Health Psychology

Question 1

What is Healthy psychology?

Answer 1

Health psychology emphasises the role of psychological factors in the cause, progression and consequences of health and illness

Aims to put theory into practice by promoting healthy behaviours and preventing illness

Question 2

What are the 3 main categories of health behaviours?

Answer 2

Health Behaviour: a behaviour aimed to prevent disease (e.g. eating healthily)

Illness Behaviour: a behaviour aimed to seek remedy (e.g.
going to the doctor)

Sick role Behaviour: any activity aimed at getting well (e.g. taking prescribed medications; resting)

Question 3

What is health-damaging/impairing and health promoting?

Answer 3

Health Damaging/Impairing e.g. smoking , alcohol & substance abuse, risky sexual behaviour, sun exposure, driving without a seatbelt

Health Promoting
e.g. taking exercise, healthy eating , attending health checks, medication compliance, vaccinations

Question 4

What percentage of cancer cases can be prevented?

Answer 4

40%

Question 5

What are the leading causes of death in England in 2022?

Answer 5

Females: Malignant Neoplasm of trachea, bronchus and lung
Male: Cerebrovascular diseases
Total : Malignant neoplasm of trachea, bronchus and lung

Question 6

What is one of the big issues faced by medical students?

Answer 6

Burnout
Lack of sleep

Question 7

Lifestyle factors and risk of sickness absence from work: What did this multicohort study show?

Answer 7

74,296 participants (UK, Finland, France)

Top two reasons for absence from work: musculoskeletal issues and depressive disorders
Overweight, low physical activity (PA) predicted musculoskeletal problems Binge drinking, smoking, low PA predicted depressive disorders
Lifestyle factors are associated with sickness absence

Question 8

What are the top 4 reasons that affect your risk of mortality over 15.5 years according to a study done in Sweden?

Answer 8

Smoking
Diet
Physical activity
Alcohol

Question 9

Mr Green is a 68 year-old male with moderate COPD, reduced physical functioning, social isolation, and symptoms of depression. He smokes 40 cigarettes a day and is reluctant to try to give up smoking, despite being aware of the impact on his health.

How can we help Mr Green?

Answer 9

Intervention - Population level
Health promotion
The process of enabling people to exert control over the determinants of health, thereby improving health
Intervention – Individual level
Patient centred approach
Care responsive to individual needs

Question 10

How can we promote health?

Answer 10

Health promotion/ awareness campaigns
“Healthier you” Diabetes prevention
Change 4 Life Campaign, “5 a day”
Every mind matters

Promoting screening and immunisations
Cervical smear screening
MMR vaccine

Question 11

How can intervention effect to more than one level?

Answer 11

E.g. a brief primary care intervention aimed at reducing alcohol consumption among individuals could have an impact:

Individual’s behaviour (level of alcohol consumption, individual health
outcomes, or incidence of domestic violence)
Local community (local alcohol sales, alcohol-related crime or accident and emergency [A&E] events)
Population level (for example, national alcohol sales and consumption, national statistics on alcohol-related crime and A&E events, or demographic patterns of liver cirrhosis)

Question 12

According to Weinstein in 1983 why do individuals continue to practice damaging health behaviour?

Answer 12

Individuals continue to practice health damaging behaviour
due to inaccurate perceptions of risk and susceptibility

Question 13

What are the perceptions of risk influenced by?

Answer 13

Lack of personal experience with problem
Belief that preventable by personal action
Belief that if not happened by now, it’s not likely to
Belief that problem infrequent
Health beliefs Situational rationality Culture variability Socioeconomic factors Stress
Age

Question 14

How can a patients perceptions of risk affect their response to risks and doctor’s advice?

Answer 14

Investigated lay explanations of heart disease People had their own ideas of causes
E.g. lifestyle, heredity, social factors, work, climate, luck, not all people exposed
to XYZ develop CHD, other people do develop it and are not exposed

Patient’s perception of their own risk varies and can predict response to advice/
intervention.

Question 15

How should doctor’s help individuals change their health behaviours according to NICE?

Answer 15

Work with your patient’s priorities
Aim for easy changes over time
Set and record goals
Plan explicit coping strategies
Review progress regularly (this really matters)
Remember the public health impact of lots of you making small differences to individuals

Question 16

Why is behaviour change important?

Answer 16

Important from both an individual and population perspective
Overwhelming evidence that changing people’s health behaviour can have an
impact on some of the largest causes of mortality and morbidity
Interventions to change behaviour may offer a relatively simple solution to reducing disease

Question 17

What do the Royal College of Physicians see as the highest priority in medicine?

Answer 17

sees preventing smoking as the highest priority in medicine

the failure of clinicians and systems to offer the cost-effective stop smoking treatments as unethical and negligent.

Question 18

What do we need to do to help change people’s health behaviours?

Answer 18

An overview of the theories and models of behaviour change

An understanding of what works in practice

Question 19

What are some models and theories of behaviour change?

