behavior to external factors such as peer pressure or the influence of the social group.  Attribution Theory Cont. b. Distinctiveness: Relates to whether a person reacts differently to various stimuli or situations. E.g.: If the individual only smokes in certain situations or around specific people (high distinctiveness), observers may attribute the behavior to external factors related to those situations or people. c. Consistency: It examines whether a person's behavior in a particular situation is relatively stable over time. E.g.: If the person consistently smokes in similar situations or around the same people over time (high consistency), observers may attribute the behavior to the individual's internal disposition, such as a smoking habit or addiction. Refer-https://youtu.be/doMOHcTlK7o & https://youtu.be/nB2ZRHS2RUE  Attributions for Health-Related Behaviours Herzlich's Attribution Theory in health focuses on how individuals attribute causes to their own health-related experiences and behaviors. It considers the emotional and behavioral consequences of these attributions, the influence on coping strategies, and recognizes the subjective nature of health perceptions. Social and cultural factors also play a role in shaping health attributions. In Herzlich's 1973 study, the interviews conducted with 80 individuals to understand their perceptions of the origins of health and illness. The findings indicated that people tended to view health as an internal quality within the individual, while illness was commonly perceived as something external that enters the body. To elaborate further, attributions regarding illness often appeared to be linked with behaviors.  Attributions for Health-Related Behaviours Cont. For example, Bradley (1985) examined patients’ attributions for responsibility for their diabetes and reported that perceived control over illness (‘is the diabetes controllable by me or a powerful other?’) influenced the choice of treatment by these patients. Patients could choose (1) an insulin pump (2) small mechanical device attached to the skin, which provides a continuous flow of insulin), (3) intense conventional treatment, or (4) a continuation of daily injections. The results indicated that the patients who chose an insulin pump showed decreased control over their diabetes and increased control attributed to powerful doctors. Therefore, if an individual attributed their illness externally and felt that they personally were not responsible for it, they were more likely to choose the insulin pump and were more likely to hand over responsibility to the doctors.  Process of using the Attribution Theory Imagine a campaign aimed at encouraging women to undergo regular mammogram screenings for breast cancer. Women who have never had a mammogram might experience anxiety or fear about the procedure, and this fear can be a barrier to getting screened. self-affirmation could be used as follows: Self-Affirmation Activity: Before providing information about mammograms, women are given an opportunity to engage in a self-affirmation activity. They are asked to reflect on and write down aspects of their lives that they value and feel proud of, such as their family, career achievements, or personal talents. Health Message: After completing the self-affirmation exercise, the women are presented with information about the importance of regular mammogram screenings for early breast cancer detection. The message emphasizes the potential health benefits and life-saving aspects of this preventive measure. Reducing Defensive Responses: Because the women have affirmed their self-worth and values in the initial activity, they are less likely to experience a defensive response to the health message. Instead of feeling threatened, they are more open to considering the information and its potential impact on their health. Motivation for Action: With reduced resistance to the health message and an increased sense of self-worth, women may be more motivated to schedule and attend mammogram screenings. They are more likely to view the decision to undergo screening as a positive action aligned with their values and self-concept.  Health Locus of Control Health locus of control explores an individual beliefs based on past experiences in health issues and having external or internal control over them in a way that could affect health and health-related outcomes (Mansour Pourhoseinzadeh et al., 2017). It examines whether people attribute their health and wellness to factors within their control (internal locus of control) or external factors beyond their control (external locus of control). ○ Internal Locus of Control: Individuals with an internal locus of control believe that their health and well-being are primarily influenced by their own actions, choices, and behaviors. E.g.: Believing that by eating healthily, exercising regularly, and following medical advice, they can maintain or improve their health. ○ External Locus of Control: Conversely, individuals with an external locus of control attribute their health to external factors, luck, fate, or powerful others (e.g., doctors, genetics). E.g.: Individuals might feel that genetics or environmental factors primarily dictate their health status. Refer- https://youtu.be/Vx1dnPMPhl0 Health Locus of Control Cont.  Unrealistic Optimism According to Shepperd et al.(2015), “People are considered unrealistically optimistic if they predict that a personal future outcome will be more favorable than that suggested by a relevant, objective standard.” In 1987, Weinstein proposed four cognitive factors that contributes to unrealistic optimism: 1. Perceived Control: People tend to overestimate the degree of control they have over events and outcomes in their lives. 2. Comparative Optimism: Individuals tends to believe that they are at lower risk for negative events compared to others. E.g.: Individuals often perceive themselves as less likely to experience health problems than their peers or the average person. 