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| Questão | Responda |
| List the components of the Health Belief model and briefly describe their role. | Susceptibility (how likely am I to be ill) Severity (how bad is the illness) Costs (what will I lose) Cues to Action (what pushes me to change) Barriers (what is stopping me from changing) Benefits (what will I gain) Perceived Control (Self-Efficacy - how much of it is within my control) |
| What is the aim of the Health Belief model? | To change perceptions and beliefs of individual leading to positive health behaviour change. |
| Who created the Health Belief model? | Becker and Rosenstock |
| Describe a study that has used HBM in regards to Eating. What were the main results? Think about critiques of the method. | Kim et al (2012). 250 students completed a survey on nutrition. Perceived benefits and barriers were significant predictors of behavioural intentions concerning food. Findings enhance the applicability of HBM |
| Describe Kazemi's study which used HBM in regards to Smoking. What were the main results? Think about critiques of the method used. | Kazemi (2011). 91 Pregnant women, some educated on smoking in the home and control group were not. Results - significant difference in perceived susceptibility & severity. No difference in barriers or self-efficacy. Conclusion: Self-efficacy is needed for a smoke free home. |
| What are the main criticisms of the Health Belief Model? Which model did Zimmerman say is better than HBM? | No role for emotion, social context, culture, socio-economic. Too robust, are humans that conscious about regular health behaviours like brushing teeth. Constructs aren't well operationalised, lack homogeneity. Harrison et al's meta analysis showed weak effect sizes (0-9% variance explained) for the main HBM constructs. Weak predictive power due to poor constructs. Zimmerman said that TRA is better than HBM. As TRA explained 34% versus HBM's 24% of the variance. |
| What does the Attribution model suggest? Hows does it link to Locus of Control? | How an individual makes sense of their health status will determine their behavioural response. Internal versus external locus - who is responsible etc. |
| What are the issues with Locus of control (Wallston)? | Is it a state or on a continuum? Some individuals that seek help may be seen as having an external locus of control but identify themselves as having an internal locus of control and making the right steps to resolve their health issue. E.g. I am responsible for my health so I am responsible for seeing a doctor. |
| What is self-affirmation (Steele, 1988)? How does it link to aiding behavioural change and what study give evidence for this? | Self-Affirmation is when an individual only accepts information that is consistent with how they see themselves. Any thing that opposes this is blocked. Example, I am a sensible person, but I smoke. Someone tells me smoking is not sensible, I will block that information. Explains why those in High SES's smoke, they avoid information that question their identity. Harris et al's study showed that when individuals self-affirmed, they were more accepting of health messages and likely to change. Health change interventions should use self-affirmation strategies. |
| What are the general criticisms (methodological and phenomenological) for research concerning health beliefs? | Self-report method, social desirability. Causality, does the belief cause the behaviour or vice versa. Critical realism, sometimes asking people about their beliefs actually changes them, so you're no longer studying the 'truth', only something you created. |
| Who created the Protection Motivation Theory? What are the key components? | PMT was created by Rogers. The process is that we are presented with environmental information (health messages) and intrapersonal information (symptoms) which cause us to enter threat appraisal (severity, susceptibility, fear) or coping appraisal (Response effectiveness, self-efficacy). These inform one's behavioural intention/change. |
| What are the criticisms of the PMT? | No role for social context, environment or emotions. Can it explain habitual health behaviours or is it too robust a theory. Operationalisation of constructs - do they all relate? Are they distinct. |
| What study by Ripptoe and Rogers supports PMT and specifically for which components? | Breast self examination study showed that response effectiveness, self-efficacy and severity were strong predictors of BSE intentions. |
