1 introduction to health and addictive behaviours Flashcards
What is a health behaviour?
any activity undertaken for the purpose of preventing or detecting disease or for improving health and wellbeing (Conner & Norman, 1996)
behaviours that increase risk = any activity undertaken by people with a frequency or intensity that increases risk of disease or injury (Kasl & Cobb)
behaviour that promotes health = any activity undertaken by a person believing themselves to be healthy for the purpose of preventing disease or detecting it as an asymptomatic stage (Kasl & Cobb, 1966)
activities that may help to prevent disease, detect disease and disability at an early stage, promote and enhance health, or protect from risk of injury (Steptoe & Wardle, 2004)
What are the main characteristics of the concept of health?
- fluid concept
- strength of evidence is extremely variable
- activities might be done for non-health reasons
- health motivations and cognitions are part of a wider set of influences on health behaviour
What are the main predictors of death?
- not being physically active
- smoking
- sleeping <7 hrs
- skipping breakfast
- eating snacks between meals
- binge drinking
- being over or underweight
What are the two models of health?
- biomedical model: focusses on physical processes, such as pathology, the biochemistry and the physiology of disease. does not consider the role of social factors or individual factors or the prevention of disease
- biopsychosocial model: psychological + social + biological
What are health behaviour theories good for?
- understand and predict the nature of human behaviour
- tackle barriers which influence behaviour
- develop behavioural modification techniques
- formulate a health intervention or education plan
- evaluate the effectiveness of intervention strategies
Why is the development of the health behaviour concept important?
health behaviours might cluster into a healthy lifestyle.
preventing premature mortality is a whole-body, whole-mind approach
What are important health behaviours in the modern world?
Diet
- fundamental importance
- energy needs, balance
- epidemic of overconsumption
- epidemic increase in obesity
Fat intake
- serum cholesterol levels - heart disease and atherosclerosis
high-fat diet appears to be necessary condition for its development
China: low fat diets, low cholesterol levels (Campbell, 1998)
- weight gain
Fruit and vegetable intake
- nutrient-rich foods, low in energy
- 400g a day
- countries with cheap, local produce eat more and reach the standard still
Physical activity
- twice as likely to develop premature mortality of inactive
- men tend to be more active that women
- higher SES - more active
Tobacco use
- burden greater than any other health behaviour
- effects are reversible
- 35% men, 22% women smoke in developed countries
- SES - more likely to smoke
Sexual behaviour
- HIV/AIDS
- 33mio ppl (22mio in sahara region, 1,2 in north america, 800.000 in Europe)
Alcohol
- excessive intake, foetal alcohol syndrome, alcoholic liver cirrhosis, illnesses
- high blood pressure, cardiac arrhythmiasm cancers
- ethanol is broken down by cells to create a potent carcinogen acetaldehyde
- road traffic accidents, domestic violence, sex diseases
- pattern of consumtion is vital
- U-shaped relationship between alcohol and mortality (protective effect of moderate intake)
- immense social harm
- clear social gradient (SES)
Cancer screening
- treatment costs…, availability…, developed country…, campaigns, education
- willingness to get medical care
Hazardous driving behaviour
- second leading death cause for children and young adults worldwide
- drunk driving (32% in USA), no seatbelt (60& effective), driving too fast
What are determinants of health behaviour?
Sociocultural and national factors
Legislative Factors
Macroeconomics (income, taxes, buoyancy of economy)
Systems of provision and services (availability of factured p and s)
urban environments
Health-service provision
Sociodemographic factors
Health status
Social and family factors
Psychological factors
Biological factors
What is the historical understanding of the concept of health?
cause of illness? external agent or internal involuntary physical changes
treatment of illness? physical changes
role of psychology? illness may have psychological consequences, but not psychological causes
currently: organ-oriented medical practice
500-300 BC: knowledge of relation between soul and body
greek philosophers
hippocrates: correct proportions of body fluids, know the patient as an individual, nature over medicine
Galen: searching local pathology - organic damage
13th centruy: Thomas Aquinas, dominican order
soul and body are not seperate entities
15th century: Scientific revolution
Descartes - complete separation
beyond the model:
hysterical paralysis - freud
psychosomatic medicine
behavioural medicine
Why is there a need for a new approach to health? hence the biopsychosocial approach?
exclusive focus
strict division between non-material spirit and material body
Engel, 1977 - paper “The need for a new medical model”
impact of physicians empathy on health outcome
high empathy → more likely to have better results on blood test
=> inter-relational focus
=> interconnected understanding
What is the field of behavioural medicine and health psychology?
