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Monday 21 April 2014

Healthy living psychology: improving adherence (study by Watt)

Approach: Cognitive

Aim: To assess the effect of adherence to prescribed asthma drugs if a 'fun-haler' or incentive toy

Method: Self report and physiological measures

Sample: Type of sample-not stated. 32 Australian children, 10 male and 22 female, mean age -3.2 years. Range 1-6. Average duration of asthma- 2 years, participants on prescribed drugs delivered by PMDI (paediotric metered dose inhaler) and spacer

Procedure: Medicine was administered using a standard inhaler for 2 weeks followed by the Funhaler for 2 weeks 

Results: 38% more patients were found to have used the medication on the prescribed period compared to the normal inhaler.

Discussion: The authors concluded that although no significant difference has been found in the medication delivery using the funhaler there was still marked improvements in the parental usage and the Children's effective use of the funhaler

Evaluation:

Sample
Advantage(A): covers both male and females who were 'experienced' asthmatics,
Disadvantage(D):quite young participants therefore the results cannot be generali:: to older people, only conducted in Australia and small sample size.

Validity:
(A): internal validity as the parental self reports were checked against the physiological measure of calculating volume of air inhaled by the child an the quantities of medication absorbed.
(D): subjective measure which would have been affected by demand characteristics. No qualitative data was gathered

Reliability:
(A): objective reliable physiological measure used. All patented completed a standardised self report. Quantative data.
(D): May not have gathered factual information-just what the parents could remember and it's hard for them to remember small tasks such as administering medicine.

Ethics:
(A): parents gVe informed consent. Anything which helps children medically is surely good for the protection of their health.
(D): Children were unable to give consent/withdraw from the study 

Usefulness:
(A): marked improvements in both parental usage and children's effective use of the funhaler, so it could lead to improved clinical outcomes and reduced morbidity from asthma
(D): only studied over a short time span so no idea about the long term effectiveness of the technique - it could have been novelty for both the kids and the parents therefore constant reinforcement may not be as effective

healthy living psychology: improving adherence (concept)

Background to improving adherence- Operant conditioning

Operant conditioning is a form of learning in which a individuals behaviour is modified by its consequences;the behaviour may change in form,frequency, or strength. Operant conditioning is distinguished from classical conditioning in that operant conditioning deals with the modification of "voluntary behaviour". Operant behaviour operates on the environment and is maintained by its consequences. while classical conditioning is not.

Reinforcement, punishment, and extinction

Reinforcement and punishment, The core tools of operant conditioning, are either positive (delivered following a response), or negative (withdrawn following a response). This creates a total of four basic consequences, with the addition of a fifth procedure known as extinction (no change in consequence following a response.)

It's important to realise its not the people themselves are not spoken as being reinforced, punished or extinguished it is the actions which are spoke of like that. those 3 terms are also not restricted to the labs as there are naturally occurring consequences can also be said to reinforce, punish, or extinguish behaviour and are not always delivered by people.


  • Reinforcement Is a consequence that causes a behaviour to occur with greater frequency
  • Punishment is a consequence that causes a behaviour to occur with less frequency
  • extinction is caused by the lack of any consequence following a behaviour. When a behaviour is inconsequential (no response at all) it will occur less frequently. When a previously reinforced behaviour is no longer enforced with either a positive or negative reinforcement, it leads to a decline in that behaviour.
Four contexts of operant conditioning

Here the terms positive and negative are not used in their popular sense, but rather: positive refers to addition and negative refers to subtraction.Positive and negative can both come under reinforcement or punishment. The means Positive punishment is sometimes a confusing term as it adds something to the negative stimulus or increasing the intensity of a stimulus which is bad such as spanking or an electric shock

  1. Positive reinforcement (reinforcement): occurs when a behaviour (response) is followed by a stimulus that is appetitive or rewarding, increasing the frequency of that behaviour. e.g. giving s sweet if a child is well behaved
  2. Negative reinforcement (Escape): occurs when a behaviour (response) is followed by the removal of an aversive stimulus, thereby increasing that behaviours frequency. for example if you put sun cream on before going to a beach you will avoid getting sunburnt, by getting rid of the aversive stimulus (sunburnt) the health behaviour is more likely to be used again
  3. Positive punishment: (Punishment): occurs when a behaviour (response) is followed by a stimulus, such as introducing a shock or loud noise, resulting in a decrease in that behaviour.
  4. Negative reinforcement (penalty): occurs when a behaviour is followed by the removal of a stimulus, such as taking away a childs toy following an undesired behaviour, resulting in a decrease in that behaviour such as taking away a toy if a child is naughty.
Using operant conditioning to improve adherence
 
The funhaler toy circuit design: harnessing play for drug delivery in an attempt to address the adherence problem from a new perspective (that of a child), a novel low volume spacer device, the 'funhaler' was designed. This device incorporates a number of features to distract the attention of children from drug delivery event itself and to provide a means of self-reinforcing the use of effective techniques
 The Funhaler differs from previous attempts in numerous ways for example it has incentive toys which is in a separate branch to the standard inhalation circuit, its set near the experimentary valve so it avoids contamination of drug delivery and the design attempts to link the optimal function of they toys to deep tidal breathing pattern conductive to effective medication

Healthy living psychology: measuring adherence (study by Chung and Naya)

Approach: cognitive

Aim: to investigate the use of track cap to measure the adherence of oral asthma medication.

Method: Objective, Track-cap and electronic measures

Participants: 57 asthmatic patients-47 completed the study-beginning 12 weeks of asthma medication

Procedure: Used on electronic device (track cap) on the medicine bottle which recorded the date and time of each use of the bottle. Compliance was defined as the number of Track cap events per number of prescribed tablets and its difference between number of tablets dispensed and number returned per number prescribed. The patients were told that adherence rates were being measured but not told about the details of track cap. It took place over 12 weeks. The medication was supposed to be taken twice a day 8 hours apart.

