2. 02 Health Psychology
Other terms (Cherry, 2020)
Medical psychology
Behavioral medicine
Sometimes, they are used interchangeably with “health psychology”
It is a specialty area that discover how health and illness are influenced by
biological, psychological and social factors (Cherry, 2020a)
It concentrates on
How biology, psychology, behavior, and social factors link to health
and illness
Promoting and maintaining health
The prevention and treatment of disease and illness
Exploring how people response to, handle with, and get well from illness
3. 03American Psychological Association
Division 38 of it is devoted to health psychology
It was introduced in 1978 (Sarafino & Smith, 2011)
Joseph Matarazzo is the first president of the
Division in 1982
Four goals
To promote and maintain health
To prevent and treat illness
To determine the causes and diagnostic
correlates of health, illness and related
dysfunction
To improve health care systems and health policy
4. 04 Current Issues in Health Psychology
Health psychologists interest in
(Cherry, 2020)
Hospice care and grief
counseling for terminal patients
Improving daily nutrition
Improving recovery
Preventing illness
Reducing risky sexual behaviors
Smoking cessation
Stress reduction
Teaching coping skills
Understanding the effects of
illness
Weight management
5. 05Health and Illness
Health and illness (Cherry, 2020)
They are caused by many factors
Contagious and hereditary illness
They are common
The whole physical well-being and different
medical conditions
They are the results of various behavioral
and psychological factors
6. 06 Life Expectancy
It is about basic hygiene and prevention of
infectious diseases
In the U.S., life expectancy is about 80 years
(Cherry, 2020)
The leading causes of mortality are chronic
diseases
Such as heart disease and stroke
Which are always connected to lifestyle
Behavior that causes disease and death
7. 07How Does Health Psychology Differ
from Other Areas of Psychology?
It stresses on how the health is influenced by the
behavior
It guides people to change the behaviors that
leading to health and well-being (Cherry, 2020)
For example, psychologists might conduct
applied research on
How to prevent unhealthy behaviors like
smoking
Look for new ways to encourage healthy
actions like exercising
8. 08
Example
Issue
Eating a diet high in sugar is not good for
their health
Problem
People still want to eat
Reason
They do not care about the consequences
Discovering at their psychological factors that
cause these health choices, psychologists find
ways to encourage people to make better
health choices (Cherry, 2020)
9. 09Illnesses Related to Psychological
and Behavioral Factors
Six types (Cherry, 2020)
Birth defects and infant
mortality
Cancer
Heart disease
HIV/AIDS
Infectious diseases
Stroke
10. 10 Centers for Disease Control
and Prevention, 2013
The US Centers for Disease Control National Center for Health
Statistics collects data about death with its justification.
In the CDC report in 2012, half of the deaths are avoidable.
Heart disease and stroke
Cancer
Chronic lower respiratory diseases
Primarily chronic obstructive pulmonary diseases (COPD)
Like emphysema and chronic bronchitis
Drug poisonings
Including overdoses
Fatal falls among an increasingly elder population
a.
b.
c.
d.
e.
11. 11Understanding
Biopsychosocial Factors
The primary approach utilized in health psychology
(Mason, Roy, Spillane & Singh, 2016)
A mixture of the following factors are linked to health and
illness
Biological factors
Genetic conditions + inherited personality traits
Psychological factors
Lifestyle + personality characteristics + stress levels
Social factors
Cultural beliefs + family relationships + social
support systems
12. 12 Biopsychosocial Model
The biopsychosocial model of health and illness
A framework developed by George L. Engel
States that interactions between biological, psychological, and
social factors
Determine the cause, manifestation, and outcome of wellness
and disease
Historically, (Lumen Boundless Psychology, n.d.)
The nature versus nurture debate argued that
Any one of these factors "was" sufficient to change the
course of development
The biopsychosocial model argues that
Any one factor "is not" sufficient that determine the course
of their health-related outcomes
13. 13Biological Factors
The role of biological factors
(Sarafino & Smith, 2011)
Genetic materials and
processes of our parents that
we inherit characteristics from
Function and structure of the
person’s physiology contain
structural defects
Malformed heart valve
Damage in the brain
14. 14 Psychological Factors
The role of psychological factors
(Sarafino & Smith, 2011)
Concentrates on
Behavior
Mental processes
Involve
Cognition
Emotion
Motivation
15. 15Cognition
Mental activity that covers
Believing + interpreting + learning + perceiving
Problem solving + remembering + thinking
Example (Sarafino & Smith, 2011)
Imagine
You enjoyed smoking cigarettes
Question
Would you stop to lessen your chance of
getting cancer or heart disease?
