applied psych quiz 3

Question 1

What do we know about domestic violence?

Answer 1

• Family violence:
- Between family members
- Typically perpetrator exercises power and control over another
- Most commonly intimate partner relationships
• Sexual violence:
- Behaviour of sexual nature carried out against a person’s will
- Perpetrated by anyone
• 1 in 6 women have experienced physical and/or sexual violence by a cohabiting partner since age 15
• 72,000 women, 34 000 children and 9000 men sought homelessness services in 2016-17 due to family/domestic violence
• 1 in 16 men have experienced physical and/or sexual violence by a cohabiting partner since age 15

Question 2

Who is at greater risk? Domestic violence

Answer 2

• Women, more likely to know the perpetrator and occur in home
• Men, more likely to be violence from strangers in public
• Repeated occurrence
- 54% women who’d experienced current partner violence experienced more than 1 incident
• 2014-15: 8 women and 2 men hospitalised each day after assault by partner
• 2012-13/2013-14: 1 woman per week and 1 man per month killed as result of violence from partner

Question 3

Who are most vulnerable groups? domestic violence

Answer 3

• Most at risk:

- Aboriginal and Torres Strait Islander women 
- Young women 
- Pregnant women 
- Women with disabilities 
- Women experiencing financial hardships
- Women and men who experienced abuse or witnessed domestic violence as children

Question 4

Who are the most vulnerable groups? Children - domestic violence

Answer 4

• Impact
- Long-term effects on development
- Increased risk of mental health issues
- Increased risk of behavioural issues
- Increased risk of earning difficulties
• 68% of mothers experiencing violence reported children witnessing violence
• 2015-16
- 45,700 children were subject of child protection substantiation
- 55,600 were placed in out-of-home care

Question 5

Who are the most vulnerable groups? Indigenous people - domestic violence

Answer 5

• Family violence within Indigenous communities needs to be understood as both a cause and effect of social disadvantage and intergenerational trauma
• 2014-15
- 14% of Indigenous women experienced physical violence in past year
- 28% reported cohabiting partner was perpetrator
- Women 32x rate of hospitalisation due to family violence
- Men 23x rate of hospitalisation

Question 6

What is the impact – Homelessness

Answer 6

• Impact on health 
    -	Mental health conditions most prevalent 
    -	35% anxiety disorders
    -	32% depressive disorders 
• Groups likely under-represented in these figures:
    -	Indigenous women 
    -	Pregnant women 
    -	Women with disability 
    -	Women experiencing homelessness

Question 7

Registering a birth

Answer 7

• 1/6 Indigenous children born in QLD do not have a birth certificate
- 15-18% of Indigenous births not registered
• Impacts:
- Enrolling in school
- Government benefits
- Medicare
- Driver’s licence

Question 8

What can happen when police are called?

Answer 8

• Ms Dhu, 22 year old woman of Yamasaki-Nanda Nation and Banjima People (WA)
• Police responding to domestic violence report
- Partner was arrested for breaching violent restraining order
- Ms Dhu had unpaid fines and was arrested
 Warrants of commitment for fines and costs $3622.34 accrued between 2009-2011
 First fine $200
- Intention to hold Ms Dhu for 4 days to clear fines
- Ms Dhu indicated sustaining a broken rib and subsequently died in custody form sepsis secondary to her injuries
• In 2013, 1 in 3 women entering prison system did so to clear fines

Question 9

When systems fail

Answer 9

• Indigenous women:
- Represent 35% of women in QLD prisons in 2015-2016
- More likely to be subject to breaches of discipline
- More likely to be in high security prisons and on safety orders than males
• 17.5x more likely to die due to homicide than non-Indigenous
• Indigenous women are least served by the legal system as men perpetrating violence against them are the least likely to be held accountable within the justice system

Question 10

What is to be done?

Answer 10

• Ngaga dji (hear me) project – aims to change approaches to justice
- Actively on going
- How do we make changes to the system
- 42 individuals interviewed – stories recorded and documented
- Speak deeply to engaging with the justice system
- De-identified stories of children and young people currently or previously under youth justice supervision
- Their words and stories, de-identified
- Created composite accounts reflecting the real lives of many aboriginal children
- All events and experiences are real, details and names changed
- Stories reviewed by focus group of young people with lived experience of justice system
• Legislative change
- Victorian government committed to ‘home stretch’
- Providing young people with option to remain with carer until age 21
- Extending care allowance support to carers
- Tailored support from specialised workers helping obtain employment, education, training and life coaching
- Gradual and supported transition to independent living
- Improve outcomes for young people
- Lower costs to government long term
• Support aboriginal ownership of community infrastructure and gathering places:
- Transfer land and property to Wurundjeri Tribe Land and compensation cultural heritage council
- Preserving cultural heritage
- Manage land and sites of significance
- Provide Wurundjeri people opportunities to connect with culture
- Aboriginal people and organisations know the issues facing their communities and the best way to respond. Giving full control of these properties to Wurundjeri is self-determination in action

