Community as practice: social representations of community and their implications for health promotion

Health promotion researchers and practitioners have increasingly turned to community-based approaches. Although there has been much work around the diverse understandings of the term in areas such as community psychology and sociology, I am concerned with how such understandings relate directly to community health research and practice. From a discursive perspective ‘community’ is seen as a socially constructed representation that is used variously and pragmatically. However, from a wider view, community can be seen as a matter of embodied practice. This paper draws on social representations theory to examine the shifting constructions of ‘community’, the functional use of those understandings in social life, and the practices that suggest that it is important to attend to their use in particular contexts. Accordingly, the paper argues that meanings of community in the health promotion or public health context must be seen as representations used for specific purposes in particular situations. Furthermore, the broader notion of embodied practice in social life has implications for community participation in health promotion. Copyright © 2007 John Wiley & Sons, Ltd.     

Mental health and welfare transitions: depression and alcohol abuse in AFDC women

From a selection perspective, does prior dysfunction select women into welfare or serve as a barrier to leaving welfare? From a social causation perspective, does entering or exiting welfare lead to changes in well being? These questions were analyzed in panel data for over 3,600 women drawn from the National Longitudinal Survey of Youth for the period 1992–94. Welfare is associated with both depression and alcohol consumption cross‐sectionally. This link appears to derive in small part from selection into welfare by depression (in interaction with marital status), but depression and alcohol abuse did not operate as barriers to leaving welfare. Entering welfare was clearly associated with increased depression and alcohol consumption, but confidence in an apparent beneficial effect on alcohol symptoms of leaving welfare for employment was limited by small sample sizes. These findings are located in the context of the 1996‐welfare reform and the recent economic expansion. One implication is that community psychology should consider welfare entry as a risk factor similar to adverse employment changes such as job loss.     

Health behaviour and attitudes to publicity campaigns for health promotion

Abstract

A sample of 403 members of the public responded to a postal questionnaire concerning their own health behaviour and their attitudes towards health publicity. A principal components analysis of these attitudes revealed three factors, the first of which reflected a tendency to deny the “relevance” of health campaigns. This tendency was higher among those who smoked, took less exercise and had less healthy diets. It is inferred that the direct effects of such campaigns may be impeded by the fact that they appeal most to those people whose own behaviour (from the point of view of health) is in least need of change.     

From health beliefs to self-regulation: Theoretical advances in the psychology of action control

Abstract

The paper reviews the theoretical concepts included in a range of social cognitive models which have identified psychological antecedents of individual motivation and behaviour. Areas of correspondence are noted and core constructs (derived primarily from the theory of planned behaviour and social cognitive theory) are identified. The role of intention formation, self-efficacy beliefs, attitudes, normative beliefs and self-representations are highlighted and it is argued that these constructs provide a useful framework for modelling the psychological prerequisites of health behaviour. Acknowledging that intentions do not translate into action automatically, recent advances in our understanding of the ways in which prior planning and rehearsal can enhance individual control of action and facilitate the routinisation of behaviour are considered. The importance of engaging in preparatory behaviours for the achievement of many health goals is discussed and the processes by which goals are prioritised, including their links to self-representations, are explored. The implications of social cognitive and self-regulatory theories for the cognitive assessment of individual readiness for action and for intervention design in health-related settings are highlighted.     

Conceptualizing ‘social capital’ for health promotion in small local communities: a micro‐qualitative study

This paper reports on a micro‐qualitative case study of peoples' experiences of local community life in a south‐east English town. This material is used as the basis for a critical discussion of the suitability of Putnam's notion of social capital as a conceptual tool for the design and evaluation of ‘community strengthening’ policies and interventions. The study was motivated by a concern that too much debate about social capital has been conducted by academics and policy‐makers in a top‐down manner, with inadequate attention to the realities of life in the local communities that they refer to. Three‐hour semi‐structured interviews were conducted with 37 residents in two less affluent wards in our town of interest. Informants—half men and half women, and spread across the 15–75 age group—were encouraged to talk about their personal experiences of local community life. Interview findings are presented within the ‘norm’ categories of trust, neighbourliness and reciprocal help and support, and the ‘network’ categories of participation in informal networks, voluntary groupings and community activist groupings. Our case study points to a number of ways in which Putnam's concept needs to be refined if it is to inform ‘community strengthening’ policies and interventions in England. Far more notice needs to be taken of the role played by informal networks of friends and neighbours in the construction of local community life. Attention also needs to be given to the complex and shifting geographical spread of peoples' significant social networks. Putnam's conceptualization of cohesive local communities and his unitary notions of trust and local identity may also be unduly essentialist. In our particular communities of interest, they failed to capture the fluidity of local community norms and networks in a rapidly changing society. They also failed to do justice to the extent to which social distinctions—such as age, gender, ethnicity and housing tenure—shape and constrain the way in which people create, sustain and access social capital. Copyright © 2001 John Wiley & Sons, Ltd.     

