COUNSELLING IN HOSPITAL SETTINGS

1. COUNSELLING IN HOSPITAL SETTINGS
RELEVANCE OF HEALTH PSYCHOLOGY

2. TOPIC- HEALTH ENHANCING AND HEALTH COMPROMISING
BEHAVIOURS.
INDIVIDUAL DIFFRENCES AND PERSONAL CHARACTERISTICS.
LIFE STYLES AND RISK FACTORS.
TRANS THEORETICAL MODEL.

3. INTRODUCTION
• Health promotion is a philosophy that has at its core the idea that good
health, or wellness, is a personal and collective achievement. For the
individual, it involves developing a program of good health habits.
• For the medical practitioner, health promotion involves teaching people
how to achieve a healthy lifestyle and helping people at risk for
particular health problems off set or monitor those risks.
• For the health psychologist, health promotion involves the development
of interventions to help people practice healthy behaviours.

4. • For community and national policy makers, health promotion
involves emphasizing good health and providing information and
resources to help people change poor health habits.
Successful modification of health behaviors will have several
beneficial effects.
• First, it will reduce deaths due to lifestyle-related diseases.
• Second, it may delay time of death, thereby increasing life
expectancy.
• Third and most important, the practice of good health behaviors
may expand the number of years during which a person may enjoy
life free from the complications of chronic disease.

5. HEALTH BEHAVIOUR AND HEALTH HABITS.
Health behaviors are behaviors undertaken by people to enhance
or maintain their health.
A health habit is a health behavior that is firmly established and
often performed automatically, without awareness.
These habits usually develop in childhood and begin to stabilize
around age 11 or 12 .Wearing a seat belt, brushing one’s teeth, and
eating a healthy diet are examples of these kinds of behaviors.

6. Although a health habit may develop initially because it is reinforced
by positive outcomes, such as parental approval, it eventually
becomes independent of the reinforcement process.
It is important to establish good health behaviors and to eliminate
poor ones early in life.

7. The importance of good health habits is provided by a classic study of
people living in Alameda County, California. Health enhancing
behavior are:-
• Sleeping 7 to 8 hours a night
• Not smoking
• Eating breakfast each day
• Having no more than one or two alcoholic drinks each day
• Getting regular exercise
• Not eating between meals
• Being no more than 10 percent overweight

8. Efforts to prevent illness can be of three types:
• Behavioral influence. In this approach, we might promote tooth
brushing and flossing by providing information and demonstrating the
techniques.
• Environmental measures. Public health officials might support
fluoridating water supplies.
• Preventive medical efforts. Dental professionals can remove tartar
from teeth and repair cavities.

9. Primary Prevention
Instilling good health habits and changing poor ones is the task
of primary prevention.
This means taking measures to combat risk factors for illness
before an illness has a chance to develop.
There are two general strategies of primary prevention.
The first and most common strategy is to get people to alter
their problematic health behaviors, such as helping people lose
weight through an intervention.
The second, more recent approach is to keep people from
developing poor health habits in the first place. Ex- smoking
prevention program for adolescents

10. Determinants of Practicing and Changing Health Behaviors.
Demographic Factors: Younger, more affluent, better-educated people with low
levels of stress and high levels of social support typically practice better health
habits than people under higher levels of stress with fewer resources.
Age: Health habits are typically good in childhood, deteriorate in adolescence
and young adulthood, but improve again among older people.
Values: Values affect the practice of health habits. For example, exercise for
women may be considered desirable in one culture but undesirable in another

11. Personal Control: People who regard their health as under their personal
control practice better health habits than people who regard their health as
due to chance. Ex-health locus control scale.
Social Influence: Family, friends, and workplace companions influence
health-related behaviours, sometimes in a beneficial direction, other times in
an adverse direction.
For example, peer pressure often leads to smoking in adolescence but may
influence people to stop smoking in adulthood.

12. Personal Goals and Values: Health habits are tied to personal goals. If personal
fitness is an important goal, a person is more likely to exercise.
Perceived Symptoms: Some health habits are controlled by perceived
symptoms. For example, a smoker who wakes up with a smoker’s cough and
raspy throat may cut back in the belief that he or she is vulnerable to health
problems at that time.
Access to the Health Care Delivery System: Access to the health care delivery
system affects health behaviors. Ex- receiving immunizations for childhood
diseases depend on access to health care.

