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.     

Alternative factor structures of health-related psychological tendencies and their relationship to self-reported health seeking behaviors

Abstract

The MHQ-Multidimensional Health Questionnaire (Snell and Johnson, 1997) and a checklist of twenty Health Promoting Behaviors were administered to 1,011 Italian subjects aged 21 to 80 years. The MHQ measures twenty health related psychological tendencies (e.g, Health Efficacy, Locus of Control, Optimistic Expectations). A Principal Components Analysis was carried out on the twenty scales to study their internal structure. Both a four- and a two-factor solution are discussed, presenting different perspectives on the data. The former solution yielded a larger motivational factor, which we labeled Aspiration for Health, and three smaller factors, which we labeled Optimistic Expectations, Internal Control and Lack of Control. All factors, particularly the first one, discriminated self-reported health seeking behaviors. The latter solution yielded a Health Management factor and a Negative Thinking one, both discriminating health behaviors. Moreover, the two factors provide a useful model for distinguishing efficacy, optimism and internal control in terms of their cognitive and affective components.     

Prevalence of mental health problems in Australian university health services

General practice patients report greater mental health problems than the general population, and students attending one university health service have reported greater prevalence rates at the end of the academic year. This study assessed the overall prevalence rate of mental health problems in university students using a cross‐sectional survey design of 1,168 students from three large, predominantly urban, Australian university health services. Approximately half of the students attending university health services reported elevated levels of psychological distress. The majority of severely distressed students had not sought any professional assistance for mental health problems. While there is scope for general practitioners to take a lead role in the identification of mental health problems in tertiary students, adequate treatment pathways need to be available. Implications for the role of universities in prevention work are discussed.     

The interpretation of change in verbal reports: Implications for health psychology

Abstract

This paper raises a number of issues for health psychology in relation to the interpretation of change in verbal reports. Drawing on a typology of change developed to evaluate organisational interventions, it is suggested that change may occur at an alpha level (e.g. changed health status), beta level (e.g. a recalibration of the respondent's scale for assessing health status) or gamma level (e.g. a reconceptualisation of the meaning attached to health). Given the likely presence of beta and/or gamma change in intervention data in health psychology, researchers may be analysing their change data at an inappropriate level. A number of existing methodologies which attempt to detect beta and gamma change are presented and discussed. The need to develop further methodologies which focus more explicitly on the nature of change is highlighted. Finally, the proposed typology has a number of practical implications for the design of health promotion interventions.     

Resistance and adherence to the norms of genetic counseling

Genetic counseling for women of advanced maternal age who are considering prenatal testing continues to be based on a principle of nondirectiveness. We interviewed 11 genetic counseling students and four counselors about how they experience and manage, in practice, the tensions between the ideology of nondirectiveness and the acknowledged reality that one can never be truly nondirective. We found that our respondents creatively resolve this tension—simultaneously resisting and adhering to the values of nondirectiveness and information-giving—in individual and situation-specific ways. This resolution is facilitated by the extent to which information given to counselees is fluid, mobile and context-dependent, but these very features of information also have critical implications for both the norms and the practice of genetic counseling.     

A role for clinical psychology in health care and policy concerning the physical environment

Some persons adversely react to specific environments, while others are impervious or actually thrive. Medical attention often overlooks such sensitivities to the physical environment. Such sensitivities, including phobias and seasonal affectivity, fall within clinical psychology's purview. A theoretical/clinical approach called the Synchronous Systems Model, which defines and uses individual differences in people and in settings, could serve medical health care and policy. When specific people are matched appropriately with specific treatments within the most propitious settings, cost effectiveness and medical efficacy rise. Such documented accountability could make clinical psychologists central to triage of medical services as well as health care policy in these days of the shrinking health care dollar. The Synchronous Systems Model provides theory, supportive data, and clinical assessment devices to strengthen clinical psychology's role in medical settings.     

Crisis for community mental health: The use of groups in the struggle for survival

The task of community mental health is to provide quality services to clients despite funding cutbacks. This paper describes the recent evolution in conceptualization and service delivery in one center. The outcomes are a philosophy that is customer oriented, and treatment that draws upon brief techniques, in group and long term contexts.     