Question 11

Sisters inside

Answer 11

• Community organisation in QLD advocating for human rights of women and girls in prison and their families
• Provides services to address individual needs
- Housing
- Income
- Health care
- Support in community
• Recognise complex factors leading to incarceration

Question 12

Indigenous Australians health in Australia

Answer 12

• Aboriginal and Torres strait islanders have:

- Higher infant mortality rates
- Higher unemployment rates
- Lower weekly income than other Australians
- More health risk behaviours
- Poorer housing circumstances
- Less access to education and child and maternal health

Question 13

Indigenous Australians health in Australia/cancer

Answer 13

• Rates of liver and lung and other smoking related cancers are higher
• Breast, prostate, colorectal and skin cancer are lower
• Rates of lung cancer 2/3 times higher in rural aboriginal communities than for the rest of Queensland
• Rates of smoking related cancers as well as for breast and other cancers are increasing
• Cervical cancer:
- incidence in indigenous Australians 2x non-indigenous (20 vs 9/100,000)
- mortality rates 4x higher (8 vs 2/100,000)

Question 14

Aboriginal and Torres straits islander’s health in Australia

Answer 14

• inequalities in sexually transmitted infections
• 2003, notification rates for people identified as indigenous were higher than rates for the total population for gonorrhoea, syphilis, and chlamydia
• Further research has suggested that rates of STI’s, as well as HIV/AIDS are also increasing in this population
• HTLV-1 virus, indigenous communities in central Australia. Highest in the world
- Associated with rapidly fatal forms of leukaemia, inflammation in organs, increased risk of other infections
• However, may be to do with higher susceptibility rather than a higher number of sexual partners
• Implications for the type of health interventions that get planned?
• Torzillo (1999):
- Difficulties in doing research with aboriginal and Torres straits islanders
- Political climate
- Should not detract from the need to do good quality research in the area
• This position is supported by a systematic review of clinical trials in this population, which found that there was a lack of such research

Question 15

Closing the gap in a generation – WHO commission on social determinants of health

Answer 15

• Reducing health inequalities is an ethical imperative. Social injustice is killing people on a grand scale
• Overarching recommendations:
- Improve daily living conditions
 Circumstances in which people are born, grow, live, work and age
- Tackle inequitable distribution of power, money and resources
 Structural drivers of those conditions of daily life
- Measure and understand the problem and assess the impact of action
 Expand knowledge base, develop work force trained in SDH, raise public awareness

Question 16

What are adjustment to illness?

Answer 16

• Illness:
    -	Presents challenges to individuals
    -	Changes over time
• Required to deal with:
    -	Uncertainty
    -	Disruption
    -	Striving for recovery
    -	Restoration of wellbeing
• Mores and Johnson 1991 – generic model of emotional and coping responses
• Life changes:
    -	Time allocation
    -	Tasks that need completing
    -	Now strive for recovery – regain prior health, great effort required

Question 17

Cancer example – stages

Answer 17

• Initial response
- Disbelief, denial, shock
- Lower capacity to process information
• Dysphoria
- Coming to terms with diagnosis
- Distress and related symptoms
• Adaption
- Lasts varying period of time
- Adapting more positively to their diagnosis
- Develop long-term coping strategies
- Holland and Gooen-Piels 2002 – stages of emotional response to cancer diagnosis

Question 18

What do we know about health differences?

Answer 18

• In Australia, the better-off live, on average, two years longer than the por
• Similarly, people who occupy minority roles in society as a result of ethnic or other factors may experience more illness or die earlier than the majority of the population
• Findings that women live longer than men may be as much the result of social and psychological factors as biological ones

Question 19

Health differentials

Answer 19

• Clear evidence of health differentials across whole populations both within and between countries
• WHO system for measuring life expectancy
- ‘equivalent of full health’
• In general, the richer the country, the longer its population lives and the longer its equivalent of full health is

Question 20

Everyone can read – or can they?

Answer 20

• We assume that most people can read, can’t imagine what it is like to not read
* Therefore, we do not cater for people who cannot read; therefore information is not being accurately displayed

Question 21

Impact of poverty on health

Answer 21

• People who live in developing countries live significantly shorter lives than those who live in more affluent countries
• Contributing factors are economic, environmental, and social lack of safe water, poor sanitation, inadequate diet and poor access to health care
• The problem now facing many developing countries in Africa is that of HIV infection and AIDS

Question 22

Health inequalities

Answer 22

• Can be found in both rich and poor countries
• Are likely to be the consequence of social, economic, educational and environmental differences
- E.g. lack of safe water, poor sanitation, access to health care
• May be amenable to reduction by intervention at a societal level – but do we want to?

