HEALTH PSYCHOLOGY

HEALTH: According to WORLD HEALTH ORGANISATION, Health can be defined as a” complete state of
physical, mental and social well being and not merely the absence of disease or infirmity”

WELLNESS: It is the common term that is used to refer to the optimum state of well being where the
individual do not have any illness as well as have a balance between the physical, mental and social
well being.

DISEASE: It can be defined as a state in which the human capacity fluctuates and represents a
deviation from the biomedical standards or normal human conditions. This is a pathological
condition which can be diagnosed with the help of a medical analysis. And it requires MEDICAL
INTERVENTIONS.

According to Boorse there are 7 major themes that are prominent in a DISEASE and they are

[Link], SUFFERING AND DISCOMFORT: Disease is something which causes human suffering by
inflicting pain and discomfort.

[Link] BY PHYSICIANS : Disease is something which requires the attention from a medical
doctor.

[Link] NORMALITY: The statistical normal or the average level of performance of the
population is considered to be normal and anything which lies towards the extremes are considered
to be abnormal or termed as disease.

[Link]: Disease can lead to many forms of disability. Eg: poliomyelitis is a typical example of
disease that can lead to physical deformity.

[Link]: Those individuals who are able to adapt to the environment is considered to be
healthy and those who cannot adapt well to the environment is considered to be diseased.

6. HOMEOSTASIS: A state of homeostasis or bodily equilibrium indicates that the individual is

healthy while the disruptions of the balance in the body indicate that the individual is suffering from
any disease.

[Link]: Disease is undesirable and health is desirable. Thus, health is a social value in human
society.

ILLNESS: Illness can be defined as the presentation of the disease condition so that it limits the
capability of an individual in the society.

1. An illness is a serious disease that can make an individuals capacities impaired hence it is
undesirable.
2. Illnesses requires treatment
3. Illness is a valid excuse for normally criticisable behaviour.

DIFFERENCE BETWEEN ILLNESS AND DISEASE: disease is the medical condition or the problem while
illness is the manifestation of the medical problem or the disability.
COMPREHENSIVE DEFINITION OF HEALTH PSYCHOLOGY: Health psychology is new field which
studies the psychological and social factors which lead to the ENHANCEMENT OF HEALTH,
PREVENTION AND TREATMENT OF ILLNESSES, and the EVALUATION AND MODIFICATION of health
policies which can influence the health care.

Eg: Health psychologist would try to understand why people smoke despite knowing that it might
cause cancer and heart diseases. Understanding this can help the psychologist to design
interventions to help the people stop smoking.

FUNCTIONS OF HEALTH PSYCHOLOGIST

1. HEALTH PROMOTION AND MAINTAINANCE:

Health psychologist would help in the promotion and maintenance of health such as making
children develop good habits, to promote regular exercise in adults, creating media campaign
to help people improve diet.

2. PREVENTION AND TREATMENT OF ILLNESSES.

A health psychologist might teach the people in high stress occupation how to manage stress
and avoid health risks. And also they would work with people who are already ill to help them
follow their treatment regiment/plans effectively.

3. ETIOLOGY AND CORRELATES OF HEALTH, ILLNESS AND DYSFUNCTION.

Health psychologist focus on etiology and correlates of health, illness and dysfunction and they
tries to understand the behavioural and social factors which contribute to health, illness and
dysfunctions such as the Alcohol consumption, smoking (illness), exercise, wearing of
seatbelts(health) etc.

ETIOLOGY refers to the origins and the causes of illnesses.

4. IMPROVE HEALTH CARE SYSTEM AND FORMULATION OF POLICY

Health psychologist would also help in improving the health care system and the formulation of
policies. They tries to understand the level of impact of the health institutions and health
professionals on people’s behaviour and also tries to formulate the policies.

BIOPSYCHOSOCIAL MODEL

BIOMEDICAL MODEL

Earlier individuals considered that the evil spirits and the supernatural elements were the things
which caused the illnesses in humans and the medical community in order to break this
superstitions considered that there was no influence of the MIND in causing the diseases and
they focused on organic factors such as the organic and cellular pathology as the causal factors
of diseases.
 This lead to the development of BIOMEDICAL MODEL. According to the BIOMEDICAL MODEL,
any illness or disease can be explained with the help of SOMATIC BODILY PROCESSES, such as
the imbalances in biochemicals and abnormalities in neurophysiology.

PSYCHOSOMATIC MEDICINE

It was the work of Sigmund Freud with the patients of CONVERSION HYSTERIA which talked
about the importance of mind in the contribution of bodily symptoms. According to him specific
unconscious conflicts can produce physical disturbances.

This lead to the development of PSYCHOSOMATIC MEDICINE.

Flanders Dunbar and Franz Alexander propagated the thought of Freud and developed the
profile of the ulcer prone personality as someone who have excessive needs for dependency
and love. Their works helped in the development of psychosomatic medicine which believed
that certain diseases and disorder were caused due to EMOTIONAL CONFLICTS. Eg: Ulcers,
hyperthyroidism etc.

BIOPSYCHOSOCIAL MODEL

Now researchers believe that any illness or disease is caused by the combination of various
factors such as biological pathogens (such as viral or bacterial infection) , psychological and
social factors (such as high stress , low social support )and other factors.

And this lead to the development of the idea that both MIND and BODY together determine
HEALTH and ILLNESS which is known as the BIOPSYCHOSOCIAL MODEL.

This can include the processes at both the MACROLEVEL (psychological and social processes such
as existence of social support or the presence of depression) AND MICROLEVEL(biological
processes such as cellular disorders or chemical imbalances)

CLINICAL IMPLICATIONS OF BIOPSYCHOSOCIAL FACTORS

This model have great implication for the people who treat and the patients as well. (for the
PRACTITIONER) That is it helps them to understand the interactions between biological,
psychological and social factors in a disease and it can also help in creating a treatment plan
while incorporating all the three aspects.

(FOR THE PATIENT) This establishes an effective patient practitioner relationship and helps the
patient to use the services better.

FIELD OF HEALTH PSYCHOLOGY

After the development of psychology, psychologists were interested in the contribution of psychology
in health. As a result, the American psychological association created a task force which had the aim
of finding out the potential of psychology in health force (1973). As a result of the combined effort
of those who were in already in the field such as the counselling, clinical and rehabilitation
psychologists, as well as the other psychologists such as the developmental, social and community
psychologists lead to the development of health psychology.
CONTRIBUTION OF THE CHANGING PATTERNS OF ILLNESS IN HEALTH PSYCHOLOGY

Earlier it was the acute disorders which were causing the illnesses but nowadays it’s the chronic
illnesses which are causing the major heath concern and this change in pattern of the health
conditions has lead to the development of the field of health psychology.

REASONS:

1. It is the psychological and social factors which majorly lead to chronic illnesses. Example:
smoking lead to the development of cancer and other heart diseases.
2. Chronic illnesses lasts for a very long period of time and hence it can lead to psychological
issues during their management.
3. Chronic illnesses can affect the relationship with a partner or a child.

HOW THE HEALTH PSYCHOLOGIST HELP THEM

1. A health psychologist would help the chronically ill patients to adjust psychologically and
socially to their changing health state and the treatment regimens.
2. Also they help in solving the interpersonal problems in their families due to their illnesses.
3. Health psychologist would also help the patients by developing interventions to help them
to adhere to their treatment plans and regimens.

EXPANDED HEALTH CARE SERVICES

There is an expanded health care services across the globe and it is very expensive as well. Here
also the health psychologist would be very helpful. That is due to increase in the health care
expenses the emphasise of the health psychology is in PREVENTION. Prevention includes modifying
peoples risky behaviours and habits before it becomes an illness.

Also the health psychologist knows what makes the people satisfied or dissatisfied with their health
care thus helping in the designing of a user friendly health care system.

INCREASED MEDICAL ACCEPTANCE

Another major reason of the development of the health psychology is due to the very high medical
acceptance. Especially health psychologists have developed a variety of interventions for health
related problems including MANAGING PAIN, MODIFYING BAD HEALTH HABITS SUCH AS SMOKING
AND CONTROLLING THE SIDE EFFECTS OF TREATMENT.

Some of the interventions which target at the RISK FACTORS have contributed to the decline
in the INCIDENCE of the diseases such as CORONARY HEART DISEASE.

APPROACHES TO HEALTH PSYCHOLOGY

There are mainly four different approaches to health psychology and they are

1. CLINICAL HEALTH PSYCHOLOGY

This refers to the application of the scientific knowledge to clinical questions that arise in the
healthcare setup. It mainly focuses on the PREVENTION AND THE TREATMENT of the health
problems, hence it is the major domain of the clinical psychologists.
METHODS: It is done through behavioural modification and psychotherapy.

ESTABLISHED AND MAINSTREAM: It is the field which is most established and the mainstream of the
four approaches and it also demonstrates the importance of psychological perspective in health,
illnesses and diseases.

ADVANCED: it is the most advanced approach in terms of professionalisation of the health

psychology.

2. PUBLIC HEALTH PSYCHOLOGY

These psychologists would try to find the link between the psychosocial factors and the health at
the POPULATION LEVEL. Their findings are most useful for the EDUCATORS, POLICY MAKERS, AND
HEALTH CARE PROVIDERS in order to promote PUBLIC HEALTH initiatives for the vulnerable groups.

METHOD: They mainly present their data in epidemiological findings.

POPULATION LEVEL: public health psychology is less concerned with individual level treatment and is
more concerned in DISEASE PREVENTION at the population level.

INTERDISCIPLINARY NATURE: public health psychology is the most interdisciplinary field than the
other approaches to health psychology and they draw their inferences from EPIDEMIOLOGICAL
STUDIES, PUBLIC HEALTH, HEALTH COMMUNICATION, HEALTH ECONOMICS AND SOCIOLOGY.

3. COMMUNITY HEALTH PSYCHOLOGY

Community health psychology tries to understand the COMMUNITY FACTORS which contribute to
health and well being. It is concerned with GENERAL HEALTH PROMOTION AND DISEASE
PREVENTION than individual diagnosis and treatment.

FOCUS: this focus on the COMMUNITIES AND GROUPS, working with them together and aiming to
promote health, combat diseases, and make a social change.

ECOLOGICAL PERSPECTIVE: This approach has an ecological in which Individuals are viewed as
embedded within a small system which is in turn embedded within a larger system.

METHODS: they employ COLLECTIVISTIC AND CARING VALUES in their researches and make use of
the concepts such as EMPOWERMENT, JUSTICE, OPPRESSION, COMPASSION( JOCE), ETC. and
mainly conduct ACTION RESEARCH, which tries to gain understandings and knowledge while trying
to make a change.

4. OCCUPATIONAL HEALTH PSYCHOLOGY

Occupational health psychology concerns with the application of the psychological principles in the
occupational setup to improve the quality of WORK LIFE, to PROTECT AND PROMOTE the safety
health and well being of the workers.

PROTECTION refers to INTERVENTION in the work place environment to reduce worker exposure to
work place hazards while PROMOTION refers to INDIVIDUAL LEVEL INTERVENTION which helps the
workers to gain knowledge on how to improve their health and resist hazards in the work
environment.

The major functions of an occupational health psychologist include,

a. Survey of the occupational safety and health

b. Analysing the organisational risk factors for occupational stress, injury and illnesses.
c. The health implications of stressful work.
d. Organisational interventions and programs for the reduction of the occupational stress,
illnesses and injury.

RELATIONSHIPS WITH OTHER PROFESSIONS

 UNIT 2

ILLNESS EXPERIENCE

Definition: Illness experience refers to the LIVED EXPERIENCE of the individual and family with an
illness. (eg: cancer).

It includes, the perceptions and beliefs about that illness and these are SUBJECTIVE and
UNIQUE. ( cancer is a very chronic and pathological illness, it includes lumps in the body)

It includes the PHYSICAL (pain in various parts of the body), PSYCHOLOGICAL( the fear of death
as a result of cancer), SOCIAL( people looking pathetically to the cancer prone patient),
EMOTIONAL( the emotional turmoil the individual have to face as a result of the deterioration
that is happening in the body as a result of the chronic illness) aspects related to an illness.

Also it includes the health and illness behaviours associated with illness(eg: vomiting, etc)

DETERMINANTS OF HEALTH/ILLNESS EXPERIENCE

HEALTH: According to WORLD HEALTH ORGANISATION, Health can be defined as a” complete state of
physical, mental and social well being and not merely the absence of disease or infirmity”

Thus health is NOT simply the absence of any illness but it is the balance of physical, mental and
social well being.

Determinants of health can be divided into 5 categories , ie NUTRITION, LIFESTYLE,SOCIAL

FACTORS, GENETICS and ENVIRONMENT and when any of these determinants becomes weak it
would need a support system and it is the 6th factor, MEDICAL CARE.

It is the interrelationship of these factors that determine the individual health and the
population health.

