Module: Health Psychology

Lecture: Health Behaviours and Beliefs

Date: 26 January 2009

Chris Bridle, PhD, CPsychol Associate Professor (Reader) Warwick Medical School University of Warwick

Tel: +44(24) 761 50222 Email: C.Bridle@warwick.ac.uk www.warwick.ac.uk/go/hpsych

Aims and Objectives

Aim: To provide an overview of the psychological determinants of health-related behaviours and beliefs

Objectives: The student should be able to provide a basic description of the …

meaning of health-related behaviours, and provide examples of different types of health behaviour

psychological processes that influence health behaviours and a framework for their organisation

common psychological components of health behaviour theories

core constructs relevant to understanding, predicting and changing health-related behaviours

Dual Pathway: Psychology and Health

PsychologicalFactors

HealthBehaviour

PhysicalHealth

Direct Path

Indirect Path

What psychologicalprocesses transmit

influence alongthese paths?

Recap

Psychoneuroimmunology (PNI)

Physiological reactivity = mechanism of action

Stress & negative affect = influence being transmitted

Interpretation = process generating the influence

Negative physical effects = chronic stable exposure

Dual Pathway: Psychology and Health

PsychologicalFactors Involved

In Appraisal

HealthBehaviour

Physical Health:Physiological

Reactivity

Chronic Stress& Negative Affect

Indirect PathStable individualdifferences

Which stable factors,and what else?

Q: Why focus on the indirect behavioural route?

Biology

Environment

Access

Behaviour

(Healthy People 2000)

20%

20%

10%

50%

Leading Causes of Disease

Behavioural contribution to management of chronic illness estimated at >90% (Wanless, 2004)

Key Questions

What psychological factors influence health behaviour?

What do we know about the determinants of health behaviour?

To what extent are we able to sufficiently explain and predict health behaviour?

Can our understanding of psychological processes be used to change health behaviour?

Will interventions that change health behaviour yield benefits for physical health?

Defining Behaviour

Behaviour: the actions or reactions of an individual to a situation – can be conscious or unconscious, voluntary or involuntary

But … what specifically?

Health behaviour Illness behaviour

Adaptive behaviour Maladaptive behaviour

Prevention behaviour Detection behaviour

Public behaviour Private behaviour

Service-use behaviours Self-care behaviours

Health behaviour: Behaviour that may have implications for health

Determinants of Health Behaviour

A framework

Background factors: Characteristics that define the context in which people live their lives; shared understanding and ways of knowing the world

Stable factors: Individual differences (personality) in psychological activity that are stable over time and context

Social factors: Social connections in the immediate environment; mostly stable, but can be fragile, e.g. when in conflict with background factors

Situational factors: Appraisal of personal relevance that shape responses in a specific situation

Why a Framework?

Background factors

Stable factors

Social factors

Situational factors

Distal

Proximal

We bring with us, to any situation, the cumulative influence of background, stable and social factors, which we combine in

various ways to form an understanding of our current situation. In most cases, our understanding (appraisal) of the

situation determines our behaviour within it.

Different intervention targets require

different intervention strategies

Stable Factors

Stable factors: i.e. individual differences, dispositions, personality

Refer to variations, between people, in psychological activities that, within people, produce responses that are stable across time and context

Influence appraisal in three key ways:

they determine if, and to what extent, an event is salient, i.e. sensitivity towards particular types of event

they provide a generalised framework for understanding and evaluating the event, e.g. as threat or challenge

they make available, or suggest, potential responses, i.e. initial response options

Individual Differences and Health

Three broad types of individual differences:

Emotional dispositions: Psychological processes involved in both the experience and expression

Generalised expectancies: Psychological processes involved in formulating expectations in relation to future outcomes

Explanatory styles: Psychological processes involved in explaining the causes of negative events

Temporal dimension:

Present

Future

Past

Emotional Dispositions

Negative affect: Tendency toward the experience of negative affective states, e.g. hostility, depression, anxiety

Appraisal bias for heightened arousal and increased frequency

Evidence for causal role in development of physical disease - health behaviour impeded as a function of fatigue and apathy.

Emotional expression: The (low) expression of (negative) emotional experience, both unconscious repression and conscious suppression

Appraisal bias for neutralising threat or extreme intensity, both leading to maladaptive responses

Risk factor for recovery (post-MI) and cancer progression

Generalised Expectancies

Locus of control: Expectations that future outcomes will be determined by factors that are either internal (self) or external (powerful others, and chance)

Internal loci generally associated with more favourable outcomes, and performance of health behaviours, but VERY dependent situational factors

Self-efficacy: Belief in one’s own ability to organise and execute a course of action, and the expectation that the action will result in, or lead to, a desired outcome

Heuristic belief in the beneficial effects of higher self-efficacy, deriving from appraisal bias for challenge rather than threat and expectation of success

