Health Psychology Exam #1

Leading causes of death vary by ethic group

White and Black Americans are more likely to die of heart disease

Asian and Hispanics of cancer

Groups with higher poverty levels and low education report

Lower life expectancies

People with higher education report

Better jobs, higher incomes, better health care access, fewer daily health symptoms, less stress, and healthier habits

Escalating cost of medical care

Longer life expectancies have contributed to medical costs

50% of US pop. have chronic disease

86% of health care dollars spent

72% of doctor visits

76% of hospital stays

88% of prescriptions written

Solutions to escalating costs of medical care? - BAE

Better preventive measures

Advertisement/awareness → education/outreach to the community

Early age screenings (ex. 40 for mamograms, 45 for colonoscopy

Biomedical model of Health

Traditional view of health, defines the health as the absence of disease (outdated)

Psychosomatic medicine

Early theorists asserted that psychological and emotional factors contribute to physical problems

Still, many regarded psychosomatic disorders (stress makes the condition worse, ex. high blood pressure, migraines) as being “all in the head”

Behavioral medicine

An interdisciplinary field that attempts to use psychology in conjuction w/ medicine to achieve better health

Health Psychology

branch of psychology that cosniders how indivdual behaviors and lifestyles affect a person’s physical health (1978 APA division 38)

Biopsychosocial model of health

in addtion to biological factors, psych and social are considered (ex. lung cancer)

WHO defintion of health

Is a state of complete physical, mental, and social well-being, and not merely the absence of disease infirmity

Network stress

the secondary stress an individual experiences due to major crises, life events, or problems happening to people within their personal social network, such as family members, close friends, or neighbors

How did psychology become involved in health care?

By the early 1970s, psychology and other behavioral sciences began to play a role in the prevention and treatment of chronic diseases and in the promotion of positive health, giving rise to two new fields:behavioral medicine and health psychology.

Placebo

Inactive substance or condition that has appearance of an active treatment

Why placebo groups?

We need to sure that the improvement is really from the treatment/drug

Placebo effect

Patient condition improves

What are some factors influencing the strength of placebo effect?

• Patient expectations

• placebo should resemble treatment (more expensive and in a name-brand bottle)

• cultures that have a stronger belief in medicine

Nocebo effect

Patient’s condition worsens from the placebo (side effects/patient expectations)

What makes a treatment deemed effective?

Treatment effect must be > placebo effect

Double-blind design

Optimal design, both researchers and participants are “blind” to condition

Single-blind design

Only participants are “blind” to condition

Correlational studies

provide information about the degree of relationship between variables

Correlation coefficient

Can range from -1 to +1

The sign tells us the direction, and the number tells us the strength
Correlation (two things change together) does not equal causation (One thing produces a change in the other.)

Ex.) There is a strong positive correlation between ice cream sales and sunburns: as ice cream sales increase, sunburn cases also tend to increase. However, this does not mean ice cream causes sunburn. A third variable, such as hot and sunny weather, may influence both.

Cross-sectional study

Looks at one point in time, comparing two or more groups of people with similar backgrounds but different ages

CONS: no cause-and-effect (no causation); other variables affecting the relationship (confounding), requires careful interpretation bc of unclear directions)

Longitudinal study

follows the same group of people over an extended time period to gather information about their health as they get older (cons: time, expenses, patient unreliability)

Experimental designs

used to determine casuality

random assignment is important

Independent Variable

is what the researcher manipulates

Dependent variable

is measured health outcome

Control groups vs experimental group

does not receive treatment (may receive placebo) vs receives treatment

Ex Post Facto designs (quasi-experiments)

Researchers use an ex post facto design (quasi-experiment) when variables of interest are impossible or unethical to manipulate

• Choose variable of interest and select participants who already differ on this variable

• No random assignment to groups because IV is not manipulated

Can't control patient lifestyle, demographics, enviornment

Example: Lung cancer and Smoking, IV: Smoking history can not be manipulated, already exists

