Psychology Revision PDF

Defining health, ill health, stress, and addiction Health and ill health General definition Complete physical, mental, and social well-being, not just absence of disease. Biomedical definition Physical/biological factors, illness is physical disease, health is absence of disease. Associated with tec...

Defining health, ill health, stress, and addiction Health and ill health General definition Complete physical, mental, and social well-being, not just absence of disease. Biomedical definition Physical/biological factors, illness is physical disease, health is absence of disease. Associated with technological advances (e.g. brain scanning, chemotherapy). Biopsychosocial definition an interaction between biological, psychological, and social factors. Aims to enhance health, focus on prevention. Influential in mental health. Health as a continuum Health/ill health are two extremes with many states in between. Stress Defining stress Emotional and physical response to situations of threat. Stressors Threats that create stress. o Physical stressors (environmental), e.g. temperature, noise. o Psychological stressors, e.g. life events and daily hassles. The stress response o Physiological stress: bodily symptoms, e.g. increased heart rate, sweating, feeling sick. o Psychological stress: emotion you experience when a stressor occurs. Perceived ability to cope People react differently to the same stressors. Stress occurs when perceived demands of environment are greater than perceived ability to cope (e.g. exams). Response affected by our perception of internal (e.g. resilience) and external (e.g. social support) coping resources. Addiction Defining addiction Complex psychological disorder, pleasurable despite harmful consequences. Classifying addiction ICD-11 substance use or addictive behaviours. Physiological (e.g. cocaine, caffeine) or behavioural (gambling, gaming). Physiological addiction Physical effects: o Withdrawal: experienced when substance/behaviour stops. o Tolerance: higher dose needed for same effect over time. Behavioural addiction Produces same physical effects as substance addiction (withdrawal, tolerance), e.g. gambling, mobile use. Griffiths' six components of addiction 1. Physical and psychological dependence (salience): addiction dominates the person's life. 2. Tolerance: more needed for same effect. 3. Withdrawal: when stopping drug or addictive behaviour. 4. Relapse: after abstinence. 5. Conflict: within self and with others. 6. Mood alteration: positive and negative subjective experiences. Biological influences Genetic predisposition What is a genetic predisposition? We do not inherit illnesses but instead genes that increase risk triggered by other factors. Genetic influences on health and illness Genes affect likelihood of physical activity (health), can increase risk of illness: o Physical illness: e.g. strong genetic influence on obesity (twin studies). o Psychological disorders: depression about 37% inherited, so environment important. Roles of neurotransmitter imbalances What are neurotransmitter imbalances? Levels of chemicals communicating between neurons are too high or low, affecting behaviour. Physical health and serotonin Exercise increases serotonin, improves sleep and alertness. Mental health and neurotransmitters High dopamine linked to optimism, neurotransmitter imbalances (e.g. dopamine) linked to schizophrenia. Evaluation Practical uses Physical activity programme can reduce mild depression symptoms, possibly by altering neurotransmitter levels. Support for effectiveness Genetic explanation includes role of environment (e.g. 'trigger' factors in PKU and resilience), so more effective explanation. Incomplete explanation Oversimplifies causes of health/illness, e.g. genes influence lifestyle (smoking, etc.), so only indirect influence on health/illness. Behaviourist approaches Role of reinforcement Positive reinforcement Pleasure from brain chemicals during exercise means activity is repeated. Also pleasure from inactivity reinforces unhealthy behaviour. Negative reinforcement Feelings of guilt avoided by exercising = rewarding. Sitting on sofa avoids other unpleasant consequences = also rewarding. Role of cues Stimuli (cues) that are associated with pleasure of healthy and unhealthy behaviours become rewarding in themselves, e.g. exercise kit, lighter. Using operant conditioning Using positive reinforcement External feedback (e.g. praise) for healthy behaviour, self-talk, achieving targets - tailored to the individual. Using negative reinforcement Behave healthily to avoid unpleasant feelings (e.g. guilt). Using punishment Giving negative feedback (telling