Unit G543 * Health and Clinical Psychology

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Unit G543 – Health and Clinical
Psychology
Overview – G543

Healthy living

Stress

Disorders and Dysfunctional Behaviour

Approaches

Methods

Issues

Debates
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

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
Overall Objectives
Healthy Living - Specification
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?
Approaches – apply to healthy living

Behaviourist

Cognitive

Biopsychologists
Why do some people choose to ignore the importance of health
behaviours?
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
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
If the benefits
outweigh the costs
Perceived seriousness
will increase the
threat
Perceived
susceptibility will
increase the threat
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)
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?
The health belief model

Perceived Costs
Influences that discourage a change
This is so difficult!
Costs - Money and time
What’s in it for me?

Perceived Benefits
Positive consequences?
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

Activity - 10 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

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?
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.


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 0.913 – arguing validity of mother’s statement
Becker’s Results



Discuss results – make notes
Positive correlation between mother’s
belief about child’s susceptibility to
asthma attacks and compliance with
regimen

Negative correlation between costs and
compliance

These costs included:
Positive correlation between mother’s
perception of child having a serious
asthma condition and compliance with
regimen


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-

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
Evaluation
Becker
Generalisability
Reliability
Validity
Ethics
Debates

Reductionism/holism

Determinism/free will

Useful

Any others?
Issues
Homework

Describe the Health Belief Model. (10)

Pay attention to time and word count

Due next lesson

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)
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
Locus of Control

Take the Locus of control test here:

http://www.psych.uncc.edu/pagoolka/LocusofControl-intro.html

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
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.
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

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

Construct reliability – why

High level of control – so what?

Ecological validity

Mundane realism

Deterministic theory

Supports nature over nurture

Usefulness
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
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
Self Efficacy Bandura and Adams
(1977)

The belief that 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:
1.
Locus of control is concerned with what/who produces a particular
outcome
2.
Self efficacy is the conviction that one’s own behaviour will influence the
outcome
High Self Efficacy

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
Low Self Efficacy

Avoid challenging tasks

Believe that difficult tasks are beyond
their capabilities

Focus on personal failings

Quickly lose confidence in their
abilities
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.
Self-Efficacy

Bandura – four sources affecting self-efficacy

Worksheet mix and match – term with definition
1.
Experience
2.
Modelling
3.
Social persuasions
4.
Physiological factors

Bandura – If someone believes they can cope they will try harder to overcome obstacles

If they master their fear self-efficacy
Bandura and Adams (1977) Analysis of selfefficacy theory of behavioural changes

Efficacy expectation – affects behaviour (a person can successfully do whatever is required to achieve an
outcome)

Previous experiences (how successful you have been in the past)

Modelling/vicarious experiences (success of others)

Social persuasion/verbal persuasion (others telling you can do it)

Physiological arousal/Emotional arousal (anxiety)

All affect efficacy expectation

Social, situational, temporal factors could influence cognitive appraisal

Example – public speaking (Self-efficacy can alter depending on the situation)


Time, audience, topic etc. may influence coping strategies
Self efficacy is not simply explained by personality
Bandura and Adams (1977) Analysis of selfefficacy 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)

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
Systematic desensitisation

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.

Phobia treatment

Anxiety hierarchy

Move up step by step – using relaxation techniques
Client forms positive associations

Post test - 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.

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.

Pairs - discuss evaluation (pg.108)

High control…therefore?

Reliability

High Ecological Validity

Generalisable to people with same phobia – why?

Sample issues?

Self report issues?

Interactionist position (nature/nurture)

Usefulness
Knowledge check

What does self efficacy mean?

What factors influence self efficacy?

What were the conclusion in Bandura and Adam’s study?
LOC – REMEMBER link back to health

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)
Self efficacy – Bandura 1977 LINK back
to health


How effective a person thinks they will be at successfully adopting a health behaviour.

Cognitive approach based on thought processes of the individual
Findings: 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

Relating it back to health….
Does self-efficacy effect the likelihood of a coping behaviour being developed?
Timed Question

Describe self-efficacy as a theory of health
belief. (10)

12 minutes

15 with extra time
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)
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
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