L11: Health Beliefs

• Health

  A state of physical, mental and social well-being and not merely the absence of disease or infirmity
• Disease

  An interruption, cessation, or disorder of body functions, systems or organs, usually characterised by at least two of: a recognised aetiologic agent(s), an identifiable group of signs and symptoms, or consistent anatomical alterations
• Illness

  The subjective experience of poor health manifesting as physical or psychological symptoms, but can have complex causes including combinations of cognitive and social processes and may or might not reflect an underlying disease
• Determinants of health


  • Non-modifiable factors
  • Modifiable factors
• Attitudes to COVID-19 before and after availability of vaccinations
• Belief

  Something one accepts as true or real; a firmly held opinion
• Sociological vs Psychological theories of beliefs

  • Sociologists (groups): Beliefs, Feelings, Values, Experiences, Meanings
  • Psychologists (individual): Cognition, Affect, Volition
• Types of health behaviours

  • Health behaviour - aimed to prevent disease (e.g. eating healthy diet)
  • Illness behaviour - aimed to seek treatment (e.g. going to see the Doctor)
  • Sick role behaviour - aimed at getting well (adhering to prescribed treatment)
• Health behaviours

  • Behavioural pathogens - health impairing habits (e.g. smoking, excess alcohol)
  • Behavioural immunogens - health protective (e.g. exercise, healthy eating)
• Sources of health advice

  • Popular - most healthcare is in the self-care, self-medication, self-help groups (independent of HCPs), and complementary therapists sectors, rather than the professional healthcare sector
  • Folk
  • Professional
• The symptom iceberg describes that most symptoms are managed in the community without people seeking professional health care

  
• Factors influencing seeking professional healthcare

  • Influence of culture
  • Access to healthcare facilities
  • Lower consultation rate among 'self-medicators'
  • Non-users of self-medication also less inclined to seek medical help for serious illness
• Over the counter medicines sales in the UK in 2020

  • Pain relief (£658,478,047, 2.7% increase)
  • Cough, cold and sore throat (£344,368,375, -28.7% decrease)
  • Vitamins and minerals (£495,164,082, 14.3% increase)
  • Gastrointestinal (£294,473,525, -4.9% decrease)
  • Skin treatments (£198,193,725, -7.3% decrease)
  • Smoking cessation (£139,943,583, -3.4% decrease)
  • Hayfever (£140,690,573, 5.8% increase)
  • Eye care (£73,030,024, -7.4% decrease)
  • Sleeping aids (£57,777,722, 1.2% increase)
  • Other (£227,071,889, -8.2% decrease)
• Acute symptoms may be perceived as more serious e.g. severe abdominal pain, high fever, COVID-19, while many serious diseases do not have striking acute symptoms at onset
• Zola's triggers influencing the timing of seeking medical care

  • Occurrence of an interpersonal crisis (family death)
  • Perceived interference with social or personal relationships
  • Pressure from others to consult (sanctioning)
  • Interference with lifestyle (work, physical activity)
  • Time deadline (if it's not better by Monday..)
• Models of health behaviour and behaviour change

  • Health Belief Model (HBM)
  • Social Cognitive Theory
  • Integrative model of behavioural prediction
  • Reasoned Action Approach (RAA)
  • Theory of Reasoned Action (TRA)
  • Theory of Planned Behaviour (TPB)
  • Stages of Change Model (Transtheoretical model)
  • Fuzzy Trace Theory
  • Theoretical Domains Framework
• Health Belief Model (HBM)

  A model of health behaviour used to explain and predict preventative health behaviour and behavioural response to treatment, with components of perceived susceptibility, severity, costs/barriers, benefits, cues to action, health motivation, and perceived control
• Social Cognitive Theory

  Based on the premise that people learn through their own experience and observation of actions and results of others, affecting their understanding of risks, perceived self-efficacy, expected outcome benefits, health goals, and perceived barriers and facilitators
• Integrative model of behavioural prediction

  Follows social cognitive theory, identifying a set of variables that can account for health related behaviour, including attitude, subjective norm, and perceived behavioural control
• Perceived self-efficacy

  Habits that help people control their health
• Outcome benefits

  Pain, pleasure, wins
• Health goals

  Plans people set themselves, short term (reasonable) goals most successful
• Perceived barriers and facilitators

  Weather & exercise, structure of services in local area
• Social Cognitive Theory (Social learning theory)

  Theoretical approach identifying a set of variables that can account for health related behaviour
• Integrative model of behavioural prediction

  Latest formulation of: The theory of planned behaviour (TPB) Reasoned Action Approach (RAA) and Theory of reasoned action (TRA)
• Integrative model of behavioural prediction

  • Follows social cognitive theory
  • Attempts to link beliefs and attitudes with health behaviour
  • Attitude – stop smoking, more money for holidays
  • Subjective norm – care about what parents think
  • Perceived behavioural control – possible to act on their beliefs
• The integrative model of behavioural prediction takes for granted that peoples behaviour is rational and that behaviour can be described as reasoned
• Stage models of health behaviour (Transtheoretical model TTM)

  Describe how people move through stages as they change their behaviour
• Stage models of health behaviour (Transtheoretical model TTM)

  • A classification system for each stage
  • Ordering of stages (people may move either way)
  • People in the same stage face similar barriers
  • People in different stages face different barriers
• Stages of Change Model (SOC)

  • Pre-contemplation – no intention to change
  • Contemplation – considering making a change
  • Preparation – making small changes
  • Action – actively engaging in a new behaviour
  • Maintenance – sustaining change over time
• There are too many theories of behaviour and behaviour change, selecting from such a large number can be challenging
• Framework of theories

  A synthesis of 33 theories of behaviour and behaviour change clustered into 14 domains; the TDF is a theoretical framework rather than a theory; it provides a theoretical lens through which to view the cognitive, affective, social and environmental influences on behaviour
• Theoretical Domains Framework (TDF)

  A theoretical framework of determinants of behaviour
• TDF domains

  • Knowledge
  • Skills
  • Social/professional role and identity
  • Beliefs about capabilities
  • Optimism/ pessimism
  • Beliefs about consequences
  • Reinforcement
  • Intentions
  • Goals
  • Environmental context and resources
  • Memory, attention and decision processes
  • Social influences
  • Emotion
  • Behavioural regulation
• The COM-B model of behaviour recognises that behaviour is part of an interacting system involving capability, opportunity, and motivation
• Interventions need to change one or more of capability, opportunity, and motivation in such a way as to put the system into a new configuration and minimise the risk of it reverting
• An individual must have adequate capability, opportunity, and motivation for a behaviour (e.g. adherence to medicine-taking) to take place
• The Theoretical Domains Framework (TDF) has been used to understand patient adherence to prescribed medicines, including for homeless patients
• Behavioural determinants of non-adherence identified for homeless patients were mostly related to their homelessness and associated lifestyle
• The Theoretical Domains Framework (TDF) can be used to inform behaviour change interventions and the education of healthcare professionals