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Health Psych 3

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Rutgers University
Mc Carthy

Health Psychology Part 3 Chapter 3 SEEKING & RECIEVING HEALTH CARE Why talk about health-care seeking behavior? • Risky behavior persists • Preventive measures underused • Poor adherence to medications that are essential • Health care is interactive Models to predict behavior • Goals of models: understand, predict, and control • Behavior plays a role in all forms of prevention and treatment • Attitudes knowledge and insurance all affect your behavior (whether you go for a mammogram or not) Becker & Rosenstock’s Health Belief Model • Health Belief Model depends on o Cues to action—symptoms. Bad advice o Susceptibility—risk of bad outcome o Severity—consequences of bad outcome o Benefits—cure, controllability o Barriers and costs—side effects, expense, time • Fishbein &Ajzen’s Theory of reasoned action o What will happen? Will I like it?  attitude toward behavior  intention  health related behavior o What do others think I should do?  subjective norm for behavior  intention  health related behavior • Ajzen’s Theory of planned behavior o Perceived behavioral control, subjective norm for behavior, and attitude behavior all lead to intention which then lead to health related behavior • Weinstein’s Precaution adoption process model o Unaware of hazard o Optimistic bias—my grandfather lived to 95 and he smoked 3 packs a day! o Acknowledge susceptibility o Decide to take action o Decide not to take action o Action taken o Maintenance • Prochaska & DiClemente’s Trans-theoretical Model o Pre-contemplation—how ready are they to change? o Contemplation o Preparation o Action o Maintenance • Other predictors: o Past behavior in similar circumstances o Self-efficacy o Access to health care o Gender o Race/ethnicity o Perceived risks of behaviors o Optimism • Model critiques o Some researched more than others o Measured problems poor predictive power  More in known that known o Results Definitions • Disease = physical damage • Illness = feeling sick and being diagnosed • Can have on without the other • Medical doctors decide who is ill Kasl & Cobb’s illness behavior • When symptomatic & undiagnosed • Aims: o Discover health status o Find suitable remedies • Related factors o Sesonal factors, Gender, Age, Culture, Symptoms, Disease concept • Mechanic predicts health seeking more likely when symptoms are o Visible, Severe, Impairing, Frequent and persistent • Leventhal and colleagues say these influence health seeking behavior o Disease identity/label, Time line, Cause , Consequences, Controllability • Example: chest pain Sick Role • Kasl & Cabb’s definition o When diagnosed as ill o Aim: get well • Segall’s modification • Rights o Decision making o Take a break o Rely on others • Duties o Be/get well o Routine care o Use resources • Doesn’t apply to all; chronic disease Deciding what to do takes time… • Notice symptoms • Interpret symptoms • Decide need help • Wait for help • And depends on what you believe From seeking to getting care • How do you get care? o Who will pay?  You, private insurer, Medicaid, medicare, VA, society (indigent care, prison care) Health Care Systems • Diverse systems in the USA o Health Maintenance Organizations o Preferred Provider Organizations o Academic Medical Centers o Community Health Centers o Veterans Affairs o Private-pay practitioners • National systems elsewhere Who will treat you? • Medical doctor, midwife, physician assistant, nurse, osteopath, therapist, chiropractor, alternative/complementary practitioner, psychologist, dentist, nutritionist Who decides? • Who is the gatekeeper? o Payer o Primary care provider • Limits on o Providers o Procedures o Duration/cost of care o Prescription drugs Hospitalization • Costs o Money, lack of control, sleep disruption, distress, isolation, errors, infection, invasive • Tips o Prevent hospitalization, work for discharge, get to know staff, ask questions, speak up nicely, control what you can, enlist family and friends, cope Health Literacy Health information is not intuitive Information is complex, changing Medspeak Health regimens are complex Health literacy is “currency of success according to SG Carmona Interventions only work if people use them AMAVideo—it doesn’t say how to take it (when you eat it don’t eat or when you sleep it wake up). Not everyone understands that taking 2 a day means 2 in 24 hrs or take with an empty stomach…some don’t understand what take orally means…many people with complex medication regimens where they have multiple pills a day, it becomes harder for them to distinguish between the pills and take the correct one, particularly when they are tired • 42% of hospital patients did not understand to take medications on empty stomach • 26% did not understand appointment slip • 60% did not understand informed consent form • 35% of patients understand “orally” • 22% understand “nerve” • 18% understand “malignant” • In one study, no one know where the colon was • On leaving a doctor’s office, patients recall less than 50% of information provided • ~ 40 millionAmericans have low health literacy (80% of those over age 60) • Average adult reading level = 8 grade • Only 19% of health pampthlets < = 9 grade th • 0% of health websites < 9 grade • providers assessed understanding 2% of the time Costs linked with low literacy (McCray, 2005; Williams et al., 2002) • less knowledge • less self-management, adherence • more chronic illness • More costly (~10,000 more per year) care, less preventive care o More visits o More hospitalization o Less screening Health Literacy • Per IOM, health literacy the d egree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions • Problems in definition and assessment of literacy o How to assess reading level o Reading ability o Numeracy o Comprehension o Cultural bias o Accuracy and comprehensiveness Definitions • Narrow: Reading level • Broad o Reading level o Oral communication o Cultural influences o Ability to negotiate system Nutbeam definitions • Interactive literacy o Cognitive skills o Social