Health Psychology

1. Health Psychology

2. Session Aims • To explore what health psychology is and how it is relevant to health • To apply and critique some of the key models in health psychology specifically relevant to health behaviour • To introduce a critical perspective within health psychology

3. Health Psychology • Branch of psychology concerned with study of mental processes and behaviour in relation to health and illness. • Sub-discipline of psychology (draws on knowledge from other areas of psychology as well as medicine and sociology for example, Sarafino, 2002) • Relatively new area but has a discrete identity

4. Health Behaviour • Any behaviour which impacts on health • Behaviour which improves or maintains health (Straub, 2007) • ‘Health-related’ behaviour • ‘it is difficult to imagine an activity or behaviour that does not influence health in some way – for better or worse, directly or indirectly, immediately or over the long-term’ (Straub, 2007:155). • Health-protective behaviour (Sarafino, 2002)

5. Health Behaviour • Behaviour may have a positive or negative impact on health • Focus on behaviour is linked to a range of lifestyle factors identified as being potentially harmful to health (for example, smoking as a risk factor for coronary heart disease)

6. Different kinds of health behaviour(Hubley & Copeman, 2008) • Decision-based • One-time • Routine (Habit) • Addictive • Custom • Tradition • Lifestyle

7. Key variables in understanding health behaviour Self Efficacy (Bandura 1977, 1986) • Self Efficacy is the belief about whether we can do something (capacity and capability). • It is linked to self-confidence. • People with high levels of self efficacy tend to carry out behaviours which enhance their health (Marks et al, 2005; Straub, 2007).

8. Key variables in understanding health behaviour Beliefs about control • Behavioural control and cognitive control (Tones & Green, 2004) • Locus of Control (Rotter, 1966) • Wallston & Wallston (1982) Multidimensional Locus of Control

9. Health Belief Model • Developed to explain/predict health behaviours • Beliefs are a central concept • Beliefs about: - Susceptibility to illness - Severity of illness - Benefits of/barriers to taking action - Ability to take action - Outcomes of taking action

10. Health Belief Model • Predicts the likelihood that a person will take action depending on their assessment of different things according to their beliefs • People weigh up the advantages and disadvantages of taking action (cost-benefit analysis) • ‘Cues to action’ are needed to provoke action (internal or external)

11. Theory of Planned Behaviour Three key variables: • Attitude to towards the behaviour • Subjective norms • Perceived behavioural control All of these combine to produce ‘behavioural intention’ (or not). The greater the intention to engage in a particular behaviour, the more likely the behaviour will happen.

12. Protection Motivation Theory • Has some similarities with components of the HBM and TPB. • Proposes that behaviour intention results from two types of appraisal – Threat Appraisal and Coping Appraisal • This results in an Adaptive (changing behaviour) or Maladaptive (avoidance or denial) response

13. Protection Motivation Theory • Central feature is ‘fear’ and role it plays in determining behaviour • Relevant where people may be fearful for their health • BUT too much fear (high levels of anxiety) might cause people to disengage

14. Stages of Change Describes the behaviour change process: • Precontemplation • Contemplation • Preparation • Action • Maintenance Allows for relapsing.

15. Utility of Behaviour Change Models • Are useful for providing some insight into why people behave in certain ways • Are useful for planning health promotion interventions • There is evidence to suggest that lifestyle interventions can be successful in promoting behaviour change at an individual level (Kitzmann et al, 2010) • Understanding the components and processes involved in health behaviour can assist in designing health promotion interventions which have a greater chance of success (Trifilettiet al, 2005; Parker et al, 2004 and NICE 2006).

16. Criticisms of theory in health psychology • Focus on the individual level rather than wider determinants of health • Reductionist approach can lead to victim blaming • Do not take an holistic approach to understanding health behaviour • Promote individualism and individual responsibility for health • Examine individual behaviour in isolation neglecting wider influences • Neglect the role of things like past behaviour, habit, emotion and culture • Simplify behaviour change, do not take into account time

17. Criticisms of theory in health psychology In terms of research a number of difficulties have been highlighted including… • Problems defining individual constructs (Bunton et al, 2002) • Limited predictive utility (Abraham and Sheenan, 2005) • A weak relationship between intention and behaviour – Stephens (2008) argues that other factors should be explored i.e. environmental factors • A lack of standardisation across constructs in experimental design (Conner and Norman, 2005). They tend to have been developed in specific contexts which can lead to a ‘Western’, patriarchal bias • Much of the research using the models relies on self-report measures which have limitations. • Whilst many of the models draw upon aspects of sociological, psychological and anthropological theory they tend to neglect political and economic theory (Hubley and Copeman, 2008).

18. Health Action Model Two key sections: • Factors influencing ‘behavioural intention’ Three interacting systems – belief system, motivation system and normative system 2) Factors influencing whether an intention will translate into ‘action’. Factors which facilitate behaviour change, such as a supportive environment, skills and knowledge.

19. Critical perspectives • Challenge the notion of ‘behaviour’ • Refers to ‘social practices’ or ‘actions’ • Challenges mainstream assumptions and understandings • Takes into account the social, political and economic context (Marks, 2002) and issues of power.

20. Summary • Health psychology is a sub discipline within psychology which can help us to understand how and why people behave the ways that they do and make the choices that they make in relation to health. • Health behaviour is complex and influenced by many different factors. • Models of behaviour change can help in designing interventions to enable people to change their health behaviour. • Critical health psychology offers an alternative perspective.