Lifestyle and Health Behaviour

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Lifestyle and Health Behaviour

TOPIC / SUB TOPICS
1 determinants of health-enhancing behaviours
Lifestyle and Health Behaviour / 2 health belief models
3 developmental, cultural and gender differences in health behaviours
CONTENTS
Sub Topic / Studies
1 determinants of health-enhancing behaviours / Friedman and Rosenman
Locus of Control (Rotter)
2 health belief models / Health Belief Model (Becker) Reasoned Action Theory (Fishbein)
3 developmental, cultural and gender differences in health behaviours / Social Identity Theory - Tajfel
Social Learning Theory - Bandura

In this section we need to be aware of some of the research around issues of lifestyle and health behaviour. This section is interested in how the way we live affects our health. When we refer to heath behaviour we are referring to something a person does, such as going to the doctor or exercising, which should have positive outcomes. A lifestyle, on the other hand, is a pattern of behaviours that are often tied into the type of job an individual has, the culture and sub-culture they feel part of, and the people they live with.

Sub Topic 1 determinants of health-enhancing behaviours

There are a number of psychological studies that investigate the factors which affect whether people will carry out health-enhancing behaviours. Friedman and Rosenman’s study investigates the behaviour patterns which make people less likely to practice health enhancing behaviours and Rotter also looks at the personality patterns which influence whether people will practice health-enhancing behaviours.

Type A & B behaviour patterns. (Friedman and Rosenman)

The narrow-band approach to personality known as Type A & Type B personality was developed as an attempt to explain why it was that some people seemed to be particularly susceptible to coronary heart disease, while others who work equally as hard, were not.

Friedman and Rosenman (1974) observed that the people who seemed to be particularly susceptible to coronary heart disease also tended to have certain personality similarities. These they argued formed the Type A pattern, which consists of three major facets. The first is a competitive achievement orientation, in that these people tend to be very self-critical and to strive towards goals without feeling a sense of joy in their efforts or accomplishments. The second personality characteristic is time urgency: Type A individuals seem to be in a constant struggle with the clock. They often become impatient with delays and unproductive time, and are likely to arrange too many commitments into their diaries and often try to do more than one thing at once. The third facet of Type A personality is a high level of anger and/or hostility, which may or may not show outwardly. By contrast, Type B individuals are less competitive, show less time urgency and experience less hostility.

The classic example of Type A and Type B personality was the 12-year longitudinal study of over 3,500 healthy middle-aged men reported by Friedman and Rosenman in 1974. The researchers found that more than twice as many Type A people as Type B people developed coronary heart disease. When the figures were adjusted for smoking, lifestyle etc. it still emerged that Type A people were nearly twice as likely to develop heart disease as Type B people.

Evaluation

+ The type A & B approach has been influential and the idea that people can be categorised into simple types has an appeal to a range of practitioners because of the implications for predictions of future health and job performance.

+ Using this model it is easy to identify Type A and modify their behaviour. Attempts at modifying behaviour have usually taken a behaviourist and cognitive approach and have had quite a high success rate.

+ The study carried out by Friedman (1974) also had a number of advantages.

It was longitudinal which allows researchers to make comparisons of the same person over time.

+ The study used a large sample (3,500).

+ The study was able to control for other important variables, such as smoking and lifestyle.

+ The psychometric tests used by Friedman and Rosenman provide quantitative data.

However there are a number of problems with the type A & B approach.

- Such approaches have been criticised for attempting to describe complex human experiences within narrowly defined parameters. Many people may not fit easily into a type a or b person.

- A longitudinal study carried out by Raglan and Brand found that as predicted by Friedman Type A men were more likely to suffer from coronary heart disease. Interestingly, though, in a follow up to their study they found that of the men who survived coronary events Type A men died at a rate much lower than type B men.

- A major problem with Friedman and Rosenman’s study is that they used a bias sample. Studies carried out on women have not shown such a major difference between Type A and Type B and subsequent health. This may suggest that different coping strategies are just as important as personality.

- The major problem with the Type A and Type B theory is actually determining which factors are influencing coronary heart disease. Some research has concentrated on hostility, arguing that the Type A behaviour pattern is characterised by underlying hostility which is a major factor leading to coronary heart disease. Other research has investigated the way that type A people experience and cope with stress which is the major factor leading to coronary heart disease. It would seem that a much more sophisticated model is needed to predict coronary heart disease than Friedman and Rosenman's Type A & Type B approach.

