Health Psychology Midterm Study Guide
Health Psychology Midterm Study Guide Psyc 3128
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This 26 page Study Guide was uploaded by Maya Blair on Thursday February 25, 2016. The Study Guide belongs to Psyc 3128 at George Washington University taught by Thomas Nassif in Winter 2016. Since its upload, it has received 143 views. For similar materials see Health Psychology in Psychlogy at George Washington University.
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Date Created: 02/25/16
Chapter 1—Interdisciplinary View of Health 1) Define physiological state, holistic health. Physiological Health ● A person’s ability to physically perform his or her daily functions without limitations, restrictions, or impediments ● Belief may derive from theories that propose that an individual’s health is defined by the presence or absence of disease, dysfunction, or other abnormal biological changes in the body Holistic Health ● NOT defined by a person’s physical functional state but ALSO their attitude about the illness and their overall mental and emotional state ● Influenced by physiological, psychological, emotional, and social factors ● Hippocrates, Greek physician was the first to acknowledge the connection between emotions and health ● Might not be able to do much (paralyzed) but under this model one might still consider themselves “healthy” 2) Be familiar with the 5 determinants that impact health. Determinants of Health Primary or contributing factors that influence health outcomes Some determinants of health are universal while others are specific to a culture or time 1. The individual (biology and behavior) 2. Social environment (created by family, community, and cultural practices) 3. Physical environment (housing conditions, sanitation, pollution, crime, and violence 4. Health systems (health care delivery organizations that provide access to care) 5. Health policy (regulations that promote or protect the health of individuals in the community) 3) What do archaeological records tell us about health policy efforts during the Indus Valley Civilization, Ancient Greece, and Roman Empire? Health Policy (2000500 BCE) ➢ Sanitation Ancient civilizations considered clean water and sanitation important health determinants ○ Ex. Public and private drainage systems inIndus Valley Region to reduce exposure to contaminants ➢ Clean Water Water reservoirs inIndus Valley andGreek and Roman aqueducts to provide access to clean water for personal consumption 1 ***We see that sanitation and clean water were most likely health determinants to these ancient civilizations 4) Distinguish between Aesculapian vs. Cnidian Theory, and be familiar with examples of these theories reappearing over time in other cultures. Ancient Greek Cultures (500 BCE) ➢ Hippocrates’ humoral theory propose association between mind and body that affects health ○ Galen believed diseases that caused imbalance were located in organs (not body fluids) ➢ Aesculapian theory illnesses have spiritual origins and require spiritual intervention, ritual cures, and mediation by priests ○ PreColumbian cultures that include the Mayans and Aztecs (1400 CE) and more than 1,000 Native American cultures (1300 CE) linked the spiritual health of individuals with their physiological health ➢ Cnidian theory illnesses associated with physical diseases and unrelated to mental, spiritual, or emotional wellbeing (purely physical!) ○ Galen, a noted philosopher and physician in Rome in 200 CE ○ Descartes, a philosopher and mathematician in France in 1600 CE ○ Both proposed that health is a disease that affected ONLY the body 5) How did people’s beliefs about the causes of plagues change during these pandemic outbreaks vs. during the Renaissance? Pandemic Outbreaks During the plagues people were influenced by the religious doctrines of the time and embraced the view that the plagues were caused by demons and a punishment from God Rome devastated by pandemics – communicable disease affecting large groups of people in different regions Successive wave of pandemics –called plagues thought to be sign of God’s punishment for sins of sufferers. Plagues of Justinian (541542 and 588 CE) killed thousands and Haemorrhagic Plague (13471350 CE) killed > 25 million Influenced by the religious doctrine of the time, people embraced the view that the plagues and other diseases were caused by demons Renaissance Western Europe experienced a renaissance (cultural rebirth) Prompted a move away from the belief that illnesses were a punishment for evil Marked the return to the scientific exploration of the human body Scholars and physicians suggested that some diseases were the result of environmental , not spiritual, factors Provide some examples of health policy initiatives set forth in Western Europe to stem the outbreak. ➢ Health policies were implemented to control outbreak during last plague ○ Isolation and quarantine of people diagnosed with the disease 2 ○ Fumigation of buildings, houses, and towns in an effort to kill the germs and the animals, especially rodents, assumed to carry the disease These policies were designed to protect the health of the COMMUNITY and INDIVIDUALS in improving outcomes. 