Health Psychology

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    • 00:06

      [Health Psychology]

    • 00:09

      RICHARD DE VISSER: Hello.I'm Dr. Richard De Visser, readerin psychology at the University of Sussexand the Brighton and Sussex MedicalSchool. [Dr. Richard De Visser, Reader in Psychology,University of Sussex and Brighton & Sussex MedicalSchool] I'm going to present a tutorial in health psychologybehavior change interventions.I'd like to give you an overview of someof the key aspects of interventionsto encourage change in health-related behaviors.By the end of this video, assuming I've done my job

    • 00:30

      RICHARD DE VISSER [continued]: and you've not fallen asleep or been distracted by somethingelse, you should be able to outline the key componentsof models of behavior change to describethe influence of information, motivation,and behavioral skills, to discusshow to motivate people and developtheir skills in behavior change, and to describehow social support and social contextual

    • 00:50

      RICHARD DE VISSER [continued]: factors may facilitate healthy behavior change.In this video, I take a psychosocial perspectivebecause although it is individualswho enact various behaviors, their choices are influencedby their social context.I'm going to be talking today about approachesto behavior change used in health psychology.Many of these models or techniquescould be applied in other areas of behavior,

    • 01:12

      RICHARD DE VISSER [continued]: but I'm going to be focusing on health-related behavior for tworeasons.One is that as a health researcher,it's something that I should be able to talk about.But the second is that lifestyle factorshave a huge influence on patternsof morbidity and mortality, illness and death.The development and provision of effective preventionand treatment of infectious diseases over the last 100or so years have resulted in a situation where

    • 01:34

      RICHARD DE VISSER [continued]: the things that kill us are quite often stronglyinfluenced by our behavior-- first of allby our patterns of consumption of food and alcohol and tobaccoand second by our patterns of physical activity.Now, when thinking about health-related behavior,it's also important to consider whether peoplemake effective use of health services.Because if prevention and treatment are to be effective,

    • 01:56

      RICHARD DE VISSER [continued]: then people must engage with these servicesand engage with them at the appropriate timerather than delaying seeking treatmentuntil things get really bad.But there are numerous approachesthat can be taken to try to change people's behavioror to encourage them to change their behavior.In one interesting review of published studiesand intervention manuals, 26 different behavior change

    • 02:16

      RICHARD DE VISSER [continued]: strategies were identified, rangingfrom providing information about a link between a behaviorand a health outcome to modelling or demonstratinga healthy behavior, using follow-up promptsfor healthy behavior, and even things like developingtime management skills.If you want to help people to change their behavior,then we must understand what influences their behavior.

    • 02:37

      RICHARD DE VISSER [continued]: Models of health behavior change areimportant because they provide a framework to guidethe development of interventions,and such models also specify whatto measure as process variables or as outcomes.[Models of Health Behavior]The social cognition models that have been most widely used

    • 02:58

      RICHARD DE VISSER [continued]: in the study of health behavior are the health belief modeland the theory of planned behavior.Examples of integrative approachesare the transtheoretical model and PRIME Theory.These models are not necessarily competing,so it's not the case of one model beingthe best, although people often present them in that way.The health belief model suggests that the likelihood of someone

    • 03:19

      RICHARD DE VISSER [continued]: changing their behavior is primarilydetermined by the perceived threatof their current situation coupledwith an evaluation of the outcome if they change.Perceived threat is thought to be mainly influencedby perceived susceptibility to negative consequencesand the perceived severity of these consequencesfor the person.For example, how susceptible do Ithink I am to contracting a sexually

    • 03:40

      RICHARD DE VISSER [continued]: transmittable infection, and how bad do Ithink getting an STI would be?Perceived susceptibility and severitycombine to produce a level of perceived threat that motivatespeople to take action.Perceived benefits are what a personthinks they will gain from the behavior or behavior change.For example, attending STI screeningmay mean that the threat of illness

    • 04:01

      RICHARD DE VISSER [continued]: is removed, although the illness is treated in its earlierstages before it causes disability.Perceived barriers are the thingsthat make it difficult for a personto carry out the behavior.So for STI screening, this might include notbe able to take time off work, the screening clinic beinga long distance away, or being embarrassed or concernedabout stigma.The health belief model is the only model