Question 23

The impact of poverty on health

Answer 23

• Within industrialised countries, rich people live longer and have less illness than the economically less able
• There is a linear relationship between income (however measured) and health
• Subtle difference may also impact on health:
- Middle class executives who own one care are more likely to die earlier than equivalent earners with two cars

Question 24

Homelessness in Australia

Answer 24

• Homelessness in Australia has increased 13.7% in 5 years – 116, 427 Australians now have no home
• 58% male, 42% female
• 20% indigenous
• 30% born overseas
• Where do people stay?
- Improvised dwellings, tents or sleeping out 7% (8200)
- Supported accommodation for the homeless 18% (21,235)
- Staying temporality with other households 15% (17,725)
- Boarding houses 15% (17,503)
- Other temporary lodging 1% (678)
- ‘severely’ overcrowded dwellings 44% (51, 088)

Question 25

Social determinants of ill health

Answer 25

• The UK current health problems should be treated with agency - Alarm about nation’s health is a rational response to recent evidence - Recent evidence has three components, probably linked: 1. Improvement in life expectancy, going on for 100 years has slowed since 2010 2. Health inequalities, which probably became smaller during the 2000’s have grown again since about 2012 3. There is a persistent North-South divide in health, particularly among younger people

Question 26

The exception to the rule

Answer 26

• USA is below the OECD average for life expectancy • Explanation include: - Some social groups have extremely poor health – more characteristic of poor developing countries rather than a rich industrialised one - The HIV epidemic caused a higher proportion of death and disability among young and middle-aged Americans than in most other advanced countries  Lack of harm minimisation interventions  War on drugs - USA is one of the leading countries for cancers relating to tobacco - The united states has high incidences of homicides compared to other industrial countries

Question 27

Health inequalities within countries

Answer 27

* A problem within rich countries * A failure of health care systems * A technical problem to be addressed by improving access to services among those with poorer health * Lifestyle, behavioural or cultural differences between socio-economic or ethnic groups that can be solved through health education and promotion * Possibly also genetic differences between groups

Question 28

Ethnic monitories

Answer 28

• Significant variations both - Between the overseas born groups - And between these groups and those in Australia • Migrants to Australia have lower rates of cardiovascular mortality than Australian born people • Deaths from lung cancer and breast cancer were higher in UK and Irish born residents than Australian born people but skin cancer was lower • People born in Asia has significantly higher rates of mortality from infectious diseases, diabetes and homicide than the Australian born population • The incidence of type 2 diabetes in Greek and Italian migrants to Australia is three times that of the Australian born population • Incidence of cervical cancer is higher in groups of migrants from the former Yugoslavia

Question 29

The ‘healthy migrant’ effect

Answer 29

* Have very controlled migration * Those who come tend to be of higher economic status, more education etc. * In general what can be found in Australia is what is called the ‘healthy migrant effect’ * The majority of people who migrate to Australia are as healthy if not healthier than the Australian born population

Question 30

Social class

Answer 30

* Lawson and Black (1993) fond that marked differences in death rates according to social class exist * If men of all social classes had the same mortality experiences as higher social class men the overall death rates for Australian men would be reduced by 60% * They suggest that socio-economic status is the most important indicator of health status among Australians * Australian socio-economic data

Question 31

Social causation versus social drift

Answer 31

• Social causation model - Low SES ‘causes’ health problems - There is something about occupying a low socio-economic group that negatively influences he health of individuals • Social drift model - Health problems cause’ low SES - When individuals develop a health problem, they may not maintain a job, or the levels of overtime required to maintain their standard of living. They therefore drift down the socio-economic scale

Question 32

Health selection explanations

Answer 32

* People are not sick because they are poor * Rather, poor health lowers income and limits earning potential * There is little empirical support for this explanation

Question 33

Statistical artefact explanation

Answer 33

* The poorest in any society are usually the sickest * A society with high levels of income inequality has high numbers of poor and consequently will have more people who are sick * There is little empirical support for this explanation

Question 34

Explaining inequalities

Answer 34

* It is impossible to decide how much each of these causes is contributing to the gradients in illness and deaths * Understanding the material, behavioural and locality-based causes, and the interactions between them is a priority * Behavioural, material and local circumstances vary with SES

Question 35

Explaining health differentials: different health behaviour

Answer 35

* More health-damaging behaviour * Less health-promoting behaviour * For example, in Australia the most socially disadvantaged people were twice as likely to smoke as those in the least socially disadvantaged group

Question 36

Different health behaviour

Answer 36

* Poorer Australians are more likely to eat a less healthy diet, and take less leisure exercise than the better-off * However, these differences do not provide the whole explanation for the health differentials

Question 37

Differences in health-related behaviour

Answer 37

* Account for some of the socio-economic differences in health but not all * Marmot, Shipley and Rose (1984) examined the impact of job level and health behaviour on health outcomes over ten years * Smoking, alcohol, obesity, cholesterol and blood pressure removed * Occupational status still remained independently predictive of health status