6) Define psychosomatic illness. Psychosomatic illness Mindbody connection and health! Some physical diseases are thought to be particularly prone to be made worse by mental factors such as stress and anxiety Your current mental state can affect how bad a physical disease is at any given time What did Freud propose that resulted in the development of this field? ➢ Freud proposed that physiological illnesses can have psychological causes 7) Know the WHO definition of health. World Health Organization Concept of Health (WHO) Integrates the physical, emotional, psychological, and social determinants WHO defines health as, “a state of complete, physical, mental, and social wellbeing and not merely the absence of disease and infirmity” Health is more than just a disease (includes emotional and mental health as factors in wellbeing) Note 4 models of health and wellbeing Biomedical model, biopsychosocial model, wellness model, social ecological model 8) Understand how Robert Koch’s discovery (pp. 1112) and Pasteur’s discovery (p. 169) led to the biomedical model of health. Which determinant of health is most emphasized in this theory? (p. 12) Robert Koch German scientist who is credited with discovering that specific bacteria can be linked to specific diseases Discovered the relationship between microorganisms and disease! Pasteur Pioneered the use of vaccines to prevent infectious disease (thereby ensuring good health) *Both explained the origins of illness and led to the development of the biomedical model of health!* Biomedical Model Return to the theory that germs, rather than sins or spiritual forces, caused disease Illness is defined as a dysfunction of the body caused by microorganisms that results in illness or disability Overlooks contributions of emotional, social, and environmental factors on health Determinants most emphasized Physiological factors 9) Explain the 3 components of the biopsychosocial model. 20th century model that reintroduced a holistic theory of health 3 Supports the link of mind and body (Hippocrates and Freud) The combination of factors contribute to overall wellbeing and health outcome 1. Physiological factors (biological factors) 2. Psychological influences (emotions, social support, personal traits) 3. Sociological factors (family, culture, community) Provide examples of how emotions can affect physical health ➢ Emotions such as stress impact physiological health by affecting the immune system and by influencing health behaviors ➢ Studies also report an association between other emotions, such as depression and heart disease and even death 10) What are 3 critiques of the biopsychosocial model? 1. Biological determinants at the core (too “biocentered”) → Psychological and sociological determinants are seen as “addons” → At it’s core it’s really a biological model and NOT a balanced model 2. Overlooks PHYSICAL environmental factors → Only focuses on social environmental factors such as family and community → Physical environmental factors are things like air and water quality, toxic waste sites or other pollutants which can produce poor health outcomes (yet they’re not addressed) 3. Ignores qualityoflife and spirituality → Yet current research suggests that quality of life and spirituality are important psychological and emotional factors that also affect health outcomes for some 11) What 2 health determinants does the Wellness Model add to other models? Spirituality ○ Individual’s perspective on the meaning of life and the impact of their values on their overall wellbeing Quality of Life ○ An individual’s perceived satisfaction with their life ○ Influenced by both psychological and physiological states 12) How can spiritual beliefs influence healthenhancing behaviors? Spiritual beliefs may enable one to experience peace and tranquility during stressful times Reducing stress is important for maintaining good physiological health Some spiritual beliefs encourage individuals to adopt behaviors such as refraining from drinking or smoking Avoiding alcohol and cigarettes are, themselves, healthenhancing behaviors 13) Understand how some individuals can have a high quality of life through positive PSYCHOLOGICAL states that help them cope with P HYSICAL limitations. 14) Be familiar with the 5 components of the social ecological model. Social Ecological Model The most broad of the models 4 5 Major Determinants of Health (the last three are unique to this model) 1. The individual (biology and behavior) 2. Social environment (created by family, community, and cultural practices) 3. Physical environment (housing conditions, neighborhood sanitation, cleanliness, safety, and a physical space free of toxicity or pollution) 4. Health systems (health care delivery organizations that provide access to care) ○ Ex. Access to care, affordable care, quality of care, treatment options 5. Health policy (regulations that promote or protect the health of individuals in the community) ○ Ex. Government regulated or restricted behaviors, mandated health plans How is it similar vs. different from the other models? ➢ Addresses the physiological and psychological consequences of negative environmental factors such as crime and violence ➢ Only model that proposes that health systems and health policy also influence health 15) Provide two examples of how the physical environment can inhibit good health outcomes (i.e. environmental pollutants; safety) 1. POLLUTANTS ○ Waste products and exhaust can affect air and water quality in negative ways 2. SAFETY ○ If a neighborhood is unsafe due to crime and violence kids are at a greater risk for obesity than those in “safer” environments ○ Reason b/c kids are kept inside which limits physical activity and increases their likelihood of consuming junk food 16) Know the 5 roles/functions of health psychologists (p. 16) proposed by Matarazzo. 