| Describe van der Velde & van der Plight's (1991) study? What was significant about the study/results? Implications for future research? | Study on homosexuals and heterosexuals with multiple parters in 6 months. Given questionnaire on sexual practice, HIV prevention, condom use, PMT constructs and additional cognitions such as social context, norms, emotion, environment. Found that overall PMT was a good predictor of HIV prevention behavioural intentions. AND predictive power/accuracy was improved with the inclusion of the additional factors. Fear was counter-productive. Implications: PMT models should be tailored to the health behaviour in question. Fear messages should be moderate. Inclusion of social norms, context is beneficial. |
| What study suggests that the influence of fear in PMT is questionable? They oppose van der Velde & van der Plight. What was significant about their findings and what are the implications? | Kanayo Umeh's (2005) study on 200+ heterosexual students showed that fear was not a significant predictor of hiv prevention behavioural intentions. They found that rationalisation was significant. People play down their risky behaviour. Also looking at individuals PMT is much better than looking at them as one entity. Individual differences require individual tailoring. |
| Who developed the Theory of Planned Behaviour? 'planned actions in pursuit of behavioural goals' What are the components? | Ajzen and Madden Attitude - positive or negative Subjective norms - how other feel/opinions on the behaviour Perceived behavioural control (Self-efficacy) |
| What are the strengths and limitations of the Theory of planned behaviour? | Strengths - constructs are well defined and related to each other. accounts for social contexts and environment, norms Limitation - issues of causality |
| Describe a few studies that support the TPB. What components were key for the studies. | Povey's study on eating behaviours found that attitudes and perceived behavioural control were significant in eliciting change. Studies on male testicular self checks found that attitude was significant in predicting intentions. Weight-loss - self-efficacy was significant |
| What was the general criticism that Schawzer gave to both the HBM, PMT TPB? | These models are unidirectional. There is no component for describing how attitudes may change. Humans are not 'constant' therefore such an element must be included. |
| What is the health action process approach model, list the components? Who created it? What is the most significant component? | It is a hybrid model that encompasses HBM, TPB and the trans-theoretical stages of change model. Developed by Schwarzer Consists of two stages, the motivational stage (self-efficacy, threat appraisal, outcome expectancies) and the action stage (cognitive factors, situational factors/barriers). Significant predictor of behavioural change is self-efficacy. |
| What are the criticisms of the HAPA model? | Too rational, does not account for emotion. Too ambitious in seeking a holistic model, too many combinations, too parsimonious. |
| What causes HIV? When does it turn into AIDS? When did it first arise? How many people have it in the UK? | CD4 lymphocytes are destroyed Turns into aids when the CD4 lymphocyte count is <200 1980s amongst homosexuals Close to 100,000 people. |
| Some early HIV/AIDS adverts were really scary with high fear - how would the Protection motivation theory react to this? | High fear based on van de Velde and van der Plight's study elicits avoidance. People focus on the fear and not the positive health behaviour. For any health behaviour change, presenting a threat needs to coincide with the presentation of strong self-efficacy |
| What are the psychological consequences of HIV diagnosis? What is the role of psychology in HIV interventions? | Anxiety, depression, coping, rejection, stigma, adherence. Psychology aim to: Reduce/prevent transmission Support the psychological coping with the diagnosis Help maintain good adherence to drugs |
| What drugs are used to treat HIV? How much adherence is needed for high effectiveness? | HAART Highly active anti-retroviral therapy 95-100% |
| What is the link between personality and sex behaviour? What are the implications? | Of The Big 5 personality traits (Goldberg), Conscientiousness and Agreeableness are both linked lower levels of risky sex behaviour (Ferguson) |
| What are the issues with sex research? | Sex is a sensitive topic, hard to get ethics approval, or have people being truthful about their behaviour. Ideologies can bias research, ie. those that believe in abstinence or have prejudice against homosexuals. Research tends to be skewed focusing mainly on sex health issues as opposed to sex as a pleasurable activity - nonetheless this skewness fulfils the 'promoting the social good' virtue in psychology. |
| What interventions have been used to prevent HIV transmission? What type is said to be more effective? | Community interventions Education by challenging the following; magical thoughts, stereotypes, isolation, myths. Educating about HIV and pregnancy. Culturally sensitive interventions - where the person delivering the health message shares the same culture/race/social identity. |
