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
