Health Psychology
Session Aims
• To explore what health psychology is and how
it is relevant to health
• To apply and critique some of the key models
in health psychology specifically relevant to
health behaviour
• To introduce a critical perspective within
health psychology
Health Psychology
• Branch of psychology concerned with study of
mental processes and behaviour in relation to
health and illness.
• Sub-discipline of psychology (draws on
knowledge from other areas of psychology as
well as medicine and sociology for example,
Sarafino, 2002)
• Relatively new area but has a discrete identity
Health Behaviour
• Any behaviour which impacts on health
• Behaviour which improves or maintains health
(Straub, 2007)
• ‘Health-related’ behaviour
• ‘it is difficult to imagine an activity or behaviour
that does not influence health in some way – for
better or worse, directly or indirectly,
immediately or over the long-term’ (Straub,
2007:155).
• Health-protective behaviour (Sarafino, 2002)
Health Behaviour
• Behaviour may have a positive or negative
impact on health
• Focus on behaviour is linked to a range of
lifestyle factors identified as being potentially
harmful to health (for example, smoking as a
risk factor for coronary heart disease)
Different kinds of health behaviour
(Hubley & Copeman, 2008)
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Decision-based
One-time
Routine (Habit)
Addictive
Custom
Tradition
Lifestyle
Key variables in understanding health
behaviour
Self Efficacy (Bandura 1977, 1986)
• Self Efficacy is the belief about whether we
can do something (capacity and capability).
• It is linked to self-confidence.
• People with high levels of self efficacy tend to
carry out behaviours which enhance their
health (Marks et al, 2005; Straub, 2007).
Key variables in understanding health
behaviour
Beliefs about control
• Behavioural control and cognitive control
(Tones & Green, 2004)
• Locus of Control (Rotter, 1966)
• Wallston & Wallston (1982) Multidimensional
Locus of Control
Health Belief Model
• Developed to explain/predict health behaviours
• Beliefs are a central concept
• Beliefs about:
- Susceptibility to illness
- Severity of illness
- Benefits of/barriers to taking action
- Ability to take action
- Outcomes of taking action
Health Belief Model
• Predicts the likelihood that a person will take
action depending on their assessment of
different things according to their beliefs
• People weigh up the advantages and
disadvantages of taking action (cost-benefit
analysis)
• ‘Cues to action’ are needed to provoke action
(internal or external)
Theory of Planned Behaviour
Three key variables:
• Attitude to towards the behaviour
• Subjective norms
• Perceived behavioural control
All of these combine to produce ‘behavioural
intention’ (or not). The greater the intention to
engage in a particular behaviour, the more likely the
behaviour will happen.
Protection Motivation Theory
• Has some similarities with components of the
HBM and TPB.
• Proposes that behaviour intention results
from two types of appraisal – Threat Appraisal
and Coping Appraisal
• This results in an Adaptive (changing
behaviour) or Maladaptive (avoidance or
denial) response
Protection Motivation Theory
• Central feature is ‘fear’ and role it plays in
determining behaviour
• Relevant where people may be fearful for
their health
• BUT too much fear (high levels of anxiety)
might cause people to disengage
Stages of Change
Describes the behaviour change process:
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Precontemplation
Contemplation
Preparation
Action
Maintenance
Allows for relapsing.
Utility of Behaviour Change Models
• Are useful for providing some insight into why people
behave in certain ways
• Are useful for planning health promotion interventions
• There is evidence to suggest that lifestyle interventions
can be successful in promoting behaviour change at an
individual level (Kitzmann et al, 2010)
• Understanding the components and processes involved
in health behaviour can assist in designing health
promotion interventions which have a greater chance
of success (Trifiletti et al, 2005; Parker et al, 2004 and
NICE 2006).
Criticisms of theory in health
psychology
• Focus on the individual level rather than wider
determinants of health
• Reductionist approach can lead to victim blaming
• Do not take an holistic approach to understanding health
behaviour
• Promote individualism and individual responsibility for
health
• Examine individual behaviour in isolation neglecting wider
influences
• Neglect the role of things like past behaviour, habit,
emotion and culture
• Simplify behaviour change, do not take into account time
Criticisms of theory in health
psychology
In terms of research a number of difficulties have been highlighted including…
• Problems defining individual constructs (Bunton et al, 2002)
• Limited predictive utility (Abraham and Sheenan, 2005)
• A weak relationship between intention and behaviour – Stephens (2008)
argues that other factors should be explored i.e. environmental factors
• A lack of standardisation across constructs in experimental design (Conner
and Norman, 2005). They tend to have been developed in specific contexts
which can lead to a ‘Western’, patriarchal bias
• Much of the research using the models relies on self-report measures
which have limitations.
• Whilst many of the models draw upon aspects of sociological,
psychological and anthropological theory they tend to neglect political and
economic theory (Hubley and Copeman, 2008).
Health Action Model
Two key sections:
1) Factors influencing ‘behavioural intention’
Three interacting systems – belief system,
motivation system and normative system
2) Factors influencing whether an intention will
translate into ‘action’.
Factors which facilitate behaviour change, such
as a supportive environment, skills and
knowledge.
Critical perspectives
• Challenge the notion of ‘behaviour’
• Refers to ‘social practices’ or ‘actions’
• Challenges mainstream assumptions and
understandings
• Takes into account the social, political and
economic context (Marks, 2002) and issues of
power.
Summary
• Health psychology is a sub discipline within psychology
which can help us to understand how and why people
behave the ways that they do and make the choices that
they make in relation to health.
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• Health behaviour is complex and influenced by many
different factors.
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• Models of behaviour change can help in designing
interventions to enable people to change their health
behaviour.
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• Critical health psychology offers an alternative perspective.