Health Psychology Notes, Summaries of Psychology

Download Health Psychology Notes and more Summaries Psychology in PDF only on Docsity! PATIENT - PRACTITIONER RELATIONSHIP patient practitioner interpersonal skills - these are the abilities we have or don’t have that allow the practitioner to communicate eectively with the patient. McKinstry &Wang: (Non verbal communication) aim- to determine how acceptable patients found dierent styles of doctors’ clothing to be and whether patients felt that a doctor’s style of dress inuenced their respect for his or her opinion sample: - 475 patients attending 30 doctors in ve general practices in Lothian - gynocentric sample (twice as many women as men) - ethnocentric sample (participants from Lothian) - obtained through opportunity sampling - sample skewed towards lower social classes procedure: - patients - asked to look at 8 photographs of male and female doctors dressed in various styles of clothing ranging from casual to formal - models posed in a similar manner for all pictures - patients - interviewed and asked following questions: 1. which doctor they’d be happiest consulting for the rst time 2. which doctor they would have the most condence in 3. whether they’d be unhappy consulting any of the doctors 4. which doctor looked most like their own doctor - they were then given a questionnaire with a series of close-ended questions about the doctors’ dress in general. - participants were to respond as quickly as possible to these questions results: - 57% preferred male doctors in a smart suit and female doctors in a skirt and jumper - older/ higher social class preferred a more formal appearance - 28% said they would be unhappy seeing one, usually the informally dressed evaluation: + high standardisation- doctors posed in the same way, had the same face in all pictures and the same pictures were shown to all participants → other researchers can test for reliability + opportunity sampling- quick and easy to collect as participants are readily available- saves researchers time + sample- wide & representative- contained twice as many women as men and more people from the lower class → exactly how they are present in the real world + quantitative data- quick and easy to analyse & no room for interpretation/bias → increases validity - low ecological validity- real life interactions are more inuential - other factors at play, example - facial expressions, body language etc - quantitative data- results don’t explain participants’ thoughts and feelings - sample- gynocentric and ethnocentric sample and was skewed towards lower social class- twice as many females than males and all participants from Lothian → can’t be generalised to higher classes or to people who are not from Lothian (unrepresentative) McKinlay: (Verbal communication) aim: to assess lower class women’s understanding of terminology doctors use sample: lower class women from Scottish maternity ward procedure: - experimenter recorded terms used in conversations with the women and then asked them what they understood by 13 of these terms → example - breech, mucus, navel, umbilicus, antibiotics & glucose - doctors had to indicate for each word whether they thought the women would understand the word or not results: - each term was understood by 39% of women - ⅔ understood the terms ‘navel’ and ‘breech’ - almost none understood ‘protein’ and ‘umbilicus’ - doctors expected even less comprehension but still used the terms often discussion: - doctors use medical terms out of habit - they may feel the patient doesn’t need to know the meaning of the word - they could want to appear more professional - sometimes, if a patient knows the exact meaning of their condition or of a word, it could produce stress or interfere with them getting treatment evaluation: + applications and usefulness- doctors should provide more information to patients because they understand more than is typically assumed and doctors also shouldn’t use words they know patients wouldn’t understand + no researcher bias- scorers blind - unbiased calculation → raises validity - narrow sample- all are lower class and women - not representative and can’t be generalised to men or higher class - situational explanation- although there were individual dierences in knowledge, situation created by doctor can improve access to information Savage & Armstrong: (Style of Communication) aim- to examine the eects of a general practitioner’s consulting style on patient’s satisfaction design- eld experiment (natural setting) sample: - 359 participants - London - random sampling (over 4 month period) - 16 - 75 years - no life threatening condition - 200 completed entries included in data analysis procedure: - before study began, they took informed consent from all participants - ‘we obtained patients consent by giving all patients attending each surgery a written request to allow audio tape recording of the consultation as part of a research project’ - if patient refused to take part or was ineligible - next eligible patient to consult was selected - 2 conditions [ Directive style & Consulting style ] - patients entered the room, were greeted by doctor and asked to describe their problem - randomly allocated to either of the conditions ( GP turned over a card ) - advice & treatment is given in that consulting style - consultations - recorded and assessed by an observer - after consultation + one week