Results: Over a 12 week period, compliance was relatively high (median 71 percent) and if the measure was a comparison of track cap usages with the number of tablets then adherence was even higher (89 percent)

Discussion: These results show that compliance with aid adherence to a treatment of an oral, twice-daily, maintenance asthma medication is high

Evaluation:

sample:
Advantage (A): all had asthma which matched the criteria
Disadvantage(D): 10 participants didn't complete the study, 47 if a small sample size

Ethnics
A: consent was given confidentiality- no names given in study
D: The participants were not told about the details of Track Cap

Validity:

A: Good face validity compared track cap with the number of tablets- all objective data no bias
D: Temporal validity-13 years ago and it doesn't measure if they actually took them

Reliability:

A: objective measurement
D: lower control- can't see if people were actually taking the tablets

Usefulness:
A: Practical applications as it gives reasons why people don't take the tablets
D: Doesn't suggest ways to improve adherence and was low validity as it doesn't measure if they had actually taken them x

Healthy living psychology: measuring adherence (concept)

Types of request:

One of the issues to consider with adherence is the type of behaviour we are asking someone to follow. Requests for health adherence can usually be discussed with the friends and family of the participant as well.

types of health request fall into a number of categories:


  1. requests for short-term adherence with simple treatments, e.g. 'take these tablets twice a day for three weeks.'
  2. Requests for positive addictions to lifestyle, e.g. 'eat more vegetables and do more exercise'
  3. Requests to stop certain behaviours e.g. 'stop smoking'
  4. Requests for long-term treatments regimes, for example sticking to a diabetic diet, or the diet prescribed for people undergoing renal dialysis.
a cursory look at these types of request reveals some striking differences, and suggests that the problems of adherence might be different for the different types of medical request. e.g. short term treatments or alot easier to follow than long term ones which can greatly change there life and make them feel uncomfortable such as not being able to go out to the pub with friends which greatly increases the barriers, alot more than the short term requirements.There is too much simplification within adherence and there is very different reasons for non adherence for each category.

When we look at studies on adherence there are two reasons for thinking that the estimates of adherence may be a bit optimistic. 
  • The first problem is the selection of people to take part in the studies. e.g. a lot may of the same personal variables such as economic status or age and also people with low adherence may not answer to a self report because they are unconfident whereas high adherence ones would not care. 
  • The other problem with adherence research is that people wont always tell the truth. one of the reasons for this is to present a good impression to health workers.This can be very important, since the patient might well believe that they will only receive the best treatment if the health staff believe that they are carrying out their instructions. An extreme example is of smokers who have been refused treatment if they admitted that they were still smoking (social desirability bias).

Implication for improving adherence

Measurement techniques

It is important to develop reliable ways of measuring adherence and the following methods can be used:
  1. Self Report: Ask the patient ans they may tell you how adherent they have been- studies have shown they seriously over estimate there adherence when compared to medical records.
  2. Therapeutic outcome: Is the patient getting better? for example is the patient is taking medication for hypertension then we would expect there heart rate to decrease however there may be a range of other factors involved so its reductionist.
  3. Health worker estimates : ask a doctor and they should be able to estimate how adherent a patient is being, this has been to be highly unreliable and subjective.
  4. Pill and bottle counts: If we count the number of pills left in the bottle and compare it with the number that should be there and we get a measure of adherence. Problem with this method is the patient may throw the pills away.
  5. Mechanical methods: A number of devices have been developed to measure how much medicine is dispensed from a bottle, These devices are expensive and they only measure how much medicine goes out the bottle, not into the participant
  6. Biochemical tests: It is possible to use blood tests or urine tests to estimate how adherent a patient has been with their medication. For example, it is possible to estimate adherence with diet in renal patients by measuring the levels of potassium and urea in their blood when they report for their next session of dialysis.
Overall, we can use a wide variety of methods to investigate patient adherence, but like all methods in psychology, they only produce estimates of behaviour, and they all contain some degree of error. A treatment that is growing in the UK is oral asthma medication, and measuring adherence rates will help us to measure the effectiveness of the medicines. If people follow the prescribed treatment programme they should reduce the attacks of breathlessness, but many people forget or decline to take the medication regularly. A study by chung and naya was done into this and this is explained in the next post

Healthy living psychology: Reasons for non adherence (study by Watson and Lowe)

Approach: Cognitive

Aim: to assess the extent to which intentional non-adherence to medical regimes is present in elderly patients.

Method: Self report

Sample: Random Sample, 161 patients, aged 65+, All taking 3 or more drugs prescribed from a general practice. Mean age :76 Range- 65 to 96. 53 were male (33%) and the rest were female. 71% lived alone. Mean number of medicines prescribed was 4.

Procedure: All participants were visited at bom, They were all interviews using a structured questionnaire, they were asked a) which medicines they took b) the dose taken c) how often). Responses were compared with their medical records. Patients were then questioned about any discrepancy between their responses and their records.

Results: There was a discrepancy in 86 cases (53% of sample). In 28 cases the discrepancy was due to an administrative error e.g. wrong prescription recorded. In 3 of these cases it was due to patient confusion. The remaining 55 patients made a rational decision to alter their medication . Overall 92 different medicines were involved. 51 medicinews were no longer being taken by the patients. in 19 cases dosage was adjusted. In 22 cases frequency was adjusted.

Reasons for non adherence:

  • Side effects: 17
  • Drugs not working: 12                                          (explain these)
  • drug not needed:10
  • adjustment to symptoms:17


Discussion: according to this student, the stereotypical image of elderly peoples non adherence to prescribed medication is not due to confusion. They argued that the elderly patients weigh up the cost and benefit of their adherence or non-adherence and showed intentional non-adherence. They believed they were making rational decision about the medication. They concluded, that it was concerning that patients didnt communicate their concerns with there doctors.

Evaluation

Sample:
Advantage(A): fairly represent both genders, large sample, ethnocentric
Disadvantage (D): demand characteristics-self report therefore they may over/underestimate there adherence, Mean age-76 which represent the elderly so its representative.

Validity:
(A): no order effects, good face validity and good temporal validity
(D): Self report so there will be demand characteristics and social desirability, also participant variables will be a issue seen as there is other problems with them and subjective answers.

Reliability:
(A): structured questionnaires so it is standardised
(D): out of date records

Ethics:
(A) protection enhanced and they had consent

Useful:
(A): collect both quantitative and qualitative data so they had patterns and why it happened- went back to find out why. also they proved elderly do make choices.
(D) Not much about the demographic details and you cant generalize them to other groups

Tuesday 15 April 2014

Healthy living psychology-reasons for non adherence (concept)

What is it

Doctors and nurses spend much of their working fine discussing and assessing patients healthcare problems and recommending actions which will help restore or maintain health. On the basis of these consultations, healthcare professionals (HCP) may recommend taking medication at set times. Keeping clinical appointments, attending physiotherapy, taking prescribed exercise or avoiding health risk behaviours such as unhealthy eating, unsafe sex or smoking. But approximately 50% of patients do not take prescribed treatments as recommended and, across the various recommendations made by HCP's anything from 15% to 93% of patients do not act on recommendations.