Rotter (locus of control)

Julian Rotter suggested that people differ in the way they practice health behaviours because they differ in the way that they experience their locus of control - in other words, where they feel the control over events in their life come from.

Some people perceive themselves as having an external locus of control, which means they do not feel they, personally, can control events: they see their lives as being controlled by outside forces. Things happen to them.

On the other hand, some people perceive themselves as having an internal locus of control, which means they experience themselves as exerting personal control over events in their lives. They make things happen, rather than passively waiting for them to occur.

Rotter went on to argue that locus of control is a significant factor in psychological and physical well-being. Studies have demonstrated that people with an internal locus of control believe that they are in control of their own health and are therefore more likely to carry out health behaviours successfully. For example they are more likely to eat a healthy diet, exercise and so on.

Below are some examples of items from Rotter's locus of control scale. (a type of psychometric test)

The I-E Scale asks you to choose one of two alternatives from items such as the following.

1.a)In the case of the well-prepared student there is rarely, if ever, such a thing as an unfair test.

1.b)Examination questions are often so unrelated to course work that studying is really useless.

2.a)The average citizen can have an influence on government decisions.

2.b)This world is run by the few people in power and there is not much the little guy can do about it.

3.a)Most people do not realise the extent to which their lives are controlled by accidental happenings.

3.b)There is no such thing as 'luck'.

4.a)What happens to me is my own doing.

4.b)Sometimes I feel that I do not have enough control over the direction my life is taking.

People with an internal locus of control tend to choose 1.a), 2.a), 3.b), 4.a); and people with an external locus of control tend to choose the alternatives.

Evaluation of Rotter

+ Locus of control has been useful because it demonstrates that being in control over one's situation is important for human beings.

+ The idea of internal and external locus of control has also been utilised in cognitive therapy. Therapists can direct people and teach them new strategies in using a more successful internal locus of control.

+ The I-E psychometric test has many strengths. It is quick and simple to use, provides quantitative data, and be designed with different people in mind (e.g. younger people, workers and so on)

- However, studies (e.g. Wortman 1975) have demonstrated that it may not be necessary to have real control, as long as you believe that you have it.

- A major criticism of Rotter's model is that it is very simplistic. Locus of control is not fixed and may change from situation. We therefore have to question the results gained from Rotter's I-E locus of control scale. The scale may not be reliable, i.e. would you get the same results from the same person in a different situation?

+ Rotter's I-E scale is a type of psychometric test. A major advantage of such tests is the apparent simplicity in their use and the apparent clarity of the answers.

- The major disadvantage of such tests is the serious limitation of trying to describe an individual's experience within very narrow pre-determined parameters. E.g. people may not be simple an external or an internal person. They may change from situation to situation, over time and so on.

- Psychometric tests, such as the I-E scale often make the fundamental attribution error. That is they assume people behave the way they do because of their personality (an internal attribution). However this ignores the fact that people often behave the way they do because of external attributions (e.g. the situation). The studies by Zimbardo and Milgram clearly demonstrate the powerful influence of the situation

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-/+ The criticisms of Rotter's model as being too simplistic has led to many psychologists developing the concept of locus of control and arguing that people do not simply have one single locus of control. For example our perceptions of our abilities differ from different types of situation. In some situations, we expect to be able to take effective action while in others we may see ourselves as less capable.

- For all of its advantages it is possible to question the idea of control. Perhaps the idea that control is so important to people can be criticised as being ethnocentric. Perhaps in other culture people do not emphasise the need to be in control. It is argued that this is a mainly Western concept and that some non-Western cultures emphasise the need to go along with the wishes and needs of the community.

Sub Topic 2 health belief models

There are a number of health belief models developed by psychologists – including the health belief model developed by Becker and reasoned action theory developed by Fishbein. These models attempt to predict when a person will or will not practice health enhancing behaviour.

Health Belief Model (Becker)

The health belief model aims to predict when a person will engage in health behaviour and is used when developing health education campaigns. According to the health belief model, the likelihood that individuals will take follow medical advice depends directly on two assessments that they make;

(i) Evaluating the threat

(ii) Cost-benefits analysis

(i) There are several factors that can influence a person's perceived threat of illness, including; perceived seriousness, perceived susceptibility, and cues to action. Also likely to affect this assessment are; demographic variables, socio-psychological variables and structural variables. For example, if a person is overweight they might be in danger of developing a heart condition. The person would probably recognise this as a serious condition, but they might believe that because they are still quite young they are unlikely to develop this problem just yet. Therefore they might judge the threat as relatively low. Even if we judge the threat to be serious, we are only likely to act if we have some cue to action. This cue might be a mass media campaign, or it might be the death of a colleague with heart disease.