1. Focus on health promotion 2. Focus on disease prevention 3. Focus on health maintenance at the individual and the family/community level 4. Have an investigative role for health psychology, exploring the causes (etiology) and the related consequences of illness 5. Analyze and identify problems and then recommend solutions that improve the health care system and that improve health policy 17) Distinguish between individual vs. demographic factors. Individual Behavior Demographic Fixed characteristics, such as gender or race/ethnicity Can also be subject to change such as age, socioeconomic class, level of education, and occupation 18) Explain an individual/genetic cause of MS (i.e. myelin sheath, nerve fibers). MS can result from damage to the body’s nerve fibers Nerve fibers transmit neurochemical messages throughout the body The fibers are encased in a myelin sheath , a coating that protects the fibers from damage and helps speed message transmission 5 Damage to the myelin sheath increases the risk of damage to the fibers → slows or impedes message transmission Interruption of message signals to or from the spinal column or to the brain can result in an impairment of motor movement or other body functions 19) Describe two ways that familial determinants of health can influence health outcomes. 1. Genetics → play a role in the transmission of many diseases (ex. asthma) 2. Health behaviors → might be practices common to family members (ex. smoking) Chapter 2—Research Methods 20) Distinguish between the following concepts: 1. Mortality vs. Morbidity Mortality refers to death Morbidity refers to diseases that may contribute to mortality ● Ex. # of deaths due to heart ● Ex. Diabetes does not cause death but can cause a number disease of health problems that lead to death 2. Raw data vs. Rates Reporting mortality/morbidity rates 2 types of data: Raw Data total number of deaths Rates if we want to understand the magnitude of a health problem in comparison to other countries Mortality Raw Data the raw data are the total number of Mortality Rates death in a population during a specific deaths for a defined population time period, scaled to size of the population CONS: cannot determine whether the number of infant deaths PROS: Allows us to compare mortality statistics across two represents a large or small % of the infant population in each or more countries. Formula: total # of infant deaths in a country. AKA: using raw data we conclude that infants in the given time period for a specific populatio /total population US are 178.5 times more likely to die than infants in of infants for the time perio *1,000 Finland...this isn’t true. We see that even though France had the 2nd highest RAW number of infant deaths, they actually have the 5th highest infant mortality rate: 3.6 3. incidence vs. prevalence vs. relative risk Turn raw data into incidence rates and prevalence rates 6 Incidence refers to the number of Prevalence total number of cases Relative Risk used to express the new cases of a disease in a specific (old and new) of a disease risk to members of a specific group population for a given time period compared to another group of We can examine how acquiring a disease quickly a disease is spreading by looking at the # of new cases, or incidence, of a disease 4. proximal vs. distal causes 2 measures that help explain individual or community health problems Proximal immediate or precipitatingcauses of health Distal remote in time orredisposing causes of health and illness and illness Individual, situational, or environmental Atrial septal defect (hole in wall) is a distal factors factor because it can CAUSE hypertension Ex. Gastrointestinal distress caused by food (high blood pressure) poisoning SUMMARY : 5 classic measures (mortality, morbidity, incidence, prevalence, and relative risk) enable health researchers to describe the health status of a population in general terms. Proximal and distal factors help explain the timing of an illness as well as the probable cause 21) Provide 3 types of Qualitative studies. Know the difference between closedended vs. openended questions. 1. Case Studies Allow for an indepth analysis of rare or unique events Case Report : very detailed report of specific features of particular participant/case Case Series : systematic review of interesting/common features of a small series ○ Does not include a control group Both are used to generate a hypothesis, which is then tested in larger studies ○ Advantages : easy to conduct ○ Disadvantage : unplanned, uncontrolled, and not designed to answer specific questions 2. Focus Groups Used primarily to gather information and generate insight through the interaction of a small group of informants Four main functions ○ To gather information ○ To generate insight ○ To explore a decisionmaking process ○ To encourage interactions between a small group → create new insights 3. Interviews Allows for structured and unstructured responses to specific questions ○ Structured: closeended (ex. yes/no) responses ○ Unstructured : openended (ex. descriptive), unrestricted responses 7 22) Understand the difference between... 