In terms of health, adherence(also known as compliance) describes the degree to which a Patient correctly follows medical advice. Most commonly, it refers to medication or drug compliance,  but it can also apply to other situations such as medical device use. Self care, self directed exercises or therapy sessions. Non adherence therefew refers to when a patient fails to correctly follow advice

Reasons for non adherence

There are a number of explanations for why people so not stick to their prescribed medical regime, but these can be devised into two types: intentional and non intentional. Non-intentional reasons include confusion and forgetfulness. People can forget intake the occasional dose or they may forget to go to the soviets to renew their prescription. Depending on the nature of the medicine prescribed. Not tracking the whole course can be unimportant d the patient is feeling better, or it can be serious. 

Intentional non adherence can be for a number of reasons, from the unpleasant taste to lack of faith in the nature of the medicine. Anything that is intentional is a act that has been consciously decided upon by a reasoning process (cognitive). In other words the patient will have carried out a cost-benefit analysis and come to a conclusion that either it is in their interest to adhere to the medical regime or not. Any such reasoned decision is suggested to be rational, but doctors may not regard it as rational as their perspective is different.

Rational non adherence is therefore an explanation for non adherence which is intentional- a conscious decision is made not to comply to medical advice. It is a cognitive explanation which involves a cost- benefit analysis on the part of the patient. Who then actively weighs up their perceptions of the pros and coma of compiling with the medical advice they have been given.
Factors such as time required, side effectsc or no immediate improvement in their health could be examples of costs which patients decide are greater than any expected benefits. Short term costs can often outweigh long term benefits in the mind of the patients (Link to HBM)

Anecdotal example: if you are taking anti biotics which make you for sick for a week when symptoms have already vanished- costs higher than benefits-severity is lowered so you stop when the costs outweigh benefits

Health promotion psychology-fear arousal (Study by ruiter)

Approach:

Cognitive

Aim:

To examine the effect of fear arousal on attitude toward participating in early detection activities(breast self examination for cancer)

Method:

Lab experiment/independent measures

Sample:

Volunteer sample of 88 female participants, all first year undergraduates who attended he university of Maastricht in the Netherlands. Mean age of 20.

Procedure:

Participants were randomly assigned to a 2 x 2 condition
Conditions were 
1. Low versus mild fear 
2. Weak versus strong argument 
Participants completed a questionnaire measuring there pre experimental attitude towards self examination. They were the. Told that they would evaluate the effectiveness of several educational messages about breast cancer.
The experiment was computer controlled. Participants first read a message about the threat of breast cancer (containing manipulation of fear). This was followed by a self report measure of fear arousal. The participants then read a message about performing a monthly breast examination these were supported by 8 weak or 8 strong arguments. A questionnaire was then administered with the post-experimental attitude as the dependant variable. The fear manipulation consisted of different levels of implied severity of breast cancer and susceptibility of participant. Argument strength varied.

Measures - Level of fear arousal was measured by reaction to 10 mood adjectives e.g nervous, frightened. These were then put on a 4 point scale and then averages into a fear arousal index

Attitude towards performing a monthly breast self-examination was assessed by four 7-point word pairs e.g. Unimportant-important. These were then averaged into a single attitude index. 2 items asked participants if they knew someone who had suffered breast cancer or another kind of cancer. Participants were then fully debriefed an offered information on breast cancer and how to perform the self examinations

Results:

The main effect of manipulated fear was not statistically significant. Nor was the predicted interaction between fear and argument strength.
However there was a significant main  effect of argument strength suggesting argument based message processing, irrespective of the level of evoked fear. There was also significant interaction between reported fear and argument strength. Participants with low fear did not differ in attitude towards breast self examination after reading either the weak or strong persuasive message. Whereas those who reported mild fear indicated that they had evoke more positive towards breast self examination after reason the strong persuasive message rather than the weak message.

Discussion:

Unlike earlier studies this study found only effect of reported fear. The authors conceded that it would have been more reliable to use physiological measures of reported fear rather than relying on self report measures. They concluded that their study supported the hypothesis that evoked fear motivates people into more argument based processing l.
However they accepted that their findings may only be generalizable to breast self examination or similar detection methods and should not be generalised to primary prevention behaviours such as using condoms to prevent HIV

Evaluation
 
Sample:
Advantage(A): 88 is an ok sample size. Volunteer sampling is a quick and easy method.
Disadvantage(D): It only reprints first year students. The age of students could be influential in their responses. Only conducted in the Netherlands. Volunteers may be A typical as they may have petticoat beliefs about the topic area before it began.

Validity:
A: high level of control for ensuring they could establish cause and effect through direct manipulation of the fear arousal IV 
No order effects as it was an IMD.
Mood adjectives should have been fairly clear:
D:IMD means that these is possibility of participant variables.
Possibly issues of interpretation of scales.

Reliability:
A: quantitate data was gathered which can be reliability measured.
D: Self report measures of reported fear may not be as effective as physiological ones.

Ethics:
A: P's volunteered so consent would have been gained. P's were fully debriefed and offered information on breast cancer and how to perform self-examination 
D: Is the use of fear ethical? Sensitive topic so protection would be a consideration

Effectiveness:
A: significant effect of strength of message on p's who reported mild fear rather than low fear.
D: No significant effect of the manipulation of fear. Fear manipulation did not have a direct effect.

Usefulness:
A: the finding are important as they show that an audience may be receptive to health promotion where fear of a condition is already high or where such fear can be evoked by emotive imagery
D:  findings may only be generalizable to breast self examination or similar detection methods and should not be generalised to primary prevention behaviours such as using condoms to prevent HIV




Health promotion: Fear appeal/arousals. (concept)

What is it?

A fear appeal- is a persuasive message which emphasis the harmful physical/social consequences of failing to comply with the recommendations of the message, it is a message designed to elicit fear in an attempt to persuade an individual to pursue some predefined course of action.

Some health promotion messages use fear appeals as a means of stimulation behavioural change. The idea that fear aroused in the target population will motivate them to change their behaviour and their attitudes.

Fear appeals: have the intent to alter intentions and motivate individuals to act on a message. Much of the research has been directed at establishing the relevant variables in both the target of the message, as well as the message itself.

Components

Researchers have examined several variables that have been thought, at one time or another, to influence the persuasive effect of fear appeals. These are the perceived threat, the strength of fear elicited, perceived efficacy, individual characteristics and defence mechanisms.