Epidemiology

Branch of medicine that investigates factors contributing to health or disease in a particular population

Prevalence

Proportion of population that has a particular disease or condition at a specific time. Total number of existing cases in the population

ex.) How many people have been diagnosed with diabetes

Incidence

Frequency of new cases of a particular disease or condition during a specified period, usually one year

Ex.) How many new cases of diabetes this year

Observational methods

can show an association between variables but cannot show causation (sounds like a correlational study)

Retrospective (case control) studies

Begin with a group of people who are already suffering from a disease and work backward to determine what factors preceded their sickness (past risk factors)

Pros: low cost, fast results, good for rare conditions (gather enough past cases)

Cons: People’s recollections may not be accurate; incomplete data, weak causal link

Prospective studies

Begin with a population of disease-free participants and follow them over time (like a longitudinal study)

Pros: Higher accuracy, less bias, stronger causal evidence

Cons: long time, expensive, participant unreliability

Randomized controlled trials

• Equivalent to experimental research in psychology

• Participants are randomly assigned to either a study group or a control group

• Researchers must control variables other than those of primary interest to

prevent them from affecting results

• Most RCTs are clinical trials

Make sure its a double blind/researchers look for side effects

Non experimental studies

can be used to make inferences about causal relationships, particularly when suspected cause cannot be manipulated (e.g., cigarette smoking → lung cancer)

Epidemiologists (investigate patterns of disease) use 7 criteria for determining a cause-and-effect relationship between a suspected cause and a disease

1.) There is a dose-response relationship between possible cause and disease (the more of smth, the stronger the effect → more ciagrettes, more side effects (higher risk)

2) Removal of possible cause reduces prevalence or incidence of disease

3) Possible cause must precede disease (cause has to come before effect)

4) Cause-and-effect relationship is physiologically plausible (has to make sense that ciagrettes could lead to lung cancer)

5) Research studies consistently show a relationship (if we look at research, we see a consistent/causal relationship)

6) Strength of association is relatively high (lung cancer + smoking across different designs)

7) Studies are well-designed

Can someone have a diease and not be ill?

• Early stages

• Hidden progression

• Immune response

• Silent killers/asymptomatic (ex. hypertension, type 2 diabetes, infections, early cancer)

Health

state of positive physical, mental, and social well-being

Disease

The process of physical damage within the body

illness

The experience of being sick or having a diagnosis

Symptoms

sign(s) that may or may not indicate disease

illness behavior

activities undertaken by someone who experiences symptoms but has not yet recieved a diagnosis

Diagnosis

label for symptoms, which can be from a health care provider for a self-diagnosis

Sick role behavior

Defined as behaviors or activities engaged in by people who believe they are ill for the purpose of getting well

examples: medicate, change lifestyle/activities, stay home/work, more googling

Segall’s 3 rights and 3 duties

3 rights:

• to make decisions concerning health issues

• to be exempt from normal duties

• to become dependent on others for assistance

3 duties:

• to maintain health and to get well

• to perform routine health care management

• to use a range of health care resources

What problems are there with Segall’s 3 rights and 3 duties? - Always Inspect Dirty Old Items

• Assumes illness is acute and temporary, no chronic illness

• Ignores socioeconomic inequalities

• Disregards gender and cultural differences

• Oversimplifies patient autonomy and stigma

• Ignores systemic barriers/disparities in healthcare availability

Factors that affect health care seeking

1. Personal factors - stress, anxiety, neuroticism predict greater healthcare seeking

2. Gender - women seek health care > men

3. Age - older people seek health care (close to death) > younger people

4. Socioeconomic,ethic, and cultural factors people lower in SES (lack of insurance, financial concerns, no child care, missing work, cost of gas) and ethnic minorities seek health care less often

5. Stigma - people with embarassing or stimgatized conditions are less likely to seek health care (ex. STI, mental health, obesity, smoker lung cancer, incontinence, obesity, acne, hormonal conditions)

6. Characteristics of symptoms - people with symptoms that are percieved as visible, severe, interfering with daily life, and continuous are more likely to seek health care

7. Conceptualization of the disease - people base their decisions on whether to seek health care, in part, on incomplete and sometimes inaccurate beliefs

Components of Disease Conceptualization - I Think Dogs Can Count 🐶

1. identity of disease - what is the diagnosis? is it minor or major?

