PSYC 314 - Lecture 5
Explain the role of behaviour in health.
The Role of Behaviour in Health.
People’s health-related behaviours (“health habits”) influence their likelihood of developing chronic and fatal diseases, such as heart disease, cancer, and HIV / AIDS.
Illness and early death could be substantially reduced if people would adopt lifestyles that promote wellness, such as eating healthy diets, exercising, not smoking, and being safe (whether in the sun or in sex).
Healthy behaviours + lifestyle.
However, the typical person’s lifestyle includes many behaviours that are risk factors for illness and injury.
Define health behaviours and cite examples of health-enhancing and health-compromising behaviours based on research cited.
Health Behaviours - any behaviour with the intention of improving health, or reducing risk of disease.
Activities that people perform to maintain or improve health (or prevent disease and illness), regardless of health status or whether the activity actually improves health.
Health Behaviour & Health Status.
People’s health status can affect the type of health behaviour they perform and their motivation to do it.
Well Behaviour - any activity people undertake to maintain or improve current good health and avoid illness.
Behaviours done to maintain good health, I.e., eating a healthy diet, exercising, getting vaccinated.
Symptom-Based Behaviour - any activity ill people undertake to determine the problem and find a remedy.
Behaviours people engage in when they feel a symptom. I.e., complaining about symptoms, seeking advice.
Sick-Role Behaviour - any activity people undertake to treat or adjust to a health problem.
Behaviours people engage in once they are diagnosed or self-diagnosed. I.e., adhering to medical advice, staying home from school/work.
Health Compromising Behaviours.
Physical inactivity.
Poor diet & nutrition.
Cigarette smoking.
Alcohol consumption.
Unprotected sex.
Excessive sun exposure.
Poor sleep habits.
Infrequent handwashing.
Poor oral hygiene.
Not seeking medical care.
Poor road safety.
Alameda County Study (1965-1999).
Investigated the link between lifestyle & health.
Identified 7 risk factors (health habits) associated with poor physical health and increased mortality.
Smoking cigarettes.
Drinking excessive amounts of alcohol.
Being obese.
Being physically inactive.
Eating between meals (I.e., high calorie snacks).
Not eating breakfast (causes people to overeat later in the day).
Sleeping fewer or more than 7-8 hours a night.
Excessive sleep is correlated with premature death. Maybe because it can be associated with increased sedentary behaviour.
US Health & Retirement Study.
Analyzed data from 13611 American adults between 1992 and 2008.
The factors most closely associated with death were (in order of significance).
Being a current smoker.
History of divorce.
History of alcohol abuse.
Recent financial difficulties.
History of unemployment.
Previous history as a smoker.
Lower life satisfaction.
Never married (perhaps due to isolation / loneliness).
History of food stamps (perhaps due to socioeconomic status).
Negative affectivity (perhaps due to frequency of negative mood).
The Prospective Urban Rural Epidemiology (PURE) Study.
A study of the relationship between health outcomes and health habits / behaviours.
Key Findings:
Higher carbohydrate and lower total fat intake are each associated with higher mortality.
Low carbs are also related to higher mortality - need to find balance.
Fruit, vegetables, & legumes are associated with lower mortality.
Ultra-processed foods are associated with inflammatory bowel disease.
Dairy, cereal, bread, snacks.
Primary Prevention.
Primary prevention involves actions taken to avoid disease or injury (or prevent onset of illness).
I.e., exercise, wearing seatbelt, flossing, immunization / vaccination, handwashing, physical distancing, wearing mask (as in pandemic).
Most well behaviours.
Secondary Prevention (treat disease with the goal of reversing it) and Tertiary Prevention (manage long term disease, prevent further decline and rehabilitate to some degree).
Health Promotion initiatives (I.e., providing information about how to stay healthy) are often aimed at primary prevention.
Identify and define key factors in health-related behaviour.