Perceived threat: Is thought to be an important moderator in the process of fear evoked persuasion. it consists of the perceived severity of the threat and the perceived susceptibility to it. LINK TO THE HBM

Perceived susceptibility:  Sometimes referred to as perceived vulnerability, is thought to be key in motivating an individual to act in response to a fear appeal. It is the perception of the probability and extent to which they might experience the threat. Perceived severity, however, is the degree to which the person believes that they will be harmed if the threat is experienced. These threat components form a perceptual trigger for the fear reaction, Perceived severity, the extent to which the individual believes they will be adversely affected by the threat has significant effect on persuasion. Though, in some cases, persuasion has been found just the opposite. Research has found that the effect of fear on intentions is mediated by the perceived severity. That is, fear does not act directly on intentions, but increases the level of perceived severity, which ion turn raises the intentions to act on the message.

Fear strength:

The strength of the fear elicited by the message is also an important determinant of the subjects intentions to change the target behaviour. Fear strength is distinct from threat severity in that, as mentioned before, fear strength is related to the emotion of fear, whereas threat severity is considered to be an entirely cognitive process. Some early research found that higher levels of dear produce defensive reactions, compelling the researchers to caution that low or moderate levels were most effective. They argue that although persuasion increases when fear rises from low to moderate levels, when rising from moderate to high levels, it actually decreases.

Individual Characteristics

A lot of interest in fear appeals literature has been the contribution of the individual characteristics. The goal has been to understand which Individual differences in personality or psychological traits contribute or detract from the effectiveness of the fear appeal. Individual moderation variables studied this far include age ethnicity, gender, coping style, locus of control, self-esteem and perceived vulnerability.

Perceived efficacy

Quite possibly the most integral element of an effectively persuasive fear appeal, and mre predictive of action than fear arousal, is perceived efficacy, this has two components; perceived self-efficacy and perceived response efficacy. perceived self-efficacy  is the extent to which the person believes they are able to avert the threat presented in the fear appeal message. Though there has been some concern that repeated exposure may result in a 'fatalism' effect, in which individuals develop a form of learned helplessness in regard to the threat, the majority of research shows that self efficacy is essential for persuasion in fear appeals. Perceived response efficacy, the belief that the action recommended will avert the threat, is another important fear appeal element. If the individual does not believes that he or she is capable of averting the threat, it is likely that denial or some other defensive response will be produced in order to lower fear. Some research has found that perceived efficacy is more predictive of intention to change behaviour than either element of perceived threat.

Defence mechanisms

The previous components are thought to determine what response an individual has to the message. One of these potential reactions to the fear appeal that is of the most negative consequence is that of the defensive fear control reaction. In response to the fear appeal, an individual May form the intent to change their behaviour. However, when either self or response efficacy is low, the individual, perceiving that they are unable to avert the threat, may rely on defensive avoidance to lower their fear.

However, research suggests that this underlying assumption does not always hold true. Some researchers have questioned the effectiveness of evoking fear when trying to persuade people to change

There are several interesting debates around the concept of fear arousal:

Whether a high fear level is more effective than a middle of lower level of fear and various studies province contradictory evidence.
The extent to which it is ethical to scare people. While around sing fear may well be considered to be unethical to many, there is a the counter-view it is worthwhile if people stop drinking driving or give up smoking-the ends justify the means.



Saturday 12 April 2014

Health promotion psychology: Legislation (study by Wakefield)

Approach: cognitive

Aim: to determine the relation between the extent of restrictions on smoking at home, in school and in public places an smoking uptake and prevalence among school students
Method: self report
Sample: sample of 17 000 Hugh school students, from 202 schools In the United States. One school (grades 9-12; age  14-17) in each county of the mainland of United States were randomly selected-73% of all schools selected agreed to participate.
One class from each grade was selected. All the students in these class's were invited to participate -
80% of students in samples class's completed the questionnaire.
Procedure: questionnaire measures
Questionnaires contained demographic data and information on whether adults in the home and sibling in the home were smokers.
They added some additional questions on family planning, sexual activity and behaviour, and exposure to various media campaigns.
Smokers were then classified by stage of smoking uptake. This was done on the basis of responses of questions on smoking history and intentions.
Participants were classified into the follow categories:
  1. Non susceptible non-smokers
  2. susceptible non-smokers
  3. early experimenters
  4. advanced experimenters
  5. established smokers
  6. current smoker
Home smoking restrictions were defined by responses go questions such as '£9/ is cigarette smoking handled in your home?' Included closed questions such as;
(a) no one is allowed (b) Special guests allowed only (c) Smoking allowed in certain areas in my home (d) smoking as allowed anywhere in my home.

Two measures of school smoking were ascertained:
  1. Whether there was a ban or not.
  2. If there was a ban how strictly was it enforced.
Researchers then added information on: state,county and city laws relating to restrictions on smoking in public places for the 202 school sites.
  • Strong public place restrictions were defined as: (a) Restrictions in private worksites and public restaurants.
  • Moderate public place restrictions were defined as: (b) Restrictions in either private worksites or public restaurants.
  • Weak public place restrictions were defined as : (c) restrictions in neither of these enviroments
Results:The study found that legal restrictions and enforced bans were significantly associated with not developing an early smoking habit, that home bans were more effective that legal restrictions on taking up smoking, and extensive restrictions on smoking in public places were associated with lower probability of transition between later stages of transition. However, school bans appeared to actually increase the probability of transitions to the last stage. It was concluded that school bans needed to be enforced to actually be effective and that although causality cannot be deduced, their findings are consistent in showing that parental opposition and banning smoking in the home reduces the uptake of smoking amongst teenagers.

Statistical analysis: Logical regression analysis was used to examine yh association between smoking status and smoking restrictions. Each analysis was adjusted for school,grade,sex, whtter adults/ siblings at home smoked.

Evaluation:

Sample:
Advantage(A): large sample size, range of schools across USSA, high response rate of both schools and students in classes, no bias in sampling method
Disadvantage(D): Only generalizable to America and to P's aged 14-17 (young people maybe more influenced by restrictions) what about the opinions od those who said no? A typical-bad kids not even taking the survey

Validity:
A: Appears to have face validity and internal validity as the questions were straight forward and classification of students should have been self explanatory
D: Cause and effect was difficult to establish. There might be other factors which influence teenage smoking apart from restrictions on smoking and these might lead to an artificial relation between restrictions and smoking as the study didn't control for other factors. Also the self-report method is always open to lies and social desirability, which may be enhanced by the p's age.

Reliability:
A: the same questionnaire was used for all students. Quantitative measures were used which allows for comparisons. Statistical tests were used to analyse data.

Ethics:
A:  P's agreed to take part so consent was given
D: Is it possible that consent and withdrawal may have been compromised because of the link to authority within the school setting?