after consultation, patients answered a questionnaire about: → satisfaction with consultation ( doctor's understanding of problem ) → adequacy of explanation of problem → feeling helped results: - Directive Style > Consulting Style → those who rarely attended surgery → had a physical problem → did not receive tests and received prescription evaluation: + random sampling- participants selected randomly - ensures there was no bias → increases validity + ecological validity- carried out in a real life setting → raises generalisability + informed consent- patients gave consent to participate in the study → ethical - individual dierences - randomly selected → can’t be generalised to everyone - demand characteristics + social desirability bias - since they gave their informed consent, they were the aim of the study - could’ve inuenced their answers in the questionnaire → reduces validity - ethnocentric bias - all from London → reduces generalisability Robinson &West: (Disclosure of Information) aim- to investigate the amount of self disclosure people make when they attend a genitourinary clinic design- eld experiment (natural setting) sample: - 69 participants procedure: - before seeing the doctor, patients were asked to complete a questionnaire administered either on a paper or computer - they recorded their previous attendances, sexual behaviour and intimate symptoms - they then had a consultation with the doctor - data was compared between consultation with the physician and the written / computerised questionnaire results: - patients revealed more information to computer than they did with paper and doctor - made more disclosure about previous attendances & symptoms to computer than to doctor - computer > paper> doctor discussion: - this result seemed strange because information you give to a doctor is condential, personal and private - however, with a computer, you wouldn’t know who or how many people may have access to the information evaluation: + applications and usefulness - results indicate - computers can be used to facilitate medical history → doctors can use computers rather than paper / verbal consultations to fully understand their patient’s symptoms etc. + sample- both men (33) and women (36) were used → representative sample → generalisable + ecological validity- carried out in a setting that is replicable to real life setting (clinic) → increases generalisability - demand characteristics - patients may have felt uncomfortable stating their actual answers as they’re being asked personal and private questions and don’t want to be judged → may have changed their answers if they know aim → social desirability bias → reduces validity - generalisability- carried out in one type of clinic (genitourinary) and location → cannot be generalised to other clinics / populations Misusing Health Services Safer: (Delay in Seeking Treatment) aim- to examine factors which aect patients’ delay in seeking treatment sample: - 4 clinics in hospitals - US - patients who were there to report a new symptom or complaint - 93 patients - 60% black - interviewers → black & female nurse + white male undergrad student procedure: - answered a questionnaire (45 minutes) - then asked when they noticed their rst symptom - when they decided/accepted that they’re sick - when they decided to seek medical help - range of other questions → open + close ended results: - no signicant statistics correlation between appraisal, illness and utilisation delay - hence, these stages operate independently - appraisal delay → reading more about their symptoms only increases delay - illness delay → longer delay if symptoms are new / experienced before / imagined / gender based - utilisation delay → longer delay if patients are concerned about costs, their own beliefs, about illness or personal problems harm themselves intentionally + case study → rich, detailed, qualitative data - case study- only one person being investigated (female)- gynocentric bias → lowers generalisability ADHERENCE TOMEDICAL ADVICE Types of Non-Adherence Types of requests practitioners ask patients: 1. Short term compliance - eg. take these tablets twice a day for three weeks 2. Positive additions to lifestyle - eg. eat more fruits and vegetables 3. Stop certain behaviours - eg. stop drinking alcohol 4. Long term treatment programmes - eg. diabetic diet or renal dialysis diet Adherence: following and sticking to the medical advice given by the medical practitioner possible ways patients may not adhere to medical advice: Reasons for non adherence: → intentional ie. I am not taking any of these drugs → unintentional ie. I forgot to take my medication Inuences on why a patient may not adhere to medical requests: Reasons why a patient fails to attend appointments: 1. forgetfulness 2. did not attend since they felt better 3. can be impatient → therefore felt as if they didn’t need to attend 4. did not understand purpose of the appointment 5. long waiting lines 6. trouble getting o work 7. child care 8. transportation 9. cost Bulpitt: (Rational Non-Adherence) Rational non-adherence : - making a positive decision not to take medication, rather than just forgetting to take it - making a choice, costs of taking medication outweigh the benets aim- to review research on adherence in hypertensive patients procedure: - research was analysed to see the eect of drug treatment on a person’s physical and psychological