Yale Model of Communication. = Health Promotion
Yale Model of communication.
Source -------------> are they credible?
Message-----------------------> one sided/ two sided?
medium-------------------------> one to one? is it personal?
target--------------------------------> who's the message aimed at? is the audience sympathethic to the message?
situation ---------------------------------------> where will message be recieved? home/ cinema/ doctors surgery?
Health promotion- worksite wellness programs
Johnson + Johnson " live for life programmes".
- Participants exceeded 31,000
health goal- help people live healthier lifestyles.
Making improvements- health knowledge, stress management, efforts to exercise, stopping smoking and controlling weight.
- Begins with a health screen
- seminar action groups were joined for specific areas of improvements
- professional lead sessions were attended
- focusing on employers altering new behaviours permantley and mainitaining.
companies provided work enviroments that support and encourages healthy behaviour.
- follow up contact made a year later.
greater improvements found into health behaviours.
Health promotion- communities.
Farquhar et al 1977
stanford heart disease prevention programme:
- an ambitious communitys wide effort to get people to change behaviour and reduce risk of cardiovascular disease.
3 communties of about 14,000 ppl, northern calafornia.
2 towns has a mass medic campaign that lasted 2 years. Tv, radio, newspapers were all used.
other community- control group.
- randomly chose several hundred 35 to 59 year olds from each community and interviewed them annually.
- took blood pressure and sample of blood to assess for risk factors of heart disease.
control community- risk increased
2 other communities- decreased risk
Health promotion- schools.
Davis Kirsh + Pullen
Promoting bicycle saftety- increase self efficacy.
aim- Evaluate effectiveness of safety control programme. USA.
Sample- 5 schools representing demographic makeup of community.( 11 teachers + 214 children 10-12 years).
observations were carried out in schools + nearby parks.
Method- 14 iten questionnaire to complete, others observed data:
- approx age
- helmet use
- alone or not
- 90% owned a helmet
- 74% wore helmet on last bicycle ride- more females.
- more likely to wear helmet if taken safety control programme.
- 50% felt knew how to fall so didnt hurt themselves.
- 82% disagreed with statement " i am a good biker so i dont have to wear a helmet".
Conclusion: booster sessions needed.
only effected 1-2 year period..?? make cool looking helmets?
Health Promotion- emotions.
Jancis + Feshback.
- investigate consequences on emotions + behaviour of fear appeals in communication.
lab experiment: showed fear arousing material + then collected data- series of questionnaires on emotional reactions + changes in dental practices.
9th grade class US highschool.
independent measures design, each participant 1 of 3 lectures. control group didn't go.
Group 1- strong fear appeal emphasises poor dental hygeine, gum disease- direct statements " this could happen to you".
Group 2- moderate fear appeal- little info on consequences- poor dental hygeine. factual statements.
Group 3- minimal fear arousal, neutral info on tooth growth + function rather than poor dental hygeine.
Procedure= Questionnaire week before lecture included some questions of dental health. week after 15 min lecture, immediatley after questionnaire handed out. 1 week later follow up questionnaire.
amount of knowledge didnt differ between 3 experimental groups. strong fear appeal= seen positive light.- should be shown to all schools.
minimal fear- most effective form of lecture with more conformity of practices.
Levental et al
Levental et al.
use of fear to arouse change in a person's behaviour.
- questionnaire of attitudes + desire to quit smoking.
watched brief colour movie.
showed mechanical smoking machine which demonstrated harmful effects of smoking.
charts-----> Correlation between cig sales/ death from lung cancer.
participants then shown either low or high fear arousal presentation.
High -operation- remove diseased lung of patient with lung cancer.
some participants so upset had to leave.
After presentation answered same questionnaire-prior to experiment.
Results- showed participants in high fear arousal more vunerable too lung cancer than those in low fear arousal.
HIGH- more effective in changing peoples attitudes to smoking.
