PSY1APP Lecture 3: Health Psychology PDF

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This Photo by Unknown Author is licensed under CC BY-SA This Photo by Unknown Author is licensed under CC BY This Photo by Unknown Author is licensed under CC BY PSY1APP Lecture 3 Health Psychology: Behaviour and Heath A/Prof Carina Chan  To apply the biopsychosocial model of health to real-world problems To discuss the multidimensional nature of the Learning Outcomes determinants that explain healthy or risky behaviours To explain the health behaviour change models/theories in predicting health behaviours What is health? What is health? WHO’s definition of health A complete state of physical, mental, and social well-being and not merely the absence of disease and infirmity  Behaviours and Health Causes of disease: a combination of non- modifiable, medical and psychosocial factors BUT Many chronic (communicable and non-communicable) diseases can be understood in terms of modifiable lifestyle or behavioral risk factors  What is Health Psychology? The study of psychological and behavioural processes in health, illness and healthcare Focuses on the understanding of biopsychosocial factors that contribute to health and illness  Health Psychology Goals Examines the effects of behaviour and contextual factors on health and illness and vice versa Encourages and supports health-promoting behaviours, and behaviour change Helps individuals, educates communities, develops policy for better physical and mental health Operates in private practice, hospital environments, research and policy-making organisations Approaches How do we get people to change their behaviour How do we assess people’s health How can we actually prevent and treat illness? What measurements can we use in health care setting when not a medical practitioner? Some examples: Addressing/modifying risk factors Promote positive health behaviours Reduce harmful or risky health behaviours Symptoms/risk perception, patients’ decision making to medical treatment Coping with illness and chronic diseases Stress and stress management? 8 Some examples: Adhering to treatments (medication and behavioural management) Understanding and improving adjustment in health-care settings 9 Some examples: Identifying determinants of health- related behaviours Social-cultural factors (e.g., gender, family, SES) Cognitive factors (e.g., health beliefs, attitudes, perceptions, motivations, goal-setting) Emotional factors (e.g., fear, worry) Ecological factors (e.g., accessibility, policy, health systems) 10 This Photo by Unknown Author is licensed under CC BY-NC-ND Bio-psycho- social Model The Biopsychosocial Model Biological Factors Psychological Factors Social Factors Society- influences health by Physiological functioning (e.g., Cognitions (e.g., beliefs about promoting the values of the structural defects, over- health) culture reactions in protective Emotions (i.e, emotionally functions) Community- people are influenced stable people tend to take by others and in turn influence Genetic abnormalities (e.g., better care of their health) others. This can determine what genetic materials and Motivation (i.e., highly health-related behaviours are processes inherited from motivated people generally adopted among various groups parents) find it easier to begin a diet or Family- people learn many health- exercise program) related attitudes and behaviours within the family Disease and health risk behaviours The common risk behaviours that are closely associated with poor health outcomes are (Chan & Yasin, 2018): Overweight/obesity (excessive calorie intake) Sedentary lifestyle Physical inactivity Elevated cholesterol Low fruit and vegetable intake Tobacco use ‘excessive’ alcohol consumption unsafe/unprotected sexual intercourse Omission of appropriate medical screening and vaccination  How does lifespan explain health and health risks? Think about the followings: Adolescents and sedentary behaviour Young adults and alcohol consumption Working adults and fast food Middle-aged adults and screening behaviours Old-aged adults and medication adherence 14  Overweight and Obesity Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health (World Health Organisation) The negative consequences of obesity include: Hypertension Heart disease Type-2 diabetes Osteoarthritis and lower back pain Psychological ill-health (e.g., low self esteem, social isolation) This Photo by Unknown Author is licensed under CC BY-SA Determinants Genetics Women more likely to be obese in all WHO regions SES and minority groups Lifestyle (physical activity and unhealthy eating) that contributes to energy imbalance This Photo by Unknown Author is licensed under CC BY-SA Diet Diet has been found to have direct and indirect links with illness High-sugar food Sweetened beverages High saturated fat High sodium Fruit and Vegetable Intake The World Health Organisation (2009) states that low intake of fruit and vegetables is linked to 1.7 million (2.8%) deaths per year, worldwide. Health benefits of fruit and vegetables include protection against cancer and heart disease (Wang et al. 2014) WHO recommends a daily consumption of at least five servings of fruits and vegetables and fat that is less than 30% of total dietary energy Determinants of Fruit and Vegetable Intake SES (higher SES, more consumption) Minority groups at great risk Sociocultural norms Environmental factors (neighbourhood, workplace) Social support (family) Physical Activity Globally, the recommendations suggest at least 30 minutes of moderate exercise, 5 days a week for adults 60 minutes for children and young people everyday This Photo by Unknown Author is licensed under CC BY Determinants SES (lower SES, less activity) Social support (friends, peers, family) Environmental factors (neighbourhood, workplace) This Photo by Unknown Author is licensed under CC BY Smoking: Determinants SES and education Modelling and social learning (Parents, siblings, peers, friends) Accessibility, availability Policy This Photo by Unknown Author is licensed under CC BY-NC-ND Alcohol Consumption: Determinants Sociocultural factors Culture Religion Family Peers Environmental factors Risky Sexual Behaviours: Determinants Nonadherence to Recommended Screening and Vaccination Guidelines Individuals Education, knowledge Risk perception Cost Fear, anxiety Sociocultural factors Family, culture Health system/policy Medicare Insurance Modifying Health Behaviours  The Health Belief Model Beliefs on Threat Beliefs about Behaviour Figure 5.1 The health belief model, (original, plus additions in italics)  The Health Belief Model Rosenstock 1974; Becker et al. 1977; Strecher et al. 1997. Perception of threat: I believe that coronary heart disease is a serious illness contributed to being overweight: perceived severity. I believe that I am overweight: perceived susceptibility. Behavioural evaluation: If I lose weight, my health will improve: perceived benefits (of change). Changing my cooking and dietary habits when I also have a family to feed will be difficult, and possibly more expensive: perceived barriers (to change). Cues to action (added in 1975, Becker and Maiman): That recent TV programme on the health risks of obesity worried me (external). I regularly feel breathless on exertion, maybe I should lose some weight (internal). Health motivation (added in 1977, Becker et al.): It is important to me to maintain my health. The Health Belief Model Applications: HBM is widely used for predicting breast self-examination; Perceived benefits of self-examination and few barriers to its performance are most consistently and most highly correlated; Other factors are predictive of BSE; perceived seriousness of breast cancer, perceived susceptibility and being motivated towards health (e.g. actively seeking health information). HBM factors are correlated with use of a variety of other health behaviours including dieting and condom use But only modest associations Vulnerability and costs are most predictive Many studies are retrospective, for example Past exercise predicts reports of severity, vulnerability, benefits and costs This Photo by Unknown Author is licensed under CC BY-ND  The Health Belief Model Limitations: HBM components are more relevant in predicting health preventive behaviour, rather than reducing risk-behaviour. HBM factors are correlated with use of a variety of health behaviours Breast self-examinations, dieting, condom use But only modest associations Vulnerability and costs are most predictive Many studies are retrospective: E.g.,: Past exercise predicts reports of severity, vulnerability, benefits and costs Little evidence of HBM-based messages changing behaviour  The Theory of Planned Behaviour (Ajzen 1985; 1991) Figure 5.2 The theory of planned behaviour  The Theory of Planned Behaviour Previously the Theory of Reasoned Action (Ajzen and Fishbein 1970; Fishbein and Ajzen 1985) The TPB assumes that: individuals behave in a goal-directed manner; the implications of actions (outcome expectancies) are weighed up in a rational manner. The TPB aims to explore and develop the psychological processes involved in making a link between attitude and behaviour, by including: social influences on behaviour; beliefs in perceived behavioural control; and the necessity of intention formation.  The Theory of Planned Behaviour Applications: eating breakfast (Wong and Mullan 2009) breastfeeding intentions (Giles et al. 2014) medication adherence (Morrison et al. 2015) mothers behaviours to encourage an active versus a sedentary lifestyle in their children (Hamilton et al. 2013) Limitations: TPB does not acknowledge likely transactions between predictor variables (attitudes and subjective norms) and outcome variables, either intention or behaviour. Little evidence that TPB messages change intentions or behaviour Assumes that the same factors and processes predict the initiation of a behaviour and the maintenance of that behaviour/change. Stages of Change Model Prochaska & DiClemente Preparation Contemplation Pre- contemplation Action Relapse Maintenance Stages of Change Model Distinguish between the stages of change in acquiring positive Model of intentional change behaviour or modifying problem behaviour Widely used as basis of health Application in smoking behaviour intervention: cessation, exercise, diet, Personalisation by motivation weight management, condom level use, cancer screening… Stages of Change Model Prochaska & DiClemente Precontemplation: Not Contemplation: Thinking, ready to change, no intend to change in the next intention to change in the 6 months next 6 months Encourage re-evaluation of Encourage re-appraisal of behaviour, explain and pros and cons for change, personalise risk for not promote positive changing outcomes expectation Stages of Change Model Prochaska & DiClemente Preparation: Ready