W16S2 - Health, Lifestyle & Behaviour Change PDF

2024/07/27 SAHL HEALTH PSYCHOLOGY & HEALTHCARE: Health, Lifestyle, and Behaviour Change – Week 16 Session 2 Dr Michael Pitman (Psychology)...

2024/07/27 SAHL HEALTH PSYCHOLOGY & HEALTHCARE: Health, Lifestyle, and Behaviour Change – Week 16 Session 2 Dr Michael Pitman (Psychology) [email protected] 1 Introduction The purpose of this session is to explore health psychology’s approach to promoting health, and preventing disease, through its understanding of health behaviours (both health-promoting behaviours and risk behaviours) and individual-level models of health behaviour such as the Health Belief Model. By the end of this session, you will be able to: Outline the concepts of health behaviour (including medical behaviours, lifestyle behaviours, and risky behaviours) Outline and explain the concepts of risk and risk factors, as applied to health Use an example (e.g. diabetes, smoking) to illustrate these concepts Outline the Health Belief Model and explain each of its constructs by way of an illustrative example Health psychologists are concerned with the prevention and treatment of illness and disability, the promotion and maintenance of good health, ways of coping and adapting to illness and disability, and improvements in the delivery of healthcare. How do the concepts, models, theories and methods of health psychology help us understand our increased risk of developing lifestyle-related negative health conditions, and how can it assist in promoting and supporting preventative and health-promoting intervention strategies? We will briefly explore answers to these questions using the Health Belief Model, and illustrative examples of diabetes and smoking. Extracted from: https://ulwazi.wits.ac.za/courses/66409/pages/w16-dot-s2-health-lifestyle-and-behaviour-change 2 1  2024/07/27 Quote for the day “…both mental states, such as a person’s outlook on life, and behaviors are critical in preventing illness, helping people regain health following illness, and helping achieve well-being. Well-being is a positive state that requires health and life satisfaction, not only the absence of disease. People need to actively participate in health-enhancing behaviors to achieve optimal health.” Phelps et al. (2022, p. 412, emphasis added) 3 Health, Lifestyle & Behaviour Change 4 2  2024/07/27 Session Plan Quick review – epidemiological shifts Health behaviour Risk & risk behaviour Models of health behaviour Health Belief Model e.g. Smoking Brain Gym (Source: www.eurokidsindia.com) 5 Historical Shifts in Health Issues and Causes of Death 6 3  2024/07/27 Significant Shifts Early 20th Century Later 20th Century Shorter life expectancy Longer life expectancy Infectious diseases as leading causes of Diseases of lifestyle and behaviour amongst death leading causes of death Infection by contact and contamination Conditions develop through unhealthy (water, food, people) behaviour* (e.g. diet, alcohol, smoking, stress, sedentary lifestyle) Medical care after falling ill Medical care ongoing, preventative, and prophylactic Diseases/ conditions of (relatively) short Diseases/ conditions are chronic duration – acute conditions Limited personal responsibility for health and Greater personal control and responsibility disease for health* 7 Health Behaviour Health behaviour refers to activities such as “medical” behaviours (e.g. treatment adherence, vaccination), “lifestyle” behaviours (e.g. diet, exercise, sex), and “risky” behaviours (e.g. alcohol, smoking, unsafe sexual practices, drugs) Health behaviour has been found to be related to a number of psychosocial influences A person's attitudes, beliefs, and mental well-being can play a major role in determining their health behaviour 8 4  2024/07/27 Health Behaviour (2) A person’s social- (e.g. education, finances, access to healthcare) and community-related circumstances can have significant effects in enabling, limiting, and shaping their health behaviour Health behaviour is influenced by interpersonal factors such as role modelling; the behaviour of parents and peers (e.g. “local norms”, Cvalues); social hapter 21 Risk behaviour media; environmental, societal, and stress sociocultural, and religious factors; history and politics. example, con icting ideas about the cause, treatment and specific disease, ill health or injury. They comprise behavioural management of HIV/ AIDS have interfered processes, within or outside individuals, which predispose with combating this pandemic. them to succumb to negative stressors. In a context of increasing social fragmentation and mistrust of expert systems, many people have a heightened An ecological-systems awareness of the physical and social dangers that they are exposed to in everyday life. Increasingly, risk-management approach to understanding strategies (such as negotiating safe sex and managing our diet or exposure to harmful