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Health Psychology

The third of our triad of disciplines relat­ing medicine to psychology is health psychology. It is compatible with psychosomatic medicine and behavioral medicine. A health psychologist is typically involved in preventative medicine and promoting healthy lifestyles. This includes promoting...

–Physical fitness

–Good nutrition and weight control

–Programs to eliminate smoking, alcohol, and chemical abuse

–Accident prevention

–Screening for high blood pressure

–Appropriate medical self-care

–Stress management

–Preventative health care for children

What is the emphasis of health psychology?

Health psychology is important because causes of death have changed greatly over the past century, and now preven­tative measures loom large. A century ago, death was often sudden and unexpected early in life, and the leading cause of death was infection.

People could become ill and die within a few weeks of receiving a cut, if it became infected. Similarly, tuberculosis, polio, smallpox, or malaria were untreatable and could cause death or disability at any early age.

How have typical causes of death changed in the past century? Why does this show a need for health psychology?

In the 21st Century, the leading causes of death before old age all related to behavior and lifestyle choices. These include heart disease, cancer, drug overdoses, and automobile accidents. If people do not engage in risky behaviors, they are likely to live to an old age.

Health psychologists face the challenge of encouraging people to behave in ways that promote longer and healthier lives. Behavioral change can reduce risks such as obesity, smoking, drinking, seat belt use, and texting while driving.

Daniel Kirschenbaum, director of the Center for Behavioral Medicine in Chicago, sketched this scenario shortly after Grateful Dead guitarist Jerry Garcia died in 1995:

Imagine that you're a successful San Francisco physician in 1992, and rock icon Jerry Garcia walks into your office for a physical. After telling the Grateful Dead guitarist that you love his music, the conversation takes a scolding turn. You have to warn him that his smoking, drug dependence, and overeating will kill him within three years (Sleek, 1995).

Would a "scolding" have worked? Very probably not, by itself. But an accurate glimpse into the future might have helped. Every year we have more infor­mation about what factors influence longevity.

Research suggests that interventions making it easier or more convenient to engage in preventative medicine are effective. For example, when insurers offer free preventative care (such as free vaccines and once-a-year blood testing) people are much more likely to take advantage of these preventative health care measures.

What interventions tend to work? How can smartphone apps be useful?

An example of convenience is the existence of smartphone apps for diagnosing skin cancer. The first, a free download for iPhones called UMSkinCheck (from The University of Michigan) was released in 2012. It was followed in 2013 by Mole Detect Pro, followed by Mole Detective and SkinVision, with more following.

At first, even the most accurate apps missed up to 30% of the melanomas diagnosable by experts. However, as usual, the technology is improving over time. The result will be fewer deaths from melanoma as diagnosis is made free and easy.

Similar health benefits come from products that monitor daily exercise, such as FitBit. This increases self-monitoring, a proven behavior change technique.

Users of such products tend to share information about their activities on social media. That is like the idea of gamification discussed on the previous page.

Apps detailing a person's daily exercise will not be entertaining for long, and FitBit may have peaked in 2017. But it has many cheap competitors now, and even if they are no longer new and exciting, such devices will be valuable aides for encouraging exercise.

Abraham and Michie (2008) pointed out that evidence-based research in health psychology requires standardized definitions of tactics used for interventions. Only then can different studies be compared, to see which techniques work best with which populations.

Why is it helpful to have a standard taxonomy of treatment interventions?

To help produce a taxonomy (standard list of categories) for health psychology treatment techniques, Abraham and Michie surveyed 195 published research reports. They identified 26 distinct behavior change techniques in health psychology.

This allowed comparisons of different tactics for achieving the same goal. For example, one common health care goal is to encourage condom use. Abraham and Michie found that 10 distinct techniques had been used to encourage condom use.

Clear trends emerged. Providing "normative arguments" (e.g. pointing out that peers were using condoms at high rates) was effective for those under 21 but not for older people. Fear appeals (pointing out the risk of HIV) were not effective with any audience, probably because everybody already knew this.

Here are the 26 distinct behavior change techniques identified by Abraham and Michie (2008). The word prompt here is used to mean suggest as it is when prompting a behavior.

  1. Provide information about behavior/health link (e.g. mortality risk of behavior)
  2. Provide information on conse­quences (e.g. costs and benefits of action or inaction)
  3. Provide information about others' approval (e.g. what others will think about the person's behavior)
  4. Prompt intention formation (Encour­agement to set a goal, e.g. "I will exercise more next week.")
  5. Prompt barrier identification (Identify impediments to performing a behavior and how to overcome them.)
  6. Provide general encourage­ment (Give non-contingent praise or rewards for effort or performance.)
  7. Set graded tasks (Set easy tasks then increase difficulty.)
  8. Provide instruction (Tell how to perform a behavior.)
  9. Model or demonstrate a behavior (An expert shows what to do, in class or on a video.)
  10. Prompt specific goal setting (Encourage detailed planning: where, when, how, or with whom.)
  11. Prompt review of behavioral goals (Review or reconsider previous goals or actions.)
  12. Prompt self-monitoring of behavior (Request that a person keep a record of specific behaviors.)
  13. Provide feedback on performance (Provide data about recorded behavior.)
  14. Provide contingent rewards (Arrange praise, encourage­ment, or material rewards linked to behaviors.)
  15. Teach to use prompts or cues (Teach people to use cues like time of day to remind them to perform a behavior.)
  16. Agree on behavioral contract (Sign a contract specifying behaviors to be performed.)
  17. Prompt practice (Remind people to rehearse or repeat a behavior.)
  18. Use follow-up prompts (Contact people again after intervention is complete.)
  19. Provide opportunities for social comparison (E.g. arrange group meetings)
  20. Plan social support (E.g. arrange buddy systems)
  21. Prompt identification as a role model (Indicate how a person may be a good example for others; provide opportunities to teach.)
  22. Prompt self-talk (Encourage self-instruction and self-encouragement.)
  23. Relapse prevention (Help people identify and avoid situations likely to cause re-adopting risky behaviors.)
  24. Stress management (Teach general stress-reduction techniques.)
  25. Motivational interviewing (Prompt people to provide self-motivating statements and evaluations of their own behavior.)
  26. Time management (Help the person make time for the behavior.)

Abraham and Michie (2008) not only provided researchers with a handy taxo­nomy for categorizing existing research. They provided beginning students with an unusually complete list of tactics used in the name of health psychology.

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Reference:

Abraham, C. & Michie, S. (2008) A taxonomy of behavior change techniques used in interventions. Health Psychology, 27, 379-387.


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