Effectiveness:
A: Parental opposition to smoking and banning smoking in the home effectively reduce the uptake of smoking in teenagers
D: Legal restrictions in the public places and school bans, have a less effective impact upon smoking uptake, with school bans only being effective when strictly enforced.

Usefulness:
A: The study could be used to advise parents on the strategies they could use to help prevent children from starting to smoke.
D: The study is reductionist which lowers the usefulness, as does the weaknesses of self-reports.

Thursday 10 April 2014

Health promotion psychology: Legislation (concept)

What is it?

Education and legislation are amount the strartagies available to persuade individuals to change their behaviour to reduce the risk of injury/poor health. Legislation refers to the law an more specifically on this case,changes to the law which are designed to reduce risk of injury/poor health. In essence, people are no longer given free will over certain behaviours.in the latter part of the 20th century laws were passed in the UK enforcing the wearing of seat belts in cars and reducing the risk of alcohol consumption in drivers. Both legal restrictions have undoubtably saved lives. However, not all legitislation is as successful e.g. Laws against drug taking, this is because some legitislation causes a increase by making things like drugs more expensive on streets so more drug dealers appear etc.

How can it be applied to health?

 Legislation can have a powerful and immediate effect on health behaviours as it is a effiecient way of affecting the enviroment and context in which health behaviours are implremented. Legislative approachs tend to focus onthe measures that act tocreat barriers which reduce the cues to unhealthynehaviours.These measures include restricting availibility, taxation and reduced advertisements.Changes in the law force peopleto adhere to a particular behaviour, However it is only effective if it is enforced

Advantages and disadvantages

Advantage: legitislation reachs a large population very fast and actually reduces the free will choice of committing a dangerous behaviour and will greatly increases the barriers to the HBM as large fines etc happen if the behaviour is commited

Disadvantage: it's at the discretion of police meaning it's up to each police officer if they choose to enforce the law or not. And some petty laws are not enforced for example littering does usually not get enforced so people don't see the consequences therefore the behaviour continues, it needs to be regularly enforced.

Tuesday 8 April 2014

Health promotion psychology: Mass media (study by keating)

Approach: cognitive

Aim: To access the extent to which a mass media campaign (VISION) focusing on reproductive health and HIV/AIDS prevention resulted in increased awareness and prevention of HIV/AIDS.

Method: Self report (interviewed and responded to a questionnaire).

Sample: stratified, random sample of 3278 participants, aged 15-49 from various ethnic groups in 3 Nigerian states. Approx 60% were married, mean age of 28.

Procedure: Data was collected by trained interviewers who interviews respondents using a questionnaire which was based on one used for a national survey, but which has additional questions on family planning, sexual activity and behaviour, and exposure to various media campaigns. Interviewers obtained verbally informed consent. Respondents were asked whether they has listened to specific radio programmes, watched particular television campaigns, seen any HIV/AIDS or reproductive health adverts in newspapers or received any information from clinics of community health workers about HIV/AIDS or reproductive health workers about the same thing.
Participants responded to the following fixed choice questions (Yes/No)

  1. Have you ever talked with a partner about ways to prevent getting the virus that causes aids?
  2. Can people reduce their chances of getting the aids veris by using a condom everytime they have sex?
  3. Did you use a condom during your last sexual encounter
Statistical tests were conducted to analyse results.

Results: 

  • Males were exposed to more media programmes but females were exposed to more clinic-based information.
  • 77% listened to the radio and 47% reported watching TV once a week.
  • Exposure to the VISION campaign was high. Those who reported high exposure to the VISION campaigns was 1.5 times more likely than those with no exposure to have discussed HIV/AIDS with a partner and over twice as likely to know that condom use can reduce the risk of HIV infection. However, exposure has no effect on condom use during the last occasion of sexual intercourse.
Discussion:
The VISION project was effective in that it reached a high proportion of its intended audience and increased HIV/AIDS awareness and communication. Clinic based session reach females better than males, Different media is important for different people. Different strategies are essential and a focus should be placed on sending information about where condoms can be sourced

Evaluation:
Sample: 
Advantage (A): Large. Use of stratified random sampling whicch improves the representativeness of the sample by reducing the sampling error.
Disadvantage (D) : Ethnocentric-only tells us about the impact of one specific campaign in one specific country

Validity: 
A: Trained interviwers were used, The questions were straight forward and tested the key points under investigation. Questions could only be yes or no- whilst fixed it was clearly yes/no
D: The nature of the topic area may bring up concern of demand characteristics and social desirability bias

Reliability:
A: The closed questions made the self-reports more reliable. Easily repeated.

Type of data:
A: Created quantitative data which was statistically analysed for patterns.
D: There is no qualitative data to explain the patterns found.

Ethics:
A: Obtained verbally informed consent.
D: Sensitive topic

Usefulness/effectiveness:
A: The mass media VISION project was found to be effective as it reached it's audience and increased awareness. Highlighted that different media are crucial to different sections of the population.
The study suggested that future health promotion should integrate information with practical advice about obtaining condoms ( link to removing barriers on the HBM)
D: One more question on the questionnaire asking about the reasons for/against using a condom would have been extremely beneficial to the study as we don't know WHY!
The study found that increased knowledge, understanding and discussion does not necessarily lead to changes in behaviour.



















Health promotion psychology: Mass media (concept)

What is it?

Mass media campaigns are widely used to expose high proportions of large populations to messages through routine uses of existing media, such as television, radio and newspapers. Exposure to such messages is,therefore,generally passive. Such campaigns are frequently competing with factors, such as persuasive marketing, powerful social norms, and behaviours driven by addiction or habit. Mass media campaigns have generally aimed primarily to change knowledge, awareness and attitudes, contributing to the goal of changing behaviour.

How effective can mass media be in promoting health?

It is apparent from the evidence that the media can be an effective tool in health promotion, given the appropriate circumstances and conditions. Some of the situations in which media have been found to be most appropriate are as follows:


  • When wide exposure is desired: Mass media offer the widest possible exposure, although this may come at some cost. Cost-benefit considerations are at the core of media selection.
  • When the time frame is urgent: Mass media off the best opportunity for reaching either large numbers of people or specific target groups within a short time frame.
  • When public discussion is likely to facilitate the educational process: Media messages can be emotional and thought provoking. because of the possible breadth of coverage, they can be targeted at many different levels, stimulating discussions and thereby expanding the impact of the message.
  • When awareness is the main goal: By their very nature, the media are awareness-creating tools. Where awareness of a health issue is important to its resolution, the mass media can increase awareness quickly and effectively,
Evaluation

  • May not been seen by full target audience which lowers effectiveness
  • recent technology has lead to people being able to skip adverts greatly lowering the effectiveness
  • just because its seen does not mean it will have an effect, defence mechanism activated if its too stressful
  • based on Yale model of persuasion of 1957



Healthy living Psychology: Self efficacy (study by zalwska-puchala)

Approach: Cognitive

Aim: To assess health behaviour of college students, to evaluate their sense of self-efficacy and to specify the relationship between health behaviour presented by participants and their sense of self-efficacy.

