1. Unit G543 – Health and Clinical Psychology

2. Overview – G543 Healthy living Stress
Disorders and Dysfunctional Behaviour
Approaches
Methods
Issues
Debates

3. What is health psychology?
Any ideas?
Defined as ‘the scientific study of psychological processes related to health and health care’ ( Freidmann and Adler, 2007)
‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity’ (WHO)
Concerned with how different factors (I.e. lifestyle or social context can influence illness and well being
Key aim: to promote understanding of appropriate behaviour that leads to a healthier lifestyle
Trauma, reduction of diseases, eating well, unhealthy behaviours (smoking) or becoming stressed

4. Relies on empirical research to support theories and models
Health interventions and promotion
Application
Healthier society, longer lives, less public spending
Mental health
Diagnoses
Causes
Treatments
Therapies – individual differences

5. Overall Objectives

6. Healthy Living - Specification

7. Healthy Living Theories of health belief Methods of health promotion
Features of adherence
Healthy living is…..the way people live their lives
A health behaviour is….something people do in order to improve health
A lifestyle is….pattern of health behaviour
Why do some people behave in healthy behaviours and others don’t?

8. Approaches – apply to healthy living
Behaviourist
Cognitive
Biopsychologists
B – behaviour and and environment what sort of background and experiences or circumstances make someone make healthy choices as opposed to those who don’t
C – thought processes – beliefs, weigh up odds, pros and cons, strong internal belief and faith
Bio- brain structure and genetics links with personality or temperament that make them more prone to being overweight or those who make life changes
Why do some people choose to ignore the importance of health behaviours?

9. Health Belief Model Health belief model - background
Originally developed in 1950s by Rosenstock to explain why some people took up the offer of free screening for tuberculosis and others did not
Used in the 1960s
To explain why the NHS (free healthcare in Britain) and free health screening in the US were not having a positive impact on certain aspects of health
HBM focuses on individual and situational factors that explain health related behaviours

10. 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

13. 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)

14. The health belief model
HBM – rests on the assumption that people will engage in healthy behaviour if they understand that a health problem will arise if they do not
Perceived susceptibility
Perceived severity
How likely am I to be affected?
How bad can it be?
Scenario 1 – someone that smokes 20 cigarettes a day
Scenario 2 – someone who uses sun beds twice a week for one hour
Scenario 3 – someone who drinks half a bottle of wine a day

15. The health belief model
Perceived Costs
Perceived Benefits
Influences that discourage a change
This is so difficult!
Costs - Money and time
Scenario 1 – someone that smokes 20 cigarettes a day
Scenario 2 – someone who uses sun beds twice a week for one hour
Scenario 3 – someone who drinks half a bottle of wine a day
What’s in it for me?
Positive consequences?

16. The health belief model
Cues to action
Examples?
Mediating factors
Demographic variables
Socio-psychological variables
Health Motivation
Self efficacy
External factors
Prompt a desire
TV programme, relative dying/falling ill
HBM – rests on the assumption that people will engage in healthy behaviour if they understand that a health problem will arise if they do not

17. Activity minutes
One person in each group to open up work sheet 1
Use this presentation, the textbook (pg. 101) to apply the health belief model to one of these scenarios
Scenario 1 – smoking 20 cigarettes a day
Scenario 2 – excessive use of a sun bed
Scenario 3 – binge drinking
Feedback

18. Who were the participants? What was the aim? Method?
What were they asked in the interview?
How did the researchers try to confirm validity of the self report?
What were the main results?
Positive correlation x2
Negative correlation x1
Conclusion?

19. Becker (1978) Compliance with a medical regime for asthma
Aim To use the health belief model to explain mother’s adherence for their asthmatic children.
Approach: Cognitive and social factors with demographic variables such as education, family size and occupation
Method and Design: correlation between beliefs reported during interviews and the compliance with self-reported administration of asthma medication
Participants and procedure:
117 mothers asked only 111 took part (7 white participants) Baltimore USA
17-54 years old
Children – 9 months – 7 yrs.

