Lecture 1: Health Psychology: Being and staying healthy

What is health psychology?

Health psychology is the study of behaviour when it comes to health, illness and healthcare. Health psychology focuses on individual strengths and puts emphasis on prevention and adaption during all phases from health to illness. Questions like How to remain healthy for as long as possible? and How to adapt in the most healthy way? are related to this.

Health psychologists work in health care (private practice, medical psychology department in the hospital, rehabilitation centres, medical centres), research, policy (local or federal government, developmental aid organisations) and primary prevention and training centres (Hersenstichting, KWF, Voorlichtingsbureau Voeding).

How can we prevent unhealthy behaviour?

There are three forms of prevention. Primary prevention is a method to keep people healthy for as long as possible. The target group of this form of prevention is healthy people. Secondary prevention focuses on finding early signs of an illness. This is done by screening and early treatment. The symptoms that may occur are still reversible at this stage. The target group for secondary prevention is (healthy) people with an increased risk of developing a certain condition. Tertiary prevention is based on the prevention of symptoms growing worse and rehabilitation. The people who this type of prevention is aimed at have already developed a certain condition.

What is ‘health’?

There are different opinions on the exact meaning of health. Some people see health as being not ill, which means showing no symptoms and not having to visit a doctor. Others see health as a reserve/resource (quick recover, strong family), behaviour (looking after yourself), physical fitness and vitality, psychological well-being (being in balance, enjoyment, harmony) or as a function (being able to do what you have to do or what you want to do).

According to the WHO, health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Why do we become ill?

According to the biopsychological model there are multiple factors which influence the development of illness. These factors are biology, psychology and social context. These three factors are work together and is shown in an overview on slide 13. Health behaviour (sleep, nutrition, smoking, drinking, gender, disability), stress/emotions (past trauma, behaviour, personality, attitudes/beliefs), social relations (support, conflict, education) are related to these three main factors. These three main factors influence each other continuously. Within health and health psychology there is an body-mind interaction which determines health and illness.

The Alameda Seven Study is a research projected that investigated the seven main health factors for longevity. These factors are:

• Sleep 7 to 8 hours
• No eating between meals
• Eat breakfast regularly
• Maintain proper weight
• Regular exercise
• Moderate or no use of alcohol
• No smoking

According to the biomedical model exposure to contagious agents, like viruses and bacteria, together with an insufficient immune response will increase the chance of developing getting ill. Symptoms can be reduced by medical treatment.

According to Matarazzo there are two types of health behaviour. Behaviour pathogens are health compromising behaviours, like smoking, alcohol and drug use and unsafe sex. Behaviour immunogens are health enhancing behaviours, like eating vegetables and fruit, psychical activity, vaccinations and medication.

The Health Belief Model is a model based on fear and it is used to explain and predict health-related behaviours. According to this model, people’s beliefs about health problems, perceived benefits of action and barriers to action, and self-efficacy explain engagement (or lack of engagement) in health-promoting behaviour. Demographic variables, like age, race, cultural background and education all influence health related factors like perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and health motivation.

Perceived susceptibility is the subjective assessment of risk of developing a health problem. People who are more susceptible of developing health problem X will perform behaviours and actions to reduce their risk of developing it. For example: condom use to reduce the chance of getting unwanted pregnancies or an STD.

Perceived severity is the subjective assessment of the severity of health problem X and its potential consequences. People who perceive health problem X as serious are more likely to engage in behaviours to prevent the health problem from occurring or worsening. For example: condom use to reduce the chance of getting unwanted pregnancies or an STD.

Perceived benefits are the benefits that may occur when engaging in certain behaviour to prevent health problem X from occurring. For example: condom use from protection and not getting unwanted pregnancies or an STD.

Perceived barriers are subjective barriers which occur related to certain behaviour. For example: wanting to use condoms, but feeling awkward buying those.

Cues to action are cues which increase the chance of engaging in a certain behaviour. For example: condom use because you have had an STD before.

An overview of the model is given on slide 34 and 35.

Why should we change behaviour?

It is important to support healthy behaviour. This is because health behaviour is related to mortality and morbidity. In the 1900s the main cause of death were infections, like flue and lung infections, tuberculoses, measles and typhus. Now, in the 2000s, the main cause of death are chronic diseases, like heart diseases, cancer, diabetes and kidney diseases. Another reason why it is important to change behaviour is because socio-demographical differences in health behaviour increase social economic differences, which is partly responsible for life expectancies between groups. A third reason why it is important to change behaviour is because prevalence of risk behaviours is high. Finally, health behaviour is not always an informed choice. People are not always aware of their unhealthy behaviour, like picking unhealthy food in the supermarket because it is placed on the shelves which are well visible, or the size of plates in restaurant which trick your mind in the portions of your food.

What determines behaviour?

There are multiple factors which determine behaviour. These factors are individual factors (skills, reactions to stress), interpersonal/network (social support, communication level), community factors (stigma, peer pressure, heterosexism), institutional/health system factors (privacy, available services, support tools) and structural factors (poverty, access to services, education). These factors are placed in an overview on slide 30.

Theories

The Social Cognition Theory describes how one’s expectations are related to their performed health behaviour and their risk behaviour. Health behaviour has different coping functions, like problem solving, feeling better, avoidance, time out and prevention. According to this theory, there are multiple factors which influence self-efficacy judgements (“I can do this”). These factors are performance accomplishments (e.g. things you have learned from past experiences), vicarious experiments/modelling by others (e.g. seeing that your friends do not play video games as often as you do), social persuasion (e.g. coaching and evaluative feedback, your parents supporting you to engage in certain behaviours) and physiological and emotional states (e.g. when you play video games very often and experience back pains from your sitting position). An overview of this model is given on slide 41.

The Theory of Reasoned Action describes how beliefs, attitudes, perceptions and expectations about behaviour X in a social context can lead to a certain behaviour.

The Theory of Planned Behaviour has an additive part to the theory of reasoned action. According to this model, perceived internal and external control factors may lead to perceived behavioural control, which then lead to behaviour intention and performing that specific behaviour. This model describes that people will change if they believe that:

• They are susceptible to some disease
• Developing the disease will have severe consequences
• Adopting the health (preventive) behaviour will make them less susceptible or will reduce the severity
• The benefits will outweigh the anticipated costs
• They feel capable of doing

According to this model, people will change if:

• Their attitude/outcome expectancies towards behaviour are positive
• Social norms are favourable/supportive of their behaviour
• Their self-efficacy/perceived behavioural control expectancies are high

An overview of these models are given on slide 37 and 42.