Health Related Behaviours, Beliefs and Attitudes PDF

Genes, Behaviour and Environment 4MBBS103 Neuroscience, Behaviour and Social Science Health related behaviours, beliefs and attitudes. Learning objectives 1. Explain the role of behaviour on health outcomes 2. Define the term health behaviour 3. Describe key determinants of health...

Genes, Behaviour and Environment 4MBBS103 Neuroscience, Behaviour and Social Science Health related behaviours, beliefs and attitudes. Learning objectives 1. Explain the role of behaviour on health outcomes 2. Define the term health behaviour 3. Describe key determinants of health behaviours using psychological theory – focus on promotion/prevention 4. Identify psychological interventions used to improve health outcomes Objective 1 Explain the role of behaviour on health outcomes Reflection Think about the last time you made a resolution to change your behaviour… Were you successful? Did you sustain your behaviour change? Avoidable mortality Preventable mortality – deaths that can be mainly avoided through effective public health and primary prevention interventions Treatable mortality – deaths that can be mainly avoided through timely and effective healthcare interventions, including secondary prevention and treatment Avoidable mortality – deaths defined as either preventable or treatable  Almost 40% of the disease burden in England is due to preventable risk factors NHS England 2019 Does our behaviour Approximately 38% of all cancers are related to behaviour affect Cancer Research UK 2015 outcomes? 80% of cases of heart disease, stroke, and diabetes could be avoided if lifestyle risk factors were appropriately managed World Health Organization, 2015 Behaviour and outcomes: Khaw et al. (2008) 20, 244 men and women aged 45 – 79 years No known CVD or cancer at baseline. Death from all causes was related to 4 health behaviours: Smoking Physical Inactivity Drinking more than moderate levels of alcohol Not eating 5 or more portions of fruit and veg per day. Relationships consistent when controlling for age, Mortality risk for those with 4 compared to zero health behaviours was sex, SES, BMI equivalent to being 14 years younger. Objective 2 Define the term health behaviour Health behaviour Health behaviours, sometimes called health-related behaviours, are actions taken by individuals that affect health or mortality. These actions may be intentional or unintentional and can promote or detract from the health of the person or others. Health Behaviours Health behaviours can be either (Steptoe, Gardener & Wardle, 2010): Enhancing Compromising Generally organise behaviours according to whether they are: Risky Promoting/ protective Illness related (e.g. excessive alcohol (e.g. healthy diet and (e.g. adherence to consumption, exercise, practicing treatment, smoking, unsafe sex) safe sex) appointment attendance) Health behaviours b As science evolves our knowledge of healthy behaviours changes. 1950s – eat the fat off meat! 1919 – USA diet advice: bread, milk, and cookies Doctor knows best! Health behaviour patterns Health behaviours are: Unstable over time Independent (e.g. can abstain from smoking but cannot exercise) Objective 3 Describe key determinants of health behaviour using psychological theory and models | Focus health promotion and prevention Why do I To change behaviour, we need a good need to understanding at what’s driving it. know about Behaviour is complex and influenced by a number of factors. health psycholog Explanatory theories are tested by using a range of research methods to help y models? illuminate the most important factors for that specific behaviour. Determinan ts of Health Cognitive factors Social(beliefs, Emotional factors attitudes) Reinforcement factors value Behaviour Symptoms Determinants of Health Behaviour | Social factors HOME Observational learning (e.g. toothcare) Modelling of positive and negative behaviours CULTURE & LEGISLATION Taxation (e.g. smoking) Criminalisation (e.g. drugs) PEER Social pressure Determinants Risky health behaviours have of Health immediate positive reinforcement (e.g. pleasure, accepted by peers) Behaviour | and started at a time when healthy Operant (e.g. no immediate impact/ punishment) on health. conditioning and Most health protective/ reinforcement promoting behaviours do NOT have short-term positive value reinforcement value, they are carried out for long-term health gain.  Some health behaviours have a physiological response (smoking, drinking, eating) - which can positively reinforce and sustain the behaviour. Determinants May also act as a negative reinforcer Cold turkey; therefore sustain behaviour to of Health prevent the side effects Behaviour | Symptoms Can act as cues/triggers for behaviour change A cough as cue for smoking cessation Breathlessness trigger increase in exercise Symptoms can also relate to adherence to medicines (a health/illness behaviour) Determinants of Health Behaviour | Emotions Negative Smoking/drinking/overeating to “self-sooth” Fear – avoidance patterns (e.g. dentist, flu jab) Above are examples of ineffective emotion focused coping Positive Exercise in response to stress Determinan ts of Health Cognitive factors Social(beliefs, Emotional factors attitudes) Reinforcement factors value Behaviour Symptoms Determinants of Health Behaviour | Cognitions/Beliefs Beliefs and perceptions about behaviour determine motivation to act Two core cognitive theories that explain promoting/preventative behaviour include: Health Belief Model