state - this included work, physical well being and hobbies results: - antihypertensive drugs can have many side eects ie. physical reactions → dizziness, sleepiness and lack of sexual functioning - they also aect cognitive functioning → work and hobbies conclusion: - when costs of taking medication, such as side eects, outweigh benets of the treatment, it is unlikely that the patient will adhere to the treatment evaluation: + reliable- collected empirical evidence - provides credibility to their ideas about adherence to medical requests → increases generalisability to other areas + holistic- both physical and psychological aspects taken into consideration - methodology- reviewed articles which may have been outdated → lacks temporal validity - low validity- article which they reviewed was brief Becker & Rosenstock: (Health Belief Model) HBM- believes that the likelihood of a person taking preventative action depends directly on the outcome of 2 assessments that they make assessment 1- threat that the person feels regarding their health problem assessment 2- pros and cons of taking action Constructs of the Model: 1. perceived seriousness - individual’s belief about the severity of the disease 2. perceived susceptibility Chung & Naya: (Objective Pill Counting) aim- to measure adherence rates in oral asthma medication using a TrackCap sample: - 57 patients - London procedure: - patients began 12 weeks of treatment with ‘zarlukast 20 mg’ twice daily - TrackCap recorded the date & time each time patients removed & replaced medication bottle caps - they were told that compliance would be assessed as a part of the study, but were not told about the specics of the TrackCap Compliance : - number of TrackCap events per number of prescribed tablets - dierence between number of tablets dispensed and number returned Adherence : - number of days with 2 TrackCap events at 8 hours apart per total number of days’ dosing results: - high rates of compliance maintained throughout trial - 47 patients completed the study - median compliance - 89% - median adherence - 71% - compliance from return tablet count - slightly higher conclusion: - results show - compliance with adherence to treatment of an oral medication is high evaluation: + ethics- written consent + reliable- method - consistent over time and produces high rates of adherence - low validity- adherence calculated from returned tablet counts greater than TrackCap may be due to accidental loss of medicine removal of multiple tablets at bottle openings, or deliberate disposal of tablets to disguise under usage - ethics- patients weren’t informed that compliance was under electronic surveillance Sherman: (Repeat Prescriptions) aim- to compare information from pharmacies about how often repeat prescriptions are lled and doctors’ estimates of the patients adherence sample: - 116 children with persistent asthma (who were MedicAid recipients) - Low income families - they didn’t have private health insurance procedure: - during clinic visits, a physician (pulmonologist) interviewed patient & their caretaker - estimated their adherence with checklist - nurse then asked the caretaker where they get their medication - then they called pharmacy for the patients’ rell history data analysis: - patient’s max adherence was calculated as a percentage prescribed for a mean of 163 days : number of doses relled/number of doses prescribed - accuracy of rell information was determined by cross checking with MedicAid’s reimbursement records results: - information given by pharmacies - 92% accurate - mean adherence - 38 - 72 % for 3 drugs - doctors - identied less than 50% who relled less than half of their prescriptions - 27% of patients - overusing drugs conclusions: - doctors - often unable to identify patients with poor adherence - only identied half of the patients who relled less than half of the prescriptions - checking rells is an accurate and practical method of identifying such patients evaluation: + objective method- no room for interpretation → high validity + data analysis- accuracy of rell information was cross checked with MedicAid’s reimbursement records → high reliability - ethics- children were used Improving Adherence Yokely & Glenwick: (Money as an Incentive) aim- to evaluate relative impact of 4 conditions for motivating parents to take their children to be immunised conditions : - general prompt - specic prompt - specic prompt + extended clinic hours - specic prompt + monetary incentive and 2 control groups method: - eld experiment - independent measures design - families - randomly assigned to one of the six conditions - prompts were constructed for each child based on information from research record cards sample: - immunisation decient children from a midwest city with 300,000 citizens - health care clinic - 5 years or younger + if they need one/more inoculations for diphtheria, tetanus, pertussis, polio, measles, mumps or rubella procedure: - prompt messages for each child, based on info from medical records, were made up and sent out on postcards - impact of dierent prompt was measured over 12 weeks by calculating the percentage of children in each condition who attended immunisation clinics - families, rather than children, were assigned to 1 of 6 conditions to prevent confounding variables results: - monetary incentive group - greatest impact on attendance - monetary incentive grp> increased