Theories of Health Belief - Health Belief Model
Background: HBM adopts the cognitive approach theory
Derived from a study on why people did or did not go for TB screening which seemed to indicate that a main consideration was how serious they percieved TB to be. If it was a threat to health, the logical thing was to be screened.
Becker: "Compliance with a medical regimen for ast
Aim: To use the HBM to explain mother's adherence to a drug regimen for their asthmatic children.
Method: Mother's beliefs identified during interviews, correlated to their self-reported administration of asthma medication to find a relationship. 111 mothers responsible for administering asthma medication to their children. Aged between 17-54. Children aged between 9months-17yrs. Mother interviewed for 45 mins. Questioned on their perception of their child's susceptibility to illness and asthma, their beliefs about how serious it is, how much it interfered with the child's education, caused embarrassment, interfered with their own activites, their faith in doctors and the effectiveness of the medication. A blood test for some was used to test the level of medication to ensure validity of the mother's answers.
Results: A positive correlation between a mother's belief about their children's susceptibility to asthma attacks and compliance with a medical regimen. A positive correlation between the mother's perception of the child having a serious asthma condition and their administration of the medication. Those who's child's asmtha interfered with their own activities also complied. A negative correlation between compliance to medical regimen and disruption to daily activities, inaccessibility to chemists, the child complaining and the prescribed schedule. Married mothers were more likely to comply, more educated mothers were more likely to follow the prescribed routine.
Conclusion: The HBM is a useful model to predict and explain different levels of compliance with medical regimens.
Locus of Control
Background: Rotter's locus of control theory. Refers to a person's belief about what causes the good or bas results in his/her life. In relation to health, it refers to people's belief of what determines their health which would influence their decision to adopt healthy behavious or not.
Internal locus of control: Addictive food such as chocolate make people happier than healthy food. Health problems within the family
External locus of control: Role models - children blame parents. Fast foods are cheaper than healthy foods.
Townsend: "Health locus of control of adolescent s
Aim: Assess whether teenages who smoke cigarettes regulary have different beliefs concerning what controls their health.
Method: Interviewed 255 patients aged 13,15 and 17 from 3 GP practices, selected from the population of 350 people who had been intivited to attend a general health check. Questions on their health, smoking, drinking, exercise and diet. A "regular smoker" being someone who has at least 1 cig a week. The main outcomes measured were "internal" health locus of control and "powerful others" health locus of control.
Results: Those who smoked regulary had significantly lower values of internal control over their health than thouse who had never smoked. 66% of smokers were in the 17 year-old group. Teenage smokers tend to attribute their unhealthy behaviour to factors outside their control. Teenage drinker had significantly lower beilief in the rols of "powerful others" in controlling their health, they seemed to attribute thier behviour to themselves (internal locus).
Conclusion: Teenage smokers tend not to believe that their health is controlled by their own behavious, whilst drinkers do. Could be due to smoker's lack of understanding about what casues disease so they might not see their own behaviour as a threat to their health.
Background: Proposed by Bandure. Outcome expectancy - A person believes that the outcome of lifestyle changes would be beneficial to them. Efficacy expectation - Whether they believe they would be successful in making the change. Linked to the social cognitive theory which relates to a person's own belief in their potential to bring about change. Suggests that individuals are actively engaged in their own development and can make rhings happen by their actions in terms of "what people think, believe, and feel affects how they behave". This is the interaction thoughts and actions. 3 factors that affect a person's efficacy expectation:
- Vicarious experience - imitation of role models
- Verbal persuasion - influence by confident assured language
- Emotional arousal - actions which are determined by a desired emotional outcome.
Can also be affected by the situation so how successful they would be in adopting a healthy behaviour will alter in different situations.
Bandura & Adams: "Analysis of self-efficacy theory
Aim: Assess the self-efficacy of patients undergoing systematic desensitisation in relation to their behavious with previously phobic objects.