13. Knowledge and Intelligence: The practice of health behaviours is
tied to cognitive factors, such as knowledge and intelligence. More
knowledgeable and smarter people typically take better care of
themselves.
LIFESTYLES AND RISK FACTORS.
The typical person’s lifestyle includes many behaviours that are risk
factors for illness and injury.
For instance, millions of Americans smoke cigarettes, drink
excessively, use drugs, eat high-fat and high-cholesterol diets, eat
too much and become overweight, have too little physical activity,
and behave in unsafe ways, such as by not using seat belts in
automobiles.

14. Many people realize these dangers and adjust their behavior to protect
their health.
Adults with healthful lifestyles that include exercising, eating diets with
fruits and vegetables, not smoking, and not drinking too much, can
expect to live 12 years longer than they would otherwise.

15. Risk Factors for the Leading Causes of Death in the United States.
Disease Risk Factors
Heart disease - Tobacco, high cholesterol, high blood pressure,
physical inactivity, obesity, diabetes, stress
Cancer - Smoking, unhealthy diet, environmental factors
Stroke - High blood pressure, tobacco, diabetes, high
cholesterol, Physical inactivity, obesity
Accidental injuries- On the road (failure to wear seat belts), in the
home (falls, Poison, fire)
Chronic lung disease- Tobacco, environmental factors (pollution, radon,
Asbestos)

16. RISK FACTORS FOR LEADING CAUSES OF DEATH INDIA/ KERALA
• Alcohol and drug usage
• Smoking
• Junk- food
• Improper exercise
• Lack of personal hygiene
• Life style decrease
• Lack of nutritional support
• Emission of carbon- dioxide
• Infectious diseases
• Lack of proper and sudden health care support
• Over usage of chemical fertilizers and pesticides
• Extreme climatic conditions
• Pollution
• Radiation
• Improper usage of resources.

17. Barriers to Modifying Poor Health Behaviours
There is often little immediate incentive for practicing good health
behaviors. Health habits develop during childhood and adolescence when
most people are healthy.
Smoking, a poor diet, and lack of exercise have no apparent effect on
health for years, and few children and adolescents are concerned about
what their health will be like when they are 40 or 50 years old .
As a result, once bad habits have a chance to make inroads and
ingrained, people may not be motivated to change them

18. Unhealthy behavior can be pleasurable, automatic, addictive and
resistant to change. Many people find it hard to change their health
habits because their bad habits are enjoyable.
Emotional Factors
Emotions may lead to or perpetuate unhealthy behaviors. These
behaviors can be pleasurable, automatic, addictive, and resistant to
change.
Ex- Stress- leads to smoking
Stress- overeating
Peer pressure

19. Threatening messages designed to change health behaviors can
produce psychological distress and lead people to respond
defensively.
People may perceive a health threat to be less relevant than it really is
and they may falsely see themselves as less vulnerable than other
people with the same habit.
Instability of Health Behaviors:
Health habits are only modestly related to each other.
Health habits are unstable overtime. A person may stop smoking for
a year but take it up again during a period of high stress

20. First, different health habits are controlled by different factors.
For example, smoking may be related to stress, whereas exercise depends
heavily on ease of access to athletic facilities.
Second, different factors may control the same health behavior for
different people.
One person’s overeating may be “social,” and she may eat primarily in the
presence of other people, whereas another person may overeat only when
under stress.

21. Third, factors controlling a health behavior may change over the
history of the behavior .
For example, although peer group pressure (social factors) is
important in initiating smoking, over time, smoking may be
maintained because it reduces feelings of stress.
Fourth, factors controlling a health behavior may change across a
person’s lifetime.
In childhood, regular exercise is practiced because it is built into the
school curriculum, but in adulthood, this behavior must be practiced
intentionally

22. PROBLEMS IN PROMOTING WELLNESS
The process of preventing illness and injury can be thought of as
operating as a system, in which the individual, his or her family,
health professionals, and the community play a role.
According to health psychologist Craig Ewart (1991), many
interrelated factors and problems can impair the influence of each
component in the system, and each component affects each other.
INDIVIDUAL DIFFERENCE
People who consider ways to promote their own health often face
an uphill battle with themselves.

23. One problem is that many people perceive some healthful behaviors as less
appealing or convenient than their unhealthful alternatives.
Some people deal with this situation by maintaining a balance in their lives,
setting reasonable limits on the unhealthful behaviors they perform.
But other people do not, opting too frequently in favor of pleasure even when
individuals know they have health problems, many drop out of treatment or fail
to follow some of the recommendations of their physician.