»interdisciplinary field concerned with the development and integration of the behavioural and biomedical science and techniques relevant to health and illness and the application of this knowledge and these techniques to prevention, diagnosis, treatment and rehabilitation.«
What is the difference between illness and disease?
disease = the actual biological process or pathology involved in a medical condition
illness = the outward expression of a disease i.e. the signs, symptoms and altered behaviours that result from changes to that person’s ‘normal’ physiology
What is the role of psychology in addressing causes of illnesses?
cause of illness? human beings as complex systems, multitude of factors
treatment of illness? whole person, including beliefs and behavours, patient is responsible for their treatment
role of psychology? contributing to all stages, not only consequences
What are current prevalences of non-communicable diseases?
WHO - 70% of deaths are attributable to NCDs
heart disease remains number 1 killer; diabetes and dementia enter top 10
global decline in deaths from communicable diseases, but still major challenge in low- and middle-income countries
people are living longer - but with more disability
Why don´t people engage in health behaviours?
…
What are current issues of health behaviours?
reliance on self-report measures
low correlation between actual physical activity and self-report
complexity of behaviours
health behaviours and health outcomes - link varies
categorisation of activities
individual recommendations
limited generalisability
What are key theories explaining health behaviour?
- health belief model (Becker, 1974)
- protection motivation theory (Maddux & Rogers, 1983)
- self-determination theory (Deci & Ryan, 2000)
- theory of planned behaviour (Ajzen, 1991)
- social congitive theory (bandura, 1982)
intentions, self-efficacy, outcome expectancies, perceived suceptibility and perceived severity
factors are unique to each behaviour
How effective are current interventions to change health behaviours?
- only small sized effects
- considerable heterogeneity in the effect sizes found for interventions
but no robust moderators found - use of theory might increase effectiveness
- classify behaviour change techniques - prompting commitment rather than just information
- policy and environmental interventions rather than on individual level
- maintenance of health behaviour - long-term efficacy
What is the intention-behaviour gap?
develops an intention to change a behaviour but takes no action actually to do that
only half of the time they are translated
information deficit, external motivation, motivation, social obligation/responsibility
What is the health action process approach?
pre-intention motivation phase - post-intention volition phase
Motivational Phase:
Risk Perception:
assesses the potential threat to their health
severity and susceptibility to a particular health issue
Outcome Expectancy:
potential outcomes or consequences of adopting or not adopting a health behavior influences motivation
Task Self-Efficacy:
belief in their ability to perform the necessary tasks required for healthy behaviour. It is a crucial factor in determining whether a person will move beyond mere intention to take concrete action.
Volitional Phase:
Action Planning:
specific plans detailing when, where, and how they will engage in the health behavior. Action planning bridges the gap between motivation and action.
Coping Planning: This involves anticipating and planning for potential obstacles or barriers that may arise during the implementation of the health behavior.
overcome challenges and maintain their commitment to the behavior.
Maintenance and Recovery Planning:
strategies to maintain the behavior in the long term. Additionally, they develop plans to recover from lapses or relapses.
Intention
-> action and coping planning
-> initiative
-> maintenance
What is the transtheoretical model?
Precontemplation:
In this stage, individuals are not yet considering making a change in their behavior. They may be unaware of the problem or may be resistant to change. Motivation to change is low, and individuals might not see the need for behavior modification.
Contemplation:
During the contemplation stage, individuals start to recognize the need for change and consider the possibility of modifying their behavior. They weigh the pros and cons of making a change and may be ambivalent about taking action.
Preparation:
In the preparation stage, individuals are actively planning and preparing for the behavior change. They may set specific goals, gather information, and take small steps toward modifying their behavior. Motivation to change is higher, and the intention to take action is becoming more concrete.
Action:
The action stage involves the actual implementation of the planned behavior change. Individuals engage in observable and measurable actions to modify their behavior. This stage requires commitment, effort, and perseverance, as individuals actively work toward achieving their goals.
Maintenance:
Maintenance is the stage where individuals work to sustain the behavior change over the long term. They have successfully implemented the desired behavior, and their goal is to prevent relapse. Strategies such as coping with challenges and reinforcing positive behaviors are crucial in this stage.
What is self-determination theory?
autonomy
competence
relatedness
-> motivation
