1. G543 Theories of health belief

2. Theories of Health Belief The main approach in this area is cognitive psychology. It is interested in how people think about health behaviours. There are many compelling and logical arguments for adopting a healthy lifestyle, however many of us choose to ignore them.

3. Task: Explain why some people adopt a healthy lifestyle and why others do not?

4. Health Belief Model Becker & Rosenstock developed this model in 1970. It is based on a cost- benefit analysis.

5. Perceived Seriousness – ‘Will it actually kill me?’ Perceived Susceptibility – ‘Am I likely to get it?’

6. Other factors that affect out decisions are demographic variables such as age, income, sex, occupation, education, family size etc.

7. Becker investigated compliance with a medical regimen for asthma in mothers with asthmatic children. He discovered a positive correlation between a mother’s belief about her child’s susceptibility to asthma attacks and compliance with the medical regimen. Two demographic variables also correlated with compliance: - marital status and education.

8. The study Becker, compliance with a medical regimen for asthma 1976-1977

9. Aim To use the HBM to explain why mother do or do not adhere to a drug regimen for their asthmatic children.

10. Method During the period October 1976 through February 1977, a total of 117 mothers of children previously diagnosed as asthmatic brought their children to the pediatric emergency facility of the Johns Hopkins Hospital for treatment of an asthma attack. These women were requested to cooperate in a study to learn more about the "problems mothers have in taking care of their children's health" and about "worries and problems in dealing with asthma.“ Prior screening assured that only mothers claiming to be responsible for the children's daily care were included in the study. Three subjects declined participation at the outset, and another three chose not to continue their involvement in the research. Consequently, 111 complete interviews were ultimately available for analysis.

11. Method A correlation between beliefs reported during interviews and compliance with self-reported administration of asthma medication. Blood tests were also used to check the validity of the mothers answers

12. Participants 111 (117) mothers responsible for administering asthma medication to their children Aged between 17 – 54 Children aged 9 months to 17 years

13. Procedure Mothers interviewed for 45 minutes Questions asked on the mothers perception s of their child's susceptibility to illness and asthma, how serious they believed asthma to be, how much asthma interfered with the child's education, caused embarrassment and interfered with the mothers activities.

14. Procedure In addition to this the participants were also asked about their faith in doctors and the effectiveness of the medication.

15. Blood samples An evaluation of compliance was also made by drawing blood by finger stick and testing it for the presence of theophylline. Participating physicians sometimes neglected to obtain a blood sample before treatment began. Consequently, such objective verification of compliance was ultimately available only for 80 (72 percent) of the 111 mothers. Their reports of medication administration were compared with laboratory findings for the 80 children; a correlation of 0.913 was obtained, arguing for the validity of the mother's statement as an additional indicator of compliance.

16. Findings Positive correlation between the mothers belief about her child’s susceptibility to asthma attacks and compliance with medical regimen Positive correlation between the mothers perceptions of the child having a serious asthma condition and compliance with medical regimen

17. Findings Negative correlations were caused by disruption of daily activities, inaccessibility of chemists, the child complaining about the medication and the prescribed schedule for administration the medication

18. Findings Two demographic variables were marital status (being married) and education (the higher the education the more likely to comply to the medical regimen)

19. Model for explaining and predicting mothers' compliance with a medical regimen for their asthmatic children General health motivations - General concern about child's health Preventive orientation Perceived Illness threat - General susceptibility to illness - Susceptibility to asthma attacks -Severity of asthma: condition itself -Severity of asthma: interference with social functioning

20. Model for explaining and predicting mothers' compliance with a medical regimen for their asthmatic children Perceived benefits and barriers to compliant behavior - Faith In physicians and medical care - Proposed regimen's efficacy to prevent, cure, or delay asthma attacks - Structure of regimen (disruption, scheduling, and so forth) Will all result in compliance!

21. Conclusion According to Becker the HBM is a useful model to predict and explain different levels of compliance with medical regimens

22. Abstract We examined the perceptions of mothers and children regarding at-home medication use, the most commonly prescribed medical treatment for asthma. Findings provide modest although consistent support for 2 components of the Health Belief Model: Drawbacks and benefits of medication emerged as factors for children's and mothers' perceptions. As predicted, the corresponding parent and child perceptions were significantly related. The more severe the child's asthma, the more benefits and drawbacks child and mother perceived.

23. Questions Why do you think mothers with a partner and a higher level of education were more likely to comply and ensure they administered their child’s medication? (in your booklets)

24. Questions Why did Becker ask the participants their views on each of these different areas? Would you have asked any other questions and if so why?

25. Task Complete the HBM in your booklets and evaluate.

26. Lesson 2

27. Locus of control Rotter’s (1966) theory is a very simple, reductionist theory. Locus of control can be either internal or external. Internal Locus of Control – A belief that you are personally responsible for your own health and can make a difference by changing your lifestyle. External Locus of Control – Your health is in someone else’s hands e.g. Doctors, parents, genes, fate or religion etc.

28. Locus of control James (1965) found that male smokers who gave up and did not relapse had a higher level of internal locus of control than those who did not successfully quit. There was not a significant difference for female smokers who cited factors such as possible weight gain as more influential.

29. Give a definition of locus of control

30. Evaluate LOC

31. Compare LOC to the HBM

32. LOC study Rotter: internal versus external locus of control

33. Develop an idea for researching LOC

34. Sample Initially six pieces of research into individuals perceptions of ability to control outcomes based on reinforcement

35. Findings Participants who felt they had control over the situation were more likely to show behaviours that would enable them to cope with potential threats.

36. Conclusions Rotter concluded that LOC would affect not only health behaviours and other behaviours James et al (1965) was included in the review Found that male smokers who gave up and did not relapse had a higher level of internal LOC No significant difference in female smokers

37. Evaluate this study

38. Self Efficay Bandura (1977) expanded on the locus of control theory which he felt was only concerned with outcomes; self-efficacy is a person’s actual conviction that their own behaviour will make a difference.

39. Self-Efficay Self-Efficacy means how effective a person thinks they will be at successfully adopting a healthly behaviour.

40. Self-Efficay Bandura suggests that there are a number of factors that affect a person self-efficacy: - Previous Experiences – how successful were you in the past e.g. quitting smoking Vicarious experiences – The success of others Verbal persuasion – Others telling you, you can do it Emotional arousal – Too much anxiety (pressure) can reduce a person’s self-efficacy.

41. Task Give examples for each of the four factors above for both success and failure at losing weight.

42. The study Bandura and Adams Analysis of self-efficacy theory on behavioural change

43. Aim To asses the self-efficacy of patients undergoing systematic desensitisation in relation to their behaviour with previously phobic objects

44. Methodology A controlled quasi-experiment with patients with snake phobias

45. Participants Ten snake phobic patients Advertised in a newspaper 9 females 1 male Aged 19 – 57 Mean age of 31

46. Procedure (pre-test) Pre-test assessment, patients assessed for avoidance behaviour towards a boa constrictor Fear arousal tested with an oral rating of 1-10 Finally efficacy expectations (how much they thought they would be able to perform differently with snakes, confidence in ability to change behaviour) All with real snakes.

47. Procedure Systematic desensitisation programme was followed Patients introduced to a series of events involving snakes and at each stage were taught how to relax Relaxation techniques was also completed at home for a further 4 days

48. Post-test assessment Pre-test measures completed again What were these? Why do them again?

49. Findings discuss

50. Conclusions discuss