Evaluation themes for Health Promotion.
- ethics- reductionism
- persuasive communication
- methodology- reliability, sampling, validity
- ethnocentrism- message being potrayed in our culture may not be important to other cultures, language.
Breech of human rights to tell people what to do.
Fear arousal- psychological harm and stress it can cause.
defence mechanisms-- Denial
Adherence to medical advice.
adherence to medical advice.
Aim- review at finding correlations between patients non adherence to medical treatment + their levels of anxiety/ depression.
Sample- 25 studies carried out between 1968/ 1998
method- all had it but werent treated for it.
Results- No correlation between anxiety + non- adherence- strong correlation between depression + non adherence.
Conclusions- depressed patients are 3 times more likely to fail to adhere to the medical regime prescribed to them.
recognising depression as a risk of non- adherence = potential to improve health care outcomes.
summarises the reasons why a rational patient might not adhere to the treatment as follows:
- they have reason to believe that the treatment is not helping( behaviourism).
- side effects are unpleasant, worrying or reduce quality of life.
- confused about when to take treatment + how much is required.
- Practical barriers- cost of medication.
therefore non- complying patients are often making the best sense they can of their health problem.
Cluss + Epstein.
1) self report- patient summarises own compliance (often exaggerated).
2)Therapeutic outcome- taking medicine to reduce a factor when other factor may help the reduction.
3) Health worker estimates- estimates patients compliance ( unreliable).
4)Pill + bottle counts- pills can be thrown away.
5) Mechanical methods- choo et al- gain medicine can be thrown away.
6) Bio chemical tests- blood + urine= very expensive.
Compliance with requirement to change lifestyle much lower + more varied.
Lustman et al
Lustman et al
Fluoxetine for depression in diabetes.
Aim- see whether when treating diabetics with anti-depressants fluoxetine- will it improve level of adherence.
sample- volunteers with a history of suicidal behaviour, bipolar disorder, current alcohol/substance abuse disorder. screened for depression
final sample consisted of 60 patients with diabetes + major depression.
Method: randomly assigned to 2 groups. one receiving fluoxetine + control group receiving identical placebos.
double blinded- neither researchers/participants knew. over 8 weeks. experimental group given daily doses of fluxoetine measure of depression by becks depression inventory. (BDI) + Hamilton rating scale for depression.
blood sugar levels monitored how much control diabetics had over their illness.
Assumed valid measure of patient adherence to medical advice. pticipants remained seriously depressed. refered to councelling and psychotheraphy.
Results- pticipants who were given fluoxetine were less depressed than control group.
showed much healthier blood sugar levels.
Conclusions- after 8 weeks of being treated with fluoxetine, patients developed better control over blood sugar levels- results of better adherence.
provides evidence to suggest that one wat of improving patient adherence is to reduce depression level
determinism- treats depression 1st then more likely to adhere.
Bulpitt et al
Bulpitt et al
importance of wellbeing in hypertensive patients.
aim- review research on adherence in hypertensive patients.
methodology- identifying problems for taking drugs 4 high blood pressure.
procedure- research analysed to identify physical/psychological effects of drug treatment on a persons life. work hobbies, physical well being.
findings- medication- many side effects= physical reactions- sleepyness dizziness, lack of sexual functioning.
1 study by curb et al 1985 found 8% males discontinued treatment because of sexual problems.
medical research council 1981 found that 15% of patients withfrew from taking medication due to side effects.
conclusion- if side effects, impotence in way of benefits of treating symtomatic ( no symptoms) problems they not likely to adhere. RELATES TO HEALTH BELIEF MODEL.
Evaluation themes for adherence to medical advice.
Evaluation themes for adherence to medical advice.
- sampling- ethnocentrism
- determinism- esp for depression study
Pain- measuring pain
Cold pressor procedure-
- involves mersing subjects hands/forearm in icewater for a few mins.
- special apparatus used so that researcher maintains standard procedure.