Method: Quasi-experiment, 10 participants with a severe phobia to snakes, newspaper ad. 9 males and 1 female with a mean age of 31. Pre-test assessment to establish their level of avoidance behaviours towards a boa constrictor, fear of snakes, fear arousal and self-efficacy expectation measured on a scale 1-10 and reported verbally. They underwent a standard systematic desensitisation programme were they are exposed to a series of events involving snakes, ranging from imagining looking at a picture to holding a live snake. At each stage they were taught relaxation techniques to overcome anxiety. An average duration of the treatment last 4hrs, 27mins. Post-test assessment, avoidance behaviour and levels of self-eficacy were measured again and compared to the pre-treatment.
Results: Higher levels of self-efficacy after the treatment correlated with higher levels of interactions with snakes, which suggests that people's belief in their success in changing their behavious is closely related to the actual display of such behaviour.
Conclusion: Systematic desensitisation enhances self-efficacy levels in people with snake phobias. If people believe they can cope with a phobis stimulus or fearful situation they are more likely to do so.
Methods of Health Promotion
Background: Considers the way in which people can be encouraged to adopt a healthy behabiour. One of the main issues being if the promotion is an effective communication of a particular message to its target audience.
Health promotion - a programme of health enhancing activities used to promote the overall health of the individual.
Types of promotion include: Media Campaigns, legislation and fear arousal.
Background: TV campaigns, leaflets or posters are used to deliver a health message across to the general public. They are a powerful way of exerting a gradual influence on people's lifestyles. They use a variety of formats so the message is recieved by a wider selection of the population. These include written, visual, printed or electronic formats.
Cowpe: "Chip-pan fire prevention"
Aim: To test the effectiveness of an advertising campaign which provided information, demonstrated procedure, challenged perceptions about lack of ability to cope and encouraging preventative actions
Method: Quasi-experiment. A media campaign was shown in 10 UK regional TV areas from 1976-1984. Measured the number of chip-pan fires reported during this time. 2 consumber surveys were carried out. 2 campaigns were shown on TV in the form of 2 60-second commercials, both showed the initial cause of fire and the actions required to put it out. They included real-time and slow motion sequences to heighten the effect. Each region was shown the chip-pan campaign and 3 areas were shown reminders a year later. The number of chip-pan fires was tehn analysed for each area.
Results: The number of chip-pan fires reported following the campaign delcined between 7-25%. The largest reduction in incidents was during the campaign period. E.g. in Tyne Tees area number of chip-pan inicident declined by 33% during the campaign, 17% over the following 6 months and 15% over the following 15 weeks. In areas with more than 1 channel recpetion, the overlap showed less impact, probably due to the overexposure. Surveys showed an increase in awareness of chip-pan fires from 62% before to 90% after the first advert and stayed at 96% after in the Yorkshire TV area. People's references to the potential of fire hazards in kitchens also increased from 12% before to 28% after the campaign in the same area.
Conclusion: Media campaigns are successful in alerting the public to dangers to health and motivating people to take further precautions. Overexposure to the information can lead to people's desensitisation so is less likely to have a positive effect on desired behavioural changes.
Background: Legislation is the act or process of making a law. They are always subject to change and vary between countries. For example, blood alcohol limits.The problem with any legislation is that for it to be effective, it needs to be enforced. Would people's health behaviour change if there was no chance of them being caught and prosecuted? If not, could legislation related to health behaviours then be considered an effective means to promoting health amongst the population?
Dannenburg: "Bicycle helmet laws and educational c
Aim: To review the impact of the passing of a law requiring children to wear a cycle helmet.
Method: Quasi-experiment. 7,322 school children aged 9-10, 12-13 and 14-15 years old who lived in one of 3 counties in Maryland, USA.
-Howard County - passed the legislation that required all children under the age of 16 to wear a bicycle safety helmets.
-Montgomery County - An extensive education campaign about the importance of safety helmets.