24. Four other factors within the individual are also important.
First, adopting wellness lifestyles may require individuals to change
longstanding behaviors that have become habitual .Habitual and
addictive behaviors are very difficult to modify.
Second, people need to have certain cognitive resources, such as the
knowledge and skills, to know what health behaviors to adopt to make
plans for changing existing behavior, and to overcome obstacles to
change.
Third, individuals need sufficient self-efficacy regarding their ability to
carry out the change. Without self-efficacy, their motivation to change
will be impaired.
Fourth, being sick or taking certain drugs can affect people’s moods and
energy levels, which may affect their cognitive resources and motivation.

25. Interpersonal Factors
Many social factors influence people’s likelihood to adopt health-related
behaviors. For instance, one partner’s exercising or eating unhealthful
before marriage can lead his or her partner to adopt the same behavior
over time.
Friends and family can encourage or discourage children’s practice of
health-related behaviors, such as smoking and exercising, by providing
consequences, such as praise or complaints, for a behavior.
Modelling it and conveying a value for good health.
These social processes may also lead to gender differences in health
behavior, such as the greater physical activity of boys than girls.

26. Factors in the Community
People are more likely to adopt healthful behaviors if these behaviors are
promoted or encouraged by community organizations, such as
governmental agencies and the health care system. Ex- ban on smoking in
public areas.
PERSONALITY CHARACTERISTICS
Two other factors that are linked to health-related behavior are the person’s
personality and emotional state, particularly stress.
Conscientiousness— the tendency of a person to be dutiful, plan full,
organized, and industrious—is a personality characteristic that is associated
with practicing many health behaviors.

27. The role of emotions can be seen in two ways.
First, among women who have a close relative with breast cancer and
are low in conscientiousness, or those who are very distressed about
cancer are especially unlikely to have a mammogram.
Second, we see people who experience high levels of stress engage in
less exercise and consume poorer diets and more alcohol and cigarettes
than those who experience less stress.

28. THE TRANSTHEORETICAL MODEL OF BEHAVIOR CHANGE
• James O. Prochaska of the University of Rhode Island and colleagues
developed the Trans theoretical Model beginning in 1977.
• It’s a model of behaviour change, a model that analyses the stages and
processes people go through in bringing about a change in behavior and
suggested treatment goals and interventions for each stage.
• People go through stages while they are trying to change their health
behaviors and the support they need from therapists or formal behavior
change programs may vary depending on the particular stage they are in
with respect to their poor health habit.

30. Stages of Change
Pre-contemplation
• The pre-contemplation stage occurs when a person has no intention
of changing his or her behavior.
• Many people in this stage are not aware that they have a problem,
although families, friends, neighbors, or co-workers may well be.
• An example is the problem drinker who is largely oblivious to the
problems he creates for his family.
Techniques:
• Validate lack of readiness
• Encourage re-evaluation of current behaviour
• Encourage self-exploration, not action
• Explain and personalize the risk

31. Contemplation
• Contemplation is the stage in which people are aware that they
have a problem and are thinking about it but have not yet made a
commitment to take action.
• Individuals in this stage are still weighing the pros and cons of
changing their behaviour, continuing to find the positive aspects of
behavior enjoyable.
Techniques:
• Encourage evaluation of pros and cons of behaviour change.
• Re-evaluation of group image through group activities.
• Identify and promote new, positive outcome expectations

32. Preparation
In the preparation stage, people intend to change their behaviour
but have not yet done so successfully. In some cases, they have
modified the target behavior somewhat, such as smoking fewer
cigarettes than usual, but have not yet made the commitment to
eliminate the behavior altogether.
Techniques:
• The individual needs encouragement to evaluate pros and
cons of behaviour change.
• The therapist needs to identify and promote new, positive
outcome expectations in the individual.
• Encourage small initial steps.

33. PREPARATION
• These individuals have taken some actions in the past year such as
joining a health education class, consulting a counsellor, talking to their
physician, buying a self-help book or relying on a self-change approach.
• These group of individuals are suitable for action- oriented programs for
smoking cessation, weight loss, or exercise programs.