Online mental health resources for adolescents: Overview of research and theory

Adolescents use the Internet at higher rates than any other age group. The Internet therefore offers an obvious opportunity for the provision of mental health information for them. Little is known, however, about adolescent behaviour online, especially access of age‐appropriate mental health resources. This review of the published literature examines theoretical and research studies to develop an understanding of adolescent mental health‐seeking behaviour on the Internet. It is clear that adolescents do seek health information online, but little is known about its content, nature or mode of delivery. There appears to be no research specific to mental health resources for adolescents online.     

Social representations of health and illness: the case of the Chinese community in England

This paper reports results from a qualitative study on social representations of health and illness among the Chinese community in England. It is assumed that representations of health and illness are grounded in cultural frameworks and are constructed through communication, social interaction and the practices of daily life. Our findings show that in spite of differences related to age and degrees of acculturation, Chinese people in England share a common representational system with respect to health and illness. This system is based on the traditional notions of “balance” and “harmony” between the interdependent forces of Yin and Yang. Health results from balance, whereas illness is brought about by disequilibrium. It is through these traditional Chinese concepts that Western biomedical knowledge is incorporated, producing a mixed representational field where Chinese and Western knowledge co‐exist. This representational field is transmitted through the most fundamental dimensions of culture: food, language and kinship relations. We conclude by showing that social representations of health and illness are inseparable from the struggles over identity experienced by the Chinese people in England. Copyright © 1999 John Wiley & Sons, Ltd.     

Effects of lifestyle and stress on the employee and organization: Implications for promoting health at work

Abstract

This research was designed to determine the extent to which employee health and performance are predicted by lifestyle and stress. Data were collected from 345 employees working in a variety of organizations in southern California. Additionally, supervisors evaluated the work performance of the participating employees whom they directly supervised, and company records of employee health care costs were obtained. Hierarchical multiple regression analyses revealed (a) that physical lifestyle (i.e., exercise pattern, eating habits, and general health practices) predicted unique variance in vitality and positive well-being; (b) that psychosocial lifestyle (i.e., social relations, intellectual activity, occupational conditions, and spiritual involvement) predicted unique variance in vitality, positive well-being, anxiety, depression, lack of self-control, and somatic complaints; (c) that employee stress predicted unique variance in vitality, positive well-being, anxiety, depression, physician visits, somatic complaints, illness absences, and supervisory ratings of job performance, absenteeism and tardiness; (d) that physical lifestyle buffered the adverse consequences of stress for anxiety, depression, physician visits, and company health care costs; and (e) that there was a Physical x Psychosocial Lifestyle interaction for anxiety, depression, and lack of self-control. However, the employee lifestyle factors were not related to supervisory ratings of performance at work. The findings have direct implications for organizational health programs and policies.     

An ecological assessment of community-based interventions for prevention and health promotion: Approaches to measuring community coalitions

Presented an ecological assessment of a community coalition to prevent alcohol, tobacco, and other drug abuse, and related risks. Ecological assessment is defined as occurring at multiple social levels and along a continuum of stages of coalition readiness. The assessment is aided by the triangulation, or combining of assessment methods and strategies. Measures used to assess the coalition's formation, implementation of community initiatives, and production of community impacts are described, along with the triangulation strategies used to enhance the assessment findings. We thank our evaluation team members including Erica Adams, Simon Choi, Cindy Crusto, Katie Davino, David delaCruz, Pamela Goodman, Maury Nation, and Diana Seybolt. We also thank the members of the community coalitions for substance abuse prevention and especially the project directors: James Bown, Dian Crain, Johneta Davis, Kelli Kenninson, Paul Pittman, Greg Sparkman, Sheryl Taylor, and Kenneth Wright.     

