Health Psychology

1. Health Psychology Health Promotion

2. Requirements • Methods • Promotion in schools, worksites & communities • Key issues

3. Background Methods • PREVENTION • Primary – combat risk factors before illness develops • People are unrealistically optimistic about health • Secondary – actions taken to identify and treat and illness in early stages • Tertiary – contain or slow injury or disease • FEAR APPEALS • Minimal fear appeals create greater increases in conformity • Efficacy – I can do this – increases conformity • YALE MODEL OF COMMUNICATION • Source – credible, expert, trustworthy • Message – 1-sided if positive, 2-sided if unsympathetic, clear, direct, colourful, vivid, state conclusions (unless an educated audience) • Medium – 1-1, personal, TV, radio, print • Target – who, sympathy, knowledge, active participation • Situation – where received • PSYCHOLOGICAL CONCEPTS • Fear appeal – sense of learned helplessness created • Self-efficacy – able to do – ‘back-to-sleep’ campaign.

4. Background Promotion • HEALTHY SCHOOLS PROGRAMME • Baseline assessments needed in order to establish what needs to be changed • PEER-BASED PROGRAMME • Information, particularly of a more sensitive kind, is easily shared between people of similar age • WORKSITES HEALTH HAZARD APPRAISAL • Counselling, health examination, feedback & information – led to improvements in general health • SMOKING REDUCTION • Temporarily effective but wear off after time as people find ways around. Competitive groups encourage quitting but once the competition is gone the motivation is also gone • COMMUNITIES CHD AND MASS MEDIA • Mass media increases awareness but does little to promote change • REDUCING CANCER RISK • Intentions to change can be judges but do people actually change? • HOMELESSNESS • Not everyone has equal access to healthcare – homeless have poor diet, malnutrition, substance misuse, mental health, infectious diseases, CVD, accidents and hypothermia. Usually come to our attention through illness rather than screening

5. Background Issues • CYBERDOCS • Websites – we share more information with these but is the advice offered really better? • SCREENING • Is the disease common enough and serious enough, is accurate diagnosis possible, is early diagnosis helpful, is there a test sensitive and specific enough, an the illness go undetected for a while? • People most likely to attend screening are young, professional women who did not believe in the role of powerful others, with some knowledge and possible religious • PROBLEMS WITH SCREENING • Risk of personal harm, anxiety, negative results, mortality questions, positive results, false positive results, effect of taking part, inconvenience & embarrassment • ULTRASOUND • Unsettling as less than 2% of high risk screens turn out to be a problem

6. 3 Short Summaries • Health promotion involves a wide range of social, medical, psychological and political activities. Psychology has made a contribution to our understanding of some of the processes around health promotion, but its research findings are not always applied to health messages • There have been numerous health promotion programmes in schools, worksites and communities with various levels of success. It remains difficult to assess the effectiveness of such programmes but there is a general belief that they are a good thing. • The promotion of good health seems to be a fairly straightforward ambition, but scratch the surface and you come up with a number of puzzling ideas. One of these is the idea that prevention is better than cure. Well yes, that might seem to be the case, but what if the prevention is a programme of mass immunisation of all children to reduce a damaging but rarely fatal disease, and what if that immunisation programme prevents a handful of deaths but at the same time opens up the risk of a reaction to the injection? You prevent illness in some people by opening people to a new risk of illness.

7. Study 1 • Detweiler • Who • 1999 • Message framing and sunscreen • Field experiment • 217 sunbathers (165 female, 52 male) 18-79y, white, middle-income. Opportunity sample. Consent and free lottery ticket • What • Given brochure about skin cancer, randomly • Information framed differently • Highlight benefit of sun-protective behaviour - +ve • Undesirable consequences avoided by using sun-protection - +ve • Benefits lost by not engaging in sun protection - -ve • Undesirable consequences arising from not engaging in sun protection - -ve • Pre-manipulation questions and instructions, elicit information about intentions to use sunscreen, spf, risk (hair colour, skin tone) • Post-manipulation; emotional reaction to brochure, beliefs, feelings about continued disuse, intentions • Voucher for spf15 given – and number exchanged counted • Results • No gender differences • 71% positive frame exchanged voucher; 53% negative frame • Positive frame – increased intentions, but did not affect those already intending to use

8. Study 2 • Chacko • Who • 2002 • Neural tube defects and prevention • Experiment, repeated measures • 387, low income, women 13-22, ethnic minorities (black 286, Hispanic 109) single at 1/3 prenatal clinics able to read English. Written informed consent • What • Seen individually, questionnaire, knowledge of NTD, preventative effects of various items, actual behaviour. Immediate and personalised NTD advice lecture given. If willing to take vitamins 3month supply given. Survey by telephone 3 months later – different questions, same variables. Results analysed. • Results • Knowledge increased, including that about vitamins/foods and intake increased. But increased intake of vitamins was seen but not in the doses required to be successful – the intervention promoted health and provided information but did not assist adherence