to change, Action: Active in change plan to act in 1 month Reinforce positive antecedents and Encourage evaluation of pros and enhance self-efficacy to overcome cons for change, identify achievable, barriers small steps to change, set realistic goal Stages of Change Model Prochaska & DiClemente Maintenance: Sustaining Relapse the change Identify and evaluate trigger of Strengthen positive outcomes relapse, formulate action plans to expectation, reinforce strategies cope with relapse and re-enter used to overcome obstacles, the cycle coping for relapse  The Common Sense Model Leventhal et al (2003) Framework for identifying the contents of health threat representations, and for understanding how these cognitions and associated emotions motivate protective behavior Leventhal, H., Brissette, I., & Leventhal, E.A. (2003). The common-sense model of self-regulation of health and illness. In L. D. Cameron, & H. Leventhal (Eds.). The self-regulation of health and illness behaviour.  P Illness Coping for Appraisal of E Representation Illness Coping M R Control Outcomes E S C S E A P G T E I S O Representation of Coping for Appraisal of N Emotional Emotion Control Coping Reaction Outcomes THE COMMON-SENSE MODEL (Leventhal)  P Illness Coping for Appraisal of E Representation Illness Coping M R Control Outcomes E Identity: S C Label/Symptoms S E Consequences A P Cause G T Control E I Timeline S Representation of O Coping for Appraisal of N Emotional Emotion Control Coping Reaction Outcomes (Worry or fear) THE COMMON-SENSE MODEL (Leventhal) Health Threat Representations: Five Attributes Identity (the illness label/symptoms and physical attributes that put one at risk) e.g., dizzy, headache, chest pain Cause (factors responsible for its occurrence) e.g., infection, tired, stress, unknown? Timeline (time of onset and its duration) e.g., acute, cyclic or chronic Health Threat Representations: Five Attributes Consequences (health/psychosocial outcomes) e.g., expected pain, psychosocial effects, and death Control/cure (personal and medical control over illness progression, prevention or cure) E.g., medication, surgery, early screening Illness perceptions and disease management Changing patients’ perceptions about MI resulted in improved functional outcome post-MI Petire, K. J., Cameron, L. D., Ellis, C. J., Buick, D., & Weinman, J. (2002). Changing illness perceptions after myocardial infarction: An early intervention randomized controlled trial. Psychosomatic Medicine, 64, 580-586. Illness perceptions and disease management Illness perceptions of MI patients predict attendance at cardia rehabilitation Controllability Symptomatic (identity) Severe consequences Coherence French, D. P., Cooper, A., & Weinman, J. (2006). Illness perceptions predict attendance at cardiac rehabilitation following acute myocardial infarction: A systematic review with meta-analysis. Journal of Psychosomatic Research, 61, 757-767. Emotional Reactions to Health Threats These representations elicit emotional arousal such as worry and fear Both representations, and emotions guide decisions to engage in protective behavior The CSM delineates abstract– conceptual processes and concrete– experiential processes in cognitive and emotional systems with representations including both abstract beliefs and concrete images. Emotion regulation interventions Using the emotion regulation arm of CSM to understand the processes for managing illness-related distress Some examples: Psychosocial support intervention for women with breast cancer Writing intervention for promoting adjustment to stress Cameron, L. D., Jago, L. (2008). Emotion regulation interventions: A common-sense model approach. British Journal of Health Psychology, 13, 215-221. From Theory to Intervention to Dissemination Identifying key constructs for intervention (Michie et al., 2008) An integrative theoretical framework Behaviour Change Wheel, Michie et al, 2011 www.behaviourchangewheel.com Michie, S., Johnston, M., Francis, J., Hardeman, W., & Eccles, M. (2008). From Theory to Intervention: Mapping Theoretically Derived Behavioural Determinants to Behaviour Change Techniques. Applied Psychology, 57, 660-680. Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, 42 Behaviour Change Wheel (Michie et al., 2011) Systematic literature review identified 19 frameworks of behaviour change interventions related to health, environment, culture change, social marketing etc. Targets for intervention COM-B model Capability Opportunity Motivation URL: Behaviour http://www.behaviourchangewheel.com/ Behaviour Change Wheel (Michie et al., 2011) Nine intervention functions (red part of the wheel) Seven policy categories (Grey part of the wheel) Linked to the COM-B model Summary Many different models, each originally developed for a different context/issue Area of growing research (more evidence needed to support the relevance of a specific model to a population or condition) Behaviour Change Wheel to consolidate theories into a taxonomy Some considerations: Different factors salient for different behavours (i.e. subjective norms more important for smoking cessation than vitamin intake). Behaviour also influenced by factors outside of these models: SES resources, culture, laws and sanctions, religion Salience of certain factors varies with age (i.e. medication compliance might be predicted in adults by locus of control, or in children by parental behavior) – lifespan factors