APPLIED

PSYCHOLOGY
Health Psychology

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What is health?

A state of complete physical, mental and

social well-being and not merely the absence
of disease of infirmity
(WHO, 1948, p. 100)

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What is Health Psychology?

Health psychology is the aggregate of the educational,

scientific and professional contributions of the discipline
of psychology to the 1) promotion and maintenance of
health, the 2) prevention and treatment of illness, the
3) identification of etiologic and diagnostic correlates of
health, illness and related dysfunction and the 4)
improvement of the health care system and health
policy formation.
(Matarazzo, 1980, p. 118)

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What is Health Psychology?
Health psychology is both an academic discipline
and a profession
 An academic discipline:
 Research focuses on the causes and processes
underpinning health and illness
A profession:
 Professional health psychologists work towards
improving health care and the delivery of health care

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A Biopsychosocial Model of
Health
An integrated model of health psychology drawing on
many disciplines including:

Biology Organisational psychology

Medicine Social psychology
Economics Developmental psychology

Aims to provide a comprehensive picture of the causes

and processes under-pining health and illness.
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A Biopsychosocial Model of
Health and Illness

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Constructing Theories of
Health Psychology

 Health psychologists aim to describe, explain,

predict and change the processes, systems and
outcomes associated with health and illness.
 Theories allow health psychologists to predict
what might happen if some element or process
in a system change.

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Observation and Induction

• Many theories are based on induction.

• Induction - The observation of repeated associations.

• However, identification of associations does not explain

why an association occurs.

• Theories are based on ideas that explain why these

associations occur.

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 Theory Testing

• The various components of a theory must be

measurable, so that the theory can be tested.

• The ability of health psychologists to measure the

processes described by theories depends on the
development of measures and equipment.

• Technological advances are important, as they can lead to

the creation of improved measurement techniques, such
as fMRI.

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Deduction

• Deduction: The process of drawing conclusions

from premises assumed to be true.

• Deductive reasoning forms the basis for testing

theories.

• Once we deduce what outcomes should follow

from our theory, we can test whether what we
have observed supports our theory.

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Interventions and Evaluation

• Interventions are psychological ‘treatments’

based on theories that have been supported by
evidence.
• Interventions seek to change the systems that
theories describe.
• The effectiveness of interventions can be tested
using experiments, such as randomised control
trials.

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Social Context of Health

 Poverty affects health by depriving individuals

of their basic health-related needs, e.g. clean
water, nutritious food, damp-free homes.
 Health inequalities are the differences
between the health and life expectancy of
individuals affected by social and economic
factors, amongst others.

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Wealth Distribution and
Health
 Epidemiological transition - A wealth
threshold which, when crossed by a country
means that increased national wealth has little
effect on the overall health of the population.
 In developed countries such as the UK,
increases in national wealth are only weakly
correlated with improvements in health.

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Wealth Distribution and
Health
But, in developed countries, increases in
individual wealth are strongly correlated
with improvements in health.

This is due to the biased distribution of

wealth within developed countries

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Health Change Behaviour

• Wealthier individuals may be more able to sustain health

behaviour change and may benefit more from these changes.

• Health behaviour change may be more difficult amongst

poorer individuals because:
– A lower, daily quality of life reduces motivation
– Health-damaging behaviours may be seen coping
mechanisms for dealing with everyday stressors.
– Changes may have less impact on their future health
because social circumstances expose them to a greater
range of health risks.

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Socioeconomic Status and
Health

• The link between Socioeconomic Status

(SES) and health cannot be explained by
differences in health behaviour between the
rich and poor.
• Differential Exposure Hypothesis suggests
that low SES individuals are less well equipped
to cope with stressors because they have
fewer material and social resources.

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Behaviour Patterns & Health

• Lifestyle factors predict how long we live.

• Two large-scale longitudinal studies have shown that

the following factors are associated with mortality:
– Smoking
– Physical activity
– Alcohol consumption
– Healthy diet
(Belloc & Breslow, 1972; Khaw et al., 2008)

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Determinants of Individuals’
Behaviour
• Behavioural determinants need to be identified in order
to initiate health behaviour change.