access grp > specic prompt grp > general prompt grp > control groups - children whose parents' motivational mailings were "returned to sender" were omitted from the data analysis Pain What is pain? - the sensory & emotional experience of discomfort which is usually associated with actual or threatened tissue damage/irritation. - chronic, acute, psychogenic & organic - people are more likely to seek professional help when pain is felt - severe & prolonged pain can impair the social & work lives of individuals - social & economic eects on all countries Qualities + dimensions of pain: - sharp/dull - burning sensation/cramping/itching/aching - throbbing/constant/shooting/pervasive/localised - how we describe our pain is generally based on the location of the injury Organic pain vs psychogenic pain: - OP is pain that is clearly linked to tissue damage/pressure eg. sprain - PP is also known as phantom limb pain → it is a physical pain that is caused, increased, or prolonged by mental/emotional factors or behavioural factors - back pain, stomach pain and headaches are most common types Acute pain vs chronic pain: - AP is the body’s normal response to temporary damage eg. cut, infection - CP is when the condition lasts longer than its expected course & it interferes with day to day activities Congenital analgesia: - cognitive insensitivity to pain is a condition that inhibits the ability to perceive physical pain - often leads to an accumulation of wounds, bruises, broken bones etc. Episodic analgesia: - little pain in relation to a severe injury that lasts for a limited time; it can be localised for certain parts of the body Theories of Pain 1. Specicity theory of pain: (Descartes, 1664) - body has a separate sensory system for perceiving pain - system - receptors for detecting pain stimuli, peripheral nerves, pathways to the brain and area to process brain signals - reductionist- only includes biological factors - pain & touch sensors on our skin are wired directly to pain centre in the brain - pain receptors carry painful sensations from stimuli directly to brain & so any emotion is just a reaction to stimulus 2. Gate control theory of pain: ( Melzack, 1965) - ‘gating mechanism’ - located in spinal cord - gates open & close at varying degrees. - after signals pass through these gates, transmission cells are activated which then sends impulses to the brain - this regulates incoming pain signals before they reach the brain - open gate- high pain, closed gate- low pain - What controls the opening/closing of the gates? 1. amount of activity in peripheral bres 2. amount of activity in pain bres 3. messages that come from brain - Eg. anxiety- opens, positive emotions- closes + holistic- psychological + biological factors + evidence to support- phantom limb pain + gate can be closed- pain shut o Measuring Pain 1. Self report measures: Questionnaire/Interview Interview→ history, patient’s emotional adjustment to pain, lifestyle, syndrome’s impact on lifestyle, social context of pain episodes, triggering factors, coping methods + qualitative data- in depth understanding of what patient is feeling + subjective- individual dierences when it comes to experiencing pain- high validity + interviewer bias- answers open to interpretation- - low validity + time consuming to collect a lot of data of patient + requires specic skills to interpret responses made by patients + social desirability bias- lowers validity Questionnaire → McGill Pain Questionnaire (MPQ) - includes location of pain - list of descriptive words ie. separated into 20 subclasses - each word had an assigned value based on the degree it reects - calculated at the end - change in pattern of pain across time - series of verbal rating scales - instrument for measuring chronic pain- research & clinical purposes - quantitative & qualitative data - requires higher literacy understanding - vocab is complicated, thus patients may not be able to understand it/could lie to appear a certain way- low validity - generalisability- low because can’t be generalised to younger kids due to diction 2. Rating scales Visual analog scale → rate pain by marking a point on line - labels at each polar end Box scale → rate pain by choosing 1 number from a series of numbers in boxes Verbal rating scale → pain rated orally + easy, quick + avg gives more accurate results than individual results + repeated ratings can also reveal pain changes over time + shows ow of pain intensity that patients often experience + reveals patterns in timing of severe pain 3. pain diaries → detailed record of a person’s pain experiences → includes pain ratings, information, episodes, meds etc. 4. Behavioural assessment approaches → UAB pain behaviour scale: - The University of Alabama at Birmingham (UAB) Pain Behaviour Scale - measure of pain based on observing patients by clinicians using a series of Stress GAS model of stress Selye, 1936 - - how the body responds to an external stressor - 3 phases body goes through when responding to stress → alarm reaction: threat or stressor is recognised and a response is made, hypothalamus in brain triggers production of adrenaline → resistance: body adapts to environment & tries to cope → exhaustion: body can no longer maintain normal functioning, initial symptoms such as sweating and increased heart rate may reoccur, immune system not able to cope Holmes Rahe Social Readjustment Rating Scale (SRRS) - - 