Hypothesis: That self-efficacy scores would correlate with healthy patterns of diet, low alcohol consumption, not smoking and engaging in physical exercise.

Method: Self report;correlation

Sample: Opportunity/self selected? 164 nursing degree students (153 female,11 male), mean age 21m various socio economic backgrounds.

Procedure: 2 self-report measures were used: The generalised self-efficacy scale and a Questionnaire of Health Belief which asked questions relating to diet, drinking alcohol, smoking and physical activity, The body mass index(physiological measure) was used to estimate a healthy body weight based on height versus width calculation.

Results: Most participants were found to be underweight (83%), had mainly high self-efficacy (54%) or average (38%). with only 8% characterised by low SE. It was not found that any socio economic variables affected SE levels.

Diet: a statistically significant correlation was found between SE and declared low fat diet. No correlation was found between SE and BMI and stated fibre consumption.

Smoking: There was no correlation between SE or BMI and smoking.

Alcohol consumption: A relationship was found between SE and drinking with those with high SE drinking alcohol was more common.

Physical exercise: Physical exercise: There was no significant relationship between self-efficacy and physical activity.

Discussion: Student were all characterised by high levels of self efficacy. The study confirmed the hypothesis about the SE only with relation to fat consumption. The surprising alcohol finding may be explained by young people with high levels of SE believing that they can safely control their consumption.

Evaluation:

Sample:
Advantage (A): representative of both genders, generalizable due to the various socio-economic
Disadvantages(D): Opportunity sample-generally high SE to do a SR confidence about themselves, Gender bias-few males.

Validity:
A: does actually measure the SE of students-based questions based on it. Gaining quantative data on the BMI and scale of SE so good to compare
D:Social desirability due to it being a self report

Reliability:
A:Self reports-standardised, easy to repeat
D: Self report, might of understood the question differently therefore cannot be consistent

Ethics:
A: Self selected- no deception and debriefing, gain consent
D: Protection- knowing they are not confident and overweight can cause psychological harm

Usefulness:
A: 2007 no issue of temporal validity because it's relevant. Alcohol finding about self find efficiency- campaigns about drinking so it can be taken into account
D: only conducted on medic students with a mean age of 21 therefore cannot be generalised to the target population.


Monday 7 April 2014

Healthy living Psychology: Self-Efficacy (concept)

What is it?

It is a construct of social cognitive theory

Self-efficacy (SE) is a person's belief in his/her own competemce, I.e as the belief that one is capable of persorming in a certain manner to attain a certain set of goals. It is believed that our personalized ideas of SE affect our social interactions in almost every way. Bandura has defined SE as ones belief in ones ability to succeed in specific situations. One's sense of SE can play a major role in how one approaches goals, task's and challenges. According to Bandura's theory, people with a high SE believe they can perform well therefore when they are presented with a difficult task they see it as something to be mastered rather than something to be avoided. SE can be closely related to Locus of Control, but the two are different in so far as Locus of control is concerned with what/who produces a particular outcome, whereas SE is the conviction that one's own behaviour will influence that outcome.



How SE affects human function

Choices regarding behaviour

People will be more likely to take on a task if they believe they can succeed. People generally avoid tasks where there SE is low, but engage in them if its high. People who's Se is actually beyond there own abilities can overestimate the goals they are capable of achieving which can obviously lead to great difficulties. However people with a lower SE than there ability will not expand their skills or grow seen as they wont challenge many things. The ideal SE is the optimum level which is a little above their actual ability which will lead the too succeed.

Motivation

People with a high SE in a task are more likely to make more of a effort, persist longer than those with a low SE. the stronger the AW or mastery expectations, the more active the efforts. On the other hang, a low SE provides a incentive to learn more about the subject. As a result, someone with a high SE might not correctly prepare for a task.

Health behaviours

Health behaviours such as non-smoking, exercise, dieting, condom use, hygiene, seat belt etc are dependant on the persons perceived SE, SE beliefs are cognitions that determine whether the health behaviour change will be initiated, how much effort will be expended and how long it will be sustained in front of obstacles and failures. SE influences the effort one puts forth to change risk behaviour and the persistence to continue striving despite barriers and setbacks that may undermine motivation. SE is directly related to health behaviour, but it also affects health behaviour indirectly through its impact on goals. SE influences the challenges that people take on as well as how high they set their goals (e.g., "I intend to reduce my smoking," "I intend to quit smoking altogether")

Critisms

You can argue that it is merely a cause of behaviour not a predictor
This theory predicts that students interest in a subject will reflect their grades which is not always the case
Attribution theory


Friday 4 April 2014

Healthy living Psychology: Locus of Control (Wineman study)

Approach:
  • Cognitive

Aim:
  • To investigate locus of control, body image and weight loss in obese individuals

Method:
  • Self-report/retrospective correlation

Sample:
  • 116 self selecting adult members of overeaters anonymous(OA) (12 male, 104 females). Mean age of 40, all were white and were form a range of social class backgrounds

Procedure:
  • Sampling procedure: volunteers were sought at an OA workshop attended by 400 members, 264 questionnaires were disrupted; 120 were completed there and then and 144 taken home (45 returned). From the 165 completed questionnaires, 116 met the criteria( over 21; 6+ months at OA and at least 20% overweight at the time and not any on medication.
  • Measurement tools: ps responded to 3 questionnaires: a democratic data questionnaire; Rotter's social reaction inventory scale, and Secord and Journards body cathexis scale. The demographic questionnaire contains age, sex and age of onset of obesity. Rotter's scale is 29 forced choice questions relating to beliefs about the world that measure internal and external control. S and J's scale uses a 5 point likert scale to measure satisfaction with various parts of the body. Both had been tested for reliability.

