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Chapter 3

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PSYC 314
Frances Chen

Chapter 3: What is Health Promotion?  Health promotion: general philosophy that holds the idea that good health or wellness is a personal and collective achievement  The process of enabling people to increase control over and to improve their health  For the individual: it involves developing a program of good health habits early in life and carrying them through adulthood and old age  For medical practitioner: teaching people how best to achieve this healthy lifestyle and helping people at risk for particular health problems learn behaviours to offset or monitor those risks  For psychologist: development of interventions to help people practise healthy behaviours and change poor ones  For community and national policy makers: general emphasis on good health, the availability of information to help people develop and maintain healthy lifestyles, and the availability of resources, conditions, and facilities that can help people change poor health habits  The mass media: can contribute to health promotion by educating people about health risks posed by certain behaviours such as smoking or excessive alcohol consumption  Legislation: contributes through mandating certain activities that may reduce risk, such as use of child restraining seats and seat belts and banning smoking in public places Why are Health Behaviours Important?  In Canada in the past 70 years the pattern of disease has changed from acute infectious disorders to preventable disorders (lung cancer, cardiovascular disease, alcohol and other drug abuse)  Nearly half the deaths in Canada are caused by modifiable behaviours  Cancer deaths could be reduced by 50% by getting people to avoid smoking, eat more fruits and vegetables, boost physical activity, protect self from the sun, tell doctor when health changes, handle hazardous material carefully, and obtain early screening for breast and cervical cancer What are health behaviours?  Health behaviours: behaviours undertaken by people to enhance or maintain their health. Poor health behaviours are important not only because they implicated in illness but also because they may easily become poor health habits  Health habits: health related behaviour that is firmly established and often performed automatically o Usually developed in childhood o Stabilize around 11 or 12 o Highly resistant to change  Study by Belloc and Breslow: defined important good health habits (having a good sleep, not smoking, eating breakfast, no more than one or two drinks each day, regular exercise, no eating between meals, being no more than 10% overweight) o They asked 7,000 country residents to indicate which of the behaviours they practiced and indicate how many illnesses they had had over a 6-12m period o They found that the more good health habits a person has, the fewer illness they had o A follow-up of these people 9-12yrs later found that mortality rates were dramatically lower for people practicing the seven health habits  Primary prevention: taking measures to combat risk factors for illness before an illness ever has a chance to develop o 2 strategies of primary prevention: o 1. Employ behaviour-change methods to get people to alter their problematic health behaviours o 2. Keep people from developing poor health habits in the first place What factors influence the practice of health behaviours?  Socio-economic factors: health behaviours differ according to demographic factors o Younger, more affluent, better educated people under low levels of stress with high levels of social support typically practise better health habits than people under higher levels of stress with fewer resources such as low in social class  Age: health habits are good in childhood, deteriorate in adolescence and young adulthood and improve again among older people  Gender: girls eat more nutritious foods than boys, but engage in unhealthier dieting. Girls are less likely to engage in sports  Values: exercise among females differ greatly across cultures as it varies if it is considered desirable  Personal control: believing that you are able to control your health predicts better health habits o Health locus of control: measures the degree to which people perceive themselves to be in control of their health, perceive powerful others to be in control of their health, etc  Social influence: peer pressure leads to smoking in adolescence, but the opposite is true for adulthood. Media may also influence health behaviours  Personal goals: if fitness or athletic achievement is an important goal they are more likely to be physically active  Perceived symptoms: if you are doing something bad for your health and you believe you are experiencing adverse health effects you are more likely to alter and improve that behaviour  Access to health care services: health behaviours linked to access to health care services include: screening programs, pap smear, mammograms, immunizations, lifestyle advice from a physician  Place: where someone lives can affect their health behaviours. Living in a rural area makes it difficult to follow through with health care behaviours due to the limited access to health care services  Cognitive factors: belief that certain health behaviours are beneficial. Being less health conscious and thinking less about the future can lead to unhealthy behavioural choices Barriers to modifying poor health behaviours: once health habits are ingrained they are difficult to change. People often have little immediate incentive to practising good health behaviour.  