Question 38

Health risk behaviours

Answer 38

``` • Poorer people doubly disadvantaged • Health-compromising behaviour • Why? - Possess insufficient knowledge - Lack of opportunities - Stress ```

Question 39

Environmental insult

Answer 39

• Exposed to working in dangerous settings such as building sites • Have more accidents • Living in rented accommodation - E.g. only 30% of the Indigenous population were homeowners compared to non-indigenous Australians • Stress, strain and depression

Question 40

Stress, strain and depression

Answer 40

• Childhood - Family instability - Overcrowding - Poor diet - Restricted educational opportunities • Adolescence - Family strife - Exposure to smoking and own smoking - Leaving school with poor qualifications - Experiencing unemployment or low-paid and insecure jobs • Adulthood - Working in hazardous conditions - Financial insecurity - Periods of unemployment - Low levels of control over work or home life - Negative social interactions • Older age - No, or small occupational pension - Inadequate heating - Inadequate food - Women aged over 65, increased homelessness

Question 41

Hobfoll and Lilly: conservation of resources model 1993

Answer 41

• Mental and physical health are determined by the amount of resources available to the individual - Economic (e.g. job, income) - Social (e.g. family support) - Structural (e.g. housing) - Psychological (e.g. coping skills, perceived control) • Indigenous Australians - have higher unemployment - Poorer housing conditions - Are less likely to have access to higher education • So their poor health fits well into this model

Question 42

Conservation of resources

Answer 42

• Hobfoll and Lilly 1993 - Mental and physical health determined by the amount of resources available to the individual - Economic (e.g. job, income) - Social (e.g. family support) - Structural (e.g. housing) psychological (e.g. coping skills, perceived control) - High level of resources is health-protective - Low levels of resources place an individual at risk for health problems

Question 43

Access to health care

Answer 43

• Access to health care services in Australia is mediated by - Availability of services, especially in rural and outer urban areas - Cost of health care services, especially services to which patients are referred from primary care - Waiting times especially allied health services - Outpatient medical specialist services - Elective procedures • Differences in response to unemployed patients with anxiety or depression - Being more likely to prescribe to - Less likely to refer or to offer non-pharmacological interventions • No problems in accessing some aspects of healthcare • Is the increased use of healthcare resources sufficient to counter the additional levels of poor health linked to the lower SES groups? • Low socio-economic status was correlated with higher rates of admission for acute myocardial infarction, it was also related to low intervention rates

Question 44

Reducing inequalities

Answer 44

• Tackling inequalities in health should involve different levels of intervention - Strengthening individuals - Strengthening communities - Improving access to essential facilities and services - Encouraging macro-economic and cultural change

Question 45

What is health and health psychology | What is health?

Answer 45

* Who definition of health as a: state of complete physical, mental and social wellbeing – not merely the absence of disease or infirmity * Bircher defines health as: a dynamic state of well0being characterised by a physical and ,mental potential, which satisfied the demands of life commensurate with age, culture and personal responsibility * Indigenous Australian people define health as: not just the physical wellbeing of the individual but refers to the social, emotional, spiritual and cultural well-being of the whole community. This is a whole of life view and includes the cyclical concept of life-death-life * No one single definition – complex multifaceted concept extending beyond biological aspects of individual functioning

Question 46

Models of health and illness

Answer 46

• Biomedical model of illness - Symptoms of illness considered to have underlying pathology - Removal of pathology > restored health - May be mechanistic, too reductionist – ignores the fact that different people respond in different ways to illness because of differences (e.g. personality, social support, cultural beliefs • Proposed in 1977 to move away from biomedical model to the bio-psycho-social model of illness - In 2002 raised idea moving beyond mind/body spilt - Now talking about social relationships impact – effects peoples willingness to participate in health treatment • Biopsychosocial model of illness - Psychological and social factors can add to biological or biomedical explanations and understanding of health and illness - Diseases and symptoms can be explained by a combination of physical, social, cultural and psychological factors - Employed in health psychology, allied health professionals and increasingly in medicine

Question 47

Health psychology

Answer 47

• Health psychology is an interdisciplinary field concerned with the application of psychological knowledge and techniques to health, illness and health care • Devoted to understanding psychological influences on how people: - Stay health - Why they become ill - How they respond if they do become ill

Question 48

Questions we might ask in health psychology

Answer 48

* What are the reasons a person might initiate, continue and cease smoking? How can we predict their behaviour, and how can we intervene? * What psychological techniques are effective in increasing health enhancing behaviours (e.g. exercise) on an individual level and population level? * How can health professionals best communicate with and empower patients who have a chronic illness? * What is the impact of cancer diagnosis and treatment on the patient and their family? How can we help?

Question 49

Why are we looking at models of health behaviour?

Answer 49

``` • Health enhancing - Healthy eating - Exercise - Safe sex - Screening - Vaccination • Reducing health risks - Sedentary lifestyle - Smoking - Alcohol - Risky sexual behaviour - Nutrient poor diet ```

Question 50

Why are models of health behaviour important?