2. Timeline of disease and treamtent - how long is the disease expected to last? what is the course of treatment?

3. Determination of CAUSE - what cause the disease to develop (if u can identify cause, you are less likely to go to doctor)

4. Consequences of disease - now that i have the disease, what will happen to me?

5. Controllability of disease - can the disease be controlled?

Seeking medicial info from nonmedical sources: Internet

Often the first place people go, may provide greater understanding, second opinion, or reassurance, can also provide misinformation, highly educated women (feel comfortable interpreting info) are the most likely demographic to seek health information online

Seeking medicial info from nonmedical sources: Lay referral network

Family and friends who offer information and advice before any official medical treatment is soguht (can encourage or discourage health care seeking)

May help person make sense of their symptoms (if family member has) and either encourage/discourage health care seeking

Recieving medical care: limited access

• Employment is an important factor in access to medical care

• Those who are unemployed

• single (no spouse insurance or younger)

• native american, hispanic/latino are more likely to be uninsured

• Even for those with insurance, it is still expensive

Choosing a practicioner

Patients who are satisfied in their relationship with their provider are more likely to follow medical advice and to continue using medical services

Verbal communication is one of the most important factors in the patient provider relationship

What personal characteristics do patients most desire in providers? Who exhibits these more often?

Women.

Confidence, thoroughness, personability, humaneness, honesty, respectfulness, and empathy

Questions doctors wish patients would ask

1. “I Googled my symptoms, but what do you think?”

2. “What Internet resources can I trust for medical

information?”

3. “What should I work on before my next visit?”

4. “What can I do to prevent this from happening again?”

5. “Why am I taking this medication?”

6. “What do you do for your personal wellness?”

7. “How many patients like me have you treated?”

8. “Does my child really need an antibiotic for this?”

9. “What is the best way for me to lose weight?”

10. “When should I come see you again?”

Being hospitalized

Hospitalization is a stressful experience, particularly for children (separated from parents, unfamiliar environment, fear of mortality

Hospitalized adults report being treated like a “nonperson” and having to

tolerate lack of information, loss of contro

Intention-behavior gap

When one intends to behave in a healthy manner, but does not follow through

Health behavior adherence

Extent to which one’s behavior coincides with medical advice or recommended health practices

Ex. working out, eating healthy, sleep, hydration, meds, doctor appts, yoga, wearing a seatbelt

Average rate of nonadherence

25%

People adhere more often when - BDR

Behavior is easy (less time/resources

Diagnosis is percieved as severe (if patient sees it as so [HIV, heart conditions, arthritis, cancer]; low adherence may be seen in diabetes or lung disease)

Regimen is less complex (once or twice a day pills/ one big pill, 8 small pills)

Health behavior theories

Help us understand why people make the health choices they make and how they successfully adhere to medical advice

Continuum theories

A name given to theories that seek to explain adherence with a single set of factors that should apply equally to all people, regardless of their existing levels or motivations for adhering. In other words, a “one-size-fits-all” approach. 

Stage theories

first classifying people into different stages of behavior change and then identifying the unique variables that predict adherence among people in different stages.

Health belief model

Assumes that health-related actions are predicted by four primary beliefs: perceived susceptibility to a disease, perceived severity of the illness, perceived benefits of taking protective action, and perceived barriers (such as financial cost or inconvenience)

Modifying factors that then influence individual beliefs to then influence a cue to action (internal symptoms, external media) to behavior

Self-efficacy theory

Grounded in social cognitive theory and reciprocal determinism (person behavior, personal factors, and enviornment influence and shape one another).