1. Positive vs. Negative Correlation Correlational Studies A way to examine the relationship between two variables Asks: do two variables share something in common? Positive Correlation as one variable increases in value, so does second variable, OR, as one variable decreases in value so does second Negative Correlation as one variable increases in value, the second decreases 2. independent vs. dependent variable Independent (IV) variable that the investigator manipulates or controls ○ Researcher examines effect of variable on study’s outcome ○ May have more than one IV ○ Ex. Exercise (manipulate how much exercise) Dependent (DV) the study’s outcome variable ○ May be influenced by IV ○ Ex. Stress (depends on how much exercise) 3. experimental vs. control group Experimental group the test group that receives a special treatment or condition ○ Ex. 30 minutes of swimming Control group does not receive any special condition or treatment that would affect the dependent variable ○ Ex. Reading about swimming for 30 minutes 4. random sample vs. random assignment Random Sampling method of choosing participants such that… ○ All have an equal chance of participating in the study ○ The study sample will be representative of the population to be studied ○ It minimizes possibility of experimenter bias Random Assignment methodology that assures every person has an equal chance of being assigned to either experimental or control condition 23) Be familiar with the findings of the Framingham Heart Study. Framingham Heart Study Longitudinal study (studying over an extended period of time using the same participants) One of the world’s most wellknown studies of risk factors for cardiovascular disease (CVD) Designed to study heart disease Goal to investigate the possible factors related to the development of various forms of cardiovascular disease (CVD) Started in 1948 with 5,000 participants free of CVD Longitudinal cohort study involved repeated assessments of participants every 2 years Able to demonstrate an association between coronary artery disease and individual as well as environmental causes (smoking, physical inactivity, and hypertension) 8 Continues today with second and third generation offspring 24) What is the major ethical dilemma of randomized controlled trials? The major ethical dilemma is that one group gets the experimental drug and one group only gets a placebo (denies the potential lifesaving benefits of taking the drug) Explain one way to address this issue. (Also refer to my powerpoint slides on Crossover Trials) ➢ One way to address this issue with with a prepostposttest design (crossover trial) ➢ Both the experimental and control groups receive the actual treatment, although not at the same time ➢ Preserves scientific approach and ability to test drug’s safety and effectiveness ➢ Ensures that both group gets potentially lifesaving drug with minimal delay ➢ “Washout period” : time when no treatments are given ➢ Treatment Assignment Random assignment: random assignment to experimental treatment or control treatment Fixed assignment: all participants assigned to same treatment sequence ➢ Advantages Each participant acts as their own control Fewer participants needed to show an effect ➢ Disadvantages May be carryover effects If participant drops out, lose data 25) Be familiar with the Tuskegee Syphilis Study and Stanford Prison Experiment, and understand the ethics issues of each. Tuskegee Syphilis Study Conducted in the US from 1932 1972 (longest run study) Was only suppose to be a ninemonth study to examine the course of syphilis and its impact on neurological functioning Example of Breech of Research Ethics Researchers wanted to observe the effects of syphilis on different races Proposed that syphilis affected the cardiovascular system for blacks, and the neurological systems for whites PROCEDURE Studied 400 African American Males Nor did they know the demonstration could be accomplished only by autopsies (after death) Syphilis was untreated even when penicillin became available in the late 1940s Letters “not to treat” were inserted in army service records Told that nontherapeutic procedures were “special treatment[s]” ETHICAL PROBLEMS Deception “Volunteers” misled 9 Not informed of the true study Not informed of their true health condition Not aware that medical treatment (intervention) would not treat their health condition Not made aware of effective treatment of syphilis Not told that untreated, their condition would result in death Spouses and children of volunteers at risk for contracting untreated syphilis Flagrant disregard of rights and welfare of study participants Stanford Prison Experiment 1971 Philip Zimbardo designed a twoweek study on interpersonal dynamics and sought to determine whether social contexts can influence, alter, shape, or transform human behavior PROCEDURE 24 male Stanford University students