Health Belief Model Key study: Becker (1978) 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.).

Aim To use the health belief model to explain mothers' adherence for their asthmatic children. Method A correlation between beliefs reported during interviews and the compliance with self-reported administration of asthma medication.

Participants 111 mothers responsible for administering asthma medication to their children. Design Correlational design.

Procedure Each mother was interviewed for about 45 minutes. They were asked questions regarding: Their perception of their child’s susceptibility to illness and asthma. How serious asthma is. How much their child’s asthma interfered with his or her education. Caused embarrassment. Interfered with the mother’s activities.

Procedure (cont.) They were also questioned about their faith in doctors and the effectiveness of the medication.

Findings A positive correlation between a mother’s belief about her child’s susceptibility to asthma attacks and compliance to medical regimen was found. There was also a positive correlation was also between the mother’s perception of the child’s having a serous asthma condition and her administering the medication as prescribed. Mothers who reported that their child’s asthma interfered with the mother’s activities also complied with the medication.

Findings (cont.) Costs negatively correlated with compliance (e.g. disruption of daily activities, inaccessibility of chemists, the child complaining, and the prescribed schedule). The demographic variable of marital status and education level correlated with compliance as follows: Married mothers were more likely to comply. The greater the mother’s education the more likely she would be to adhere.

Conclusion The health belief model is a useful model to predict and explain different levels of compliance with medical regimens.

Locus of control Key study: Rotter (1966) Terminology 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.

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

Findings Participants who felt they had control over the situation were more likely to show coping behaviours. Conclusion Rotter concluded that locus of control would affect many of our behaviours.

Self efficacy Key study: Bandura (1977) Terminology Outcome expectancy – based on previous experiences a person could estimate the likely outcome in any situation. Efficacy expectation – the belief that a person has that they can successfully do whatever is required to achieve the outcome.

Terminology (cont.) The key factors which affect a person’s efficacy expectation are: Vicarious experiences – seeing other people do something successfully. Verbal persuasion – someone telling you that you can do something. Emotional arousal – too much anxiety can reduce a persons’ self-efficacy. In addition cognitive appraisal of a situation might also effect expectations of personal efficacy.

Aim To assess the self-efficacy of patients undergoing systematic desensitisation. Method A controlled quasi-experiment with patients with snake phobias.

Participants 10 snake phobic patients: who replied to an advertisement in a paper. 9 females and one male. aged 19–57 years.

Procedure Pre-test assessment. Each patient was assessed for: avoidance behaviour towards a boa constrictor. fear arousal with an oral rating of 1–10. efficacy expectations (how much they thought they would be able perform different behaviours with snakes).

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 Higher levels of post-test self-efficacy were found to correlate with higher levels of behaviour with snakes. Conclusion 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.

Possible Section A Questions Describe what psychologists have found out about theories of health belief Describe one piece of research into self-efficacy Outline the health belief model Describe factors that influence health beliefs and behaviours Describe one piece of research into locus of control

Possible Section B Questions Discuss the usefulness of research into theories of health belief

Media Campaigns Key study: Cowpe (1989) Aim To test the effectiveness of an advertising campaign. Method A quasi-experiment where a media campaign was shown in 10 regional television areas from 1976 to 1984.

Participants People living in the chosen television areas.

Procedure The campaigns were shown on television. There were two 60-second commercials, one called ‘inattendance’ and one called ‘overfilling’. These showed the initial cause of the fire and the actions required to put it out. Three areas were shown reminders one year later. The number of reported chip pan fires was analysed for each area.

Findings The net decline in each area over the twelve-month period of the campaign was between 7% to 25%. The largest reduction was during the campaign. ‘Overlap’ areas (areas that received two of the television stations) showed less impact. The questionnaires showed an increase in the awareness of chip pan fire advertising. The mention of chip pan fires as a danger in the kitchen also increased in the questionnaires.

Conclusions The advertising proved effective as shown by reduction in chip pan fires. The behaviour change is seen most during the campaign and reduces as time passes after the end of the campaign. The viewer is less likely to be influenced by the campaign if overexposed to it, as in the overlap areas.

Legislation Key study: Dannenberg et al. (1993) Aim To review the impact of the passing of a law promoting cycle helmet wearing in children. Method Natural experiment when a law was passed in Howard County, Maryland, USA.

Participants Children from Howard County, and two control groups from Montgomery County and Baltimore County, all in Maryland, USA. Aged 9–10 years, 12–13 years and 14–15 years. Design Independent design with each child naturally falling into one of the three counties.