1. NUTRITION:
i. calorie deficiency, malnutrition, the absence of a proper balanced diet would lead to
various problems including low birth and premature babies.
i. Consumption of saturated and polysaturated fats can lead to obesity, heart diseases
, stroke and other vascular diseases.
ii. Alcohol consumption can lead to various physiological and social after effects. For
example drinking and driving leading to accidents, domestic violence etc.
2. LIFESTYLE: lifestyle including the ways in which the person lives, their working times, food
intake, sleep patterns etc can have a great influence in the way an individual perceive health
and illness.
i. Eg; food and water are the major sources of exposure to both chemical and
biological hazards. Viruses such as hepatitis A and parasites such as trichomonosis
in pigs and cattle can cause diseases.
ii. The changing work job patterns and the irregular sleep patterns are leading to
hypertension and other related disorders.
iii. Consumption of alcohol or tobacco.
iv. Exercise or workout done by individuals.
3. SOCIAL FACTORS: social determinants of health reflects the conditions of the environment
in which the person is BORN, LIVE, LEARN, WORK and AGE.
 i. INCOME AND SOCIAL STATUS: Availability of resources to meet daily needs are
included in this. It is seen that higher income and social status are linked to better
health
ii. Education and job including quality schools and job environment. Low education
levels are linked to poor health, more stress and low self confidence.
iii. Social norms, support and attitudes such as Discriminations. Greater support from
families, friends and communities are linked to better health. Also the customs and
traditions of the families( burari) and communities (trance) also affect the health of
the individual.
iv. Exposure to crime, violence and social disorder.
v. Urbanisation and built environment such as the building or the transportation.
(pollution)
4. BIOLOGY AND GENETICS. Some biological and genetic factors affect specific population more
than others.( GAS family)
i. Age: . For example, older adults are biologically prone to more health problems than
the younger adults.
ii. Sex: men and women suffer from different types of diseases at different ages.
iii. Family history: the family history is whether or not the members of the family have
suffered from any particular disease also determine whether the individual is
vulnerable to that disease. Eg: schizophrenia, breast cancers.
iv. Genetics: sickle cell disease is a common example of genetic determinant of health.
It is a condition that is inherited if both the parents contain that genes.
5. PHYSICAL ENVIRONMENT : the environment in which the person lives also matters.
i. Natural environment such as green space and a pleasant weather is shown to improve
the health and wellbeing of the individual. Whereas a crowded and unhealthy
environment with erratic climatic changes contribute to more health problems.
ii. Also individuals should make sure that they are being provided with safe and clean
drinking water and food supplies.
iii. Air pollution is shown to lead to various respiratory problems such as asthma and lung
diseases.
iv. Apart from the natural environment , the work space and a safe and pleasant schooling
environment should also be present.

ILLNESS BEHAVIOUR/ RECOGNISING AND ATTENDING TO SYMPTOMS.

ILLNESS BEHAVIOUR refers to the way in which the SYMPTOMS are perceived, evaluated and acted
upon by a person who recognises some pain, discomfort and other signs of organic malfunction.

Generally, it is the signs and severity of the disease which determine an individuals illness response.
But contrasting to this, many people would not seek medical help despite the symptoms and signs
being severe and others would see a physician even for trivial health concerns. This clearly
demonstrate that the illness behaviour is not only influenced by the PHYSIOLOGICAL CONDITIONS
but also by the SOCIAL AND CULTURAL FACTORS.

As the individual matures through their life stages they are socialized on how to respond to
ILLNESSES. This includes OBSERVING how others react to similar signs and symptoms of the similar
disorders and diseases.
STAGE 1: SYMPTOM EXPERIENCE.

The illness experience is initiated when the individual recognises that something is wrong
because of the experience of of PAIN, UNEASINESS, DISCOMFORT(PUD). According to Suchman
there are three processes that occur during this stage and they are

i. The physical pain or the discomfort

ii. The cognitive recognition that the physical symptoms of any particular disease is
present.
iii. The emotional response regarding the implications of the illness including the
disruptions to function properly.

1. THE VISIBLITY AND RECOGNISABILITY OF THE SYMPTOM: many symptoms would be having
a striking appearance such as the symptoms of a heart attack, sharp abdominal pain etc.
whereas some of the other disorders would be having little visibility and they require special
checkups for its detection and treatment such as the disease of CANCER.
2. THE PERCEIVED SERIOUSNESS OF THE SYMPTOM AND ITS FAMILIARITY: if the symptom is
familiar and if the person knows why he is having that particular symptom then the patient is
less likely to seek medical care for that symptom but if the symptom is unusual, threatening
and unpredictable , then the patient is more likely to seek the medical care.
3. THE EXTEND TO WHICH THE SYMPTOM DISRUPTS THE FAMILY, WORK AND OTHER SOCIAL
ACTIVITIES: symptoms that are disruptive and which causes inconvenience and difficulties
are more attended to .
4. THE FREQUENCY OF THE APPEARANCE OF THE SYMPTOM : a person is likely to seek help if
he or she feels ill or sick persistently given that all other factors remain constant.

5. THE TOLERENCE THRESHOLD OF THE PATIENT Some individuals have a very high threshold of
pain and discomfort while others have a very low threshold and they seek medical help as
soon as they experience a mild form of discomfort.
6. THE PSYCHOLOGICAL PROCESSES OF THE PATIENT: anxiety and fear can have an impact on
the symptom recognition. That is the anxiety about the illness can cause the person to seek
help immediately while the absence of it would not cause the individual to seek help until
the symptoms become worse.
7. PRIORITIES OF THE PATIENT: individuals can assign varying levels of priority to their health.
Some people would be having a CENTRAL PRIORITY for their health and some others priority
would be FAMILY, WORK etc.
8. COMPETING POSSIBLE OTHER INTERPRETATIONS TO THE SYMPTOMS: people who work
long hours expect to be tired and therefor they are less likely to see tiredness as a symptom
of any illness.

9. AVAILABILITY OF TREATMENT RESOURCES: the COST of the treatment , convenience of the

treatment , and the cultural and social accessibility ( tribes would be facing difficulties to
seek help) of the provider also determine the illness experience.
10. PERSONALITY DIFFERENCES: depending on the differences of the personality the individuals
would notice the signs and symptoms. For instance: the hypochondriacs are more worried
whether any normal bodily symptoms are the indication of any particular disease. Also
neurotics are more likely to notice and report a symptom than non neurotics.
 11. SITUATIONAL FACTORS: people are more attentive to the symptoms when they are in boring
situations and they are less attentive to the symptoms when they are in interesting
situations.
Another example for the situational factor is the MEDICAL STUDENTS DISEASE ( medical
syndrome) that is as the students study an illness, many imagine that they have it.
12. MOOD: people who are in a positive mood rate themselves as healthy, report fewer
symptoms but those who are in negative mood rate themselves as more diseased and
having more symptoms of a disorder. Also, those in negative mood would be PESSIMISTIC
about the relief from their symptoms and would perceive themselves to be more
VULNERABLE to FUTURE ILLNESSES.
13. ILLNESS SCHEMAS: illness schemas refer to the mental structures of knowledge of the
representations of the illnesses. They are mostly acquired through MEDIA, PERSONAL
EXPERIENCE, and FAMILY AND FRIENDS

3 MODELS OF ILLNESS: generally people have three models of their illness and they are,

i. ACUTE ILLNESS: they are the illness which occur for a SHORT DURATION of time and
they do not have long term CONSEQUENCES. Eg: Common cold
ii. CHRONIC ILLNESS: they are illness which occur for LONG DURATION of time and
they have long term CONSEQUENCES. Eg: Heart disease
iii. CYCLIC ILLNESS: they are the illnesses which occur with the symptoms showing in an
alternating fashion. Eg: HERPES

ASSUMPTION OF SICK ROLE

If the individual acknowledges that the signs are the symptoms of any particular illness and if it is
sufficiently WORRISOM, then the individual would take up the SICK ROLE. When an individual takes
up the sick role, then he or she might leave behind all the NORMAL SOCIAL ROLES that they have.

INTRODUCED BY: The concept of sick role was introduced by TALCOTT PARSON in his book , “the
social system” . According to him sickness is a deviant behaviour that is in violation of the role
expectations.

DYSFUNCTION FOR THE FAMILY AND THE SOCIETY: sickness and sick role is considered to be a
dysfunction because when an individual is sick and withdraws from one’s social responsibilities, then
the other members are expected to take up the role of the sick person and this might OVERBURDEN
them.

Also the EQUILIBRIUM of the society would be hampered when the individual members fail to
do their social responsibilities.

SICKNESS AS A FORM OF DEVIANT BEHAVIOUR: Sickness is considered to be a kind of deviant

behaviour , however they are not equivalent to other forms of deviances such as CRIME.
INSTITUTIONS are created in the society to deal with both the kind of behaviours , but criminals are
punished while the sick people are provided with THERAPEUTIC CARE so that they will become well
and return to their normal social roles.
When a person assumes the sick role , the society would ALLOW and EXEMPT two behaviours
respectively. The exemptions are

1. The sick person is EXEMPTED FROM THE NORMAL SOCIAL ROLES.: that is depending on the
nature and severity of the illness, a PHYSICIAN impose the sick role status to an individual
and this would enable the individual to FORGO normal responsibilities.
2. The sick person is NOT held RESPONSIBLE for the illness. Hence the patient is “taken care”
by the family and the medical care professionals.

But however in order to grant all these social exemptions, the patient should take up the following
obligations.

1. The person should be WANTING to get well. That is the patient should not get so accustomed
to the sick role and the lifting of the social responsibilities that the motivation to get well is
surrendered.
2. The sick person is expected to SEEK MEDICAL ADVICE AND COOPERATE WITH MEDICAL
EXPERTS. That is the person who refuses to seek the medical help would create a SUSPICION
that the illness is not LEGITIMATE. Such a refusal would reduce the SYMPATHY of the society
and the people who are surrounding them.

STAGE 3: SEEKING MEDICAL CARE

The individuals after assigning sick role would seek MEDICAL CARE or SELF CARE.

FACTORS: there are many factors which determine the individuals behaviour of seeking medical help
and some of them are,

1. The general physical, political and economic environment,. Eg in a war prone area like
Gaza , the symptoms and the acquisition of the sick role would not cause them to seek
medical help because they know they wont survive if they step out of the home.
2. Characteristics of the health care system including health care policy and resources. Eg : in
a country in which there is no much health care policies and resources people wont seek
medical help and they can go to foreign countries which have better health care facilities to
seek medical help
3. Characteristics of the POPULATION such as AGE, GENDER, ATTITUDES etc.

Concentrating more on the individual level , Dimatteo and Friedman have specified three factors
which influence the individuals decision to seek medical help.

1. THE BACKGROUND OF THE PATIENT: eg men are more reluctant to see a physician and many
of them schedule an appointment only when they are pressurised by their wives. Many a
times men are conditioned to ‘’ tough it out’’ and they feel ashamed to talk about SEXUAL
DYSFUNCTION, DEPRESSION AND PROSTATE ENLARGEMENT.
2. THE PATIENT’S PERCEPTION OF THE ILLNESS: researchers have identified ‘’SOCIAL
TRIGGERS’’ which help them make the judgement that the symptoms needs professional
health care and these triggers are,
i. The interference of the symptoms with the VOCATIONAL AND PHYSICAL ACTIVITIES.
ii. The interference of the symptoms with SOCIAL AND PERSONAL RELATIONS.
iii. TEMPORALIZING OF SYMPTOMOLOGY eg; if im not better by Monday ill call the doc.
iv. Pressure from family and friends.
 3. THE SOCIAL SITUATION: Even for the pain that are related to serious conditions, the situation
matters. Eg: people are more concerned to seek medical help to those symptoms that
develop during the week , rather than on weekends.

THE CONCEPT OF SELF CARE

Self care refers to a broad range of behaviours which includes promoting health( through exercise,
balanced diet, drinking more water), preventing illness(regular checkups, wearing masks to prevent
influenza), detect symptoms of ill health( including using screening tests ) , curing acute and
managing chronic illnesses(including self medication).

Although the term ‘’SELF CARE’’ implies individual behaviour it occurs within a SOCIAL NETWORK
and is influenced by FAMILY, FRIENDS AND CULTURAL NORMS.

Self care is not a new concept and since earliest civilizations people have taken personal measures to
protect their safety and well being however with the advent of the newer technologies and
advancements people rely more on physician to detect and treat their ailments.

SELF HELP MOVEMENT

Since the beginning of 1960’s and 1970’s there has been a change in the way people seek and take
medical facilities and they are,

1. Increase in the ALTERNATIVE MEDICAL PHILOSOPHIES AND CLINICAL APPROACHES that

places primary responsibility for health on the INDIVIDUAL rather than on the
PROFESSIONAL. And these are based on the eastern philosophies such as YOGA ,
MEDITATION etc.
2. Studies have indicated that people who use self care practices REDUCE THE NUMBER OF
VISITS TO THE HOSPITAL and SAVE A LOT OF MONEY THAT IS SPENT ON MEDICAL CARE
AND ON DRUGS.
3. Increased recognition that it is the personal patterns of lifestyle which changes the one’s
HEALTH STATUS and not the advancements in the medical care.