Theory of Planned Behaviour Determinants of Health Behaviour | Cognitions/Beliefs b Health Belief Model Theory of Planned Behaviour Health Belief Model (Rosenstock 1966) PERCEIVED SUSCEPTIBILITY PERCEIVED PERCEIVED THREAT CUE TO SEVERITY LIKELIHOOD ACTION OF BEHAVIOUR PERCEIVED CHANGE COSTS/BARRIERS COST BENEFIT ASSESSMENT PERCEIVED BENEFITS  The Health Belief Model in action The HBM is one of the longest standing models of health behaviour. In has been used in research in relation to many health behaviours. Reviews of the evidence of the HBM have been generally positive and find that perceived barriers are often the most important factor in preventing change. The health belief model and different types of behaviour (adapted from Harrison et al. 1992) Case study Sarah is a 22 year old woman who has smoked 20 cigarettes a day since she was 15 years old. She coughs every morning and gets breathless easily. Although she has a family history of asthma, she has never been checked for asthma herself. Case study: Health Belief Model PERCEIVED SUSCEPTIBILITY “my chances of getting lung cancer are low” PERCEIVED PERCEIVED THREAT CUE TO SEVERITY LIKELIHOOD ACTION “cancer is a serious illness” OF Billboard BEHAVIOUR PERCEIVED CHANGE COSTS/BARRIERS COST “smoking helps when stressed” BENEFIT ASSESSMENT PERCEIVED BENEFITS “I’ll save money” Health Belief Model in clinical practice Clinical application Clinical application Explore patients’ perceived: Target these perceptions Susceptibility with: Severity Education Benefits Action plans Barriers Problem-solving Cues Case study: approaches “How do you think “How concerned are you PERCEIVED smoking is affecting your about your health” SUSCEPTIBILITY health… in 10 years? PERCEIVED PERCEIVED THREAT ‘Has anything SEVERITY LIKELIHOOD made you CUE TO think about ACTION OF “What are the pros giving up BEHAVIOUR and cons for you?” smoking?’ PERCEIVED CHANGE COSTS/BARRIERS COST BENEFIT “Is there anything ASSESSMENT stopping you from giving PERCEIVED up?” BENEFITS “You’ll save a huge amount of money” Case study: approaches 2 “How do you think “How concerned are you PERCEIVED smoking is affecting your about your health” SUSCEPTIBILITY health… in 10 years? PERCEIVED PERCEIVED THREAT ‘Has anything SEVERITY LIKELIHOOD made you CUE TO think about ACTION OF “What are the pros giving up BEHAVIOUR and cons for you?” smoking?’ PERCEIVED CHANGE COSTS/BARRIERS COST BENEFIT “Is there anything ASSESSMENT stopping you from giving PERCEIVED up?” BENEFITS “You’ll save a huge amount of money” Determinants of Health Behaviour | Cognitions/Beliefs TPB Health Belief Model Theory of Planned Behaviour Theory of Planned Behaviour (Fishbein and Ajzen 1975) Beliefs about outcomes Evaluations of these outcomes Attitude towards “Exercising is fun and will improve the behaviour my health” Beliefs about important others’ attitude to Behavioural Subjective Behaviour the behaviour Motivation to comply with important norm intention others “My friends will think exercising more is good AND their approval is important to me” Perceived Behavioural “I am capable of Internal control factors achieving my exercise control goals“ External control factors  Theory of Planned Behaviour : a worked example -Beliefs about outcomes -Evaluations of these outcomes “In what way do you think it is bad for you?” Attitude towards the behaviour -Beliefs about important others’ attitude to the behaviour -Motivation to comply with important others Subjective Behavioural Behaviour “What do your friends/ family/ partner think intention about you smoking” norm -Internal control factors “Have you ever thought about -External control factors giving up smoking?” …do you “Do you think you can give up smoking?” Perceived intend to give up in next few “What makes you think you can’t?” Behavioural months?” control  Theory of Planned Behaviour: Attitude towards The evidence: the behaviour Meta-analytic reviews suggest the model can account for 41% of the variance in intentions. Subjective Behavioural Behaviour norm intention However the TPB is less successful at predicting actual behaviour (c 34%). Perceived Behavioural control The intention-behaviour gap Why? Automatic habit – past behaviour dominating Emotion – low mood/anxiety associated with decreased health behaviour Implementation Intentions (Gollwitzer, 1995; Golwitzer & Sheeran, 2006) Includes combining an intention to behaviour with clear action plan: When – on Wednesday after work Where – Attend a group PT sessions How – Will walk a different route when I leave work, so I don’t head to the tube instead Who with – Will invite a friend to go together Shown to have medium to large effect on translating intention into behaviour Cues behaviour into conscious awareness  COM-B theoretical framework model (Michie et al., 2011)  COM-B theoretical framework Perceived susceptibility/severity (HBM) Capability Benefits/Barriers/Outcome Expectancies (HBM & TPB) Perceived Behavioural Control (TPB) Voluntary (conscious rational decision making) Motivation Involuntary (habits, emotions, impulse) Implementation Intention/Action Plan (TPM) Factors outside the control of the individual (e.g. Opportunity social environments) Social norms (TPB) HBM = Health Belief model TPB = Theory of Planned Behaviour Objective 4 Identify psychological interventions used to improve health outcomes Population Level Interventions to change behaviour Provides an action plan Targets perceived threat (HBM)  INFORMATION PROVISION Just giving information has minimal