The Psychology of Health

An Introduction

Keith Phillips, Marian Pitts

• Publisher: Routledge
• Year: 2002
• Print ISBN: 9780415150248
• eBook ISBN: 9781134748686
• Topic: Psicología
• Subtopic: Historia y teoría en psicología

The first edition of The Psychology of Health has become the standard recommended text for many courses. This completely revised and updated second edition contains new material in all chapters and has several additional chapters on such topics as cancer, nutrition and exercise, social drugs, and the impact of social inequalities upon health. The Psychology of Health will continue to be invaluable for students of health psychology and related fields, including nursing, social work, community care and health studies.
The Psychology of Health, second edition, is:
* comprehensive: its four parts cover the scope and ambition of health psychology, acute and chronic illness, hospitalisation and the management of disease, primary prevention and health promotion, the importance of the family and the wider social context for health
* user-friendly: includes tables, figures and boxes with discussion ideas and questions in each chapter. Prefaces to each part, key point summaries and a glossary of terms give students a useful framework for revision
* clearly written by an experienced team involved in undergraduate teaching
* a source for further study: with annotated guides to reading and an extensive bibliography.

Part one
Introduction

PART ONE introduces you to the basic elements underpinning the psychology and experience of health. We need explanations of the ways in which psychological variables interact with biological predispositions of disease, and environmental and social factors such as economic status. These explanations give rise to theories of health behaviour. Chapter 1 reviews the evidence which implicates health behaviours and other psychological variables as major determinants of health; it shows how the causes of ill health and death have changed in the western world over the last century from infectious diseases to those linked to behaviours, including cancers, and circulatory diseases. The approach adopted throughout the book is to view health as a function of biological, psychological and social elements—known as the biopsychosocial approach. Several models are reviewed in Chapter 1, and will be used as the basis for understanding a range of health issues that are covered by chapters in Part Three.

Chapter 2 reviews the biological underpinnings of health and health behaviours. It is necessary to understand how the nervous system, the endocrine and immunological systems together regulate physiological reactions and behaviour. Biofeedback is introduced as an example of the importance of physiological regulation in modifying reactions, and hence to reducing risks associated with psychophysiological disorders. Chapter 3 considers the constructs of stress and coping. Stress has come to be regarded (rightly or wrongly) as one of the major problems of our busy lives. In this chapter we consider carefully the nature of the construct and look at how it has been measured. Philip Evans examines closely the physiological basis of the concept. He then considers the other construct: coping. Coping also needs to be ‘unpacked’ to understand how it is that we can cope with stress and why some people appear to manage to do so better than others. Finally, the exciting new field of psychoneuroimmunology is reviewed to show how psychology and physiology interact in determining health.

Chapter 1
An introduction to health psychology

Marian Pitts

Introduction

What is health and what is health psychology?

Historical background

Health behaviours

Models of health behaviour

The health belief model (HBM)

Protection motivation theory

Leventhal’s self-regulatory model

The theory of planned behaviour (TPB)

Schwarzer’s health action process

approach (HAPA)

The transtheoretical model

Comparing the models

Individual differences

Health locus of control

Self-efficacy

Optimism

Doing health psychology research

Ethics in health psychology research

Key point summary

Further reading

Introduction

This chapter will introduce the area of health psychology. It will outline briefly the historical background to the field, consider the development of our understanding of health behaviours and introduce the major models which have been developed to aid our understanding of people’s health-related behaviours. We will look at individual differences and how they impact on health behaviours. Finally, we will consider the methodologies used in health research and the particular ethical problems which accompany research in these areas.

What is health and what is health psychology?

How are you feeling today? As you read these words are your eyes sore? Does your back ache? How’s the head? Do you find your concentration wandering (already?!). It is extremely unlikely that anyone reading this book is entirely and absolutely healthy and free of symptoms. It would be difficult to know what that would mean; we all are ‘imperfect machines’. The study of health psychology is concerned with the ways in which we, as individuals, behave and interact with others in sickness and in health. Any activity of psychology which relates to aspects of health, illness, the health care system, or health policy may be considered to be within the field of health psychology. Health psychology deals with such questions as: What are the physiological bases of emotion and how do they relate to health and illness? Can certain behaviours predispose to particular illnesses? What is stress? Can educational interventions prevent illness? And many others. The beginnings of the formal interest of psychologists in these areas can be dated to the convening of a conference in the USA in 1978 and to the creation of a section devoted to health psychology in the American Psychological Association in 1979. The British Psychological Society (BPS) set up a Health Psychology Section only in 1986. This year (1997) the section should become a formally recognised division of the BPS and the profession of health psychologist may be established in the UK.