It posits that adherence depends heavily on a person's self-efficacy (their situation-specific belief in their capability to execute a behavior) alongside their outcome expectations (the belief that performing the behavior will lead to valuable results)

Theory of planned behavior

Contends that the immediate predictor of behavior is a person's intention to act. Intentions are driven by three elements: attitudes toward the behavior, subjective norms (perceived social pressure and motivation to meet others' expectations), and perceived behavioral control

Behavioral theory

(based on B. F. Skinner’s operant conditioning) Focuses on environmental factors, habits, and reinforcement principles. Adherence is established and maintained using positive and negative reinforcement, reminder cues/prompts, and contingency contracts

Transtheoretical model/stages-of-change model

Proposes that people progress (and often regress/relapse) through five spiraling stages when altering behavior: precontemplation, contemplation, preparation, action, and maintenance. Interventions are most effective when tailored to an individual's specific current stage

Health action process approach HAPA

Not just how intentions form but how they translate into behavior change

• risk perception - ppl have to perceive that they have a risk

• outcome expectancies - what do they expect the outcome to be if they change their behavior (they have to have favorable perceptions, like perceived benefits)

• self-efficacy - acknowledges the confiendence that someone needs to have to make the change

• planning is a critical middle step

this model argues that there are action planning (planning for how we are going to carry out this change) and coping planning (we are planning for setbacks, barriers, what am I going to do if there is a setback that does not let me reach this goal)

• Many people fail because they do not think of the setbacks

HAPA motivational phase

The individual forms an intention to change based on risk perception, outcome expectancies, and action self-efficacy

HAPA volitional phase

The individual translates that intention into action, where detailed action planning (identifying when, where, and how to act) and coping planning (identifying how one will cope with potential barriers or obstacles that could get in the way of the goal-striving process) are essential to maintain the behavior

HAPA vs HBM

• Stage theory vs continuum theory

• Motivational/Volitional phase vs modifying factors/indivdual beliefs phase

• Crucial for bridging intention to action vs No planning (HBM does not explain well how we fall through on those actions)

• Specifically designed to solve the intention–behavior gap by making detailed planning a required bridge between having an intention and successfully taking action vs Focuses heavily on motivation and attitudes, but fails to account for the intention–behavior gap (it does not explain how a motivated person actually executes or sustains a new habit)

• Complex, ongoing lifestyle behaviors vs Best for one-time or infrequent health actions

Adherence is difficult

• adherence does not equal willpower

• multiple, overlapping barriers (personal, economic, sociocultural

• If a person fails to adhere it does not mean they are weak, there are many barriers to consider. We are complex beings and everyday things can work against us

Personal barriers to adherence - Tom Only Makes Friends In Secret Rooms

• Time and effort (too difficult/time consuming

• Optimism bias—belief that one will be spared from negative consequences (Weinstein, 1980, 2001)

• Mental health (stress [binge-eating, substance use, everyday behaviors], depression [risk of nonadherence is 3x greater with people w/depression than not])

• Forgetfulness (common in older people; impacts not going to the gym, taking ur meds)

• Treatment is perceived as ineffective

• Side effects (for some experiencing the side effects/ knowing the side effects turns them off from continuing to take the meds)

• Starting to feel better (if a patient starts to feel better, they will feel that they do not need to continue to take meds or seek help because they are “recovered”)

Economic, Social, & Cultural Barriers to Adherence

• Low income (affects both access to healthcare and ability to pay)

• Food deserts (lesser access to fresh produce)

• Lack of transportation or childcare (prevents adherence to regular checkups)

• Work or school schedules (can make it hard to find an available appointment and find one that fits your schedule; working out and making dinner can be hard if ur schedule is irregular)