Answer 50

• Theoretical models have proposed and tested in terms of their ability to explain and predict why people engage in health risks or health enhancing behaviours - Why do individuals smoke? What factors predict whether or not someone engages in smoking? • The models we will describe have identified many modifiable influences upon health behaviour that offer potential targets for health intervention – promotion and education - Using models of health behaviour – we can design interventions to address the modifiable influences on a behaviour such as smoking (e.g. overcoming barriers, highlighting benefits, increasing confidence to quit) - We want to underpin our research and interventions with evidence based theory - E.g. many health psychology honours projects underpin theories

Question 51

Some of the different models to discuss

Answer 51

• Transtheoretical model - Stage based model of behaviour change • Health belief model/ theory of planned behaviour - Social cognitive models of behaviour change • Health action process approach/ temporal self-regulation theory - Models of behaviour change focusing on post intentional behaviour of individuals

Question 52

Transtheoretical model

Answer 52

• Stage model of behaviour change – individuals can be at ‘discrete ordered stages’, each one denoting a greater inclination to change • Transtheoretical model provides a framework for explaining how behaviour change occurs as individuals move through stages of motivational readiness • Makes 2 broad assumptions - People move through stages of change - Processes involved at each stage differ • The model is not linear • People can enter and exit at any point and some people may repeat a stage several times • It implies that different interventions are appropriate at different stages of health behaviour change - Implications for interventions > little point in trying to show how to achieve change if in precontemplation; that type of intervention may be beneficial if individual in planning (preparation) or action stage • According to this model there are 5/7 stages of change • Precontemplation - Has no intention of taking action within the next 6 months • Contemplation - Intends to take action within the next 6 months • Preparation - Intends to take action within the next 30 days and has taken some steps in this direction • Action - Has changed overt behaviour for less than 6 months • Maintenance - Has changed overt behaviour for more than 6 months • Termination - Behaviour change has been maintained for an adequate time for the person to feel no temptation to lapse • Relapse - Where a person lapses into their former behavioural pattern and returns to a previous stage (common, can occur at any stage)

Question 53

Transtheoretical model – tailoring intervention

Answer 53

• Implies that different interventions are appropriate at different stages of health behaviour change • Precontemplation - Individuals more likely to be using denial, may report lower self-efficacy and more barriers to change • Contemplation - More likely to seek information and may report reduced barriers and increased benefits – although may still underestimate their susceptibility • Preparation - People start to set their goals and priorities, and some will make concrete plans. Motivation and self-efficacy are crucial if action is to be elicited • Action - Realistic goal setting is crucial if action is to be maintained. Use of social support is important to receive reinforcement of change • Maintenance - Can be enhanced by self-monitoring and reinforcement • Example of these approaches – smoking intervention

Question 54

Transtheoretical model – criticisms

Answer 54

• Criticisms of the model: - An individual may be in several stages of change at one time - Perhaps too much focus on motivation and intention – past behaviour is a more powerful predictor of future behaviour - Participants stage of change may not be predictive of success of intervention - Doesn’t consider social aspects of health behaviour, severity of illness/disease/outcome, characteristics of the individual

Question 55

Health belief model

Answer 55

• The HBM is a social cognitive model that attempts to explain and predict health behaviours • This is done by focusing on the attitudes and beliefs of individuals • The HBM was first developed in the 1950’s by social psychologists HochBaum, Rosenstock and Kegels • Since then, the HBM has been adapted to explore a variety of long and short term health behaviours • According to the model, a person’s readiness to take a health action (e.g. quit smoking, start exercising, practice safe sex) is determined by four main factors 1. Perceived severity or seriousness of the disease - I believe coronary heart disease is a serious illness contributed to by being overweight 2. Perceived susceptibility of the disease - I believe I am susceptible to heart disease because I am overweight 3. Perceived benefits of the health action - If I lose weight my health will improve, my risk of heart disease will decrease, and I’ll feel good 4. Perceived barriers to performing the action - Finding the time to exercise and eat well in my current lifestyle will be difficult and possibly more expensive

Question 56

HBM – criticisms

Answer 56

• Static model - Does not allow for staged or dynamic process of change in beliefs which later models show • Assumption that individuals are rational information processors and decision-makers, which is not always the case • Limited account of social influences on behaviour

Question 57

Theory of planned behaviour

Answer 57

* Behaviour is thought to be proximally determined by intention * Intention is influenced by a person’s attitude towards the behaviour (outcome expectancy, outcome value) and their perception of social pressure regarding the behaviour (subjective norm) * Perceived behavioural control (a person’s belief that they have control over their own behaviour in certain situations – similar to self-efficacy) can directly or indirectly influence health behaviour

Question 58

Theory of planned behaviour – attitude

Answer 58

• Attitude is made up of components outcome expectancies and outcome evaluations • Outcome expectancies: the expected consequences of the health behaviour (e.g. smoking cessation, healthy eating). Can be +/- • Outcome evaluation: your evaluation of the favourableness of expected consequences of a behaviour - E.g. if I eat breakfast I will gain weight (outcome expectancy), which would be bad (outcome evaluation) - E.g. if I eat breakfast I will have more energy and vitality (outcome expectancy), which will be great (outcome evaluation)

Question 59

The theory of planned behaviour – subjective norm

Answer 59

* Subjective norm is made up of two components normative beliefs and motivation to comply * Normative beliefs- your perception of how people regard your performance of a behaviour * Motivation to comply your desire with the wishes of others

