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Health Psychology Flashcards

1
Q

Lecture 1: Health Psychology
Learning Intentions

A
  • Review of course content
  • Defining health psychology
  • Applications of health psychology
  • Models in health psychology

After todays lecture you should be able to:
- Explain what health psychology is
- Discuss the type of work undertaken by Health Psychologists
- Describe three models in health psychology

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2
Q

What is Health Psychology?

A

Health psychologists specialise in understanding the connection between
physical, psychological and social health.
Health psychologists work to promote positive health behaviours and
reduce harmful health behaviours.
Health psychologists work with other health professionals and advise on
attitudes, beliefs and behaviours that contribute to ill health, and how they
might be changed.

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3
Q

What do Health Psychologists do?

A

Health psychologists have expertise in developing education and
behaviour change programs to help people to recover from, and/or to
self-manage acute and/or chronic illness, trauma, injury or disability
Health psychologists design and evaluate interventions to improve
communication and relationships between multidisciplinary health
professionals, the functioning of health systems
Health psychologists may work one-on-one, in groups, systems,
communities or populations

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4
Q

Health Psychology Areas of
Practice

A
  1. Health Promotion - Concerned with illness prevention and
    promotion of health.
  2. Clinical Health Psychology - Applying psychology to illness diagnosis,
    adjustment, treatment, and rehabilitation.
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5
Q

Defining Health Promotion

A

In the Ottawa Charter (1986), the WHO stated:
“Health promotion is the process of enabling people to increase control
over, and to improve, their health. To reach a state of complete physical,
mental and social well-being, an individual or group must be able to
identify and to realize aspirations, to satisfy needs, and to change or
cope with the environment. Health is, therefore, seen as a resource for
everyday life, not the objective of living. Health is a positive concept
emphasizing social and personal resources, as well as physical capacities.
Therefore, health promotion is not just the responsibility of the health
sector, but goes beyond healthy life-styles to well-being.”

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6
Q

Health Promotion Aims

A

Aims to:
* Promote positive health behaviours and reduce harmful health
behaviours
* Reduce risk factors associated with chronic conditions
* Identify and address attitudes, beliefs and behaviours that contribute
to ill health

  • Design behaviour change-related public
    health programs
  • Gather data about disease and ill-health and
    identify health behaviours and modifiable
    determinants of health and wellbeing
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7
Q

What are Common Health
Promotion Campaigns?

A
  • smoking
  • physical activity
  • diet
  • alcohol
  • R U OK
  • White Ribbon
  • Cancer Screening
  • Drink Driving
  • Drug Driving
  • B Part of It
  • Covid-19
  • Blood Donation
  • Sunsmart - Slip, Slop, Slap, Seek, Slide.
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8
Q

Clinical Health Psychology

A

Aims to:
* Design education and behaviour change interventions to improve
health for people with health conditions
* Assist with psychosocial issues that can contribute to or accompany
health conditions
* Assist people to cope with diagnoses and medical treatment
* Assist people to cope with terminal illness

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9
Q

Biopsychosocial Model

A

Biological
Age, Sex, Genetics,
Physiological Reactions

Sociological
Interpersonal
Relationships, Social
Support, SES

Psychological
Beliefs and
Expectations, Mental
Health

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10
Q

Biopsychosocial Model
Interactive and bi-directional influences amongst 3 dimensions

A
  • Biological-physiological - genetics, biochemistry, immunology
  • Psychological-behavioural - thoughts, beliefs, expectations, habits
  • Social-environmental - family and cultural context, financial stability,
    SES, access to health care, environmental stressors
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11
Q

Behaviour Change with regard to addiction and health barriers

A

Behavioural approach: the easy option?
◦ Think of a health behaviour you tried to change
recently
◦ Barriers?
◦ If behaviour change was achieved, for how long
was it maintained?

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12
Q

Health Beliefs

A

The “social cognitive” models seen in health psychology in recent years
aim to predict health-related behaviours such as:
◦ health behaviours
◦ self-care
◦ adherence
◦ health service use
from reported cognitions such as beliefs, expectations, health-related
locus of control or self-efficacy, and intentions.

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13
Q

Health Belief Model (Becker, 1974, 1988; Janz & Becker, 1984).

