Lectures Health and Medical Psychology
Lecture 1 – Explaining Health Behavior
What is health and medical psychology?
It consists of promoting health behavior, but also help GPs in how to guide and discuss issues
with their patients, and help people in the endocrinology (diabetes) department, to engage in
health behaviors help patients to engage in health behaviors and healthcare workers
to communicate well with their patients. Helping with breaking vicious cycles, and the
effect of psychosocial consequences and expectations on illness psychosocial effects.
Health and medical psychologists talk to people who have to make difficult medical decisions
and help people with trauma and serious scarring counselling.
Health and medical psychologists work in:
Health care: primary health care, private practices, organizational health/burn-out
prevention, secondary health care (mental health organizations, pain clinics and rehab
centers), medical psychology department in the hospital (pain management, oncology
and hematology, endocrinology, cardiology). Usually members of a
multidisciplinary team.
Primary prevention, policy, and training: municipal health organizations, Public
Health Service, companies, Voedingscentrum, Trimbos, Rutgers, national foundations
like Hersenstiching, also lifestyle coaching.
Research and policy: universities and research institutes, local, regional or federal
government, developmental aid organizations.
General topics in health and medical psychology: body & mind, capacity & empowerment,
coping with chronic diseases, the relation between stress and disease, prevention & health
promotion, eHealth & self-management.
What is health?
People think health is about: not being ill, resources (strong family, resilience), behavior,
physical fitness and vitality, psychological well-being, function (able to do what you
want/have to do). It can be defined negatively (absence of illness), functionally (being able
to do what you want to do, cope with stressors), positively (fitness, well-being). The
importance of the different factors differs per person. So, it is highly personal, and it has
many dimensions (for example, the psychological dimension is seen as very important).
Definition of health:
1948: health is a state of complete physical, mental, and social well-being and not only the
absence of disease or infirmity. (criticism on complete, but it included the mental and social
dimensions)
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,Understanding health and illness
Biomedical model would argue that you can only become ill if some sort of bodily
process is affected: underlying pathology, neural and/pr biochemical activity. For example, a
contagious agent (like a virus), or a insufficient immune response. This is related to dualism
(body and mind are separated)
But there are many more things that predict health and illness: health behaviors (like physical
activity, nutrition, and sleep), stress and emotions, social relations (support as a buffer,
conflict).
Newer models have a more holistic perspective; more dimensions are included (like the
psychological and social perspective).
Biopsychosocial model:
In this model body and mind interact and this interaction determine health and illness. The
consequences are determined by the interplay of biological, psychological, and social factors.
The different systems influence each other continuously.
Models of prevention
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,Primary prevention focuses on healthy people (every age group). We implement
interventions that promote a healthy lifestyle. In this stage we try to prevent the emergence of
diseases. Secondary prevention focuses on people with early and reversible symptoms, and
people who are at high risk for obtaining a chronic disease. For example: genetic screening
and early treatment. In this stage we try to prevent later diseases from occurring by tracing
illness in an early phase. Tertiary prevention focuses on people that already have an illness.
In this stage we try to prevent new incidents or worsening of symptoms (like prevent another
heart attack), but also revalidation, coping with chronic illness, self-regulation interventions.
The aim is having a high quality of life.
Does our behavior influence our health?
There are different studies on this:
The Framingham Heart study: the participants had to answer questions on their
physical health every two years, also physical exams, and laboratory tests high
blood pressure, unhealthy eating habits, smoking and unhealthy weight all have a
strong relationship with cardiac health. To prevent heart problems, you have to
influence those behaviors.
The British Doctor study: focused on smoking it is strongly related to cardiac and
lung diseases, and cancer.
The Alameda County study: which characteristic and behaviors predict health
they found 7 factors for longevity (levensduur). The factors were: exercising, drinking
less than 5 drinks in a sitting, sleeping 7-8 hours, no smoking, good weight for height,
avoid snacks and eat breakfast.
There is a distinction between different health behaviors:
Behavioral pathogens (health risk behaviors): behaviors that increase your chance
of being ill (drinking, smoking, etc.). You should avoid these behaviors.
Behavioral immunogens (health protective behaviors): behaviors that protect your
health (healthy nutrition, sun protection, etc.) You should engage in these behaviors.
This distinction is important because the different categories also need different types of
interventions.
Why encourage a healthy lifestyle?
1. Health and health behavior is clearly related to morbidity (illness) and mortality, so
we want people to behave in a protective way, and to engage in health behaviors.
2. Differences in prevalence in health behavior between SES groups. People with higher
SES on average live 6 years longer in the Netherlands. Also, the quality of life differs
between high and low SES people with high SES live in good health for 15/16
years more than people with low SES. These differences enhance social inequality.
3. The prevalence of risk behaviors is still very high.
4. Health behavior is not always an informed choice. A lot of our behaviors are
influenced by our environment (whether people in your direct environment smoke, the
prices of healthy versus unhealthy food)
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, Interventions are important. But adverse effects may occur as well. An intervention can
increase inequalities for example eHealth interventions (low SES groups might not have
the supplies). It also can cause hardening: “I don’t longer trust the government’’.
Stigmatization: people who are overweight or who smoke can become stigmatized for their
behavior or illness.
How can we explain / understand health behavior? 3 phases (models)
1. Getting motivated
a. Health Belief Model (Becker, 1974)
Central in this model the perceived threat, this is based on the perceived susceptibility
and the perceived severity of obtaining a negative outcome. Whether you will take
action is is partly determined by the susceptibility and the severity (is it bad? Am I
likely to get it?). We are generally a bit optimistic, which influences the perceived
threat. Another factor is the behavioral evaluation: what will happen if you take
prevented action? will this lead to benefits, and what are the barries to perform the
behavior. The health motivation consists of how important you find your health. Cues
to action are how often you are prompted to engage in health behavior. The perceived
threat, behavioral evaluation and health motivation influence your action. Cues to
action have a direct and separate effect on action. The perceived threat, behavioral
evaluation and health motivation are influenced by demographic variables (age,
gender) and psychological charachteristics (personality, peer pressure). *This model
doesn’t include self-efficacy!
b. Social Cognitive Theory (Bandura, 1977, 1989)
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