Modelling decisions to undergo genetic testing for susceptibility to common health conditions: an ancillary study of the Multiplex Initiative

New genetic tests reveal risks for multiple conditions simultaneously, although little is understood about the psychological factors that affect testing uptake. We assessed a conceptual model called the multiplex genetic testing model (MGTM) using structural equation modelling. The MGTM delineates worry, perceived severity, perceived risk, response efficacy and attitudes towards testing as predictors of intentions and behaviour. Participants were 270 healthy insured adults aged 25-40 from the Multiplex Initiative conducted within a health care system in Detroit, MI, USA. Participants were offered a genetic test that assessed risk for eight common health conditions. Confirmatory factor analysis revealed that worry, perceived risk and severity clustered into two disease domains: cancer or metabolic conditions. Only perceived severity of metabolic conditions was correlated with general response efficacy (β?=?0.13, p<0.05), which predicted general attitudes towards testing (β?=?0.24, p<0.01). Consistent with our hypothesised model, attitudes towards testing were the strongest predictors of intentions to undergo testing (β?=?0.49, p<0.01), which in turn predicted testing uptake (OR 17.7, β?=?0.97, p<0.01). The MGTM explained a striking 48% of the variance in intentions and 94% of the variation in uptake. These findings support use of the MGTM to explain psychological predictors of testing for multiple health conditions.     

Identification of cognitive profiles among women considering BRCA1/2 testing through the utilisation of cluster analytic techniques

Based on the cognitive-social health information processing model, we identified cognitive profiles of women at risk for breast and ovarian cancer. Prior to genetic counselling, participants (N?=?171) completed a study questionnaire concerning their cognitive and affective responses to being at genetic risk. Using cluster analysis, four cognitive profiles were generated: (a) high perceived risk/low coping; (b) low value of screening/high expectancy of cancer; (c) moderate perceived risk/moderate efficacy of prevention/low informativeness of test result; and (d) high efficacy of prevention/high coping. The majority of women in Clusters One, Two and Three had no personal history of cancer, whereas Cluster Four consisted almost entirely of women affected with cancer. Women in Cluster One had the highest number of affected relatives and experienced higher levels of distress than women in the other three clusters. These results highlight the need to consider the psychological profile of women undergoing genetic testing when designing counselling interventions and messages.     

An investigation of preconditions necessary for the introduction of a campaign to promote breast self-examination amongst Zimbabwean women

This study examines elements of the health belief model as predictors of intentions to self-examine breasts in two samples of women. Undergraduate samples from London and Harare are compared on levels of knowledge of breast cancer and breast self-examination (BSE), and on scales measuring perceived susceptibility to breast cancer, exposure to information and experience of breast cancer and perceived costs, barriers and benefits of BSE. Analysis of results indicates that an education campaign to promote awareness and the practice of BSE which incorporates factors of the health belief model could increase the number of Zimbabwean women performing this valuable preventive health behaviour.     

Reliability of self-reported service use: Test-retest consistency of children's responses to the Child and Adolescent Services Assessment (CASA)

This paper reports on the reliability of children's responses on the Child and Adolescent Services Assessment (CASA) — a self-report instrument for use with 8– to 18-year-olds that gathers information about services used to address mental health problems. Findings were based on interviews completed by 77 children at a one week test-retest interval. Results showed that reports of lifetime service use were as reliable as were reports of service use in the preceding three months. Children reported restrictive and intrusive services more reliably than services that were provided in their natural environment. Reliability appeared to be associated more strongly with characteristics of the type of service than with characteristics of the child. Children also could report reliably on some details about their encounters with service providers (e.g., length of stay, number of visits, and onset of service use).     

A brief screening tool for suicidal symptoms in adolescents and young adults in general health settings: reliability and validity data from the Australian National General Practice Youth Suicide Prevention Project

Using data from a nationwide project on young people in Australia aimed at assessing suicidality in general health settings, we present a brief screening tool for suicidality (the depressive symptom index suicidality subscale). Two thousand eight hundred and fifty-one (15-24 year old) patients presenting to 247 Australian general practitioners between 1996 and 1998 were assessed. In addition to the suicide screen, patients completed the general health questionnaire-12 and the Center for Epidemiological Studies depression scale. Patients' chief complaints were taken from the summary sheets completed by their general practitioners. Using inter-item correlational and factor-analytic techniques, as well as a general approach to construct validity, we show that the measure has favorable reliability and validity characteristics. We also provide results on cut-points that may facilitate its use in clinical and research settings. Because the screen is brief, easy to use, reliable, and valid, we encourage its use to combat the vexing international health problem of suicide.