3. Optimistic Bias: This factor relates to the selective processing of information while downplaying or ignoring negative information that contradicts those beliefs. 4. Personal Experience: Individuals exhibit unrealistic optimism when they anticipate that a future outcome for themselves will be better than what an appropriate, objective benchmark would indicate. Unrealistic Optimism Cont.  Self-Affirmation Theory This theory posits that individuals have a fundamental need to maintain a positive self-image and self-esteem. Self-affirmation theory suggests that people are motivated to protect and enhance their sense of self-worth, even in the face of health threats or challenges. a. Cognitive Dissonance: is the discomfort individuals feel when they hold conflicting beliefs or attitudes when confronted with health information that threatens their self-concept. E.g: A person who has always prided themselves on their healthy eating habits suddenly receives a health report indicating high cholesterol levels due to their diet. Their self-concept as a health-conscious individual clashes with the negative health outcome. Refer- https://youtu.be/1YlO6hIN-bc b. Self-Integrity: To reduce cognitive dissonance and maintain self-integrity, individuals engage in self-affirmation, which involves affirming positive aspects of the self that are unrelated to the health threat. E.g. Someone who values physical health might affirm their self-integrity by reminding themselves of past achievements, such as consistently exercising or making healthy food choices. This affirmation helps them uphold their self-image as a health-conscious individual, reducing stress or guilt when they occasionally deviate from their health goals, like indulging in a dessert.  The Transtheoretical Model It is a model developed by James O. Prochaska and Carlo C. DiClemente in late 1970s and early 1980s. The model proposes that individuals go through a series of stages when making intentional changes in their behaviour, including health-related behaviours. 1. Precontemplation: In this stage, individuals are not yet aware of their need to change their behavior. They may be resistant to change or in denial about the issue. They may lack awareness of the risks associated with their current behavior. 2. Contemplation: During the contemplation stage, individuals recognize the need for change and are actively considering it. They may weigh the pros and cons of changing their behavior and may seek information and support to make an informed decision. 3. Preparation: In the preparation stage, individuals have made the decision to change their behavior. They begin taking small steps toward change, such as setting goals, making plans, and gathering resources. They are mentally preparing themselves for action.  The Transtheoretical Model Cont. 4. Action: This stage involves the actual implementation of the behavior change plan. Individuals modify their behavior, routines, and environments to support the desired change. Action requires effort, commitment, and persistence. 5. Maintenance: After successfully making a behavior change, individuals enter the maintenance stage. During this phase, they work to sustain the new behavior and prevent relapse. Maintenance can be an ongoing process, and individuals continue to use strategies to prevent a return to the old behavior. 6. Relapse: In this stage the old behavior return after a period of successful change. It is seen as a normal part of the change process and does not necessarily signify failure. Individuals who experience relapse can move back through the stages and make another attempt at change. 7. Termination: In this stage individuals have successfully maintained the new behavior for an extended period, and they no longer feel tempted to return to the old behavior. Refer-https://youtu.be/Twlow2pXsv0 The transtheoretical Model Cont.  Group Activity Use the transtheoretical model to identify the stages of change for a health behaviour of your own choosing. You may refer to online sources and build your behavioural change process for the chosen health disorders.  Cognition Models in Health Cognitive models of health focus on understanding and explaining how cognitive processes, such as thoughts, beliefs, attitudes, and perceptions, influence health-related behaviors and outcomes. Cognitive models describe behaviour as result of logical/rational evaluation of potential costs and benefits of a particular behaviour. There are couple of cognitive theories in health psychology; 1. The Health Belief Model. 2. Protection Motivation Theory. 3. Social Cognition Model. 4. Theory of Reasoned Action and Planned Behaviour.  Health Belief Model The health belief model is a widely used psychological framework in the field of health psychology. It was developed by Rosenstock (1966). The model is designed to understand and predict individuals health-related behaviors, particularly in the context of preventive health actions, such as getting vaccinated, undergoing screenings, or adopting healthier lifestyles. Key Principles of the Health Belief Model: 1. Perceived Susceptibility- Individuals assess their personal risk of developing a health problem or condition. 2. Perceived Severity- People evaluate how serious or severe the health problem or condition is (higher the severity, more likely they are to take action). 3. Perceived Benefits- Individuals consider the advantages and benefits of taking a specific health-related action. 4. Perceived Barriers- People assess the obstacles or barriers that may prevent them from taking the recommended action. 5. Cues to Action- External cues or triggers, such as health campaigns, advice from healthcare providers, or personal experiences, can prompt individuals to take action. 6. Self-Efficacy- Self-efficacy refers to an individual's belief in their ability to successfully perform the recommended health behavior. The Health Belief Model Cont.  Protection Motivation Theory Protection Motivation Theory (PMT) is a widely recognized psychological model developed by Rogers (1983) which is used to explain and predict how individuals respond to health threats and make decisions related to protective behaviors. The theory is based on the idea that individuals are motivated to protect themselves from perceived threats to their health and well-being (Lahiri et al., 2021). 