Health habits develop during childhood and adolescence; smoking and drinking show little immediate health detriments and children and adolescence aren’t generally concerned about their future health  Unhealthy behaviours can be pleasurable, automatic, addictive, and resistant to change; thus people find it too difficult to change their health habits because they bad habits are enjoyable Instability of health behaviours: health habits are unstable over time  Different health habits are controlled by different factors (smoking being related to stress and exercise dependent upon ease of access to sports equipment)  Different factors may control the same health behaviour for different people (for one person overeating may be a social thing and they only eat when others are around, for someone else it may be caused by tension and they may overeat when stressed)  Factors controlling health behaviour may change over time. The initial behaviour may be caused by something no longer significant and new maintaining factors may replace them  Factors controlling the health behaviour may change across a person’s lifetime  Health behaviour patterns, their developmental course and the factors that change them across a lifetime will vary substantially between individuals Interventions with children and adolescents:  Socialization: parents instill habits in their kids that become automatic  As children move to adolescence they may ignore the early training they received from their parents. Adolescents are vulnerable to an array of problematic health behaviours including excessive alcohol consumption, smoking, drug use and sexual risk taking  Using the teachable moment: health promotion efforts capitalize on educational opportunities to prevent poor health habits from developing o Teachable moment: certain times are better than others for teaching particular health practices. Many teachable moments are in early childhood o Identifying teachable moments is crucial as the point in which a person is ready to modify a health behaviour  Closing the window of vulnerability: there is a window for vulnerability for smoking and drug use that occurs in junior high school when students are first exposed to these habits  Adolescent health behaviours influence adult health: precautions taken in adolescence are better predictors of disease after age 45 than are adult health behaviours. o Adolescence may be a highly vulnerable time for a variety of poor heath behaviours that lay the ground work for future problems in adulthood Interventions with at risk people: vulnerable groups include but are not limited to children, adolescence, and people who are at risk for a particular health problem (daughters of women who have had breast cancer)  People do not always perceive their risk correctly and most people are unrealistically optimistic about their vulnerability. Sometimes testing positive for a risk factor leads people into needlessly hypervigilent and restrictive behaviour. They may become defensive and minimize the significance of their risk factor and avoid using appropriate services or monitoring their condition  There are ethical issues in working with at-risk populations as psychological disturbance may be created in exchange for instilling risk reduction behaviours  In many cases there is no successful intervention for genetically based risk factors Health promotion and the elderly: healthy elderly populations are essential for increasing the quality of life of this growing group of citizens now and in the decades to come.  Exercise is one of the most important health behaviors because it helps keep people mobile and able to care for themselves  Participating in social activities, running errands, and other normal activities reduce the risk of mortality  Controlling alcohol consumption is an important target for good health among the elderly. Metabolic changes related to age may reduce the capacity for alcohol and many older people are on medications which may have dangerous interactions with alcohol. Alcohol consumption increases the risk of accidents which can produce broken bones, limit mobility, and further health problems  By age 80 health habits are the major determinant of whether an individual will have a vigorous or an infirmed old age Ethnic and Gender differences in health risks and habits: health promotion programs and guidelines need to take these differences into account.  Alcohol is a greater problem among men and smoking is somewhat greater for non-minority men. Aboriginals smoke 3X more than Canadians in general.  Aboriginals are less likely to exercise regularly and are more likely to be overweight. South Asians and Chinese may have more dangerous abdominal fat than Europeans with the same total amount of body fat Attitude Change and health behaviour:  Educational appeals: make the assumptions that people will change their health habits if they have correct information. Suggestions for the best ways to persuade people through educational appeals: 1. Communications should be colorful and vivid and if possible, they should use case histories 2. The communicator should be expert, prestigious, trustworthy, likable, and similar to the audience 3. Strong arguments should be presented at the beginning and end of a message (not the middle) 4. Make the messages short, clear, and direct 5. The message should state conclusions explicitly 6. Extreme messages produce more attitude change, but only up to a point. Very extreme messages do not work 7. For illness detection behaviours, emphasizing the problems that may occur if it is not undertaken will be most effective. For health promotion behaviours emphasizing the benefits to be gained may be more effective 8. If the audience is receptive to changing a health habit then the communication should include only favorable points, but if the audience is not inclined to accept the message the communication should discuss both sides of the matter  Fear appeals: often used as an approach to changing health habits. If people are fearful that a particular habit is hurting their health they will change their behaviour to reduce their fear. Messages that elicit too much fear may undermine health behaviour changes and fear along may not be sufficient to change behaviour Message framing: according to the prospect theory, different presentations of risk information will change people’s perspectives and actions. Messages that emphasize potential problems (loss-framed) should work better for behaviours that have uncertain outcomes (high risk), whereas messages that stress benefits (gain frames) may be more persuasive for behaviours with certain outcomes (low risk) were seen as more convincing when they were gain framed rather than loss framed  People who are approach oriented or who seek to maximize rewards are more influenced by messages that are gain framed  People who are avoidance oriented or who seek to minimize losses are influenced by messages that are loss framed The health belief model: the most influential attitude theory of why people practice health behaviours  Whether a person practises a health behaviour can be understood by 2 factors 1. Whether the person perceives a personal health threat 2. Whether a person believes that a certain health practice will be effective in reducing the threat  Perception of health threat: perception of personal health influenced by general health values (interest and concern ab
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