The likelihood that a person will perform some health behaviour depends on the outcome of two assessments the person makes:
(1) the threat associated with a health problem and (2) pros and cons of taking action.
This finding is widely supported across various health behaviours (I.e., dental visits, vaccinations, exercise programs).
Perceived Risk & Optimism.
Can perceiving physiological risk be harmful psychologically?
I.e., can we perceive too much threat?
According to Cognitive Adaptation Theory, those who do not fully accept their physiological risk may have better mental health and be able to better cope with risk.
Too little or too much optimism are both problematic when it comes to health.
Summarize and provide examples of models of health behaviour change (health belief model, theory of planned behaviour, transtheoretical model); compare and contrast these models.
Health Belief Model.
Perceived Threat (Belief in Health Threat).
Perceived seriousness.
Perceived vulnerability.
Cues to actions / reminders.
Perceived Benefits and Barriers (Pros and Cons).
Perceived “Pros + Cons.”
Belief that benefits outweigh.
Costs (sum = benefits - barriers).
Perceived threat and perceived benefits and barriers contribute to the likelihood of performing the health behaviour.
Theory of Planned Behaviour.
Theory that purports that health behaviour is the direct result of behavioural intentions, which are influenced by 3 key factors.
Attitude Regarding the Behaviour - judgment of whether the behaviour is good or bad.
Subjective Norm - appropriateness or acceptability of behaviour (based on beliefs about others’ opinions, social norms).
Perceived Behavioural Control - expectation of success.
Similar to self-efficacy - belief that one can execute a course of action, achieve a goal; correlated with performance / success.
Transtheoretical Model.
The Transtheoretical Model (Stages of Change Model) recognizes that it may not be possible to change all at once.
Validated across various health behaviours (I.e., quitting smoking, cancer screening, vegetable consumption, safe sex practices).
Especially useful in clinical settings.
Transtheoretical Model Stages.
Precontemplation - not considering changing, no intention to change.
Contemplation - aware of the need to change, contemplating change.
Preparation - ready to change, plan to implement change soon.
Action - start successfully making changes to behaviour.
Maintenance - work to maintain new behaviour, avoid relapse.
Advancing through the Stages.
Ways to help people through the stages…
Describe in detail how a person would carry out the behaviour (I.e., provide information, steps to carry out the behaviour).
Match strategies to the person’s current needs to promote advancement to the next stage (I.e., provide info on health risks in precontemplation; discuss perceived barriers in contemplation).
Plan for problems that may arise when trying to implement the change (I.e., plan for how to deal with cravings, lapses).
Identify and describe less rational and emotional factors in health behaviour change.
Less Rational Processes.
The decisions people make are often irrational or unwise.
The flawed decisions that people make about their health often result from other motivational and emotional processes.
I.e., desires, hopes, fears, disgust, status and affiliation.
Motivated Reasoning.
Emotionally-biased reasoning intended to produce justifications or make decisions that are most desired rather than those that reflect the evidence.
Specifically, people may search for reasons to accept supportive information and discount disconfirming information (denial).
This is one way that people may maintain unhealthy behaviours and resist adopting healthy ones.
Conflict Theory.
When people are faced with health-related decisions, they experience stress due to the conflict over what to do.
People deal with this conflict differently depending on their evaluations of risk, hope, and adequate time.
In certain instances (I.e., as in hypervigilance, when risk is high, hope remains, but adequate time is low), people will be desperate for a solution and may act irrationally.
Discuss key psychosocial factors involved in disease threat and related behaviours (I.e., handwashing, vaccination).
Celebrity influence impacts subjective norms.
SuperAmma Handwashing Campaign.
Designed to increase handwashing in 14 rural villages in South India.
Diarrhea kills ~800000 children every year; handwashing prevents 1/3.
Targeted emotional drivers found to be the most effective levers for behaviour change.
Disgust (desire to avoid and remove contamination).
Nurture (desire for a happy, thriving child).
Status (desire to have greater access to resources than others).