Response
Probably not
16. 16Emotion
Personal feeling that “influences and is influenced” by
Our thoughts, behavior and physiology
Two types of emotions (Sarafino & Smith, 2011)
Positive or pleasant - joy
Negative - anger and fear
Emotions relate to health and illness in various ways
If comparing people whose emotions are relatively negative
People whose emotions are relatively positive
Less disease-prone
More likely to take good care of their health
Recover quickly from an illness
17. 17 Motivation
How to motivate people?
(Sarafino & Smith, 2011)
Why people behave the
way they do?
Why they start some
activity, choose its
direction and persist in it?
Example
Parents who stop smoking.
Why?
Because their child explain
to them for their health
protection
18. 18Social Factors
Include culture, religion, socioeconomic status and
technology (Lumen Boundless Psychology, n.d.)
Like losing a job or ending a romantic
relationship may place one at risk of stress and
illness
The role of social factors (Sarafino & Smith, 2011)
Family
Friends
Community
Society
19. 19 Family
Family is the major influence (Sarafino & Smith, 2011)
Children learn from their parents, brothers and sisters
Attitudes
Beliefs
Health-related behaviors
Good examples for healthful behavior of parents
Exercising
Not smoking
Using seat belts
Serving and eating nutritious meals
20. 20Friends
We keep in touch with our friends (Sarafino &
Smith, 2011)
We influence them and they influence us
An example of being influenced by peer pressure
Adolescents often start
Smoking cigarettes
Drinking alcohol
In their friend zone, they want
To be popular
To look “cool” or “tough”
21. 21 Community
Community involves individuals who live
Near to one another like in the same town or country
Organization like government
An example of the environmental characteristics of a
community
There are many green parks in the community
It encourages the residents to do
Walking or running
Other physical activities
Residents will be more active in the community
(Sarafino & Smith, 2011)
22. 22Society
Society influences the health of each person by
Promoting certain values of our culture like being fit and
healthy is good
Example of the mass media (Sarafino & Smith, 2011)
It shows these values by setting good examples, like
Urging us to eat well
Not to use drugs
Not to drink and drive
Sometimes, it shows celebrities on TV with unhealthful
behaviors like
Smoking cigarettes
Drinking excessively
23. 23
A Diagram of the
Interplay of
Systems
in the
Biopsychosocial
Model
(Sarafino & Smith, 2011)
The person consists of biological and psychological systems, which interrelate; and
each of the systems includes component systems.
The person interrelates with the social systems of his or her world.
Each system can affect and be affected by any of the other systems.
24. 24Application of the
Biopsychosocial Model
The biopsychosocial model states that
The workings of the body, mind, and
environment all affect each other
None of these factors in isolation
Is sufficient to lead to health or illness
It is deeply related to all of the three factors that
leads to an outcome (Lumen Boundless
Psychology, n.d.)
25. 25 Limitations (Henriques, 2015)
Based on a falsely small concept of biology
Can confuse treatment versus etiology
If true, it is trivial
Inconsistent about the mind/body relationship
Limited resistance to rebirth of biological dogmatism
Not more advantageous than Osler’s medical humanist model
Poor model to show costs and managed care
Poor teaching tool when simplistically applied
Presumes psychiatric superiority to other mental health
disciplines
Unclear boundaries
26. 26Introducing the Theories and Models
of Health Psychology
Health
Is the “state of holistic physical, social and spiritual well-being,
with the presence of illness” according to World Health
Organisation (Rieger, 2017)
Health behaviour is defined as
“Activities that may assist to avoid disease, notice disease
and disability at an early stage, encourage or enhance health
or protect from risk of injury”
Health promotion
Targets behaviours likely to lessen the burden of illness within
the population
27. Table 11 shows a summary of
theoriess in different levels
(National Cancer Institute, 2005)
The most commonly used theories
of health behavior (Glanz, n.d.)