All these have led to the people taking responsibility and involvement in their own health which
came to be known as SELF HELF MOVEMENT.

SELF HELP GROUPS

In the recent years there has been a tremendous growth in the number of SELF HELP GROUPS, which
are the group of individuals who experience a common problem and who come together and share
their PERSONAL STORIES AND KNOWLEDGE to help one another cope with their situation.

SELF HELP GROUPS have been organised around almost every disease, addiction and disability.
PSYCHOLOGICAL TRIGGERS IN SEEKING HELP

A trigger is a stimulus which ELICITS A REACTION. In health psychology trigger can be referred to
something which worsen the symptoms and as a result the patient would seek help.

PSYCHOLOGICAL TRIGGERS CAN BE OF THREE TYPES , THAT IS THE

1. INTERNAL TRIGGERS: internal triggers refers to the strong feeling that arise out of PAST
[Link]: making a doctors appointment after a NEGATIVE experience can trigger
fear.
2. TRAUMA TRIGGERS : trauma triggers refer to strong feelings that arise out of PAST
TRAUMA. Eg: the sound of firecrackers can be a trauma trigger for the veterans of war.
3. SYMPTOM TRIGGER: symptom trigger refers to the condition in which a physical change can
trigger a larger mental health issue. Eg: lack of sleep can lead to symptoms of bipolar
disorder.

Seeking the medical help can be triggered by many factors and some of them are as follows(SEFAC)

1. PERCEIVED SEVERITY OF THE SYMPTOMS : When individuals perceive their symptoms as

severe and disabling then they are more likely to seek medical help. And the perception of
the severity of the symptom would depend upon the pain intensity, the duration of the
symptom etc.
2. COGNITIVE APPRAISAL: it includes how the individual label their symptoms. If the individual
perceive their symptoms as abnormal and uncontrollable they would seek medical help.
3. FEAR AND ANXIETY: fear and anxiety about ones health and its potential consequences of
the symptoms can cause an individual to seek medical help. Particularly the fear of
unknown , fear of serious illness and the fear of worsening of the symptoms can also lead us
to seek help.(mom)
4. PREVIOUS EXPERIENCES: an individuals past experiences with illness, medical care and
treatment can influence the individuals future willingness to rely on the medical care. That is
the positive experiences may increase the individuals confidence in the health care system
while the negative experiences may reduce it and may create barriers in seeking help.
5. CULTURAL AND SOCIETAL NORMS: the social and the cultures would be having certain
stigmas and stereotypes regarding particular medical condition and symptoms and this in
turn can cause the individual to be reluctant to seek help. Eg the stigma and stereotypes
related to sexual disfunctions would make the individuals not take medical help for it.

WAYS TO HELP SOMEONE WHO GETS TRIGGERED

1. BE CURIOUS: learn what is triggering for someone who is around you and try to not cause
pain to them. Also respect each and everyone’s freedom to be not open or be open with
their pace.
2. BE EMPATHETIC AND LISTEN WITHOUT ANY JUDGEMENTS: be a safe space for the people
around you. Avoid taking someone’s behaviour personally nor making negative judgements
about someone’s feelings and behaviour.
3. HELP WITH COPING :ask about the strategies that work for the person to take care of
themselves and encourage the person to spend more time on self care activities.
 4. USE TRIGGER WARNINGS: when creating a content which have potentially triggering stimuli,
then provide a trigger warning before the presentation of the content would give the
vulnerable population some time to be prepared.

COPING STRATEGIES

1. LEARN TO IDENTIFY: consider reactions to past experiences. Observe patterns and

obvious signs of risk to prevent a similar situation.
2. LOOK FOR TRIGGER WARNINGS: trigger warnings can help you understand that the
presented material have triggering content. Eg : sometimes an article will provide a
trigger warning at the start of the piece.
3. MAKE A PLAN TO ADDRESS: create a plan to address the TRIGGERS AND EMOTIONAL
REACTIONS. Also carefully address the triggers and reactions that occur repeatedly,
because each time the emotional reaction would be greater.
4. PRACTICE SELF CARE: prioritise your health care. You can talk to your loved ones, friend
or the therapists about your triggers. Also people can practice MINDFULNESS,
MEDITATION, DEEP BREATHING AND JOURNALING
5. PROBLEM FOCUSED COPING: Confront your stressor directly to find a solution to the
stressor eg: if driving past your hospital gives you the memories of the trauma find
another route.
6. EMOTION BASED COPING: when you cannot eliminate or avoid the trigger, focus on
regulating your reaction to the stressor/ trigger which may reduce its impact. Eg:
meditation can reduce stress , anxiety and depression.
7. COMMUNICATE IF SOMEONE IS TRIGGERING YOU : A person triggering another is
often UNINTENTIONAL. Talk to them about the impact that they are creating on you.
Even after talking , if the person is insensitive to your needs , then keep clear
boundaries.
8. THERAPY: therapies such as the exposure therapy and EYE MOVEMENT
DESENSITISATION REPROCESSING (EMDR) therapy have been useful in addressing
triggers.

DELAY IN SEEKING MEDICAL HELP

According to PACK AND GALLO (1938) delay in help seeking or PATIENT DELAY is the time taken
from the detection of a symptom to the first consultation with a healthcare professional for
that symptom.

According to the study conducted by Safer et al, the patient delay can be can be divided into
three sequential stages. And they are.

1. APPRAISAL DELAY: the time that the patient takes to appraise a symptom as a sign of illness
2. ILLNESS DELAY: the time taken from deciding that a person is ill until deciding to seek
medical help.
3. UTILIZATION DELAY: the time taken by the patient from the decision to take health care until
he or she actually goes to the clinic to use its services.

It was seen that , those patients experiencing severe symptoms and pain and those patients who
have not read about their symptoms had the SHORTEST APPRAISAL DELAY.
Those who had OLD SYMPTOMS had the longest illness delay.

Those who did not worried about the treatment cost, had extreme pain and those who believed
that their illness can be cured had the shortest utilization delay.

FACTORS CAUSING DELAY IN SEEKING TREATMENT (APT LesBian Couple, FIN)

There are several factors which contribute to the delay in illnesses and they are

1. LACK OF AWARENESS: many people may not recognise the symptoms of a health problem
or may underestimate its severity, leading to the delay in seeking treatment
2. PROCRASTINATION: many people would not seek medical help to a problem because of
their busy schedule(officers), competing priorities (house wives), or due to the belief that
the disease would get reduced on its own.
3. TRUST ISSUES: previous negative experiences with a health care provider or a health care
system can cause the individual to lose his /her trust in the medical care system thus the
delay in seeking medical help.
4. LANGUAGE BARRIER: limited proficiency in the language spoken by the healthcare provider
may hinder communication and contribute to the delay in seeking medical treatment.
5. STIGMA: stigmatisation of certain disorder and diseases such as the MENTAL ILLNESS/
SEXUALLY TRANSMITTED DISORDERS , may prevent the individual from seeking treatment.
6. CULTURAL BELIEFS AND PRACTICES: cultural beliefs, norms and practices may influence the
attitudes towards their health care seeking behaviour. Some cultures would prefer more
their TRADITIONAL REMEDIES AND MEDICATION over other treatment methods leading to
the delay in medication
(trance movie)
7. FINANCIAL BARRIER: cost of the healthcare services, lack of medical insurance, or the
concerns about the medical expenses can hinder timely access to the treatment.
UNIT 4: STRESS AND ILLNESS

The concept of stress

DEFINTION: stress can be defined as the circumstance in which TRANSACTIONS leads a person to
PERCEIVE A DISCREPANCY between the physical or psychological DEMANDS of a situation and the
biological, psychological and social resources of the individual.

STRESSOR: Stress is most often caused by a stressor. Stressors are the external stimuli which causes
the stress and it can be physically or psychologically challenging situations and circumstances.

STRAIN: Individuals might have various responses to the perceived stressor. The physiological and
psychological reaction to a stressor is often called STRAIN. People can vary in the amount of strain
that they experience from a same stressor. Eg: for a student the thought of an impeding exam might
be stress provoking while for some other student such an event would be very trivial and wouldn’t
cause any stress.

SOME COMPONENTS OF DEFINITION

1. Resources: it refers to the person’s biopsychosocial resources for coping with the difficult
situations or circumstances. These resources as possessed by the individual would be
LIMITED.
2. Demands: refers to the demand of the resources that the stressor requires.
3. Discrepancy: it refers to a situation in which there is a mismatch between the demands of
the situation and the resources of the person .
4. Transactions: Refers to the continuous interactions between the person and the environment

REAL OR IMAGINED: One of the point here is that the resources, demands, and the discrepancy
between the person and the environment would be either real or imagined. Eg: suppose you wanted
to take an exam and if you are having stress because you have been procrastinating and not prepared
well then the stress is real but if you are worrying despite having good scores in similar previous
exams and being prepared well then the stress is imagined.

THE ROLE OF COGNITIVE APPRAISAL IN STRESS

According to Richard Lazarus the intensity with which we experience a stressor is due to the
cognitive appraisal that we make.

Cognitive appraisal: it refers to the mental label that we give to any potential stressor.

According to him there are two kinds of appraisal, ie the primary appraisal and the secondary
appraisal.

1. PRIMARY APPRAISAL: the primary appraisal will determine whether the stressor poses a
threat or not / the meaning of the stressor.

RESULT: The primary appraisal can lead to the person concluding either the stressor is IRRELEVANT,
IT IS NOT THREATENING OR IT IS STRESSFUL. And it can be made by assessing,

i. HARM/LOSS: it refers to the amount of damage that has already occurred.

ii. THREAT: it refers to the expectation of the future harm
 iii. CHALLENGE: it refers to the situation in which the individual sees a stressor an
opportunity to achieve growth, mastery or profit.

2. SECONDARY APPRAISAL: it refers to determining whether the individual would be able to

COPE UP with the CONSEQUENCES of the event.

RESULT:. That is if we find that our resources are enough to meet the demands of our stressor, then
we might not experience stress. But if we realise that our resources are not sufficient to meet the
demands of the stressor, then we might experience stress.

RESEARCH FINDINGS PROVING THE IMPORTANCE OF APPRAISAL IN EXPERIENCING STRESS

In an early study conducted by SPISMAN et al, the subjects were shown a film depicting an
unpleasant genital surgery. There were three conditions of the independent variable that is the film
was shown in three different sound tracks.

TRAUMA CONDITION: In the first condition, the soundtrack emphasised pain and mutilation.

DENIAL CONDITION: in the second condition, the soundtrack emphasised that the participants are
willing and doing the surgery happily.

INTELLECTUALIZATION CONDITION: in the third condition, the soundtrack gave an anthropological

interpretation of the ceremony.

Thus, in each of the condition the appraisal of the participants was manipulated and the effect of
these manipulation in the amount of stress experienced by them were evaluated.

Results: the subjects/ participants reported that the trauma condition was most stressful. Thus we
can conclude that the cognitive appraisals have an important role in the amount of stress that we
experience.

CHARACTERISTICS OF STRESSFULL EVENTS (USUAL U)

According to Lazarus, some of the characteristics of the life events would cause us to appraise it as
more stressful than other events. And some of such conditions are;

1. SALIENT EVENT: Some of the researchers argue that the stressors which appears in ones
important domain would cause more stress. Eg: for some individuals work environment
would be more important while for some other people, the family would be more important.
2. OVERLOAD: this refers to the fact that a single stressor which appears in the background of
other stressors are appraised as more stressful than the same stressor appearing in
isolation.
3. AMBIGUOUS EVENTS: ambiguous events would not give the any clear idea about the
stressor and thus it would cause the individual to take more time in deciding the COPING
STRATEGY that has to be employed. On the other hand, if the event is clearly defined, then
the person can effectively decide the coping strategy which would in turn reduce the stress
experienced.
4. UNCONTROLLABLE EVENT: those stressors which can be predicted and controlled are
appraised as causing less stress while those events which cannot be predicted and
controlled would cause more stress. Eg: sudden natural calamities.
 5. LIFE TRANSITIONS: those events which determine passing from one life phase to another
phase. Eg: moving to a new community, becoming a parent.
6. UNDESIRABLE EVENT: those events which are undesirable are viewed as more stressful. Eg :
the passing away of a close friend, and the loss of home due to fire.

ACUTE AND CHRONIC STRESS

STRESS RESPONSE: it refers to a cluster of physiological changes that occur when our body is
exposed to a harmful or threatening situation.

TWO TYPES OF STRESS – ACUTE AND CHRONIC

1. ACUTE STRESS: acute stress is a short term stress, something which affects almost everyone
from time to time. It relates to the pressures of the present and near future.
A small amount of acute stress can be helpful, motivating you to keep going and get things
done.
Eg: running late for work, or forgetting an important assignment.