volunteered to participate Randomly assigned 2 roles: prison warden or prisoner Prisoners assigned to live in a mock prison for a full two weeks Wardens worked 8 hour shifts “guarding” the prisoners Study terminated after 6 days due to prisoner’s extreme psychological trauma and the increasingly hostile and abusive behavior of the wardens “Bad” social contexts or environments can alter the behavior of otherwise “good” people Study suggests that individuals may come to perform hostile or abusive behaviors when placed in a social context that permits or encourages such behaviors ETHICAL PROBLEMS Lack of fully informed consent by participants Didn’t know they were going to be ‘arrested’ at home → social stigma by neighbors who may have viewed the ‘arrest’ Prisoner participants were not protected from psychological harm Didn’t realize the extent of humiliation and distress that they were going to 26) Know and briefly describe the 3 ethical principles of the Belmont Report. 1. Respect for persons 2. Beneficence 3. Justice Principle Application Respect for Persons Informed Consent Autonomy says that each individual... Very clear Is unique and free This is what you’re Has the right and capacity to decide responsible for Has value and dignity We want to make sure Has the right to informed consent you’re okay with this Protection for vulnerable persons Have the right to leave at Special protections must be in place for those whose decisionmaking any time capacity is impaired or diminished, whether due to physical or social factors (youth, cognitive impairment, other mental health issues or 10 illness) Beneficence Assessment of Risks/Benefits Protection of the study participants is the most important responsibility of the MUST think about the risks researcher Can be physical, social, or mental harm Research must Protect the physical, mental and social wellbeing of each research participant Minimize physical and social risks Maximize the possible benefits Retain the community perspective Justice Fair Selection of Subjects Obligation to treat people fairly and equitably Making sure all participants Equal access to benefits/equal share of burdens get equal share of Avoid underprotection and overprotection burdens/risk Chapter 3—Global Communicable and Chronic Disease 27) Briefly explain how the mode of transmission of the A/H1N1 influenza changed, and why this was seen as a danger to public health. Animal → animal Animal → human (people who worked with livestock) Human → human (airborn) Very contagious and communicable. Now we see something at pandemic proportions 28) Distinguish between epidemic vs. pandemic. Epidemic when a disease affects large numbers of a population within a geographic area ( epi “upon” and demos “people) Pandemics when a disease spreads through large geographic regions of the world or occur worldwide ( pan “all” demos “people) 1 example of an epidemic ➢ The Athenian plague 4 examples of a pandemic. ➢ Haemorrhagic plague (Black Death) ➢ Cholera ➢ Influenza ➢ HIV/AIDS 29) What is the most likely cause for the slower reduction in rates of TB in the U.S. compared to other developed countries? TB rates are not increasing HOWEVER data show a slower reduction in the rates of TB relative to other developed countries Reasons ○ Might be related to immigration (foreignborn residents have higher rates of TB) How should this type of information be used by health psychologists? 11 ➢ Health psychologists who work to reduce TB rates in the US could use the statistic to identify groups of people at greatest risk for contracting TB ➢ Could design intervention, prevention, and treatment programs tailored specifically to the higherrisk groups ➢ Ex. Could target RECENT minority populations 30) Prevention of which of the childhood viral diseases is given the highest medical priority? Explain Why. Measles Presents as fever with rash on face/neck that spreads to the body Illness itself is not dangerous but can lead to complications that can result in death Ex. Pneumonia, severe diarrhea, encephalitis (inflammation of brain) In developing countries, children who are merely exposed to the measles virus are likely to contract the disease. In many cases it will be fatal High contagion and fatality rate for children < 5 years old (considered most serious) In emergency settings (ex. refugee camps) 25% of all child deaths attributed to measles In what regions of the world is this disease most prevalent? ➢ Developing countries like Africa and Southeast Asia 31) List 5 factors that determine the likelihood that a person may forgo vaccinations. 