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Module: Health Psychology
Lecture: Health Behaviours and Beliefs
Date: 26 January 2009
Chris Bridle, PhD, CPsychol Associate Professor (Reader) Warwick Medical School University of Warwick
Tel: +44(24) 761 50222 Email: [email protected] www.warwick.ac.uk/go/hpsych
Aims and Objectives
Aim: To provide an overview of the psychological determinants of health-related behaviours and beliefs
Objectives: The student should be able to provide a basic description of the …
meaning of health-related behaviours, and provide examples of different types of health behaviour
psychological processes that influence health behaviours and a framework for their organisation
common psychological components of health behaviour theories
core constructs relevant to understanding, predicting and changing health-related behaviours
Dual Pathway: Psychology and Health
PsychologicalFactors
HealthBehaviour
PhysicalHealth
Direct Path
Indirect Path
What psychologicalprocesses transmit
influence alongthese paths?
Recap
Psychoneuroimmunology (PNI)
Physiological reactivity = mechanism of action
Stress & negative affect = influence being transmitted
Interpretation = process generating the influence
Negative physical effects = chronic stable exposure
Dual Pathway: Psychology and Health
PsychologicalFactors Involved
In Appraisal
HealthBehaviour
Physical Health:Physiological
Reactivity
Chronic Stress& Negative Affect
Indirect PathStable individualdifferences
Which stable factors,and what else?
Q: Why focus on the indirect behavioural route?
Biology
Environment
Access
Behaviour
(Healthy People 2000)
20%
20%
10%
50%
Leading Causes of Disease
Behavioural contribution to management of chronic illness estimated at >90% (Wanless, 2004)
Key Questions
What psychological factors influence health behaviour?
What do we know about the determinants of health behaviour?
To what extent are we able to sufficiently explain and predict health behaviour?
Can our understanding of psychological processes be used to change health behaviour?
Will interventions that change health behaviour yield benefits for physical health?
Defining Behaviour
Behaviour: the actions or reactions of an individual to a situation – can be conscious or unconscious, voluntary or involuntary
But … what specifically?
Health behaviour Illness behaviour
Adaptive behaviour Maladaptive behaviour
Prevention behaviour Detection behaviour
Public behaviour Private behaviour
Service-use behaviours Self-care behaviours
Health behaviour: Behaviour that may have implications for health
Determinants of Health Behaviour
A framework
Background factors: Characteristics that define the context in which people live their lives; shared understanding and ways of knowing the world
Stable factors: Individual differences (personality) in psychological activity that are stable over time and context
Social factors: Social connections in the immediate environment; mostly stable, but can be fragile, e.g. when in conflict with background factors
Situational factors: Appraisal of personal relevance that shape responses in a specific situation
Why a Framework?
Background factors
Stable factors
Social factors
Situational factors
Distal
Proximal
We bring with us, to any situation, the cumulative influence of background, stable and social factors, which we combine in
various ways to form an understanding of our current situation. In most cases, our understanding (appraisal) of the
situation determines our behaviour within it.
Different intervention targets require
different intervention strategies
Stable Factors
Stable factors: i.e. individual differences, dispositions, personality
Refer to variations, between people, in psychological activities that, within people, produce responses that are stable across time and context
Influence appraisal in three key ways:
they determine if, and to what extent, an event is salient, i.e. sensitivity towards particular types of event
they provide a generalised framework for understanding and evaluating the event, e.g. as threat or challenge
they make available, or suggest, potential responses, i.e. initial response options
Individual Differences and Health
Three broad types of individual differences:
Emotional dispositions: Psychological processes involved in both the experience and expression
Generalised expectancies: Psychological processes involved in formulating expectations in relation to future outcomes
Explanatory styles: Psychological processes involved in explaining the causes of negative events
Temporal dimension:
Present
Future
Past
Emotional Dispositions
Negative affect: Tendency toward the experience of negative affective states, e.g. hostility, depression, anxiety
Appraisal bias for heightened arousal and increased frequency
Evidence for causal role in development of physical disease - health behaviour impeded as a function of fatigue and apathy.