2. CHRONIC STRESS: chronic stress is the stress that builds up when you are exposed to a high
pressure or a highly threatening situation over a long period of time. Once you get into
chronic stress it can result in constant feelings of ANXIETY, DEPRESSION or other symptoms
of stress. (PHYSICAL SYMPTOMS).

GENERAL LEVEL OF ACTIVITY: People who are under chronic stress usually show HIETENED
REACTIVITY when a stressor occurs and their arousal may take more time to return to baseline
levels.

GENERAL ADAPTATION SYNDROME

When the body is exposed to long term stress or the chronic stress it would show a set of
symptoms which is known as GENERAL ADAPTATION SYNDROME. This was initially proposed by
Hans Selye. Hans Selye studied this by subjecting laboratory animals to a variety of stress such as
very high or low temperatures, X rays, insulin injections and exercise over a long period of time.

According to this model, there are 3 stages to the reaction of stress they are,

1. ALARM STAGE/ REACTION: this stage is called so because it would act as an alarm which
indicates the presence of any harmful stimulus. The first stage of the GAS model is
characterised by increased activity of the SYMPATHETIC NERVOUS SYSTEM, readying the
body for a brief emergency situation.
2. RESISTANCE PHASE: if the stressor persists, then people might move on to the next stage
that is resistance. here the sympathetic response declines, but the adrenal cortex secretes
cortisol and other hormones that enable the body to maintain prolonged ALERTNESS, FIGHT
INFECTIONS, HEAL WOUNDS.
3. EXHAUSTION PHASE: after intense and prolonged stress, the body would enter the third
stage that is exhaustion. During this stage the individual is TIRED, INACTIVE and
VULNERABLE because the nervous system and the immune system is no longer having the
energy to sustain their heightened responses.
If the stressor prolongs even after the resistance phase, then the persons ability to adapt to the
stressor reduces and the NEGATIVE CONSEQUENCES of the stress starts to appear.

STRESS ACTIVATES TWO BODY SYSTEMS/ MECHANISMS

1. SAM pathway : SYMPATHETO ADRENO MEDULLARY PATHWAY

2. HPA AXIS: hypothalamus, anterior pituitary gland and adrenal cortex axis.

SYMPATHETO ADRENO MEDULLARY PATHWAY

The sympathetic nervous system prepares the body for any brief emergency STRESS RESPONSE such
as the flight or fight response.

During the alarm phase of the GAS model, the stressors would activate the sympathetic nervous
system hence increasing the secretions of EPINEPHRIN AND NOR EPINEPHRIN which are also
collectively called the CATECHOLAMINES from the adrenal medulla.

When large portions of the sympathetic nervous system gets activated at the same time it would
INCREASE THE BODYS PERFORMANCE ABILITY to do VIGOUROUS MUSCLE ACTIVITY.

Some of the changes which happens in the body during this period is,

1. Increased arterial pressure.

2. Increased heart beat
3. Increased cellular metabolism
4. Increased GLYCOLYSIS in the liver and in the muscles.
5. Increased blood glucose level
6. Increased blood flow to the active muscles and decreased blood flow to the organs such as
the GASTROINTESTINAL TRACT and KIDNEY which are not necessary for rapid motor activity.
7. Increased muscle strength
8. Increased MENTAL ACTIVITY.
9. Increased rate of BLOOD COAGULATION.

HPA AXIS

In the presence of a PROLONGED STRESSOR, the hypothalamus gland in our brain would produce
CRF (corticotropin releasing factor) which would act on the ANTERIOR PITUITARY gland and cause it
to produce ACTH (adrenocorticotropic hormone). This ACTH is released directly into the blood
stream by the pituitary gland. This hormone transported by our circulatory system to the ADRENAL
GLAND that is located on the top of our kidney. ACTH acts on the adrenal cortex and causes it to
produce GLUCOCORTICOIDS which include the STRESS HORMONE called CORTISOL and CORTISONE.

Almost any type of mental or physical stress can greatly enhance the secretions of ACTH and the
subsequent release of the glucocorticoids, often increasing the cortisol up to 20 folds.

FUNCTIONS OF GLUCOCORTICOIDS: the glucocorticoids especially the cortisol helps in GLUCOSE

METABOLISM and increase the blood levels glucose and other nutrients.
Glucocorticoids also help in the RAPID MOBILISATION of the AMINO ACIDS and FATS from their
cellular storage making them available for energy and for the synthesis of other compounds such as
glucose, needed by the MUSCULAR SKELETAL SYSTEM during a stressful situation.

STRESS HORMONE: many of the researchers refer cortisol as the stress hormone and use the level
of cortisol in the blood as an indicator of the stress levels.

ACTIVATION: the HPA axis activates and responds in a slow pace compared to the sympathetic
adrenal pathway but HPA axis becomes a dominant response to PROLONGED and CHRONIC
STRESSORS such as living with an abusive parent or spouse.

MERITS AND DEMERITS of CORTISOL: cortisol helps the body to mobilise the energy to cope up with
a stressful situation but it can have negative impacts when it is present for a long period of time.

CAUSES OF STRESS: MAJOR LIFE EVENTS, DAILY HASSLES AND IMPACT OF DISASTER.

MAJOR LIFE EVENTS

DEFINITION: Life events refer to the MAJOR HAPPENINGS that occur in ones life that require some
amount of psychological adjustments.

SCALE: Two pioneers in research, T.H. Holmes and Rahe proposed that when a person is adjusting to
a changing environment it would cause some amount of stress. They also created an inventory
called the SOCIAL READJUSTMENT RATING SCALE of STRESSFUL LIFE EVENTS by rating the stressful
life events by the amount of change those events cause.

SOME OF THE MAJOR LIFE EVENTS WHICH WOULD CAUSE THE STRESS

1. DEATH OF THE SPOUSE OR LOVED ONE: losing a significant person in one’s life is one of the
most distressing event in one’s life. Sometimes the age of the person who have died can also
create a great impact. The death of an elderly person would not cause as much as stress as
the death of a young member in the family.
2. DIVORCE: the dissolution of a family or a long term relationship can lead to significant
emotional TURMOIL and STRESS. A divorce in the family can have different effects in
different family members. In the case of children, they might move to a new
neighbourhood, left out with new sitters or have to take chores at home.
For the people who have divorced either it would lead to an independence from a highly
negative circumstance or it might create a new situation in which the individual have to
learn to adjust.
3. SERIOUS ILLNESS OR INJURY: being diagnosed with a serious injury or experiencing a major
injury can have profound stress both PHYSICALLY AND EMOTIONALLY.
4. JOB LOSS/ UNEMPLOYMENT: losing ones job or facing unemployment can cause financial
strain and lead to feelings uncertainty and insecurity.
5. FINANCIAL PROBLEM: struggling with debt , bankrupcy or financial instability can be a
significant source of stress for individuals and family.
6. MOVING OR RELOCATION: relocating to a new country or city can disrupt the social
networks, routines and the familiarity with people thus leading to stress
7. MARRIAGE: while marriage is usually considered to be a positive life event, planning and
adjusting to married life can be stressful.
 8. PREGNANCY AND CHILD BIRTH: even though the birth of a child is a joyful event, it can bring
significant changes and challenges particularly for the first time parents.
For the mother it can bring stress during the pregnancy and delivery. The father may worry
about his wife’s and baby’s health. The event of a childbirth can also be a stressful event for
the other children in the family.
9. CONFLICTS IN RELATIONSHIPS.: relationship conflicts whether it be family conflicts, conflicts
within romantic relationships and friendships can cause an immense amount of stress.
10. TRAUMATUIC EVENT: experiencing or witnessing a traumatic event such as terrorist attacks,
violent crimes can lead to acute stress reactions and long term psychological consequences.

HASSLES OF EVERYDAY LIFE

DEFINITION: The minor stressful life events are referred to as daily stress or the DAILY HASSLES. Eg
being struck in the traffic, waiting in a line, doing household chores, having difficulty making small
decisions, and daily conflict.

Even though they are the minor stressful life events they can have a cumulative effect on our health
and well-being.

i. The cumulative effect impact of small stressors may wear a person down leading to
illness.
ii. Such daily hustles may aggravate an individual’s reaction to some other MAJOR LIFE
EVENTS/ CHRONIC STRESSORS which may in turn produce stress/ illness.

HASSLE SCALE: Richard Lazarus and his associates have developed a scale to measure the peoples
experience with daily hustles or potentially harmful events. This instrument is called the HASSLE
SCALE. This scale contains events that range from MINOR ANNOYANCES such as silly practical
mistakes to MAJOR PROBLEMS such as not enough money for food.

UPLIFT SCALE: Most of the researchers also believed that having DESIRABLE EXPERIENCES would
reduce the impact of such daily hassles and make it more bearable and reduce its impact on our
health, because of that they also developed what is known as UPLIFT SCALE. Which contains the
events that bring PEACE, SATISFACTION, AND JOY.

The impact of such daily hustles and uplifts were studied by researchers on MIDDLE AGED ADULTS
using four instruments. They are 1) the hassle scale, 2) the uplift scale, 3) a LIFE EVENT SCALE that
included no desirable events, 4) a HEALTH STATUS questionnaire which contained questions
regarding the various signs and symptoms.

RESULTS: the results found out that HASSLES SCORE AND LIFE EVENT SCORES were related with
HEALTH STATUS. But both the correlations were weak but hassles were more strongly correlated
than the life events were.

They also found out that UPLIFTS scores had NO relation with HEALTH STATUS scores.
IMPACT OF DISASTERS

An individual’s life is often a mixture of NORMATIVE and NON NORMATIVE LIFE EVENTS. Normative
life events refer to those events which take place naturally to many individuals at certain times
during their lives and these events are EXPECTED to occur at particular time in their lives. EG: school
transitions, marriage, child birth, academic stress, death of the parents etc.

Non normative events refer to the RARE and UNEXPECTED events such as DISASTERS, ACCIDENTS or
DISEASES.

TYPES: : disasters can be mainly classified into two types that is the NATURAL and TECHNOLOGICAL
DISASTERS. Natural disasters are the ones which occur without the direct influence of the humans.
But humans may have contributed to the likelihood of such cataclysmic events by changing the
COURSE OF THE NATURE like cutting trees, allowing landscapes to erode etc. Eg: hurricanes,
tornadoes, earthquakes, floods, drought and famine.

Predictability of such natural disasters vary greatly. Eg: the occurrence of an earthquake is highly
unpredictable while most of the volcanic eruptions are easily predictable due to the detectable
seismic changes.

TECHNOLOGICAL DISASTERS: Technological disasters can also be SUDDEN and INTENSE creating a
havoc in the community. Eg: leaking toxic waste dumps, collapsing bridges and dam failures, but also
industrial accidents involving chemical spill.

VICTIMS OF DISASTER:. Some are the direct victims who have experienced the traumatic event
themselves while others are involved indirectly Eg: observing a train collision or losing a family
member in an earthquake.

POST TRAUMATIC STRESS DISORDER

Most of the people who have gone through a disaster is likely to experience PTSD. PTSD is defined as
the patterns of symptoms which follow after a traumatic event and which causes clinically
significant distress or impairment of human functioning.

DIAGNOSIS: a person in order to be diagnosed with PTSD should be repetitively reexperiencing the
traumatic event, should be having distressing recollections of the event, feeling as if the event was
recurring and suffer intense distress at the exposure to INTERNAL and EXTERNAL cues that
symbolise/ resemble an aspect of the traumatic event.

TIME PERIOD: these symptoms should have persisted at least for a month causing significant distress
or impairment of functioning.

MECHANISMS FOR THE EFFECT OF STRESS ON HEALTH: SAM PATHWAY and HPA AXIS.
COPING PROCESS.

DEFINITIONS:

COPING: according to LAZARUS, coping refers to the COGNITIVE AND BEHAVIOURAL EFFORTS to
manage the discrepancy between the resources of the individual and the demands of the situation.

COMPONENTS OF COPING PROCESS: there are several components to the coping process and they
are

1. An individual’s coping with a stressor is determined by the APPRAISAL of the HARM/ LOSS
posed by the stressor.
2. An individual would determine his COPING STRATEGY based on the appraisal of the degree
of CONTROLLABILITY of the stressor.
3. The evaluation of the OUTCOME of their COPING EFFORTS and their expectations for future
success in coping with the stressor.

TYPES OF COPING

1. PROBLEM FOCUSED COPING: this focuses on doing something CONSTRUCTIVE about the
stressful condition that are not HARMING, THREATENING and CHALLENGING to an individual.
Eg: for work related problems people generally use PROBLEM FOCUSED COPING in which
they seek help from others or take direct actions
2. EMOTION FOCUSED COPING: it focuses on the regulation of the emotions that are
experienced due to the stressful event. Eg: for health related problems, people tend to take
EMOTION FOCUSED COPING because in such situation most often problem focused coping
strategies cannot be adopted and the person also have to control their emotions.

Generally, people use both problem focused and emotion focused coping to manage a stressful
event , thus both types of coping are useful.

