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Psychological Basis of Health Education (CHS 384)

This lecture explores the ecological perspective and key concepts in the field of health education. It discusses the multiple levels of influence on behavior, including individual, interpersonal, and community factors. Various theories and models are examined, including psychodynamic theories, social cognitive theory, and the health belief model. The lecture also highlights the principles of reciprocal causation and the importance of multiple-level interventions. The lecture concludes with an overview of Freud's psychoanalytic theory and its application to health and illness.

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Psychological Basis of Health Education (CHS 384)

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  1. Psychological Basis of Health Education (CHS 384) INSTRUCTOR: NORAH ALSADHAN, MPH Lecture-2-

  2. Ecological perspective • Key concepts • Multiple levels of influence • Behavior affect and is affected by multiple determinants at all level of human life • Reciprocal causation • Individual behavior shapes and is shaped by the social environment.

  3. Levels of influence

  4. Levels of influence • 52-year old women delays getting a mammogram. Possible reason for this occur on all levels of influence.

  5. Factors influencing behavior • Socioeconomic status: education, income, occupation • Skills • Culture: norms, values, beliefs • Beliefs: one’s own perception of what is true. Not always based on culture. • Attitude: a series of beliefs linked together to form patterns of behavior • Values: not always valid to assume that health is a strong value for everyone • Religion: social behavior, practices, social support • Gender: Men eat more fat, less fiber, sleep less, and are more often heavier than women.

  6. Intrapersonal level • Knowledge • Attitudes • Beliefs • Personality traits • Personal history

  7. Intrapersonal theories • Psychodynamic theories: • Drives and repressed emotion create physical symptom and anxiety • Behavioral therapies: • Behavior is determined by reinforcement • Cognitive theory • Behavior is determined by thoughts, feelings, perceptions, goals, and other mental activity

  8. Intrapersonal theories • Health Belief Model: • Perceptions of threat, benefit and barrier to action • Transtheoretical Model: • Motivation and readiness to change behavior • Theory of planned behavior: • Attitudes, intentions, beliefs, and control

  9. Interpersonal level • Family, friends, and peers • Social identity • Social support

  10. Interpersonal theories • Social cognitive theory: • Triadic influences of self, behavior, and the environment • Social influence: • Different types of relationships have differing effects on behavior • Social support: • Support of varying types from other people buffers individuals against the effects of stress.

  11. Intrapersonal and Interpersonal level Assumption • Most theories at these levels are based in Cognitive-behavioral Theory: • Behavior is mediated by cognitions • Knowledge is necessary but not sufficient to produce most behavior change • Perceptions, motivations, skills, and the social environment are key influences on behavior

  12. Community level • Community • Social networks and norms that are informal or formal and serve to guide behavior • Community building: uniting people around a common goal using available resources • Social networks: the amount of social dyads around each individual

  13. Community level • Diffusion of innovations: • How new ideas, products, and practices spread within a defined population • Communication Theory: • How different modes of communication influence the behavior of populations and individuals

  14. Community level • Institutional: • Rules, regulations, policies, that constrain or encourage recommended behaviors. • Public policy: • Multi-level governmental policies and laws that regulate all aspects of health care.

  15. Meta Information • No one theory is Adequate • Every theory and model has a specific goal • What does it try to explain? • Is it about how people learn? • Is it about how people change? • Is it about how people relate to others?

  16. Meta Information • Every theory/model is somehow connected to what came before • Evolution of understanding • Increasing complexity and sophistication

  17. Meta Information • Every theory/model has a better/best fit: • For particular problems • For particular populations • For particular interventions • Every theory/ model was developed in a cultural and social milieu that may be different from present day

  18. Reciprocal Causation • People influence the people and situations around them • People are influenced by the people and situations around them • Example: 56 year-old man with elevated cholesterol- workplace cafeteria provides only fatty-unhealthy food choices.

  19. Principles • Multiple types of environmental influences affect behavior • Natural environment • Built environment • Multiple-level interventions are usually most effective • But most interventions still target the individual

  20. Psychodynamic Theories of Health and Illness

  21. Psychoanalytic Theory • Sigmund Freud (1856-1939) • Vienna, Austria • Studied medicine at university of vienna • Specialized in Neurology

  22. Freud’s Theories • Unconscious events influence psychic life • Unconscious and conscious forces determine: • Mental events • Experiences • Behavior • Many physical symptoms are caused by psychological conflicts

  23. Freud’s Theory of Personality • Id, Ego and Superego • Three aspects of most internal (neurotic) conflict • This conflict is almost always repressed.

  24. The Id • True psychic reality • Contains instinctual urges • Sources of desire for immediate gratification • No values, ethics, or logic • Obeys the pleasure principle

  25. The Superego • Values and ideals of Society • As conveyed by parents • Aims for Perfection. • The super-ego strives to act in a socially appropriate manner. • The super-ego controls our sense of right and wrong and guilt. • A type of conscience that punishes misbehavior with feelings of guilt.

  26. The Ego • The executive function • Organized and rational • Defers gratification • Mediates between • Id • Superego • Outer world • Obeys the reality principle

  27. Generation of anxiety • Id presents ego with an unacceptable wish • Ego perceives danger associated with expression of the wish • Superego reinforces danger perceptions • Defenses are mounted against the wish • Balance is struck between wish and defense

  28. Defense Mechanisms • Sublimation: • Manifesting an unacceptable impulse in socially acceptable ways • Violence-Surgery • Denial: • Very commonly used • Repression: • Involuntary forgetting of a painful feeling or experience

  29. Wish-Defense Compromise • Takes many forms: • Symptoms • Character trait • Character style • Inhibition

  30. Psychodynamics • Repression remains prominent as an explanation for physical and psychological distress • Repression can lead to active suppression of strong emotional expression • Changes in immune function • Discrepancy between self-reports of distress and physiological state.

  31. Modern Application • Type A behavior pattern • Risk factor for heart disease • Components: • Time urgency • Orderliness • Hostility • Irritability with interruptions • Hyper alertness

  32. Modern Application • Type A behavior pattern • Anger and Hostility appear to be most important • Predictive relationship between hostility and atrial fibrillation in men (Eaker et al, 2004)

  33. Modern Application • Scriptotherapy • Pennebaker,1995; Smyth et al.,1999 • Disclosure relieves the anxiety and physical stress of repression • Interventions using writing about traumatic experiences • Immune function and symptoms decreased in Asthma and rheumatoid arthritis.

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