Health Psychology Notes

Health Psychology: The Patient–Practitioner Relationship

Interpersonal skills of both practitioner and patient are vital in medical consultations.
Argyle (1975) suggests non-verbal communication is four times more impactful than verbal, requiring alignment between them.
Trust is compromised when a practitioner's verbal reassurance contradicts their anxious non-verbal cues.

Types of Non-Verbal Communication

Facial expression: Patients seek diagnostic clues from practitioners' faces; practitioners gauge patient reactions to diagnoses (Silverman & Kinnersley, 2010).
Paralanguage: Includes non-verbal speech aspects like volume, speed, pitch, and filler words, which all can significantly impact patient perception. Tone can signal disinterest (Marcinowicz et al., 2010).
Personal space: Practitioners' physical examinations can encroach on patients' personal space, leading to discomfort, especially for those with greater privacy at home or who experience loneliness (Marin et al., 2018).
Gestures: Must be culturally appropriate to aid understanding without causing offense.
Appearance: The practitioner's attire and grooming can influence patient confidence.

Relevant Research: McKinstry and Wang (1991)

Aim: To determine whether doctors' clothing influences patients’ respect and acceptability.
Methodology: Involved 475 patients from 30 doctors across five Scottish practices.
Procedure: Patients completed a questionnaire on five occasions, assessing photos of male (white coat, suit, tweed jacket, cardigan, jeans) and female (white coat, skirt, trousers) doctors.
Measurements: Acceptability, confidence levels, matching to their own doctor’s attire, and importance of clothing style were gathered.
Results: Table 1 presents acceptability scores for doctors in different clothing styles. Older patients favored suits and white coats for male doctors, and white coats for female doctors. 64% of participants considered clothing style important.
Conclusion: Patients generally prefer conservatively dressed doctors, suggesting doctors may strategically dress to gain approval.

Verbal Communication

Focuses on the practitioner's questioning and information delivery regarding diagnosis and treatment.

Factors Affecting Verbal Communication

Primacy effect: Initial consultation information is better retained in long-term memory (Ley, 1988).
Forgetting: Patients often recall very little from consultations. Richard et al. (2016) noted patients remember as little as 20% of information, forgetting 40-80% immediately.

Relevant Research: McKinlay (1975)

Aim: To investigate working-class Scottish families’ understanding of medical terminology.
Methodology: 87 working-class women attending obstetrics and gynaecology appointments were divided into utilisers and underutilisers of medical services.
Procedure: Participants were presented with a 13-word list read aloud and in sentences, then asked to define the words. Responses were recorded and scored.
Results: Table 2 shows utilizer's understanding of the words. Utilisers showed consistently higher understanding. Table 3: shows how often physicians underestimated patient's comprehension of medical words.
Conclusions: Physicians underestimated comprehension among working-class participants, often using terms patients didn't understand.

Methodological Issues of Verbal and Non-Verbal Communication Research

Validity: McKinstry and Wang used photos of unknown doctors, not their own doctors. McKinlay interviewed patients at the clinic about words they would hear there, representing their real-life understanding.
Generalisability: McKinstry and Wang’s Scottish sample may not represent other areas. McKinlay’s participants were working-class women. Including patients with a wider range of conditions and from a wider range of backgrounds would increase generalisability.
Usefulness: McKinlay’s results may be used in healthcare settings to address miscommunication and improve understanding between practitioners and patients.
Quantitative data: McKinlay’s data showed underutilisers generally had poorer technical vocabulary; qualitative interview data is needed to discover why.
Questionnaires: McKinstry and Wang included quantitative data reliably obtained from closed questions.
Validity: McKinstry and Wang used more photos of males than females, with no picture of a female doctor in a suit. A white coat being voted highest for the female doctor could just be because this was the most formal style.

Issues and Debates

Application to everyday life: Research shifts responsibility for communication barriers from patient to practitioner.
Idiographic versus nomothetic: Research primarily uses a nomothetic approach, useful for generalization but lacking nuanced insight into individual needs.