COGNITIONS AND COPING

COGNITIVE PROCESSING: cognitive processing in coping is defined as the cognitive activities that
help an individual to view an undesirable event in PERSONALLY MEANINGFUL WAY and find ways to
understand THE NEGATIVE ASPECTS of the event and finally reach at a STATE OF ACCEPTANCE.

FINDING MEANING: By finding meaning in a negative experience, individuals would be able to

accept the losses that they experience. This meaning can be found out by focusing on the POSITIVE
IMPLICATION OF THE ILLNESS and by FINDING PERSONAL SIGNIFICANCE in a situation. Eg: due to a
serious illness people have found a new meaning for life and relationships. ( as in the father of
Bhavana in Lollipop movie)

CORE ASSUMPTIONS: According to the COGNITIVE PROCESSING THEORIES, traumatic events can
change the people’s CORE ASSUMPTIONS about themselves and the world. EG: a traumatic event in
which a person do not get any social support would change his/ her cognitive assumption that
he/she can cope up with any stressful situation and that she/ he cannot rely on the world to help
them at any stressful situation.

SOCIAL COMPARISONS: it refers to a process in which people compare themselves with others to
gain better knowledge about themselves. According to social comparison theory, health problems
increase UNCERTAINITY, uncertainty increase DESIRE FOR INFORMATION, and this creates need for
comparison.

DOWNWARD SOCIAL COMPARISON/ DOWNWARD COUNTERFACTUAL THINKING: this has been a

focus of study by researchers in which they found out that those patients who have chronic illnesses
such as rheumatoid arthritis have shown an improvement in mood if they understand that there are
people out there who suffering even worse conditions than them.

CAN INCLUDE LAZARUS COGNITIVE APPRAISAL TOO

COPING STYLE THEORIES

COPIG STYLE: it refers to the characteristic methods that people employ to deal with a threatening
situations. Generally behavioural scientists consider that each of the individual has an CONSISTENT
AND STABLE manner in how they would respond to a threatening situation and how they react to it.

MONITORING PROCESS THEORY/ MONITORING COPING STYLE CONSTRUCT: this construct was
proposed by Miller and according to this there are 2 characteristic ways of dealing with health
threat. These processes are MONITORING and BLUNTING.

MONITORS scan for and magnify the threatening cues while the blunters distract from and
downgrade the threatening information.

REPRESSIVE COPING STYLE AND EMOTIONAL CONTROL: another coping styles that have been
widely studied under health psychology are the repressive coping style and emotional control.

Repressive coping style which is a construct from psychoanalytic theory is based on the defence
mechanism of repression. That is, they are consciously repressing their threatening feelings and
concerns. Eg: those individuals who believe that they are not upset despite the contrary evidence
that they are in great stress This coping style is sometimes also referred to as ATTENTION REJECTION
and REPRESSION SENSITIZATION.

Repressive coping style is associated with poorer disease outcome as researches shows that people
who adopt repressive coping style have increased systolic blood pressure.

EMOTIONAL CONTROL: this coping style is employed by those individuals who EXPERIENCES and
LABELS THE EMOTION but doesn’t express the emotions.

CAUSAL ATTRIBUTION

ATTRIBUTION: it can be defined as the process through which we individuals would try to
understand the cause of others behaviour and sometimes our own behaviour.

People can generally make two kinds of attribution and they are DISPOSITIONAL ATTRIBUTION and
SITUATIONAL ATTRIBUTION.

1. DISPOSITIONAL attribution is the type of attribution in which we try to attribute the

behaviour of others based on his personality traits and characteristics. This is also called as
internal attribution.
 2. SITUATIONAL attribution is the attribution in which we attribute others behaviour to
situational factors and not on their personalities. This is also called as external attribution.

Eg: if an individual finds that his friend is unemployed , then if he attribute it to his laziness, then
it is dispositional attribution. But if he attribute his unemployment to the lack of job
opportunities in his field, then it is referred to as situational attribution.

STRESSED PEOPLE: generally stressed people are likely to make DISPOSITIONAL ATTRIBUTION
rather than situational attribution.

KELLY’S THEORY OF CAUSAL ATTRIBUTION

The theory of causal attribution was proposed by Kelly and according to him people make
attribution on the basis of the already existing beliefs and schemas about how people behave
generally. This knowledge or schema is referred to as CAUSAL SCHEMA and view point came to
be known as CAUSAL SCHEMATA MODEL.

PRINCIPLE OF COVARIATION: he introduced the concept of COVARIATION in order to explain the

attributive behaviour of humans. According to this principle, in order for something to be a
cause of a behaviour, it must be present when the behaviour is present and it must be absent
when the behaviour is absent.

3 EVIDENCES: in order to make attributions, people generally use 3 kind of evidences and they
are

1. CONSENSUS: it refers to the extent to which other people react in a similar way to the same
stimuli.
2. CONSISTENCY: the extent to which the same individual would react in the same way to the
same stimuli in different situations.
3. DISTINCTIVENESS: it refers to the extent to which the same individual would react similarly
to different stimuli/ different situations.

According to Kelly, by using these evidences we make either dispositional/ internal attributions or
situational/ external attribution.

If the consensus and distinctiveness is low and consistency is high , then we make dispositional
attribution. But if all three consensus, consistency and distinctiveness is high, then we tend to make
situational attribution. If consensus and distinctiveness is high and consistency is low, then we tend
to make Circumstantial attribution in which we attribute that behaviour to those combination of
factors which occurred at that particular moment only.

FUNDEMENTAL ATTRIBUTION ERROR: sometimes attributions would lead one of the major error
called FUNDEMENTAL ATTRIBUTION ERROR, in which the observer have a tendency to overestimate
the role of dispositional factors in attribution. Hence correspondence bias can be defined as the
tendency to explain the behaviour of others as stemming from dispositional factors even when the
observer is provided with clear evidences for situational causes. (just like in case of delusion).
EXLANATORY STYLES: WEINERS CAUSAL ATTRIBUTION MODEL & DEPRESSIVE EXPLANATORY STYLE.

DEFINITION: explanatory style can be defined as the way in which a person would narrate about a
specific event in their life. This explanation can either be categorised as POSITIVE (optimistic) or
NEGATIVE (pessimistic).

BERNARD WEINERS CAUSAL ATTRIBUTION MODEL.

Weiner’s attribution model was developed by Weiner for attributing SUCCESS or FAILURE at any
task. Weiner opined that we attribute our success or failure to any one of the following that is luck,
ability , task difficulty and effort.( LATE)

THREE-DIMENSIONAL MODEL: Wiener proposed the 3-dimensional model of attribution for

explaining the process of attribution and the 3 dimensions according to his model are
CONTROLLABILITY, LOCUS OF CONTROL and STABILITY.

1. STABILITY: it refers to whether the INTERNAL cause is STABLE or UNSTABLE, that is whether
it is CHANGEABLE or UNCHANGEABLE. Eg : changeable dispositional causes are mood,
fatigue etc and the unchangeable dispositional causes are personality traits.
2. CONTROLLABILITY: it refers to whether the INTERNAL CAUSE can be controlled or cannot be
controlled. Eg: if a student believes that he has failed the exam because he has not prepared
well and if he have prepared well he would be able do the exam well, then the situation is
under control. But if the student believes that he has failed the exam because he is not
having the ability, then the situation is not controllable.
3. LOCUS OF CONTROL: it refers to whether the behaviour was caused due to external factors
or internal factors. Eg: if the student believes that he has failed the exam due to internal
factors then the MOTIVATION would reduce, but if he believes that he have failed due to
external factors then the MOTIVATION wouldn’t reduce.

PESSIMISTIC AND OPTIMISTIC EXPLANATORY STYLE

PESSISMISTIC EXPLANATORY STYLE: people who generally tend to blame themselves for the
NEGATIVE EVENTS, believe that such events will continue indefinitely. Such events affect many
aspects of their life.

OPTIMISTIC EXPLANATORY STYLE: people who tend to blame others for the negative events believe
that such events will end soon and do not let such events affect too many aspects of their life.

DEPRESSIVE EXPLANATORY STYLE: one of the main reasons for depression is the type of attribution
style that the individuals adopt. That is, they adopt a negative attribution style that is exactly
opposite to the SELF-SERVING BIAS.

That is those individuals with depression would attribute any negative event in their life to the
STABLE INTERNAL CAUSES such as PERSONALITY TRAITS AND CHARACTERS and they attribute the
POSITIVE OUTCOMES in their life to the EXTERNAL UNSTABLE CAUSES such as luck.

SENSE OF CONTROL (FAC)

DEFINITION: a sense of self control refers to the feelings of sufficient CHOICE, FREEDOM and
AUTONOMY that encourages you to feel motivated and act. Eg: those individuals who are suffering
from terminal illness feel a sense of powerlessness of being unable to do anything about it. They also
know that others would not be able to help them as well. Both of these feelings together would be
more painful than the impending death.

According to JULIAN ROTTER, locus of control which is the extend of the control that an individual
have on an situation can be viewed as a continuum with the internal locus of control at one end and
the external locus of control at the other end.

INTERNAL LOCUS OF CONTROL: Those who have internal locus of control believe that he is the one
who is making things happen and the consequences of his behaviour is under his control.

EXTERNAL LOCUS OF CONTROL: Those individuals who are having external locus of control believes
that things happen to him and the consequences of his behaviour are not under his control.

UNDER STRESS: under a stressful situation an individual with low locus of control would show more
EMOTIONAL DISTRESS than an individual who feel more control. Hence if the individuals with low
locus control receive help to increase their perception of control, they can better cope with the
stressor. This can be achieved with the help of the health psychologist by training them to cope up
with the stressor.

LEARNED HELPLESSNESS

DEFINITION: it can be defined as the PASSIVE RESIGNATION produced by repeated exposure to

NEGATIVE EVENTS that are perceived to be UNAVOIDABLE.

Learned helplessness is a CONTROL PROBLEM and it is not a COMPETENCE PROBLEM.

It is a situation in which the humans and animals are expected to experience, PAIN, SUFFERING and
DISCOMFORT without a way to escape it. Eventually the animal will stop avoiding the escape even if
there is a chance to truly escape it.

LEARNING: This phenomenon is called ‘’learned’’ helplessness because it is not something which is
innate but is learned through EXPERIENCES in which the individual would have tried to escape a
difficult situation but has not been able to since then the individual would believe that he would not
be able to escape the situation even if there is a chance to escape.

HELPLESSNESS: That is when the humans and animals feel that they cannot do anything to get out
of a difficult situation they would feel HELPLESS.

EXPERIEMENTS CONDUCTED BY MARTIN SELIGMAN ON LEARNED HELPLESSNESS

Seligman was already working with dogs at that time and testing their responses to electric shocks.

For his experiment, the dogs were placed in a box with two chambers divided by a low barrier. One
chamber had an electrified floor and the other was not.

RESULT: the researchers noticed that when the dogs were placed in the electrified floor, some of
them didn’t even bother to escape from the situation even if it was very easy to jump the low barrier
and escape. It was further understood that those dogs who didn’t jump were the ones who were
previously been given shocks with no escape and those dogs who jumped to avoid the situation were
the ones who have not received such a treatment before.
CONCLUSION: Seligman and colleagues found out that when individuals are exposed to those
situations in which they cannot escape, it would lead to three deficits in humans. they are the
deficits in MOTIVATION, COGNITION AND EMOTION.

COGNITIVE DEFICIT: it refers to the idea that an individual’s circumstances are uncontrollable.

MOTIVATIONAL DEFICITS: refers to the individual’s lack of response to potential methods of

escaping a negative situation.

EMOTIONAL DEFICITS: it refers to the depressive state of the individual which occurs when the
individual is in a negative state which is not under his control.

VICIOUS CYCLE OF LEARNED HELPLESSNESS

Learned helplessness is often a vicious cycle in which the individual would believe that he has the
capability to escape a situation but gradually fails at that task and thus later on he would avoid the
situation which would in turn lead to low achievement and poor grades leading to negative attitude
that he won’t be able to escape a negative situation. This cycle then continues.

Sense of failure -> lack of effort->low achievement/ poor grades->negative attitude->sense of

failure.

SOCIAL RESOURCES AND SUPPORT

Social resources have been seen to have a positive influence in maintaining health and well being
according to health psychology.

Mainly there are three types of social support that are available and they are,

1. PERCEIVED SUPPORT: It is more of an APPRAISAL rather an actual support. In this the

individual would believe that they would receive support when needed.
2. RECEIVED SUPPORT: it is the ACTUAL SUPPORT received by the individual.
3. SOCIAL INTEGRATION: It is concerned with the number of social roles that the individual
has. And a person who have more social relationships would have more DIFFERENTIATED
IDENTITY and the stressful events which are present in one area of life would be less likely to
disrupt the functioning in other areas of life.