394 participants - 43 life events are listed (e.g. loss of job) - person chooses which events have happened to them over the past 12 months - each event has a score associated with it that the person adds up at the end to get their stress scores - higher score → higher stress levels evaluation: + quantitative & reliable data + large sample - culture & gender bias - fatigue eect - social desirability bias Causes of Stress Chandola et al aim - to investigate which biological & behavioural factors linked work stress to coronary heart disease → investigated following questions: - is the accumulation of stress associated with higher chances of developing CHD - is this association stronger among the working-age population - does work stress aect CHD directly ( through neuroendocrine mechanisms or indirectly through behavioural risk factors) sample - 10,308 civil servants from Whitehall, London method: repeated measures design procedure: - work stress measured by a job-strain questionnaire - classied under work stress: reported job strain, low job control, & socially isolated at work - follow-up measures: fatal & non-fatal CHD episodes assessed, cortisol levels through saliva samples biological risk factors- waist circumference, blood pressure, serum triglycerides, low-heart rate variability behavioural risk factors- alcohol, smoking activity, diet results: - work stress is associated with a higher risk of CHD - younger participants showed stronger linked between work stress & CHD - greater work stress=poorer diet, less physical activity evaluation: + data assessed through quantitative measures → reliable + ethical approval issued from UCL medical school committee + informed consent - possibility of confounding variables Friedman and Roseman aim - to investigate whether personality could aect stress sample - 3200 men from 10 companies in San Francisco - initially free from CHD procedure: - separated into type A & type B personality types - type A - competitive, impatient, fast driven - type B - patient, calm, laid back - personality types assessed with structured interview ( their response in situations + behaviour during interview ) results: - type A twice as likely as type B to develop CHD - 70% of those who developed CHD - type A, even when risk factors were taken into account evaluation: + longitudinal - conducted over 8.5 yrs - assessed variations over time + structured interview - verbal & non-verbal info + questionnaires - easy & ecient, quantitative - androcentric sample - self-report - social desirability bias - dicult to classify as strictly type A or type B Measures of Stress Evans and Wener aim- to investigate how crowding and personal space invasion can be a major stressor during & post commute sample- 139 adult commuters from New Jersey to Manhattan procedure: - car density – total number of passengers / total number of seats in train - seat density – proximal measure of crowding to participant → number of people in the row / 5 (number of seats in the row) - cortisol levels collected results: - personal space invasion -correlated with elevated salivary cortisol levels, higher frustration, and poorer performance on proofreading tasks, unlike that of car density - immediate presence is more important than total number of people evaluation: + practical application + reliable- statistical analysis + holistic: biological & psychological factors considered + measures of stress + equal gender in sample - only seat position calculated (ignored standees) - sample bias: wealthy and educated Management of Stress biochemical → antidepressants (SSRIs) such as uoxetine, regulates serotonin, mood stabiliser - blocks absorption of serotonin Health Promotion Methods for Promoting Health Janis and Feshbach (1958) aim- to investigate the consequences of fear arousal on emotions and fear about dental hygiene sample- 200 freshmen high school students from Connecticut method: laboratory experiment design: independent measures design procedure: 4 groups - high fear arousal – shown pictures and descriptions of diseased mouths and explanations of tooth decay and gum disease - moderate fear arousal – shown similar pictures and descriptions but less graphic & disturbing - minimal fear arousal – given lecture about teeth & cavities, without mention of serious impacts or pictures - control group – given lecture about structure and functions of human eye → one week later a follow-up questionnaire was given, asking about long-term eects of lecture and changes in dental hygiene results: - high fear arousal: increase in conformity by 8% - moderate fear arousal: 22% - minimal fear arousal: 36% - control grp: 0% conclusion: - the eectiveness of health promotion campaign is likely to be reduced by use of strong fear appeal - fear appeals can be helpful in changing behaviour, but it is important that the level of fear is tailored to each audience evaluation: + validity- independent variable was well dened and manipulated + practical application and use- it helps with increasing health behaviour in individuals, found that fear arousal isn't the most eective way of promoting healthy living - ethnocentrism- the sample is freshmen only, dicult to generalise results - unethical- psychological harm, disturbing - low generalisability – we cannot easily generalise the results to other fear appeals for example smoking or drunk driving Cowpe (1989) aim- to test the eectiveness