Becker - AIM?
Health belief model
Use the health belief model to test mothers’ compliance to a drug regime for their child with asthma
Becker - BACKGROUND?
Health belief model
Rosenstock (1966)
To explain why people failed to participate in preventative campaigns for Tuberculosis (using cognitive explanations)
Individual and situational factors = less reductionist
6 elements:
-perceived threat / seriousness / susceptibility
-cost-benefit analysis
-internal/external cues
-demographic variables
Becker - SAMPLE?
Health belief model
111 mothers (17-54 years) Children aged 9 months to 17 years
Becker - METHOD?
Health belief model
Self report
Correlation between beliefs and compliance with asthma medication
Covert blood test (70%) - confirm validity
Becker - PROCEDURE?
Health belief model
Each mother interviewed about their perception of:
-susceptibility (of child to illness)
-seriousness (of asthma)
-inconvenience (how much asthma interfered with life)
-effectiveness of doctors and medicine
Child given covert blood test (70%)
Becker - RESULTS?
Health belief model
Blood tests showed 66% compliance
Supports the health belief model - mothers who feared their child was vulnerable = more likely to comply
Becker - CONCLUSIONS?
Health belief model
The Health Belief Model is useful at predicting and explaining levels of compliance of a medical regime
Becker - EVALUATION?
Health belief model
Individual differences - socio-demographic variables
Holistic - cognitive and social factors
Ignores irrational factors - people aren’t always logical
Not all health behaviours are a rational decision (brushing teeth is a habit)
Low validity - interviews (social bias)
Ethics - covert blood sample of children BUT improves concurrent validity
Reductionist - ignores how adherence will change with age
Correlation - no cause and effect (psychology science) BUT collected quantitative and qualitative data
Useful - can target specific groups for closer monitoring
Rotter - BACKGROUND?
Locus of control
The location an individual places their control over events - internal (they control) or external (outside their control)
Determines whether an individual will seek out healthy lifestyles
3 dimensions:
-internality: extent of internal/external perceived control
-chance: belief that external factors (eg chance) influences health
-powerful others: belief in the control of health professionals
Rotter - AIM?
Locus of control
To test if a reward is more effective if a person believes it was the result of themselves (internal) or other factors (external)
Rotter - SAMPLE?
Locus of control
6 pieces of research about an individual’s perception of how they can control an outcome
Rotter - RESULTS?
Locus of control
Participants who felt they had control - more likely to cope with potential threats
Smokers who gave up smoking (and didn’t relapse) had a higher level of internal locus of control
Rotter - CONCLUSIONS?
Locus of control
Locus of Control affects many of our behaviours
Rotter - EVALUATION?
Locus of control
Deterministic - human behaviour influenced by reinforcement
Ecological validity low - artificial task
Doesn’t have any health related tasks/ill patients so results can’t be generalised to health behaviour
Bandura - BACKGROUND?
Self Efficacy
Developed (by Bandura) from internal locus of control
If we think we can succeed (cope with a threat) we work harder = more likely to succeed
Belief (affects perception and motivation) you can perform well in a situation
More confident = more likely to succeed
4 influences:
-Persuasory: positive feedback
-Enactive: past experiences (eg GCSEs)
-Emotive: mental state (eg anxiety)
-Vicarious: comparing ourselves to others (eg friend)
Bandura - AIM?
Self Efficacy
Assess the self efficacy of patients engaging in systematic desensitisation for snake phobias
Bandura - SAMPLE?
Self Efficacy
10 snake phobic patients (9 female, 1 male)
Mean age: 31
Bandura - METHOD?
Self Efficacy
Quasi (level of fear)
Bandura - PROCEDURE?
Self Efficacy
Level of fear and perception of how well they’d do was measured
Relaxation exercises
Systematic desensitisation:
-shown photos of snakes
-once arousal levels fall, put in same room as snake
-eventually able to handle them
Fear and perception of how well they’d do measured again
Bandura - RESULTS?
Self Efficacy
Second fear score (after systematic desensitisation) were lower.
Coping perception higher
Bandura - CONCLUSIONS?
Self Efficacy
Systematic desensitisation works.
Supports self efficacy
Self efficacy is cognitive (perception affects behaviour) and behavioural (perception is learned from past experiences - nothing happening with snake)
Bandura - EVALUATION?
Self Efficacy
Lab experiment - high control and can test cause and effect
Nature/nurture - self efficacy influenced by personality and environment
Useful - can be applied to disorders
Low ecological validity
Keating - BACKGROUND?
Media campaigns
Get health messages across (TV adverts, posters)
Allow people the choice to choose healthy behaviours
Legislation more authoritarian - prevents people acting unhealthy
Keating - AIM?
Media campaigns
Assess how effective the VISION mass media campaign was at increasing awareness and preventing HIV/AIDS
Keating - SAMPLE?
Media campaigns
3278 (15-49yrs)
3 Nigerian States
60% married
Keating - METHOD?
Media campaigns
Self report
Keating - PROCEDURE?
Media campaigns
Interviewed by questionnaire
Asked about family planning, sexual activity and exposure to media campaign
Asked 3 closed questions:
-have you talked to a partner about ways of preventing AIDS?
-does condom usage reduce chances of getting AIDS?
-did you use a condom last time?
Keating - RESULTS?
Media campaigns
Exposure to media campaign was high
Women most exposed to adverts in clinic
Men to radio adverts
-1.5x more likely to have discussed HIV/AIDS
-2x more likely to know that condoms reduce risk of HIV/AIDS
-No affect on condom usage
Keating - CONCLUSIONS?