effects on behaviour change. Interventio People differ in motivation and differ in ns to attitudes and beliefs about the behaviour. change FEAR AROUSAL Why don’t we scare people into behaviour behaviour change? Does fear drive behaviour? Fear arousal Fear only has impact if self- efficacy for required behaviour is high. Self-efficacy: belief/confidence that one can perform a behaviour + Action planning allows self-efficacy to be boosted and cues behaviour Need fear (via beliefs/cognitions) and action plans to boost self-efficacy. Promotion of response efficacy (i.e., suggesting that the recommended action will avoid the danger Self affirmation Enhancing self-affirmation can reduce defensiveness and consequently the message is more likely to be absorbed (Steele, 1988) and health Armitage, Harris, Hepton & Napper, 2008 Enhanced self- affirmation before handing out anti-smoking leaflets. Self affirmation focused on instances in their lives they were ‘kind’. Self affirmation was associated with: greater acceptance of anti-smoking information, increased intentions to reduce their smoking behaviour, higher likelihood of taking a brochure with further tips on how to quit smoking 43 Summary Risky health behaviours compromise health outcomes Determinants of health outcomes = multifaceted. Focused on the below theories for explaining behaviours: Health Belief Model Theory of Planned Behaviour Briefly referred back to COM-B To improve efficacy of population level, interventions need to: Target perceived risk (encourage motivation to act) Provide a clear action-plan  James has high cholesterol and has been recommended by his doctor to change his diet. According to the Health Belief Model, what factor will most strongly influence whether James will attempt to change his diet? Quick A: Their causal beliefs about the medical problem quiz 1Q B: Their necessity beliefs about the recommendation C: Their perceived severity of the medical problem D: Their perceived control over the behaviour  According to the Health Belief Model, what factor will most strongly influence whether James will attempt to change his diet? Quick A: Their causal beliefs about the medical problem quiz 1A B: Their necessity beliefs about the recommendation C: Their perceived severity of the medical problem D: Their perceived control over the behaviour  A systematic review of fear appeal research concluded that: A: Fear tactics are the most appropriate strategy to promote healthy behaviour Quick B: Presenting coping information that increases perceptions of response quiz 2Q effectiveness may be more effective in promoting healthy behaviour than presenting fear arousing stimuli C: No conclusions could be made concerning the effectiveness of fear tactics in promoting healthy behaviour D: None of these  A systematic review of fear appeal research concluded that: A: Fear tactics are the most appropriate strategy to promote healthy behaviour Quick B: Presenting coping information that increases perceptions of response quiz 2A effectiveness may be more effective in promoting healthy behaviour than presenting fear arousing stimuli C: No conclusions could be made concerning the effectiveness of fear tactics in promoting healthy behaviour D: None of these Core reading books Ayers, S., & De Visser, R. (2017). Psychology for medicine and healthcare. Sage. Ogden, J. (2012). Health psychology: A textbook: A textbook. McGraw-Hill Education (UK). Useful references Conn, V. S., Ruppar, T. M., Enriquez, M., & Cooper, P. (2016). Medication adherence interventions that target subjects with adherence problems: systematic review and meta-analysis. Research in Social and Administrative Pharmacy, 12(2), 218-246. Rosenstock, I. M. (1974). The health belief model and preventive health behavior. Health education monographs, 2(4), 354- 386. Conner M & Armitage CJ (1998). The theory of planned behavior: A review and avenues for further research. Journal of Applied Social Psychology, 28, 1430-1464. Godin G & Kok G (1996). The theory of planned behaviour: A review of its applications to health related behaviors. American Journal of Health Promotion, 11, 87-97. Gollwitzer PM & Sheeran P (2006). Implementation intentions and goal achievement: A meta-analysis of effects and processes. Advances in Experimental Social Psychology, 38, 69-119. Useful references contd. https://www.gov.uk/government/publications/health-profile-for-england/chapter-2-major-causes-of-death-and-how-they-have-changed Pu Khaw, K. T., Wareham, N., Bingham, S., Welch, A., Luben, R., & Day, N. (2008). Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study. PLoS Med, 5(1), Berkman, L. A., & Breslow, L. (1984). Health and ways of living: The Alameda county studies. The Journal of Ambulatory Care Management, 7(1), 80. Witte, K., & Allen, M. (2000). A meta-analysis of fear appeals: Implications for effective public health campaigns. Health education & behavior, 27(5), 591-615. https://doi.org/10.1177/109019810002700506 Ruiter, R. A., Kessels, L. T., Peters, G. J. Y., & Kok, G. (2014). Sixty years of fear appeal research: Current state of the evidence. International journal of psychology, 49(2), 63-70. Steele CM. The psychology of self-affirmation: Sustaining the integrity of the self. Advances in experimental social psychology. 1988;21:261-302. Armitage CJ, Harris PR, Hepton G, Napper L. Self-affirmation increases acceptance of health-risk information among UK adult smokers with low socioeconomic status. Psychology of Addictive Behaviors. 2008; 22:88.