Social Cognitive Theory
Transtheoretical Model/Stages
of Change
Health belief model
Theory of planned behavior
Three commonly used health
behaviour change models at the
individual level (Bishop, 2014) will be
discussed
Health belief model
Theory of planned behaviour
Transtheoretical model
27
28. 28Health Belief Model (HBM)
One of the first and famous models for changing to healthy behaviour
(Morrison & Bennett, 2016)
In the early 1950s , social scientists at the U.S. Public Health Service
developed it to examine (Behavioral change models, n.d.)
Why people reject screening tests in the early detection of disease
What are the patients' reaction to symptoms and take medical
treatments in the later uses
Good for predicting simple, one-time or limited behaviors like
immunizations than habitual behaviors (Lakhan, 2006)
It proposes that a person's belief in the following will predict the likelihood
the person will adopt the behavior
A personal threat of a disease or illness
The effectiveness of the recommended health behavior or action
29. 29 Perception of Threat
Perceived severity
The condition is severe enough to have a negative
consequence
"I believe that coronary heart disease (CHD) is a
serious illness contributed to by being overweight"
Perceived susceptibility
The condition may hurt the individual on any aspect
of the biopsychosocial model
"I believe that I am overweight" (Lakhan, 2006 and
Morrison & Bennett, 2016)
30. 30
Perceived benefits (of change)
The advised actions may stop, lower, or lessen the affect,
risk, and consequences of the condition, respectively
"If I lose weight, my health will improve"
Perceived barriers (to change)
The corrective/preventive benefits outweigh the
psychological and physical harms of abiding to the
advised behavior
"Changing my cooking habits will be difficult, and possibly
more expensive" (Lakhan, 2006 and Morrison & Bennett,
2016)
Behavioural Evaluation
31. 31
Cues to Action
There is an internal or external cue, or both,
that trigger the individual to finally act
(Lakhan, 2006 and Morrison & Bennett, 2016)
External cues
"That recent television programme on
obesity worried me"
Internal cues
"I feel breathless when I go upstairs, so
maybe I should lose some weight"
Health Motivation
"My health is important to me"
32. 32 Limitations (Bishop, 2014)
People are not always
rational
Social influences are
limited
Does not explain how
variables interact
Does not allow for a
dynamic “shift” into change
Effectively to predict breast
self-examination
Not predictive of condom
use (threat perceptions are
weaker)
33. 33Theory of
Planned Behaviour (TPB)
It began as the Theory of Reasoned Action in 1980 (Behavioral
change models, n.d.)
It proposes that both ability (behavioral control) and motivation
(intention) are depended by the behavioral achievement
To find out a person’s intention to perform a behavior, three
judgments indicated by the theory are (Sarafino & Smith, 2011)
Attitude regarding the behavior
Subjective norm
Perceived behavioral control
An example of a scenario: Zoey has planned to start exercising
a.
b.
c.
34. 34 Attitude regarding the Behavior
Zoey has decided that exercising “would be good for me
to do”
This judgment is based on two expectations (Sarafino &
Smith, 2011)
The likely outcome of the behavior
“If I exercise, I will be healthier and more
attractive”
Whether the outcome would be rewarding
“Being healthy and good looking will be satisfying
and pleasant”
a.
b.
35. 35Subjective Norm
This judgment shows the result of social influence on
the behavior’s acceptability. (Sarafino & Smith, 2011)
Zoey has decided that exercising “is socially
appropriate thing for me to perform”
This decision is based on:
Her beliefs regarding others’ opinions about the
behavior
“My family and friends think I should exercise”
Her motivation to follow those opinions
“I want to do according to their expectations ”
a.
b.
36. 36
The successful
expectation of the
individual in doing the
contemplated behavior
(similar to the self-
efficacy concept)
Zoey thinks she can
exercise and follow the
program (Sarafino &
Smith, 2011)
Perceived Behavioral Control
37. 37 What if?
If Zoey had the opposite beliefs, like the following, she
probably wouldn’t generate an intention to exercise
“Exercising is a waste of time”
“I do not care about my family’s opinion”
“I will never find time to exercise”
Self efficacy is a critical component (Sarafino & Smith, 2011)
People evaluate their efficacy on the basis of the effort
required, complexity of the work and other condition with
the given support from others
38. 38Limitations
(Behavioral change models, n.d.)
