Psychological Basis of Health Education (CHS 384)

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.