A

(diagram on page 28: Lecture 1)

Applications
◦ Genetic screening, cancer screening, smoking,
diet, exercise, adherence to diabetic regimens
and many more
◦ Quantitative reviews described in Conner &
Norman
◦ Barriers most reliable predictor of behaviour
followed by susceptibility and benefits, and
finally severity
◦ Effect sizes are small

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14
Q

Health Belief Model Limitations

A

◦ Interaction between variables not specified
◦ Static model (not staged or dynamic process)
◦ Little account of social influences
◦ May overemphasise threat

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15
Q

Information Motivation Behavioral
Skills (IMB) Model

A

(diagram on page 31 lecture 1) HEALTH BEHAVIOUR
INFORMATION
* Myths/Misinformation
* Accurate Information

HEALTH BEHAVIOUR
MOTIVATION
* Personal motivation
* Social Motivation

HEALTH BEHAVIOUR
SKILLS
* Objective Capacity
* Self-efficacy

HEALTH BEHAVIOUR
* Diet
* Physical Activity

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16
Q

Cardiac Psychology: Overview and Outcomes

A
  • Cardiovascular disease and coronary heart disease (CHD)
  • Health behaviours: Development and progression of CHD
  • Psychology and cardiac events
  • Cardiac rehabilitation

Outcomes:
Describe coronary heart disease and explain cultural variability in coronary heart disease

Summarise the role of health behaviours and psychological factors in the development and progression of coronary heart diseases

Compare and contrast different forms of cardiac rehabilitation

Explain the role of psychology is assisting people after a cardiac event

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17
Q

Cardiovascular Diseases

A
  • General heading - Several diseases that result from problems with the
    heart and the circulatory system
  • Most common:
    o Coronary Heart Disease
    o Heart Failure
    o Stroke
    o Hypertension
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18
Q

Coronary Heart Disease: Arteriosclerosis

A
  • Arteriosclerosis- any hardening of
    the arteries, making them more
    susceptible to blockages
  • Atherosclerosis – buildup of plaque
    fat in and on artery walls that can
    cause arteries to narrow, blocking
    blood flow. The plaque can also burst,
    leading to a blood clot.

(diagram on page 6: Lecture 2)

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19
Q

Heart Disease: The Australian Figures

A
  • In 2017-2018 – 1.2 million adults (6.2%) had 1 or > conditions related to
    heart, stroke or vascular disease
  • CVD – Leading cause of death: 42,300 deaths (25%) in 2019
  • Stroke – 38,600 events (100 per day) in 2018
  • Heart attack or (angina) - 58,700 (161 per day) in 2018
    *In 2019, 11.8 billion for CVD, with 2.4 billon for CHD
  • 2017-2018 - An estimated 580,000 Australians aged 18+ (3.1% of the
    adult population) had CHD at some time
  • 430,000 had a heart attack or other CHD
  • In 2018, 65% of acute coronary events occurred in males
  • CHD and acute coronary events are more common with increasing age
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20
Q

Heart Disease: The Australian Figures - Indigenous

A
  • In 2018-2019 - CHD among Aboriginal and Torres Strait Islander adults
    was more than double that of non-Indigenous adults (7.4% vs 2.7%)
  • Sex
    o First Nations men - 2.5 times as likely as men who are not First Nations
    people (9.1% vs 3.6%)
    o First Nations women - 3.3 times as likely as women who are not First Nations
    people (5.9% vs 1.8%)
  • In 2017–18, CHD was higher among people in the most
    socioeconomically disadvantaged areas
  • Rates were significantly higher for men than women across most
    socioeconomic groups
21
Q

Risks Factors for CHD

A
  • Physiological
    o Age
    o Sex
    o Race/ethnicity
    o Family history
    o Hypertension
    o Diabetes
    o High cholesterol
    o Overweight and obesity
  • Psychological risk factors
    o Stress
    o Depression
    o Hostility/anger
    o Social support
    o Discrimination
  • Health behaviours
    o Tobacco
    o Diet
    o Physical activity
22
Q

Myocardial Infarction

A
  • Chest pain – aching, squeezing,
    pressure, tightness, pain, numbess
  • Pain/discomfort – can spread to arms,
    neck, jaw or back.
  • Lightheadedness or sudden dizziness
  • Sweating or cold sweat
  • Heartburn or indigestion
  • Nausea or vomiting
  • Difficulty breathing/shortness of
    breath
  • Fatigue
23
Q

Recovery from Heart Attack

A
  • Psychological factors
    o Depression
    o Social Support
  • Health behaviours
    o Tobacco
    o Diet
    o Physical activity
24
Q

Cardiac Rehabilitation

A

Form of secondary prevention
* Designed to improve physical and psychological health

  • Benefits:
    o Reduces one-year hospital readmission rates by 31%
    o Reduces CVD mortality by 26%
    o Reduces 5-year all-cause mortality by up to 34%
    o Improved quality of life