off') for unhealthy behaviour, less effective than reinforcement. Evaluation Practical uses Tokens given to hospital inpatients to positively reinforce physical activity, exchanged for treats. Support for effectiveness Positive and negative reinforcement increased exercise compared with controls (Strohacker et al. 2014). Limited use Narrow range of behaviours because real-world rewards can take a long time to appear, weak reinforcement, other approaches better. Social learning approach Effects of parental role models Modelling and imitation Parents/ carers are role models, demonstrating (modelling) health-related behaviours for children. Children observe behaviours (e.g. brushing teeth) and imitate them (also modelling). Vicarious reinforcement Observing a model's behaviour being rewarded makes imitation more likely (e.g. enjoying exercise). Effects of peer role models Modelling of peer behaviour is more likely because we identify with them (similarity). Peers establish social norms of a group, e.g. desirable to smoke or exercise. Role models in health education Peers School-based health programmes use popular students as role models, reinforce healthy values, credibility. Healthcare professionals Nurses have direct contact with clients and train others. Celebrities Campaigns use celebrities via media, status, and glamour, e.g. Kate Middleton and Covid-19 vaccinations. Evaluation Practical uses ASSIST, peer-led anti-smoking intervention successful in schools, adapted for other health behaviours (Campbell et al. 2008). Support for effectiveness Children sample new foods when seeing parents/carers eating them, also other health behaviours ('Do as I do). Issues with health education role models Some lead unhealthy lifestyles (obesity), little credibility with clients or perhaps relate to them more easily? Cognitive approach Making health-related decisions Relief from stress, anxiety, and boredom Some unhealthy behaviours reduce anxiety and stress (e.g. smoking), self- medication and habitual. Short-term coping strategies but with longer-term health consequences. Mitigating other health problems Some healthy behaviours reduce impact of other health issues, e.g. being physically active. Resolving cognitive dissonance Feeling of discomfort when choosing between two equally attractive options, e.g. smoking for pleasure but knowing it is unhealthy. Resolve dissonance by changing behaviour (healthy) or changing belief (unhealthy). Professional biases Some healthcare professionals may have unconscious biases that affect their decision-making. Racial and gender bias may mean diagnosis is less accurate, clients get less time. Biases are cognitive because they are based on stereotypes. Evaluation Practical uses Become aware of unhealthy decisions (e.g. comfort eating) and do something healthier (e.g. social support). Support for effectiveness Smokers who experienced dissonance were more likely to change behaviour (Simmons and Brandon 2007). More practical uses White doctors and Black clients signed a 'Team contract, clients had more trust, reduced bias (Penner et al. 2013). Theory 1: Health belief model Key concepts of the model Rosenstock (1966) developed HBM to explain why people, engage in healthy behaviour (or not). Three key elements: 1. Perceived seriousness Change depends on how we perceive outcomes of not changing (e.g. condoms may prevent chlamydia but is seriousness enough to warrant use?). 2. Perceived susceptibility Only change (e.g. use condoms) if we see ourselves as realistically vulnerable to illness (chlamydia, HIV/AIDS, etc.). 3. Cost-benefit analysis Balance of: o Perceived benefits: advantages of changing behaviour (e.g. protection). o Perceived barriers: obstacles preventing us changing (e.g inconvenience). Modifying factors o Demographic variables (age, gender, religion etc.) affect above factors and therefore likelihood of change. o Cues to action: internal (e.g. pain) and external (e.g. advice) cues make us 'ready' to change. o Self-efficacy: change more likely if we believe we have ability to do it. Evaluation Practical uses Use of HBM (e.g. increase perceived susceptibility) increased uptake of bowel and colon screening (Williamson and Wardle 2002). Strong credibility Devised by health researchers and practitioners working with real-life behaviour change, so well accepted Are we rational model assumes decisions are rational (e.g. cost-benefit analysis), but emotions and habits are important Theory 2: Locus of Control Key concepts of the theory Rotter (1966) - where you believe control over your life (e.g. health) comes from. Internal LoC Internals believe events are under own control, e.g. success