PSY306 Health psychology Morrison Ch 6

Question 1

What are the benefits of running a theory-based health campaign?

Answer 1

Theory-based campaigns more effective in promoting health-protective behaviour compared to atheoretical campaigns (Noar, 2006; Webb et al., 2010)
Evaluation of advertising measures is easier and more cost effective with theoretically devised approaches due to the clearly measurable constructs (French et al., 2012; Prestwich et al., 2015; Stead et al., 2005)

Question 2

What are some demographic influences on health behaviour? (Demographics and personality)

Answer 2

Social class: those with lower socio-economic status, drink and smoke more, exercise less, and have poorer diets;

Age: Behaviours either positively or negatively associated with health tend to commence in childhood or adolescence;

Gender: Males tend to engage in behaviours that project masculinity e.g., drink more, but paradoxically, also engage in more physical activity to project fitness and strength;

Ethnicity and Religion: For Muslim males, religion exerted stronger influences on their behaviour than the need to look ‘masculine’.

Question 3

How do personality traits influence behaviour? (Demographics and personality)

Answer 3

Neuroticism (N): associated with negative health behaviours, e.g,. neophobia. Conversely, greater health care use
Extroversion (E): associated with increased risk-taking
Openness (O): associated with willingness to try new healthier foods; yet increased risk-taking
Agreeableness (A): associated with less risk-taking
Conscientiousness (C): associated with health-protective behaviour, i.e. reported self-motivations to safe sex

Question 4

What influence does locus of control have on health behaviour? (Demographics and personality)

Answer 4

Internal: individuals as the prime determinant of their health state. Internal beliefs associate with health-protective behaviour and self-efficacy.
External/chance: external forces such as luck, fate or chance determine an individual’s health state, rather than their own behaviour.
Powerful others: health state to be determined by the actions of powerful others such as health and medical professionals.

Question 5

What are the four types of distal factors that help to explain health behaviour?

Answer 5

Demographics and personality
Self determination theory
Social influences
Goals and self-regulation

Question 6

Self-determination theory. What conditions lead to self determination/internalisation?

Answer 6

The behaviour needs to feel as though it is helping to fulfil the three psychological needs:

• Feelings of belongingness and relatedness to others in engaging in the behaviour.
• Feeling as though one is competent in engaging in the behaviour.
• Autonomy is supported through encouragement, provision of choice, minimal pressure.

Question 7

What has been found to undermine autonomous motivation? (Self-determination theory)

Answer 7

Monetary rewards

Question 8

How do social influences impact on health behaviour?

Answer 8

• Humans are fundamentally social
• We learn how to behave from positive and negative social experiences, and observation of others’ behaviour and expectancies
• Social norms have a powerful effect on many behaviours; Teenage smoking initiation; University/college alcohol
• Broader social influences; Televised and social media advertisements; Depictions on TV and in movies

Question 9

Social cognition theory assumes that behaviour is motivated by…

Answer 9

…outcome expectancies and short- and long-term goals. Goals:
-focus our attention;
-directs our efforts;
-encourage persistence even when faced with set-backs.
Self-regulatory processes (cognitive, emotional and behavioural) help us achieve our goals.

Question 10

What do theories of health behaviour offer?

Answer 10

Partial explanation which can guide the content of interventions.

Question 11

Within the sociocognitive models of health behaviour what are the three components of Attitudes (that are relatively enduring and generalisable)?

Answer 11

Cognitive: thoughts and beliefs about the attitude-object – e.g., cigarette smoking is a good way to relieve stress; cigarette smoking is a sign of weakness.
Emotional: feelings towards the attitude-object – e.g., cigarette smoking is disgusting/pleasurable.
Behavioural (or intentional): intended action towards the attitude-object – e.g. I am not going to smoke.

Question 12

What are the four factors identified by Weinstein (1987) associated with unrealistic optimism? (sociocognitive model)

Answer 12

• a lack of personal experience with the behaviour or problem;
• a belief that their individual actions can prevent the problem;
• the belief that if the problem is unlikely to emerge if it hasn’t done so already; e.g. ‘I have smoked for years and my health is fine, so why would it change now?’;
• the belief that the problem is rare; e.g., ‘Cancer is rare compared to smoking, so it is pretty unlikely I’ll develop it’.

Question 13

Define self-efficacy.

Answer 13

Bandura (1986)
“beliefs about whether one can produce certain actions”
e.g. Believing that a future action is within your capabilities is likely to generate other cognitive and emotional activity, such as setting high personal goals, positive outcome expectancies and reduced anxiety about future.

Question 14

Explain social cognitive theory

Answer 14

Behaviour is determined by three types of individual expectancies:

• Situation-outcomes expectancies:whereby a person connects a situation to an outcome; for example, smoking to heart attack.
• Outcome expectancies:for example, believing that stopping smoking would reduce the risk of heart attack.
• Self-efficacy beliefs:for example, the extent to which the person believes they can stop smoking.

Question 15

apply the health belief model to a health outcome.