Some time ago the World Health Organization put forward a definition of health which has been widely quoted. Health is ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (WHO, 1946). Recently this definition has come under scrutiny and some criticism as representing an unrealistic goal, nevertheless it does emphasise the holistic nature of health involving body and spirit,

physical and mental states. Matarazzo in 1980 offered a definition of health psychology which has become widely accepted:

Health psychology is the aggregate of the specific educational, scientific and professional contributions of the discipline of psychology to the promotion and maintenance of health, the prevention and treatment of illness, the identification of etiologic and diagnostic correlates of health, illness and related dysfunction, and the analysis and improvement of the health care system and health policy formation.

This definition emphasises the diversity of issues encompassed by the emerging discipline. There is also variety in the approaches brought to those issues. Some health psychologists would see themselves primarily as clinicians, others as psychophysiologists, and others still as cognitive psychologists; some will practise health psychology in the health care settings, others will teach and research in academic institutions—what unifies them is their interest in the areas delineated by Matarazzo and their approaches to these issues.

Historical background

The recognition of health psychology as a clearly designated field is very recent, as we have seen; however, many of the ideas and basic concepts have been around psychology for a great deal longer. The relationship between mind and body and the effect of one upon the other has always been a controversial topic amongst philosophers, psychologists and physiologists. Within psychology, the development of the study of psychosomatic disorders owes much to Freud. Psychologists such as Dunbar (1943), Ruesch (1948) and Alexander (1950) attempted to relate distinct personality types to particular diseases with an implicit causation hypothesis. Work of this type has become more sophisticated in its approach and the chapters in the book on coronary heart disease and cancer are illustrative, and critical, of this orientation. This approach has been largely abandoned by health psychologists in favour of more behavioural or biological approaches which seek to employ interventions derived from behavioural medicine (see the chapters concerning pain (Chapter 6) and hypertension (Chapter 10) as examples of this).

Another important aspect in the development of health psychology has been the changing patterns of illness and disease. If we were to compare 1898 with 1998 we would see that contagious and infectious diseases now contribute minimally to illness and death in the Western world, and other illnesses have become more frequent and are of a different nature. Major breakthroughs in science have reduced the prevalence of diseases such as smallpox, rubella, influenza and polio in the Western world; more deaths are caused now by heart disease, cancer and strokes. Recent studies and theories suggest that these diseases are, in part, a by-product of changes in lifestyles in the twentieth century. Psychologists can be instrumental in investigating and influencing lifestyles and behaviours which are conducive or detrimental to good health. The chapters in this book on AIDS (Chapter 8) and coronary heart disease (Chapter 11) illustrate areas where such interventions are being attempted. Increasingly, then, the major causes of death are those in which so-called behavioural pathogens are the single most important factor. Behavioural pathogens are the personal habits and lifestyle behaviours, such as smoking and excessive drinking, which can influence the onset and course of disease. It is not just the diseases of the ‘developed’ world which can be affected by behaviour and attitude: combating malaria, schistomiasis and other diseases endemic in different parts of the world can also be greatly helped by psychological input into campaigns to change behaviour. As people the world over live longer, the long-term effects of what Matarazzo (1983) calls ‘a lifetime of behavioural mismanagement’ can begin to express themselves as diseases such as lung cancer, and heart and liver dysfunctions.

Health behaviours

We will now look at behaviours which can be part of maintaining a healthy lifestyle and avoiding ill health. These are known as (protective) health behaviours. Harris and Guten (1979) conducted an exploratory study of 1250 residents in Greater Cleveland, USA. Residents were asked: What are the three most important things that you do to protect your health? Following this free recall, they were presented with statements on cards which described health behaviours and were asked to sort them into those that they did and those that they did not practise. Cluster analyses performed on these data produced categories to account for the various responses obtained by both methods. Categories of health protective behaviours thus found were:

• environmental hazard avoidance—avoiding areas of pollution or crime;
• harmful substance avoidance—not smoking or drinking alcohol;
• health practices—sleeping enough, eating sensibly and so forth;
• preventive health care—dental check-ups, smear tests;
• safety practices—repairing things, keeping first aid kits and emergency telephone numbers handy.

