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by: Samantha Riley

WEEK 3 Class notes for HEALTH PSYCHOLOGY Psyc 400

Marketplace > Humboldt State University > Psychlogy > Psyc 400 > WEEK 3 Class notes for HEALTH PSYCHOLOGY
Samantha Riley
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The class notes from week 3 in Aigner's PSYC 400 Course at Humboldt State (Spring 2016)
Health Psychology
Carrie Aigner
Class Notes
health, Psychology
25 ?




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"The content was detailed, clear, and very well organized. Will definitely be coming back to Samantha for help in class!"
Ava Hills

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This 11 page Class Notes was uploaded by Samantha Riley on Thursday February 4, 2016. The Class Notes belongs to Psyc 400 at Humboldt State University taught by Carrie Aigner in Winter 2016. Since its upload, it has received 54 views. For similar materials see Health Psychology in Psychlogy at Humboldt State University.

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Date Created: 02/04/16
Week Three Class Notes: th Tuesday, 2 February 2016 **** Exam = Next Tuesday (Feb 9 )…multiple choice application style questions -982E Scantron -Most questions will be from class -Minor focus on questions from book Seeking Healthcare cont…: (beginning of this section overlap w/ last week) I. Factors relates to seeking healthcare a. Personal factors- anxiety, coping, knowledge, personality i. Neuroticism = strong emotional reactions to negative events 1. More readily willing to report physical symptoms and seek care b. Gender Differences i. Women report symptoms and seek care more readily than men ii. Possibly due to male gender role iii. Impact of marriage on health in males and females 1. Married people have better health 2. Benefit of marriage on health stronger for men. Why? 3. But the affect of marriage on health seeking is stronger on men than women a. Probably due to the woman (in a heterosexual marriage) urging them to go b. Women more negatively impacted by conflict c. Women may encourage healthy behaviors in husbands 4. The support within marriage could be expanded to other social support systems for research c. Age i. Younger people more reluctant to seek care, in general ii. Older people more likely to seek care if symptoms not attributed to normal aging d. Symptom Characteristics i. Visibility (osteoporosis vs. acne) ii. Symptom severity iii. Symptom interference iv. Symptom persistence e. SES (Socioeconomics) i. Low SES – less likely to utilize medical care 1. Yet more likely to be hospitalized and have more severe illness a. Why? i. People who are uninsured or have little insurance tend to put off seeking care until they absolutely have to. 2. Research Example: Diverse group of women were given vignettes describing symptoms. All identified symptoms correctly and identified similar courses of action a. Implications: i. Lack of resources, instead of a lack of knowledge, accounts for differences in seeking healthcare II. Access to care a. Medical Insurance i. Medical bankruptcy (account for half of all personal bankruptcies in US) 1. Occurs even among people with insurance 2. New rules of out-of-pocket maximums a. Meant to help not have bills in the millions, but can still happen 3. Premium = The monthly fee for insurance 4. Deductible = How much you must pay for care BEFORE your insurer pays 5. Co-Pay = Your cost for routine services to which your deductible does not apply 6. CO-Insurance = The percentage you must pay for care AFTER you’ve met your deductible (usually about 20%) 7. Out-of-Pocket maximum = the absolute max you’ll pay annually (Can no longer pay for anything yourself- should check to make sure your plans have this) 8. EXAMPLE a. Why out-of-pocket maximum is important i. You have a deductible of $1,000, a coinsurance of 20%. ii. You break your leg, go to ER and are hospitalized for 3 Days Out-of Pocket No Limit limit of $5000 ER Visit $1600 ($1000 $1600 (Billed: deductible $4000) +20% co- insurance) Hospital $3400 $8,000 Stay (Billed: $40,000) Office $0 $60 Check-up (Billed: $300) Total: $5000 $9660 - infinity ii. Article 1. “The Chargemaster” a. Chargemaster = office where prices are set for different hospitals, supplies, etc. b. Supplies from the hospital tends to be extremely high compared to finding it elsewhere i. Hard to do that if you are needing on-site care ii. Insurance company is able to negotiate prices down iii. ASK QUESTIONS when you go to the hospital 1. Ask how much what they want to do to you will cost 2. Ask why they are doing something 3. Will your insurance cover that? Theories of Health Behavior Change I. Operant Learning Theory a. Behavior à Results i. Positive Reinforcement 1. Introducing a stimulus a. Ex: Praising a child for cleaning their room ii. Negative Reinforcement 1. Removing an aversive stimulus a. Ex: Not spanking a child anymore to try and get them to clean their room iii. But, what about motivation for initiating behavior? How did you get there initially? 