Health PsychologyHealth Psychology

Health PromotionHealth Promotion

RequirementsRequirements

MethodsMethods Promotion in schools, worksites & Promotion in schools, worksites &

communitiescommunities Key issuesKey issues

Background MethodsBackground Methods

PREVENTIONPREVENTION Primary – combat risk factors before illness developsPrimary – combat risk factors before illness develops

People are unrealistically optimistic about healthPeople are unrealistically optimistic about health Secondary – actions taken to identify and treat and illness in early Secondary – actions taken to identify and treat and illness in early

stagesstages Tertiary – contain or slow injury or diseaseTertiary – contain or slow injury or disease

FEAR APPEALSFEAR APPEALS Minimal fear appeals create greater increases in conformityMinimal fear appeals create greater increases in conformity Efficacy – I can do this – increases conformityEfficacy – I can do this – increases conformity

YALE MODEL OF COMMUNICATIONYALE MODEL OF COMMUNICATION Source – credible, expert, trustworthySource – credible, expert, trustworthy Message – 1-sided if positive, 2-sided if unsympathetic, clear, direct, Message – 1-sided if positive, 2-sided if unsympathetic, clear, direct,

colourful, vivid, state conclusions (unless an educated audience)colourful, vivid, state conclusions (unless an educated audience) Medium – 1-1, personal, TV, radio, printMedium – 1-1, personal, TV, radio, print Target – who, sympathy, knowledge, active participationTarget – who, sympathy, knowledge, active participation Situation – where receivedSituation – where received

PSYCHOLOGICAL CONCEPTSPSYCHOLOGICAL CONCEPTS Fear appeal – sense of learned helplessness createdFear appeal – sense of learned helplessness created Self-efficacy – able to do – ‘back-to-sleep’ campaign.Self-efficacy – able to do – ‘back-to-sleep’ campaign.

Background PromotionBackground Promotion

HEALTHY SCHOOLS PROGRAMMEHEALTHY SCHOOLS PROGRAMME Baseline assessments needed in order to establish what needs to be changedBaseline assessments needed in order to establish what needs to be changed

PEER-BASED PROGRAMMEPEER-BASED PROGRAMME Information, particularly of a more sensitive kind, is easily shared between Information, particularly of a more sensitive kind, is easily shared between

people of similar agepeople of similar age WORKSITES HEALTH HAZARD APPRAISALWORKSITES HEALTH HAZARD APPRAISAL

Counselling, health examination, feedback & information – led to Counselling, health examination, feedback & information – led to improvements in general healthimprovements in general health

SMOKING REDUCTIONSMOKING REDUCTION Temporarily effective but wear off after time as people find ways around. Temporarily effective but wear off after time as people find ways around.

Competitive groups encourage quitting but once the competition is gone the Competitive groups encourage quitting but once the competition is gone the motivation is also gonemotivation is also gone

COMMUNITIES CHD AND MASS MEDIACOMMUNITIES CHD AND MASS MEDIA Mass media increases awareness but does little to promote changeMass media increases awareness but does little to promote change

REDUCING CANCER RISKREDUCING CANCER RISK Intentions to change can be judges but do people actually change?Intentions to change can be judges but do people actually change?

HOMELESSNESSHOMELESSNESS Not everyone has equal access to healthcare – homeless have poor diet, Not everyone has equal access to healthcare – homeless have poor diet,

malnutrition, substance misuse, mental health, infectious diseases, CVD, malnutrition, substance misuse, mental health, infectious diseases, CVD, accidents and hypothermia. Usually come to our attention through illness accidents and hypothermia. Usually come to our attention through illness rather than screeningrather than screening

Background IssuesBackground Issues

CYBERDOCSCYBERDOCS Websites – we share more information with these but is Websites – we share more information with these but is

the advice offered really better?the advice offered really better? SCREENINGSCREENING

Is the disease common enough and serious enough, is Is the disease common enough and serious enough, is accurate diagnosis possible, is early diagnosis helpful, is accurate diagnosis possible, is early diagnosis helpful, is there a test sensitive and specific enough, an the illness go there a test sensitive and specific enough, an the illness go undetected for a while?undetected for a while?