substances) position individuals risk behaviour as being ultimately responsible for monitoring and Why do people sometimes behave in ways that can be managing the risk in their lives (Rhodes & Cusick, 2000). But perceived as harmful or risky to their mental and this can be problematic in situations where people do not physical health? An ecological-systems approach 9 have the freedom to control their lives. For example, it has (Bronfenbrenner, 1986) understands vulnerability to risk been found that gender inequality and economic behaviour as being in uenced by multiple contexts. ese dependence make women less likely to be able to control contexts can be broadly categorised into four levels of whether they have safe sex or not (Jewkes et al., 2003). in uence, namely the individual or intrapersonal level, the interpersonal level, the community level and the societal Risk behaviour level (see Figure 21.2). An ecological-systems approach to understanding a health problem emphasises the inter- Risk & Risk Behaviour Risk is the possibility of harm, and to risk something (such as your health) means to put it in danger. Risk behaviours refer to speci c forms of behaviour that are proven to be dependence between the factors across all the levels. Society associated with increased susceptibility to a specific Community disease or ill-health. Vulnerability, or the susceptibility to Interpersonal negative outcomes, is determined by a number of risk factors. Risk factors refer to biological, psychological, Individual social or economic behaviours or environments that are Risk associated with, or cause increased susceptibility to, a The possibility of harm Figure 21.2 Bronfenbrenner’s four levels of in uence To risk something (such as your health) means to When considering these four levels, we can see how they provide di erent strategies for reducing vulnerability to high-risk behaviour and promoting healthy behaviour. put it in danger ese strategies can generally be split into person-centred and situation-centred interventions: Person-centred interventions work with individuals Risk Behaviours and groups to promote health-protective behaviour and enhance resilience. Resilience is the successful Refer to specific forms of behaviour that are proven to be adaptation to the environment despite exposure to risk. Situation-centred interventions are focused on associated with increased susceptibility to a specific creating environments with protective factors that enable individuals and groups to practise healthy disease or ill-health behaviour. Protective factors are those influences Figure 21.1 Risky behaviour can be as simple as smoking, that limit or reduce the likelihood of high-risk drinking too much alcohol and overeating behaviour and play a moderating or bu ering role. 467 9780190748906_ Intro_to_Psychology_5e.indb 467 2021/10/22 13:07:59 10 5  2024/07/27 Common Examples of ‘Lifestyle’ Risk Factors Smoking Physical Inactivity Drinking Unsafe Unhealthy sex diet 11 Risk & ‘Risk Society’ “We live in a ‘risk society’” Individuals and societies are confronted by both visible and invisible risks – especially as a result of the accumulation and awareness of scientific research (but also digital and social media) ‘Risk society’ – individuals increasingly expected to take responsibility for managing a range of risks to themselves, their loved ones, their communities, and societies 12 6  2024/07/27 Risk behaviour, Preventative Health Behaviour, Health-promoting Behaviour Medical researchers/ practitioners, health psychologists, public health experts, etc. are increasingly interested in preventative healthcare – identifying, measuring, understanding risk; individualised medicine (e.g. personalised risk profiles); risk reduction and management; promotion of health-promoting and preventative health behaviour 13 Models of Health Behaviour To better understand, predict, and design interventions relating to health behaviour, health psychologists (and others) have formulated a range of models of health behaviour Range from individual-level models to community- and society-level models Focus on individual-level models – e.g. the Health Belief Model 14 7  2024/07/27 Individual-level Models of Health Behaviour At the individual (intrapersonal) level, the cognitive (mental) perspective is commonly used for understanding health behaviour Intrapersonal factors include knowledge, attitudes, beliefs, motivation, self-concept, developmental history, past experience, and skills 15 The Health Belief Model (HBM) One of the first models that adapted theory from the behavioural sciences to understand health behaviour Developed in the 1950s by psychologists (in the US Public Health Service) Specific purpose – helping to understand why people did not participate in public health programmes 16 8  2024/07/27 The Health Belief Model (HBM) (2) The HBM focuses on six constructs that it claims