Answer 15

Perception of threat:
I believe that coronary heart disease is a serious illness contributed to being overweight: perceived severity.
I believe that I am overweight: perceived susceptibility.
Behavioural evaluation:
If I lose weight, my health will improve: perceived benefits (of change).
Changing my cooking and dietary habits when I also have a family to feed will be difficult, and possibly more expensive: perceived barriers (to change).
Cues to action (added in 1975, Becker and Maiman):
That recent TV programme on the health risks of obesity worried me (external).
I regularly feel breathless on exertion, maybe I should lose some weight (internal).
Health motivation (added in 1977, Becker et al.):
It is important to me to maintain my health.

Question 16

What are some applications of the health belief model?

Answer 16

Dental behaviours
Breast self examination
Diet and exercise
Smoking and alcohol behaviours
Vaccination
Contraception use (mixed findings)

Question 17

What are some limitations of the Health belief model?

Answer 17

-Older studies did not include cues to action and health motivation
-Interactions between constructs not specified
-Predictor variables only correlate weakly with -behaviour - may be better predictive of intentions
-More relevant in predicting initiation of health-protective behaviour
-Overestimates the role of threat and risk perceptions
-Promotes use of counterproductive fear arousal
-No standard method of measuring or scoring key components
-Incomplete explanation of health behaviours
Self-efficacy, context, mood and negative affect

Question 18

Theory of planned behaviour assumes that…

Answer 18

• Individuals behave in a goal-directed manner;

- The implications of actions (outcome expectancies) are weighed up in a rational manner.

Question 19

The TPB aims to explore and develop the psychological processes involved in making a link between attitude and behaviour, by including…

Answer 19

• social influences on behaviour;
• beliefs in perceived behavioural control;
• and the necessity of intention formation.

Question 20

What are the limitations to TPB?

Answer 20

• Does not acknowledge the potential bi-directional transaction between predictors and outcomes.
• TPB consistently predicts behavioural intention better than behaviour (Intention-behaviour gap).
• Meta-analysis of experimental studies revealed that medium sized changes in intention result in trivial changes in behaviour (Rhodes & Dickau, 2012).
• Majority of studies focus on initiation of behaviour rather than maintenance.
• Does not account for automatic and habitual actions.

Question 21

What are some potential additions for the TPB gaps?

Answer 21

Past behaviour – likely the best predictor of behavior; does not tell us why a behaviour occurs; can develop into a habit; not fully mediated by TPB variables.

Habits and automaticity – Meta-analytic correlation of r = 0.44 between habit and behaviour (Gardner et al., 2011)

‘Moral norms’ – it has been recognised that some intentions and behaviours may be partially motivated by moral norms, not just social norms (e.g., drink driving; Evans and Norman 2002)

Anticipatory regret – anticipating that regret will result if a certain behavioural decision is made/not made which influences both future behavioural intentions and behaviour (e.g., not using a condom; Richard et al., 1996)

Self-identity – how one perceives and labels oneself may influence intention above and beyond the effect of core TPB variables (e.g. self as being ‘green’ and subsequent dietary change; Sparks and Shepherd, 1992)

Planning and Implementation intention (II) – forming an II is thought to be part of the process involved in turning an intention into action

Question 22

According to Weinstein what are the four properties of stage theory?

Answer 22

A classification system to define stages:
Stage classifications are theoretical constructs and although a prototype is defined for each stage, few people will perfectly match this ideal.

Ordering of stages:
People must pass through all the stages to reach the end point of action or maintenance, but progression to the endpoint is neither inevitable nor irreversible.

Common barriers to change facing people within the same stage:
This idea would be helpful in encouraging progression through the stages.

Different barriers to change facing people in different stages:
If the factors producing movement to the next stage were the same, regardless of the stage (e.g., self-efficacy), the same intervention could be used for all, and the stages would be redundant.

Question 23

What are 7 stages in the transtheoretical model?

Answer 23

Pre-contemplation: no current thoughts of dieting, no intention of changing diet within next 6 months, may not consider that they have a weight problem.

Contemplation: e.g. ‘I think I need to lose a bit of weight, but not quite yet’ reflects awareness and consideration to do so. Generally plan to change within next 6 months.

Preparation: ready to change and set goals such as planning a start date for diet (within 3 months); includes thoughts and action, by specific plans for change.

Action: e.g., person starts eating fruit instead of biscuits – overt behaviour change.
Maintenance: keeps up with the dietary change, resists temptation.

The above stages are the 5 most commonly referred to, there are also other stages:
Termination: behaviour change has maintained for adequate time and feels no temptation to lapse, believe in their total self-efficacy to maintain the change.

Relapse: di Clemente and Velicer (1997) acknowledged that relapse (where a person lapses into their former behaviour pattern and returns to a previous stage) is common and can occur at any stage.

Question 24

What are the targets of intervention using the TTM?