People most likely to attend screening are young, People most likely to attend screening are young, professional women who did not believe in the role of professional women who did not believe in the role of powerful others, with some knowledge and possible powerful others, with some knowledge and possible religiousreligious

PROBLEMS WITH SCREENINGPROBLEMS WITH SCREENING Risk of personal harm, anxiety, negative results, mortality Risk of personal harm, anxiety, negative results, mortality

questions, positive results, false positive results, effect of questions, positive results, false positive results, effect of taking part, inconvenience & embarrassmenttaking part, inconvenience & embarrassment

ULTRASOUNDULTRASOUND Unsettling as less than 2% of high risk screens turn out to Unsettling as less than 2% of high risk screens turn out to

be a problembe a problem

3 Short Summaries3 Short Summaries

Health promotion involves a wide range of social, medical, Health promotion involves a wide range of social, medical, psychological and political activities. Psychology has made a psychological and political activities. Psychology has made a contribution to our understanding of some of the processes around contribution to our understanding of some of the processes around health promotion, but its research findings are not always applied to health promotion, but its research findings are not always applied to health messageshealth messages

There have been numerous health promotion programmes in There have been numerous health promotion programmes in schools, worksites and communities with various levels of success. It schools, worksites and communities with various levels of success. It remains difficult to assess the effectiveness of such programmes but remains difficult to assess the effectiveness of such programmes but there is a general belief that they are a good thing.there is a general belief that they are a good thing.

The promotion of good health seems to be a fairly straightforward The promotion of good health seems to be a fairly straightforward ambition, but scratch the surface and you come up with a number of ambition, but scratch the surface and you come up with a number of puzzling ideas. One of these is the idea that prevention is better puzzling ideas. One of these is the idea that prevention is better than cure. Well yes, that might seem to be the case, but what if the than cure. Well yes, that might seem to be the case, but what if the prevention is a programme of mass immunisation of all children to prevention is a programme of mass immunisation of all children to reduce a damaging but rarely fatal disease, and what if that reduce a damaging but rarely fatal disease, and what if that immunisation programme prevents a handful of deaths but at the immunisation programme prevents a handful of deaths but at the same time opens up the risk of a reaction to the injection? You same time opens up the risk of a reaction to the injection? You prevent illness in some people by opening people to a new risk of prevent illness in some people by opening people to a new risk of illness.illness.

Study 1Study 1 DetweilerDetweiler

WhoWho 19991999 Message framing and sunscreenMessage framing and sunscreen Field experimentField experiment 217 sunbathers (165 female, 52 male) 18-79y, white, middle-income. Opportunity 217 sunbathers (165 female, 52 male) 18-79y, white, middle-income. Opportunity

sample. Consent and free lottery ticketsample. Consent and free lottery ticket WhatWhat

Given brochure about skin cancer, randomlyGiven brochure about skin cancer, randomly Information framed differentlyInformation framed differently

Highlight benefit of sun-protective behaviour - +veHighlight benefit of sun-protective behaviour - +ve Undesirable consequences avoided by using sun-protection - +veUndesirable consequences avoided by using sun-protection - +ve Benefits lost by not engaging in sun protection - -veBenefits lost by not engaging in sun protection - -ve Undesirable consequences arising from not engaging in sun protection - -veUndesirable consequences arising from not engaging in sun protection - -ve

Pre-manipulation questions and instructions, elicit information about intentions to use Pre-manipulation questions and instructions, elicit information about intentions to use sunscreen, spf, risk (hair colour, skin tone)sunscreen, spf, risk (hair colour, skin tone)

Post-manipulation; emotional reaction to brochure, beliefs, feelings about continued Post-manipulation; emotional reaction to brochure, beliefs, feelings about continued disuse, intentionsdisuse, intentions

Voucher for spf15 given – and number exchanged countedVoucher for spf15 given – and number exchanged counted ResultsResults

No gender differencesNo gender differences 71% positive frame exchanged voucher; 53% negative frame71% positive frame exchanged voucher; 53% negative frame Positive frame – increased intentions, but did not affect those already intending to usePositive frame – increased intentions, but did not affect those already intending to use

Study 2Study 2

ChackoChacko WhoWho

20022002 Neural tube defects and preventionNeural tube defects and prevention Experiment, repeated measuresExperiment, repeated measures 387, low income, women 13-22, ethnic minorities (black 286, Hispanic 387, low income, women 13-22, ethnic minorities (black 286, Hispanic

109) single at 1/3 prenatal clinics able to read English. Written informed 109) single at 1/3 prenatal clinics able to read English. Written informed consentconsent

WhatWhat Seen individually, questionnaire, knowledge of NTD, preventative effects Seen individually, questionnaire, knowledge of NTD, preventative effects

of various items, actual behaviour. Immediate and personalised NTD of various items, actual behaviour. Immediate and personalised NTD advice lecture given. If willing to take vitamins 3month supply given. advice lecture given. If willing to take vitamins 3month supply given. Survey by telephone 3 months later – different questions, same variables. Survey by telephone 3 months later – different questions, same variables. Results analysed.Results analysed.