| What are the psychological effects of HIV diagnosis? What co-morbid illness develops and what are the effects on the HIV diagnosis? | Stress, anxiety, acceptance then isolation. Depression can develop which results in a lower CD4 count and few T lymphocytes, suppressors. Bad for the immune system |
| What are the benefits of active coping with HIV according to Goodwin? | Active coping improves the function for NKCC Natural killer cells. |
| HBM has some predictive value in condom use, but what are the main limitations? What social cognition model is better than HBM and why? | No real difference in peoples perceptions of the the severity and susceptibility, which produces ceiling and floor effects respectively. Sex is an emotional, interactive act within a context. HBM does not account for this. HBM does not explain how one moves from a belief to a behaviour. TRA is said to be much better because it explains the 'behaviour' part in the intentional phase. Also, it highlights the emotions and context. Lastly, the TRA/TPB take into consideration the normative beliefs, norms of significant others etc. |
| State a few aims of cognitive behavioural stress management in HIV? | Challenging cognitive distortions Developing Coping Replacing thoughts Giving a rational for CBSM |
| What type of maladaptive thoughts do people diagnosed with HIV tend to develop? What therapy is used to challenge these thoughts, who created it and what are the steps? Is there a similar therapy from the general cognitive field? | Automatic thoughts or cognitive distortions Cognitive behaviour stress management (Antoni) the Rational Though Replacement: Aware, Belief, Challenge, Delete, Evaluate. A similar one is by Albert Ellis the REBT: Action, Belief, Consequences, Dispute, Effect. |
| What studies show the outcome of CBSM therapy? What studies show the outcome of general CBT on HIV patients? What are the benefits and differences between them. | Antoni et al found that CBSM reduces anxiety, stress, anger, but they all had small to medium effect sizes. Carrico and antoni et al, found that gay hiv positive men reduced depression and denial coping when treated along with HAART. Crepaz's (2008) meta analysis on 15 CBT found that anger was significantly reduced with d=1.00 effect size. All these studies showed that better mood/psychological state meant better immune system functioning. The NKCC cells functioned better. |
| What is the current level (%) of adherence to HIV drugs? Why is adherence important? What are the main reasons why adherence is not at 100%? | 70% in the UK It is important for the patient's health and public health (to prevent incurable mutations). 20+ drugs have to be take, the drug regime is aversive, inconvenient, hard to swallow, has side effects; nausea, diarrhoea, etc. |
| What study gives evidence as to why adherence is low amongst gay men? What was good about this study? | Cooper et al, percentage of gay men that refused to take HAART explained why via qualitative interviews. They said they were healthy, that taking the drugs would make them feel like they are accepting the illness, denial, lack of symptoms. Good thing about the study is the qual method. It bridges the gap between the researched and the researcher, produces semantically rich data, to highlight the possible themes and constructs amongst patients, which can be reified and tested experimentally. The qualitative method moves away from essentialism and offers an integrated holistic understanding of the individuals assessed. Through this, we can better understand how HIV patients make sense of the world, and enable health interventions to reflect that in treatment. |
| Describe another study that came up with 3 factors explaining non-adherence. | Walsh et al. 3 Factors: Negative experience with drug Low priority for drug - want to drink, socialise Unintentional - just forgot |
| What is the PACT intervention and what are some of the components? | Prevention and Access to Care and Treatment. Tailors drug regime Explains it much better for the individual Support Removing the barriers Reminding them of the severity Building self-efficacy |
| What is behaviour change via reinforcement? Give two study examples? | Barthomeuf, pairing food with emotion changes preferences. When behaviour eg, smoking is no longer functional, the behaviour ceases (Ogden and Hill) |
| Incentives are a crude version of reinforcement, what does this mean? | Bribe Short term Depends on the financial state of the individual Secondary gains Not genuine change Greater the incentive, greater likelihood of change |
| What is the role of modelling in behaviour change? Food example with kids | More likely to imitate the behaviour of a significant other, eg. parent, peers, celebrity. Example of Food dudes in changing kids behaviour. |