Patient and Practitioner Diagnosis and Style

Practitioner Diagnosis

Misunderstandings occur due to patient factors (lack of vocabulary, unwillingness to share, mistrust) and practitioner gender (Hall et al., 1994; female practitioners elicit more information).
Practitioners must accurately diagnose: false positives (diagnosing healthy as ill) and false negatives (diagnosing ill as healthy) constitute medical negligence.

Disclosure of Information

Non-verbal cues outweigh verbal in diagnosis delivery.
Shapiro et al. (1992) found that participants receiving mammogram results from a 'worried' practitioner remembered fewer details than those receiving results from a 'not worried' practitioner.
Telephone diagnoses during COVID-19 increased misunderstanding risks due to absent non-verbal signals.

Key Study: Savage and Armstrong (1990)

Context: Patient preferred sharing styles ensure medical advice compliance, while traditional directed styles limit patient autonomy.
Aim: To investigate whether a sharing consultation style increases patient satisfaction compared to a directed style.
Research method(s) and design: field experiment.
Variables: Independent variable: directed or sharing consultation style. Dependent variable: patient level of satisfaction. Controlled variables: random selection of patients; same doctor used throughout.
Sample: 200 randomly sampled patients (aged 16–75) from a London GP practice.
Procedure: Participants were randomly assigned to 'directed' or 'sharing' style consultations. Doctors used prompts to maintain consistent styles.
Data Collection: Satisfaction was assessed via a five-question questionnaire post-consultation and one week later. Consultation lengths and demographics were recorded.
Ethics: Participants consented to audio recording.
Results: Table 5 shows that the directed style was preferred for simple physical illnesses because these patients preferred certainty and paternalism. Advisory patients with mental or psychological illnesses did not benefit from directed style.
Conclusion: Patients with simple physical illnesses benefit more from the directive style. Patients prefer certainty and paternalism.

Methodological Issues

Ecological validity: Savage and Armstrong used real-world settings, while Shapiro et al. used video clips.
Holistic approach: Shapiro et al.’s research focused on the practitioner’s and patients’ verbal and non-verbal communication. This holistic approach increases validity.
Cultural differences: Elwyn et al. (2002) reported how in the USA patients are told the diagnosis, no matter how serious it is; but in Japan patients are often not told about a serious or terminal diagnosis (Noguchi, 2007). Cultural factors are important when presenting diagnoses.
Representativeness: participants selected by random sampling are representative of patients registered to the doctor. Opportunity sampling might have meant only those known well were selected.
Generalisability: in Savage and Armstrong, 11 per cent of patients did not complete the first questionnaire and 44 per cent did not complete the second. This lowers generalisability.

Issues and Debates

Significant applications to everyday life by understanding styles so practitioners can adapt to suit individual patients. This may help with information disclosure, meaning more accurate diagnoses.
Savage and Armstrong (1990) offers situational explanation, while ignoring individual differences for patient satisfaction with one style.

Misusing Health Services

Delay in Seeking Treatment

Safer et al. (1979): People view symptoms differently than suspected illnesses, lack trust in doctors, and perceive stigma around mental health treatment.
Fernando et al. (2017): In Sri Lanka, stigma influences delays.
Bruffaerts et al. (2007): Median delay was one year for mood disorders and 16 years for anxiety in a Belgian sample.

Health Belief Model (HBM)

HBM posits that perceived threat from symptoms prompts seeking help, while those viewing symptoms as non-threatening delay or avoid it.
Table 8: HBM explanations for delays in seeking medical help.

Relevant Research: Safer et al. (1979)

Aim: To investigate factors that influence delays in seeking medical treatment.
Methodology: Structured interviews with 93 patients in an inner-city hospital waiting room.
Measurements: Symptoms, reactions, negative consequences, pain levels, and delay length at illness stages.
Results: Table 10 shows delay lengths at each stage (appraisal, illness, utilisation) depending on various factors like pain, visual imagery, and cost concerns.
Conclusions: Bleeding/severe pain reduces delay; negative imagery and cost concerns increase it.