skills o Extract & derive information o Apply information to new situations • Critical literacy o Analyze information o Exert control over own health Assessing Health Literacy • Problems in definition and assessment of literacy o How to assess reading level o Reading ability o Numeracy o Comprehension o Cultural bias o Accuracy and comprehensiveness Barriers to addressing low literacy • Providers don’t ask • People don’t volunteer • People compensate th th • Materials often at 10 or 11 grade level • 5 to 6 grade level recommended • Reading level not equal to comprehensible • Health care consumption more complex Provider Behavior • Beckman & Frankel, 1984 o Transcribed 74 patient encounters o Providers interrupted 18 seconds after eliciting the chief complaint o Questions resulted in provider taking control o Few patient complaints were completed, especially after interruption o Patients don’t know how to organize presentation of concerns Solutions • Assess understanding o Teach back o Show me • Conversational style • Avoid jargon • Invite patient participation • Focus on patient concerns HEALTH COMMUNICATION Cross Cultural Comparison of Provider Behavior • Patient-centered approach o Biopsychosocial rather than biomedical model o Invite patient engagement o Emotional rapport • System differences o National health c are in Netherlands o More visits per year with PCP in Netherlands • Visits with hypertensive patients in primary care in US vs. Netherlands o US physical exams and overall visits longer than Dutch visits o Same proportion of patient participation o Provider contributions differed  US physicians did more than 50% of the taking  Dutch physicians did 50% or less  US physicians focus on instrumental behavior rather than affective information  Dutch providers do more rapport building • Cluster analyses o More biomedically intensive exchanges in US o More socioemotional exchanges in Netherlands • Length vs. Quality o Many interventions given in longer visits may be superfluous o Bias against doing too much vs. too little may differ across cultures Bensing et al. 2003 Critique • Methods o Review of videotaped visits from 10-20 years ago o Samples matched on age, gender, hypertension diagnosis o Reports of frequency and duration of events o Cluster analysis of types of exchanges o Limitations or problems with study? AModel of Persuasion: Petty & Cacioppo Elaboration Likelihood Model • Central route o Critival evaluation of message o Attention to logic, supporting facts, credibility of source • Peripheral route o Affect-based o Attention to feeling, tone, likeability • Individual differences in receptivity to each route of persuasion which influence attitude behavior concordance The Truth • Which route does the truth campaign target? o Truth ads decrease intentions to use among teens, whereas Phillip Morris information ads do not o Youths smoking prevalence decreased in areas with truth advertisement o Does-response relationships between exposure to truth ads and decreased smoking prevalence Communication strategies • Targeting • Tailoring • Framing o How you say it matters o Best way to frame depends on risk of behavior o Not equal to fear messages Message Framing • To promote behavior, emphasize costs or benefits? o If you get an HIV test, you may feel the peace of mind that comes with knowing about your health o If you don’t get an HIV test, you may feel more anxious because you may wonder if youre ill Why? Prospect Theory • Kahneman & Tyversky, 1981 o When considering losses, people accept greater uncertainty (risk) to avoid the loss o When considering gains, people opt for greater certainty in an effort to conserve gain o Why? Non-linear relation between objective and subjective value Example • Bird flu is coming, will kill 600 people on campus o ProgramA: 200 people will be saved o Program B: 33% chance that 600 people will be saved and 67% chance no one will be saved • One of the options has more uncertainty, therefore more people would choose ProgramAbecause it is the more certain option HIV Testing Study • Ethnically diverse sample of 480 women in public housing and community clinics • Testing attitudes, behavior, and intentions assessed pre- and post-video • Random assignment to gain vs. loss framed video • Follow-up through 6 months o Gain frame video  38% perceive testing as certain  40% perceive testing as uncertain o Loss frame video  26% perceive testing as certain  47% perceive testing as uncertain Other factors in Communication • Credibility of source, spokesperson • Modality of communication • Characteristics or recipients: o Need for cognition o Monitoring vs. blunting o Age & developmental level Scare Tactics—Leventhal et al. 1965 vaccine study • No action plan o 8% low threat o 0% high threat • Action plan o 27% low threat o 31% high threat Scare tactics • Negative message not necessarily better, even for risky behavior • High arousal interferes with processing • Threat messages increase intentions, not necessarily action • Messages best when paired with message about what to do Steps in Communication • Exposure • Attention • Comprehension • Retentions • Acceptance (attitude change) • Action (behavior change) Public Health Messages • Thank about messages you see/hear/read • How are they framed? Are they targeted?Are they engaging? Did you learn anything? CH. 4ADHERENCE Adherence: a person’s ability and willingness to follow recommended health practices • Ideally, cooperation between patient and provider • Why important? o Medication use o Following screening & preventative recommendations o Pre-and post-surgical care o Obtaining benefit form treatments (HIV, chemo) Example: transplant • Adherence influences o Need to transplant o Evaluation for transplant o Ability to tolerate surgery o Post-surgical course o Survival Theories • Behavior theory o Operant conditioning o Positive reinforcement o Negative reinforcement o Punishment • Adherence may not change if contingencies do not change • Incentives improve adherence rr • Self-Efficacy Theory o Bandura: social cognitive theory  Person environme
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