Other studies carried out by Pill and Stott (1986) and Amir (1987) confirm these findings that people can identify behaviours which they carry out to protect health. Amir (1987) developed the General Preventive Health Behaviours (GPHB) Checklist. It consists of twenty-nine items which were selected to represent a range of behaviours thought to be relevant to a British population. Amir carried out the study on elderly (65–75 years) Scottish people and found the following items to be endorsed by more than 90 per cent of respondents:

• Avoid drinking and driving
• Wear a seat-belt when in the car
• Do all things in moderation
• Get enough relaxation
• Check the safety of electrical appliances
• Avoid overworking
• Fix broken equipment around the home
• Eat sensibly

At the other end of the spectrum, only 10 per cent reported taking dietary supplements or vitamins, and only 12 per cent regularly got a dental check-up. It is likely that these percentages would look very different in different age groups (see the discussion topic at the end of this chapter).

There is thus a common-sense notion that a relationship exists between good health and personal habits. Plato said, ‘where temperance is, there health is speedily imparted’. Many groups have codified ‘good’ living habits into their religions and there is strong evidence of the outcome of healthy living and abstinence in such communities: Mormons in Utah have a 30 per cent lower incidence of most cancers than the general population of the USA, and Seventhday Adventists have 25 per cent fewer hospital admissions for malignancies (Matarazzo, 1983). Such statistics are powerful indicators that personal lifestyles do much to ensure healthy bodies. This idea was first studied systematically by a much cited study carried out in Alameda County, California and reported initially by Belloc and Breslow (1972). They asked 6928 county residents which of the following seven health behaviours they practised regularly:

• not smoking;
• having breakfast each day;
• having no more than one or two alcoholic drinks each day;
• taking regular exercise;
• sleeping seven to eight hours per night;
• not eating between meals;
• being no more than 10 per cent overweight.

They also measured the residents’ health status via a number of illnessrelated questions: for example, how many days they had taken off from work due to sickness in the previous twelve months. They were also interested in physical, mental and social health which they defined as ‘the degree to which individuals were functioning members of their community’. Although criticisms have been made of this study, most notably the lack of independence between the questions, some strong and well-replicated relationships were demonstrated. A health habit is a health behaviour which is well established and often carried out semiautomatically: do you actually decide each morning and evening to clean your teeth, or do you ‘just do it? Adults in the study who engaged in most of the health habits reported themselves to be healthier than those who engaged in few or none. A follow-up study nine-and-a-half years later showed that mortality rates were significantly lower for both men and women who practised the seven healthy habits. Men who had all seven healthy habits had only 23 per cent of the mortality rate of men who carried out none or fewer than three health habits (Breslow and Enstrom, 1980). There were also clear links between physical, mental and social health. These findings reinforce the holistic notion of health proposed by the WHO as a composite of effective functioning, whether physically, mentally or socially.

This original Californian cohort has been studied for twenty-five years. A survey in 1982, seventeen years after the study first began, considered those individuals who had been at least 60 years old at the time of the first survey. It was found that not smoking, taking physical activity, and regular breakfast eating were strong predictors of their mortality (Schoenborn, 1993). The Alameda Study reinforced the idea of ‘moderation in all things’ as the basis of good health. It also emphasised the role of social and mental aspects in achieving good physical health.

Although most of us are familiar with the need to engage in preventive health behaviours, few of us actually do so. Berg (1976) has stressed that most people are aware of which health behaviours should be engaged in; however, they frequently do not do so, and furthermore do engage in activities which they know to be harmful to their health. It is this cantankerousness which psychologists have spent a great deal of time examining. The dilemma or challenge then is how best to encourage, persuade or coerce people into adopting the healthy habits which it is believed are good for them. This enterprise carries values and expectations which will be e...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Figures
• Tables
• Contributors
• Preface
• Acknowledgements
• Abbreviations
• Part One: Introduction
• Part Two: Patient Behaviour and the Management of Illness
• Part Three: Health Issues
• Part Four: Wider Social Issues
• Glossary
• Bibliography