of an advertising campaign warning people about chip pan res method: quasi-experiment procedure: - two 60 sec advertisements about the use of chip pans & how to avoid chip pan res were made - these were screened in 10 regions in the UK - re brigade statistics- used to measure eectiveness results: - 12% decrease in res - high awareness levels and recall excised for a considerable period of time evaluation: + ecological validity + generalisability- large population + ethics- no harm done, ethically strong + quantitative data + real world application, high external validity - not generalisable to other countries - quasi-experiment doesn’t use random allocation (cannot establish an association between the IV and results) yale model of communication model which explains how persuasive communication can take place- → attention – the message must grab people’s attention, sound and visual stimuli are thought to be the most eective (using television is better) → comprehension – the message needs to be concise and clear in order to be understood\d → acceptance – the overall message needs to be accepted by the recipient for behaviour change to occur factors that aect the stages above are: → communicator (source) – the person or organisation that delivers the message, a message is more persuasive if the source is attractive, similar to the recipient and likeable → message (content) – it is best to cause mild fear and present a two-sided argument. → medium (channel) – where the message is delivered, channel of communication needs to be adapted to message Health Promotion in schools, worksites and communities Tapper et al aim- to increase fruit & vegetable intake by use of role model “Food Dudes” in schools sample- - 4-11 yrs kids in primary schools - 435 children participated procedure: - the “food dudes” programme- 6 adventure episodes with characters who gain superpowers from eating fruits & vegetables - random allocation: they were rewarded either taste exposure, peer modelling, or both - rewards - food dude stickers, pens & erasers for eating target amts of fruits & veggies - sta manuals and brieng → support materials to ensure teachers used “food dudes” theme and programme was done correctly results: - after 15 months and 3 yrs respectively: → 74 percent rise in fruit intake → 89 percent rise in veggie intake - fall in consumption of sweets and savoury snacks - children had better attendance and were enthusiastic about the curriculum work involving “food dudes” theme evaluation: + large sample, 435 children + quantitative data, high reliability + application in real life + ecological validity - cultural bias- conducted in Ireland - children in research, ethical issues - disruption of education procedure: - study 1: rated the likelihood of experiencing 42 life events (positive and negative) using a 15 point scale - study 2: a booklet prepared containing many events that had evoked unrealistic optimism in the rst study - students also listed down the factors they thought would inuence their chances of rating eight future life events - when a second group of students read it they reported less unrealistic optimism for the same 8 events results: - led researchers to conclude that unrealistic optimism - only experienced when people focus on their own chances of achieving these outcomes and don’t realise that others may have just as many factors in their favour Prochaska et al - health behaviour change involves progress through six stages of change: → precontemplation- don’t intend to take action in foreseeable future → contemplation- intend to start healthy behaviour in foreseeable future → preparation- ready to action in next 30 days → action- changes behaviour in 6 months, intends to continue → maintenance- sustained change in behaviour for a while, intend to maintain it → termination- no desire for unhealthy behaviour, no relapse - 10 processes identied to help individuals move from one stage to the next (e.g. self-liberation and helping relationships) - stage matched interventions (where the therapy matches the stage of change the patient is at) and proactive recruitment procedures have been to bring about dramatic improvements in recruitment, retention and progress towards change in health behaviours Lau et al aim- to explore the sources of stability and change in young adults’ health beliefs sample- 947 students - provided data for themselves & their parents design: longitudinal study procedure: data collected from self-report questionnaires with 6 research questions: - is there a link between the health beliefs of parents and students when they initially leave home for college? - how do parents exert their inuence on children? - how much do young adults’ health beliefs change during the rst few years of their college life? - how strong is the association between the health beliefs of young adults and their peers at this time? - how do peers exert their inuence on these young adults? - how strong is parental inuence compared to peer inuence? results: - substantial change in the performance of health behaviours during the rst three years of college - parents’ inuence is much more signicant than that of peers - direct modelling of behaviour is the most powerful inuence on an individual’s health beliefs - children see parents behaviour from a young age - parental inuence subsides as children leave for college as they spend more time with peers