Assumes the individual has received the chances and information to be
successful in doing the desired behavior regardless of the intention
Does not consider for other variables that cause the behavioral intention and
motivation, like fear, threat, mood, or past experience
Normative influences are considered, but not environmental or economic
factors that may affect a person's intention to do
Assumes that behavior is the consequence of a linear decision-making process,
and does not consider that it can change in the future
The added construct of perceived behavioral control was an important addition
to the theory, but nothing is considered about the actual control over behavior
The time frame between "intent" and "behavioral action" is not considered
39. 39Transtheoretical Model (TTM)
Also known as the Stages of Change Model
Developed by Prochaska and DiClemente in the late
1970s
Formulated through studies mostly for smoking
cessation in 1991 (Behavioral change models, n.d.)
This model has been employed in many other
behaviours who are ready to change, like (Morrison &
Bennett, 2016)
Alcohol use, cocaine use, condom use, dietary fat
intake
Exercise, mammography screening, sunscreen use
40. 40 Transtheoretical Model (TTM)
Hence, it concentrates on the individual's plan for intentional and
behavioural change which is not made immediately and decisively
(Behavioral change models, n.d.)
Instead, the change in habitual behavior happens endlessly via a
cyclical process or a spiral linear pattern that the person may move
forward or backward until the change is accomplished (Lakhan, 2006)
It is a model, not a theory, because different behavioral theories can
be effectively used on different stages
They are the stages of motivational readiness (Morrison & Bennett,
2016)
41. 41Stages of Change
Five most common stages (Lakhan, 2006, Sarafino & Smith, 2011 and Morrison & Bennett,
2016)
Precontemplation
No idea about the problem or overlook its consequences
"Having a weight problem"
Contemplation
Thinking to change their behaviour after realizing the issue within the next six
months
"I think I need to lose a bit of weight, but not quite yet"
Preparation
Ready to change, and set goals within a specific period of time, within three months
"Changing to healthy food option for diet"
Action
The behaviors are obviously adapted to make a change, usually six months
"Start eating fruits instead of snacks or junk food"
42. 42
Maintenance
Maintain the successful behavioral changes they achieved, usually over six
months
Maintain the dietary change and resists temptation
Termination
It was not included as it is not always used (Behavioral change models, n.d.)
Since the behaviour change has been maintained for some time, the person will
feel no temptation to lapse and believes in themselves to maintain the change
Relapse
A person may lapse into older behaviour patterns and come back to a previous
stage.
This is common and possible to happen at any stage, because it is not at the
terminal stage (Morrison & Bennett, 2016)
Most likely to happen at the stages of action and maintenance (Lakhan, 2006)
In each stage, moving the person to the following stage to the ideal behaviour will be
effective for various intervention strategies
43. 43Limitations (Bishop, 2014)
Disregard the social context in which change happens, like
cultural issues and income
The lines between the stages can be subjective without limit
criteria of how to find out a person’s stage of change. The
questionnaires for each stage of change are not standardized.
Uncertain for how long the period is required for each stage, or
a person can stay in a stage
Expects that everyone to make clear plans, but this is not
always true
People can naturally quit smoking without going through these
stages
44. 44 Application in Journal Articles
Adefolalu, A. O. (2018). Cognitive-
behavioural theories and adherence:
Application and relevance in antiretroviral
therapy. Southern African Journal of HIV
Medicine, 19(1).
doi:10.4102/sajhivmed.v19i1.762
For HIV or AIDS patients to
reduce the infections
45. 45Application in Journal Articles
Coulson, N. S., Ferguson, M. A., Henshaw, H., &
Heffernan, E. (2016). Applying theories of health
behaviour and change to hearing health research: Time
for a new approach. International Journal of Audiology,
55(sup3), S99-S104.
doi:10.3109/14992027.2016.1161851
For audiology field
Hearing loss with hearing aid
Promotion of hearing health in hearing
screening
46. 46Application in Journal Articles
Lawal, O., Murphy, F., Hogg, P., & Nightingale, J. (2017). Health
behavioural theories and their application to women's participation in
mammography screening. Journal of Medical Imaging and Radiation
Sciences, 48(2), 122-127. doi:10.1016/j.jmir.2016.12.002
Concern
Having a mammogram regularly would reduce the chances of
dying due to breast cancer?
