3.1 Models of health belief

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3.1 Models of health belief
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Health Belief Model Key study Becker (1978)

• Terminology
• perceived seriousness (Will it actually kill
  you?).
• perceived susceptibility (Am I likely to get
  it?).
• costs/benefits analysis.
• cues to remind us (external or internal cues).
• demographic variables (factors such as gender,
  culture, age, etc.).

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Aim

• To use the health belief model to explain
  mothers' adherence for their asthmatic children.
• Method
• A correlation between beliefs reported during
  interviews and the compliance with self-reported
  administration of asthma medication.

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Participants

• 111 mothers responsible for administering asthma
  medication to their children.
• Design
• Correlational design.

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Procedure

• Each mother was interviewed for about 45 minutes.
• They were asked questions regarding
• Their perception of their childs susceptibility
  to illness and asthma.
• How serious asthma is.
• How much their childs asthma interfered with his
  or her education.
• Caused embarrassment.
• Interfered with the mothers activities.

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Procedure (cont.)

• They were also questioned about their faith in
  doctors and the effectiveness of the medication.

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Findings

• A positive correlation between a mothers belief
  about her childs susceptibility to asthma
  attacks and compliance to medical regimen was
  found.
• There was also a positive correlation was also
  between the mothers perception of the childs
  having a serous asthma condition and her
  administering the medication as prescribed.
• Mothers who reported that their childs asthma
  interfered with the mothers activities also
  complied with the medication.

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Findings (cont.)

• Costs negatively correlated with compliance (e.g.
  disruption of daily activities, inaccessibility
  of chemists, the child complaining, and the
  prescribed schedule).
• The demographic variable of marital status and
  education level correlated with compliance as
  follows
• Married mothers were more likely to comply.
• The greater the mothers education the more
  likely she would be to adhere.

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Conclusion

• The health belief model is a useful model to
  predict and explain different levels of
  compliance with medical regimens.

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Locus of control Key study Rotter (1966)

• Terminology
• Internal locus of control where a person feels
  he or she is in control of his or her health and
  is therefore likely to adopt healthy behaviour.
• External locus of control where a person feels
  his or her health is controlled by external
  factors (e.g. fate) and is therefore less likely
  to adopt a healthy behaviour.

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Method

• Review article.
• Procedure
• Sample six pieces of research into individual
  perceptions of ability to control outcomes.

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Findings

• Participants who felt they had control over the
  situation were more likely to show coping
  behaviours.
• Conclusion
• Rotter concluded that locus of control would
  affect many of our behaviours.

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Self efficacy Key study Bandura (1977)

• Terminology
• Outcome expectancy based on previous
  experiences a person could estimate the likely
  outcome in any situation.
• Efficacy expectation the belief that a person
  has that they can successfully do whatever is
  required to achieve the outcome.

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Terminology (cont.)

• The key factors which affect a persons efficacy
  expectation are
• Vicarious experiences seeing other people do
  something successfully.
• Verbal persuasion someone telling you that you
  can do something.
• Emotional arousal too much anxiety can reduce a
  persons self-efficacy.
• In addition cognitive appraisal of a situation
  might also effect expectations of personal
  efficacy.

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Aim

• To assess the self-efficacy of patients
  undergoing systematic desensitisation.
• Method
• A controlled quasi-experiment with patients with
  snake phobias.

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Participants

• 10 snake phobic patients
• who replied to an advertisement in a paper.
• 9 females and one male.
• aged 1957 years.

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Procedure

• Pre-test assessment. Each patient was assessed
  for
• avoidance behaviour towards a boa constrictor.
• fear arousal with an oral rating of 110.
• efficacy expectations (how much they thought they
  would be able perform different behaviours with
  snakes).

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Procedure (cont.)

• Systematic desensitisation a standard
  desensitisation programme was followed where
  patients were introduced to a series of events
  involving snakes and at each stage were taught
  relaxation.
• Post-test assessment. Each patient was again
  measured on behaviours and belief of
  self-efficacy in coping.

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Findings

• Higher levels of post-test self-efficacy were
  found to correlate with higher levels of
  behaviour with snakes.
• Conclusion
• Desensitisation enhanced self-efficacy levels,
  which in turn lead to a belief that the
  participant was able to cope with the phobic
  stimulus of a snake.

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Possible Section A Questions

• Describe what psychologists have found out about
  theories of health belief
• Describe one piece of research into self-efficacy
• Outline the health belief model
• Describe factors that influence health beliefs
  and behaviours
• Describe one piece of research into locus of
  control

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Possible Section B Questions

• Discuss the usefulness of research into theories
  of health belief

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3.2 Health Promotion
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Media Campaigns Key study Cowpe (1989)

• Aim
• To test the effectiveness of an advertising
  campaign.
• Method
• A quasi-experiment where a media campaign was
  shown in 10 regional television areas from 1976
  to 1984.

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Participants

• People living in the chosen television areas.

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Procedure

• The campaigns were shown on television.
• There were two 60-second commercials, one called
  inattendance and one called overfilling.
• These showed the initial cause of the fire and
  the actions required to put it out.
• Three areas were shown reminders one year later.
• The number of reported chip pan fires was
  analysed for each area.

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Findings

• The net decline in each area over the
  twelve-month period of the campaign was between
  7 to 25.
• The largest reduction was during the campaign.
• Overlap areas (areas that received two of the
  television stations) showed less impact.
• The questionnaires showed an increase in the
  awareness of chip pan fire advertising.
• The mention of chip pan fires as a danger in the
  kitchen also increased in the questionnaires.

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Conclusions

• The advertising proved effective as shown by
  reduction in chip pan fires.
• The behaviour change is seen most during the
  campaign and reduces as time passes after the end
  of the campaign.
• The viewer is less likely to be influenced by the
  campaign if overexposed to it, as in the overlap
  areas.