• Behavioural determinants are the underlying causes

of behaviour including beliefs, attitudes and intentions.

• The information-motivation-behavioural skills model

provides a useful guide for identifying behavioural
determinants.

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Information-Motivation-
Behavioural Skills Model

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Information

• Lack of relevant information can predict

negative health behaviours.
• There are a number of reasons why individuals
may not have the relevant information:
– Information is not generally available
– Information not available when decision making
– Information is provided in a confusing manner.
– Information from disliked or poorly informed or
untrustworthy source

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Motivation
• Once relevant information has been provided in an
easy to understand format – and from a reliable
sources - practitioners can then work on improving
individuals’ motivation.

• There are a number of psychological models that

identify elements of elements of motivation that
psychologists use in this process.

• Theory of Planned Behaviour is one such model

and will be discussed in depth in Chapter 10.

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Behavioural Skills

• Once motivation has been established, individuals need to

develop the skills needed to perform a behaviour.

• Abraham et al (2008) have identified 3 types of behavioural

skills:
– Self-regulatory skills
– Motor skills
– Social skills
• Skills development enhances self-efficacy - the belief that one
can perform an action or series of actions successfully.

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Multi-Level Framework for
Health Behaviour Change

Social Ecological Model of Change is a

model emphasising the different levels at
which intervention may be required to
successfully change behaviour
Health psychologists may be involved in
individual, family, community,
organisation, national and international
interventions.

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Multi-Level Framework for
Health Behaviour Change

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NICE Guidelines
National Institute for Health and Clinical
Excellence (NICE) provides guidance on
behaviour change.
◦ Emphasises the importance of assessing and
intervening to change the social context which
health-related behaviour develops and is
sustained.
◦ Health promoters need to remove social and
financial barriers

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NICE Guidelines
◦ Policy makers need to focus on reducing
poverty, limited employment and poor
education opportunities.
◦ Therefore health psychologists need to
promote societal, as well as individual level
change

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Planning Interventions
• ‘Intervention Mapping’ is a step-by-step
method for planning, developing and
evaluating behaviour change interventions.
(Bartholomew et al., 2006)

• Planning is important. A review of 70 studies

found that planning was the best predictor of
intervention effectiveness.
(Mullen, Green & Persinger, 1985)

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Planning Interventions

• 6 stages of intervention planning

have been identified:
1. Needs assessment
2. Setting change objectives
3. Theoretical design
4. Conversion to practical plan
5. Implementation
6. Evaluation

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Enhancing Health Care
• Three types of prevention:
– Primary Prevention: Interventions to prevent
illness
– Secondary Prevention: Interventions designed
to change patients’ responses to their illness and
so prevent long-term illness.
– Tertiary Prevention: Interventions designed to
promote coping with illness or minimise the
effects of established illness, rather than prevent
illness.

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 Improving Adherence
• Between 15% and 93% of patients do not
follow health-care professionals’ advice.
(Abraham et al., 2008; Myers & Midence, 1998)

• Even when the consequences are fatal, many

patients still do not adhere.

• Non-adherence is expensive as it can lead to

further demand on health-care systems.

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Improving Adherence

Patients fail to adhere to medical advice for

a variety of reasons:
◦ Forget
◦ Find it difficult
◦ Fear of medication dependency
◦ Disagree with health-care
practitioner’s diagnosis or prescribed
treatment

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Improving Adherence
• A number of factors have been shown to be
significantly correlated with adherence:
– Patient satisfaction.
– Doctors satisfaction with their own work.
– Social support.

• Interventions for improving adherence are

often targeted at improving each of these
three factors.

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Improving Health-Care
Professionals’ Consultations

 The way in which health-care professionals

manage consultations with their patients
determines their own professional
effectiveness.
 Positivity is important
◦ Practitioners should adopt a positive approach, and
encourage a positive approach in their patients.
(Little
et al., 2001)

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Models for the Improvement
of Practitioner-Patient
Interaction
• The Calgary-Cambridge Model was designed to
improve consultations and practitioner-patient
interactions. It outlines six stages:
1. Initiating the consultation
2. Gathering information
3. Building a relationship
4. Providing structure
5. Explanation and planning
6. Ending the consultation

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