Healthy Living - G543


Health Belief Model

The Health Belief Model predicts the reasons why a person may adopt healthy behaviours due to a number of factors including:

  • Perceived susceptabillity 
  • Perceived seriousness
  • Costs vs Benefits
  • Cues to action (internal and external)
  • Demographics (age/gender/social)

According to the model someone will adopt healthy behaviours if they perceive a threat to their wellbeing if they don't adopt the behaviour, perceive the illness as serious and think that they are susceptable to the illness.

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Becker's Study

Aim: To use the HBM to explain mothers' adherence to a drug regime for their asthmatic children

Participants: 141 mothers responsible for administering asthma medication to their children

Methodology: Self Report - Interview

Findings: A positive correlation was found between a mother's belief about her childs susceptibility to asthma attacks and compliance with a medical regimen. This positive correlation also existed between a mothers perceptions of the seriousness of asthma and her administering the medication. Mothers who reported that their child's asthma interfered with their own activities also complied with the medication.

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Locus of Control

The Locus of control theory suggests that people have either an internal locus of control (they belive their own behaviour or actions directly impact on their behaviours and life) or they have an external locus of control (they belive their life and bahviours are outside of their control and instead are led by fate/chance). The theory is concerned with the extent to which someone's perception of how far their own actions determine the events of their life or their behaviours.

People with an internal locus of control are more likely to alter their behaviours to become more healthier.  

Those with an external locus of control may not try as hard as they believe that their own actions will make no difference.

People who have had success in the past are more likely to have an internal locus of control than those who have been unsuccessful.

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Rotter's Study

Method: Review article

Sample: 6 pieces of research 

FIndings: Participants who felt they had control over the situation were more likely to show behaviours that would enable them to cope with potential threats than participants who thought that chance and other non controllable forces determined the effects of their behaviours.

Conclusion: Locus of control would affect many of our behaviours not just health behaviours.

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The self efficacy theory is essentially about learning from consequences of behaviour.  

If people believe they will be successful at changing their health behaviours this will positively impact on their ability to change. 

However, those people with low self efficacy do not have a lot of confidence in the fact that their actions in a situation will be successful which may give them low motivation.This diminished motivation in turn may make them less likely to attempt to improve their health behaviours.

The level of self efficacy we have, depends on the following:

  • VIcarious experiences (seeing others doing something successfully)
  • Verbal persuasion (being told you can do something)
  • Emotional arousal (worry or stress can lower self efficacy)
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Bandura's Study

Aim: to assess the self efficacy of patients undergoing systematic de-sensitisation in relation to their behaviour with previously phobic objects.

Methodology:  Quasi-Experiment

Participants: 10 snake phobic patients who responded to an advert

Procedure: Pre-test assessment - each patient was assessed for avoidance behaviour towards a boa constrictor, then fear arousal was assessed with an oral rating of 1-10 and finally efficacy expectations.

Systematic Desentisation - a standard desenstisation programme was followed from imagining looking a picture of a snake to handling live snakes.

Post test 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 interactions with snakes.

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Media Campaigns

Media messages can be persuasive to change a persons health behaviour dependant on specific factors of the Yale Model of Communication.

According to the model there must be:

  • A valued communicator (an expert, trustworthy, credible)
  • A believable message 
  • The  method of communication must be accessible
  • The message must be aimed at the target audience
  • The situation the message is received in must be taken into account (home, cinema, surgery)

Media is used to promote health.  This is often through the NHS or government safety organisations.

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Cowpe's Study

Aim: to test the effectiveness of an advertising campaign.  

Methodology:  Quasi experiment

Participants:  people living in television areas

Procedure: 2 60 second commercials (in attendance and over filling) showing cause of the fire and actions required to put it out were shown in three areas (Granada, Harlech and Tyne Tees).  The number of reported chip pan fires were analysed for each area.

Findings: The net decline in each area over the 12 month period of the campaign was between 7% (Central) and 25% (Granada). The largest reduction was during the campaign.  In Tyne Tees there was a reduction of 33% during the campaign, 17% over the next six months and then 15% over the following 15 weeks.  

The questionnaires showed an increase in the awareness of chip fan fire advertising from 62% to 90% after the first adverts and stayed at 96% after the campaign.

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Legislation is law passed by governing bodies and many legislations exist which protect or promote the publics health.  Laws must go through a lengthy process before being passed and one of the first stages if the WHite Paper in which the proposal for the new law is outlined.  

Both Houses of Parliament must agree on the passing of laws by a majority and so legislation to promote health must be popular to come into effect.  

The first White Paper about Health in 1992 called `Health of the Nation` showing that legislation is developed for the good of the people.  As these are laws failing to adhere to the legislation will have criminal consequences.

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Dannenberg's Study

Aim: to review the impact of the passing of a law requirin cycle helmet wearing in children.

Methodology:  Quasi-experiment

Participants: children from 47 schools in Howard County and two control groups (one from Montgomery County and one from Baltimore County).  In all, 7322 children were sent questionnaires.

