Health Belief Model Key study: Becker (1978)Terminology

perceived seriousness (‘Will it actually kill you?’).

perceived susceptibility (‘Am I likely to get it?’).

costs/benefits analysis.cues to remind us (external or internal cues).demographic variables (factors such as

gender, culture, age, etc.).

AimTo use the health belief model to explain

mothers' adherence for their asthmatic children.

MethodA correlation between beliefs reported during

interviews and the compliance with self-reported administration of asthma medication.

Participants111 mothers responsible for administering

asthma medication to their children.

DesignCorrelational design.

ProcedureEach mother was interviewed for about 45

minutes.They were asked questions regarding:

Their perception of their child’s susceptibility to illness and asthma.

How serious asthma is.How much their child’s asthma interfered

with his or her education.Caused embarrassment.Interfered with the mother’s activities.

Procedure (cont.)They were also questioned about their faith

in doctors and the effectiveness of the medication.

FindingsA positive correlation between a mother’s

belief about her child’s susceptibility to asthma attacks and compliance to medical regimen was found.

There was also a positive correlation was also between the mother’s perception of the child’s having a serous asthma condition and her administering the medication as prescribed.

Mothers who reported that their child’s asthma interfered with the mother’s activities also complied with the medication.

Findings (cont.)Costs negatively correlated with compliance

(e.g. disruption of daily activities, inaccessibility of chemists, the child complaining, and the prescribed schedule).

The demographic variable of marital status and education level correlated with compliance as follows:Married mothers were more likely to comply.The greater the mother’s education the more

likely she would be to adhere.

ConclusionThe health belief model is a useful model to

predict and explain different levels of compliance with medical regimens.

Locus of control Key study: Rotter (1966)TerminologyInternal locus of control – where a person feels

he or she is in control of his or her health and is therefore likely to adopt healthy behaviour.

External locus of control – where a person feels his or her health is controlled by external factors (e.g. fate) and is therefore less likely to adopt a healthy behaviour.

MethodReview article.

ProcedureSample – six pieces of research into

individual perceptions of ability to control outcomes.

FindingsParticipants who felt they had control over

the situation were more likely to show coping behaviours.

ConclusionRotter concluded that locus of control would

affect many of our behaviours.

Self efficacy Key study: Bandura (1977)TerminologyOutcome expectancy – based on previous

experiences a person could estimate the likely outcome in any situation.

Efficacy expectation – the belief that a person has that they can successfully do whatever is required to achieve the outcome.

Terminology (cont.)The key factors which affect a person’s efficacy

expectation are:Vicarious experiences – seeing other people

do something successfully. Verbal persuasion – someone telling you

that you can do something.Emotional arousal – too much anxiety can

reduce a persons’ self-efficacy.In addition cognitive appraisal of a situation

might also effect expectations of personal efficacy.

AimTo assess the self-efficacy of patients undergoing systematic desensitisation.

MethodA controlled quasi-experiment with patients with

snake phobias.

Participants10 snake phobic patients:

who replied to an advertisement in a paper.9 females and one male.aged 19–57 years.

ProcedurePre-test assessment. Each patient was

assessed for:avoidance behaviour towards a boa constrictor.fear arousal with an oral rating of 1–10. efficacy expectations (how much they thought

they would be able perform different behaviours with snakes).

Procedure (cont.)Systematic desensitisation – a standard

desensitisation programme was followed where patients were introduced to a series of events involving snakes and at each stage were taught relaxation.

Post-test assessment. Each patient was again measured on behaviours and belief of self-efficacy in coping.

FindingsHigher levels of post-test self-efficacy were

found to correlate with higher levels of behaviour with snakes.

ConclusionDesensitisation enhanced self-efficacy levels,

which in turn lead to a belief that the participant was able to cope with the phobic stimulus of a snake.

Possible Section A QuestionsDescribe what psychologists have found out

about theories of health beliefDescribe one piece of research into self-

efficacyOutline the health belief modelDescribe factors that influence health beliefs

and behavioursDescribe one piece of research into locus of

control

Possible Section B QuestionsDiscuss the usefulness of research into

theories of health belief

Media Campaigns Key study: Cowpe (1989)AimTo test the effectiveness of an advertising

campaign.

MethodA quasi-experiment where a media campaign

was shown in 10 regional television areas from 1976 to 1984.

ParticipantsPeople living in the chosen television areas.

ProcedureThe campaigns were shown on television.

There were two 60-second commercials, one called ‘inattendance’ and one called ‘overfilling’.

These showed the initial cause of the fire and the actions required to put it out.

Three areas were shown reminders one year later.

The number of reported chip pan fires was analysed for each area.

FindingsThe net decline in each area over the twelve-

month period of the campaign was between 7% to 25%.

The largest reduction was during the campaign. ‘Overlap’ areas (areas that received two of the

television stations) showed less impact.The questionnaires showed an increase in the

awareness of chip pan fire advertising. The mention of chip pan fires as a danger in the

kitchen also increased in the questionnaires.

ConclusionsThe advertising proved effective as shown by

reduction in chip pan fires. The behaviour change is seen most during

the campaign and reduces as time passes after the end of the campaign.