    • 04:22

      RICHARD DE VISSER [continued]: that explicitly recognizes the importance of cues to actionthat prompt people to change.These can be internal cues, such as symptoms,or external cues, such as health promotionor the advice of a health professional.For example, one of the most effective triggersto getting someone to quit smokingis for a doctor to tell a patientthat they should give up.Media coverage of the illness or death of a known person

    • 04:44

      RICHARD DE VISSER [continued]: can also provide strong cues to act.[Theory of Planned Behavior]The theory of planned behavior was initiallyproposed to explain all kinds of behavior, not justhealth behavior.This theory starts with the assumptionthat the strongest predictor of behavioris a person's intentions.In other words, how a person intends to behave

    • 05:07

      RICHARD DE VISSER [continued]: is the strongest determinant of how they actually behave.Intention is thought to be determined by three factors.The first is the person's attitudes towards the behavior.The second factor that determines intentionsis the subjective norm.This is influenced by the perceived beliefsof other people about the behaviorand the person's motivation to comply with these beliefs.

    • 05:28

      RICHARD DE VISSER [continued]: Research has also shown that perceived behavioral control isimportant in behavior change, and thiscan be thought of as whether a person feelsthey have the opportunity, skills,and confidence to engage in the type of behavior.Although the TPB is very good at explaining people's intentionsto act in certain ways, much of the variance in behavioris not explained by its components.

    • 05:49

      RICHARD DE VISSER [continued]: Researchers are therefore lookingfor ways in which the theory can be improved by adding thingslike anticipated regret of a not changing behavior, moral norms,and implementation plans, such as how a person plansto take action to change.Interventions based on the theory of planned behaviorappear to be effective.[PRIME Theory]

    • 06:13

      RICHARD DE VISSER [continued]: One of the difficulties with many theories of healthbehavior, including the ones discussed earlier,is that they assume that people think rationallyabout their behavior.Very few theories of health behaviorconsider the role of emotions, or whypeople behave without thinking or in waysthat they did not intend.PRIME theory is an attempt to incorporate motivation,emotions, impulses, and cognitive factors

    • 06:34

      RICHARD DE VISSER [continued]: into one model.PRIME theory also makes important assumptionsabout motivation and health behavior.One key assumption is that we needto understand moment-to-moment control of health behaviorbefore we can understand long-term influenceson behavior.Another assumption is that self-identityis highly important in behavior, our motives, and our plans.

    • 06:55

      RICHARD DE VISSER [continued]: The five structural elements of PRIME theoryare plans, which are conscious representationsof future action, including commitment to act;responses, which are starting, stopping, or modifyingany action; impulses or inhibitory forces,which are experienced as urges; motives,which are experienced as desires;

    • 07:15

      RICHARD DE VISSER [continued]: and evaluations, or evaluative beliefs.PRIME theory argues that momentary responsesare influenced by external stimulisuch as triggers, internal states such as arousaland emotion, and then directly moderatedby impulses and inhibitions.Impulses and inhibitions are in turn influencedby motives and evaluations.

    • 07:35

      RICHARD DE VISSER [continued]: These motives and evaluations can be consciously experienced,but it's not necessarily so.It's only at this level that beliefs and higher thoughtprocess come in.Finally, plans are cognitive intentions for future actionthat moderate motives and evaluations.The strength of PRIME theory is that itintegrates motivation and emotion into a theory of health

    • 07:57

      RICHARD DE VISSER [continued]: behavior.A further strength is the inclusionof self-identity, which is rarelyconsidered in other models.The difficulty with PRIME theory is that it's fairly new,so there's little evidence available on whether it'seffective at explaining health behaviors.[Transtheoretical Model]The models presented thus far are fairly static or linear.

    • 08:19

      RICHARD DE VISSER [continued]: They do not easily account for key issuesas people move from thinking about behavior changeto enacting it.In contrast, the transtheoretical modelis often referred to as the stages of change model.It proposes that people move through these stages of changewhen they change their behavior.In pre-contemplation, a person is not evenconsidering changing their behavior.