9. Study 3 • Icard • Who • 2003 • African-American health promotion and marketing • Quasi-experimental, 52 male, 47 female, low income af-am, 26-55y, 2 groups. Informed consent, paid • What • Led in structured discussion by trained af-am researcher. • Source of information – what type of person to deliver • Message content – what should we say • Channel – TV, radio etc • Target – how can participation of af-am men be increased? • Taped and a trained af-am student (1m, 1f) acted as note-taker. Data transcribed and content analysed • Results • Source – credible, trustworthy, well known, a member – not too high profile, direct experience better than professional stranger • Message – straightforward, language familiar, concern but not patronising, positve frame and promoting • Channel – 1-1, leaflet, direct mail. Radio if music appropriate. Literacy a problem. Saturation coverage. • Target – sports events/ men's venues. Word of mouth. Sub-groups need to be individualised (single men, prisoners, absent dads etc)

10. Study 4 • Oh • Who • 2003 • Decreasing pain and depression – rheumatoid arthritis • Field experiment. 36 out patients (5 male) ~48y, clinic S. Korea. 18 volunteers (experimental), 18 opportunity sample (control). Promised access to health promotion program later. • What • 3 variables pain, depression, disability measured in both groups (all tests had been previously used and validated/reliable) • Pain – pictorial, VAS (current and average), SR hours of pain • Depression – Depression scale (CES-D) translated 11 years before • Disability – likert scales performing everyday tasks • Attend series of 2-hour health promotion activities once a week for 7 weeks – group discussion, lecture, demonstration, role-play, contract, feedback, diary • After 7 weeks all tested for 3 variables again. • Results • HP programme reported subsequent lower level of pain and depression • No difference in disability

11. Study 5 • Janis • Who • 1953 • Effects of fear • Entire freshman class, 15y, m+f • What • Divided into 4 groups. 3 given 15 minute lecture on tooth decay and importance of dental hygeine. 4th group control. Different forms of lecture • Form 1 – strong fear appeal – pain • Form 2 – moderate fear – dangers milder and factual • From 3 – minimal fear – tooth neglect consequences skirted around • Given questionnaires 1 week before lecture (asking about dental hygiene), one immediately after and one a week later • Results • Higher levels of fear arousal resulted in greater anxiety about decay in the immediate time period. • But minimal fear group changed conformity and took longer term action

12. Study 6 • Parry • Who • 2000 • Smoking bans at work • Evaluate a smoking policy • What • Implemented a smoking ban policy in 1997 and evaluated in 2000 • Results • Unintended consequences • Smokers congregated around entrances • Smokers became more visible and gained a higher profile • Accumulation of smoking debris around areas • Sympathy for smokers increased as perceived to be discriminated against

13. Study 7 • Davis • Who • 2003 • Bicycle safety • 5 schools (11 teachers, 284 children 10-12y, 51% female) 4 observation sites: 2 near schools which had participated, 2 near schools which hadn’t • What • Questionnaire. Children observed. Recorded time, date, weather, gender, ethnicity, ~age, helmet (used?), alone • Results • 84% had participated in safety programme. 90% own safety helmet. 74% report wearing it (males or older less likely) if involved in programme more likely to wear • Observations not useful – not many cycle riders seen! • Programme effective and knowledge retention/safe behaviour present – a booster session suggested. Low cost ‘cool’ helmets need to be made available.

14. General Review • Ethnocentrism • Assumptions made based on our own culture. With regard to HP the assumption that what works for one group will work for another is dangerous. Oh used a translation which had already been validated/reliability checked. Chacko excluded any non-English speakers. • Reliability/validity • Oh validated and checked the reliability of all their scales by pretesting or using existing scales. Detweiler and Chacko have face validity but we can go no further. Icard suggests the questions have face validity but goes no further • Perspectives • Detweiler and Oh ask patients to assess levels of pain/risk and this requires them to process a question correctly, transform a verbal response to a non-verbal one and match to the measuring instrument. Man is not always logical or rational (or 100% in Chacko would take vitamins 100% Detweiler will use sunscreen vouchers) if we do not like something the chances are we will not do it. Icard – we may choose to ignore information because it came from the wrong person • Sampling • Appropriate samples were used. Detweiler used sun-bathers rather than mall-shoppers, Chacko used black and Hispanic because NTD had not been conducted with these groups. But by defining the groups so precisely we limit our ability to generalise to the population as a whole.

15. Questions • Describe what psychologists have found out about health promotion • Discuss the psychological evidence on health promotion • Suggest one psychological technique for promoting the eating of fresh fruit. Give reasons for your answer • Describe one study of health promotion (6) • Discus the ethics of research into health promotion (10) • Describe one study of health promotion in school (6) • Discuss the strengths of promoting health in schools (10) • Describe one study of health promotion in a worksite (6) • Evaluate the effectiveness of health promotion in worksites (10)