Getting breast cancer due to exposing to ionising radiation?
Culture influence
Viewing breast cancer as a shameful illness, so women would
willing to die without being diagnosed
47. 47
Comparison of the Health Behavioural Theories that
Explore Women's Behaviour Toward Mammography Screening
(Lawal, Murphy, Hogg & Nightingale, 2017)
48. 48Application in the Current News
The Official Source for Auburn University News. (2020). Learning
healthy habits is vital in the time of COVID-19. Retrieved from
https://ocm.auburn.edu/experts/2020/04/070958-healthyhabits-
covid19.php
[US News] Jan Kavookjian, an associate professor in the Department
of Health Outcomes Research and Policy, from Auburn’s Harrison
School of Pharmacy, is an expert on human health behavior in
making healthy decisions
One of the biggest factors in the spread of COVID-19 is the
"individual decision making" for not bothering about preventive
practices, like social distancing, quarantine and cleanliness
49. 49 Application in the Current News
Michie, S. (2020). Changing Behavior in a Pandemic. Retrieved from
https://www3.nhk.or.jp/nhkworld/en/tv/directtalk/20200625/2058
647/?cid=wohk-fb-org_site_dt_changingbehavior-202006-
001&fbclid=IwAR2d4fhjzSDe_mzJInMr8cSBm9YV8QOOIIxvznv1Gy
Cuye5drlFs5PShbOA
[UK News] Health psychologist, Professor Susan Michie,
Director of the Centre for Behaviour Change at University
College London
This professor is advising "the British government on how to
assist people" to change their behavior in a pandemic to
reduce the spread of coronavirus
50. 50What Do Health Psychologists Do?
Work in various tasks about health and
wellness
The specific type of work may depend on the
work setting on a daily routine (Cherry, 2020a)
Work directly in hospitals to help
individuals or groups to promote healthy
behaviors and prevent illness
Investigate on health-related issues
Contribute public policy on health care
issues
51. 51 Clinical Work
In clinical and medical settings, (Cherry, 2020a)
Conduct behavioral assessments
Clinical interviews
Personality tests
Involve in interventions with individuals or groups
Educating people about stress reduction
techniques
Offering smoking cessation tips
Teaching people how to avoid unhealthy
behaviors
52. 52
Research
Conduct research focus on health-related issues,
(Cherry, 2020a) such as
The justifications of health problems
Effective preventative measures
The best health promotion techniques
How to effectively help people to cope with pain or
illness
How to get people to seek treatment for medical
conditions
53. 53 Research Methods
Five types (Sarafino & Smith,
2011)
Case studies
Correlational Studies
Cross-Sectional Study
Designs
Experimental Designs
Longitudinal Design
54. 54Case Studies
In depth analysis of one individual
Type of single-subject research design
Advantage (Sarafino & Smith, 2011)
It is a more complete analysis of
the individual
Disadvantage
It can magnify sampling errors
55. 55 Correlational Studies
Yield degree of relationship between two variables
Type of descriptive research design
Advantage (Sarafino & Smith, 2011)
It can examine variables that cannot be
experimentally manipulated
Intelligence quotient (I.Q.)
Occupational status
Disadvantage
It cannot determine causality
56. 56Cross-Sectional Study Designs
Compares groups at one point in
time Age groups
Ethnic groups
Disease groups
Advantage (Sarafino & Smith, 2011)
To identify possible group
differences at one point in time
Disadvantage
Cannot rule out cohort effects
57. 57 Experimental Designs
Examines differences between
experimentally manipulated
groups
Group A gets a certain drug
Group B gets a placebo
Advantage (Sarafino & Smith, 2011)
Can determine causality
Disadvantage
High cost
Many variables cannot be
experimentally manipulated
Example, smoke exposure
over time
58. 58Longitudinal Design
To gather data on the course of health or disease
over time
Example: progression of multiple sclerosis
Advantage (Sarafino & Smith, 2011)
Can see the time course of the disease or
behaviour
Example: smoking cessation over time
Disadvantage
It is costly
It is still subject to bias
59. 59 Application in the Technical Report
Angus K, Cairns G, Purves R, Bryce S, MacDonald L, Gordon R.