    • 08:40

      RICHARD DE VISSER [continued]: In contemplation, they begin to consider changing.And this leads into preparation, where the individual preparesto change-- for example, setting a smoking quit date.The final two stages are action and maintenance,where the person makes the initial changein the short term, and then this behavior changeis consolidated and maintained in the long term.An important aspect of this model

    • 09:00

      RICHARD DE VISSER [continued]: is the inclusion of relapse, whichrecognizes that people can relapse backto previous behaviors at any pointand that they may have to go through the cyclea few times before the new behavior becomes permanent.The advantage of this is that it normalizes relapseand encourages people not to see relapse as a failure,but to keep trying to change their behavior.In clinical practice, a health care professional

    • 09:21

      RICHARD DE VISSER [continued]: would emphasize what a person has learned from the relapseand how this can be used to increase the chances of successthe next time around.Within this model, the concept of decisional balanceinvolves weighing the relative pros and consof changing the behavior.People are asked to write down the prosand cons of changing their behaviorin a decisional balance task.This is similar to the balancing of perceived benefits

    • 09:43

      RICHARD DE VISSER [continued]: and perceived barriers in the health belief modeland could be aligned with attitudesin the theory of planned behavior.[Information, Motivation, and Behavioral Skills]As if four different models of behavior were not enough,here's a fifth.I like this model because it's simple and broad,and it's applicable to many contexts.

    • 10:04

      RICHARD DE VISSER [continued]: Rather than focusing on specific variables definedin particular ways, it focuses on three key influenceson health-related behavior.The information, motivation, behavioral skills modelproposes that the likelihood of a person engagingin a particular health behavior increasesif a person has information about the healthissue of concern and how individuals' behavior is

    • 10:25

      RICHARD DE VISSER [continued]: related to the health outcome of interest.However, the model argues that just having informationis not sufficient to prompt behavior change.People must have motivation to act on the informationthat they have.People are more likely to act on informationthey receive if they see it as personally relevant,and this motivation can be thought of in health behaviormodel or theory of planned behavior terms,

    • 10:47

      RICHARD DE VISSER [continued]: such as perceived susceptibility, perceivedbarriers, social norms, and attitudes.Or we may use emotion-focused termsfrom PRIME theory, such as wants or desires.We can also think of motives in relationto the outcome of a decisional balance processin the stages of change model.Whichever of these approaches we apply,it's important to find out what motivates each person.

    • 11:08

      RICHARD DE VISSER [continued]: And this may include diverse factorssuch as feeling healthier, looking better, or wantingto live to see children and grandchildren grow up.The information, motivation, behavioral skills modelacknowledges that motivation is important,but a motivated person will not beable to enact effective behavior change if they don't possessthe relevant behavioral skills.So can people do what's required to be healthy?

    • 11:31

      RICHARD DE VISSER [continued]: One example of developing people's behavioral skillsthat people might easily recognizeis learning to put a condom on a banana or a cucumberin a school sex education class.However, it's important to note that this is justa part of the skill set required for condom use.People must know how to put on a condom,but what about negotiating condom use?One example of applying all three elements

    • 11:52

      RICHARD DE VISSER [continued]: of the information, motivation, and behavioral skills modelcomes from my own research into people's use of governmentalcohol consumption guidelines.Many countries have guidelines specifiedin terms of units of alcohol or standard drinks.Our earlier research had shown that although most people areaware of these guidelines, they tendnot to have good detailed knowledgeof these unit-based guidelines, so the information provided

    • 12:14

      RICHARD DE VISSER [continued]: by the government does not appearto have reached its target.We've also found that even when peoplehave good knowledge of the guidelines,few people are motivated to adhere to them.Often, this is because they don'tfeel their patterns of drinking are likely to lead to harmand because social norms suggest that it's typical and expectedto drink in ways that may mean exceeding the governmentguidelines.

    • 12:35

      RICHARD DE VISSER [continued]: Here it's also important to note that drinking motives maybe influenced less by concerns about the healtheffects of drinking than by concernsabout the social costs of not drinking,so interventions that focus on healthmight be barking up the wrong tree.The third factor we're focused onis behavioral skills, because manyof the people who do want to adhere to the governmentguidelines don't always know how to do so.