Social orientations and adolescent health behaviours in Hungary

Adolescent health behaviours are influenced by a variety of social factors, including social orientations, such as social comparison or competitiveness. The main goal of the present study was to investigate the role that these social orientations might play in health behaviours (both health‐impairing and health‐promoting). Data were collected from high school students (N = 548; ages 14–20 years; 39.9% males) in two counties of the Southern Plain Region of Hungary. The self‐administered questionnaires contained items on sociodemographics, such as age, sex, parental schooling, and socioeconomic status (SES) self‐assessment; school achievement, health behaviours, competitiveness and social comparison. Multiple regression analyses suggest that those who scored higher on competitiveness engaged in more substance use, a pattern that was not present for health‐promoting behaviours. Social comparison, however, was associated with lower levels of substance use. In addition, in relation to health‐impairing behaviours, both competitiveness and social comparison interacted with sex; both social orientation variables proved to be more important for boys. Social comparison also contributed to health‐promoting behaviours among boys. Findings support the idea that the role of social orientations, such as competitiveness and social comparison, can be quite different depending on sex and the nature of the health behaviour. While competitiveness may act as a risk factor for substance use among boys, social comparison may act as a protection. It appears that social orientations play less of a role in girls' health‐related behaviours. More focus is needed on gender differences in influences on adolescents' health‐related behaviours.     

Expanding the conceptual range of health self-regulation research: A commentary

Abstract

In contrast to models that endeavor to link human motives to important adjustive outcomes in a largely idealized, lock-step fashion, the theory and research presented in this special issue afford the reader an opportunity to consider the advantages of various “deep structural” conceptions of health self-regulation. I discuss how the present elaborated volitional models can help potentially overcome the “problem of psycho-semanticism”, i.e., the faulty doctrine that mental contents or propositional attitudes cause behavior simply be virtue of what they represent. I also suggest several routes by which self-regulated health-promotion efforts can become derailed, including the inherent fuzziness of many health goals, conflict within the individual's system of goals, and conflicts between the goals of the would-be self-regulator and those of significant others.     

Identity,coping style,and health behaviour among first generation Irish immigrants in England

Abstract

Berry's (1997) framework for acculturation research was used to explore the relationship between identity and health among Irish immigrants in England. One hundred and twelve first generation Irish immigrants completed questionnaire measures of ethnic identity, opportunities for identity expression, generalised coping style, and health behaviour. Significant, though small, positive correlations were observed between identity and health behaviour as predicted. Regression analyses and path analysis were used to present a model of the link between variables. Of particular note were the contrasting ways in which the two dimensions of identity were associated with health behaviour. Participants who positively evaluated their ethnic origins reported engaging in healthier behaviour and adopting more beneficial coping strategies when faced with day-to-day stresses and problems. Participants who reported their ethnic origin as more central to their overall identity were also more likely to adopt beneficial coping strategies. Concomitantly, however, they had fewer than desired opportunities for expressing their ethnic identity which was, in turn, associated with less beneficial coping and health behaviour. In looking for ways to tackle the well-documented health problems of both first and second generation Irish in England, the results suggest that encouragement to feel more positive about their ethnic identity might result in greater usage of behavioural approach coping and, relatedly, to improved health behaviour.     

Psychology,health and health care

This article traces the development of the World Health Organization's emphasis on psychological and behavioural factors in health and notes its encouragement of recognition of these factors by member states. The article further outlines the reasons for this increasing recognition and stresses the important role of psychological and behavioural factors in the maintenance of health and prevention of illness.     

Evaluating complex interventions: Perspectives and issues for health behaviour change interventions

Objective: Health behaviour change interventions (HBCIs), used in health education, health promotion, patient education and psychotherapy areas, are considered complex interventions. The objective of this article is to discuss the value and limitations of using randomised clinical trials (RCTs) to asses HBCIs.

Methods: A scoping review of the literature was conducted to identify the main challenges of using RCTs for evaluating HBCIs. The issues were illustrated by case studies selected from research conducted by our multidisciplinary team.

Results: In complex interventions, effects are produced not only by the intervention, but are strongly linked to context. Issues relating to transferability of results are therefore critical, and require adjustments to the RCT model. Sampling bias, biases related to the experimental conditions and biases due to the absence of double-blindness were examined and illustrated by case studies.

Conclusion: The results underline the importance of a multidisciplinary approach. They call for adapted or alternative evaluation models that overcome the limitations of RCTs.     