Affiliation (desire to fit in).
6 months after the campaign was rolled out in 14 villages in rural India, rates of handwashing with soap increased by 31% compared to communities without the program, and were sustained for 12 months.
Nurse / Physician Handwashing.
Grant & Hoffman monitored contents of hand soap / gel dispensers in a hospital, before and after putting new signs near them.
A patient focused sign (emphasized how handwashing helps prevent patients from catching diseases) saw a 17% increase in use. Possibly explained by empathy.
Empathy and Disease Threat.
Studies of several outbreaks found the same relationship; higher empathic responding leads to a higher rate of following the recommended precautions.
Empathic Responding - trying to understand what others are experiencing and offering support and assistance.
Recommended Precautions include handwashing, disinfectant use, vaccination (if applicable), and physical distancing.
Empathy During COVID-19.
Confirmed the same role of empathic responding (as well as an important role of trait empathy) in uptake of health precautions during the COVID-19 pandemic.
Also found a significant interaction between empathic responding and perceived threat of COVID-19.
Social Benefits of Empathy.
Empathy and perspective taking have been shown to…
Reduce prejudice.
Reduce stereotype expression.
Reduce interpersonal aggression.
In addition to increasing health precautions, empathic responding may also mitigate the negative social consequences of pandemics (racism, discrimination, “othering”, while also improving support and care provision to the sick.
Herd Immunity.
It’s not just about you or your family; individuals who are allergic to ingredients in vaccines or who are severely immuno-compromised must depend on herd immunity for protection from many diseases.
The more people that are immunized for a virus, the more that chains of infection are disrupted.
Antisocial Traits in a Pandemic.
Miguel et al. (2021) examined the role of antisocial traits in compliance with COVID-19 containment measures in Brazil.
Antisocial traits, especially lower levels of empathy and higher levels of callousness, deceitfulness, and risk-taking (as seen in psychopathy) were directly associated with lower compliance with containment measures, including social distancing, mask-wearing, handwashing.
Antisocial = socially disruptive, violating the rights of others.
Nowak et al. (2020) also found links between narcissism and less prevention / more hoarding during COVID-19.
Mask Wearing.
“Not Cool” to wear a mask?
Capraro & Barcelo (2020) examined intentions to wear face coverings during COVID-19 in a large American sample.
Where face masks were not mandatory, men were less likely to report intentions to wear them.
Men were also more likely to say that wearing a face covering is shameful, not cool, a sign of weakness, and a stigma.
Empathy and Mask Wearing.
Capraro & Barcelo (2020) also found that messages focusing on “your community” were most effective in motivating mask-wearing behaviour.
I.e., “COVID-19 remains a serious threat to your community. Fortunately, there are steps you can take when you go out to keep your community safe.”
Compared to messages stating things such as “you”, “your family”, “the U.S.”
Identify and describe key factors in vaccine hesitancy and resistance.
Anti vaccine attitudes are not new, and are persisting.
Anti-Vax Movement & Vaccine Hesitancy.
In Western nations, there has been a rise in negative attitudes about vaccines over the past 2 decades, ranging from “vaccine hesitancy” to “anti-vaccine” (or “anti-vax.”)
This has led to declining immunization rates and an increasing frequency of outbreaks in viruses like measles and whooping cough in Western nations and other parts of the world.
Originally just Western nations, but these trends are spilling over between countries. Also spills from rich populations to poorer ones.
Now affecting other vaccines, like the flu vaccine; and has had a significant impact on COVID-19 vaccine uptake.
Vaccine hesitancy was rated the 8th biggest threat to global health in 2019 by the WHO.
MMR Vaccine & Autism.
A 1998 study linking autism to the MMR (measles, mumps, rubella) vaccine was not only incorrect, it was fraudulent and has been retracted by the Lancet.
It is the only study to have ever found this link, but it still fuels anti-vax attitudes despite being proved as fraudulent.