Results:
  • Majority of p's had childhood onset obesity (59%). Multiple regression analysis was performed on the age of onset categories separately in order to analyse the relationship between locus of control and weight loss.
  • Locus of control significantly predicted body image in the adult group but there was no relationship between LOC and either body image or weight loss in the sample overall.
  • Body image and weight loss correlated in the adolescent group. Analysis by gender was conducted using t-tests. Males had a higher degree of satisfaction with their bodies than did females. Males also lost more weight.
Discussion:
  • Wineman concluded that external cues may influence a person's eating habits specifically but may not be reflected in those persons' general belief about LOC. She suggests that maybe the Rotter scale was not the most suitable measure of LOC with regard to eating habits.
  • The sample and sampling method may have also affected the results. Memory and honesty of the answers may have affected crucial variables of age of onset and weight loss
Evaluation:
  • Sample:
Advantage: Large sample-big target population, representational and covers a range of social class's
Disadvantage: Gender bias (104 females), ethnocentric because different cultures=different beliefs and a typical because general internal people would be more likely to take the survey-being 40 more experience.
  • Validity:
advantage: good face validity and collecting the data direct from P's.
Disadvantage: Social desirability bias- touchy subject so more likely to lie to look better, forced choice questions-may not agree with the answers given, temporal validity, and some P's took it home with them so different answers could occur
  • Reliability:
Advantage: questionnaires were standardised, tested for reliability, tested on some measurement tools
Disadvantage: some took the questionnaires home with them.
  • Usefulness:
Advantage: tested on a specific health behaviour and LOC so can  have direct impact
Disadvantage: no qualitive data and no cause and effect


































Thursday 3 April 2014

Healthy living Psychology- Locus of control (concept)

What is it?

Locus of control (LOC) is a theory within personality psychology and it is basically whether the individual believes they can control the events that affect them. The understanding of the concept was developed by Rotter in 1954 and since then become a aspect of personality studies. A persons individual 'Locus' is conceptualised as either internal (belief they can affect there own life) or external (meaning they believe that their decisions and life are controlled by environmental factors which they cannot influence for example fate, luck or chance)

People who have a very high internal LOC believe the events in their life come primarily from their own actions for example if they did not do well on a test they would blame it on themselves for not preparing as much and vice versa. If a person has a high external LOC stuff 'external' from themselves is responsible for example if they did a test and did well they might think the teacher was being lenient or they was lucky.

Those with a high internal LOC exhibit better control over there own behaviour, they also tend to be more politically involved in the current government and are more likely to influence others than those who have a high external LOC seen as they believe if they don't influence and convince people no one else will therefore they are responsible. Internal LOC people also have a increased perception that the likelihood of their efforts being successful and more actively seek information concerning their situation.

There is a high interest in understanding the relationship between LOC beliefs and loads of health attitudes, behaviours and situations. Health Locus Of Control (HLC), examines the degree to which a person believes that their health is controlled by internal or external factors. External beliefs are on the idea that their health outcome is under the control of powerful others e.g. health care professionals or determined by fate, luck and chance. Internal beliefs are that their health is determined directly from their own actions.

How does it relate to health?

A great deal of research has linked internal LOC to positive health beliefs and behaviours. It has been widely accepted that HLC is associated with a variety of health behaviours and outcomes. Internal has been assiocated with knowledge about disease,ability to stop smoking,ability to lose weight,adherence to medical regimen,effective use of birth control and things like wearing seat belts. The importance of the LOC makes its developement a crucial thing to learn as professionals etc can become more aware of the circumstances that might lead to adopting a particular LOC belief,

How do we learn positive HLC beliefs?

Rotter said LOC beliefs and types come from specific experiences and past reinforcement history. Reinforcement theory (Skinner) argues that what controls behaviour are reinforcer. A reinforce is a consequence that immediately follows a response and either removes a negative stimulus or adds a positive one, increases the probability that the good health behaviour will be repeated. Using this theory individuals who have had a history of successful attempts at health control are more likely to be internal than those who have been unsuccessful in the attempts. A possible determinant of these beliefs is practice in taking care of oneself. Practisinf a variety of different health habits as a child is associated with optimistic beliefs in the controllability of health,both for beliefs in the efficiency of self care and of doctors.

Who most influenced the adoption of your present health habits?

internal LOC is associated with nurturing and accepting parents who display consistent discipline. Reinforcement theory easily explains why this should be the case.Nurturing parents are attentive to there childs health and use reinforces to encourage the practise of good health habits and discourage poor ones, not only the parents are responsibile, peers, teachers and mass media are important factors influencing health beliefs.

Socio-economic status is another variable correlates with LOC. This is because there is greater availability of reinforces for middle class children explaining why they or more internally orientated that lower class children. Also visiting health care professionals is a lot less stressful for richer families as they come at a less finical stress compared to working class. People who experience unpredictable sickness of been conditioned to be more aware of this than those who haven't, this would account for feeling of inefficacy towards ones health or belief towards external HLC

So which ones better?

Internals don’t necessarily fare better than their external counterparts. Many externals are very happy people. “Think of highly religious people who believe their existence is in the hands of their gods,” says Williams. “They have turned over control to a spiritual entity and feel much more ease with ‘God as their co-pilot’.” Personally, Williams believes internals fare better in North American society where we tend to reward intrinsically motivated people. “Our countries were founded by people who take control of their destinies,” he says.

Strengths: It has high practical applications because it can be used by professionals etc to predict behaviour performed and learn way to increase medical adherence and health belief, this therefore makes it alot more useful

Limitations: Since 1966, locus of control as measured by the I-E scale has been shown predictive of many different dependent variables in both health and nonhealth situations. In hundreds of articles, expectancies have been reported to mediate perceptual, cognitive, and motivational processes. However, in many other investigations, locus of control has failed to predict the dependent variable being studied. Therefore, it is clear there are limitations to the predictive power of the construct. In recent years published research highlighting these limitations has resulted in a decrease in research about locus of control and the use of the I-E scale. Yet many investigators do not know or perhaps choose to ignore the criticisms published in recent years. Nurses who are interested in locus of control are encouraged to understand the construct and the frequent misapplications of it which occur, to realize the limitations of the I-E scale when considering instrumentation, and to consider multidimensional attribution theory as more appropriate to understanding behaviour than locus of control.






Healthy living Psychology-The Health belief Model (Study by Becker)

Approach: Cognitive

Aim: To test the ability of the HBM to explain mothers' differential compliance with a drug regimen prescribed for their asthmatic children.

Method: Self-report/clinical tests/correlation

Sample: Opportunity sample of 111 mothers (mean age 31, mean kids age 8, 94% black) from a low-income clinical population who agreed to participate in the study.