• Lack of social support (our friends and families can be critical in helping us adhere, just can be support (emotional, physical, and tangible; ex.) someone to remind us of a medicine)

• Stigma and discrimination (with racial and ethnic minority group, LGBTQ, stigmatized health conditions)

• Low health literacy (reading directions or following doctor’s instructions)

• Cultural and religious beliefs (more resistence of modern medicines and doctors, more true for immigrants (storng ties to culture)

Improving adherence: implementation intentions

Specific plans that identify not only what one intends to do, but also where, when, and how

• I will [do action] at [time] in

[location]

ACTION PLANNING

Should also plan for barriers

• If [this happens], then I will [do

this]

COPING PLANNING

Improving adherence: behavioral strategies

• opt in for reminders

• fit the behavior into existing habits and routines, tying the behavior into other things that you are already doing (compatible with ur life; ex., medicine with food, exercise with listening to an audiobook)

• gradually increase intensity

• have an accountability buddy

• modify your environment (for sleep: turn the lights down, putting ur devices in the other room; gym bag by the door; food in the fridge is healthier/fresh produce)

• reduce stress

Key findings of the Scherer et al. (2021) article

• Susceptibility is Generalized, Not Topic-Specific: Individuals who believe misinformation about one medical subject (such as the HPV vaccine) are highly likely ($r = .70–.71$) to believe misinformation about other subjects (such as cancer treatments or statin medications)

• Core psychosocial factors: The findings highlight that susceptibility to medical misinformation is influenced by psychosocial factors, including lower health literacy, positive attitudes toward alternative medicine, distrust in healthcare, and a preference for active interventions.

• Personal Health & Cognitive Factors: having a relevant health diagnosis doesnt make you more immune to misinformation except statin users. Also, lower analytical thinking correlates with higher susceptibility overall

Key implications from Scherer et al. (2021) article

1. Target Audience Characteristics, Not Diagnoses: Public health communications should be tailored to specific psychosocial groups (e.g., populations with lower health literacy or higher healthcare distrust) rather than creating separate messaging solely by patient diagnosis

2. Addressing Distrust and Alternative Beliefs: Interventions must address root causes of distrust in the medical system and engage respectfully with beliefs surrounding complementary medicine, rather than focusing purely on fact-checking.

3. Health misinformation often incorporates partial truths or genuine patient concerns.

People’s motivations for spreading misinformation - S M P S

• Sharing new information: People like to feel that they have new or exclusive information that others don't know.

• Protecting loved ones: People want to keep friends and family safe, often adopting a "better to be safe than sorry" mindset even without checking the facts first.

• Making sense of events: People may share content when seeking explanations or trying to process conflicting information.

• Seeking connection: Sharing health information serves as a way to feel connected to others

Types of misinformation sharers

• Oversharer: Driven by the belief that it is better to provide as much information as possible when seeing something worrying or helpful.

• Casual Sharer: Shares carelessly out of habit or distraction, such as while waiting in line or scrolling late at night.

• Believer: Deeply connected to an online community whose false or misleading claims they genuinely believe and want to spread.

• Enthusiast Posts misinformation frequently in support of a specific cause or person

• Hoaxsters/Disinformers: Financial gain or political advantage

• Mischief-Makers: Mischief or trickery, such as seeing if they can fool people for fun

If you had a friend or family member that you were worried would be suseptible, what are the DOs and DONTs?

DOs: Listen to their fears and feelings, empathize and ask open questions, don’t shame, use inclusive language, point toward credible sources

DON’Ts: Don’t lead with a fact-check, don’t publicly shame them, don’t jump to conclusions and call them out

Communication problems

Physicians may not have a lot of time to devote to a patient, which may create communication problems that reduce patients’ satisfaction. These problems include using medical language unfamiliar to the patient, as well as focusing on determining and describing a diagnosis rather than allowing patients to fully describe their concerns.