1. Cultural or religious beliefs (individual, family, cultural factors) 2. Fear of the consequences of vaccines (individual factors) 3. Cost of vaccines (affordability, a demographic factor) 4. Access to health care (health systems factor) 5. Vaccine programs (a health policy factor) 32) Understand how cholera is transmitted, the symptoms it causes, and why travelers to developing countries are warned not to drink tap water. Cholera Waterborne bacteria! Symptoms : Can cause severe dehydration, kidney failure, death in 1020% of cases Intestinal infection caused by vibrio cholerae bacteria Bacteria is found in contaminated food, water, or human feces Closely linked to poor environmental management and unsafe water conditions Prevention and eradication of cholera linked to health policy 33) Briefly describe how malaria is transmitted. Virus transmitted from person to person through the female Where do 90% of deaths from malaria occur and why is it so prevalent in this region? ➢ Over 90% of deaths occur in subSaharan Africa ○ Children disproportionately are the victims ➢ Malaria is most prevalent when environmental conditions are hot and humid (tropical climates) as this is the preferred breeding grounds for carrier mosquito 34) Explain how Florida may use mosquitoes to combat the dengue outbreak (please refer to my powerpoint slide). Florida may use mosquitoes to combat the dengue outbreak Would release millions of genetically modified MALE mosquitoes (they don’t bite for blood) Male mosquitos then would mate with wild females whose offspring would die, reducing the population 12 What are the possible benefits vs. risks? ➢ Benefits would be that the population of dengue carrying mosquitos would lower ➢ Risks are that they could mistakenly release a female genetically modified mosquito that could bite a human. If this happens the outcome is unknown. Potential genetically modified DNA could enter the bloodstream ➢ Further we don’t know to what extent mosquitos plan in our ecosystem. If we kill them there could be dire consequences 35) Define Chronic Disease. Defined as longterm (>3 months) complex illnesses that can be treated but not cured Are the leading causes of death worldwide In 2000, 60% of all deaths worldwide due to chronic illnesses 80% of deaths due to chronic illnesses occur in developing countries Common examples: arthritis,asthma , cancer,diabetes, and heart disease MORE DEATHS DUE TO CHRONIC ILLNESSES WORLDWIDE THAN TO INFECTIOUS DISEASES 36) Approximately what percentage of deaths due to chronic illness occurred in developing countries vs. developed countries in 2008? 78% of the deaths due to chronic illnesses occurred in developing countries 22% in developed countries What is believed to be the reason for this disparity in health outcomes? (both in terms of individual and health system/policy determinants) ➢ Country’s economic status ➢ A country’s low economic status → lack of access to health care ➢ Infrequent or irregular medical care → higher mortality rate associated with chronic illnesses ➢ REASON for lack of access is the low gross national income per capita of individuals in developing nations ➢ Thus, higher death rates due to chronic illnesses in developing countries could be caused, in part, by an individual’s inability to afford health care or by a nation’s inability to provide medical care to its neediest citizens: health systems and health policy determinants 37) What are the 3 principal causes of chronic illness? 1. Unhealthy diets (evolutionarily makes sense b/c we use to survive on sweet and fatty foods) 2. Physical inactivity 3. Tobacco use Define confounding factors, and provide 2 examples. ➢ Confounding factors are variables that do not cause but my exacerbate the problem ➢ Examples: Socioeconomic class (specifically income) Race/ethnicity (studies have shown dissimilar treatment) 38) Distinguish between Type 1 vs. Type 2 diabetes (biology, causes, relative prevalence) Type I Type II 13 Biology Body fails to produce insulin Insulin resistance or the inability of the body to use insulin properly Causes Genetic origin Unhealthy/sedentary lifestyles Relative Prevalence Affects 515% of diabetics Over 90% (20 million in the US) Chapter 4—Theories and Models of Health Behavior Change 39) According to The Theory of Reasoned Action, intentions are influenced by what two factors? Understand how each factor influences health behavior. Theory of Reasoned Action Individual’s behavior is determined by his or her intentions Behavior/intention and expected outcome determined by: 1. Attitudes about the behavior (positive/negative) 2. Subjective norms (normative behavior of peer group) Ex: Intention to text & drive influenced by 1. Attitude: if texting while driving, behavior is influenced by expected outcome (no accident) and positive attitude behavior 2. Subjective norms : behavior influenced by what other influential members of social group think of the behavior 40) What concept was added to the Theory of Planned Behavior, and how does this factor influence health behavior? Theory of Planned Behavior Individual’s behavior is determined by his or her intentions Behavior/intention and expected outcome determined by: 1. Attitudes about the behavior (positive/negative) 2. Subjective norms (normative behavior of peer group) 3. Perceived behavioral control (similar to selfefficacy. Added to account for nonvolition actions) 14 Suggests that peoples’ belief that they possess the resources and the opportunities needed to perform a behavior is directly related to their perceived control over their behavior 1. The greater the perceived behavior control, the greater the likelihood that the behavior will be performed 41) Be familiar with the 5 motivational factors of the Health Belief Model. Health Belief Model Examines the motivational factors specifically associated with health behaviors ○ Introduced to understand why and under what conditions a person uses preventative health services Model