Question 60

The theory of planned behaviour – perceived behavioural control

Answer 60

* Perceived behavioural control is quite similar to concept of self-efficacy * Perceived behavioural control: your beliefs about the extent of your control over your behaviour (especially in the face of barriers)

Question 61

The theory of planned behaviour – intention

Answer 61

* Intention is thought to be the most proximal predictor of behaviour – with attitude and subjective norm (and most of perceived behavioural control) influencing behaviour through theory effect on intention * Intention – your readiness (or plans) to perform a behaviour

Question 62

Theory of planned behaviour - strengths and criticisms

Answer 62

* The theory of planned behaviour addresses many of the criticism of the health belief model * The relationship between variables is well defined * Includes consideration of the social influences on behaviour * Considers whether the individual feels able to perform the behaviour * However… prediction of behaviour from TPB variables is significantly lower than the prediction of intention

Question 63

Intention-behaviour gap

Answer 63

• Although intention are an important part of predicting future behaviour – not all intentions are translated into behaviour • The inconsistency between strong behavioural intentions and subsequent behaviour has resulted in a theoretical ‘intention behaviour’ gap • There are two main approaches to addressing the intention behaviour gap - Adding extra variables (e.g. to the theory of planned behaviour-moral norm, self-regulation, habit) - Developing new models to explain post-intentional behaviour

Question 64

Post-intentional models

Answer 64

• Some researchers have developed new models to explain what happens after you form an intention to perform a behaviour • Focus on post-intentional behaviour - Health action process approach (HAPA) - Temporal self-regulation theory

Question 65

Health action process approach

Answer 65

• HAPA attempts to fill the ‘intention-behaviour gap’ by highlighting the role of self-efficacy and action plans • It is particularly influential because it suggest that the adoption, imitation and maintenance of health behaviours must be explicitly viewed, and maintenance of health behaviours must be explicitly viewed as a process that consists of at least - A pre-intentional motivation phase - A post-intentional violations phase • It emphasises the importance of self-efficacy • Requires two separate processes - Motivation (intention) - Volition (action) • First, an intention to change is developed, in part on the basis of self-beliefs • Second, the change must be planned, initiated and maintained and relapses must be managed

Question 66

HAPA – motivation phases

Answer 66

* The HAPA proposes that self-efficacy and outcome expectancies are important predicators of goal intention (as found in studies with the TPB and perceived behavioural control) * Perceptions of threat severity and personal susceptibility (perceived roles) are considered a distal influence on actual behaviour, playing a role only in the motivation phase

Question 67

HAPA -volition phase

Answer 67

• HAPA proposes that in order to turn intention into action-planning has to take place • Gollwitzer’s (1999) concept of implementation intentions- when, where, how plans to turn goal intention into specific plan of action • Self-efficacy also involved - Initiative self-efficacy: individual believes they are able to take initiative when planned circumstances arise - Coping/maintenance self-efficacy: belief in one’s ability to overcome barriers and temptations - Recovery self-efficacy: important to get individual back on track if they suffer a setback

Question 68

The health action process approach – criticisms

Answer 68

* The body of literature applying to HAPA to behaviour is still limited * Too rational? Emotion may be neglected * The social and environmental influences are not considered as directly affecting behaviour, but rather as cognitions

Question 69

Temporal self-regulation theory

Answer 69

• Temporal self-regulation theory (TST) addresses criticism of the theory of planned behaviour - Adds variables to explain the intention-behaviour gap • It is novel in the it incorporates behavioural pre-potency (habits) and individual differences in self-regulatory capacity • TST posits that health behaviour is proximally determined by three factors 1. Intention strength 2. Behavioural pre-potency 3. Self-regulatory capacity • The latter two constructs are theorised to have direct influences on behaviour and also to moderate the intention-behaviour link

Question 70

Temporal self-regulation theory – intention

Answer 70

• Intention strength is a function of: • Connectedness beliefs: - Anticipated connections between one’s behaviours and salient outcomes (i.e. connectedness beliefs) - The valences of outcomes can range from negative (costs) to positive (benefits) • Temporal proximity: beliefs are weighted by temporal valuations - E.g. a health behavioural might include eventual benefits (e.g. improved appearance, better health status), but more temporally proximal – therefore more heavily influential -immediate costs (e.g. inconvenience, monetary costs, time costs)

Question 71

Temporal self-regulation theory – temporal valuations

Answer 71

* TPB and other social-cognitive models (HBM, PMT) may not predict adequate intention-behaviour consistency because they have no temporal (immediate vs distal) weighting of anticipated outcomes * Differing relationship between the proximity and valence characteristics * TPB and other social-cognitive models (HBM, PMT) may not predict adequate intention-behaviour consistency because they have no temporal (immediate vs distal) weighting of anticipated outcomes * Differing relationship between the proximity and valence characteristics

