Unit G543 Health & Clinical Psychology healthy living A2 Psychology Unit G543 Health & Clinical Psychology theories of health belief

Healthy Living

Lesson One: Health belief model Locus of control

Health Belief Model (Becker) Aims to predict the likelihood that a person will carry out a health behaviour.

According to the health belief model, the likelihood that individuals will carry out a health behaviour depends directly on two assessments that they make Evaluating the threat Cost-benefits analysis

Terminology perceived seriousness (‘Will it actually kill you?’) perceived susceptibility (‘Am I likely to get it?’) costs/benefits analysis cues to remind us (external or internal cues) demographic variables (factors such as gender, culture, age, etc.)

(i) Evaluating the Threat Perceived seriousness Perceived susceptibility Cues to action Other variables

Cost-benefits analysis Do the perceived benefits of changing behaviour exceed the perceived barriers? Benefits include improved health, relief from anxiety Barriers include financial, situational (getting to a gym)

Other Variables Demographic such as age, race ethnicity, class sex etc. Socio-psychological such as peers, personality, social pressure. Structural such as prior contact or knowledge about the disease.

Health Belief Model: Becker 1978 A person will adopt a health behaviour If they perceive a threat to their health if they don’t adopt it Perceived seriousness will increase the threat Perceived susceptibility will increase the threat If the benefits outweigh the costs If they are reminded by internal and/or external cues: media campaigns, lay advice, reminders from GP’s, magazine articles Depending on demographic variables: age, race, ethnicity, class, gender, peers, personality, social pressure, prior knowledge of the disease

HBM – what is it actually for? It is used to predict the uptake of health behaviours based on several factors The more factors that are present in a particular situation, the more likely you are to behave healthily Health behaviours include giving something up (smoking), refusing to try something (drugs), regularly checking your health (self-examination), regularly preventing problems (brushing your teeth)

Applying the HBM Why a teenage boy may not want to go to the doctors about a rash he has. Why an elderly lady may not be taking her asthma medication every day. Why a middle-aged couple who have just met through online dating may not be using condoms when they first have sex. Why an elderly man may not visit the doctor about some chest pains he has been feeling. Why a mother may not give her children the cough medicine they need to cure their chest infections. Why a 30-year-old female may not lead a very healthy lifestyle. She does not exercise, she eats fast food and she drinks alcohol. Why a 20-year-old student may suddenly start taking illegal drugs like amphetamines and ecstasy.

Does the HBM work? Becker’s study used the HBM to explain mums’ adherence to a drug regimen (i.e. routine for taking medication) for their asthmatic children The study confirms the HBM is an accurate predictor of the likelihood of a parent giving the medication

Becker’s Method A correlation between beliefs reported during interviews and compliance with administration of asthma medication (also self-reported) A blood test was used on some participants to confirm the validity of the self-report

Becker’s Participants 111 mothers responsible for administering asthma medication to their children Aged 17 – 54 Children aged 9 months to 17 years

Becker’s Procedure Mum interviewed for 45 minutes Asked questions about Perception of child’s susceptibility to illness Beliefs about seriousness of asthma How much child’s asthma interfered with their education, caused embarrassment and interfered with mum’s activities Faith in doctors and medication

Becker’s Results Positive correlation between mother’s belief about child’s susceptibility to asthma attacks and compliance with regimen Positive correlation between mother’s perception of child having a serious asthma condition and compliance with regimen

Becker’s Results Negative correlation between costs and compliance These costs included: Disruption of daily activities Inaccessibility of chemists Child complaining about medication Prescribed schedule for administering the medication 2 demographic variables that correlated with compliance were marital status and education

Becker’s Conclusion HBM is a useful model to predict and explain different levels of compliance to medical regimes Person will adopt a Health behaviour If they perceive a threat to their health Perceived seriousness will increase the threat susceptibility If the benefits outweigh the costs If they’re reminded by internal and/or external cues Depending on demographic variables (e.g. age and gender)

Becker (1978) Pps = 111 mothers responsible for administering asthma medication to their children. Design Correlational design.

Becker (1978) What can we conclude from Becker’s research?

Evaluation Rotter Generalisability Reliability Validity Ethics

Debates: Approach Reductionism/holism Any others?

Choose a health behaviour and complete the diagram.

Locus of control

Locus of Control refers to the individual differences in people’s beliefs and expectations about what/who controls events in their lives. It is measured along a scale from high internal locus of control to high external locus of control.

Rotter (1966) Internal locus of control – where a person feels he or she is in control of his or her health and is therefore likely to adopt healthy behaviour. External locus of control – where a person feels his or her health is controlled by external factors (e.g. fate) and is therefore less likely to adopt a healthy behaviour. How might someone who has internal locus of control act? (Health behaviours) AND How might someone who has external locus of control act? (Health behaviours)

Example:

Rotter (1966) Method Review article. Procedure Sample – six pieces of research into individual perceptions of ability to control outcomes.