- arm rest mounted on ice chest filled with water
assessed several ways:
- self rating
- length time he/she willing to endure discomfort
Pain- Measuring Pain.
Girodo + Wood.
- used cold pressor procedure to examine role of coping methods on pain perception.
subjects all underwent CPP twice. Before 2nd go, subjects in diff groups recieved diff types of training for coping with pain.
2 groups trained by:Group 1= making positive self statements, taught list of 20 "no matter how cold it gets i can handle it".
Group 2= same self statements but also received explanation of how these help personal control and help them control pain.
immediatley after :rated experience on 11 point scale ranging from no pain felt- worst pain. comparing data from 1st/2nd procedure showed that pain rating decreased for subjects who recieved explanation. vice versa. suggest peoples experience of pain maybe affected by belief about purpose of self statements.
Gate control theory.
theory suggests that there is a gate in the nervous system that either allows pain messages to travel to the brain or stop those messages.
gate is in the spinal cord+ is opened or closed by following factors:
- activity in pain fibres- suggest activity in small diameter fibres, respond specifically to pain to open the gate.
- activity in other sensory nerves- large diameter nerves- carry info-touching rubbing close the gate
- messages from brain- central control mechanism- responds to excitement, aniety to open the gate/close the gate. e.g distracting people help them to forget about pain.
GCT would suggest there is a limit to pain tha can be experienced. intense pain= lose conciousness- gate open fully.
mechanism to prevent some kind of overload to system.
Mc Gill Pain Questionnaire.
refers to sensory, emotional. cognitive and miscallenous elements of pain.
part 1- please mark on drawing below the areas were you feel pain. put E is external or I if internal.
part 2- some words below describe your present pain. circle only those words. 20 categories- 1 word in each category.
1) flickering 2)jumping 3)pricking 4) sharp
Evaluation issues for pain.
- validity- self report measures people can lie.
report pain to be higher or lower than it actually is.
- language - words in MPQ may be difficult to understand.
- english isnt everyones first language.
psycological harm? in order to measure pain..have to cause pain?
Managing + controlling pain.
Stimijs et al
aim: investigate which of 2 methods for managing the pain of tennis elbow was more effective.
participants- 31 participants with tennis elbow. they had been suffering from it for a minimum of 6 weeks and max of 6 months.
pilot study- small sample
informed consent was obtained and 3 of particpants withdrew from study b4 was completed.
procedure- pticipants were randomly allocated to one of 2 treatment groups.
1st group received treatment. in form of manipulation of the wrist, up to twice a week over a 6 week period with max of 9 treatment sessions.
Methods of promoting health.
Health belief model.
Health belief model allows us to consider the psychological factors that influence a patients decision to engage with health services.
1) Percieved susceptibility= whether they are likely to get the disease or not.
2)Perceived seriousness= how serious the disease is likely to be.
3)Perceived benefits + barriers=how easy it would be to get something done about it? whats it going to cost me?
4)self-efficacy= am i able to make changes?
5)Cues to action= what triggers exist to transform the accumlated concern into an actual action.
Methods to promoting health.
Abraham et al.
aim- investigate whether the health belief model could explain condom use in adolscents
method- 2 sets of adolscents: one at 16 yrs old and other at 18 yrs old. a health belief model questionnaire was sent out with 690 returns it was then sent out a year later. pairing up questionnaires ended up with 333 responses. questions included those about intented condom use.
results:not encouraging in that HBM did not predict condom use.
conclusion: authors suggest that safer sex health beliefs are in place for all participants, but other factors lead to actual health behaviour.
- for males there was a small significant relationship between the 2 ages but for women there was not. some ideas in HBM did predicts condom use in males but not in females.
- it maybe that females rely more on males for condom use as they see it as a mans responsibility to provide condoms.
Determinants of health enhancing behaviour.
Biological determinants- genetics.
some evidence that alcoholism may be inherited or least genetics may contribute to it.
