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Notes lectures Health and Medical Psychology 2018/2019
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Lecture 1Health psychology: Being and staying healthy
Explaining health behaviour
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.
Lecture 2
Changing health behaviour
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