Explanatory Styles

Optimism (Pessimism): Expectation of positive future outcome (however achieved) despite current negative event

Appraisal bias for brief, low levels of physiological reactivity, and promoting active coping responses

Optimism, vis-à-vis pessimism, associated with better physical health, illness recovery, and health behaviour performance

Attributional style: Causal explanations of negative events as internal (self), stabile (time), and global (situation)

Generally better if attributions are external, unstable and specific, rather than internal, stable and global

Causal attributions influence expectations about controllability of future outcomes, i.e. the relevance of health behaviours

Social Cognition Theories

Social cognition theories attempt to explain the relationship between social cognitions (e.g. beliefs, attitudes, goals, etc.) and behaviour

Some examples: Health Belief Model (Rosenstock, 1966)

Protection Motivation Theory (Rogers, 1975)

Theory of Reasoned Action (Fishbein & Ajzen, 1975)

Theory of Planned Behaviour (Ajzen, 1988)

Transtheoretical Model (Prochaska and DiClemente, 1983)

Health-Belief Model (HBM)

HealthBehaviour

PerceivedThreat

PerceivedSeverity

PerceivedEfficacy

PerceivedSusceptibility

PerceivedBenefits

PerceivedBarriers

(Rosenstock, 1966)

Theory of Planned Behaviour (TPB)

Behaviour

BehaviouralAttitude

SubjectiveNorm

PerceivedBehavioural

Control

Behavioural beliefs+

Outcome evaluation

Normative beliefs+

Motivation to comply

Control beliefs +

Self-efficacy

BehaviouralIntention

(Ajzen, 1988)

Transtheoretical Model

PC C P A M

Self-Efficacy

Temptations

Pros

Cons

Experiential + Processes of Change + Behavioural

Stages of Change

(Prochaska & DiClemente, 1983)

Health Behaviour Models / Theories

Which model / theory is best? At the end of every ‘theory’ chapter in every health psychology text, you’ll receive the following expert advice:

‘Models are not in competition … …they offer different perspectives on the relationship between

social cognitions and (health) behaviour … …’

… blar, blar, blar, blar …

Which ‘perspectives’, on which ‘relationships’ and between what cognitions, etc., will help us to

… understand …

… predict ….

… and change …

… the health damaging behavioursin which so many people habitually engage?

ConceptProposition – Behaviours more likely when

Health Belief Model

Theory of Planned

Behaviour

Transtheoretcial Model

Normative beliefs

Belief that significant others desire one to adopt the behaviour

X Subjective normPoC: Helping relationships

Outcome Evaluation

Perceived benefits outweigh perceived costs of behaviour

Benefits and Barriers

BehaviouralBeliefs

DecisionalBalance

Self-efficacy

Belief in one’s ability to perform behaviour

Perceivedefficacy

Perceived Behavioural

Control

Self-efficacy and Situational

Temptations

Risk beliefs One feels at risk of an outcome with negative consequences

PerceivedSusceptibility

XDecisionalBalance

Risk affectEmotional response to perceived risk within normal limits

PerceivedThreat

XPoC: Dramatic

relief

Intention / Motivation

One has formed / holds an intention to perform the behaviour

XBehaviouralintentions

Stages if Change (Cont, Preparation

and Action)

Conceptual Framework

Determinants of health behaviours and beliefs

Background factors: Cultural norms; SES; Gender; Ethnicity; Genes; Chronic health status

Stable factors: Emotional disposition, Generalised expectancies; Explanatory styles

Social factors: Perceived support (family, friends, peers, etc.); Subjective norm; Helping relationships

Situational factors: Situation-specific self-efficacy; Perceived risk; Emotional response; Intention (motivation); Outcome evaluation;

Conclusions

There are many determinants of health-related behaviours

Determinants can be usefully grouped to form a conceptual framework

Background, stable and social factors shape beliefs and situational appraisals

Behaviour (typically) is most strongly influenced by situational beliefs / appraisals

Psychological models attempt to explain the relationship between beliefs and behaviour

Changing beliefs promotes long-term behaviour change

Summary

This session would have helped the student to understand the … range of behaviours that can be described as being

health-related

different types of determinants of health-related behaviours and the level at which they operate

common psychological components of health behaviour theories

core constructs relevant to understanding, predicting and changing health-related behaviours

Next Week

Illness Behaviours & Beliefs Common sense would suggest that people who seek

medical help have more severe symptoms than those who do not seek help.

Research demonstrates that this is incorrect.

Peoples interpretation of their symptoms and their help-seeking behaviour is determined by many factors aside from the presence or severity of physical symptoms.

These factors will be the examined in next week’s session.

Any questions?

What now?

Obtain / download one of the recommended readings

In your small groups consider today’s lecture in relation to next week’s tutorial tasks:

a) integrated template

b) ESA question