    • 12:57

      RICHARD DE VISSER [continued]: So in one study, we provided personalized feedbackfrom a drink pouring activity and foundthat this helped increase knowledge of the unitcontent of different drinks and was associated with reductionsin alcohol consumption.In another study, we provided cupsmarked with the unit content of different drinksso that people would have a better idea of how many unitstheir usual drinks contained.And in this way, we enhanced their behavioral skills.

    • 13:19

      RICHARD DE VISSER [continued]: [How to Convince/Help People to Change]Whichever model of health behaviorwe apply, it's usually important to motivate peopleto change their behavior and to persist with efforts to changebehavior.The need for ongoing motivation isclear in the stages of change model in relation to responsesto relapse.

    • 13:40

      RICHARD DE VISSER [continued]: One way to motivate behavior changeis at the general population level, or alternatively,generic information for segments of the population.This may take various forms using a varietyof media or modes of delivery.Two key factors to be considered include the sourceof the message and its form.In relation to who delivers the message,we're more likely to be persuaded

    • 14:02

      RICHARD DE VISSER [continued]: if the sender of the message is credible and trustworthy andappealing.So we're more likely to respond positively to a messageif it is advice from a health professionalor a professional body that does notappear to have a vested interest, rather than a companymarketing a supposedly healthy product.We also need to consider the message itself.The motivating message must get to its intended recipient.

    • 14:24

      RICHARD DE VISSER [continued]: And various approaches may be used,including TV, radio, internet, print media, billboards,and posters.And it's important to choose methods that arerelevant to the target group.The message must also be attention-grabbing,and there are different ways to do this.Many health promotion campaigns use shocking images.And although these can be effective for capturingpeople's attention, they do not work for all people

    • 14:46

      RICHARD DE VISSER [continued]: or in all situations.If the images are too confronting,then people may engage in defensive avoidanceand try to avoid thinking about the undesirable outcomeand how to avoid it.Furthermore, scaring people in order to motivate themis only part of the story.We also need to help them developthe behavioral skills required to avoidthe unpleasant outcome.

    • 15:07

      RICHARD DE VISSER [continued]: The message must be understood by the intended recipient.So it must be presented at the appropriate level of complexityand should use language and terminology that the targetaudience will understand.In multicultural societies, we'llalso need to consider the need to present the messagein different languages.The message must be accepted by the target audienceas relevant and important.

    • 15:28

      RICHARD DE VISSER [continued]: This is important because it actsas a link between having information and being motivatedto act on that information.An important thing to consider is whether the messageis gain-framed or loss-framed.In other words, the message may emphasizewhat a person will gain if they change their behavior.They'll live longer, they'll look better,or they'll feel healthier.Or alternatively, a message may emphasize

    • 15:49

      RICHARD DE VISSER [continued]: what a person will lose if they don't change their behavior.Will they die early or lose their teeth?Within each of these broad frames,messages may emphasize gains or losses in relationto health or life expectancy, well-being, or appearance,and it's important to determine which of these arethe most influential motives.It's also important that any message

    • 16:09

      RICHARD DE VISSER [continued]: is retained in people's memories,translated into an intention, and acted upon.We can also try to motivate people on a one-to-one basis.This may be part of brief advice,or it may be part of a more structured processof tailored, individual-focused intervention.Motivational interviewing is an approach to individual behavior

    • 16:30

      RICHARD DE VISSER [continued]: change that designed to help people identifytheir own motives for change, to examine any ambivalenceto change, and to plan for change.Within this approach and other individual-focused approaches,it's possible to monitor behavior and reward effortsto ensure that people are able to maintain their motivationto follow through on a commitment to change.[Social Factors]

    • 16:56

      RICHARD DE VISSER [continued]: Within health psychology, models of behavior changeand interventions tend to focus on individuals.However it's important to take a psychosocial perspectiveand to consider social contextual factors.Some models do this to some extent.For example, as noted earlier, oneof the key components of the theory of planned behavioris subjective norms.In that model, subjective norms arestages of injunctive norms, which