| How can associative pairing bring about health behaviour change? | Change preferences for one health behaviour by pairing i with an aversive consequence. Eg. Burger with pics of stomach ulcer Or the homosexual aversive strategy extreme |
| What is the role of exposure in behaviour change? Give study example. | More exposure, greater acceptance/preference. Children exposed to vegetable they did not like for days started eating it. Worked better than talking to them about the health benefits. |
| What is the role of CBT in behaviour change? | Patient as scientist Collaborative Set agendas Experimental, self directed, set goals, self awareness. Challenge cognitive distortions. Eg. Dichotomous thinking, magnification, fortune telling etc. Antoni et al ABCDE model |
| What is the relapse prevention strategy? Marlett and Gordon | Abstinence as the baseline high risk event Coping mechanisms, there or not there if not, leads to lapse, lowers self-efficacy leads to relapse, cognitive dissonance, abstinence violation behaviour. Gotta go through ABCDE and REBT again. To overcome, need to have rehearsed, prepared/plan in advance what to do in such a situation. Relapse fantasies, build up SE and coping. Challenge AVB |
| What are the 5 steps in the stages of change model? DiClemente What are the criticisms? | 1. Pre contemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance Not linear, can jump stages Stages make it seem to rigid, omits some key processes like 'quitting'. Too rational |
| What is needed to go from stage to stage in the stages of change theory? | Motivational interviewing. Challenges dissonance because it doesn't feel nice to be dissonant. |
| How have emotions been used in behaviour change? | Visual Fear appeals Self-affirmation |
| How has modern technology been used in behaviour change? | EMI (Ecological Momentary interventions) eg. texts for the hard to reach. Sometimes has a paradoxical effect - ironic process theory. Mass media eg. horse meat, ebola. Causes clear behaviour change. Media adverts - Elaboration likelihood model for persuasive ads. |
| What are the four stages of substance use? | Initiation Maintenance Cessation Relapse |
| Percentage of men to women that smoke in the UK? | 27% and 24% |
| What are the health consequences of smoking? | Cancer, Bronchitis, Emphysema, 10 years off life expectancy, financial stress. |
| What are the two factors present in smoking initiation? | Social factors and Beliefs. Social norms, environment, peers, parents. Beliefs that it is fun, social, relieves stress etc. |
| What causes people to maintain smoking? | Addictive element Social function - peers work Environment Stress relief Weight management Mood management |
| What interventions have been used to encourage people to stop smoking? | Clinical - NRT, CBT, drugs Social learning - Aversion, cue exposure control Public Health - banned smoking in public places, cessation messages Self-help - management, diary etc. Government - policy, increase tobacco price Work site Community - good for light smokers but not heavy. |
| Relapse is an issue when it comes to smoking cessation, what model explains this? | The relapse prevention model by Marlatt and Gordon. High risk, coping, self efficacy, lapse, relapse, AVE (abstinence violation effect). |
| Summarise Niaura and Abrams findings (2002) | Work site interventions effective when approach was tailored to each work environment. Community based interventions - worked better for prevention, takes longer to see the effects. GPs are not taking advantage of their access to patients. Goldstein, 70% of patients see their doctor, and will listen to advice concerning smoking. 4A's Ask, Advise, Assist, Arrange The health practitioners defence is that: They are not trained, it takes time and resources. Smoking is seen as co morbid with other diseases. |
| What are the benefits of qualitative studies? | Provide rich data Reveal dynamic processes and complexities that could not be shown quantitatively. |
| What is tautological pluralistic ignorance? How does it relate to smoking initiation? | 'everybody smokes because everyone thinks that everyone smokes' A false perception of what is permissible in a social group will lead people to engage in the behaviour thus increasing its prevalence. Berkovitz Social norms approach. |
| Actions speak louder than words. How does Franca et al (2009) study on adolescents illustrate this? | 49% young adults still went on to smoke even though their smoking parents told them not to. Modelling is strong |
| Hajek and Stead 2001 did a meta analysis on aversion therapy for smoking. Summarise the results. | 25 studies, lack of support for aversion therapy. Self-efficacy and CBT focused interventions are much better. Issues with meta analysis: hetrogeneity across demographic, method, assumptions. |
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