Munchausen Syndrome

Munchausen syndrome (factitious disorder) is when people seek out excessive medical attention, often going from city to city to get a new diagnosis and new surgical intervention. It is not malingering, which is when a person feigns or exaggerates symptoms for an obvious gain or incentive. There is no thought of gain with Munchausen syndrome.
Diagnostic Features: Table 11 lists essential (pathological lying, peregrination) and supporting (borderline traits, deprivation in childhood) features (Aleem & Ajarim, 1995).

Relevant Research: Aleem and Ajarim (1995)

Aim: To present a case study of Munchausen syndrome.
Methodology: 22-year-old female university student was referred to hospital with a possible case of immune deficiency or neutrophil disorder.
Findings: Psychiatrist diagnosed Munchausen syndrome. A nurse found a syringe containing faecal matter with which the patient had been injecting herself. The patient became angry when informed and left hospital.
Conclusion: Munchausen syndrome diagnosed, but nothing further could be concluded.

Methodological Issues

Case study: Aleem and Ajarim (1995) used an appropriate method for a condition that is difficult to research ethically; experimental method cannot be used.
Validity: Safer et al. (1979) used retrospective data. Memories could be inconsistent, especially under stress.
Usefulness: from Safer et al., medical practices can develop strategies to reduce patient delays. Aleem and Ajarim provides information, allowing more reliable diagnosis of Munchausen syndrome.
Reliability: Qualitative data is subject to interpretation by the researchers. For example, Aleem and Ajarim possibly interpreted information about the first hospitalisation differently due to already knowing about the discovered syringe.

Issues and Debates

The health belief model explanation is holistic, considering multiple reasons. This makes it hard to isolate which variables have the strongest effect in delaying seeking treatment. It is also difficult to create effective interventions.
Idiographic versus nomothetic: An idiographic approach with rich in-depth information is appropriate in Aleem and Ajarim (1995) as Munchausen syndrome is relatively rare and generalising from small samples in a nomothetic manner may not be valid. Practitioners can decide whether findings may apply to their own clients.

Adherence to Medical Advice

Types of Non-Adherence and Reasons

Adherence is when patients follow health professionals' guidance.
Unintentional and intentional non-adherence.
Laba et al. (2012) identified six intentional factors.
Failure to attend appointments is a worldwide problem as past failures predict future failures. Other predictors include age (either young or over 80 years old) and multiple factors.

Explanation of Non-Adherence

Rational non-adherence due to beliefs about ineffectiveness, side effects, confusion, cost, etc. (Sarafino, 2006).
Health belief model: Taking preventative action depends on considering how much of a threat the health problem poses.
Table 13: Health belief model explanations for action.

Relevant Research: Laba et al. (2012)

Aim: To explore decisions leading to intentional non-adherence.
Methodology: online survey.
Procedure: The Beliefs About Medication Questionnaire (BMQ) was used to create a ten-question discrete- choice questionnaire on two hypothetical drugs.
Results: Table 14: Example of a discrete-choice question.
Conclusions: Adherence could be improved by reducing costs, changing regime, and educating. Patients make rational choices.

Methodological Issues

Usefulness: results from Laba et al. (2012) show factors that influence patients’ adherence to their treatment regime. This could help practitioners design interventions to improve adherence.
Representativeness: 1,668 people were initially invited to participate. However, only 248 respondents commenced the questionnaire and 161 completed it = 10 per cent participation rate. Maybe a certain type of person participated.
Reliability: Objective and quantitative data from a discrete-choice questionnaire meant that the results had high reliability.
Ecological validity: The questionnaire scenarios were all hypothetical and may not reflect real life.

Issues and Debates

Explanations of non-adherence are applicable to real life. If health service professionals know that cost and complexity affect non-adherence then, strategies to overcome this can be introduced, such as lowering the cost or making instructions clearer.
Laba et al's nomothetic approach led to objective conclusions but individual understanding was missing.

Measuring Non-Adherence

Subjective Measures

Table 16: Subjective measures of adherence.

Relevant Research: Riekert and Drotar (1999)

Aim: To assess implications of non/incomplete participation of adolescents with diabetes in treatment adherence research.
Methodology: Participants were recruited through a clinic as families (parents plus adolescents aged 11–18).
Findings: Number of blood glucose tests was monitored through a reflectance meter. Adolescents of non-returner families also had significantly lower rates of adherence than those of families who returned their questionnaires.
Conclusion: Lower adolescent adherence to treatment regime is associated with lower participation in adherence studies by adolescents and their families.