    • 17:18

      RICHARD DE VISSER [continued]: are a reflection of what people feel is the right thing to do.However, it's also important to notethe influence of descriptive norms, whichare a reflection of what people perceivethat other people actually do.Both types of social norms appear to influence behavior,but the latter are interesting because people's behavior maybe influenced by erroneous descriptive norms.For example, young people often overestimate

    • 17:39

      RICHARD DE VISSER [continued]: how many of their peers are sexually activeor how often they drink or get drunk, and this results in themtrying to meet a behavioral standard that noneof their peers actually meet.In addition to subjective norms, there are other waysthat an individual's behavior maybe influenced by other people.Concerns are often expressed about peer pressure,and this can be an important influence in some cases.

    • 17:59

      RICHARD DE VISSER [continued]: However, we should not only thinkof these social influences as being negative.Other people can be an important source of encouragementor support for the initiation and maintenanceof healthy behavior.If we take a resilience approach,then it's important to think of the way in whichvarious people-- peers, family members, or school-- can helppeople to develop the skills to deal with peer pressureor internalized expectations to engage in unhealthy behavior.

    • 18:23

      RICHARD DE VISSER [continued]: And there's some overlap between this resilience frameworkand the concept of social support.One source of social support or encouragementis that provided by friends or partners.They can help us stick to a course of actionand help us through tempting situations.So we may have a situation wherebywomen who give up alcohol during pregnancymight benefit if their partner also gives up alcohol

    • 18:43

      RICHARD DE VISSER [continued]: during the pregnancy.Another important social support isthat provided by health professionals.Follow-up contact from health professionalscan be a great way to acknowledge and rewardefforts and progress.It can be used to monitor physiological benefitsof behavior change, such as weight loss or reductionsin blood cholesterol, and it can alsobe used to help people to deal with any relapsesor tempting situations.

    • 19:06

      RICHARD DE VISSER [continued]: Social support may also take the formof buddy systems, whereby people undertaking the same behaviorchange pair up to provide each other with supportand encouragement.One reason why buddy systems may be effectiveis that each buddy wants to avoidbeing the person who fails.Another important feature of buddy systemsis that the buddies could help each otherto deal with any relapses or tempting situationsand can encourage and reward each other

    • 19:28

      RICHARD DE VISSER [continued]: for reaching milestones, such as one month without smoking.Although buddy systems work for some people,they're not everyone's cup of tea,and they shouldn't be imposed on people.We also need to encourage how macro-social factors mayinfluence individuals' behavior.Legislation can be used to encourage or enforcehealthy behavior.One example of this is legislation

    • 19:48

      RICHARD DE VISSER [continued]: related to the use of seat belts and appropriate childrestraints in cars.Another is the introduction of banson smoking in public places.Such legislation has some direct effectsrelated to actual or feared punishment of transgressions.However, it's important to note that it can alsohave indirect effects.Widespread acceptance of public smoking bansmeans that social norms about the appropriateness of smoking

    • 20:10

      RICHARD DE VISSER [continued]: in public have changed.And this appears to have knock-on effects in relationto norms about smoking in private contexts,such as homes or cars.[Summary]So to summarize, there you have it,an overview of interventions to encouragechange in health-related behaviorfrom a psychosocial perspective.

    • 20:32

      RICHARD DE VISSER [continued]: I hope that now you have a betteridea of the key components of models of behavior change;the influence of information, motivation,and behavioral skills; how to motivate people and developtheir skills for behavior change;and how social support and social contextualfactors may facilitate healthy behavior change.

Health Psychology

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Abstract

Dr. Richard De Visser discusses how to outline the key components of models of behavior change to describe the influence of information, motivation, and behavioral skills. He also explains how social support and social contextual factors may facilitate healthy behavior change. Dr. De Visser takes a psychosocial perspective because, he explains, although it is individuals who enact various behaviors, their choices are influenced by their social context.

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Health Psychology

Dr. Richard De Visser discusses how to outline the key components of models of behavior change to describe the influence of information, motivation, and behavioral skills. He also explains how social support and social contextual factors may facilitate healthy behavior change. Dr. De Visser takes a psychosocial perspective because, he explains, although it is individuals who enact various behaviors, their choices are influenced by their social context.

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