Question 72

Temporal self-regulation theory – self regulation

Answer 72

• In addition to intention, two important moderating and direct effects on health behaviour performance are: 1. Self-regulatory capacity - Self-regulation includes impulse control/management of short term desires - Composed primarily of executive functioning resources through the prefrontal cortex - Executive functioning refers to the ability of an individual to exert control over cognition, emotion, behaviour and physiology 2. Behavioural pre-potency - Behavioural pre-potency examine she strength of past performance in similar contexts - It through to represent a quantifiable values reflecting frequency of past performance and/or presence of cures to action in the environment - The combination of self-regulation and behavioural pre-potency determines the likelihood that intentions will be translated into behaviour, and each also has direct influences on behaviour itself regardless of intention

Question 73

Temporal self-regulation theory -criticisms

Answer 73

* The body of research using temporal self-regulation theory is small (but growing) * We are still trying to find good ways to measure self-regulation and behavioural pre-potency * It is unclear whether the model is better than the theory of planned behaviour (but it seems likely)

Question 74

Stigma

Answer 74

• A mark of disgrace associated with a particular circumstance, quality or individual

Question 75

Disgust

Answer 75

• A feeling of revulsion or strong disapproval aroused by something unpleasant or offensive

Question 76

Process of stigma

Answer 76

• Involves severe social disapproval of a person’s characteristics or their beliefs which at the time are considered to be unacceptable to dominant cultural norms

Question 77

How does stigma apply to health?

Answer 77

``` • Health risk behaviours - Smoking (shift in last 20 years of social acceptableness) - Alcohol consumption (the way health professionals ask about consumption can alter the truthfulness) - Unsafe sex • Health enhancing behaviours - Exercise - Healthy diet - HPV vaccination ```

Question 78

Health behaviour

Answer 78

• Mataazzo (1984) distinguished between: - Behavioural pathogens: the health damaging/health risk behaviours such as excessive alcohol consumption, smoking, fatty diet - Behavioural immunogens: the health protective/health enhancing behaviours such as exercise, health screening uptake, breast self-examination, and low fat diets

Question 79

Chronic disease in Australia

Answer 79

``` • Heart disease, stroke, cancer and other chronic diseases looming epidemics that will take the greatest toll in deaths and disability • Chronic diseases impact heavily on: - Burden upon patients/carers - Rates of death and disability - Use of health services - Healthcare expenditure ```

Question 80

Primary causes of death in Australia

Answer 80

``` • Coronary heart disease - Smoking - Diet - Exercise - Alcohol • Stroke (and other cerebrovascular diseases) - Smoking - Diet - Alcohol - Exercise • Cancer (primarily lung, breast, prostate, colorectal) - Smoking - Alcohol - Diet - Health screening - Self-examination • Dementia - Smoking? - Alcohol? - Exercise? - Diet? ```

Question 81

Health risk behaviours – smoking

Answer 81

``` • Recommendation: don’t smoke • Risks: - Coronary heart disease - Stroke - Peripheral vascular disease - Cancer • Prevalence (5 or 14+ years) daily smoking - 2001: 19% - 2013: 13% • Prevalence – never smoked (no more than 100 in a lifetime) - 2001: 51% - 2013: 60% ```

Question 82

Australia’s approach to cigarettes

Answer 82

• Banned tobacco advertising - Significant different between us and the rest of the world • Leaders in plain packaging - Structured approach of determining how we would change this - The colour – ugly - Larger warnings - Very good campaign • Making things more difficult at point of sale • Significant taxes - Major impact – less affordable - Can’t bring in much duty free tobacco

Question 83

Factor associated with smoking

Answer 83

• Location - Remote ad very remote areas (2x more likely than major cities) • SES - Lower SES (3x more likely than highest SES) • Indigeneity - Indigenous Australians (2.5x more likely than non-indigenous) • Sexual orientation - Homosexual and bisexual (more likely to smoked daily than heterosexual)

Question 84

Why start smoking?

Answer 84

• Modelling (peers, siblings, parents) • Social pressure, social learning and reinforcement • Weight control (when people stop smoking they gain 3kg) • Risk taking or problem behaviours • Health cognitions (unrealistic optimism) - Perhaps because gratification is immediate whereas health consequences aren’t

Question 85

Why continue smoking?

Answer 85

* Enjoyment (behaviour, taste, effects) * Habit * Physical and/or psychological addiction * Stress/anxiety management * Low self-efficacy

Question 86

Alcohol

Answer 86

• Second most widely used psychoactive substance in the world (after caffeine) • Recommendations: for reducing long-term harm, no more than 2 standards per day • For reducing short-term harm (.e. injury), no more than 4 standards on any given day • Prevalence (% of 14+ years) – exceeding guidelines for reducing long-term harm - 2001: 21% - 2013: 18% • Prevalence for reducing short-term harm: - 2001: 29% - 2013: 26%

Question 87

Increased risk of (drinking)