Objective Measures

Table 17: Objective measures of adherence.

Relevant Research: Chung and Naya (2000)

Aim: to electronically assess compliance with an oral asthma medication.
Methodology: Patients gave informed consent but did not know about the device. Patients with asthma, aged 18–55.
Results: there was compliance with TrackCap. There was compliance on TrackCap and tablet count. Under-compliance by participants.
Conclusion: Monitoring systems like TrackCap measure adherence effectively.

Biological Measures

Table 18: Biological measures of adherence describes Urine Analysis and Blood Sampling.

Methodological Issues

Application to everyday life: in Riekert and Drotar (1999), the families not completing research tasks may lack organisational skills. This allows real-life interventions for non-participants, increasing adherence.
Ethical issues: Reikert and Drotar used data from non-consenters. There are ethical issues about informed consent and using information without permission.
Quantitative data: electronic monitoring is objective, giving quantitative analysis of adherence to medical advice.
Validity: Chung and Naya found adherence rates to be high. However, participants knew adherence was being measured.

Issues and Debates

Quantitative and qualitative data: Reikert and Drotar (1999) used method triangulation to gain data, improving the validity of results.
Application to everyday life: Research into reasons for non-adherence can be applied to improve the medical profession’s understanding of why people may not adhere to advice or regimes, and what they can do about it.

Improving Adherence

Improving Adherence in Children

Strategies include: simple regime, pleasant-tasting medicine, easy-to-take liquids rather than tablets, text message reminders for older children, regular phone contact with parents and involving children fully with treatment plans, considering their concerns (Benn, 2014).
Relevant research: Chaney et al. (2004) compared Funhaler, which is a children's asthma inhaler, to currently used spacer devices.

Relevant Research: Chaney et al. (2004)

Aim: to compare the Funhaler device to currently used spacer devices.
Methodology: Randomized sample of children to compare Funhaler to existing spacer devices.
Results: Table 20: Adherence to prescribed technique. Current device (59%); Funhaler (81%). The Funhaler could be useful in managing asthma in young children.
Conclusions: The Funhaler could improve clinical outcomes, suggesting the effectiveness of behavioral theories in medication adherence.

Individual Behavioral Techniques

Table 22: Individual behavioural techniques.

Key Study: Yokley and Glenwick (1984)

Context: Behavioral psychology increasing immunisation adherence.
Aim: to evaluate the impact of four conditions on motivating parents to have children immunized.
Methodology: Field experiment, longitudinal design.
Variables: General and specific prompts, incentives.
Procedure: 715 immune-deficient children were enrolled. Prompt for parents and children for immunization.
Ethics: Participants (parents) did not consent to participate and were unaware behavior was being manipulated.
Results: The study found incentivized programs effective.
Conclusions: Behavioral incentives motivate parents to immunize.

Methodological Issues

Generalisability: in Chaney et al. (2004), 32 Australian children is not representative of the wider population.
Reliability: Yokley and Glenwick used standardised procedures, meaning research is replicable.
Validity: in Chaney et al., parents probably wanted to show they were doing their best for their children, so put in extra effort to ensure adherence; this lowers the validity of results.

Issues and Debates

Yokley and Glenwick (1984) used children ethical concerns include consideration of effects and treatment for the control groups after the study.
Applications to the real world by developing incentives to promote immunizations.

Pain

Types of Pain

Pain is subjective and has a sensory and affective component.
Acute and chronic pain.
Phantom limb pain is experienced by 80 per cent of people after limb loss.
Mirror treatment uses a mirror to create the illusion of the amputated limb being there, by placing the opposing limb in front of the mirror, with the amputated limb behind it.

Relevant Research: MacLachlan et al. (2004)

Aim: to report the effects of mirror treatment on a person with lower limb amputation.
Methodology: The patient massages and moves the opposing limb and feels the benefit in the phantom limb. Case study of 32-year-old man with leg amputation.
Results: Pain reduced and he felt more control over the phantom limb than prior to mirror treatment.
Conclusion: Mirror treatment is effective for phantom limb pain. It also avoids patients taking pain medication, giving them control over their pain.