-Baltimore County - Neither legislation nor campaign to promote wearing of safety helmets.
Children asked to complete a survey that contained questions about bicycle use, helmet ownership, peer pressure and bicycle-related injuries, had to rate their responses on a 4-point likert scale. Parents assisted them. Response rate obtained ranged between 41-53% across the 3 groups and 3 counties.
Results: Howard county , the reported use of helmets had increased by 23% within the year of the law being passed, 4% increase in Montgomery county and 5% in Baltimore. Younger age groups increased their helmet usage more than older children across all counies. Most children in Howard County (87%) were aware of the law but 38% of those had reported actually wearing one on their last bicycle ride.
Conclusion: Legislation has a clear impact of children's health behaviour as there was a large increase in satefty awareness and adaption to the law requirements. Educational campaigns are not an effective way in bringing about change as they did not lead to any significant difference in children's behaviour any more than areas with no campaigns or legislation.
Backgroung: Fear arousal is a way of making a percieved threat to a person's health appear frightnening so that their fear motivates them into action to make relevant changes to their lifestyle. Linked to the HBM.
It is a way to promote health by creating emotional tension so that the person is not only forced to make a cognitive decision to change their behaviour but also needs to remove the source of anxiety that otherwise they will be continously experiencing. These campaigns are to try and firghten people into changing their lifestyle.
Janis & Feshbeck: "Effects of fear arousal"
Aim: To investigate the consequences on emotion and behaviour of fear appeals in communication.
Method: Lab experiment. 200 high school students. Average age of 15. Completed questionnaires about heir dental health practice, then a week later attend a 15min illustrated lecture about the importance of dental hygiene.
Group 1- Lecture with a strong fear appeal, emphasising the painful consequences of poor dental hygiene, such as tooth decay and gum disease. "this could happen to you"
Group 2- Moderate fear appeal. Little info on the consequences with statements being more factual than audience-focused
Group 3- Minimal fear arousal. Neutral info on tooth growth and function rather than the consequences of poor dental hygiene.
Group 4- Control group. Lecture about the functions of the human eye.
Same presenter and number of slides used in each lecture. A follow-up questionnaire was given a week later, asking p's about the long-term effects of the lecture.
Results: The amount of knowledge on dental hygiene did not differ between the 3 experimental groups so all lectures conveyed the same info. Group 1 saw the long-term benefits of the lecture in the most positive light, but reported higher levels of dislike of unpleasant slides. In terms of changing their dental hygiene routine and conforming to the recommendation, group 3 showed the highest increase of 36%, then group 2 with 22% and then group 1. Any difference with group 4 were found not to be siginificant.
Conclusion: Fear appeal can be an effective method in changing people's behaviour but only if communication is approproate for the targeted audience. In this case, minimal fear was the most effective way in bringing about changes in people's health behaviour.
Features of Adherence to Medical Regimes.
Background: A need for individuals to be more responsible for their own care. Doctors need patients to follow medical advice and adhere to the medication schedule prescribed, which at times are time-consuming and complicated. Linked to the cost-benefit model in that people weigh-up the costs of following the medical advice against the benefits they will gain in doing so.
Reasons people give for not following medical advice include the level of complexity of treatment (the more complicated the medical regime the less likely they are to follow), the length of the treatment (the longer the treatment programme the less likely people are to complete it) and the amount of percieved change required (the more changes to everyday routine the treatment requires, the less likely they are to follow it)
Cognitive reasons for non-adherence.
Background: Refers to the deliberate decision not to follow medical advice. May be linked to the HBM as the costs of adhereing outweigh the benefits, so the rational decision might be to not continue following the prescribed treatment as it costs more than the benefit to the individuals overall health.
For example, how we process info given to us by a doctor can be affected by a number of factors such as how much a patient trusts the doctor. Therefore, instructions given may be ignored as the patient processes the info given by the doctor as untrustworthy.