20. Covert evaluation of compliance
Interview – 45 mins
Mother’s general health motivations
Attitudes and views about asthma and consequences
Provide measures of the HBM’s dimensions
Perception of their child’s susceptibility to illness and asthma
Beliefs about its seriousness and interference (education, activities, embarrassment, mother’s activities)
Faith in doctors and effectiveness of medication
Covert evaluation of compliance
Blood test (finger stick) – t confirm validity of self report
Test presence of theophylline – substance basic to all asthma medication prescribed to the children taking part
Only available for 72% 80 of the participating mother’s
Reports of medical administration compared to lab findings
Correlation of – arguing validity of mother’s statement

21. Becker’s Results Discuss results – make notes
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
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-

22. Conclusion: HBM is a useful model to predict and explain different levels of compliance with medical regimes
Interesting finding – correlation between compliance a being critical of doctors (lack of trust) – not predicted by HBM
Evaluation – Issues and debates
Class discussion (making notes) pg. 103

23. Evaluation
Becker
Generalisability
Reliability
Validity
Ethics

24. Debates Issues Reductionism/holism Determinism/free will Useful
Any others?

25. Homework Describe the Health Belief Model. (10)
Pay attention to time and word count
Due next lesson

26. Briefly explain the Becker (1978) study Aim, results, conclusion (3)
Hand in homework
Recap Quiz out of 10 marks
HBM is used to? Predict the uptake of health behaviours based on several factors
Describe:
Perceived Severity (1)
Perceived susceptibility (1)
Perceived costs (1)
Perceived Benefits (1)
Cues to action (1)
Briefly explain the Becker (1978) study Aim, results, conclusion (3)
Provide two evaluative points (2)

27. Rotter (1966) Internal vs External Locus of Control
Background – Rotter 1950s
Aspect of personality
Reductionist theory
The extent to which individuals believe they can control events that affect them
Influential in explaining individual differences in psychology –especially health behaviours
Group work to research locus of control (books, PowerPoint, psychteacher.co.uk, etc.)
Groups to discuss - but make individual notes
Every one to feedback one aspect regarding locus of control to the class
Nature Vs Nurture
Stable underlying personality construct OR
Largely learned
Some evidence that psychological and educational interventions have been found to shift towards internal locus of control

28. Locus of Control Take the Locus of control test here:
Guided by “reinforcements” (rewards and punishments)
Through these individuals come to hold beliefs about what causes their actions
Locus of control orientation
Outcomes of actions are contingent to what we do (internal)
Or events outside of control (external control)
Unidimensional continuum – range external to internal

29. High internal locus of control: feel that their actions are their own choice and responsibility
Low: actions results of factors outside of their control (i.e. luck or fate)
High internal LOC, Low external LOC : health is In MY hands. I can eat healthily and go to the gym 3 times a week. Success/failure is due to my own efforts
High external LOC, Low internal LOC: Things in my life are controlled by luck, chance or religion. There is no point in me going to the gym. Doctors will help me if I get ill. My health is in their hands and fate will decide.

30. Rotter (1966) Internal vs external locus of control
Aim: Examines the degree by which individuals believe their health is controlled by internal or external factors
Approach: Cognitive
Method: Review of 6 pieces of research into individuals perceptions of ability to control outcomes based on reinforcement
Lab experiments – tasks such as line matching with small differences
1st condition – Participants thought the tasks were skill based and that they were in control
2nd task – chance and skill based tasks
Participant reinforced as right or wrong but success/failure was controlled by the experimenter

31. Results: Participants with internal LOC were more likely to show behaviours that would enable to cope with a threat than those with external LOC
Conclusions: LOC can effects many different behaviours not just health
James et al (1965) smokers who give up and didn’t relapse had a higher level of internal LOC
Women- with no significant difference between internal and external LOC would take other factors into consideration such as weight gain (other factors play a part not just LOC)
Internal LOC – can control it, beat it and survive

32. Construct reliability – why
High level of control – so what?
Ecological validity
Mundane realism
Deterministic theory
Supports nature over nurture
Usefulness

33. Recap - 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

34. Homework Write a paragraph criticising the methodology
Write a paragraph answering the following question: Is Locus of control a good predictor of healthy behaviour?
Due next lesson