Theories of Pain

Specificity theory suggests we have a sensory system specifically dedicated to pain.
Gate control theory: Small, slow fibres carry pain stimulation to the spinal cord. They pass through a ‘gating mechanism’, activating T-cells to transmit the pain signal to the brain.

Methodological Issues

Application to everyday life: MacLachlan et al.’s (2004) case study of mirror treatment shows how it could be used by practitioners or even by people in their own homes.
Case study: MacLachlan et al.’s research gave detailed insight into the patient’s background and effectiveness of treatment compared to other treatments.
Validity: specificity theory is now outdated and discredited. There is no physical evidence of a gating mechanism in the spinal cord, suggesting other mechanisms might be involved.
Generalisability: MacLachlan et al.’s findings cannot be generalised to the wider population as individual experience with mirror treatment differs. Pain is subjective and varies with culture and gender.

Issues and Debates

Gate control theory of pain focuses on the nature side of the debate, which ignores environmental (nurture) factors affecting pain perception.
Gate control theory takes a holistic approach to pain, accounting for both physical and psychological factors, but neither accounts for individual differences in pain experience.

Measuring Pain

Subjective Measures

Clinical interviews are used to assess patients with chronic pain.
They may use psychometric tests to help understand the type and intensity of the patient’s pain, everyday functioning, emotional distress, beliefs and expectations.

Psychometric Measures and Visual Rating Scales

McGill pain questionnaire and Visual analogue scales.

Behavioral Measures

UAB pain behavior scale measures observable pain behaviour and verbal/non-verbal signs of pain.

Key Study: Brudvik et al. (2016)

Aim: to explore
- the relationship between children’s self-reported pain and parents’ and doctors’ pain ratings
- how age, medical condition and severity of pain affect pain estimates
- whether pain assessment affects administration of pain relief.
Methodology: Field study; correlational, using questionnaires, opportunity sample of pediatric patients.
Results: Table 25 demonstrates relationships between parent and practitioner responses within patient data.

Methodological Issues

Reliability: the MPQ was standardised. Brudvik et al. (2016) used a standardised procedure.
Validity: Byrne et al. (1982) tested MPQ comparing results of patients with back pain to previous research and found similar results.
Generalisability: Brudvik et al. only looked at one Norwegian emergency department. They were not specialist children’s doctors, so they did not routinely assess pain.

Issues and Debates

Idiographic versus nomothetic: Brudvik et al.’s (2016) research illustrates the nomothetic approach: measuring pain numerically and using statistical analysis to determine the significance.
Brudvik et al.’s could be used to support changes in Norwegian paediatric care, and training should include listening to children/parents regarding pain levels and remembering individuals with the same condition may experience pain differently.

Managing and Controlling Pain

Biological pain treatments

Table 27: Biochemical pain treatments.

Psychological treatments

Table 28: Psychological treatments.

Methodological Issues

Usefulness: psychological treatments have no side effects. Effectiveness: psychological treatments alone are ineffective for severe pain.
Adherence: people are more likely to adhere to psychological treatments if pain is moderate and/or short-lived, as side effects are one of the main reasons for non-adherence.
Reductionist: biological treatments are reductionist, focusing on the biological mechanisms of pain and ignoring environmental factors.

Issues and Debates

Biological treatments take a nomothetic approach and are prescribed for pain despite research that finds them ineffective and/or cause side effects.
Acupuncture demonstrates alternative pain relief techniques to traditional Western drug therapy, supported by research evidence.

Stress

Sources of Stress

Defining stress: Stress is how our body reacts when we feel under pressure.
Sarafino (2006) provides three definitions by effect of environment on individuals, bodily response to stressful events and interaction between person and environment.

Physiology of Stress

General Adaptation Syndrome: Selye (1936) suggests three stages of his General Adaptation Syndrome (GAS):
Alarm, Resistance and Exhaustion

Effects of Stress on Health

Chronic stress affects the following systems:
- Digestive System.
- Circulatory System:
- Immune system and immunosuppression.