1. Social learning 2. Inconsistency in reinforcement II. Health Belief Model a. Behavior is dependent upon: i. Perceptions of susceptibility (Perceived risk) ii. Severity (Perceived consequences on one’s well-being) iii. Perceived benefits and barriers to taking action iv. Cues to taking action (messages, physician advice, etc.) b. Two ways to look at the model i. Model is not perfect 1. It assumes that we are all rational beings 2. All signs could point one way, yet still the opposite happens 3. What’s missing from this model? a. Past behavior b. Other contexts about what is happening in one’s life III. Theory of Reasoned Action a. Attitudes (beliefs and evaluation of behavioral outcomes) b. Subjective Norms (social network members’ perceptions and one’s motivation to comply i. A + B à intention àBehavior 1. Example = intend to buy a helmet 2. Example = behavior is actually buying helmet c. What’s missing in this model? i. Reinforcement in terms of positive or negative ii. Ability to take the action 1. Ex: Can you afford the helmet? a. Can you find one that fits? d. It’s a useful model i. Attitudes and subjective norms often influence our intentions to do something, but it is not always enough ii. Additional variable needed: Perceived Control 1. The more resources and opportunities a person has, the stronger their belief that they will be able to control the behavior IV. The Theory of Planned Behavior a. Same as Theory of reasoned behavior i. But you ADD Perceived Control (Self efficacy – belief in ability to change and controllability) ii. Better at predicting behaviors iii. EX: Agnes is a college student living at home with parents 1. Attitude: Agnes believes that STD Testing can prevent spread of disease and feels that it is important 2. Subjective Norms: Friends have all been tested and tell her it’s the right thing to do a. Intention: Agnes does not intend to get tested b. Behavior: Agnes does not get tested 3. What’s missing? a. Perceived Control i. May not want parents to know ii. May not know how to access it 4. Perceived Control = Agnes’s parents pay for her insurance. She cannot afford testing on her own and doesn’t know how she could get tested without them finding out. She doesn’t believe in her ability to figure it out on her own. iv. Why is this model important? 1. Helps to design interventions 2. Helps find out WHY people are or are not doing something b. Critique of Theory of Planned Behavior i. In general better than the Theory of Reasonable Action ii. Problem: intention is not always enough to change behavior V. Correlations between behavior and intention (Meta-analysis of over 20 studies) Health Behavior Averaged Correlation between Intention and Behavior Overall .46 Exercise .52 Oral Hygiene .37 VI. Promoting Behavior Change with Motivational Interviewing a. Transtheoretical Model: i. Stages of Change 1. Pre-contemplation a. No intent to change 2. Contemplation a. Seriously considering change 3. Preparation a. Make small changes 4. Action a. Active Change 5. Maintenance a. Keeping up with the change ii. Helps think about how to talk to people one-on-one about making changes so that you are on the same page and not talking to them like they are in the ACTION stage, but they are still in PRE- CONTEMPLATION iii. Has many applications outside of exercise and health changes iv. Helps to reduce being pushed out of talking about a change b. Why not just TELL someone to change? i. People may respond in an opposite manner if they feel that that personal freedom is being infringed upon 1. Response may be in opposition of what you were telling them a. Ex: I tell my boyfriend to workout i. He makes a point of staying inside and playing video games. b. Ex: Telling someone to stop smoking i. They increase their smoking habits in spite c. Motivational interviewing (MI) helps people explore their own motivations for change without forcing them in one direction. i. Ex: 1. What is it? a. Client centered therapy (Rodgers) that increases readiness to change by helping patients to explore ambivalence i. Uses reflective listening, empathy, supportive b. What is ambivalence? i. Simultaneously wanting to change and not wanting to change 1. Ex: drinking alcohol a. You know it’s not good for family, but keep doing it because you need it. ii. Motivational Interviewing Techniques: 1. Ask open ended questions a. Ex: “Do you think you drink too much?” VS. “Tell me about your drinking.” b. What can you learn from this? i. You gather more information than just asking for a one word response 2. Use reflective listening a. “I hear you saying that ____.” i. Reflecting back to them what your understanding of what they are saying is. 3. Asking Permission a. Rationale: i. Communicates respect ii. Clients are more likely to discuss changing when asked, than when they are being lectures or being told what to change. iii. Ex: “Do you mind if we talk about your drinking?” 