Emotional expression: The (low) expression of (negative) emotional experience, both unconscious repression and conscious suppression
Appraisal bias for neutralising threat or extreme intensity, both leading to maladaptive responses
Risk factor for recovery (post-MI) and cancer progression
Generalised Expectancies
Locus of control: Expectations that future outcomes will be determined by factors that are either internal (self) or external (powerful others, and chance)
Internal loci generally associated with more favourable outcomes, and performance of health behaviours, but VERY dependent situational factors
Self-efficacy: Belief in one’s own ability to organise and execute a course of action, and the expectation that the action will result in, or lead to, a desired outcome
Heuristic belief in the beneficial effects of higher self-efficacy, deriving from appraisal bias for challenge rather than threat and expectation of success
Explanatory Styles
Optimism (Pessimism): Expectation of positive future outcome (however achieved) despite current negative event
Appraisal bias for brief, low levels of physiological reactivity, and promoting active coping responses
Optimism, vis-à-vis pessimism, associated with better physical health, illness recovery, and health behaviour performance
Attributional style: Causal explanations of negative events as internal (self), stabile (time), and global (situation)
Generally better if attributions are external, unstable and specific, rather than internal, stable and global
Causal attributions influence expectations about controllability of future outcomes, i.e. the relevance of health behaviours
Social Cognition Theories
Social cognition theories attempt to explain the relationship between social cognitions (e.g. beliefs, attitudes, goals, etc.) and behaviour
Some examples: Health Belief Model (Rosenstock, 1966)
Protection Motivation Theory (Rogers, 1975)
Theory of Reasoned Action (Fishbein & Ajzen, 1975)
Theory of Planned Behaviour (Ajzen, 1988)
Transtheoretical Model (Prochaska and DiClemente, 1983)
Health-Belief Model (HBM)
HealthBehaviour
PerceivedThreat
PerceivedSeverity
PerceivedEfficacy
PerceivedSusceptibility
PerceivedBenefits
PerceivedBarriers
(Rosenstock, 1966)
Theory of Planned Behaviour (TPB)
Behaviour
BehaviouralAttitude
SubjectiveNorm
PerceivedBehavioural
Control
Behavioural beliefs+
Outcome evaluation
Normative beliefs+
Motivation to comply
Control beliefs +
Self-efficacy
BehaviouralIntention
(Ajzen, 1988)
Transtheoretical Model
PC C P A M
Self-Efficacy
Temptations
Pros
Cons
Experiential + Processes of Change + Behavioural
Stages of Change
(Prochaska & DiClemente, 1983)
Health Behaviour Models / Theories
Which model / theory is best? At the end of every ‘theory’ chapter in every health psychology text, you’ll receive the following expert advice:
‘Models are not in competition … …they offer different perspectives on the relationship between
social cognitions and (health) behaviour … …’
… blar, blar, blar, blar …
Which ‘perspectives’, on which ‘relationships’ and between what cognitions, etc., will help us to
… understand …
… predict ….
… and change …
… the health damaging behavioursin which so many people habitually engage?
ConceptProposition – Behaviours more likely when
Health Belief Model
Theory of Planned
Behaviour
Transtheoretcial Model
Normative beliefs
Belief that significant others desire one to adopt the behaviour
X Subjective normPoC: Helping relationships
Outcome Evaluation
Perceived benefits outweigh perceived costs of behaviour
Benefits and Barriers
BehaviouralBeliefs
DecisionalBalance
Self-efficacy
Belief in one’s ability to perform behaviour
Perceivedefficacy
Perceived Behavioural
Control
Self-efficacy and Situational
Temptations
Risk beliefs One feels at risk of an outcome with negative consequences
PerceivedSusceptibility
XDecisionalBalance
Risk affectEmotional response to perceived risk within normal limits
PerceivedThreat
XPoC: Dramatic
relief
Intention / Motivation
One has formed / holds an intention to perform the behaviour
XBehaviouralintentions
Stages if Change (Cont, Preparation
and Action)
Conceptual Framework
Determinants of health behaviours and beliefs
Background factors: Cultural norms; SES; Gender; Ethnicity; Genes; Chronic health status
Stable factors: Emotional disposition, Generalised expectancies; Explanatory styles
Social factors: Perceived support (family, friends, peers, etc.); Subjective norm; Helping relationships
Situational factors: Situation-specific self-efficacy; Perceived risk; Emotional response; Intention (motivation); Outcome evaluation;
Conclusions
There are many determinants of health-related behaviours
Determinants can be usefully grouped to form a conceptual framework
Background, stable and social factors shape beliefs and situational appraisals
Behaviour (typically) is most strongly influenced by situational beliefs / appraisals
Psychological models attempt to explain the relationship between beliefs and behaviour
Changing beliefs promotes long-term behaviour change
Summary
This session would have helped the student to understand the … range of behaviours that can be described as being
health-related
different types of determinants of health-related behaviours and the level at which they operate
common psychological components of health behaviour theories
core constructs relevant to understanding, predicting and changing health-related behaviours
Next Week
Illness Behaviours & Beliefs Common sense would suggest that people who seek
medical help have more severe symptoms than those who do not seek help.
Research demonstrates that this is incorrect.
Peoples interpretation of their symptoms and their help-seeking behaviour is determined by many factors aside from the presence or severity of physical symptoms.
These factors will be the examined in next week’s session.
Any questions?
What now?
Obtain / download one of the recommended readings
In your small groups consider today’s lecture in relation to next week’s tutorial tasks:
a) integrated template
b) ESA question