1. Threat Appraisal Perceived Severity: Individuals assess how serious they perceive the health threat to be. The more severe the threat, the more motivated they are to take protective action. Perceived Susceptibility: People evaluate their personal risk of experiencing the health threat. Higher perceived susceptibility increases motivation to engage in protective behaviors. 2. Coping Appraisal Perceived Response Efficacy: Individuals consider the effectiveness of the recommended protective actions in reducing the threat. E.g.: If they believe that the suggested behaviors will be effective, they are more likely to adopt them. Perceived Self-Efficacy: Self-efficacy refers to an individual's confidence in their ability to perform the recommended protective actions.  Protection Motivation Theory Cont. It takes into account both the costs and benefits in behaviour predicting the likelihood of change. Motivation is maximized when: 1. The threat to health is severe. 2. The individual feels vulnerable 3. The adaptive response is believed to be an effective means for averting the threat 4. The person is confident in his or her abilities to complete successfully the adaptive response 5. The rewards associated with the maladaptive behaviours are small 6. The costs associated with the adaptive response are small  Social Cognitive Theory Social Cognitive Theory, was developed by renowned psychologist Albert Bandura,(1977, 1986) and it emphasizes the role of social and cognitive factors in shaping health-related behaviors and outcomes. 1. Observational Learning- people can acquire health-related knowledge, attitudes, and behaviors by observing the actions and experiences of others. 2. Self-Efficacy- In health psychology, self-efficacy plays a crucial role in explaining why some individuals are more likely to engage in health-promoting behaviors, such as exercise or smoking cessation, while others are not. e.g. ‘I can stop smoking if I want to’. 3. Outcome Expectations- individuals are motivated to engage in behaviors that they believe will lead to desirable outcomes and avoid behaviors associated with negative outcomes. e.g. ‘stopping smoking can reduce the chances of lung cancer’.  Theory of Reasoned Action & Planned Behaviour The Theory of Reasoned Action was initially proposed by Martin Fishbein and Icek Ajzen in the late 1960s. It posits that individuals' behavioral intentions are the key predictors of whether they will engage in a specific behavior. 1. Attitude Toward Behavior- It considers the person's beliefs about the consequences of the behavior and their evaluation of those consequences as positive or negative. 2. Subjective Norms- Subjective norms refer to the perceived social pressure or influence from important others (e.g., family, friends, healthcare providers) regarding the performance of the behavior. It assesses whether individuals perceive that people they care about expect them to engage in the behavior. The theory of planned behaviour was later reintroduced by Fishbein and Ajzen in the 1980s with an additional component which was included to enhance the predictive power of the model. 1. Perceived Behavioral Control- This component measures an individual's perception of the ease or difficulty of performing the behavior. It reflects their perceived level of control over the behavior. Refer-https://youtu.be/nZsxuD3gExE Theory of Reasoned Action & Planned Behaviour  Criticisms of Health Models Main observations that were made in the evaluation of the models discussed. Firstly, it was recorded that the models are not that successful at predicting behavioural intentions and that they should be expanded to incorporate new cognitions. Secondly, it has been argued that they are even less successful in predicting actual behaviour due to the new research finding exploring the intention-behaviour gap. ○ As behaviours are simplified- These models may not fully capture the complexity and interplay of these factors. ○ Limited predictive power- Other variables, such as emotions, impulsivity, or habit, may play a more significant role in determining behavior than these models account for. ○ Overemphasis on rational decision-making- In reality, people often make decisions based on emotions, habits, and situational factors that may not align with rational decision-making. ○ Inconsistent results- these models may not universally apply to all health behaviors and populations.  Discuss Consider a recent change in your health-related behaviours (e.g.stopped/started smoking, changed diet, aimed to get more sleep, etc.). Discuss your health beliefs that relate to this change.  References Jefferson, A., Bortolotti, L., & Kuzmanovic, B. (2017). What is unrealistic optimism? Consciousness and Cognition, 50, 3-11. https://doi.org/10.1016/j.concog.2016.10.005 Lahiri, A., Jha, S. S., Chakraborty, A., Dobe, M., & Dey, A. (2021). Role of Threat and Coping Appraisal in Protection Motivation for Adoption of Preventive Behavior During COVID-19 Pandemic. Frontiers in Public Health, 9. https://doi.org/10.3389/fpubh.2021.678566 Mansour Pourhoseinzadeh, M., Mahin Gheibizadeh, P., & Mehrnaz Moradikalboland, P. C. (2017). The Relationship between Health Locus of Control and Health Behaviors in Emergency Medicine Personnel. International Journal of Community Based Nursing and Midwifery, 5(4), 397-407. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5635559/ Schrader, F., & Helmke, A. (2014). School Achievement: Motivational Determinants and Processes. International Encyclopedia of the Social & Behavioral Sciences (Second Edition), 48-54. https://doi.org/10.1016/B978-0-08-097086-8.26055-8 Shepperd, J. A., Waters, E., Weinstein, N. D., & P. Klein, W. M. (2015). A Primer on Unrealistic Optimism. Current Directions in Psychological Science, 24(3), 232. https://doi.org/10.1177/0963721414568341  Thanks! Do you have any questions? [email protected]