This is the Chapter 4 of the book Introduction to Health Psychology (Val Morrison_ Paul Bennett) 4th Edition. Which is content for the exam of the component Health Psychology of Module 5 (Health Psychology & Applied Technology) of the University of Twente, in the Netherlands. 

Ch. 4: Health-protective behaviour

Adherence behaviour:

Definition and measurement:

• Compliance: behaviour which conforms with “doctors’ orders”
• Adherence: person sticks to/cooperates with/advice about medication (or lifestyle change) in a more collaborative practitioner-patient relationship --> influenced individual/environmental factors (healthcare practices)
  • 60% of drug needed daily, any less defined as non-adherence
• Concordance: agreement physician/patient as to what appropriate treatment (not describe adherence behaviour, but more the conditions in which to encourage it)

Do people adhere?

• Gather data: combine self-/other- report, with biological measurements/pill counts/electronic monitoring systems
• Adherence rate vary:
  • Treatment complexity (timing medicines/…)
  • Individual beliefs/actual illness severity

Cost of non-adherence:

• Hospital readmission
  • UK --> £200 million per year due t repeat admissions to hospital

Why not adhere:

• Patient-related factors: self-efficacy beliefs
• Condition-related factors: symptom type, perceived severity
• Treatment-related factors: number/type/timing/side-effects
• Socioeconomic factors: access to dispensing pharmacy/social isolation
• System-related factors
• Nonadherence behaviour:
  • Intentional non-adherence: “I stopped taking my pills as they made me feel sick”
  • Unintentional non-adherence: “Sometimes I forget…”
• Influences:
  • Micro level: personality
  • Macro level: cultural/political context
  • Meso level: social institutions

Healthy Diet:

• Low intake fruit/vegetables --> responsible for over 3 million deaths yearly

Fruit/vegetables

• Essentials healthy body: 5 per day
  • Vitamins
  • Folic acid
  • Antioxidants: oxidation of low-density lipoprotein (LDL/bad cholesterol) --> some chemical properties (polyphenols) of substances (red wine) inhibit process of oxidation
  • Fibre
• Meta-analysis: review/re-analysis of pre-existing quantitative datasets, combines analysis to provide large samples/high statistical power to draw reliable conclusions about specific effects
  • Vegetarians lower cancer incidence/lower rates of ischaemic heart disease: restriction of blood flow to heart

Why problem with intake?

Food preferences:

• Biological preferences/social + cultural factors
  • Parents major role patterns eating/food choices/leisure activities/rules & guidelines as to what considered appropriate behaviour
• Food Dudes: pre-/primary-school children UK --> programme draws on learning theory techniques of increased taste exposure to fruit/vegetables
  • Cartoon youth characters reinforcement by means of rewards for fruit/vegetable eating

Exercise:

• Physical inactivity: 4^th leading risk factor for global mortality
• Exercise: health-protective, reduce risk of developing -->
  • Cardiovascular/CHD
  • Type 2 diabetes mellitus
  • Osteoporosis: reduction bone density due to calcium loss
  • Obesity
  • Some forms of cancer --> colorectal/breast cancer

Recommendations:

• Adults [18-64]:
  • At least 30 min moderate intensity exercise on least 5 days week
  • 150 min moderate exercise/75 min high-intensity exercise
• Youth [5-17]:
  • 60 min least moderate to vigorous intensity daily

Physical health & exercise:

• Exercise: balance energy intake/output
  • planned physical activity (swimming)
  • Pursuit one’s daily life (going shopping)
• Regular performance of exercise:
  • Strengthens heart muscles
  • Increases cardiac/respiratory efficiency
  • Reduce blood pressure
  • Reduces body fat

Psychological benefits:

• Elevated mood/reduced anxiety & depression/improved self-esteem & body-image
  • Benefits attributed biological mechanisms:
    • Release body’s own opiates (endorphins) into bloodstream --> natural high, acts as painkiller/reduces stress hormone (cortisol)
    • Release catecholamines (chemical substances, brain neurotransmitters) --> enhanced mood
      • Noradrenaline (norepinephrine): found in brain and in SNS
        • Sympathetic nervous system (SNS): part autonomic nervous system involved mobilising energy to activate/maintain arousal
      • Adrenaline (epinephrine): neurotransmitter/hormone secreted by adrenal medulla --> increases physiological activity in body
• Prosocial behaviour: behaviour acts positively valued by society and elicit positive social consequences
• Affective experiences:
  • Cognitive distraction or actual physical removal form life problems --> means coping with stress
  • Social support from exercise environment
  • Enhanced self-esteem/self-image attributed weight loss and general fitness

Cognitive function:

• May improve some aspects cognitive functioning --> benefits ageing/dementia

Why exercise (or not)?

• Yes:
  • Physical fitness
  • Lose weight/body shape
  • Maintain/enhance health status
  • Improve self-image/mood
  • Stress reduction
  • Social activity
• No:
  • Time
  • Cost
  • Access appropriate facilities/equipment
  • Embarrassment
  • Self-belief
  • Lack social support

Health-screening behaviour:

• Purposes heath-screening:

1. Identification risk factors for illness --> enable behaviour change or surgery
2. Detect early asymptomatic signs disease in order to treat

Screening for risk factors:

• Public health (societal)/individual benefit
  • For cardiovascular risk --> cholesterol/blood pressure assessment and monitoring
  • Eye test -->  diabetes/glaucoma/myopia
  • Prenatal genetic testing
  • Genetic testing for carrier status --> cystic fibrosis or Huntington’s disease gene or breast/ovarian/colon cancer in those with family history

Disease detection:

• Biomedical model: identify abnormalities in cell/organ functioning asap
  • Mammography: breast cancer. X-ray procedure creates image breast --> identify early stages tumours
  • Cervical smear or Pap test: cervical cancer
  • Antenatal screening: down’s syndrome or spina bifida
  • Bone density screening
  • Prostate Specific Antigen (PSA): assess levels/density of protein produced by prostate and released into bloodstream
    • Lack sensitivity: Ratio true positive test to total number of positive cases. PSA fails to detect disease 15% of cases
    • Specificity: ratio true negative test to total number of negative cases. PSA says about 2/3 men with high scores won’t have prostate cancer, but have other conditions that influences PSA

Criteria screening programmes:

• UK National Screening Centre criteria (2005):
  • Health-care costs should be considered
  • Evidence-based info provided participants to enable them informed choice
  • Sub-groups to target should be identified
  • Importance health problem
  • Clear benefit to identifying changeable risk/should be recognisable early
  • Treatment early stage should have clear benefits compared to later treatment
  • Good sensitivity/specificity
  • Acceptable general population
  • Adequate facilities
  • Screening frequency/follow-up

Decision Screening:

• Utility maximisation: Intention seek such test, from perceived pros/cons of such testing
• Ehealth sources: overstating benefits/understating potential risk of screening results --> most people cope screening process/outcome, but for some emotional/behavioural consequences are significant

Self-screening behaviour:

• Breast self-examination (BSE): costs health-care visits --> BSE recommended

Screening behaviour:

• Education/income
• Age
• Knowledge about condition
• Knowledge about purpose screening
• Knowledge potential outcomes of screening
• Embarrassment regarding procedures involved
• Fear outcome
• Fear procedure
• Self-efficacy for self-examination
• --->Implementation intention: focused individualised plan for action

Immunisation behaviour:

• Immunisation behaviour: crucial to public health, yet influenced by cultural/social/emotional/cognitive factors
• Health policy: provide vaccinations/long-lasting protection against specific disease without adverse consequences --> costs vaccination outweighed by cost of dealing disease if no vaccine
  • Antigen: process on surface of pathogen --> enable immune system to recognise pathogen as foreign substance and hence produce antibodies to fight it (vaccinations introduce prepared viruses/bacteria, and these have antigens)
• Human papillomavirus (HPV): present 70-95% cervical cancers. Although small % of HPV infections develop into cancer