Health, Stress & Coping - Week 12 Notes

Health Psychology

What is a Health Psychologist?

  • Health psychologists examine behavioral and psychological factors that increase the risk of illness.
    • Examples include smoking and unsafe sexual practices.
  • They facilitate the development or change of behaviors that promote health and prevent illness.
    • Examples include diet, exercise, and self-exams.
  • They are often consulted for public health policies and health delivery services.

Health-Compromising Behaviors

  • Include social isolation, physical inactivity, and sedentary behaviors.
  • Why they matter:
    • Social Isolation: Increased stress, low resilience, mental ill-health.
      • Increased stress and low resilience can lead to mental health issues.
    • Physical Inactivity: Muscular weakness, reduced motor skills, mental and physical ill-health.
      • Can result in muscular weakness and reduced motor skills, impacting both mental and physical health.
    • Sedentary Behaviors: Mental and physical ill-health.
      • Related to mental and physical health problems.

Leading Causes of Death in Australia

  • Mortality data, comparing an earlier dataset to a later one:
    • The order of leading causes of death shifted slightly over time, but coronary heart disease and dementia remained at the top.
  • Dataset 1:
    1. Coronary heart disease: 10,04010,040
    2. Dementia including Alzheimer's disease: 9,3259,325
    3. Cerebrovascular disease: 5,4965,496
    4. Lung cancer: 4,7514,751
    5. Prostate cancer: 3,5683,568
  • Dataset 2
    1. Coronary heart disease: 6,5476,547
    2. Dementia including Alzheimer's disease: 5,2505,250
    3. Cerebrovascular disease: 3,9743,974
    4. Lung cancer: 3,7063,706
    5. Breast cancer: 3,1103,110

Health Behaviors and Preventable Diseases

  • Death rates from preventable diseases are improving due to science and medical advances.
  • Lifestyle choices and health-compromising behaviors are major contributors to the leading causes of death.
  • Mortality rates from leading preventable causes of death could be reduced by half if people altered their health behavior.
  • Morbidity is an important factor to consider in an aging population.

Why Engage in Health-Compromising Behaviors and Can We Change It?

  • Exploration into the reasons behind unhealthy behaviors and the potential for change.

Biopsychosocial Model of Health

  • An integrative approach considering biological, psychological, and social factors influencing health and illness.
  • Biological Factors: Genetic vulnerability, neurochemistry, metabolic disorders, immune/stress response, comorbidity, response to reward, drug effects.
  • Psychological Factors: Trauma, grief, perceptions, temperament, coping skills, attitudes/beliefs, self-esteem.
  • Social Factors: Interpersonal & environmental relationships, socio-economic status, culture, family circumstances, work, school, peer group, diet/lifestyle.

Biopsychosocial Model - Example

  • Illustrative scenario depicting the interaction of biological, psychological, and social factors in determining an outcome.
  • Test - Exam Stress - Bio, Psycho, Social

Barriers to Health Promotion

  • Impediments to promoting health at individual, health system, community & cultural, and family levels.
Individual Barriers
  • Gender.
  • Negative behaviors are rewarding.
  • Negative effects/consequences are not immediate, while positive effects come first.
Family Barriers
  • Children often model the behavior of their parents.
  • Parents who smoke and consume alcohol are more likely to have children who smoke and consume alcohol.
  • Genetics can play a role, but it is not the sole reason.
Health System Barriers
  • Doctors and health professionals are trained to focus on illness, not health.
  • Lack of private health insurance.
  • Patient-practitioner relationship issues.
Community & Cultural Barriers
  • Norms.
  • Health disparities.