ResultsResults Knowledge increased, including that about vitamins/foods and intake Knowledge increased, including that about vitamins/foods and intake

increased. But increased intake of vitamins was seen but not in the doses increased. But increased intake of vitamins was seen but not in the doses required to be successful – the intervention promoted health and provided required to be successful – the intervention promoted health and provided information but did not assist adherenceinformation but did not assist adherence

Study 3Study 3

IcardIcard WhoWho

20032003 African-American health promotion and marketingAfrican-American health promotion and marketing Quasi-experimental, 52 male, 47 female, low income af-am, 26-55y, 2 groups. Quasi-experimental, 52 male, 47 female, low income af-am, 26-55y, 2 groups.

Informed consent, paidInformed consent, paid WhatWhat

Led in structured discussion by trained af-am researcher.Led in structured discussion by trained af-am researcher. Source of information – what type of person to deliverSource of information – what type of person to deliver Message content – what should we sayMessage content – what should we say Channel – TV, radio etcChannel – TV, radio etc Target – how can participation of af-am men be increased?Target – how can participation of af-am men be increased?

Taped and a trained af-am student (1m, 1f) acted as note-taker. Data transcribed and Taped and a trained af-am student (1m, 1f) acted as note-taker. Data transcribed and content analysedcontent analysed

Results Results Source – credible, trustworthy, well known, a member – not too high profile, direct Source – credible, trustworthy, well known, a member – not too high profile, direct

experience better than professional strangerexperience better than professional stranger Message – straightforward, language familiar, concern but not patronising, positve Message – straightforward, language familiar, concern but not patronising, positve

frame and promotingframe and promoting Channel – 1-1, leaflet, direct mail. Radio if music appropriate. Literacy a problem. Channel – 1-1, leaflet, direct mail. Radio if music appropriate. Literacy a problem.

Saturation coverage.Saturation coverage. Target – sports events/ men's venues. Word of mouth. Sub-groups need to be Target – sports events/ men's venues. Word of mouth. Sub-groups need to be

individualised (single men, prisoners, absent dads etc)individualised (single men, prisoners, absent dads etc)

Study 4Study 4

OhOh WhoWho

20032003 Decreasing pain and depression – rheumatoid arthritisDecreasing pain and depression – rheumatoid arthritis Field experiment. 36 out patients (5 male) ~48y, clinic S. Korea. Field experiment. 36 out patients (5 male) ~48y, clinic S. Korea.

18 volunteers (experimental), 18 opportunity sample (control). 18 volunteers (experimental), 18 opportunity sample (control). Promised access to health promotion program later.Promised access to health promotion program later.

WhatWhat 3 variables pain, depression, disability measured in both groups (all 3 variables pain, depression, disability measured in both groups (all

tests had been previously used and validated/reliable)tests had been previously used and validated/reliable) Pain – pictorial, VAS (current and average), SR hours of painPain – pictorial, VAS (current and average), SR hours of pain Depression – Depression scale (CES-D) translated 11 years beforeDepression – Depression scale (CES-D) translated 11 years before Disability – likert scales performing everyday tasksDisability – likert scales performing everyday tasks

Attend series of 2-hour health promotion activities once a week for Attend series of 2-hour health promotion activities once a week for 7 weeks – group discussion, lecture, demonstration, role-play, 7 weeks – group discussion, lecture, demonstration, role-play, contract, feedback, diarycontract, feedback, diary

After 7 weeks all tested for 3 variables again.After 7 weeks all tested for 3 variables again. Results Results

HP programme reported subsequent lower level of pain and HP programme reported subsequent lower level of pain and depressiondepression

No difference in disabilityNo difference in disability

Study 5Study 5

JanisJanis WhoWho

19531953 Effects of fearEffects of fear Entire freshman class, 15y, m+fEntire freshman class, 15y, m+f

WhatWhat Divided into 4 groups. 3 given 15 minute lecture on tooth decay and Divided into 4 groups. 3 given 15 minute lecture on tooth decay and

importance of dental hygeine. 4importance of dental hygeine. 4thth group control. Different forms of group control. Different forms of lecturelecture

Form 1 – strong fear appeal – painForm 1 – strong fear appeal – pain Form 2 – moderate fear – dangers milder and factualForm 2 – moderate fear – dangers milder and factual From 3 – minimal fear – tooth neglect consequences skirted aroundFrom 3 – minimal fear – tooth neglect consequences skirted around

Given questionnaires 1 week before lecture (asking about dental Given questionnaires 1 week before lecture (asking about dental hygiene), one immediately after and one a week laterhygiene), one immediately after and one a week later