or failure due to own efforts (or lack of). External LoC Externals believe events are outside own control, explained by luck, other people, weather, etc. LoC continuum People can be high internal, high external or anything in between (e.g. low/moderate). Measuring LoC Rotter's questionnaire with pairs of statements (one internal, one external). Other measures are linked to health-related LoC. Attributions and health behaviour Attribution is the process of explaining other people's behaviour and also explaining our own behaviour. Internals attribute their health behaviours to causes they can control (e.g. avoid risk factors for addiction). Externals attribute their health behaviours to causes they cannot control (e.g. addiction is down to genes). Evaluation Practical uses by age 30 those who were assessed as internal at 10 were less likely to be obese or stressed than externals. Internal LoC protects against stress (Gale et al. 2008). Support for effectiveness External students reported more study-related stress than internals, significant correlation (Abouserie 1994). Limited role for LoC in health LoC only relevant in new situations, otherwise previous experience more important. So, LoC role exaggerated. Theory 3: Theory of planned behaviour Key concepts of the theory Ajzen (1985, 1991) proposed the TPB to explain how people control voluntary behaviours. Intention to change is the central concept, affected by three sources: 1. Personal attitudes Balance of the person's favourable and unfavourable judgements of own behaviour. 2. Subjective norms Person's beliefs about whether people who matter to them approve or disapprove of their behaviour. 3. Perceived behavioural control (PBC) How much control we believe we have over own behaviour: o Indirect influence on intentions, e.g. the more control I have over my weight, the stronger my intention to lose weight. o Direct influence on behaviour, e.g. the more control I have, the longer and harder I will try to lose weight. Evaluation Practical uses Focus on increasing PBC, e.g. smokers had stronger intentions to give up and were more likely to do so (Borland et al. 1991). Lacks effectiveness Teenagers who gambled intended to give up but did not do so, too many factors added to TPB (Miller and Howell 2005). Short-term versus long-term Intention is a good predictor of not drinking within 5 weeks but not over longer period. So TPB not applicable to real-life behaviour change (McEachan et al. 2011). Theory 4: Self-efficacy theory Key concepts of the theory Self-efficacy is the belief in one's own ability to perform a task successfully, central to behavioural change. Awareness of self-efficacy comes from four sources: 1. Mastery experiences Experience of performing task successfully means you learn about your own capability and expect to succeed on future tasks. 2. Vicarious reinforcement Your self-efficacy increases when you observe someone else succeeding at a task. Especially if you perceive them as similar to you (identification). 3. Social persuasion Encouragement from others (using words) increases self-efficacy, adds to belief we can succeed. Source has to be credible (e.g. qualified). 4. Emotional states Stress, anxiety and fear reduce self-efficacy (e.g. being evaluated", we expect to fail and do. Evaluation Practical uses Break target behaviour down into achievable tasks (easiest first), use relaxation training to reduce stress. Support for effectiveness Self-efficacy linked to several health behaviours (eg. exercise), can be increased leading to change (Strecher et al. 1986). Negative effects Increasing self-efficacy lowered performance on next task, led to overconfidence and less effort (Vancouver et al. 2002). Theory 5: Transtheoretical model Key concepts of the model Model makes four assumptions about change (Prochaska and DiClemente 1983): o Change occurs through stages. o But not in tidy order - cyclical process. o People differ in how ready they are to change. o Usefulness of intervention depends on stage client is in. Five stages of model are: 1. Precontemplation Client not thinking of changing in next 6 months, so help consider the need to change. 2. Contemplation Client thinking of change in next 6 months, so help by emphasising benefits of change. 3. Preparation Client believes benefits of change outweigh costs, will change in next month, so help with plan and options. 4. Action Client has done something in past 6 months to reduce health risk, so help client to develop coping skills to keep on going. 