influence how a person will act in a given situation Before someone engages in any behaviour, they will consider the health risk of the situation, as well as available health-promoting and preventative health behaviours in terms of these constructs, and this accounts for and predicts the person's readiness to act In terms of the model, action is also moderated by a number of personal/ demographic factors – e.g. age, sex, personality, culture, education, etc. 17 The Constructs of the HBM Perceived susceptibility – individual’s opinion of the chances of developing/ contracting a negative health condition Perceived severity – individual’s opinion of how serious a negative health condition and its consequences are Perceived benefits – individual’s opinion of the efficacy of the available/ recommended risk-reducing/ health-enhancing behaviours Perceived barriers – individual’s opinion of the material and psychological costs of the available/ recommended risk-reducing/ health-enhancing behaviour Self-efficacy – individual’s confidence in being able to successfully perform a risk- reducing/ health-enhancing behaviour Cues to action – messages individuals are exposed to that promote/ activate their readiness to act 18 9  2024/07/27 Illustrative Example - Smoking Tobacco smoking has been and continues to be a significant risky lifestyle behaviour that has been linked to multiple negative health conditions, including lung cancer, lung disease, heart disease, etc. Subject of mass information and misinformation in long-running skirmishes between healthcare authorities/ public health and tobacco industry Contemporary smokers presented with numerous options for risk-reducing/ health-enhancing behaviours and strategies for “kicking the habit” How can the HBM be used to understand the situation of a smoker presented with information/ misinformation about smoking and its potential consequences, and various risk-reducing/ health-enhancing behaviours that could lead to quitting, and to predict their likely course of action? 19 Using the HBM - Smoking Health Behaviour/s Health Condition/s 20 10  2024/07/27 Illustrative Example (2) - Diabetes Diabetes Mellitus – endocrine disorder Type I (autoimmune damage to beta cells in the pancreas) Type II (decrease in insulin production or insulin resistance) Type II – now considered more of a lifestyle disease because of relation to obesity (esp. central adiposity – fat around the middle) 21 Using the HBM (2) - Diabetes Health Behaviour/s Health Condition/s 22 11  2024/07/27 Criticisms of the HBM Too individualistic ❖primary focus on individual beliefs/ attitudes; insufficient recognition of social and cultural influences on individuals’ attitudes and behaviours ❖Glaring neglect of interpersonal factors ❖Individual attitudes, motivation, self-efficacy need to be understood in the context and environment in which an individual finds themselves – esp. socioeconomic and healthcare context. Inclusion of “Demographic variables” too vague to be informative Assumes levels of rationality (rational deliberation and decision-making) that are not justified ❖As in many other fields (e.g. economics), assumed levels of rationality in humans are exaggerated beyond what can be supported by evidence ❖Many humans (adults, adolescents) don’t approach (potentially pleasurable) risk-taking behaviour from the point of view of instrumental rationality (i.e. logical means-end reasoning based on optimally objective cost-benefit analyses) ❖Importance of emotional factors ❖Short-term and long-term life strategies; differing approaches to valuing/ costing/ discounting the future 23 Conclusion Health psychologists use the concepts, theories and methods of psychology to better understand and predict our health behaviours – risky behaviour, preventative behaviour, and health-promoting behaviour. They do so by constructing hypotheses and models at multiple levels, from individual to social. In our all-too- brief we have encountered the Health Belief Model – an individual-level model that is probably the most well-known and influential. For all its flaws, the HBM can provide useful insights into the cognitive complexities of health behaviour. 24 12  2024/07/27 What to look forward to… Stress, Burnout, & Resilience Our next three sessions will focus on the important topic of stress, exploring how this phenomenon has been understood and researched, understanding its consequences for health, its connection to burnout, and possibilities for coping and resilience in the face of acute and chronic stressors. 25 Thank You 26 13  2024/07/27 COPYRIGHT This presentation is the intellectual property of the University of the Witwatersrand, Johannesburg. Copyright 2024. It is provided to you as a registered student for personal (study) use only. It is not to be distributed in any manner whatsoever. 27 ‘DISCLOSURE STATEMENT’ “There are no conflicts of interest to declare”. 28 14