KEY COMPONENTS OF SOCIAL SUPPORT:

1. EMOTIONAL SUPPORT: this involves the expression of EMPATHY, CARE, TRUST, AND LOVE
from others.
USE: Emotional support can help the individual cope up with anxiety, stress and other
negative emotions and thus can reduce the health risks.
EG: close friends and family members provide a hope and listening ear.
2. INSTRUMENTAL SUPPORT: this refers to TANGIBLE ASSISTANCE such as the FINANCIAL AID,
TRANSPORTATION, or PRACTICAL HELP with tasks.
USE: Instrumental support can help an individual to access the medical resources without
any problem . Eg : to attend the medical appointments, purchasing food etc.
Eg: providing money to help with treatment expenses.
3. INFORMATIONAL SUPPORT: this involves providing guidance, advice and information
relevant to the health related DECISIONS AND BEHAVIOURS.
 USE: This informational support can help the individual to make INFORMED CHOICES about
their health and well being.
Eg: doctors providing facts about breast cancer and guidance during the treatment phase.
4. APPRAISAL SUPPORT: this refers to the FEEDBACK, AFFIRMATION AND ENCOURAGEMENT
from others regarding one’s thoughts, feeling and behaviours
USE: Appraisal support is helpful for an individual to maintain their confidence and self-
esteem.
Eg: doctors feedback on the cancer patients after the treatment for some months.

LEARNING TO COPE: EFFECTIVE STRESS MANAGEMENT

STRESS MANAGEMENT: it refers to any program of BEHAVIOURAL and COGNITIVE techniques that is
designed to reduce the PSYCHOLOGICAL and the PHYSICAL reactions to any stress. There are several
techniques or stress management methods that are employed to reduce the stress and they are

1. MEDICATION

Two of the major medications that the physicians prescribe when people have stress is
BENZODIAZEPINES and BETA BLOCKERS. Both of these would reduce physiological arousal and
feelings of anxiety.

Benzodiazepines acts by reducing the neural transmission of the neurotransmitters in the CENTRAL
NERVOUS SYSTEM.

Beta blockers acts by reducing blood pressure and anxiety by blocking the activity of EPINEPHRINE
AND NOR EPINEPHRINE in the PERIPHERAL NERVOUS SYSTEM.

ADVANGE OF BETA BLOCKERS OVER BENZODIAZEPINES: beta blockers would cause less drowsiness
than the other because they act on the PNS rather than CNS.

LIMITATION: it might have long term consequences and side effects thus taking medication for
STRESS should be a temporary measure only.

2. BEHAVIOURAL AND COGNITIVE MEASURES.

These are the measures which focus on the individual’s behaviour as well as the persons thinking
process.

i. RELAXATION: Relaxation is a good method to reduce stress because it is the opposite of

stress. And one way through which a person can reduce stress is through PROGRESSIVE
MUSCLE RELAXATION (JPMR) in which the individual would progressively tighten and
relax their muscles in an alternative fashion.

This technique was initially introduced by EDMOND JACOBSON.

 In this technique, the person would first tense the muscle group for 7 to 10 seconds and
then relaxes it for almost 15 seconds simultaneously paying attention to how it feels.
This procedure is repeated for almost 20 to 30 minutes.
This relaxation works best when done in a quiet room and a non-distracting situation.

ii. SYSTEMATIC DESENSITISATION: This is a very effective method to reduce fear and
anxiety. This conditioning of a fear evoking situation with a pleasant condition is referred
to as COUNTERCONDITIONING.

STIMULUS HIERARCHY: one of the important features of this technique is that it uses
stimulus hierarchy in which a list is created which contains the fear evoking situations in
an increasing order of anxiety response.
GRADUAL EXPOSURE: starting with the least anxiety creating situation the individual is
exposed to each of the item in the stimulus hierarchy while giving relaxation training as
well. The therapist would help the individual to move up the hierarchy only when they
can remain relaxed in the current level.

iii. BIOFEEDBACK: This refers to the electromechanical devices which monitor the status of
a person’s physiological processes such as the heart rate, muscle tension etc. This
information regarding one’s own bodily sensations and mechanism would help the
individual to get a VOLUNTARY CONTROL over the bodily processes through OPERANT
CONDITIONING.
Eg: if the individual is trying to reduce the neck muscle tension and the device reports
that their tension has reduced then information would reinforce the person.

Biofeedback have proven useful to treat stress related problems such as headache etc.

iv. MODELING: Through observational learning or through modelling people can learn
fearful responses or other stress related behaviour. Since people are learning such
behaviour through observational learning, such behaviour can also be reduced through
modelling. Eg: if the person relaxes while watching a model calmly perform a series of
activities it can lead to reduce the stress.

v. COGNITIVE RESTRUCTURING: it is the process through which stress provoking thoughts

or beliefs are replaced with more constructive or realistic ones that reduce a person’s
appraisal to such threats.
There are many kinds of irrational beliefs that can ultimately lead to many kinds of stress
and they are:
According to Albert Ellis there are,
a. Can’t-stand-itis thinking in which the person cannot stand certain situations. Eg: I
can’t stand not doing well on a test.
b. Musterbating thinking in which the person places so many ‘musts’ or compulsory
things on themselves. Eg: people must like me or else I’m worthless.

According to Aaron Beck there are other irrational thought processes such as

a. Arbitrary inference: In which the individual would draw conclusions from

insufficient, ambiguous and contrary evidences. Eg: A husband would interpret his
unhappy mood of the wife as arising from something that he did.
 b. Magnification: in which the individual would exaggerate the meaning or the impact
of an event. Eg: recently retired person would exaggerate a diagnosis as a
catastrophe.

vi. COGNITIVE THERAPY: it is a widely used method in cognitive restructuring in which the
clients are made understood that they are not responsible for all the problems that they
encounter and the negative events that they encounter are not catastrophes, and that
their maladaptive beliefs are not logically correct.

This includes variety of methods such as PROBLEM-SOLVING TRAINING and STRESS

INOCULATION TRAINING.

PROBLEM SOLVING TRAINING: in this method the client would discover or invent
effective ways to address a problem in everyday life. In this training they are taught to
watch for a problem, define a problem clearly and generate a variety of POSSIBLE
SOLUTION for the problems and finally decide a solution.

STRESS INOCULATION TRAINING: this involves teaching the clients a variety of methods
or skills to remove the stress. The training involves 3 phases and they are.

PHASE I : in the first phase the individual would learn about the nature of the stress and
how people react to it.

PHASE II: in the second phase the individual would acquire the BEHAVIOURAL and
COGNITIVE skills such as relaxation and seeking social support.

PHASE III: practises the coping skills with actual and imagined stressors.

3. ADDITIONAL TECHNIQUES/ RELAXATION METHODS.

There are other additional techniques like massage, hypnosis and meditation.

i. MASSAGE:

TYPES OF MASSAGE: there are different kinds of massages depending on the PRESSURE
APPLIED, such as those involving soothing strokes and those involving rubbing motion
with moderate force. Infants seem to prefer those massages with light strokes while
adults like to have the massage with more force.

BENEFITS: massage therapy can reduce anxiety and depression. It increases the body’s
production of various hormones such as the OXYTOCIN that decrease blood pressure
and the stress hormone.

ii. MEDITATION: it is a method in the practice of yoga which is beneficial to improve the
physical and mental health and reducing the stress. Individuals whom are practicing
meditation should do it TWICE A DAY sitting upright, comfortable with eyes closed. They
should also repeat a word or a sound called the MANTRA to prevent distraction.
 Practising meditation on a regular basis shown to reduce the blood pressure and
enhance the immune factor.

iii. HYPNOSIS: it is considered to be an altered state of consciousness that is induced by

suggestion and which can also lead to changes in perception such as memory,
perception and behaviour.

SELF HYPNOSIS: people who are easily suggestible can often learn to induce hypnotic
states in themselves through a process which is known as SELF HYPNOSIS. And they
learn self-hypnosis after they have experienced hypnosis under the supervision of a
SKILLED THERAPIST.

STUDIES: studies have shown that hypnosis is effective in stress management but it is
not the best method that is available. Other researches have shown that people who
have received training in hypnosis or those who have practised hypnosis showed
enhanced immune functions.

UNIT 3 :

HEALTH RISK BEHAVIOUR

DEFINITION: health risk behaviour can be defined as those behaviour that would undermine or
harm the CURRENT or FUTURE HEALTH of that individual.

DIFFICULTY IN BREAKING THESE BEHAVIOUR: many of such health risk behaviour are HABITUAL and
ADDITIVE (such as smoking and alcohol consumption), therefor such behaviour are very difficult to
break.
SOLUTION: however, such health risk behaviour can be modified or reduced with the help of with
PROPER INTERVENTIONS. That is by compensating such health risk behaviour by healthy life styles.

CHARACTERISTICS OF HEALTYH RISK BEHAVIOURS

There are several characteristics of health risk behaviour and they are.

1. VULNERABLE PERIOD: Most of the health risk behaviour would develop during that period
of time in the lifespan during which the individual is vulnerable to such behaviour. For
example most of the humans are vulnerable to such behaviour during the ADOLESCENCE. Eg
behaviours such as smoking, drinking, using drugs, engaging in unsafe sex etc.
2. PLEASURABLE: most of such health risk behaviour are pleasurable and enhance the
adolescent’s ability to better cope with the stressful situation. However, such behaviour are
DANGEROUS too. Eg: unsafe driving and using drugs.
3. PATTERN OF DEVELOPMENT: all of this health risk behaviour generally develop when first
the individual is exposed to the behaviour, experiments with it and later engage in it
regularly.

Expose experiment engage in it regularly.

4. SAME UNDERLYING CAUSE: most of such health risk behaviours have the same or similar
underlying causes such as conflicting parents, low self esteem, academic pressure, low IQ,
have temperament issues, low socio economic status, etc.

Underlying causes

Conflicting parents low self esteem

Academic pressure low IQ

Low socio – economic status.

HEALTH PROTECTIVE BEHAVIOUR

DEFINITION: health protective behaviour refers to those behaviour that are performed by the
person, regardless of his or her actual health status, to protect, promote or maintain his or her
health, whether or not the behaviour is really helpful in promoting the health. Eg: Exercising,
vaccination and screening, developing a healthy diet, sleep etc.

MOTIVATIONAL FACTORS: engaging in healthy behaviours would also include the motivational
factors such as the individual’s perception of the threat, the motivation to reduce the unhealthy
behaviour and the attractiveness towards the opposite behaviour.

INCONSISTENCY IN HEALTH PROTECTIVE BEHAVIOURS. : Research results shows three results.

i. Although most of the behaviours of the individuals are stable some of the health
protective behaviours are not stable over time and they can change as well.
 ii. Particular health care behaviours are not strongly linked to each other. Eg: if an
individual is practicing some health care behaviour such as wearing a seatbelt we cannot
ensure that the individual is practising other health care behaviours such as doing
exercise.
iii. Health behaviours are not determined by a single set of attitudes or response
tendencies.

Also, there are many reasons why such health protective behaviours are not constant in an
individual’s life.

LEVELS OF PREVENTIVE MEASURE/ INTERDESCIPLINARY PERSPECTIVES OF HEALTH PROTECTIVE

BEHAVIOUR.

The efforts to prevent illness can be of three types and they are as follows,

i. BEHAVIOURAL INFLUENCE: It includes the health enhancement behaviours. Eg in the

case of the tooth decay, the individual would promote tooth brushing and flossing.
ii. ENVIRONMENMTAL MEASURES: it includes the preventive measures occurring in the
community level in the surrounding environment. Eg: In the case tooth decay, the public
health care officials would support fluoridating the water supplies.
iii. PREVENTIVE MEDICAL EFFORTS: these are the preventive measures which are taken at
the medical level to prevent the disease or the disorders, Eg: in the case of tooth decay,
the dental professional can remove tartar from the teeth and repair the cavities.

MEDICAL LEVEL

ENIVIRONMENTAL/

COMMUNITY LEVEL

PERSONAL/ BEHAVIOURAL LEVEL

TYPES OF HEALTH RELATED BEHAVIOURS.

1. HEALTH DIRECTED BEHAVIOUR: Therse are the observable acts that are undertaken with a
specific health outcome in the mind.
2. HEALTH RELATED BEHAVIOUR: These are the observable acts which have a health
implication but they are not undertaken with a specific health objective in mind.
3. PREVENTIVE HEALTH BEHAVIOUR: these are the actions or the behaviour that the
individuals undertake when a person wants to prevent being in ill or having any problem. Eg:
a mother would take her child for immunization.
 4. ILLNESS BEHAVIOUR: these refers to the actions which are taken by an individual when he or
she experiences the signs and symptoms which are associated with an illness. Eg: a mother
would give her child cough syrup when her child starts to have cough and sneezing.

THEORIES AND MODELS OF HEALTH BEHAVIOUR

1. HEALTH BELIEF MODEL.

The HBM is the model which is having the LONGEST HISTORY of all the theories.

ORIGINAL USE: it was originally used by the social psychologist to PREDICT who would use the
SCREENING TESTS and VACCINATIONS.