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Legislation Key study Dannenberg et al. (1993)

• Aim
• To review the impact of the passing of a law
  promoting cycle helmet wearing in children.
• Method
• Natural experiment when a law was passed in
  Howard County, Maryland, USA.

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Participants

• Children from Howard County, and two control
  groups from Montgomery County and Baltimore
  County, all in Maryland, USA.
• Aged 910 years, 1213 years and 1415 years.
• Design
• Independent design with each child naturally
  falling into one of the three counties.

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Procedure

• A questionnaire that asked about
• bicycle use.
• helmet ownership.
• awareness of law.
• sources of information about helmets.
• peer pressure.

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Findings

• Helmet ownership was higher amongst cycle owners
  and highest in younger age groups.
• In Howard County (the one with the law), reported
  usage had increased.
• Howard County 11.4 to 37.5.
• Montgomery County 8.4 to 12.6.
• Baltimore County 6.7 to 11.1.

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Conclusions

• Legislation has more effect than educational
  campaigns alone.
• This study was correlated with an observational
  study by Cote et al. in 1992, which found similar
  rates of cycle helmet usage.

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Fear Arousal Key study Janis and Feshbeck (1953)

• Aim
• To investigate the consequences on emotions and
  behaviour of fear appeals in communications.
• Method
• Laboratory experiment, which showed fear-arousing
  material.

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Participants

• 9th Grade students aged 14.0 to 15.11 years, mean
  age 15 years.
• Design
• Independent design, with three experimental
  groups and one control group.

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Procedure

• A questionnaire was given one week before the
  lecture on health to ascertain dental practices.
• A fifteen minute illustrated lecture was
  presented to each group.
• 3 groups had a lecture on dental hygiene and the
  control group had a lecture on the human eye.

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Procedure (cont.)

• Immediately after the lecture a questionnaire was
  given asking for emotional reactions to the
  lecture.
• One week later a follow-up questionnaire asked
  about longer term effects of the lecture.

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Findings

• The amount of knowledge on dental hygiene didnt
  differ between the three experimental groups.
• The strong fear-appeal lecture was generally seen
  in a more positive light.
• The strong fear-appeal group showed a net
  increase in conformity to dental hygiene of 8.

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Findings (cont.)

• The net increase in the moderate fear group was
  22.
• The net increase in the minimal fear group was
  36.
• The control group showed 0 change.

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Conclusion

• Fear appeals can be helpful in changing
  behaviours, but it is important that the level of
  fear appeal is right for each audience.

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Possible Section A Questions
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Possible Section B Questions

• Discuss the usefulness of research into health
  promotion

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3.3 Adherence to medical advice
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Reasons for non adherence Key study Bulpitt and
Fletcher (1988)

• Aim
• To review research on adherence in hypertensive
  patients.
• Method
• Review article of research identifying problems
  with taking drugs for high blood pressure.

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Procedure

• Research was analysed to identify the physical
  and psychological effects of drug treatment and
  the adherence rates of patients.

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Findings

• There are many side effects of taking
  anti-hypertension medication.
• In one study by Curb (1985) 8 of males
  discontinued treatment because of sexual
  problems.
• Research by the Medical Research Council (1981)
  found that 15 of patients had withdrawn from
  taking medication due to side effects.

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Conclusion

• When the costs of taking medication, such as side
  effects, outweigh the benefits of treating a
  mainly asymptomatic problem such as hypertension,
  there is less likelihood of the patient adhering
  to their treatment.

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Measuring adherence Key study Lustman et al.
(2000)

• Aim
• To assess the efficacy of the anti-depressant
  fluoxetine in treating depression by measuring
  glycemic control.
• Method
• A randomised controlled double-blind study.

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Participants

• 60 Patients with type 1 or type 2 diabetes and
  diagnosed with depression.

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Procedure

• Patients were randomly assigned to either a
  fluoxetine or a placebo group.
• Patients were assessed for depression using
  psychometric tests and their adherence to their
  medical regimen was assessed by measuring their
  GHb levels, which indicated their glycemic
  control.

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Findings

• Patients given fluoxetine reported lower levels
  of depression.
• Patients given fluoxetine had lower levels of
  GHb, which indicated their improved adherence.

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Conclusions

• Measuring GHb in patient with diabetes indicates
  their level of adherence to prescribed medical
  regimes.
• Greater adherence was shown by patients who were
  less depressed.

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Improving adherence Key study Watt et al. (2003)

• Aim
• To see if using a Funhaler could improve
  childrens adherence to medication for asthma.

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Method

• A field experiment, although it used children
  with asthma so could also qualify as a
  quasi-experiment. The experiment set up two
  conditions, and then used self-report to measure
  the adherence rates.

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Participants

• 32 Australian children with asthma
• 10 males and 22 females
• aged from 1.5 to 6 years
• mean age 3.2 years.
• Design
• A repeated design as each participant had one
  week using the normal inhaler then one week using
  the Funhaler.

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Procedure

• Each child was given the Breath-a-Tech to use for
  one week, and a questionnaire was given for the
  parents to complete.
• In the second week, the children used the
  Funhaler, and the parents were given a matched
  questions questionnaire.

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Findings

• 38 more parents were found to have medicated
  their children the previous day when using the
  Funhaler compared to the normal inhaler.

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Conclusions

• The Funhaler reinforced correct usage of the
  inhaler with a toy that spins and a whistle that
  blows.
• This did improve the adherence to the medication.
  
• By making the medical regime fun, the adherence,
  certainly in children, can be improved.

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Possible Section A Questions
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Possible Section B Questions

• Discuss the usefulness of research into health
  promotion