Answer 87

``` • short term: - Pedestrian, road and other accidents. - Domestic and public violence - Crime • Long term - Liver disease - Cancer (oral, oesophagus, larynx) - High blood pressure - Pancreatitis - Brain damage ```

Question 88

Factors associated with risky drinking

Answer 88

• Location: - Remote and very remote areas (2x more likely than major cities) • SES: - Higher SES (more likely to drink in risky quantities than people with lowest SES) • Indigeneity: - Indigenous Australians: more abstinence but (if drinking) more risky • Sexual orientation: - Homosexual and bisexual (more likely to drink in risky quantities)

Question 89

Why higher amongst same-sex attracted people?

Answer 89

* Negative reactions to disclosure of orientation * Experiences of bisexual-negativity * Minority stress theory – experience both internalised and external stigma ‘

Question 90

Unsafe sex

Answer 90

• Recommendation: - Regular STI - Covering potentially-infectious areas - Preventing/reducing the transfer of bodily fluids between partners • Use of: - Internal (‘female’) or external (‘male’) condoms or gloves during penetrative sex - Condoms and dental dams for oral sex - Lubricant to reduce condom breakage during anal sex • Prevalence of condom use: amongst adults who had casual intercourse: used condom every time - 2002: 41% - 2013: 49%

Question 91

With protection, reduced risk of…

Answer 91

``` • Unplanned pregnancy • Infections: e.g. - HIV - HPV - Chlamydia - Herpes simplex - Genital warts - Etc. ```

Question 92

Factors associated with condom-use

Answer 92

• Amongst women - Age (less likely after 30) - Excessive alcohol consumption (less likely after > alcohol) • Amongst men; - Number of sexual partners (more likely with more than one partner)

Question 93

Why not use protection?

Answer 93

``` • social - difficulty/embarrassment in raising issue - anticipated objection - worry about STI implications • lack of self-efficacy for correct use • attitudes - reduced spontaneity - unrealistically positive ```

Question 94

exercise

Answer 94

• recommendations (for adults) - moderate activity, at least 150-300 min/week - vigorous activity, at least 75-150 min/week • benefits – reduced risk of - physical  cardiovascular disease  type 2 diabetes  cancer (colon, breast) - psychological  anxiety disorders + symptoms  major depressive disorder + symptoms  stress • prevalence (amongst adults) – meeting exercise guidelines - 2005: 30% - 2012: 43%

Question 95

Factors associated with exercising

Answer 95

• Ages - Younger (more likely to meet guidelines) • SES - Higher (more likely to meet guidelines) • education - higher more likely to meet guidelines) • location - major cities (more likely to meet guidelines)

Question 96

why exercise? Why not exercise?

Answer 96

``` • Internal - Self-efficacy - Lack of interest - Enjoyment • External - Time constraints - Modelling from family - Social support - Number of active neighbours ```

Question 97

Healthy diet

Answer 97

``` • Recommendations – women • Recommendation – men • Serving size - Vegetable serve is 75g – about half a cup of cooked vegetables or a cup of raw vegetables like lettuce - Fruit serve is 150g – 2 small pieces of fruits or one medium size piece of fruit • Benefits – reduced risk of - Coronary heart disease - Stroke - Lung cancer • Prevalence (amongst adults) – meeting fruit guidelines - 2005: 54% - 2012: 49% • Prevalence – vegetable guidelines - 2005: 14% - 2012: 6% ```

Question 98

Factors associated with F and V consumption

Answer 98

``` • SES - Higher (more likely to meet guidelines) • Age - 5-7 years: 55% - 12-34: 4% - 55+: 8% ```

Question 99

Why not eat F and V?

Answer 99

``` • Parent socialisation - Permissiveness, feeding practices • Perceived and/or actual barriers - Lack of knowledge and skills - Length of preparation time - Cost and availability (e.g. Rural areas) • Misinformation - Consumers reluctant to eat vegetarian diet because of concerns about lack of nutrients and iron ```

Question 100

Why eat F and V? (Young Australians)

Answer 100

``` • 12-15 year old’s in Victoria • Vegetables - Peer support - Self-efficacy - Perceived availability of F and V in the home • Fruit - Healthy eating value - Modelling by mother - Self-efficacy - Perceived availability of energy-dense food in the home ```

Question 101

HPV vaccination

Answer 101

• Recommendation - ideally, before sexually active - Free nationally for 12-13 year old’s (school vaccination) – immune system most responsive at this age - 3 vaccinations over 6 months • Benefits of HPV vaccination - Protects against HPV types 16 and 18. Amongst cancer attributable to HPV, types 16 and 18 cause approximately:  75% of cervical cancers  85% of vulva and vaginal cancers  90% of cancers of the mouth/throat  75% of penile cancer  95% of anal cancers  45-90% of tonsil and base of tongue cancers - Also protects against HPV types 6 and 11, which cause:  90% of genital warts • Prevalence – had all three vaccinations

Question 102

Factors associated with uptake

Answer 102

• Heath insurance status (may not be an issue in Australia) • Program location (higher for school-based population) • Recommendation by health care professional • Parental concern about: - Safety and side effects - Initiation of early sexual behaviour (although unlikely to be a founded concern)\