ASSUMPTION: according to this model the likelihood that someone would TAKE ACTIONS TO
PREVENT ILLNESS would depend upon the following,

1. PERCEIVED SUSCEPTIBILITY

It refers to the probability that an individual would assigns PERSONAL VULNERABILITY in

developing a particular illness. If an individual have a perceived susceptibility towards a disease such
as cancer, then he or she would ENGAGE IN BEHAVIOURS TO PREVENT IT. Eg: for an individual who
has a perceived susceptibility towards cancer would quit smoking., eat healthy diet, exercise, does
mammogram tests etc

2. PERCEIVED SEVERITY

It refers to perception of the severity of the consequences of developing a particular disease. If the
individual believes that the development of a particular disease has serious consequences then he
or she would engage in PREVENTIVE BEHAVIOURS. Eg: if an individual believes that the
development of the condition of cancer would cause a huge impact on the physical, psychological,
social and other aspects then the individual would take actions to prevent it.

THREAT: the COMBINATION of perceived severity and perceived susceptibility together constitute
threat.

Perceived severity perceived susceptibility

THREAT

3. PERCEIVED EFFECTIVENESS (of health protective behaviour)

It refers to the BENEFITS of engaging in protective behaviour. Eg: individuals who do not believe
that there is a CAUSAL RELATIONSHIP between smoking and cancer would not quit smoking
because they believe that quitting will not PROTECT AGAINST THE DEVELOPMENT OF CANCER.

4. PERCEIVED COST.

It refers to the damge or the LOSSES that as a result of engaging in health protective behaviours.
EXPECTATION: the combination of perceived effectiveness and perceived cost would constitute
expectation.

Perceived effectiveness perceived cost

EXPECTATION

5. CUES TO ACTION

It involves the STIMULI that motivate an individual to engage in the health behaviour. This stimulus
can be either INTERNAL or EXTERNAL. Eg: ANGINA would be an internal cue to initiate an action
whereas spouse’s illness, death would be an external cue that would lead to adopt health protective
behaviours.

external internal

Motivates

Stimuli engage in health protective behaviour

Some of the recent FORMULATIONS OF HBM have included factors such as SELF EFFICACY, GENERAL
SUSCEPTIBILITY TO ILLNESS, THE VALUE OF HEALTH etc as key factors.

6. MEDIATING FACTORS: some of the mediating factors such as demographic, structural and
social variables have also been studied and have found out that all these factors would
indirectly influence the perceived susceptibility, perceived severity, perceived cost and
perceived effectiveness and would lead to a change in BEHAVIOUR.

2. THEORY OF REASONED ACTION/ PLANNED BEHAVIOUR.

This theory represents SOCIAL PSYCHOLOGICAL APPROACH to UNDERSTANDING AND PREDICTING

the health behaviour.

APPLICATION: This theory has been applied to a wide range of health related behaviours such as
WEIGHT LOSS, SMOKING, HIV etc.

MAJOR CRUX: this theory states that the INTENTION to perform a particular behaviour is strongly
related to the ACTUAL PERFORMANCE.

ASSUMPTIONS: this theory is build upon two basic assumptions and they are,

1. Behaviour is under VOLITIONAL CONTROL: that behaviour occurs mostly as a result of the
wilful decision of an individual.
2. People are RATIONAL BEINGS.
That is, we do certain behaviour because we want to do that and we are doing RATIONAL DECISION
MAKING PROCESS in choosing and planning our actions.

THEORY OF PLANNED BEHAVIOUR: it is a modified version of theory of reasoned action which

includes the ADDITION OF PERCEIVED CONTROL over the behaviour.

GOAL: the major goal of this theory is to PREDICT THE BEHAVIOUR. According to TPA, behaviour is
influenced by the INTENTION TO PERFORM and it is influenced by three variables. And they are
SUBJECTIVE NORMS, ATTITUDES and SELF EFFICACY.

SUBJECTIVE NORM: it refers to an individual’s belief about how the SIGNIFICANT OTHERS of an
individual’s life believe about his or her ability to perform a behaviour. Eg: whether a person would
be able to put down weight would be determined by the individual’s spouse’s belief about that.

ATTITUDE: it refers to the values that are assigned to various health related behaviours. Eg: one
may have an attitude that eating healthy would be a good way to prevent heart diseases.

SELF EFFICACY: it refers to the self confidence that an individual has in successfully performing a
health related behaviour.

All of three variables are in turn influenced by BELIEFS and there are two such kind of beliefs and
they are, NORMATIVE and BEHAVIOURAL BELIEFS. NORMATIVE BELIEFS refers to how much each of
the personal contact approves or disapproves a behaviour. And BEHAVIORAL BELIEF refers to the
belief that performance would lead to certain outcomes.

Normative beliefs

Beliefs

Behavioural beliefs

Subjective norms attitude self efficacy

3. SOCIAL COGNITIVE THEORY

This is BANDURA’S SOCIAL COGNITIVE THEORY which is also referred to as SOCIAL LEARNING
THEORY. This theory apart from the INDIVIDUAL FACTORS also includes the ENVIRONMENT AND
SOCIAL FACTORS in determining one’s health behaviours.
 ENVIRONMENT FACTORS

INDIVIDUAL FACTORS HEALTH BEHAVIOUR

SOCIAL FACTORS

APPLICATION: this theory has been applied to health behaviour to prevent diseases, for promoting
health related behaviours and also to modify the unhealthy behaviours.

EMPHASISE: social cognitive theory emphasis on WHAT PEOPLE THINK and its EFFECT ON THE
BEHAVIOUR.

EXPLANATION: SCT proposes that behaviour can be explained in terms of TRIADIC RECIPROCITY
between the three components which are the PERSON, ENVIRONMENT and BEHAVIOUR. Which
operate as determinants of each other. The BASIC ORGANISING PRINCIPLE of this is RECIPROCAL
DETERMINISM.

RECIPROCAL DETERMINISM: this principle states that there is a CONTINUOS AND DYNAMIC
INTERACTION between the individual, environment and behaviour and a change in any of these
factors would impact the other two factors.

ENVIRONMENT

PERSON BEHAVIOUR

KEY CONCEPTS ASSOCIATED WITH PERSON: the key concepts which are associated with person are
personal characteristics, emotional arousal, behavioural capacity, self-efficacy, expectations,
expectancies, self-regulations, observation/ experiential learning and reinforcements. (BEOS PERS)

1. PERSONAL CHARACTERISTICS: it includes the demographics, personality, cognitive factors,

motivation, skills etc.
2. EMOTIONAL AROUSAL: this refers to an individual’s ability to respond to an emotional
stimuli with various techniques, strategies and activities that help them to deal with the
arousing situation.
3. BEHAVIOURAL CAPACITY: it refers to the possession of both KNOWLEDGE AND SKILLS to
perform a behaviour.
4. SELF EFFICACY: it refers to an individual’s confidence in his or her ability to perform a
behaviour in various situations.
 5. EXPECTATIONS: are the beliefs related with the OUTCOMES of a BEHAVIOUR.
6. SELF REGULATIONS Self-regulation refers to the processes by which individuals control or
direct their thoughts, emotions, and actions to achieve their goals. Individuals use GOAL
SETTING, SELF MONITORING and SELF REINFORCEMENT to regulate their performances.
7. OBSERVATIONAL/ EXPERIENTIAL LEARNING: it refers to the acquisition of a behaviour
through observation and experience.
8. REINFORCEMENT: it refers to the consequences of a behaviour that would cause that
individual to perform that behaviour again.

ASSUMPTION: SCT assumes that most behaviour are learned responses and can be MODIFIED as
well. SCT also emphasis on learning both COGNITIVE AND BEHAVIOURAL SKILLS for coping with
situations and making changes in health behaviour.

EG: an individual who wants to quit smoking but lacks the cognitive and behavioural skills to
effectively cope with the stressful situation without cigarettes is less likely to successfully change
smoking behaviour.

4. TRANSTHEORETICAL MODEL

The TTM is a model of INTENTIONAL BEHAVIORAL CHANGE that has produced a large volume of
research and services across a WIDE RANGE OF PROBLEM BEHAVIOURs.

ADVANTAGES: this model have several advantages,

1. It describe the behavioural change as a process rather than an event. That is by breaking the
change process into different stages and studying which variable is the one that is
contributing strongly in each of these stages, this model provides IMPORTANT TOOLS for
both RESEARCH AND INTERVENTIUON DEVELOPMENT.
2. Its focus on measurement of constructs has provided a strong foundation for the model.

This model describes the relationships among,

1. STAGES OF CHANGE

This states that individual would not change their behaviour all at once. That is, they change it
incrementally or a stepwise stage. And these stages are PRECONTEMPLATION, CONTEMPLATION,
PREPARATION, ACTION, AND MAINTANANCE.

Precontemplation contemplation preparation action maintenance

Also, people would not move in a linear fashion across the stages.

PRECONTEMPLATION: these are the individuals who do not have the intention to change their
problem behaviour within the next 6 months. Some of the individuals would want to change in the
coming future but not in the near future: a life long smoker.

CONTEMPLATION: these are the individuals who are thinking about to change their problem
behaviour within the next 6 months. They might be open to feedback and information about their
problem behaviour.

PREPARATION: they are the people who are committed to change their problem behaviour within
the next 30 days.
ACTION: these are the individuals who have changed their problem behaviour within the past 6
months.

MAINTENANCE: these are the individuals who have changed their problem behaviour for at least 6
months. Their change has become a HABIT and their risk for the relapse of behaviour is low.

2. PROCESS OF CHANGE

It refers to the COGNITIVE, EMOTIONAL, BEHAVIOURAL and INTERPERSONAL strategies and

techniques which are used by the individuals to change their problem behaviour.

The 10 most used processes of change is organised into HIGHER ORDER clusters of processes and
they are EXPERIENTIAL PROCESSES AND BEHAVIORAL PROCESSES.

EXPERIENTIAL PROCESSES: the experiential set of processes are the ones which are used in earlier
stages such as PRECONTEMPLATION, CONTEMPLATION AND PREPARATION.

BEHAVIOURAL PROCESSES: these are the processes that are used in the later stages such as
PREPARATION, ACTION AND MAINTENANCE.

Higher order process/cluster

ORGANISATION

Experiential process behavioural process.

Used in early
Used in later
stages,
stages,
precontemplation
preparation, action
, contemplation
and maintenance.

3. DECISION BALANCE

Decision balance or the PROS AND CONS of the behavioural change and it determine the change of
the behaviour. PROS are the positive aspects of changing the behaviour and the CONS are the
negative aspects of changing a behaviour. That is the individual would change his or her problem
behaviour if the pros are greater than the cons.

The pros of healthy behaviour are LOW IN EARLY STAGES and they become HIGH DURING THE LATER
STAGES OF CHANGE.

INDICATOR: Decision balance is an excellent indicator for the individual to move from the
PRECOMTEMPLATION STAGE.
 4. SITUATIONAL CONFIDENCE AND TEMPTATIONS.

Confidence and temptation both vary across the stages and the confidence usually rises while the
temptation usually decreases. Particularly confidence is the lowest in the precontemplation stage
because the people have LITTLE PERFORMANCE FEEDBACK. And Confidence is higher during the
CONTEMPLATION STAGE.

In the MAINTENANCE STAGE, TEMPTATION is the factor which predicts relapse.

5. OPTIMAL HEALTH MODEL

OPTIMAL HEALTH MODEL is a model which emphasise on PREVENTION through the following
policies.

1. IDENTIFY THE HEALTH CONCERN

2. IDENTIFY THE RISK FACTOR THAT INFLUENCE THAT HEALTH CONCERN
3. RESPOND WITH AN INTERVENTION THAT WOULD PROMOTE THE BEST POSSIBLE HEALTH
OUTCOME FOR THE POPULATION
4. ENCOURAGE THE INDIVIDUALS TO MAKE APPROPERIATE CHANGES THAT WOULD REDUCE
THE HEALTH RISKS.

ADAPATABLE: this model is adaptable to a range of risk behaviours and diseases. it measures the
degree of success by measuring the movement away from the RISK. And this model would be helpful
to PROMOTE OPTIMAL HEALTH FOR ALL.

APPROACH TO LEARN WHAT IS OPTIMUM HEALTH: One of the helpful approaches to understanding
Optimum Health is to acknowledge what it is NOT. We are NOT in Optimum Health if we are
experiencing any one of the following 3:

1. Pain. If you have knee pain, back pain, chest pain, a headache or sore throat, it is
obvious that you are not in Optimum Health.
2. Discomfort. Feeling fatigued, short of breath, overweight, weak, lethargic, sleepy,
hungry, angry, anxious, tired, sad, or having difficulty with walking, bending, stooping
are all types of discomfort that signal a lack of health.
3. Absence of well-being. This is missing something that should be there. Lacking joy,
energy, sexual health, enthusiasm, peace, vitality, fitness, creativity, quality sleep, a
normal mood, or just having a sense that yes, indeed, you are enjoying the most
optimum health possible. Or, it may be more subtle, such as an elevated blood
pressure, blood sugar, cholesterol, or some other surprising test abnormality without
symptoms.

COMPONENTS OF OPTIMUM HEALTH: Optimum health of the body has two major components. And
they are optimum body composition and optimum body function.