Best mortality and morbidity benefits after heart attack and CABG

  • Types
    o Outpatient
    o Home
    o Technology-assisted
  • Content
    o Risk factor management
    o Health and nutrition education
    o Physical activity
    o Psychological support
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Cardiac Rehabilitation is Under-utilised
o 50–70% of people eligible do not attend o Among those who attend, 30–60% do not complete * Attendance is important - people who attend more sessions have lower mortality than those who attend less sessions * This mortality benefit can be up to 1% per session attended
26
Cardiac Rehabilitation Barriers
Medical Professional Barriers * Low referral rates * Health professional endorsement System Barriers * Distance and Transport * Cost Patient Barriers * Gender and race/ethnicity * Medical comorbidities * SES * Psychological factors * Identity and the self * Negative views and reactions to health services * Views and reactions to heart disease * Lack of family support
27
Cardiac Rehabilitation: The Importance of Sex
* Females are less often referred – 39% vs 49% * After being referred, females are less likely to: o enrol o attend * Reasons for under-utilisation o Lack of awareness o Transport barriers o Family obligations o More co-morbidities o Preferences o Culture
28
Women-Focused Cardiac Rehabilitation
* Tailored - for women - physical activity and education * # of Sessions: 4-56 (median 24) * Physical activity o Aerobic exercise o Resistance exercise o Alternate exercise * Psychosocial components * Barriers o Knowledge o Referral o Frequency * Average enrolment - 93.7% vs 87.2% * Adherence – similar or better than traditional cardiac rehabilitation * Completion - average 83.9% vs 76.9%
29
Health Anxiety and Heart Rhythm Issues
Anxiety as a Trigger for Arrhythmias Vicious Cycle of Health Anxiety/ Misinterpretation of Physical Symptoms: Constant worry about heart health can lead to avoidance Impact on Quality of Life
30
Cardiac Distress: Psychological and Emotional Strain on the Heart
Cardiac Distress impacts Recovery and Health Cardiac distress can worsen outcomes in individuals with heart conditions, delaying recovery and increasing the risk of further heart issues. Measuring Cardiac Distress using Cardiac Distress Inventory (CDI) and short form of CDI Mind-heart-body Connection
31
Lecture 3: Behaviour Change and Interviewing - Overview and Outcomes
Overview * Behaviour change interventions * Behaviour change techniques and their relevance to cardiac rehabilitation * Basic interviewing skills Outcomes - Explain the importance of behaviour change techniques to behavioural interventions - Describe the behaviour change taxonomy - Describe basic interviewing skills - Compare the most commonly used behaviour changes techniques in community-based and home-based cardiac rehabilitation
32
Health Psychology: Behaviour Change
* Behaviour change is a key aspect of health psychology o Encourage positive health behaviours o Discourage or minimise harmful health behaviours * Behaviour change interventions are complex * Essential to: o Be able to identify the active components o Implement and replicate the intervention o Evaluate and gather evidence
33
Behaviour Change Interventions
* Interventions must be well-described before evaluation * Publications * Protocols *The issue of labels o Different labels for the same BCT - “self-monitoring” and “daily diaries” o Same label for different techniques - “behavioral counseling”, “educating patients” , “feedback, self-monitoring, and reinforcement” o Researchers/reviewers develop their own definitions and classification systems
34
Behaviour Change Techniques
* BCT defined: “An observable, replicable, and irreducible component of an intervention designed to alter or redirect causal processes that regulate behavior; that is, a technique is proposed to be an “active ingredient” (e.g., feedback, self-monitoring, and reinforcement)” (Michie et al., 2013, p. 82) BCTs can be used in isolation or combination
35
* Abraham and Michie set out to develop a Behaviour Change Taxonomy
* 5 Benefits: o Promote accurate replication of interventions o Facilitate faithful implementation of effective interventions o Systematic reviews can better gather information o A comprehensive list of BCTs to consider when developing interventions o Enable exploration of possible mechanisms of action * Initially identified 22 BCTs, later 96 BCTs within16 clusters
36
Behaviour Change Techniques
* Goals and planning * Feedback and monitoring * Social support * Shaping knowledge * Natural consequences * Comparison of behaviour * Associations * Repetition and substitution * Comparison of outcomes * Reward and threat * Regulation * Antecedents * Identity * Scheduled consequences * Self-belief * Covert learning
37
Behaviour Change Techniques and COVID
