3 1 Models of health belief Health Belief
3. 1 Models of health belief
Health Belief Model Key study: Becker (1978) Terminology �perceived seriousness (‘Will it actually kill you? ’). �perceived susceptibility (‘Am I likely to get it? ’). �costs/benefits analysis. �cues to remind us (external or internal cues). �demographic variables (factors such as gender, culture, age, etc. ).
Aim �To use the health belief model to explain mothers' adherence for their asthmatic children. Method �A correlation between beliefs reported during interviews and the compliance with self-reported administration of asthma medication.
Participants � 111 mothers responsible for administering asthma medication to their children. Design �Correlational design.
Procedure �Each mother was interviewed for about 45 minutes. �They were asked questions regarding: �Their perception of their child’s susceptibility to illness and asthma. �How serious asthma is. �How much their child’s asthma interfered with his or her education. �Caused embarrassment. �Interfered with the mother’s activities.
Procedure (cont. ) �They were also questioned about their faith in doctors and the effectiveness of the medication.
Findings �A positive correlation between a mother’s belief about her child’s susceptibility to asthma attacks and compliance to medical regimen was found. �There was also a positive correlation was also between the mother’s perception of the child’s having a serous asthma condition and her administering the medication as prescribed. �Mothers who reported that their child’s asthma interfered with the mother’s activities also complied with the medication.
Findings (cont. ) �Costs negatively correlated with compliance (e. g. disruption of daily activities, inaccessibility of chemists, the child complaining, and the prescribed schedule). �The demographic variable of marital status and education level correlated with compliance as follows: �Married mothers were more likely to comply. �The greater the mother’s education the more likely she would be to adhere.
Conclusion �The health belief model is a useful model to predict and explain different levels of compliance with medical regimens.
Locus of control Key study: Rotter (1966) Terminology �Internal locus of control – where a person feels he or she is in control of his or health and is therefore likely to adopt healthy behaviour. �External locus of control – where a person feels his or health is controlled by external factors (e. g. fate) and is therefore less likely to adopt a healthy behaviour.
Method �Review article. Procedure �Sample – six pieces of research into individual perceptions of ability to control outcomes.
Findings �Participants who felt they had control over the situation were more likely to show coping behaviours. Conclusion �Rotter concluded that locus of control would affect many of our behaviours.
Self efficacy Key study: Bandura (1977) Terminology �Outcome expectancy – based on previous experiences a person could estimate the likely outcome in any situation. �Efficacy expectation – the belief that a person has that they can successfully do whatever is required to achieve the outcome.
Terminology (cont. ) �The key factors which affect a person’s efficacy expectation are: �Vicarious experiences – seeing other people do something successfully. �Verbal persuasion – someone telling you that you can do something. �Emotional arousal – too much anxiety can reduce a persons’ self-efficacy. �In addition cognitive appraisal of a situation might also effect expectations of personal efficacy.
Aim �To assess the self-efficacy of patients undergoing systematic desensitisation. Method �A controlled quasi-experiment with patients with snake phobias.
Participants � 10 snake phobic patients: �who replied to an advertisement in a paper. � 9 females and one male. �aged 19– 57 years.
Procedure �Pre-test assessment. Each patient was assessed for: �avoidance behaviour towards a boa constrictor. �fear arousal with an oral rating of 1– 10. �efficacy expectations (how much they thought they would be able perform different behaviours with snakes).
Procedure (cont. ) �Systematic desensitisation – a standard desensitisation programme was followed where patients were introduced to a series of events involving snakes and at each stage were taught relaxation. �Post-test assessment. Each patient was again measured on behaviours and belief of self-efficacy in coping.
Findings �Higher levels of post-test self-efficacy were found to correlate with higher levels of behaviour with snakes. Conclusion �Desensitisation enhanced self-efficacy levels, which in turn lead to a belief that the participant was able to cope with the phobic stimulus of a snake.
Possible Section A Questions �Describe what psychologists have found out about theories of health belief �Describe one piece of research into self-efficacy �Outline the health belief model �Describe factors that influence health beliefs and behaviours �Describe one piece of research into locus of control
Possible Section B Questions �Discuss the usefulness of research into theories of health belief
3. 2 Health Promotion
Media Campaigns Key study: Cowpe (1989) Aim �To test the effectiveness of an advertising campaign. Method �A quasi-experiment where a media campaign was shown in 10 regional television areas from 1976 to 1984.
Participants �People living in the chosen television areas.
Procedure �The campaigns were shown on television. �There were two 60 -second commercials, one called ‘inattendance’ and one called ‘overfilling’. �These showed the initial cause of the fire and the actions required to put it out. �Three areas were shown reminders one year later. �The number of reported chip pan fires was analysed for each area.
Findings �The net decline in each area over the twelve-month period of the campaign was between 7% to 25%. �The largest reduction was during the campaign. �‘Overlap’ areas (areas that received two of the television stations) showed less impact. �The questionnaires showed an increase in the awareness of chip pan fire advertising. �The mention of chip pan fires as a danger in the kitchen also increased in the questionnaires.