4. Eliciting/Evoking Change Talk a. Rationale: i. Change talk is associated with successful outcomes. ii. Elicit reasons for changing by having clients give voice to the need or reasons for changing b. Questions to Elicit/Evoke Change Talk i. “What would you like to see different about your current situation? ii. “What would your life be like 3 years from now if you changed your drinking?” c. Exploring Importance and Confidence i. Rationale: 1. Ratings give the therapist information on how clients view the importance and change and can also give rise to conversations on how to go about change. ii. Examples of How to Explore Importance and Confidence Ratings 1. “Why did you select a score of 4 on the importance scale rather than 3?” 2. “What would need to happen for your confidence score to move up from a 5 to an 8?” iii. How well does MI work?: 1. Meta-analysis of 72 clinical trials found a short-term effect size of MI was 0.77 a. Decreasing to 0.30 at follow-ups to one year 2. Small to medium effect sizes for most health behaviors studied = not bad 3. Most effective for substance abuse a. Alcohol b. Other illicit substances 4. Promoting diet and exercise 5. HIV risk reduction, 6. Mixed findings for smoking cessation Thursday, 4 February 2016 ***Exam On Tuesday! Chapters 1-4*** Adherence (what is it and how can it be improved) I. Adherence: What is it? a. A person’s ability and willingness to follow recommended health practices i. Applies to medication and healthy lifestyle practices, among others b. Cooperation/collaboration vs. compliance/adherence i. What do these imply? II. How do we measure it? a. Ask the practitioner i. Least valid form ii. They’ll have the least accurate response 1. They could be clouded by wishful thinking 2. Too little time spent with doctor to be able to actually have them gather information b. Ask the patient i. Problems with asking patient 1. May present oneself in favorable light 2. They really just don’t know how well they are adhering c. Ask other people (i.e. caregiver) d. Monitor medication usage (bring in the pill bottles to be checked) i. Pill counting 1. Used in clinical setting 2. Does not ensure taken at prescribed time in prescribed manner ii. Medication Even Monitoring System 1. Used in research 2. Records every time pill bottle opened a. Electronic device attached to bottle lid to do recording e. Examine biochemical evidence (i.e. drug screening) i. Do you have the right amounts in your body ii. Blood, urine tests 1. Problems: a. People vary in their response to drugs b. Expensive and intrusive f. Use a combo of many of these III. How high (or low) is Adherence? a. Meta-analysis of 500 adherence studies i. About 75% adherence ii. Which has a higher level of adherence? 1. Treatment or prevention a. TREATMENT 2. Lower level?: Medication or Lifestyle changes a. LIFESTYLE IV. What factors are related to Adherence? a. Treatment characteristics: medication side effects i. Greater side effects = lower adherence 1. EX: Antipsychotics and weight gain (Olanzapine, risperidone) b. Treatment Characteristic: Treatment complexity i. Greater complexity = lower adherence 1. Complexity: a. Great frequency with meals/without meals b. Managing side effects c. Person al Factors i. Age 1. Related to adherence, cut in a complex manner 2. Colorectal Cancer Screening a. Best compliance – age 70 b. US preventive Services Task Force recommends beginning screening at age 50 ii. Psychological Variability 1. Greater stress or greater depression a. Generally relates to lower adherence 2. Greater optimism or great conscientiousness a. Related to higher adherence d. Environmental Factors i. Socioeconomic Status 1. Ability to pay a. Lack Insurance to cover medication (Biggest factor) 2. Choices some people make: a. Making the rent/childcare/food vs. medication decisions b. Take only partial medication i. In order to stretch the meds further if they cannot afford them. ii. Social Support 1. Generally, more support = better adherence 2. Support from a. Family b. Peers c. Others with a similar disease or condition d. Friends e. Community 3. Marital Status as social support a. Research Example i. 51 studies correlating marital status with adherence produced effect sizes ranging from -0.25 à 0.44 (overall r of 0.06) ii. The odds of adhering is married are 1.27 times higher than if unmarried iii. Discussion: 1. What do you think of these findings? 