Cluster & Example Techniques Goals and Planning * Goal setting * Problem solving * Action planning Feedback and Monitoring * Monitoring of behaviour by others * Self-monitoring * Feedback Social Support * Practical * Emotional Shaping Knowledge * Information about antecedents * Instructions about how to perform a behaviour * Behavioural experiments Natural Consequences * Information about health consequences * Salience of consequences * Information about social and emotional consequences Comparison of Behaviour * Demonstration of the behaviour * Social comparison Associations * Prompts/cues * Reduce prompts/cues Repetition and Substitution * Behavioural rehearsal * Behaviour substitution * Habit formation Comparison of Outcomes * Credible Source * Pros and cons Reward and Threat * Material incentives or rewards * Social-incentives or reward Regulation * Regulating emotions Antecedents * Restructuring the physical environment * Restructuring the social environment * Distraction Identity * Identifying self as a role-model * Identity with changed behaviour Scheduled Consequences * Punishment * Reward alternative or incompatible behaviour * Rewarding completion Self-belief * Self-talk * Mental rehearsal * Focusing on past suceess Covert Learning * Imaginary reward * Imaginary punishment
38
Behaviour Change Techniques and Cardiac Rehabilitation
* Cardiac rehabilitation is often not standardised * The BCTs used in effective cardiac rehabilitation are unclear * McAuliffe et al. (2021) analysed 10 sessions of a community-based cardiac rehabilitation program to identify BCTs and patient and facilitator perceptions of the BCTs. * Mixed methods – coding and focus groups Most frequently used BCTs o Credible source (Comparison of Outcomes) o Information about health consequences (Shaping Knowledge) o Instruction on how to perform a behaviour (Shaping Knowledge) o Problem Solving (Goals and Planning) o Behavioural practice – rehearsal (Repetition & Substitution) o Self-monitoring of behaviour (Feedback and Monitoring) Other BCTs o Biofeedback (Feedback and Monitoring) o Graded tasks (Repetition & Substitution) o Generalisation of a target behaviour (Repetition & Substitution) o Demonstration of the behaviour (Comparison of Behaviour) o Behavioural substitution (Repetition & Substitution) o Action planning (Goals and Planning) o Verbal persuasion about capability (Self-belief) o Goal setting (behaviour) (Goals and Planning) o Pharmacological support (Regulation)
39
Behaviour Change Techniques and Participant Views
* Social support (emotional and practical) seen to influence behaviour change * Facilitators used problem-solving, goal setting, motivation, and encouragement to overcome individual patient barriers * Improving knowledge positively influenced behaviour change * Facilitator is key – in motivating, demonstrating skills, and managing emotions * Self-acceptance and acceptance of the diagnosis
40
Behaviour Change Techniques and HOME BASED Cardiac Rehabilitation
* Heron et al. (2016) in a meta-analysis of studies from 2005-2015, analysed BCTs in home-based cardiac rehabilitation * Most commonly used BCTS: o Social support o Goal setting o Monitoring o Instruction on how to perform a behaviour o Credible source
41
Basic Interviewing Skills
* Types of interview: o Fully-structured o Semi—structured o Unstructured
42
Open Questions
Invite others to ‘tell their story’ in their own words without leading them in a specific direction Use often, but not exclusively Listen to the answer!!
43
Examples
How can I help you with ___? Help me understand ___? How would you like things to be different? What are the good things about ___ and what are the less good things about it? When would you be most likely to___? What do you think you will lose if you give up ___? What have you tried before to make a change? What do you want to do next?
44
Reflective Listening
Process for engagement, building trust and fostering motivation to change Important to think reflectively Express interest and respect
45
Techniques and Examples
Voice goes down, which leads to clarification and greater exploration (compared with asking questions, which can interrupt client flow) It sounds like you… You’re wondering if… So you feel….. I’m hearing you say… One the one hand you…. And on the other hand you… Your worried that your X (behaviour) may be a life and death matter for you
46
TECHNIQUES
Repeating or rephrasing: Listener repeats or substitutes synonyms or phrases, and stays close to what the speaker has said Paraphrasing: Listener makes a restatement in which the speaker’s meaning is inferred Reflection of feeling: Listener emphasizes emotional aspects of communication through feeling statements. This is the deepest form of listening
47
LECTURE 4: Applying the Information Motivation Behavioural Skills Model in Cardiac Psychology and Behavioural Rehearsal - Overview and Outcome
Overview: Apply the IMB Model to cardiac psychology * Consider the information needed to inform an intervention plan * Behavioural rehearsal of basic interviewing skills Outcomes: Apply the IMB model to a clinical scenario – cardiac psychology Identify and explain the information you would want to gather for each element of the model Utilise behavioural rehearsal to practice basic interviewing skills for a client interview
48

Foundations of Health + Lifespan (5 decks)

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