Procedure A questionnaire that asked about: bicycle use. helmet ownership. awareness of law. sources of information about helmets. peer pressure.

Findings Helmet ownership was higher amongst cycle owners and highest in younger age groups. In Howard County (the one with the law), reported usage had increased. Howard County – 11.4% to 37.5%. Montgomery County – 8.4% to 12.6%. Baltimore County – 6.7% to 11.1%.

Conclusions Legislation has more effect than educational campaigns alone. This study was correlated with an observational study by Cote et al. in 1992, which found similar rates of cycle helmet usage.

Fear Arousal Key study: Janis and Feshbeck (1953) Aim To investigate the consequences on emotions and behaviour of fear appeals in communications. Method Laboratory experiment, which showed fear-arousing material.

Participants 9th Grade students aged 14.0 to years, mean age 15 years. Design Independent design, with three experimental groups and one control group.

Procedure A questionnaire was given one week before the lecture on health to ascertain dental practices. A fifteen minute illustrated lecture was presented to each group. 3 groups had a lecture on dental hygiene and the control group had a lecture on the human eye.

Procedure (cont.) Immediately after the lecture a questionnaire was given asking for emotional reactions to the lecture. One week later a follow-up questionnaire asked about longer term effects of the lecture.

Findings The amount of knowledge on dental hygiene didn’t differ between the three experimental groups. The strong fear-appeal lecture was generally seen in a more positive light. The strong fear-appeal group showed a net increase in conformity to dental hygiene of 8%.

Findings (cont.) The net increase in the moderate fear group was 22%. The net increase in the minimal fear group was 36%. The control group showed 0% change.

Conclusion Fear appeals can be helpful in changing behaviours, but it is important that the level of fear appeal is right for each audience.

Possible Section A Questions

Possible Section B Questions Discuss the usefulness of research into health promotion

Reasons for non adherence Key study: Bulpitt and Fletcher (1988) Aim To review research on adherence in hypertensive patients. Method Review article of research identifying problems with taking drugs for high blood pressure.

Procedure Research was analysed to identify the physical and psychological effects of drug treatment and the adherence rates of patients.

Findings There are many side effects of taking anti- hypertension medication. In one study by Curb (1985) 8% of males discontinued treatment because of sexual problems. Research by the Medical Research Council (1981) found that 15% of patients had withdrawn from taking medication due to side effects.

Conclusion When the costs of taking medication, such as side effects, outweigh the benefits of treating a mainly asymptomatic problem such as hypertension, there is less likelihood of the patient adhering to their treatment.

Measuring adherence Key study: Lustman et al. (2000) Aim To assess the efficacy of the anti-depressant fluoxetine in treating depression by measuring glycemic control. Method A randomised controlled double-blind study.

Participants 60 Patients with type 1 or type 2 diabetes and diagnosed with depression.

Procedure Patients were randomly assigned to either a fluoxetine or a placebo group. Patients were assessed for depression using psychometric tests and their adherence to their medical regimen was assessed by measuring their GHb levels, which indicated their glycemic control.

Findings Patients given fluoxetine reported lower levels of depression. Patients given fluoxetine had lower levels of GHb, which indicated their improved adherence.

Conclusions Measuring GHb in patient with diabetes indicates their level of adherence to prescribed medical regimes. Greater adherence was shown by patients who were less depressed.

Improving adherence Key study: Watt et al. (2003) Aim To see if using a Funhaler ® could improve children’s adherence to medication for asthma.

Method A field experiment, although it used children with asthma so could also qualify as a quasi-experiment. The experiment set up two conditions, and then used self-report to measure the adherence rates.

Participants 32 Australian children with asthma: 10 males and 22 females; aged from 1.5 to 6 years; mean age 3.2 years. Design A repeated design as each participant had one week using the normal inhaler then one week using the Funhaler.

Procedure Each child was given the Breath-a-Tech to use for one week, and a questionnaire was given for the parents to complete. In the second week, the children used the Funhaler, and the parents were given a matched questions questionnaire.

Findings 38% more parents were found to have medicated their children the previous day when using the Funhaler compared to the normal inhaler.

Conclusions The Funhaler reinforced correct usage of the inhaler with a toy that spins and a whistle that blows. This did improve the adherence to the medication. By making the medical regime fun, the adherence, certainly in children, can be improved.

Possible Section A Questions

Possible Section B Questions Discuss the usefulness of research into health promotion