Causes of Stress

Life events measured with the Social Readjustment Rating Scale.
Work: under-stimulation, high workload, low control

Relevant Research: Chandola et al. (2008)

Aim: to determine biological/behavioural factors linking work stress and CHD.
Methodology: (A 17-year longitudinal study).
Conclusion: Chronic work stress is a risk factor for CHD and poor health behaviors.

Type A Personality

They called these behavior patterns ‘Type A’ personality, characterized as competitive, ambitious, work-driven, time-conscious and aggressive.
The Type A personality was identified as a risk factor for white, middle-class men (Friedman and Ulmer, 1985).

Methodological Issues

Correlational Research, Longitudinal Research and Cultural/Individual Differences

Issues and Debates

Biological, SRRS and Type A/B personality explanations are reductionist. A holistic approach may be more beneficial as situational factors also impact people’s reaction to stress.
Research into work causing chronic stress was conducted in Western individualist cultures so jobs with low responsibility and low control may be viewed differently in other cultures.

Measures of Stress

Biological measures

Heart rate, Heart rate variability (HRV), Brain function (fMRI), Sample tests: salivary cortisol.

Relevant Research: Wang et al. (2005)

Aim: to study neural circuitry of psychological stress.
There were some participants who's brains were scanned.
The ventral right prefrontal cortex (RPFC) showed continued activation during and after stress tasks.
Conclusion: the ventral RPFC plays a central role in stress response.

Relevant Research: Evans and Wener (2007)

Aim: to investigate how density and proximity of other train passengers affect commuter stress.
Procedure: During the morning commute, travelers completed a proofreading task to measure motivation/persistence.
Results: Proximal crowding significantly correlated with cortisol levels, mood, errors and longer commutes were associated with higher cortisol levels.
Conclusion: proximal crowding is related to commuter stress, possibly due to invasion of personal space, but distal crowding is not.

Psychological measures

Self-report questionnaires. For example: Friedman and Rosenman’s personality test or Life events questionnaire created by Holmes and Rahe).

Methodological Issues

Generalisability: Wang et al.’s (2005) fMRI research was expensive and time-consuming, and there were just 32 participants, giving low generalisability.
Validity Holmes and Rahe´s (1967) research was correlational, only looking at the relationship between health and life events. There could be other variables (like poor nutrition through stress) affecting health.
Objective data: Evans and Wener (2007) measured cortisol in saliva samples; this is an objective way of measuring physiological effects of stress.

Issues and Debates

Individual and situational explanations: The scales used take an individualist approach to stress and illness, seeing the cases as lying in people’s individual behavior.
Cultural differences: Rating scales assume that Christmas, weddings and moving house are all highly stressful events, but this has not been tested cross-culturally.

Managing Stress

Psychological Therapies

Biofeedback is based on operant conditioning.

Relevant Research: Budzynski and Stoyva (1969)

Aim: to describe a biofeedback instrument incorporating operant conditioning principles.
Methodology: Biofeedback using operant conditioning during several sessions to allow the Experimental group participants to receive continuous feedback about muscle activity.
Conclusion: biofeedback may be useful for people with certain psychosomatic disorders.

Preventing Stress

Stress inoculation training (SIT) has three phases: Conceptualisation, Skill acquisition and Rehearsal and Application.

Key Study: Bridge et al. (1998)

Aim: Bridge wanted to see that stress could be reduced in patients diagnosed with stress from chemotherapy.
Methodology: randomized control trial using questionnaires, in which data was fully informed and written with content, but no drugs used.
Results: the treatment groups had audio tapes at home and could continue to use them. Mood disturbances worsen in patients with no intervention.
Conclusions: Relaxation combined with imagery is effective at reducing mood disturbances.

Methodological Issues

Application to real life: Budzynski and Stoyva (1969), EMG techniques gave individuals a way of managing stress in different everyday situations.
Ethics - SIT is costly, and excludes some people from benefits of management as well as that fact that they may need audio for there sessions.
Generalisability: in Bridge et al., there were only small group sizes, and were likely to not represent the target population.