(2013). Systematic literature review to examine the evidence for the
effectiveness of interventions that use theories and models of
behaviour change: towards the prevention and control of
communicable diseases. European Centre for Disease Prevention
and Control (ECDC) Technical Report. Retrieved from
https://dspace.stir.ac.uk/bitstream/1893/16455/1/ECDC%20Technic
al%20Report_health-communication-behaviour-change-literature-
review.pdf
There are many researches conducted on a wide range of
issues with various theories and models of behaviour change
in this report
60. 60Public Policy Work
Work in government or private sector
to improve public policy on health
issues (Cherry, 2020a)
This work involves
Lobbying government agencies
Concerning inequalities in
healthcare
Improving governmental bodies on
healthcare reform
61. 61Where Do Health Psychologists Work?
Different workplace settings, like
Hospitals, health care clinics, private companies and
universities
Specialized fields of health care, like
Oncology, pain management, women's health and
smoking cessation programs
In government settings, like
Managing community health programs or improving
public policy (Cherry, 2020a)
62. 62 Subfields Within Health Psychology
Clinical Health Psychology (Cherry, 2020a)
It is related to clinical psychology
Practices behaviour change, health education and psychotherapy
Community Health Psychology
Making interventions and prevention techniques at the community level
Work with groups to encourage healthy behaviors or promote behavior
change
Public Health Psychology
Understanding health at the population-level
Give advice to health care professionals, health educator and government
agencies
Occupational Health Psychology
Combines industrial-organizational psychology and related disciplines
Understanding how workplace issues are related to both physical and
mental illness
63. 63Reference
Adefolalu, A. O. (2018). Cognitive-behavioural theories and adherence: Application and relevance in antiretroviral
therapy. Southern African Journal of HIV Medicine, 19(1). doi:10.4102/sajhivmed.v19i1.762
Angus K, Cairns G, Purves R, Bryce S, MacDonald L, Gordon R. (2013). Systematic literature review to examine the
evidence for the effectiveness of interventions that use theories and models of behaviour change: towards the
prevention and control of communicable diseases. European Centre for Disease Prevention and Control (ECDC)
Technical Report. Retrieved from
https://dspace.stir.ac.uk/bitstream/1893/16455/1/ECDC%20Technical%20Report_health-communication-
behaviour-change-literature-review.pdf
Behavioral change models. (n.d.). Retrieved from https://sphweb.bumc.bu.edu/otlt/MPH-
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is-health-psychology-2794907
Cherry, K. (2020a). Health Psychologist Career Profile. Retrieved from https://www.verywellmind.com/what-is-a-
health-psychologist-2795652
64. 64 Reference
Centers for Disease Control and Prevention. (2013). CDC National Health Report Highlights. Retrieved from
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Coulson, N. S., Ferguson, M. A., Henshaw, H., & Heffernan, E. (2016). Applying theories of health behaviour and
change to hearing health research: Time for a new approach. International Journal of Audiology, 55(sup3), S99-
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Lawal, O., Murphy, F., Hogg, P., & Nightingale, J. (2017). Health behavioural theories and their application to
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122-127. doi:10.1016/j.jmir.2016.12.002
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Mason, P., Roy, A., Spillane, J., & Singh, P. (2016). Social, Historical and Cultural Dimensions Of Tuberculosis.
Journal of Biosocial Science, 48(2), 206-232. doi:10.1017/S0021932015000115
Michie, S. (2020). Changing Behavior in a Pandemic. Retrieved from
https://www3.nhk.or.jp/nhkworld/en/tv/directtalk/20200625/2058647/?cid=wohk-fb-
org_site_dt_changingbehavior-202006-
001&fbclid=IwAR2d4fhjzSDe_mzJInMr8cSBm9YV8QOOIIxvznv1GyCuye5drlFs5PShbOA
Morrison, V., & Bennett, P. (2016). Introduction to health psychology. (4th ed). Pearson Higher Ed.
National Cancer Institute. (2005). Theory at a Glance: A Guide for Health Promotion Practice. (2nd ed). U.S.
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The Official Source for Auburn University News. (2020). Learning healthy habits is vital in the time of COVID-19.
Retrieved from https://ocm.auburn.edu/experts/2020/04/070958-healthyhabits-covid19.php