Teleonics of health and healthcare: Focus on health promotion

Teleonics is an approach to the study of living systems. The latter can be regarded as synergistic collections of processes through which the systems interact with their internal and external environments. Teleonics can serve as a framework for positioning issues of health into the wider context of the fabric of life. There are essentially three webs of processes that are of relevance for a discussion of healthcare, viz, the normal web of the living fabric (Biomatrix), the “web of disease” (Pathomatrix) and the web of Healthcare. The latter interacts with the first two through the processes of Health Promotion, Disease Prevention and Disease Management. The end result of these interactions is an entirely new web of great complexity that incorporates the processes of all three webs intertwined with each other. This complexity presents a considerable challenge to all those involved in healthcare and can only be untangled with the aid of a process‐based methodology, such as teleonics.     

Family characteristics and health behaviours of adolescents and families

Abstract

The relationship between general family characteristics, represented by family cohesion and adaptability, and health behaviours (smoking, alcohol use, food choice, sleeping, Body Mass Index, and physical activity) is studied in a first study of 429 adolescents and young adults, and in a second study of 522 family triads (adolescent-mother-father). Using cluster analysis, adolescent groups with four different profiles of health behaviour were identified. Very similar results were found in the two studies. The health behaviour patterns in the different subgroups show that forms of (un)desirable health behaviours are interrelated in some clusters. Adolescents in the most healthy clusters, consistently reported highest levels of family cohesion. The relationship between family adaptability and health behaviours showed only limited significance. In families characterised by a high level of emotional bonding between family members together with stability and regularity in roles rules and power structure, adolescents' behaviour is the most healthy. The findings suggest that parental involvement is desirable in health promotion intervention. Further, it seems possible that health behaviours originate from a relatively small set of family Characteristics and that modifying family interactions might be powerful, albeit very difficult to do so, in changing a variety of health behaviours in adolescents.     

Scary warnings and rational precautions: A review of the psychology of fear appeals

Abstract

Research into the effects of fear-arousal on precautionary motivation and action is reviewed. Current models do not adequately distinguish between emotional (i.e., fear arousal) and cognitive (i.e., threat perception) responses to fear appeals and, in general, are not well supported. Evidence suggesting that (i) coping appraisals are more powerful predictors of precautionary action than threat perception and that (ii) fear control processes may interfere with precautionary motivation, recommends cautious and limited use of fear appeals in health promotion. It seems likely that fear arousal is less important in motivating precautionary action than perceptions of action effectiveness and self-efficacy. Moreover, perceived personal relevance may be critical to the emotional and cognitive impact of threat information. Available findings are summarised in the form of a process model that highlights the potential complexity of fear arousal effects. Sequential measurement of fear arousal, other than by self-report, is recommended in studies seeking to clarify these effects.     

Parent-adolescent health conversations as action: Theoretical and methodological issues

Abstract

A qualitative research method based on action theory is proposed and illustrated for use in health psychology and health promotion research. Action refers to the goal-directed and intentional behaviors of individual and groups. Action theory has the advantage of using the perspectives provided by manifest behavior, internal processes, and social meaning in the analysis of action. In this article, the actions under consideration are the health-related conversations of parents and their adolescent children. The approach is premised on an understanding of health promotion as a family task constructed through actions such as conversations between family members. Health conversations in two parent-adolescent dyads are used to illustrate the method. The analysis includes the identification of goals, functional steps, and elements and their relation to the family health promotion project. Specific attention is paid to data gathering and analysis issues and their implications for health promotion research.     

Social cognition models and health behaviour: A structured review

Abstract

A number of social cognition models have been developed to account for socio-demographic variations in health behaviour. This paper distinguishes between: (a) motivational, (b) behavioural enaction, and (c) multi-stage models of health behaviour. The models are evaluated in terms of advancement of existing knowledge and - where appropriate - predictive utility. Common themes that appear within- and between- these categories are discussed, with consideration of ways in which theory may be advanced by future research. Each approach has associated strengths and weaknesses, suggesting that a “consensus” approach to the study of health behaviour may prove fruitful. Identification of the key constructs across different model types would allow coherent integration and promote further understanding of the psycho-social determinants of health behaviour.     