Sher 1991 provides evidence that children of alcholics are more likely to become alcoholics themselves.
It maybe that the gene increases tolerance of affects that the metabolism has on alcohol + the resultant hangover.
it is difficult to seperate genetics + learning (nature/nuture).
although children may become alcoholics following their parents because of social learning not genetics.
SUGGEST?? research could be carried out on children of alcoholics who do not live with parents.
Ego-defence mechanisms- freud.
At times people suffer anxiety and stress, they can use ego defence mechanisms to cope. an example of a mechanism is denial. another example of how this can be related to health is after a self examination and a lump is found, they may avoid visiting the doctor due to fear. this is not a health enhancing behaviour. it is a short term coping strategy.
Peer pressure and copying the behaviour of friends +peers or joining with peers in activity. this can cause positive or negative results.= e.g joining a sports group will lead to health enhancing behaviour whereas joining a group of friends binge drinking leads to non-healthy enhancing behaviours.
- Social identity theory suggest that we aim to conform to our social group causing positive or negative results.
Erskine + Williams.
Operant techniques: the idea behind operant techniques is to use the principles of operant conditioning to encourage behaviours that reduce pain + discourage behaviours that increase pain...
Erskine + Williams suggest that these methods work by:
- using social reinforcements and periods of rest to gradually increase activity levels.
- gradually decreasing the use of medication
- training people associated with the patient (medical staff and family) not to reinforce the pain behaviours through their sympathy and practical help.
this approach only deals with behavioral responses to pain + is most useful if someone has developed inappropraite behaviour for dealing with their pain. i.e excessive use of drugs or avoidance of acitivity.
however if someone has chronic pain from cancer i. e approach is unlikely to have much of an effect.
Kanner et al.
aim- see whether the daily hassles + uplfts scales are more accurate in prediciting stress than a life events scale.
pticipants- 52 women and 48 men= white, well educated and comfortably well off. selected from a population of 1000 that had been previously selected from another study.
method- each ptcipant assessed once a month for 10 months a)a daily hassles + daily uplift scale developed by researchers.
b) life events scale similar to the SRR
c)the hopkins symptoms, checklist of psychological wellbeing.
d) bradburn morale scale to measure psychological wellbeing.
Cognitive appraisal. stress
Primary appraisal( is the event positive, neutral or negative?)
Secondary appraisal ( are coping abilities + resources sufficient to overcome the harm, threat)
Stress (physiological, cognitive, emotional + behavioral responses.
Stress Sosa et al
Sosa et al. = carried out a field experiment to study the effects of instrumental support on experiences of childbirth.
method- expectant mothers were assigned at random to either an experimental or a control group. the women in the experimental group were accompanied throughout labour by an untrained helper who provided social support in the form of conversation + general care. also nursing care provided by hospital staff.
the control group recieved only nursing care.
results= Average labour time was much shorter for the experiemental group (8.8 hours) than for the control group (19.3) hours.
conclusion- by providing social support this releived stress in the experimental group of mothers making them less anxious and allowing for shorter labour.
Health + Safety.
Defintions, factors + causes of accidents.
Pheasant: describes accidents as being " a combination of unlikely circumstances that lead to an unexpected event". he suggest that accidents are usually caused by " unsafe behaviours".
Riggio: suggested 4 types of human errors:
- errors of ommission (missing things out)
- errors of commission ( doing the wrong thing)
- timing errors ( too late/too early)
- sequence errors ( doing things in wrong order)
example of error of ommission relates to lack of sleep.
Ashen demonstrated that sleep deprivation leads to a) more errors and b) more time needed to complete a task.
Health + safety.
Defintions, factors + causes of accidents.