(ii) The cost-benefit assessment looks at whether the perceived benefits exceed the perceived barriers. The barriers might be financial (prescription charges are about to rise again,) situational (difficult to get to the health clinic), social (don't want to acknowledge getting old). The benefits might be improved health, relief from anxiety, and reducing health risks.

Therefore when health professionals design health education campaigns, according to this model, they should emphasise the threat to the individual (e.g. lung cancer for smokers) whilst also stressing the benefits of carrying out the behaviour (e.g. stopping smoking makes you feel better, smell better, saves you money and so on).

Evaluation

+ The health belief model aims to predict when a person will engage in health behaviour, i.e. adhere to medical advice. The model is useful because it takes into account the many factors which influence whether we engage in health behaviour. The model uses a social cognitive approach because it acknowledges the role of cognitive processes such as beliefs and social factors such as social class.

+ The health belief model has been fairly successful. For example, Kasl (1975) found that participants in disease prevention programmes were more likely to value their health highly, to feel susceptible to the disorder in question and to believe in the power of modern medicine to cure disease if detected early. Results from this and similar studies suggest that health beliefs are an important factor in the decisions to adopt health behaviours or not. The health belief model has been found to be much more useful than a straightforward attitude measure which does not take social factors into consideration.

- However the model does have a number of limitations. Firstly there are a number of health behaviours that do not fit the model such as habits (e.g. teeth brushing). Secondly, there is no standard way of measuring the standard components, such as perceived susceptibility and seriousness. Different studies have used different questionnaires to measure the same factors therefore making it difficult to compare the results across studies. Thirdly we have to recognise the limitations of the questionnaire as a method. Fourthly the model assumes that we make decisions on a rational basis. We have come across many studies in psychology, which demonstrate that humans don't always act rationally (e.g. Freudian defence mechanisms etc.).

Reasoned Action Theory – Fishbein (1975)

Reasoned action theory is often referred to as a health belief model.

Reasoned action theory states that intention is the best predictor of health behaviour.

According to this theory intention is determined by two attitudes.

(a) One attitude is personal in nature – the person’s attitude regarding the behaviour, which is simply a judgement of whether or not the behaviour is a good thing to do.

This judgement is based on two types of behavioural beliefs: beliefs as to the likely outcomes of the behaviour and evaluations of whether the outcomes would be rewarding.

(b) The second attitude that determines people’s intention to practice a behaviour reflects the impact of social pressure or influence.

This second attitude that determines people’s intention is based on two normative beliefs – beliefs regarding others’ opinions about the behaviour and the person’s motivation to comply with those opinions.

An example

Diana intends to wear a seatbelt. Her first attitude (attitude regarding the behaviour) might be ‘using seatbelts would be a good thing’. This attitude might be based on the two behavioural beliefs that ‘using seatbelts will protect me in an accident’ and ‘being safe and avoiding injury is satisfying to me’. Her second attitude might be ‘using seatbelts is appropriate behaviour’. This second attitude (impact of social pressure) might be based on the two normative beliefs ‘my family and friends think I should use seatbelts’ and ‘I value their opinion and want to follow their advice’.

The important thing to remember with this theory is that behaviour is directly determined by intentions.

Evaluation

+ The Reasoned Action Theory has been successful in explaining several health-related behaviours. For example Bagozzi (1981) found that attitudes about donating blood influenced peoples actual behaviour. Other studies have found that people’s attitudes and intentions are related to their cigarette smoking (Fishbein 1982), exercising (Wurtele) 1987) and loosing weight (Schifter 1985).

+ The theory is fairly simple to test and use because it involves collecting people’s attitudes and intentions that can be done using questionnaires. Questionnaires can provide lots of quantitative data and can be analysed statistically.

- A major problem with Reasoned Action Theory is that like the Health Belief Model it does not adequately account for irrational decisions that people make about their health, such as delaying medical treatment when clear symptoms exist.

- Another problem is that intentions and behaviour are only moderately related – people do not always do what they plan (or claim they plan) to do.