Findings Show more coping behaviours Can deal with potential threats I’m in control of my health behaviour Findings I’m not in control of my health behaviour Show more coping behaviours Can deal with potential threats Chance or other non-controllable forces determine the effects of their behaviours

Conclusion Rotter concluded that LOC would effect many of our behaviours, not just health. James et al. (1965): smokers who give up and did not relapse had a higher level of internal LOC than those who did not. However, for women, where there was no significant difference between internal and external LOC in those giving up instead other factors such as weight gain were influential in giving up smoking. (Therefore indicating that LOC a factor in health behaviours but other factors play a part).

Evaluation Rotter Generalisability Reliability Validity Ethics

Debates Determinism and Free will (does this study/perspective suggest we have freewill or that our behaviour/experience is determined?) Reductionism and Holism (do the results of the study focus on one single level of explanation, ignoring others or do they consider many explanations?) Nature and Nurture (is this characteristic/behaviour due to genetics or learning?) Individual and situational explanations (can this behaviour be explained by the situation/environment or is it due to personal characteristics?) Ethnocentrism (can this behaviour be considered to be biased towards one ethnic group or society?) Psychology as a Science (is the method used within the study rigorous, ie. objective, reliable, falsifiable?) Usefulness?

Internal or External? A person believes they can beat heart disease through a better lifestyle Someone believes God will decide if they will survive their heart transplant A parent believes that healthy eating for their child is the responsibility of the school A woman stays out of the sun to avoid skin cancer A man thinks he can still smoke as no one else in his family got cancer despite all smoking

Homework Describe the Health Belief Model. (10) Due next lesson

Lesson Two: Self-efficacy Exam practice

Social Cognitive Theory Source: http://www.uky.edu/~eushe2/Bandura/BanEncy.html

Self-efficacy How effective a person thinks they will be at successfully adopting a health behaviour. Cognitive approach based on thought processes of the individual

Bandura – Self efficacy (1977) Bandura was interested in treating people with a fear of snakes He believed Locus of Control was too simple as a theory of health belief Why would he say this?

Bandura’s theory Bandura developed a theory of self-efficacy (1977):- Went further than the locus of control which he thought was too simplified Considered how treatments for disorders such as anxiety can be helped by increasing self-efficacy It is important to note that this isn’t just about treating anxiety – you must link it to self-efficacy, i.e. does self-efficacy effect the likelihood of a coping behaviour being developed?

The three factors that affect our efficacy expectation: Bandura’s ideas Outcome expectation: We learn from previous experience and use this to estimate a likely outcome in any situation. Efficacy expectation – we believe we can successfully do whatever is required to achieve the outcome The three factors that affect our efficacy expectation: Vicarious experiences – when we see people succeeding our self efficacy increases; when we see people failing it decreases Verbal persuasion – direct encouragement or discouragement; discouragement will lower self-efficacy more than encouragement will increase it Emotional arousal – how is this perceived? Someone with low self-efficacy will perceive physiological symptoms or emotional symptoms as proof they are incompetent, rather than as a normal response.

Aim – Bandura and Adams WHY? To assess the self-efficacy of patients undergoing systematic desensitisation. Method A controlled quasi-experiment with patients with snake phobias. WHY?

Systematic desensitisation Phobia treatment Anxiety hierarchy Move up step by step – using relaxation techniques Client forms positive associations

Procedure Pre-test assessment 10 snake phobics 9 females 1 male 19-57 yrs old Replied to an advert in paper Procedure Pre-test assessment Avoidance behaviour Oral fear rating (1-10) Efficacy expectations (how much can they cope) Boa constrictor Assessed on:

Procedure (cont.) Systematic desensitisation – a standard desensitisation programme was followed where patients were introduced to a series of events involving snakes and at each stage were taught relaxation. Post-test assessment. Each patient was again measured on behaviours and belief of self-efficacy in coping.

Findings & conclusion Higher levels of post-test self-efficacy were found to correlate with higher levels of coping behaviour with snakes. Desensitisation enhanced self-efficacy levels, which in turn lead to a belief that the participant was able to cope with the phobic stimulus of a snake.

Knowledge check What does self efficacy mean? What factors influence self efficacy? What were the conclusion in Bandura and Adam’s study?

Evaluation Reductionist Holist Science Not Science Individual Situational Approach bias Not approach bias

Evaluation Study G R A V E

Homework Discuss the theoretical approaches to beliefs about health. (15) Due next lesson