1. OPTIMUM BODY COMPOSITION: it refers to the fact that our body composition should be
the balanced and it should not be skewed or out of normal. Eg: if someone have muscle
 deficiency it can result in fatigue and weakness. Or if someone have excess body weight, it
can be a risk of cancer, diabetes etc.

Muscle deficiency fatigue and weakness.

Excess body weight risk for cancer and diabetes.

2. OPTIMUM BODY FUNCTION: Body function is our ability to have normal body processes,
like circulating blood and oxygen to all our tissues, and also the ability for normal body
activities, like running from a burning building.

5. SELF REGULATION MODEL OF ILLNESS / COMMON SENSE MODEL by Leventhal and

colleagues.

SELF REGULATION: Self-regulation refers to the processes by which individuals control or direct their
thoughts, emotions, and actions to achieve their goals.

According to self-regulation theory, behaviour is guided by a motivational system of setting goals,

developing and enacting strategies to achieve those goals, evaluating progress, and revising goals
and actions accordingly.

Motivational system of setting goals

Developing and enacting strategies

to achieve goals GUIDES

BEHAVIOUR

Evaluating progress

Revising goals and actions

USAGE IN HEALTH PSYCHOLOGY: self-regulation models are being used to explain health behaviours
taken to achieve goals of improving health, such as through changes in exercise or diet behaviours,

FEEDBACK: one of the fundamental component in this is FEEDBACK that is appraisal that is received
by the individual in making a change in their behaviour. That this the changes that are bringing
them closer to the goal.

GIST: The commonsense model focuses on cognitions, emotions, and actions elicited in response to
health threats. It gives particular emphasis to individuals’ personal beliefs about illnesses and their
commonsense rules for making health-related decisions.

According to this model (see Figure 3), the perception of health threat cues simultaneously activates
problem-focused self-regulation (efforts to control the health threat itself) and emotion-focused self-
regulation (efforts to manage emotional distress).
 Problem focused self regulation

(efforts to control the health threat itself)

Simultaneously

Perception of a health threat

Emotion focused self regulation.

(efforts to manage the emotional distress that occurs as a

result of the health.)

PROBLEM FOCUSED LEVEL: At the problem-focused level, threatening cues (e.g., symptoms such as
wheezing and difficulty breathing) elicit the activation and development of a cognitive representation
of the health threat. This representation includes beliefs about five attributes: (1) the identity of the
condition, including its label (e.g., asthma) and associated symptoms (e.g., wheezing, shortness of
breath, and dizziness); (2) the cause of the condition (e.g., heredity or exposure to dust mites); (3) its
timeline or duration, which may be acute (short term), cyclical (it comes and goes over time), or
chronic; (4) its consequences (e.g., asthma interferes with one’s ability to play sports); and (5) the
potential for its control or cure (e.g., it can be controlled using inhalers and medication).

These representations would help in the selection of the coping behaviours.

EMOTION FOCUSED LEVEL: at the same time these threatening cues would also cause the
EMOTIONAL RESPONSES such as fear and distress. Eg: the experience of wheezing and breathing
difficulty can evoke feelings of panic

6. THE SOCIAL SUPPORT THEORY OF HEALTH BEHAVIOUR

ASSUMPTION: the social support theory assumes that the SOCIAL RELATIONSHIPS AND NETWORKS
play a very important role in influencing the individual’s health behaviour and outcomes.

And according to this theory those people who perceive themselves as having STRONG SOCIAL
SUPPORT are more likely to adopt healthy behaviour and experience better health outcomes
compared to those who do not have such social support.

KEY COMPONENTS OF SOCIAL SUPPORT:

5. EMOTIONAL SUPPORT: this involves the expression of EMPATHY, CARE, TRUST, AND LOVE
from others.
USE: Emotional support can help the individual cope up with anxiety, stress and other
negative emotions and thus can reduce the health risks.
EG: close friends and family members provide a hope and listening ear.
6. INSTRUMENTAL SUPPORT: this refers to TANGIBLE ASSISTANCE such as the FINANCIAL AID,
TRANSPORTATION, or PRACTICAL HELP with tasks.
USE: Instrumental support can help an individual to access the medical resources without
any problem . Eg : to attend the medical appointments, purchasing food etc.
Eg: providing money to help with treatment expenses.
 7. INFORMATIONAL SUPPORT: this involves providing guidance, advice and information
relevant to the health related DECISIONS AND BEHAVIOURS.
USE: This informational support can help the individual to make INFORMED CHOICES about
their health and well being.
Eg: doctors providing facts about breast cancer and guidance during the treatment phase.
8. APPRAISAL SUPPORT: this refers to the FEEDBACK, AFFIRMATION AND ENCOURAGEMENT
from others regarding one’s thoughts, feeling and behaviours
USE: Appraisal support is helpful for an individual to maintain their confidence and self-
esteem.
Eg: doctors feedback on the cancer patients after the treatment for some months.

NEED : social support have a very important role in the health related behaviours that are performed
by the individuals. Individuals with HIGH LEVEL of perceived social support will have fewer negative
health effects following a stressful life event compared to an individual who has few social support.

ADHERING TO MEDICAL ADVICE

DEFINITION: Adherence OR compliance are terms that refer to the degree to which patients carry
out the behaviours and treatments their practitioners recommend.

Eg: failures to adhere may occur in many forms such as the patients may fail to take medication as
directed, not show up for appointments, skip or stop doing rehabilitation exercises etc.

ASSESSMENT OF PATIENT’S ADHERENCE TO MEDICAL REGIMENS: Researchers assess patient

adherence to medical recommendations in several ways. One of the easiest approaches for
measuring compliance is to ask a practitioner who works with the client to estimate it. The second
methos is to ask the patient about it , but patients generally tend to OVERREPORT their adherence
because they know that they are supposed to adhere to the doctor’s instructions.

As a result, researchers who use these approaches today often supplement them with reports of
family members or medical personnel and with other methods that are more objective.

OBJECTIVE METHODS:

1. PILL/ QUANTITY COUNTING: in which the remaining medication is measured, such as by

counting the number of pills left.
2. MEDICATION RECORDING DISPENSERS: contain mechanical or electromechanical recording
devices that can count and record the time when the dispenser is used.
3. BIO CHEMICAL TESTS: such as of the patient’s blood or urine. This approach can assess
whether medication was used recently.

REASONS FOR THE NON ADHERENCE: there are several factors which influence the patient’s non
adherence to the medical regimens and some of them are,

(1) the illness or regimen:

Some regimens require clients to change longstanding habits—for example, to begin and maintain
exercising regularly, stop smoking cigarettes, or cut down on drinking alcoholic beverages and
patient’s are LESS LIKELY TO ADHERE TO THOSE MEDICAL REGIMENS which change their LONG
STANDING HABITS.
Some treatment regimens are more complex than others—such as by requiring the person to take
two or more drugs, each with its own special instructions

The duration, expense, and side effects of a medical regimen are also factors in people’s adherence
to their practitioner’s advice. That is most of the people who adhere to the medical regimens do so
because they have sufficient income or the insurance to pay for it.

(2) the person : that is characteristics of the person such as the gender, age, psychosocial and socio
cultural factors.

(3) the interactions between the practitioner and patient.

PATIENT PRACTITIONER INTERACTION.

The word ‘‘doctor’’ comes from the Latin “docere”, which means ‘‘to teach.’’ Two features of good
teaching involves,

a. explaining information in a clear and organized fashion

b. assessing whether the learner has learned or understands.

Eg: there are cases in which men has consumed the contraceptive pills that were intended for their
wives. This example clearly illustrates that physicians do not always make sure the patient
understands what they have said. Successful communication in patient–practitioner interactions is
essential if the client is to adhere to the advice.

INADEQUATE COMMUNICATION OF THE DOCTORS WITH THE PATRIENTS

In a research study conducted by BONNIE SVARSTAD, she interviewed patients at a community

health centre, recorded their actual verbal interactions with their physicians, and checked their
medication containers a week later.

The major findings of the study are,

1. The patients’ knowledge about their treatment was deficient. For example, half of them did
not know how long to continue the medication, and many others did not know the
purpose of or the prescribed drugs.
2. The patients’ poor knowledge often resulted from the physicians not providing the needed
information.
3. The clients asked very few questions during the visits.
4. The more explicit the doctors’ directions, the more the people complied, which was
measured by pill counts at the patients’ homes about a week later.

RESULTS: A person’s adherence to medical advice depends on the practitioner’s communicating

information. Good communication takes time and is much more likely to occur when the
practitioner’s style is more patient-centred than doctor.-centred.

INCREASING PATIENT’S ADHERENCE TO MEDICAL REGIMEN

1. MAKING THE PATIENTS PROMISE: that is by making the patient’s promise that they would
abide by the instructions that are provided by the doctor and would take the pills in the
recommended time in the recommended dosage.
 2. MOTIVATIONAL INTERVIEWING: this can be used to identify the benefits and the problems
of not adhering to the regimen.
3. SOCIAL SUPPORT: practitioner or client to recruit constructive sources of social support
from family and friend. Effective social support can also come from self-help and support
groups established to give information and assistance with specific health problems.
4. BEHAVIOURAL METHODS: Several behavioural methods are also useful in enhancing the
patients’ motivation to adhere to their treatment regimens and they are,
a. TAILORING THE REGIMEN: in which activities in the treatment are designed to be
compatible with the patient’s habits and rituals. For example, taking a pill at home
at breakfast or while preparing for bed is easier to do and remember for most
people than taking it in the middle of the day.
b. PROVIDING PROMPTS AND REMINDERS: which serve as cues to perform
recommended activities. These cues can include reminder phone calls for
appointments or notes posted at home that remind the client to exercise.
c. SELF MONITORING: in which the patient keeps a written record of regimen
activities, such as the foods eaten each day.
d. BEHAVIOURAL CONTRACTING: in which the practitioner, the client, and a family
member negotiate a series of treatment activities and goals in writing and specify
rewards the patient will receive for succeeding

MAJOR ADVANTAGE OF THESE BEHAVIOURAL METHODS: A major advantage of these methods is

that the client can become actively involved in their design and execution.

SOURCES OF HEALTH INFORMATION

1. HEALTH EDUCATION FROM MEDICAL INTERACTION: the health education from medical
interactions can include,
a. PRIVATE PRACTITIONER’S OFFICE: Some health information can be received from
psychologists and other practitioners privately on a one-to one basis.
This approach has two major advantages, and they are the individual treatment a
person receives makes success more likely, and second, the intervention can be tailored
to the needs of the particular person.
b. THE HEALTH PRACTITIONER’S OFFICE: Many people have regular contact with a
physician or other health care professional who knows their medical history and can
help them provide information to modify their health habits.
They are highly CREDIBLE SOURCE for getting the information regarding such health
promoting behaviour.
There are also clinical facilities which run to help people stop smoking, change their
diet, and make other healthy lifestyle changes.
This also have some advantages like a number of people can be reached simultaneously,
and there is a direct link from knowledge of a person’s health risks to the type of
intervention that person receives.
2. HEALTH EDUCATION FROM SOCIAL NETWORKS: the health education from social networks
include,
a. FAMILY: for instance, children learn their health habits from their parents and family
members.
 Thus, if behaviour change is introduced at the family level, it would ensure greater
commitment to the behaviour change program and provide social support for the
person whose behaviour is the target.
b. SELF HELP GROUPS: health education can be acquired through self help groups which
would also help in modifying their unhealthy habits.
Self-help groups bring together people with the same health habit problem, and often
with the help of a counsellor, they attempt to solve their problem together.
c. SCHOOL: many of the health education is provided through SCHOOL SYSTEMS. Th e
school population is young, and thus we can inculcate healthy habits through school
promotion.
d. WORKPLACE: Workplace interventions to promote health include on-the-job health
promotion programs that help employees stop smoking, reduce stress, change their
diet, exercise regularly, lose weight, control hypertension, and limit drinking, among
other problems.
e. COMMUNITY BASED INTERVENTIONS: s. A community-based intervention could be a
door-to-door campaign about a breast cancer screening program.
There are several advantage for community based health education. First, such
interventions reach more people than individually based interventions or interventions
in limited environments, such as a single workplace or classroom. Second, community-
based interventions can build on social support for reinforcing adherence to
recommended health changes. For example, if all your neighbours have agreed to
switch to a low-cholesterol diet, you are more likely to do so as well.

3. HEALTH EDUCATION THROUGH MEDIA: health education can be provided through mass
media as well. Mass media campaigns bring about modest attitude change but less long-
term behaviour change. Eg: about covid pandemic.

By presenting a consistent media message over time, the mass media can also have a
cumulative effect in changing the values associated with health practices. Eg: cumulative
mass media messages of ANTISMOKING have had a great impact.

Health information is also provided through automated phone interventions.

INTERNET: Internet provides information and low-cost access to health interventions for
millions of people. Thus, websites for SMOKING CESSATION and other HEALTH HABITS have
been formed.