Answer 24

Pre-contemplation stage: individuals are likely to use denial, report lower self-efficacy (to change) and more barriers to change.
Contemplation stage: likely to seek information; report reduced barriers to change and increased benefits; yet still underestimate their susceptibility to the health threat concerned.
Preparation stage: start goal-setting, making concrete plans (see also implementation intentions) and small behaviour changes (i.e., joining a gym). Some may set unrealistic goals or underestimate their own ability. Motivation and self-efficacy are crucial if action is to be elicited.
Action stage: realistic goal setting is crucial. Social support provides reinforcement for changed behaviour and to maintain lifestyle change.

Question 25

What are some applications of the TTM?

Answer 25

Smoking
Drinking
Drug use
Exercise
Healthy eating
Condom use
Sun protection
Mammography screening

Question 26

What are some limitations of the TTM?

Answer 26

• The theory ignores the social context in which change occurs, such as SES and income
• The lines between the stages can be arbitrary with no set criteria of how to determine a person’s stage of change
• The questionnaires that have been developed to assign a person to a stage of change are not always standardized or validated
• There is no clear sense for how much time is needed for each stage, or how long a person can remain in a stage
• The model assumes that individuals make coherent and logical plans in their decision-making process when this is not always true
• Several reviews on the effectiveness of stage-based interventions have found limited evidence for behaviour change or for facilitating stage progression (Bridle et al., 2005; Riemsma et al., 2003; van Sluijs, van Poppel, & van Mechelen, 2004)

Question 27

What are the stages of the precaution adoption Process model?

Answer 27

Stage 1: ‘unaware’ of the threat to health posed by a certain behaviour; person has no knowledge and therefore is not aware of a risk.
Stage 2: ‘unengaged’; here a person has become aware of the risks attached to a certain behaviour, but doesn’t believe the self is at risk – unrealistic optimism.
Stage 3: ‘consideration’ (akin to pre-contemplation); individuals are deciding about acting on something they have considered.
Stage 4: ‘decide not to act’; this stage is important as it acknowledges that although perceived threat and susceptibility may be high, some people may actively decide not to act. This is very different from intending to act, but then not doing so.
Stage 5: ‘decide to act’ (similar to intention/preparation); important differences between people with a definite stance who have decided to act and those who are undecided (Stage 3). A motivational stage.
Stage 6: The action stage when a person has initiated what is necessary to reduce their risk, i.e. it is volitional stage.
Stage 7: This final stage is not always required. This stage is about maintenance, and unlike that with smoking cessation, some health behaviour processes are not long-lasting (e.g. deciding to be vaccinated).

Question 28

Explain the health action process approach (HAPA).

Answer 28

The HAPA attempts to fill the ‘intention–behaviour gap’ by highlighting the role of self-efficacy and action plans.
It suggests that the adoption, initiation and maintenance of health behaviours must be explicitly viewed as a process that consists of at least a pre-intentional motivation phase and a post-intentional volition phase.
The HAPA highlights the role of stage-specific self-efficacy beliefs, i.e.,
pre-action self-efficacy;
Initiative self-efficacy;
coping (or maintenance) self-efficacy;
recovery self-efficacy.

Question 29

What are some limitations of the HAPA?

Answer 29

• Similar to previously discussed models
• Little attention on automatic processes
• More work is needed to better understand volition-action processes

Question 30

What is the difference between health behaviours and health habits?

Answer 30

Health Behaviours - Include health-protective and health-risk behaviours
Health Habits - Are firmly established and automatically performed health behaviours

Question 31

Explain reflective-impulsive model

Answer 31

• Strack and Deutsch (2004) – a dual-systems theory.
• Behaviour is a joint task of reflective (explicit, deliberative) and impulsive (implicit, automatic) systems/processes.
• The systems operate in parallel, competing for control of overt responses.

Question 32

What is the difference between reflective system and impulsive system?

Answer 32

Reflective system executes behaviour through an explicit, deliberative decision-making process. Knowledge, values and intentions are considered. Uses high cognitive volume: distraction and extreme arousal can cause system to disengage – Influence on behaviour mediated by intention

Impulsive system operates outside of conscious awareness, requires little cognitive capacity, and is always engaged, controlling behaviour in suboptimal conditions. – Direct influence on behaviour

Question 33

What are the goals of theoretical integration?

Answer 33

• Reduce complexity, eliminate redundancy

- Explain more variance in health behaviour and underlying processes involved

Question 34

Describe integrated behaviour change model.

Answer 34

Combines:
Intentional and motivational processes (i.e., autonomous motivation, TPB)
Dual-phase volitional processes (i.e., action planning)
Dual-systems implicit processes (i.e. implicit attitudes and motivation)

Question 35

What are the advantages of Integrated behaviour change model?

Answer 35

• Utilises motives supported by SDT and TPB
• Aims to reduce intention-behaviour gap
• Acknowledges potential for automatic processing of behaviour

Question 36

What are some applications of the integrated behaviour change model in predicting health behaviour?

Answer 36

Physical activity 
Pre-drinking
Condom use in Sub-Saharan Africa 
Heavy episodic drinking 
Child sun safety 
Sugar consumption 
Social distancing