5. Maintenance Client continued a change for more than 6 months, way of life, so help to apply coping skills. Evaluation Practical uses Positive realistic view of relapse as part of change process, built into model and credible with clients. Dynamic process Change is a continuing process not one-off, stages vary for different people, moving backwards as well as forwards. Arbitrary stages No research support for 'cut-off' points between stages, which matters because intervention depends upon which stage client is at. Theories of persuasion Hovland-Yale theory The communicator (source) Credibility: more persuasive when seen as credible (e.g. anti-smoking expert), also honest, trustworthy. Personal experience helps (e.g. ex-drug user). Attractiveness: physically attractive = more persuasive (halo effect). The communication (message) Emotional appeal: fear-related threat plus way to avoid negative outcomes. One side or two? intelligent audience see one-sided argument as biased, less persuasive. The recipients (audience) Intelligence: intelligent people resist persuasion because they can process complex messages. Self-esteem: people with low self-esteem easier to persuade. Predicting behavioural change More persuasive = attractive, credible source with experience + fear message with way out + argument to match audience + audience with low intelligence and low self-esteem. Evaluation Support for effectiveness Most persuasive anti-smoking message was high threat + possible to quit (Sturges and Rogers 1996). Attitude change, not behaviour change Factors of theory show how people change their minds, but not necessarily behaviour, Role of self-esteem People with high self-esteem are easier to persuade, opposite to theory (Baumeister and Covington 1985). Fear arousal theory Fear as a drive Motivates to change behaviours because creates unpleasant physiological arousal, reduce = relief, negative reinforcement. Fear-behaviour relationship Curvilinear not linear: o Low fear: not enough unpleasant arousal to motivate change. o Moderate fear: just enough arousal. o High fear: counterproductive, believe changing behaviour not enough to relieve arousal (so denial instead of change). Predicting behavioural change Use moderate fear in adverts + show audience they are currently at risk + identify change to reduce arousal. Evaluation Support for effectiveness Fear arousal persuaded students to get vaccinated (Dabbs and Leventhal 1966), also other changes. Linear or curvilinear? Most change produced by low fear (Janis and Feshbach 1953) or high fear (Tannenbaum et al. 2015) but not moderate, is it really fear? Messages intend to arouse fear but not easily measured so could be other emotions e.g. anger, disgust. Elaboration-likelihood model (ELM) Process 1: Central route Message is persuasive when it is relevant and I evaluate content (high elaboration), long-term change. Process 2: Peripheral route Persuaded by non-content factors, e.g. source attractiveness, little processing of message (low elaboration), short-term change. Factors of influence Personal relevance: I elaborate relevant message more, so more persuasive = central route. Time and attention: lack of these means low elaboration, ignore content, other factors persuasive = peripheral route. Role of celebrity: both routes - focus on message (central) or provide glamour (peripheral). Individual differences People high in need for cognition (NFC) enjoy evaluating arguments, able to process message detail = central route. Evaluation Practical uses Short-term change with celebrities via peripheral route, so combine with central route (e.g. role play provides personal relevance). Effective for behaviour change Both routes can change attitudes, but behaviour changed by central route = better predictor of change. Generalisation issues Studies use students (greater cognitive abilities, not representative). Non-student studies do not support ELM. Treatment and management of addiction and stress Mindfulness What is mindfulness? Positive psychological approach to stress and addiction by being in the present moment: Attending to and regulating thoughts, feelings, and emotions: monitor these, observe and accept them. Being in the present moment-to-moment awareness of sensations. Promoting healthy behaviours: through training and practising techniques, experience present clearly Mindfulness and stress Mindfulness-Based Stress Reduction (MBSR, Kabat-Zinn 2003) - standardised programme based on Buddhist meditation. Regular group sessions, mindful focus on own thoughts, body scan, mindful stretching Less troubled by stressful thoughts, promotes distraction. Mindfulness and addiction Mindfulness-Oriented Recovery Enhancement (MORE, Garland o 2013) Awareness of automatic behaviour - mindful not mindless Chocolate exercise - practise