The viewer is less likely to be influenced by the campaign if overexposed to it, as in the overlap areas.

Legislation Key study: Dannenberg et al. (1993)Aim To review the impact of the passing of a law

promoting cycle helmet wearing in children.

MethodNatural experiment when a law was passed in

Howard County, Maryland, USA.

ParticipantsChildren from Howard County, and two

control groups from Montgomery County and Baltimore County, all in Maryland, USA.

Aged 9–10 years, 12–13 years and 14–15 years.

DesignIndependent design with each child naturally

falling into one of the three counties.

ProcedureA questionnaire that asked about:

bicycle use.helmet ownership. awareness of law.sources of information about helmets.peer pressure.

FindingsHelmet ownership was higher amongst cycle

owners and highest in younger age groups.In Howard County (the one with the law),

reported usage had increased. Howard County – 11.4% to 37.5%. Montgomery County – 8.4% to 12.6%.Baltimore County – 6.7% to 11.1%.

ConclusionsLegislation has more effect than educational

campaigns alone.

This study was correlated with an observational study by Cote et al. in 1992, which found similar rates of cycle helmet usage.

Fear Arousal Key study: Janis and Feshbeck (1953)

AimTo investigate the consequences on emotions

and behaviour of fear appeals in communications.

Method Laboratory experiment, which showed fear-

arousing material.

Participants9th Grade students aged 14.0 to 15.11 years,

mean age 15 years.

Design Independent design, with three experimental

groups and one control group.

ProcedureA questionnaire was given one week before

the lecture on health to ascertain dental practices.

A fifteen minute illustrated lecture was presented to each group. 3 groups had a lecture on dental hygiene and

the control group had a lecture on the human eye.

Procedure (cont.)Immediately after the lecture a questionnaire

was given asking for emotional reactions to the lecture.

One week later a follow-up questionnaire asked about longer term effects of the lecture.

FindingsThe amount of knowledge on dental hygiene

didn’t differ between the three experimental groups.

The strong fear-appeal lecture was generally seen in a more positive light.

The strong fear-appeal group showed a net increase in conformity to dental hygiene of 8%.

Findings (cont.)The net increase in the moderate fear group

was 22%.The net increase in the minimal fear group

was 36%.The control group showed 0% change.

ConclusionFear appeals can be helpful in changing

behaviours, but it is important that the level of fear appeal is right for each audience.

Possible Section A Questions

Possible Section B QuestionsDiscuss the usefulness of research into health

promotion

Reasons for non adherence Key study: Bulpitt and Fletcher (1988)AimTo review research on adherence in

hypertensive patients.

MethodReview article of research identifying problems

with taking drugs for high blood pressure.

ProcedureResearch was analysed to identify the

physical and psychological effects of drug treatment and the adherence rates of patients.

FindingsThere are many side effects of taking anti-

hypertension medication.In one study by Curb (1985) 8% of males

discontinued treatment because of sexual problems.

Research by the Medical Research Council (1981) found that 15% of patients had withdrawn from taking medication due to side effects.

ConclusionWhen the costs of taking medication, such as

side effects, outweigh the benefits of treating a mainly asymptomatic problem such as hypertension, there is less likelihood of the patient adhering to their treatment.

Measuring adherence Key study: Lustman et al. (2000)AimTo assess the efficacy of the anti-depressant

fluoxetine in treating depression by measuring glycemic control.

MethodA randomised controlled double-blind study.

Participants60 Patients with type 1 or type 2 diabetes

and diagnosed with depression.

ProcedurePatients were randomly assigned to either a

fluoxetine or a placebo group.Patients were assessed for depression using

psychometric tests and their adherence to their medical regimen was assessed by measuring their GHb levels, which indicated their glycemic control.

FindingsPatients given fluoxetine reported lower

levels of depression. Patients given fluoxetine had lower levels of

GHb, which indicated their improved adherence.

ConclusionsMeasuring GHb in patient with diabetes

indicates their level of adherence to prescribed medical regimes.

Greater adherence was shown by patients who were less depressed.

Improving adherence Key study: Watt et al. (2003)Aim To see if using a Funhaler® could improve

children’s adherence to medication for asthma.

MethodA field experiment, although it used children

with asthma so could also qualify as a quasi-experiment. The experiment set up two conditions, and then used self-report to measure the adherence rates.

Participants32 Australian children with asthma:

10 males and 22 females;aged from 1.5 to 6 years; mean age 3.2 years.

DesignA repeated design as each participant had

one week using the normal inhaler then one week using the Funhaler.

ProcedureEach child was given the Breath-a-Tech to

use for one week, and a questionnaire was given for the parents to complete.

In the second week, the children used the Funhaler, and the parents were given a matched questions questionnaire.

Findings38% more parents were found to have

medicated their children the previous day when using the Funhaler compared to the normal inhaler.

ConclusionsThe Funhaler reinforced correct usage of the

inhaler with a toy that spins and a whistle that blows.

This did improve the adherence to the medication.

By making the medical regime fun, the adherence, certainly in children, can be improved.

Possible Section A Questions

Possible Section B QuestionsDiscuss the usefulness of research into health

promotion