ResultsResults Higher levels of fear arousal resulted in greater anxiety about decay in Higher levels of fear arousal resulted in greater anxiety about decay in

the immediate time period.the immediate time period. But minimal fear group changed conformity and took longer term But minimal fear group changed conformity and took longer term

actionaction

Study 6Study 6

ParryParry WhoWho

20002000 Smoking bans at workSmoking bans at work Evaluate a smoking policyEvaluate a smoking policy

WhatWhat Implemented a smoking ban policy in 1997 and evaluated Implemented a smoking ban policy in 1997 and evaluated

in 2000in 2000 ResultsResults

Unintended consequencesUnintended consequences Smokers congregated around entrancesSmokers congregated around entrances Smokers became more visible and gained a higher profileSmokers became more visible and gained a higher profile Accumulation of smoking debris around areasAccumulation of smoking debris around areas Sympathy for smokers increased as perceived to be Sympathy for smokers increased as perceived to be

discriminated againstdiscriminated against

Study 7Study 7

DavisDavis WhoWho

20032003 Bicycle safetyBicycle safety 5 schools (11 teachers, 284 children 10-12y, 51% female) 4 5 schools (11 teachers, 284 children 10-12y, 51% female) 4

observation sites: 2 near schools which had participated, 2 near observation sites: 2 near schools which had participated, 2 near schools which hadn’tschools which hadn’t

WhatWhat Questionnaire. Children observed. Recorded time, date, Questionnaire. Children observed. Recorded time, date,

weather, gender, ethnicity, ~age, helmet (used?), aloneweather, gender, ethnicity, ~age, helmet (used?), alone ResultsResults

84% had participated in safety programme. 90% own safety 84% had participated in safety programme. 90% own safety helmet. 74% report wearing it (males or older less likely) if helmet. 74% report wearing it (males or older less likely) if involved in programme more likely to wearinvolved in programme more likely to wear

Observations not useful – not many cycle riders seen!Observations not useful – not many cycle riders seen! Programme effective and knowledge retention/safe behaviour Programme effective and knowledge retention/safe behaviour

present – a booster session suggested. Low cost ‘cool’ helmets present – a booster session suggested. Low cost ‘cool’ helmets need to be made available.need to be made available.

General ReviewGeneral Review

EthnocentrismEthnocentrism Assumptions made based on our own culture. With regard to HP the Assumptions made based on our own culture. With regard to HP the

assumption that what works for one group will work for another is assumption that what works for one group will work for another is dangerous. Oh used a translation which had already been dangerous. Oh used a translation which had already been validated/reliability checked. Chacko excluded any non-English speakers.validated/reliability checked. Chacko excluded any non-English speakers.

Reliability/validityReliability/validity Oh validated and checked the reliability of all their scales by pretesting or Oh validated and checked the reliability of all their scales by pretesting or

using existing scales. Detweiler and Chacko have face validity but we using existing scales. Detweiler and Chacko have face validity but we can go no further. Icard suggests the questions have face validity but can go no further. Icard suggests the questions have face validity but goes no furthergoes no further

PerspectivesPerspectives Detweiler and Oh ask patients to assess levels of pain/risk and this Detweiler and Oh ask patients to assess levels of pain/risk and this

requires them to process a question correctly, transform a verbal requires them to process a question correctly, transform a verbal response to a non-verbal one and match to the measuring instrument. response to a non-verbal one and match to the measuring instrument. Man is not always logical or rational (or 100% in Chacko would take Man is not always logical or rational (or 100% in Chacko would take vitamins 100% Detweiler will use sunscreen vouchers) if we do not like vitamins 100% Detweiler will use sunscreen vouchers) if we do not like something the chances are we will not do it. Icard – we may choose to something the chances are we will not do it. Icard – we may choose to ignore information because it came from the wrong personignore information because it came from the wrong person

SamplingSampling Appropriate samples were used. Detweiler used sun-bathers rather than Appropriate samples were used. Detweiler used sun-bathers rather than

mall-shoppers, Chacko used black and Hispanic because NTD had not mall-shoppers, Chacko used black and Hispanic because NTD had not been conducted with these groups. But by defining the groups so been conducted with these groups. But by defining the groups so precisely we limit our ability to generalise to the population as a whole.precisely we limit our ability to generalise to the population as a whole.

QuestionsQuestions

Describe what psychologists have found out about Describe what psychologists have found out about health promotionhealth promotion

Discuss the psychological evidence on health promotionDiscuss the psychological evidence on health promotion Suggest one psychological technique for promoting the Suggest one psychological technique for promoting the

eating of fresh fruit. Give reasons for your answereating of fresh fruit. Give reasons for your answer Describe one study of health promotion (6)Describe one study of health promotion (6) Discus the ethics of research into health promotion (10)Discus the ethics of research into health promotion (10) Describe one study of health promotion in school (6)Describe one study of health promotion in school (6) Discuss the strengths of promoting health in schools Discuss the strengths of promoting health in schools

(10)(10) Describe one study of health promotion in a worksite Describe one study of health promotion in a worksite

(6)(6) Evaluate the effectiveness of health promotion in Evaluate the effectiveness of health promotion in

worksites (10)worksites (10)