Issues and Debates

Determinism versus free will: The research demonstrates that training helps people manage their low mood by exercising free will, reducing feelings of helplessness and increasing empowerment during difficult treatments.
Application to everyday life: Relaxation techniques could be carried out at home. They are more effective with women over 54. Interventions could be targeted at older women who are most likely to benefit.

Health Promotion

Strategies for Promoting Health

Fear arousal: using vivid imagery to raise public awareness of risky health behaviors Success is more likely if the individual has a high level of self-efficacy.

Relevant Research: Janis and Feschbach (1953)

Aim: to investigate potential adverse effects and defensive reactions to fear appeals.
Methodology: 200 American high school students were allocated into a varying amount of fear with dental hygiene. With the use of information with the dangers, the study found how the effects impact people in terms of concentration, and aggressive communicating.
Conclusion: Fear appeals create a high level of tension and concern, but little change in behavior. Low fear results in behavior change. Level of fear appeal does not affect the amount of knowledge

Providing Information

To provide people with information they need to stop an unhealthy habit. For example, to help people give up smoking, they could be provided with links for buying nicotine patches or details of stop smoking programs.

Home-Based Exercise Programs

To promote health and wellness at home for exercise and myocardial infarction (MI) after release.

Relevant Research: Lewin et al. (1992)

Aim: to evaluate the effectiveness of a home-based post-MI exercise program.
During a program after release to test cardiac effects.
Results: There was a significant improvement in anxiety and depression in the rehabilitation group at six weeks, six months and one year.
Conclusion: self-rehabilitation programs lead to better and more productive results towards healthcare than clinical rehabilitation.

Methodological Issues

Application to everyday life: the fear arousal method of persuading individuals to change their behavior is still used today in health promotion campaigns. This shows that fear appeals are useful.
Validity: In the double blind test during a study, cardiac and nursing care could have been more improved, but they were assigned by double blind selection which could have skewed results.

Issues and Debates

Individual vs situational explanations due to covid. It is important for researchers to consider both factors when researching fear appeals.
Tannenbaum et al. (2015) reviewed data from 127 cross-cultural studies on fear appeals and found no evidence of cultural differences in effects.

Health Promotion: Schools and Worksites

Schools and healthy eating Research

The UK Department of Health (2000) found that fewer than 4% of children ate the recommended of vegetables a day.

Relevant Research: Tapper et al. (2003)

Aim: to increase consumption of fruit and vegetables through the use of ‘Food Dudes’ in schools.
Methodology: A variety of studies carried out, including one in a nursery, in which modeling plus rewards approach resulted in increasing fruit and vegetable consumption that persisted at the 15-month follow-up with a school set program of food rewards.
Conclusion: behavior modification programs can change children’s eating habits, in both the short term and the long term.

Worksites and health and safety Promoting

South Africa recorded mining fatalities in the first six months of 2021, with many other accidents. Behavior modification methods using operant conditioning principles, like token economies, have been used to try and decrease accidents.

Relevant Research: Fox et al. (1987)

Aim: to investigate whether token economies are an effective long-term way of reducing accidents and injuries in two USA mines.
Methodology: Miners were divided into four hazard groups and rewarded monthly, and if injured lost some stamps.
Results: both mines showed substantial decreases in the number of days lost during the first five years of the token economy program.
Conclusion: token economies are a cost-effective way of reducing work-related injuries in mining.

Methodological Issues

Longitudinal Design, Validity ad Generalizability

Issues and Debates

Application to everyday life due to work time. If workplace token economies can decrease accidents, there is less chance of negative consequences for the employee.
Use of children: When researchers work with children, they must design age and/or developmentally appropriate materials.

Individual Factors in Changing Health Beliefs

Unrealistic Optimism

This is the cognitive belief that negative events are less likely to happen to us than other people and that positive events are more likely to happen to us. Individuals feel invulnerable to disease and may disregard health advice and engage in risky behavior.

Relevant Research: Weinstein (1980)

Aims: 1 To investigate whether people believe that negative events are more/less likely to happen to them than others. 2 To investigate whether the more control people feel they have over negative events, the more they think it will not happen to them.
Methodology: In Study 1, a diverse group of American college students estimated their chances, Comparative rating group
Results: Participants’ scores