Andrew Wakefield intentionally falsified medical information of the 12 study subjects in his original study in order to demonstrate a link.
It was later discovered that Wakefield had been paid by a law firm that was looking to sue the vaccine manufacturer.
The study had no ethics approval and performed invasive practices such as colonoscopies on the children.
Wakefield was subsequently stripped of his medical license, but continues to be a leading voice in anti-vax movements.
Anti-vaccine rhetoric linking MMR vaccine to autism began in 2007, led by celebrities like Jenny McCarthy.
This underscores the role of subjective norms; the celebrity influence led to renewed anti-vax rhetoric.
Childhood Vaccinations.
A 2014 review of 11 different childhood vaccines (including MMR, hepatitis B, and chickenpox), found…
No link with childhood leukemia.
No link between MMR vaccine and autism.
No link between hepatitis B vaccine and multiple sclerosis.
These vaccines are safe. This research is done to combat vaccine dis / misinformation.
A waste of research money; this is all already scientifically proven, but just being replicated to counter anti-vax views.
Adverse reactions (including seizure & fever) are extremely rare, ranging in frequency from 1 in 4000 to 1 in 70000. These reactions are far less likely than complications due to the viruses themselves.
Factors in Vaccine Hesitancy & Resistance.
Threat, Fear, & Disgust.
Fear / perceived dangers of vaccines, disgust of blood or needles.
Lack of Trust.
Mistrust in the medical community, low trust in general.
Maybe from groups who have been historically mistreated.
Beliefs, Preference for Complementary and Alternative Medicine.
Reliance on religious beliefs, alternative medicine.
Conspiratorial Thinking, Paranoia.
Believing in one conspiracy theory leads to an increased likelihood to believe in others (I.e., someone who believes the earth is flat is more likely to believe vaccines cause autism).
High Narcissism (less likely to take advice), Low Empathy, Low Altruism, High Individualism.
Reactance.
Low tolerance for perceived infringements on personal rights and freedoms.
Some people are far more reactive than others.
Reactance is correlated with vaccine hesitancy.
High individualism = high reactance.
Individualism.
Individualism and narcissism are correlated with anti-vaccine attitudes and defiance of COVID-19 precautions like mask-wearing.
To combat this we need to remind people that they are a part of a larger society so that they partake in health behaviours. (Remind them that their actions affect other people).
Dunning-Kruger Effect.
The Dunning-Kruger effect is a cognitive bias whereby people with limited knowledge or competence in a given intellectual or social domain greatly overestimate their own knowledge or competence in that domain.
Overconfidence is associated with anti-vaccine attitudes (and opposition to vaccine mandates); and overconfidence in anti-vaccine ideas is highest among those with low levels of knowledge about vaccines and diseases.
Overconfidence is also associated with increased support of non-expert views in policy decisions.
It is easier to understand non-experts.
Explain how accurate information on vaccines and vaccines safety can most effectively be communicated.
Misinformation & Vaccine Hesitancy.
Good hooks, such as personal stories, can effectively break through to those who are vaccine hesitant.
Many Canadians are vaccination-hesitant.
Being exposed to false balance in the media (I.e., false representation that there even is debate), a falsely balanced portrayal of the science, can have an impact on vaccination hesitancy.
Countering these messages is a tall order.
The parents of vaccine injured children are so loud online that they make it seem like the occurrence is much more common than it actually is.
The Backfire Effect.
The backfire effect is a cognitive bias that causes people who encounter evidence that challenges their beliefs to reject that evidence and strengthen their support of their original stance.
Maybe because they feel threatened or challenged.
I.e., when people concerned about side effects of the flu shot were given information about how it couldn’t cause the flu, they actually became less willing to get it.
Solution?
Information on disease threat, rather than information debunking vaccination myths, works best to change attitudes about vaccines.
Don’t worry about correcting the false beliefs, just provide general info on risk to avoid the backfire effect while still educating the vaccine-hesitant with general scientific information.