reducing cravings. Guided techniques - recorded or live Evaluation Practical uses Lower stress to improve cancer treatment, increase academic achievement, and job performance - flexible and tailored. Support for effectiveness better outcomes for MORE than other programmes (reduced cravings, Li et al. 2017), MBSR effective stress reduction (Grossman et al. 2004). Exaggerated claims Inconclusive evidence, supporting studies have weaknesses (e.g. no control groups). overhyped, unscientific. СВТ Irrational thinking leads to (e.g.) taking drugs as a way to cope with stress, and then leads to addiction. Cognitive = change thinking. Behavioural = avoid situations, learn coping skills. Functional analysis Client and therapist identify high-risk situations and which thoughts trigger cravings, keep 'thought diary, ongoing process. Cognitive restructuring Therapist challenges distorted thinking (e.g. client may wrongly believe they are coping). Behaviour change Learn new skills for coping (e.g. anger management), practise in safe environment. Relapse prevention Skills to avoid relapse. Identify cues triggering irrational thoughts, challenge them, learn to cope with situation. Evaluation Practical uses Learn a more realistic view of relapse (not one-off event), see as a chance for growth, breaks addiction cycle. Support for effectiveness Small but significant benefit of CBT over controls for substance addictions (Magill and Ray 2009). Limited effectiveness Good short-term for gambling (3 months) but no benefit over controls after 12 months (Cowlishaw et al. 2012). Counselling Therapeutic relationship Warm, open, honest, working together, client trusts counsellor and feels safe. Emotional support Client talks about emotions but with recovery/coping-focused goal. Counsellor actively listens but does not direct or judge. Relapse prevention plan Together discuss warning signs and how to recover quickly. Evaluation Practical uses Flexible so helps wide range of clients (individuals, groups) using other methods e.g. CBT. Lack of effectiveness Hard to measure client-counsellor relationship, any treatment better than none. Guided self-help (GSH) GSH basics Self-help: client is own therapist, learning and applying CBT techniques. Guided: supported by mental health professional, not directed Practical steps in GSH Materials: structured programme online/print, advice, CBT activities. Guided sessions: contact with PWP, 6 × 30 minutes, review task, set goals, discuss techniques. Evaluation Evidence for effectiveness Bigger reduction in stress in eight-week GSH group over six months (Williams et al. 2018). Limited effectiveness Too flexible, so blurs boundaries with other treatments. Contact more effective than materials. SIT Stressful thinking We can control how we think about stressors, thinking positively helps coping. Inoculation SIT protects (inoculates) against future stressors. Learn coping skills in advance, exposed to small stress first. Practical issues 9-12 sessions in 2-3 months, follow-up. Phase 1: Cognitive preparation Client and therapist identify stressors, break them down, learn to perceive them as challenges. Supportive therapeutic relationship. Phase 2: Skill acquisition Client learns skills (e.g. social skills, relaxation) to cope with future stressors. Most benefit from 'self-talk, coping self-statements. Behavioural element: observe, model, practise skills. Phase 3: Application and follow-through Personal experiments: homework tasks in increasingly stressful real-world situations. Relapse prevention: setbacks are chances to learn, develop internal locus of control. Evaluation Practical uses Lots of skills suitable for different groups (e.g. older people), flexible, tailored to client (e. g. online). Support for effectiveness Short SIT course reduced stress in law students, improved exam performance of bottom 20% (Sheehy and Horan 2004). Too complex Broad range of skills for many stressors, not equally effective. May just be positive thinking and skill acquisition is only secondary importance. Social support Support networks can help during stress/ addiction. Vary in size but quality more important. Instrumental support Practical help, physical (e.g. lift to hospital, giving information (e.g. bus times). Emotional support Feelings, expressing warmth, concern, etc., offers comfort and lifts mood. Esteem support Express confidence in someone, increases self-efficacy and self-esteem. Explaining the benefits Buffering hypothesis: support gives psychological distance from stressor (buffer zone). Only helps during stress (Cohen and Wills 1985). Direct effects hypothesis: support helps at all times, reduces physiological