Reason suggested 2 approaches which can be applied to causes of accidents:
person approach + system approach
by studying accidents helps to enable the development of methods of reducing accidents.
in 2001 a patient of QMC hospital Nottingham was given a fatal injection-----> given into spine rather than intravenously (into veins). department of health enquiry showed personal causes- profession mistakes and also system causes= equipment + procedural mistakes
Sherry et al. Health and safety.
Traffic accidentes, job stress + supervisor support in trucking industry.
aim- relationship between stress + accidents in occupational setting.
method- correlation of r'ship stress. The drivers perceptions of:
- their supervisors abilties in goal settings
- appropriate feedback/support
- accidents measured.
participants- 55 lorry drivers, consented
procedure- asked p'ticipants to rate relevant items on 5 point scale (1 little 0 degree 5= great degree) asked 3 questions: 1) how many injuries in last 4 yrs?
2) collisions and 3) traffic tickets have you recieved in last 4 yrs?
results: no r'ship between personal attributes + no of collisions. sig r'ship between stress + injuries. sig r'ship of drivers perceptions being supportive/feedback + no of tickets recieved.
Personality + accident proneness. health + safety.
Greenwood + woods
research industrial accidents. -----------> some individuals are accident prone + more likely to have accidents than others. found statistical ddistrubutions of accidents which support idea.
Liao= carried out longitudinal study of 171 firefighters USA. showed introversion- related to higher injury rates. ----------> Liao suggested- exaplined by fact that introverts have less well developed team working skills.
this contradicts research by Furnham + Heaven
who suggest that extroverts are more likely to have accidents as they tend to be impulsive risk takers.
Substance use + abuse.
Moochan et al.
- described psychological + social causes indicating reasons why people smoke.
- aim- review research on smoking in adolscents by reviweing previous data.
- found that: almost half of students in grade 9 had used tobacco.
- 75% had 1 or 2 parents who smoke.
- adolscent smokers report more symptoms of depression
- female smoker are more confident and rebellious than male smoker who are socially insecure.
- girls smoke = weight loss/dieting
conclude that adolscent smoking= range enviromental and biological factors. treamtents aimed at adolscents to quit smoking have not been effective up til now.
Substance use + abuse.
File, Fluck and leahy.
examine + claim that nicotine has a calming effect= why people smoke.
method= 36 male/female non smoking students tested on.
- ability to perform cognitive task when given nicotine
double blinded technique. sometimes recieved nicotine/ sometimes not.
results= nicotine did not increase attention/memory
made male p'ticipants more aggressive + anxious but calmed down females.
conclusion- women may take up smoking because it can reduce anxiety/stress.
Substance use + abuse.
Robinson et al
aim- identify risk factors associated with diff stage of cig use in adolscents.
results= 37.8 participants had tried smoking + 4.1 regular smokers.
best predictor of exp cig= easily available + affordable
adolscent likely to smoke if friends did ---- not the case with boys
conclusion- range social influences contribute to both experimental/ regular smoking.
Substance use + abuse.
Charlton + Blair.
aim- know what factors influenced the start of smoking in young boys/girls.
method- surveyed 1213 girls, 1123 boys 12 -13 yrs
knowledge of cig advertising
diff brand cigs
what they had been taught/beliefs on smoking.
results- none factor sig predicted smoking in boys. girls all 4 factors predicited smoking having a friend who smoked was the factor with the strongest effect.
conclusion- female smoking predicted by parents smoke, positive views bestfriend smokes, knowledge + awareness of brands available . must be other reasons to predict male smoking.
Substance use + abuse.
interviewed young women smokers with children
main source income= state benefits
argued that they needed a cig to help clam down when children tempered and crying
by smoking may intentionally avoid physical/ psychological abuse of children.
substance use + abuse Evaluation themes.
reductionism- depends on how is defined -----------> assumed addictive is purely physical
medical approach thinks of addiction as illness not individuals fault.
usefulness- reason why women smoke diff---------suggest diff campaigns for diff sexes
determinsim- vs freewill
genetic/social learning- if parents smoke we are more likely too.