35. Self Efficacy Bandura and Adams (1977)
The belief one can successfully engage in a behaviour to produce the desired outcome
Faith in your ability to do something impacts your actual ability to do it
Note: closely related to the locus of control theory however there are important differences:
Locus of control is concerned with what/who produces a particular outcome
Self efficacy is the conviction that one’s own behaviour will influence the outcome

36. High Self Efficacy Low Self Efficacy Avoid challenging tasks
View challenging problems as tasks to be mastered
Develop interest in the activities in which they participate
Stronger sense of commitment to interests/activities
Recover quickly from setbacks/ disappointments
Avoid challenging tasks
Believe that difficult tasks are beyond their capabilities
Focus on personal failings
Quickly lose confidence in their abilities

37. Self-Efficacy Relate to health…. Example?
Cognitions that determine whether health behaviour change will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and failures.
Effort to change risk behaviour
Persistence to continue
Self efficacy has been found to be one of the most important factors of an individual’s ability to successfully negotiate health changes.

38. Self-Efficacy Bandura – four sources affecting self-efficacy
Worksheet mix and match – term with definition
Experience
Modelling
Social persuasions
Physiological factors
Bandura – If someone believes they can cope they will try harder to overcome obstacles
If they master their fear self-efficacy

39. Bandura and Adams (1977) Analysis of self-efficacy theory of behavioural changes
Efficacy expectation – affects behaviour
a person can successfully do whatever is required to achieve outcome
Previous experiences
Vicarious experiences
Verbal persuasion
Emotional arousal
All affect efficacy expectation
Social, situational, temporal factors could influence cognitive appraisal
Example – public speaking
Self efficacy is not simply explained by personality

40. Bandura and Adams (1977) Analysis of self-efficacy theory of behavioural changes
Aim: to assess the self-efficacy of patients undergoing systematic desensitisation
Approach: Cognitive
Type of data: Quantitative and qualitative
Method: controlled quasi-experiment (patients with snake phobias)
ACTIVITY

41. 10 snake phobics
9 females 1 male
19-57 yrs old
Replied to an advert in paper
Pretest:
To test level of fear using rating scales 1-10 – testing how frightened they would be to approach the Boa constrictor
Avoidance behaviour
Self efficacy – tested using 100 point probability scale for how likely they felt they would succeed

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

43. 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 - Each patient was again measured on behaviours and belief of self-efficacy in coping.

44. Findings & conclusion
Higher levels of post-test self-efficacy were found to correlate with higher levels of coping behaviour with snakes.
The boa constrictor was used to test changes in self efficacy
Corn snake used to see if self-efficacy generalised to other 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.

45. Pairs - discuss evaluation (pg.108)

46. Evaluation Pairs - discuss (pg.108)
Study G R A V E

47. Relate these studies to health psychology
Links to AS
Griffiths (1994)
Bandura (1961)
Milgram (1963)
Cognitive styles
Cognitive processes affect behaviour
Regular gamblers way of thinking about gambling, weighing odds and explaining away losses different to non gamblers
Situational explanations
Bashing bobo
Social learning theory
Obedience
Behaviour depends on certain situations
Relate these studies to health psychology

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

49. Tasks & Recap
Homework
Read up on: How can health professionals use the media to encourage healthy living?
Find an example of a media campaign related to health
Everyone to feedback next lesson

50. Timed Question
Describe self-efficacy as a theory of health belief. (10)
12 minutes
15 with extra time
For third class before introducing media.

51. Peer assessment
Use the mark schemes I have handed out and also bear in mind this extract from the examiners’ report.
Give a www and an ebi
Give a mark
When you get it back read it through – do you agree/disagree?
Write up on your feedback sheet, don’t forget to include how you will improve (put ‘PA’ next to the mark)

53. Recap - Health Belief Therapies
Becker (1978) Compliance with a medical regime for asthma
Rotter (1966) Internal Vs external locus of control
Bandura and Adams (1977) Analysis of self-efficacy theory of behavioural change
Brief summary on pg. 109