seeks to explain the preventive health behaviors of persons who believe they are healthy and who attempt to maintain that stage by preventing disease or by detecting and treating a disease in its earliest, asymptomatic stages Goal coincides with the public health goals of prevention, early detection, and disease control Attempts to explain and predict an individual’s health behavior using the individual’s own subjective frame of reference → considered a psychosocial model Subjective focus in 5 key concepts used to explain health behaviors 1. Perceived susceptibility degree to which an individual feels at risk for catching a disease or illness 2. Perceived severity perception of the seriousness of a disease 3. Perceived benefits benefits of performing health behavior 4. Perceived barriers Any impediment that prevents an individual from performing a behavior that would benefit their health (time, money, effort, stigma) 5. Cues to action prompts an individual to act when several conditions are met ➢ Person perceives that they are susceptible to a disease ➢ Person views the disease as serious ➢ Person positively views the benefits to action ➢ Identifies few if any barriers to action Which 2 factors contribute to the perceived threat of a disease? ➢ Perceived susceptibility ➢ Perceived severity ***When combined, a perceived high susceptibility to and a perceived high severity to the disease should result in a strong perceived threat of the disease, perception that should lead to action*** Which factor has been shown to be the strongest in explaining preventive health and sick role behaviors? ➢ Perceived susceptibility 15 Which factor explained the least? ➢ Perceived severity Provide examples of tangible vs. psychological barriers. ➢ Tangible = money, time, and effort ➢ Psychological = stigma or a negative response from peers 42) Be familiar with the 6 stages of the Transtheoretical Model. Transtheoretical Model Explains change as a process, not an event (IMPORTANT DISTINCTION) Change takes place over time Stage model → each stage of change is completed before moving to the next or more advanced level Person must be READY for change...successful behavioral outcomes are more likely when people, and programs, carefully consider a person’s level of readiness for change 5 stages 1. Precontemplative Stage 4. Action Stage Characterized as the “notreadyforchange” Time to enact the plan and perform the new stage health behavior Not thinking about change Highly active stagemust work to adhere to the new behaviors 2. Contemplative Stage Constant monitoring and attention to the new Signals the beginning of the change process behavior Person is thinking about change but no action Active resistance against old behaviors is involved Usually lasts about 6 months in order to Weight the benefits of the changed behavior solidify the behavior very critical time. We against the barriers to change can move into the maintenance stage after this 6 month period 3. Preparation for Action Signals a readiness to change behaviors 5. Maintenance Stage Plans the activities needed for change Requires less active monitoring and attention By this time, individual has adopted the new behavior Regressing back to old behavior is called recidivism 6. Recidivism (NOT a formal stage) Part of the process of change, although not a formal stage 6th stage: recidivism is included to reflect the process of failure to maintain the new behavior Individuals may revert to the action stage, the preparation for action stage, the contemplative stage, and finally the precontemplative stage People approach the process of change from different starting points 16 These steps are all very fluid. Can make BIG changes with the right marketing techniques (see section II) 43) Be familiar with the Four P’s of social marketing. Social Marketing ➢ Social marketing is the use of marketing techniques to solve social and health problems ➢ Develop promotional efforts designed to get individuals to change highrisk health behaviors ➢ Health products need to be attractive, reasonably priced, and readily available Promotion Product Place Price Market No tangible product to Location for gaining Tangible costs (price, segmentation sell access to the tools distance, time) selection of target Product = desired needed to perform the Intangible costs audience who is the outcome new behavior (emotional or social intended recipient of Desired outcome Should be price) the message Includes sustainable ,reative, Message must appeal stopping a & compete w/ to specific behavior (ex. campaigns marketing demographics or littering) bad behaviors behavior characteristics Includes Once motivated to of targeted group modifying(ex. adopt a new behavior, Will attract and dietary habits) the target audience retain their Includes new needs to know where to attention behaviors (ex. obtain the product, Will motivate them exercising) materials, or services to to assist them in initiate To reinforce performing the new the intended behaviors, social behavior behavior marketers must associate an intangible Distribution channel concept with a tangible place that distributes symbol that evokes the the product. A good concept → symbol will channel would serve as a reminder minimize barriers to Ex. logos or slogans