Procedure: questionnaires containing a 4 point Likert scale were sent. The topics included bicycle use, helmet ownership and use, awareness of the law, sources of information about helmets and peer pressure.

FIndings: Howard County (the one with the law) reported that usage had increased from 11.4 to 37.5% compared with 8.4 to 12% in Montgomery County and 6.7 to 11.1% in Balitmore County.

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Fear Appeals

Fear appeals are a method of frightening people by showing them or making them aware of the consequences of their unhealthy life choices. It shocks people into interest for the topic and so they pay more attention to the message. The government use fear appeals frequency, eg, they have insisted that cigarette companies show images of tar filled lungs etc.  The strongest fear appeals are found to be the most interesting but least effective.  In fact, it is  found that the most effective campaigns are those with minimal fear arousal.

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Janis and Feshbeck's Study

Aim:  to investigate the consequences on emotions and behaviour of fear appeals in communications. 

Methodology: laboratory experiment

Participants: an entire 9th grade freshman class at a US High School

Design: participants were split into four groups including a control group.  Group 1's lecture had strong fear appeal.  Group 2's lecture had moderate fear appeal.  Group 3's lecture had minimal fear appeal and Group 4 had a lecture on the functioning of the human eye.

Procedure:  a questionnaire was given one week before the lecture including some questions on dental health practices.  A 15 minute illustrated lecture was given by the same lecturer.  A questionnaire asking for emotional reactions to the lecture was handed out immediately after the lecture.  One week later a follow up questionnaire asked about the long term effects of the lecture.

Findings: The strong fear appeal lecture was generally seen as more interesting and the group showed a net increase in conformity to dental hygiene practices by 8%.  The net increases in the other groups was 22% in the moderate fear group and 36% in the minimal fear group.

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Reasons for Non-Adherence to Medical Regimes

Adherence to medical advice is when people comply with the advice they are given.  One theory for non adherence is rational non adherence.  This is when someone makes rational decisions to not follow advice or treatment.  One theory that comes under rational adherence is the cost benefit analysis.  This theory states that people are less likely to adhere to medical treatment if the costs outweigh the benefits.  However, if an individual feels that the benefits of the medical treatment, will in the long run, outweigh the sacrifices of possible costs then they are more likely to adhere to treatment. 

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Bulpitt's Study

Aim: to review research on adherence in hypertensive patients.

Methodology:  Review article.

Procedure:  research was analysed to identify the physical and psychological effects of drug treatment on a persons life. 

Findings: anti-hypertension medication can have many side effects including physical reactions such as sleepiness, dizziness and lack of sexual functioning.  

In one study 8% of males discontinued treatment due to sexual problems.  

In another study 15% of patients had withdrawn from taking medication due to side effects.

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Measures of Non-Adherence to Medical Regimes

Adherence to medical treatment can be measured both psychologically and physiologically, although the latter may be more reliable because the results are harder for patients to falsify.  Measuring non adherence is necessary so that professionals such as doctors are able to track their patients progression and solve any issues there may be with treatment.  Non adherence can be measured in a variety of ways which include behavioural measures, physiological measures and self report measures.

Ways to measure non-adherence: 

  • Blood tests
  • ECG
  • Interviews
  • Questionnaires'
  • Patients erratic behaviour
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Lustman's Study

Aim: to assess the efficacy of the anti-depressant Fluoxetine in treating depression by measuring glycemic control.

Methodology: Double blind study

Participants:  60 patients with type 1 or type 2 diabetes who had been diagnosed with depression

Procedure: patients were randomly assigned to either the Fluoxetine or Placebo group. Patients were assessed for depression using psychometric tests and their adherence to their medical regime was measured by measuring their GHb levels which indicated their glycemic control.

Findings: patients given Fluoxetine reported lower levels of depression and they also had lower levels of GHb which indicated their improved adherence.

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Improving Adherence to Medical Regimes

Individuals use the cognitive model when they make the decision whether or not to adhere by weighing up the costs and the benefits. However, in order to improve non adherence the behaviourist method can also be used. The positive behaviour of individuals (Adhereing to medical treatment) can be reinforced by rewards in order to make it likely that they will engage in this positive behaviour again. The individual will adhere to their medical treatment because they have learned that their behaviour receives the positive consequences of a reward. 

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Watt's Study

Aim: to seek if using a Funhaler can improve children's adherence to taking medication for asthma.  

Methodology:  field experiment using self report.

Participants: 32 Australian children diagnosed with asthma

Procedure: each child was given a Breath-a-tech to use for one week and the parents were given a questionnaire to complete.  The second week the children used the Funhaler and the parents were given a questionnaire with matched questions at the end of the second week.  The Funhaler has incentive toys which function best when the children best uses the deep breathing method which ensures the effective inhalation of the medication.

Findings: 38% more parents were found to have medicated their children the previous day when using the Funhaler compared to the existing treatment. 

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