Answer 19

Health belief model (HBM)
Theory of Planned Behaviour (TPB)
Stages of change /Transtheoretical model (TTM)
Social norms theory
Motivational interviewing
Social marketing
Nudging (choice architecture)
Financial incentives

Question 20

What is the health belief model?

Answer 20

Individuals will change if they:

Believe they are susceptible to the condition in question (e.g. heart disease)
Believe that it has serious consequences
Believe that taking action reduces susceptibility
Believe that the benefits of taking action outweigh the costs

Question 21

Health belief model picture

Answer 21

Slide 10 in health psychology part 2

Question 22

What are the cues to action in the health behaviour model?

Answer 22

Unique component of the model
Can be internal or external cues
Not always necessary for behaviour change

Question 23

What are some critics of the health behaviour model?

Answer 23

Alternative factors may predict health behaviour, such as outcome expectancy (whether the person feels they will be healthier as a result of their behaviour) and self-efficacy (the person’s belief in their ability to carry out preventative behaviour)
As a cognitively based model, HBM does not consider the influence of emotions on behaviour
HBM does not differentiate between first time and repeat behaviour
Cues to action are often missing in HBM research

Question 24

What is the summary of the health behaviour model?

Answer 24

Longest standing model of behaviour change
Successful for a range of health behaviours (breast self-examination, vaccinations, diabetes management, adherence to medication, cancer screening)
Perceived barriers have been demonstrated to be the most important factor for addressing behaviour change in patients

Question 25

What is the theory of planned behaviour?

Answer 25

An expansion of the earlier Theory of Reasoned Action (TRA) Proposes the best predictor of behaviour is intention e.g. I intend to give up smoking

Question 26

What is intention in the theory of planned behaviour?

Answer 26

A person's attitude to the behaviour The perceived social pressure to undertake the behaviour, or subjective norm A person's appraisal of their ability to perform the behaviour, or their perceived behavioural control

Question 27

What is the model for the theory of planned behaviour?

Answer 27

Attitudes + Subjective norm + Perceived behavioural control > Intentions > behaviour

Question 28

Example of theory of planned behaviour - smoking

Answer 28

Attitude – I do not think smoking is a good thing Subjective Norm – most people who are important to me want me to give up smoking Perceived Behavioural Control – I believe I have the ability to give up smoking Behavioural Intention – I intend to give up smoking

Question 29

How do we help people to act on their intentions?

Answer 29

Encourage more preparatory actions

Question 30

What are some ways to help people act on their intentions?

Answer 30

Perceived control – Fisher & Johnson (1996) patients with chronic back pain took part in a lifting task. Recalled success predicted success in the task Anticipated regret – Abraham &Sheeran (2003) increased anticipated regret was related to sustained intentions Preparatory actions – Stock & Cervone (1990) dividing a task in to sub-goals increases self-efficacy and satisfaction at the point of completion Implementation intentions – Gollwitzer (1999) “if-then” plans facilitates the translation of intention in to action (specify a time and a context) Relevance to self

Question 31

What are the critics for the theory of planned behaviour?

Answer 31

Criticisms include the lack of a temporal element, and the lack of direction or causality (Schwarzer, 1982) TPB is a “rational choice model”. Does not consider emotions such as fear, threat, positive affect, all of which might disrupt “rational” decision making Model does not explain how attitudes, intentions and perceived behavioural control interact Habits and routines - which Simon (1957) referred to as “procedural rationality” - bypass cognitive deliberation and undermine a key assumption of the model Assumes that attitudes, subjective norms and PBC can be measured Relies on self-reported behaviour

Question 32

What is the summary for Theory of planned behaviour?

Answer 32

Rational choice model Attitudes, subjective norms, PBC are the major determinants of intentions TPB can predict intentions for a wide range of health behaviours (smoking, self-examination, abortion, diet, condom use) Takes in to account the importance of social pressures and norms as well as perceived control Useful for predicting people’s intentions but not as successful for actual behaviours – techniques to bridge the gap between intentions and behaviours

Question 33

What is the flow of the transtheoretical model?

Answer 33

Pre- contemplation (Not ready yet Contemplation (Thinking about it) Preparation (Getting ready) Action (Doing it) Maintenance (Sticking with it) Going back is relapse

Question 34

Does the transtheoretical model work?

Answer 34

Most studies and results are inconclusive

Question 35

What are some advantages of the transtheoretical model?

Answer 35

Acknowledges individual stages of readiness (tailored interventions) Accounts for relapse Temporal element (although arbitrary)

Question 36

What are critiques of the transtheoretical model?

Answer 36

Not all people move thorough every stage, some people move backwards and forwards or miss some stages out completely Change might operate on a continuum rather than in discrete stages Doesn’t take in to account values, habits, emotions, culture, social and economic factors People often change their behaviour in the absence of planning/ intentions can change over a very short time period