34. Action
The action stage occurs when people modify their behaviour to overcome
the problem. Action requires the commitment of time and energy to making
real behavior change.
It includes stopping the behavior and modifying one’s lifestyle and
environment to rid one’s life of cues associated with the behaviour.
Techniques:
• Help the individual on restructuring cues and social support.
• Enhance self-efficacy for dealing with obstacles.
• Help to guard against feelings of loss and frustration

35. Maintenance
In the stage of maintenance, people work to prevent relapse and to
consolidate the gains they have made. For example, if a person is able
to remain free of an addictive behaviour for more than 6 months, he or
she is assumed to be in the maintenance stage.
Techniques:
• Follow-up support
• Reinforce internal rewards
• Discuss coping with relapse

36. TERMINATION
People have learned and adapted the coping skills and have no desire to return
to their previous behavior and are sure they will not relapse into their earlier
unhealthy behaviors.
This stage model is conceptualized as a spiral, i.e. a
person may take action, attempt maintenance, relapse,
return to the pre-contemplation phase, cycle through the
subsequent stages to action, repeat the cycle again, and do
so several times until they have eliminated the behaviour.

37. Relapse is the rule rather than the exception with many health behaviors.
Techniques:
• Evaluate trigger for relapse
• Re-assess motivation and barriers
• Plan stronger coping strategies
Using the Stage Model of Change
• Providing people in the pre-contemplation stage with information about their
problem may move them to the contemplation phase.
• To move people from the contemplation phase into preparation, an
appropriate intervention may induce them to assess how they feel and think
about the problem and how stopping it will change them

38. Interventions designed to get people to make explicit commitments
as to when and how they will change their behavior can bridge the
gap between preparation and action.
Individuals already moving through the action phase into long-term
maintenance, interventions that emphasize providing self-
reinforcement, social support, stimulus control, and coping skills
should be most successful.
The model has been used with many different health behaviors,
including smoking cessation, quitting cocaine, weight control,
modification of a high fat diet, adolescent delinquent behavior
practice of safe sex and exercise acquisition etc.

39. Processes of Change in Trans-theoretical Model.
Processes of change is a major dimension of the Trans-theoretical model that
enables us to understand how shifts in behavior occur.
Change processes are covert and overt activities and experiences that
individuals engage in when they attempt to modify problem behaviors.
Each process is a broad category encompassing multiple techniques, methods,
and interventions.
Numerous studies have shown that successful self-changers employ different
processes at each particular stage of change
The ten processes of change are experiential and behavioral

40. I. Processes of Change: Experiential
1. Consciousness Raising [Increasing awareness]
I recall information people had given me on how to stop smoking
2. Dramatic Relief [Emotional arousal]
I react emotionally to warnings about smoking cigarettes
3. Environmental Re-evaluation [Social reappraisal]
I consider the view that smoking can be harmful to the environment
4. Social Liberation [Environmental opportunities]
I find society changing in ways that make it easier for the non-smoker
5. Self-Re-evaluation [Self reappraisal]
My dependency on cigarettes makes me feel disappointed in myself.

41. II. Processes of Change: Behavioural
6. Stimulus Control [Re-engineering]
I remove things from my home that remind me of smoking
7. Helping Relationship [Supporting]
I have someone who listens when I need to talk about my smoking
8. Counter Conditioning [Substituting]
I find that doing other things with my hands is a good substitute for smoking
9. Reinforcement Management [Rewarding]
I reward myself when I don’t smoke
10. Self-Liberation [Committing]
I make commitments not to smoke
Experiential process are used in primary stages and behavioral process are
used in later stages.

42. The TTM is comprised of a number of core constructs that include the Stages
of Change, Processes of Change, Decisional Balance, Self-Efficacy, and
Temptation.
The Decisional Balance construct refers to an individual’s weighing of the
pros and cons of their behaviour change. Sound decision making requires the
consideration of the potential benefits (pros) and costs (cons) associated with
a behaviour’s consequences. Decisional balance is one of the best predictors
of future change.

43. Self-Efficacy construct outlines an individual’s confidence in their ability to
not relapse when in high-risk situations that tempt them to engage in a
specific behavior. It plays a major role in how successful people are in
changing their behavior and maintaining the change.
Temptation reflects the intensity of URGE, the strength of the drive within,
which urges us to engage in specific behavior when in midst of a situation.
Although the majority of the applications of TTM have focused on smoking
cessation, the model has also been applied to other problem behaviors such
as alcohol and substance abuse, eating disorders, and domestic violence.

44. CONCLUSION
Health psychology is a rapidly growing field. Health psychologists are
focused on educating people about their own health and well-being.
Many health psychologists work specifically in the areas of prevention and
focus on helping people prevent health problems before they start.
It includes helping people maintain a healthy weight, avoid risky or
unhealthy behaviors and maintain a positive outlook through identifying
the individual differences and personality characteristics, and the
influence of social, community and interpersonal factors.
The Trans Theoretical model of change is also used effectively to help
individuals to cope, change unhealthy behaviors and to maintain healthy
behavior.

45. THANK- YOU