Health Psychology

Question 1

Describe the links between attitudes and health-related behaviour

Answer 1

Attitude affects behaviour

A central component of many models of behaviour​

Attitudes can predict behaviour.
- There is usually congruence between attitudes and behaviour​

Cognitive dissonance:
- Mismatch between attitude and behaviour
- We are motivated to remove by changing behaviour or changing attitudes

• Attitudes reflect what we think about something
• How we feel about it
• What we plan to do about it

Changing attitudes is often an important part of health promotion interventions (at individual and population level)

If we want to change behaviour via attitudes, our messages must be persuasive …

Question 2

Identify the characteristics of persuasive messages and persuasive messengers

Answer 2

Population Level Messaging

• Minimise ‘I’ and emphasise the ‘we’
• Deliver messages from a trusted credible source in relatable terms to the target audience
• Create worry but not fear
• Identify what influences each preventative behaviour and ensure policies, messaging and interventions target all relevant behaviours
• Clearly specify behaviours and the related outcomes
• Avoid unintentional negative consequences

Persuasive attitude-change message

Stay Home - Behaviour

Protect the NHS - Reason of behaviour

Save lives - Outcome of behaviour

Fear Appeals

• A certain amount of fear may motivate people
• Meta-analysis showed a positive effect of fear appeals on attitudes, intentions, and behaviours.
• Fear messages impact when:
  1. They also convey how they can perform the recommended behaviour
  2. Recommend for one-time behaviours
  3. Gender effect: Fear appeals are more effective for women because women tend to be more “prevention-focused” than men

but it can be counterproductive if

• people lack the knowledge, skills and confidence needed to change their behaviour
• the message generates too much fear -> people cope by ignoring the message or criticising the message

Individual Approaches

1. Information about antecedents that reliably predict behaviour
2. Information about health consequences (Fear appeals)
3. Salience of health consequences
4. Information about emotional consequences
5. Pros and cons
6. Comparative imaging of futures
7. Framing/reframing
8. Incompatible beliefs (Cognitive dissonance)

Question 3

Discuss how self-image and self-esteem affect health-related behaviour

Answer 3

Self-esteem = feelings and evaluations about ourselves

Favourable social comparisons are one way to boost self-image and self-esteem:
- downward comparisons with people whose situations are worse than our own
- upward comparisons to highlight similarities between ourselves and people we consider superior

It is important for self-esteem to affirm positive aspects of ourselves when we are criticised

Question 4

Discuss the concepts of attribution for behaviour and health, including the fundamental attribution error

Answer 4

Efforts to maintain a positive self-image are influenced by the attributions we give for ours and others’ behaviour

Health locus of control: how an individual perceives cause of illness.
- internal attributions/locus of control: voluntary and reflects the person’s attitudes and beliefs.
- external attributions/locus of control: external factors responsible eg luck

Risk of biased attributions:
- internal attributions for our successes
- external attributions for our failures

Fundamental Attribution Error

We tend to attribute others’ situations to internal/ dispositional causes rather than external/situational causes
e.g., more likely to attribute being unemployed, unhealthy, or depressed, to their individual behaviour/ characteristics rather than to external social factors

Attribution errors can affect clinical care through their impact on doctor-patient relationship.

We must ensure that we consider external and situational factors in attempts to understand and explain illness.

Question 5

Outline why stereotypes are relevant in medicine

Answer 5

Stereotypes are generalisations e.g. nationality, occupation, religion
- they are “rules of thumb” which may be correct, but can often be erroneous
- often used as the basis of jokes

Prejudice toward particular social groups is commonly based on inaccurate stereotypes of group members
- prejudice = judging before having relevant facts

History is replete with clashes between groups based on erroneous stereotypes and prejudice

Impact on Medical Care

Implicit biases are automatic and unintentional associations

Health professionals are influenced in their clinical judgment and decision making by implicit biases.

Biases are likely to influence diagnosis, treatment decisions and levels of care

Complex relationship: multiple patient characteristics that can interact with healthcare professional characteristics

Question 6

Describe what is meant by the term “social roles”

Answer 6

A social role defines the expectations of how
someone is supposed to behave:

• Dynamic nature
• Temporary or fixed?
• Happens when interaction occurs and we enter relationships with others
• Playing roles
• Multiple roles
• Importance of context/culture

Question 7

Describe different types of roles (e.g., ascribed/acquired), rights and obligations associated with roles

Answer 7

Social roles can be:
- ascribed (e.g., daughter)
- acquired (e.g. doctor) voluntarily assumed

Confer rights and responsibilities (obligations)

Awareness of roles shapes social expectations

Competent role performance requires “actors” who recognise role rights and responsibilities (e.g., patients and doctors)

Role of power

The role of doctor

• Doctor’s obligations to patients
• Evolving role
• Patient satisfaction affect adherence to medical advice
• Doctor’s rights and obligations override many everyday social rules

Delegation of power, doctor-patient partnership with expert patients.

Question 8

Discuss the consequences of role stress/conflict/loss

Answer 8

Obligations attached to different roles may conflict

Competing demands = role conflict = potential stress

Stress is a response to a situation and results in physiological, cognitive, emotional and behavioural responses

_Strain and stress in managing roles

• Role sets e.g. doctor + patient
• Psychological stress: “a relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being”

Stress can arise from:

• unrealistic expectations
• conflicting expectations
• ambiguous expectations
• inter-group conflict

Role Loss

• Important social roles become central to identity
• Role-related goals, plans, social relationships and reputation provide a meaningful and valued sense of self
• If meaningful alternative social roles cannot be established, life may be experienced as empty or meaningless
• loss of sense of self and social isolation
• depression

Question 9

Describe key features of the “sick role” and “carer roles”

Answer 9

A specific social role (Parsons, 1975)

• Person is not responsible for assuming the sick role
• the right to relinquish other roles and responsibilities
• the obligation to strive to recover - sickness as temporary
• doctors are gatekeepers of the sick role
• secondary gains may make the sick role attractive

criticism

• Long-term conditions
• Living as normal a life as possible
• Self-management
• Patients as experts
• Patient’s own goals to what they want to achieve in life
• Doctor-patient partnerships
• Move away from paternalism; doctor telling you what to do

The (informal) carer role

Unpaid care provided to older and dependent persons by a person with whom they have a social relationship
- Common
- Typically short in duration compared to other roles
- Typically female (relative)