Theories of Health Behavior

  • Frameworks for understanding and predicting health-related actions.
  • Scientific theories are testable and make falsifiable predictions.
Health Belief Model
  • Components:
    • Demographic variables.
    • Perceived threat of disease (Perceived susceptibility and Perceived seriousness).
    • Perceived benefits minus perceived barriers.
    • Cues to action.
    • Likelihood of taking health action.
Health Belief Model - Example
  • Research example – Zewdie et al. (2022):
    • A systematic review examined the predictive ability of the health belief model in COVID-19 preventive behaviors.
    • Overall, the health belief model predicted from 6.5% to 90.1% of engagement in COVID-19 preventative behaviors.
    • The majority of studies had good predictive ability regarding COVID-19 related behavior.
    • Perceived benefit was the most frequently significant predictor.
Protection Motivation Theory
  • Components:
    • Threat appraisal (Perceived severity and Perceived vulnerability).
    • Coping appraisal (Response efficacy and Perceived self-efficacy).
    • Protection motivation.
    • Health behaviors (Intention).
Protection Motivation Theory
  • Expanded Health Belief Model with self-efficacy added.
  • Perceived response efficacy: one’s expected efficacy that performance of the recommended behavior will avoid the threat/negative outcome.
  • Self-efficacy: a person’s belief in their ability to successfully avoid a behavior or engage in a new behavior.
Protection Motivation Theory - Research Example
  • Research example – Bui et al. (2012):
    • A review investigated the effectiveness of protection motivation theory in the promotion of physical activity.
    • 20 studies were reviewed.
    • Self-efficacy (part of coping appraisal) was the strongest predictor of physical activity engagement.
    • Perceived severity and perceived vulnerability of non-engagement were also significant predictors of physical activity engagement.
Self-Efficacy Theory
  • Influences on self-efficacy:
    • Mastery experiences – past performance accomplishments.
    • Vicarious experiences – watching others perform (i.e., modeling).
    • Verbal persuasion – social support and positive self-talk.
    • Physiological arousal – how we feel (e.g., self-efficacy has been reported to have a negative relationship with stress).
Self-Efficacy Theory
  • Meta-analysis (Ashford et al., 2010) of 27 intervention studies:
    • Interventions targeting mastery experience were more effective than those targeting vicarious experience or verbal persuasion.
Theory of Planned Behavior
  • Behavior is largely determined by one’s intention to perform that behavior.
  • Intention is determined by attitudes, subjective norms, and perceptions of control over the behavior.
Theory of Planned Behavior
  • Components:
    • Attitude (Beliefs regarding behavior & Evaluation of outcomes).
    • Subjective norms (Beliefs important others have & Motivation to comply with others).
    • Perceived behavioral control (Control variables & Power over control variables).
    • Intention.
    • Behavior.
Theory of Planned Behavior - Example
  • Evidence suggests that:
    • Attitude can have a moderate-large effect on intention (Ha Sur 2022; Hagger et al., 2002).
    • Perceived behavioral control can be manipulated to increase exercise behavior (Darker et al., 2010; French et al., 2013).
    • Education is important (Schüz et al., 2017).
    • Intention has a moderate-large effect on exercise behaviors (Ha Sur 2022; Hagger at al., 2002).
Theory of Planned Behavior
  • Addresses the gap between limitations and behavior.
  • One solution is implementation intentions (i.e., goal setting, planning).
Transtheoretical Model
  • People move through five states towards the adoption and maintenance of exercise.
    • Pre-contemplation (no intention to change behavior).
    • Contemplation (intend to start exercising in near future).
    • Preparation (currently exercising but not regularly).
    • Action (physically active for less than 6 months).
    • Maintenance (physically active for more than 6 months).
Transtheoretical Model

*Model of Stages:
* Pre-contemplation
* Contemplation
* Preparation
* Action
* Maintenance
* Termination

Transtheoretical Model
  • Model doesn’t explain how to go between stages.
  • Intended to be combined with other theories/models (e.g., self-efficacy theory).
  • Studies that have incorporated self-efficacy have been most effective.
  • Long-term effectiveness has been critiqued (i.e., maintaining behavior).

The Importance of Targeting Behavior Change and Maintenance

  • Highlights the need for strategies to both initiate and sustain health-promoting behaviors.

Gym Dropout Rates

  • The dropout rate for new members signing up to a gym (fitness center) was 45% by the second month, 86% by six months, and 96% by the 12 months (Sperandei et al., 2016).

Summary of Theories

  • Health Belief Model centers on our perceived threat of disease, balanced against the benefits and barriers to acting.
  • Protection Motivation Theory builds on the Health Belief Model by considering self-efficacy.
  • Self-Efficacy Theory highlights the role of our efficacy beliefs in behavior.
  • Theory of Planned Behavior focuses on intentions – which are determined by attitudes, subjective norms, and perceived behavioral control.
  • Transtheoretical Model outlines the stages of change and can be combined with other models.

Consistencies Across Behavior Change Models

  • Importance of:
    • Self-efficacy and perceived control
    • Attitudes and beliefs
    • Intentions