arousal. Relationships between types All three types overlap, often provided together and without face-to-face contact (e.g. social media). Evaluation Practical uses Benefit of social support types depends on culture (Taylor et al. 2004), less used by Asian Americans. Support for effectiveness Belief in social support protected against common cold even when stressed. Hugs provide one third of effect (Cohen et al. 2015). Risk of backfiring Support not always beneficial, e.g. relative accompanying you to hospital may create more anxiety. Biofeedback Tackles stress by reducing ANS activity (sympathetic nervous system) - but automatic, no voluntary control over ANS. Client learns to take control after seeing or hearing physiological responses. Phase 1: Awareness and physiological feedback Machine convert client's arousal (e.g. heart rate, muscular tension) into signals (e.g. sound) that reflect changed activity. Therapist explains feedback. Phase 2: Relaxation training and control Client learns to take control by changing the signal (e.g. by slowing heart rate), Relaxation training helps reduce arousal. Role of operant conditioning: machine feedback and therapist's praise positively reinforce client control. Phase 3: Transfer Portable devices help client transfer skills to real-life situations. Evaluation Support for effectiveness Doctors using biofeedback reduced stress scores more than controls over 28 days (Lemaire et al. 2011). Inconsistent effectiveness Objective measures (e.g. heart rate) did not reduce in doctor study (Lemaire et al. 2011). Not always useful Commitment and effort needed especially in transfer phase; stress may prevent this happening. Skills training Skills training basics Self-efficacy increases through skills training, develop internal locus of control. Assertiveness training Relationship conflict stressful and triggers relapse, so cope with conflict in controlled way. Anger management Arousal expresses as anger, so express emotions (e.g. from childhood) constructively. Social skills training (SST) Improve communication to cope with anxiety in social situations. Skills training techniques Group discussion: share ideas and thoughts, identify common risks. Modelling and role play: imitate therapist, record role play and get positive reinforcement. Homework: real-world practice, more challenging, keep diary. Visualisation: imagine using skills, role play. Evaluation Support for effectiveness Skills training just as good as CBT to reduce gambling (e.g. spent less money, Toneatto 2016). Long-term effectiveness Benefits after 12 months (Toneatto), future-focused treatment, learn Skills to cope. Role of cognitive factors CBT helps even severely dependent drinkers, but skills training works only for moderate drinkers (Heather et al. 2006). Physiological treatments Nicotine substitutes NRT by patches, gum, etc., controlled 'clean' nicotine dose. Mechanism: nicotine molecules attach to VTA receptors, dopamine release in NA Withdrawal: manage symptoms by reducing NRT dose. Drug treatments for alcohol addiction Disulfiram (Antabuse): alcoholic drink triggers severe hangover, associated with drinking so avoided. Acamprosate (Campral): stabilises GABA, reduces cravings after withdrawal, avoids relapse. OTC stress remedies Valerian, chamomile, lavender derived from herbs, mildly sedative reducing anxiety. Exercise Replicates fight or flight symptoms, giving small protective 'doses' of stress, also distraction. Release of endorphins: natural painkillers and stimulate dopamine, euphoria, improved mood, and outlook. Evaluation Practical uses NRT type usually suits most people, Disulfiram everyday use (slow release), exercise includes many physical activities. Support for effectiveness NRT increases stop rate 50-60% (Hartmann-Boyce et al. 2018), disulfiram more effective than alternatives (Skinner et al. 2014), exercise improves stress coping (Sharon-David and Tenenbaum 2017). Side effects NRT and OTC remedies = headaches, sleep problems. Disulfiram = lower mood. Exercise = endorphin dependence. Sometimes side effects outweigh benefits of treatments. Maintenance of behavioural change Reasons for non-adherence Stress Poverty is stressful - non-adherence in lower socioeconomic groups. Chaotic lifestyles are stressful - disorganised people forget or have no time to adhere. Anxiety narrows attention - latch onto key words (e.g. 