Bulpitt: "Impotance of well-being in hypertensive
Aim: To review research on adherence to medical treatment amongst hypertensive patients.
Method: A review of article research that identified problems with taking drugs for high blood pressure in men. Research studies were analysed to investigate the physical and psychological effects of drug treatments on a person's life, including: work, physical well-being, hobbies, etc. Researchers wanted to find out if the side effects of the drug treatment affect people's decision of whether they would continue the treatment or not.
Results: Anti-hypertension medication had many physical side effects: sleepiness, dizziness and erectile dysfunction in men. Also they affect cognitive functioning so impact people's work and hobbies. 1 study reported that the patients discontinued the treatment due to sexual problems experienced. Another reported that 15% of patients withdrew from the treatment 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, the patients are less likely to adhere to the treatment advice suggested by their doctor.
Physiological measures of non-adherence.
Background: How non-adherence can be measured. Most commonly, monitoring of adherence can be done by doctors who look at the therapeutic outcomes or the medicine's effect on the person's health. This might not provide an accurate picture of adherence as sometimes medication does not work. Blood tests can be used but these might not be useful for cases where the symptoms might not have a physiological origin (e.g. mental health).
Ways of measuring adherence could include: Pill and bottle counts, Mechanical methods, Biomedical tests.
Braam: "Bromide as a marker for adherence in hyper
Aim: To investigate different methods for measuring adherence in hypertensive patients.
Method: Field experiment. 14 men and 16 women with poorly controlled high blood pressure were asked to test a combination of drugs to reduce blood pressure. Not told the true purpose of the experiment but written informed consent was gained. After a 4-week period during which patients were prescriebed a placebo, they were given the new drug combination and their blood pressure was measured at regular intervals over a 20-week period. IV- adherence was measured by capsule counting, elextronic registration of pill box openings and by measuring serum bromide conc. (added to capsules) in the blood.
Results: According to capsule counting method, almost all patients showed a high level of adherence. Both electronic monitoring and measurements of bromide levels in the blood showed good levels of adherence. Electronic monitoring and blood testing showed that 4 patients did not adhere to the treatment.
Conclusion: Objective measures such as electronic monitoring and blood tests provide more accurate measures of patients' adherence to medical treatments.
Improving adherence using behavioural methods.
Background: Reducing the costs and increasing the benefits. There are a number of simple and effective ways in which to try and improve adherence to medical treatments, regardless of the factors causing non-adherence. This may include:strengthening social support where family and friends could be involved in the consulatation process and asked to encourage the patient to follow the regime, doctors ensuring patients are well-informed of the nature of the treatment and provides clear written instructions on how to follow the treatment.
Health psychologists have investigated the ways in which behavioural methods might improve adherence and in particular the use of reiniforcement for correct adherence. Promts such as an alarm that sounds when medication needs to be taken. Social rewars could also be given by the doctor or family members as a way of encouraging the patient to continue with the mediciation.
Watt: "Improving adherence to taking medication fo
Aim: To see if using a Funhaler can improve children's adherence to taking medication for asthma.
Method: Field experiment. 32 children. Average age of 3.2 years. All diagnosed with asthma and had been prescribed with medication through a pressurised metered does inhaler (pMDI). Each child used the normal inhaler for one week and then was given the Funhaler to use the following week, which contains and incentive toy (spinner/whistle) that only worked if the child used the correct breathing pattern. Children's adherence to medication was measured by their parents completing a questionnaire at the end of each week which asked about the frequency of use of the inhaler.
Results: A 38% increase in adherence to medication using a Funhaler compared to the standard inhaler. 60% increase in the number of times the full recommended dose of medication was successfully administered when using the Funhaler.
Conclusion: Adherence in children can be improved if they find taking medication fun, which suggest that the way medication is delivered needs to be appropriate for the patient if they are to adhere to the treatment programme.