2. What variables might explain the wide range of effect sizes? V. Cultural Factors a. Discussion: i. What are some examples of how culture may come into play as we think about adherence? ii. What is important for health providers to know when working with patients? 1. Home life 2. Background 3. Religious factors 4. Lifestyle cultures a. Impact abilities to follow prescribed programs b. Importance of culture and tradition or tribal medicine i. May be inappropriate to label as ‘non-adherent’ c. Important to consider relationship with Western Medicine and Healthcare system i. Is there a lack of trust in the system 1. Most the time we do not get to know our doctors anymore a. Makes it hard to have full trust d. EX: Native Hawaiians and Disease Prevention i. Incorporating traditional medicine and cultural awareness into the healthcare system 1. The Hawaiians will implement Hula into the therapy 2. Trying to recruit native Hawaiians more to close the cultural disconnect gap VI. Documentary: The Waiting Room (2012)- Full Video Available on Youtube a. One man, though in pain, was told he may not hear back for a month b. A man with a testicular cancer was cancelled on for a surgery by Kaiser because he was not a member or didn’t have insurance after he went through a ton of tests already, and told them they weren’t a member the entire time i. Never thought anything bad would happen to him c. A person with a stroke could not afford his blood thinning medications d. A man with back pain tried to Google his symptoms and take care of it for a week before entering hospital i. Many people do this when they know they cannot afford a hospital visit e. Person with diabetes had almost a dozen different medications This Week Bolded Words From the Book I. Chapter Three: a. Illness Behavior – Activities undertaken by people who feel ill, who wish to discover their state of health, as well as suitable remedies. Illness behavior precedes formal diagnosis. b. Lay Referral Network – The network of family and friends from whom a person may first seek medical information or advice. c. Neuroticism – A personality trait marked by a tendency to experience negative emotional states. d. Sick Role Behavior – Those activities undertaken by people who have been diagnosed as sick that are directed at getting well. II. Chapter Four: a. Behavioral Willingness – A person’s motivation in a given situation to engage in a risky behavior, often as a reaction to social or situational pressures b. Conscientiousness – A personality trait marked by a tendency to be planful, and goal-oriented, to delay gratification, and to follow norms and rules. c. Continuum Theories – A theory that explains adherence with a single set of factors that should apply equally to all people. d. Implementational Intentions – Detailed plans that link a specific situation with a goal that a person wants to achieve. e. Motivational Interviewing – A therapeutic approach that originated within substance abuse treatment that attempts to change a client’s motivation and prepares the client to enact changes in behavior f. Motivational Phase – In the health action process approach, the stage in which a person develops an intention to pursue a health related goal g. Negative Reinforcement – Removing an unpleasant or negatively valued stimulus from a situation, thereby strengthening the behavior that precedes this removal. h. Optimistic Bias – The belief that other people, but not oneself, will develop a disease, have an accident, or experience other negative events. i. Outcome Expectations – The beliefs that carrying out a specific behavior will lead to valued outcomes. j. Positive Reinforcement – Adding a positively values stimulus that, when added to a situation, strengthening the behavior it follows. k. Punishment – The presentation of an aversive stimulus or the removal of a positive one. Punishment sometimes, but not always, weakens the response. l. Reciprocal Determinism - Bandura’s model that includes environment, behavior, and person as mutually interacting factors. m. Self-Efficacy – The belief that one is capable of performing the behaviors that will produce the desired outcomes in any particular situation. n. Social Support – Both tangible and intangible support a person receives from other people. o. Stage Theories – A theory that proposes that people pass through discreet stages as they attempt to change a health behavior. Stage theories proposes that different factors become important at different times depending on a person’s stage. p. Volitional Phase – In the health action process approach, the stage in which a person pursues a health related-goal. A study guide for EXAM #1 will NOT be available for purchase as I can only submit three study guides total per course. A study guide for EXAMS #2, #3, and the final WILL be posted for purchase 4 days prior to each exam. Good Luck on EXAM #1


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