Conclusions �The advertising proved effective as shown by reduction in chip pan fires. �The behaviour change is seen most during the campaign and reduces as time passes after the end of the campaign. �The viewer is less likely to be influenced by the campaign if overexposed to it, as in the overlap areas.
Legislation Key study: Dannenberg et al. (1993) Aim �To review the impact of the passing of a law promoting cycle helmet wearing in children. Method �Natural experiment when a law was passed in Howard County, Maryland, USA.
Participants �Children from Howard County, and two control groups from Montgomery County and Baltimore County, all in Maryland, USA. �Aged 9– 10 years, 12– 13 years and 14– 15 years. Design �Independent design with each child naturally falling into one of the three counties.
Procedure A questionnaire that asked about: �bicycle use. �helmet ownership. �awareness of law. �sources of information about helmets. �peer pressure.
Findings �Helmet ownership was higher amongst cycle owners and highest in younger age groups. �In Howard County (the one with the law), reported usage had increased. �Howard County – 11. 4% to 37. 5%. �Montgomery County – 8. 4% to 12. 6%. �Baltimore County – 6. 7% to 11. 1%.
Conclusions �Legislation has more effect than educational campaigns alone. �This study was correlated with an observational study by Cote et al. in 1992, which found similar rates of cycle helmet usage.
Fear Arousal Key study: Janis and Feshbeck (1953) Aim �To investigate the consequences on emotions and behaviour of fear appeals in communications. Method �Laboratory experiment, which showed fear-arousing material.
Participants � 9 th Grade students aged 14. 0 to 15. 11 years, mean age 15 years. Design �Independent design, with three experimental groups and one control group.
Procedure �A questionnaire was given one week before the lecture on health to ascertain dental practices. �A fifteen minute illustrated lecture was presented to each group. � 3 groups had a lecture on dental hygiene and the control group had a lecture on the human eye.
Procedure (cont. ) �Immediately after the lecture a questionnaire was given asking for emotional reactions to the lecture. �One week later a follow-up questionnaire asked about longer term effects of the lecture.
Findings �The amount of knowledge on dental hygiene didn’t differ between the three experimental groups. �The strong fear-appeal lecture was generally seen in a more positive light. �The strong fear-appeal group showed a net increase in conformity to dental hygiene of 8%.
Findings (cont. ) �The net increase in the moderate fear group was 22%. �The net increase in the minimal fear group was 36%. �The control group showed 0% change.
Conclusion �Fear appeals can be helpful in changing behaviours, but it is important that the level of fear appeal is right for each audience.
Possible Section A Questions
Possible Section B Questions �Discuss the usefulness of research into health promotion
3. 3 Adherence to medical advice
Reasons for non adherence Key study: Bulpitt and Fletcher (1988) Aim �To review research on adherence in hypertensive patients. Method �Review article of research identifying problems with taking drugs for high blood pressure.
Procedure �Research was analysed to identify the physical and psychological effects of drug treatment and the adherence rates of patients.
Findings �There are many side effects of taking antihypertension medication. �In one study by Curb (1985) 8% of males discontinued treatment because of sexual problems. �Research by the Medical Research Council (1981) found that 15% of patients had withdrawn from taking medication due to side effects.
Conclusion �When the costs of taking medication, such as side effects, outweigh the benefits of treating a mainly asymptomatic problem such as hypertension, there is less likelihood of the patient adhering to their treatment.
Measuring adherence Key study: Lustman et al. (2000) Aim �To assess the efficacy of the anti-depressant fluoxetine in treating depression by measuring glycemic control. Method �A randomised controlled double-blind study.
Participants � 60 Patients with type 1 or type 2 diabetes and diagnosed with depression.
Procedure �Patients were randomly assigned to either a fluoxetine or a placebo group. �Patients were assessed for depression using psychometric tests and their adherence to their medical regimen was assessed by measuring their GHb levels, which indicated their glycemic control.
Findings �Patients given fluoxetine reported lower levels of depression. �Patients given fluoxetine had lower levels of GHb, which indicated their improved adherence.
Conclusions �Measuring GHb in patient with diabetes indicates their level of adherence to prescribed medical regimes. �Greater adherence was shown by patients who were less depressed.
Improving adherence Key study: Watt et al. (2003) Aim �To see if using a Funhaler® could improve children’s adherence to medication for asthma.
Method �A field experiment, although it used children with asthma so could also qualify as a quasi-experiment. The experiment set up two conditions, and then used self-report to measure the adherence rates.
Participants � 32 Australian children with asthma: � 10 males and 22 females; �aged from 1. 5 to 6 years; �mean age 3. 2 years. Design �A repeated design as each participant had one week using the normal inhaler then one week using the Funhaler.
Procedure �Each child was given the Breath-a-Tech to use for one week, and a questionnaire was given for the parents to complete. �In the second week, the children used the Funhaler, and the parents were given a matched questions questionnaire.
Findings � 38% more parents were found to have medicated their children the previous day when using the Funhaler compared to the normal inhaler.
Conclusions �The Funhaler reinforced correct usage of the inhaler with a toy that spins and a whistle that blows. �This did improve the adherence to the medication. �By making the medical regime fun, the adherence, certainly in children, can be improved.
Possible Section A Questions
Possible Section B Questions �Discuss the usefulness of research into health promotion
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