'cancer') and ignore the rest. Stress disrupts memory - 40-80% of medical advice immediately forgotten. Evaluation Support for effectiveness Clients with highest stress most non-adherent to medication and lifestyle advice (Roohafza et al. 2016). Short-term vs long-term Stress affects adherence short-term but long-term is unclear, so practical uses limited. Rational non-adherence Making a logical decision not to follow medical advice. Cost-benefit analysis Main benefit = reduction of symptoms, but costs are: o Side effects: e.g. dizziness, memory problems, injury. o Financial barriers: o unaffordable, e.g. cost of drugs. o Patient-practitioner relationship: e.g. lack of trust, dislike style. Evaluation Support for effectiveness Adherence dropped for expensive drugs when patients had to pay for them in Spain, barrier (González López- Valcárcel et al. 2017). Unjustified assumption Health decisions not usually made rationally, often unplanned and made under stress. Learned helplessness Ill people learn to be helpless in uncontrollable situations. Link with health Client learns controlling adherence makes no difference to health, so no longer behave to change situation. Thinking in negative ways = passivity and less motivation. Downward spiral Learned helplessness may lead to depression, reduces adherence, makes depression worse... Evaluation Practical uses Cognitive therapy to change perceived (non)link between behaviours and outcomes, break downward spiral. Lack of research support Learned helplessness linked to depression and low self-esteem - perhaps these cause non-adherence (Kuttner et al. 1990). Lack of support Significant others Lack of practical support: no family/friends to give reminders, lifts, etc. Lack of emotional support: no one to improve mood, give rewards. But some relationships are negative, so better to rely on professionals. Health professionals Lack of practical support: no access to experts, no information. Lack of emotional support: client perceives no trust or poor communication. Evaluation Support for effectiveness Adherence lower in older people living alone, homeless people, people with mental health issues (Wheeler et al. 2014). Limited effectiveness Non-adherence still widespread and costly because not due to just one factor, so address more than one. Methods to improve adherence Health education and promotion Relevance to target group Take account of differences between people, e.g. confirm clients remember advice, use simple language, modelling by health professional (specific exercises, meal planning). Improving access to information Client needs: type must suit client (printed, online, apps), be accessible. Health professionals: appointments via apps, pharmacists are accessible, phone follow-ups. Evaluation Practical uses Avoid vague language and make instructions specific (Eraker et al. 1984). Access or quality? Quality more important - dangers of improving access to poor information. Reduction of perceived threats Client believes they risk harm from medical advice - change perceptions. Resistance Reduce client's resistance to change their perceptions (e.g. build exercise into a habit). Understanding of needs Give client a source of medical advice that meets their need to be accepted. Safety and security: including client in decisions helps them to feel safe and secure, gives control. Fears: address fears directly by discussing them. Evaluation Practical uses Increase client's perception of threat from illness (vulnerability, health belief model). Perception-behaviour gap Reducing threat perception does not always increase adherence, so address different aspects. Using lifestyle changes Reduction in stress Manage stress (skills) to increase motivation to adhere. Improve self-esteem and self-confidence Give support to improve both by succeeding in health behaviours. Emotional resilience Positive outlook and mindfulness can help people 'bounce back. Insight into own behaviour Become aware of mindless habits to overcome them. Improved outlook on life Encourage optimism, positive outlook. Evaluation Effectiveness is cumulative Factors are often linked, so improving one (outlook) can improve others (resilience). Vicious cycle Changing lifestyle factors not enough because worst cases (most stressed) drop out. Using behavioural change Provision of incentives Money to quit smoking better than information (Volpp et al. 2009). Persuasive health reminders Provide support as well as information. o Persuasive texts: remind of goals and give encouragement. o Self-tracking: apps track health behaviours. o Progress monitoring: also, apps to show improvement. Social prescribing non-medical options e.g. support groups - helpful for complex, long-term, mental health. Evaluation Practical uses eCoaching uses technology, tailors messages to client's goals, improves adherence. Limited effectiveness Best quality research shows social prescribing has no positive impact (Mason et al. 2019).