performing behavior (ex. not out in the open) EXAMPLE: Ex. Kelly & colleagues 1991 Promotion: 17 ● Gay men trained as leaders and asked by researchers to engage their social network groups in discussion on preventing HIV/AIDS Product : Ultimate goal adopt safer sexual behaviors (modification) ● Leaders wore lapel pin fashioned as traffic light into nightclub ● Lapel pin and colors (reddanger, yellowcaution and greensafer) initiated conversation about the product safer sexual behavior Place: ● Kelly’s study did not include distribution channel ● Channels could have included condom vending machines in nightclubs Price: ● No discussion of costs in study ● Potential costs could occur if ○ Selecting a public distribution channel ○ Selecting distribution channel too far from home/work environment 44) How do boys vs. girls and men vs. women differ in healthseeking behaviors? Provide possible explanations for why these differences exist. Healthseeking behaviors actions taken to obtain guidance or assistance with healthrelated issues Have a direct impact on the quality of an individual’s health status Boys less likely to seek out health care services than girls Girls are more likely to take time off of work (more likely to recognize) Reasons: Men ignore health symptoms, thinking they will go away if ignored Not recognizing the symptoms Believing a man would appear weak or non masculine if seeking medical care Some studies attribute the difference to gender socialization which subtly discourage health seeking behaviors among men (social norms) 45) Even though individuals may have sufficient knowledge about a health issue, what are 4 types of barriers that could be more important? (p. 119) 1. Practical social 2. Socioeconomic 3. Cultural barriers 4. Family size 46) Define acculturation and briefly explain how it influences health behavior. (p. 120) Acculturation the adoption of behaviors and values of a majority group (conform) Studies suggest that individuals who are influenced by the norms and behaviors of the dominant culture group in their communities attempt to imitate the same behaviors The greater the attempt to acculturate to the dominant culture, the greater the likelihood of experimenting with substances Also explain how acculturation explains differences in smoking rates among Hispanic women. (p. 143) ➢ More acculturated Hispanic women reported higher rates of cigarette use than less acculturated Hispanic men or women ➢ Suggests that perceived social norms influence smoking initiation and behavior 18 47) What are 2 problems with the health system in the U.S. that inhibit healthseeking behavior? 1. Inability to pay for needed medical care at the time of service ➢ Causes people to postpone care for otherwise treatable illness → more health problems ➢ 3x more likely to experience adverse health outcomes ➢ 4x more likely to experience p reventable hospitalizations 2. Access to medical care provider ➢ People w/o primary care provider are likely to delay needed treatment ➢ May end up seeking treatment from emergency service centers (more costly & less effective) When care is unavailable (may take weeks to schedule an appointment) or inconvenient (clinics only open during working business hours), people often choose one of two options: Find alternative sources of care (ex. hospital emergency departments) Forego care entirely Chapter 5—Risky Health Behaviors 48) Be familiar with the 3 major contributing factors to car accidents involving teens. 1. Inexperience accident rates reduced by ½ after 18 months of experience 2. Age correlated with experience 3. Other teenage passengers teen drivers 1517 years of age have a 40% higher accident rate when accompanied by 1 other teenager 49) Define ‘antecedents’ and ‘risky behavior.’ Antecedents Factors that influence the behaviors; the frequency of the behavior across age groups; and the longterm health implications of the behavior Trigger, cue (ex. stress might be an antecedent for cigarette use) Risky Behavior An action that increases the probability of an adverse outcome 50) Identify 3 reasons why younger adolescents have higher accident rates. What has the U.S. and Canada adopted to help reduce adolescent automobile accidents? Graduated license law issues firsttime adolescent drivers a provisional driving license , a license that limits driving to only specific conditions Restrictions vary by state and country Many include prohibition from driving at night or with other teens Allows opportunity for drivers to establish an accidentfree driving record Has been effective Has reduced accidents by 9 41% 19 51) Define domestic violence, and the 3 types of abuse that are also included. Domestic violence describes actions by one person in a relationship intended to control or dominate another Includes Elder abuse physical or emotional maltreatment of older persons Child abuse physical mistreatment of a child by an adult Emotional abuse psychological intimidation and trauma that can include physical acts Actions can be physical, sexual, emotional Acts of intimidation or threats 52) Identify 3 lasting psychological effects of domestic violence on children. 1. Might experience psychological trauma due to witnessing the violence 2. Ma
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