Procedure: Mothers were interviewed about their health motivations and attitudes about various aspects of asthma and its consequences. Each mother was asked to recall her handling of the child's current asthma attack, including whether the most recently prescribed asthma medication had been administered. Compliance was checked by a covert blood sample and checked in 70% of cases

Results: sample was tested positive for 53/80 children (compliance rate of 66% of those tested). Associations between each compliance measure and mothers' general health motivation were as follows...
  • Perception of the overall severity of the child's asthma was the best predictor of compliance
  • Highest level of statistical significance was found on the question of whether the mother gives asthma medication even when the child feels well
  • Perceptions of the child as being poor health and susceptible to health problems and whether the child's asthma interfered with the child's normal functioning were good predictors of adherence
  • Mother's stated level of concern about her child was correlated with compliance only when asked whether she had grater concern for the child with asthma than her other children
  • Mothers who complied were significantly more likely to feel in control of the situations generally (link to locus of control)
  • Mothers who complied were more likely to feel that most illness's were preventable.
All of the above associations present support for the relationships hypothesised by the HBM.
One find that conflicted with the HBM was that mothers who were compliant were more like to question doctors knowledge yet also felt better when heeding doctors advice.

Two demographic variables were significantly associated with adherence- mothers martial status (relationship) and level of education- Married most likely to comply; better educated more likely to comply

Discussion: the study proved general support for validity and reliability of the HBM. The HBM is based on hypotheses formulated about peoples beliefs prior to receiving medical care, whereas this study was conducted after a period on the medical regimen, therefore results should be interpreted in this light.

Evaluation

Sample:
strength: reasonable sample size, specific target group and with it being a opportunity sample they are willing to participate

Weakness: gender bias-role of mothers, ethnocentric-94%black, all low income backgrounds- not representative and its A typical because generally compliant mothers would take part

Reliability:
Strength: objective blood tests, standardised self questionnaire, test for controversy between self report and blood test, gathered quantities data

Weakness: only 70% had blood tests

Validity
Strength: objective clinical test, scientific, allows us to test validity of reports due to blood samples etc, Self report- no assumptions were made

Weakness: temporal validity-changed over time therefore more research is needed, Potential researcher bias because its the same guy who developed the theory therefore wanting evidence, obvious sign of social desirability or demand characteristics as there was problems between answers giving in the self reports and the clinical tests.

ETHICS

Strength: consent seen as it was opportunity sample and there was no real harm.

Weakness: lack of informed consent, covert blood sampoles- obligation to participant














Wednesday 2 April 2014

Healthy living Psychology-The Health Belief Model (concept)


The health belief model is a Cognitive explanation for behaviour and is one of the first models into health behaviour, it was developed during the 1950s by a group of U.S Public Health Service social psychologists who wanted to find out why people were not participating in disease prevention groups etc then it was later developed by a guy named Becker (remember his name). The Health Belief Model (HBM) is a good model for addressing problems that evoke health concerns for example high-risk sexual behaviour and the possibility of contracting HIV.



(copyright from http://www.o-wm.com/article/continence-coach-revitalizing-health-belief-model-support-shared-decision-making)

The health belief model proposes that a person's health related behaviour depends on the person's perception of four critical areas

  • The severity of a potential illness- how bad will the hangover be after a night out (how harmful the behaviour will be, low harm=lower cost)
  • The susceptibility to that illness-will they get a hangover when they wake up (How likely the person is to get it, less likely=lower cost)                                                                                                         (the two above come under the perceived threat box in the diagram above-Both influencing factors)                              
  • The perceived benefits of taking a preventive action, for example, drinking a pint of water after a night out, the benefit would be no hangover
  • The perceived barriers (cost)to taking that action for example having to get out of bed to get the water or feeling more sick after drinking it.                                                                                                                                                                                      

Now if the Barriers outweigh the benefit of doing the certain action the health behaviour will not be performed

Enabling and modifying factors of the health behaviour (more technical)

perceived susceptibility:   Refers to a person's perception that a health problem is personally relevant or that a diagnosis of illness is accurate.
Perceived severity: Even when someone recognises personal susceptibility, action will not occur unless the individual perceives the severity to be high enough to have serious problems caused physically and mentally
Perceived benefits: Refers to the patient's belief that a given treatment will cure the illness or help to prevent it
Perceived costs: Refers to the complexity, duration, and accessibility of the treatment
Motivation: The desire to comply with a treatment and the belief that people should do what.
Modifying factors: including personality variables, patient satisfaction and socio-demographic factors

Advantages and disadvantages

Advantages


  •  The main benefit of the Health belief model is that it promotes the uptake of services offered by social psychologists.

Study information (not fully needed)

The outbreak of Swine influenza in 1976 presented an opportunity for researchers to test the Health Belief Model (HBM).  The health beliefs and inoculation status of 122 senior citizens (primarily black and Portuguese-American) who were active in two senior centers was surveyed, and their results were documented.  They were given a 45-item interview designed to draw out the respondents' beliefs along all of the major Health Belief Model dimensions.  As a result, the investigators found positive correlations between the HBM items and the subjects' inoculation status along all of the dimensions of the HBM except for "severity".  The authors concluded that the model was useful in regards to understanding the variables which influence a person's readiness to undertake recommended preventive medical care

This therefore gives it high practical applications (being used in real life situations) because it was able to locate the variables affecting the person to take the medical care needed.

(Copyright from http://healthbeliefmodel.weebly.com/evidence.html).


  • It offers a individual explanation of behaviour (individual-situational debate), this offers a explanation of the persons individual thoughts on performing the behaviour for example someone smoking will be based on the persons thoughts about getting lung cancer or some illness from it and weighs up whether the action is worth it instead of explaining they might smoke because everyone else is smoking around them


Disadvantage

Limited ability for predicting behaviour e.g. sexual practices in university students.

study information (not needed in much detail for exam)

In 1992, a survey was conducted on 122 US college students aged 17-35 to predict condom usage and risky sexual practices.  However, the HBM didn't significantly explain condom usage, but instead partially explained the variance in sexual risk behaviours.  The HBM focuses more on motivating people to take action instead of predicting future behaviours.  Researchers noted, "Unless the HBM is expanded to include other behaviour-specific cognitive factors (like barriers and benefits associated with multiple sexual partnerships), its ability to explain more than a small proportion of the variance in behaviours that prevent AIDS will remain limited".

this lowers the usefulness of the Health belief model.

(copyright from http://www.ncbi.nlm.nih.gov/pubmed/9451482)



  • Its ignores other factors that influence health behaviour

The HBM is not a good fit for school smoking education programs that cover a variety of information related to smoking but are not specifically action-oriented.

Applying the HBM to smoking education is possible but is not necessarily a good fit. Youth smoke for many reasons — personal reasons, religious reasons, logistical reasons — not always mainly to avoid a perceived threat of a negative health outcome. Using HBM's threat-logic model to promote not smoking could be less effective then using other methods.