The relationship between religion and cardiovascular outcomes and all-cause mortality in the women's health initiative observational study

Some studies suggest that religiosity may be related to health outcomes. The current investigation, involving 92,395 Women's Health Initiative Observational Study participants, examined the prospective association of religious affiliation, religious service attendance, and strength and comfort from religion with subsequent cardiovascular outcomes and death. Baseline characteristics and responses to religiosity questions were collected at enrollment. Women were followed for an average of 7.7 years and outcomes were judged by physician adjudicators. Cox proportional regression models were run to obtain hazard ratios (HR) of religiosity variables and coronary heart disease (CHD) and death. After controlling for demographic, socioeconomic, and prior health variables, self-report of religious affiliation, frequent religious service attendance, and religious strength and comfort were associated with reduced risk of all-cause mortality [HR for religious affiliation = 0.84; 95% confidence interval (CI): 0.75–0.93] [HR for service attendance = 0.80; CI: 0.73–0.87] [HR for strength and comfort = 0.89; CI: 0.82–0.98]. However, these religion-related variables were not associated with reduced risk of CHD morbidity and mortality. In fact, self-report of religiosity was associated with increased risk of this outcome in some models. In conclusion, although self-report measures of religiosity were not associated with reduced risk of CHD morbidity and mortality, these measures were associated with reduced risk of all-cause mortality.     

社会网络视角下的同伴关系与心理健康

近年来, 从社会网络视角考察同伴关系与心理健康的相互作用正成为发展心理学和健康心理学研究的热点。研究者多借助整体网和纵向数据, 通过两种作用机制, 即选择过程(selection process) (强调心理和行为变量对社会网络和同伴关系的影响, 如关系的形成、维持和解除)和影响过程(influence process) (强调社会网络和同伴关系对心理和行为变量的影响), 来分析同伴关系与心理健康协同演进的动态过程。实证研究关注的领域集中在青少年健康风险行为(如吸烟、喝酒、药物滥用)和情绪问题(如抑郁、焦虑、孤独感)。未来研究应该注重拓展社会网络的类型和样本、加强理论建构、增加对积极心理和消极关系的研究, 并有望在互联网领域及社会网络的生物学基础等方面取得进展。     

Being and feeling liked by others: How social inclusion impacts health

This study examined the effects of perceived and actual social inclusion on health across and within individuals from a network perspective. During the first semester, 75 freshmen students provided bi-weekly ratings on their perceived social inclusion and health. To capture actual social inclusion, each student nominated liked and disliked fellow students. Perceived social inclusion mediated the effect of actual social inclusion on health. Specifically, students with more ‘likes’ perceived more social inclusion and those with higher perceived inclusion reported a better health status (between-person effect). In addition, at time points, when students received more ‘likes’ they also perceived more social inclusion. They reported better health at times when they felt more included (within-person effect). Thus, the perception of social inclusion is rooted in reality and actual social inclusion has an impact on health when passing the filter of perception.     

An exercise in nostalgia: Nostalgia promotes health optimism and physical activity

Objective: Previous research has shown that nostalgia, a sentimental longing for the past, leads to greater feelings of optimism, with other work demonstrating that optimistic thinking (general & health-orientated) is associated with better physical and psychological health. Integrating these two lines of research, the current studies examined whether nostalgia-induced health optimism promotes attitudes and behaviours associated with better physical well-being.

Methods: Participants, in three experiments, were randomly assigned to write about either a nostalgic or ordinary event. Following this, everyone completed a measure of health optimism (Studies 1–3), measures of health attitudes (Study 2) and had their physical activity monitored over the course of 2 weeks (Study 3).

Results: The results revealed that, in comparison to control conditions, nostalgic reverie led to greater health optimism (Studies 1–3). Further, heightened health optimism following nostalgic reflection led to more positive health attitudes (Study 2), and increased physical activity over a two-week period (i.e. Fitbit activity trackers; Study 3).

Conclusions: These findings highlight the importance of nostalgia on health attitudes and behaviours. Specifically, this work suggests that nostalgia can be used as a mechanism to increase the importance, perceived efficacy and behaviour associated with better physical health.     

Integration of five health behaviour models: Common strengths and unique contributions to understanding condom use

The purpose of this research was to select from the health belief model (HBM), theories of reasoned action (TRA) and planned behaviour (TPB), information–motivation–behavioural skills model (IMB) and social cognitive theory (SCT) the strongest longitudinal predictors of women's condom use and to combine these constructs into a single integrated model of condom use. The integrated model was evaluated for prediction of condom use among young women who had steady versus casual partners. At Time 1, all constructs of the five models and condom use were assessed in an initial and a replication sample (n?=?193, n?=?161). Condom use reassessed 8 weeks later (Time 2) served as the main outcome. Information from IMB, perceived susceptibility, benefits, and barriers from HBM, self-efficacy and self-evaluative expectancies from SCT, and partner norm and attitudes from TPB served as indirect or direct predictors of condom use. All paths replicated across samples. Direct predictors of behaviour varied with relationship status: self-efficacy significantly predicted condom use for women with casual partners, while attitude and partner norm predicted for those with steady partners. Integrated psychosocial models, rich in constructs and relationships drawn from multiple theories of behaviour, may provide a more complete characterisation of health protective behaviour.