Media campaigns
VISION increased awareness/understanding of HIV/AIDS
Different media reaches different people
No affect on condom usage - didn’t know where to get them (include in future campaigns)
Wakefield - BACKGROUND?
Legislation
Authorities create enforceable rules that inhibit or promote health behaviours
Requires effective enforcement
More authoritarian than media campaigns
Wakefield - AIM?
Legislation
Compare effectiveness of smoking restrictions - home bans, school bans and legal bans
Wakefield - SAMPLE?
Legislation
17287 high school students
202 schools in USA
80% of selected students completed the questionnaire
Wakefield - METHOD?
Legislation
Self report
Wakefield - PROCEDURE?
Legislation
Asked if adults at home smoke If smoking banned at home, school (how well enforced) and in public places Sorted into 6 categories: -non susceptible non smokers -susceptible non smokers -early experimenters -advanced experimenters -established smokers -current smokers
Wakefield - RESULTS?
Legislation
Not developing a smoking habit was linked to home bans (parent restrictions), school bans and public bans
Home bans more effective than legal or school bans
11% reduction in smoking uptake due to school bans (still effective)
Wakefield - CONCLUSIONS?
Legislation
Consistent with other research
Parental opposition reduced uptake of teen smoking
Legal restrictions and school bans less effective
Ruiter - BACKGROUND?
Fear arousal
Fear arousal used in many health promotion campaigns
Increase emotional tension so that individual must change their behaviour to reduce the tension
Ruiter - AIM?
Fear arousal
Examine effect of fear arousal on attitudes towards taking part in early detection for breast cancer
Ruiter - SAMPLE?
Fear arousal
88 female undergraduates (1st year)
University in the Netherlands
Mean age: 20
Volunteer sample
Ruiter - METHOD?
Fear arousal
Lab
Independent measures:
-low/mild fear
-strong/weak argument
Ruiter - PROCEDURE?
Fear arousal
Questionnaire - asses pre-experimental attitude to breast self-examination
Effectiveness of several educational messages about breast cancer (low or mild fear) evaluated
Read a persuasive message about performing monthly breast exam checks (weak or strong argument)
Questionnaire to assess post-experimental attitude
Fear - level of implied severity
Random allocation to 2x2 condition
Ruiter - RESULTS?
Fear arousal
Low effectiveness of manipulated fear
Argument strength was more effective
Argument based messages more effective than fear
Ruiter - CONCLUSIONS?
Fear arousal
Evoked fear causes people to have more argument based processing
Only applicable to breast self examination - not all health detection
Bulpitt - BACKGROUND?
Reasons for non-adherence
Valid reasons not to adhere:
- don’t believe treatment is working
- unpleasant side effects
- confused about how much to take
- too expensive
- withdraw to ‘see if the illness is still there’
Bulpitt - AIM?
Reasons for non-adherence
Review research on adherence to hypertensive (high blood pressure) medication
Bulpitt - METHOD?
Reasons for non-adherence
Review article of research identifying problems with taking medication
Bulpitt - PROCEDURE?
Reasons for non-adherence
Statistical analysis of physical and psychological effects of adherence
Bulpitt - RESULTS?
Reasons for non-adherence
15% dropped out due to side effects: -sleepiness -dizziness -lack of sexual functioning -lower cognitive functioning 8% dropped out due to sexual problems
Bulpitt - CONCLUSIONS?
Reasons for non-adherence
When the cost of taking the medication outweigh the perceived benefits there is less likelihood of the patient adhering
Lustman - BACKGROUND?
Measures of adherence
Ways to measure adherence:
- self report - asking patient about how compliant they have been
- health worker estimates - asking a doctor to ‘guesstimate’ how complient the patient is
- biochemical tests - blood and urine tests
- pill and bottle counts - number of pills left compared to how many here should be
Lustman - AIM?
Measures of adherence
See if there’s a link between depression and non-adherence to diabetic medication
Lustman - SAMPLE?
Measures of adherence
60 diabetic patients with depression
Volunteer sample
Lustman - METHOD?
Measures of adherence
Randomised double blind study
Lustman - PROCEDURE?
Measures of adherence
Patients randomly assigned to fluoxetine (depression treatment) or placebo (double blind)
Depression assessed using psychometric tests
Adherence assessed through blood sugar levels
Lustman - RESULTS?
Measures of adherence
After 8 weeks:
-Fluoxetine group had healthier blood glucose levels (adherence) and
lower levels of depression
-Less depression (fluoxetine) = more regularly monitored blood glucose levels
Lustman - CONCLUSIONS?
Measures of adherence
Measuring blood sugar levels in patients with diabetes indicates adherence
Less depression = greater adherence
Not being anxious or depressed improves compliance
Watt - BACKGROUND?
Improving adherence
Non adherence:
- can be fatal
- expensive
- wasted medication
- require follow up measures
Watt - AIM?
Improving adherence
To see if funhaler improves children’s adherence to asthma medication
Watt - SAMPLE?
Improving adherence
32 Australian children (10m and 22f)
Asthmatic
Watt - PROCEDURE?
Improving adherence
Repeated measures:
-normal ‘breath-a-tech’
-funhaler
Each used for 1 week and parent answers questionnaire
Watt - RESULTS?
Improving adherence
Adherence to asthma medication increases by 38% using the funhaler than the breath-a-tech’
Watt - CONCLUSIONS?
Improving adherence
Previous research suggests forgetfulness and boredom influenced non-adherence
Funhaler solves this and encourages correct usage of the inhaler with a spinner and whistle
Making the medical regime fun can improve adherence in children