Transcript Health Promotion Health Psychology

Health Promotion
Health Psychology
Concerns of health
promotion (Ewles and
Simnett, 1992)
 Health
education programmes - to raise
awareness of health risk and to encourage
behaviour change
 Primary
health education - to prevent ill
health developing (e.g. diet, hygiene, social
skills, etc)
Concerns of health
promotion (Ewles and
Simnett, 1992)
 Preventive health
services - e.g. family
planning, immunisation and well person
clinics
 Community-based
work - local
communities identify health problems and
address them
 Healthy
public policies - housing,
employment, transport, etc
Concerns of health
promotion (Ewles and
Simnett, 1992)
 Environmental health
issues - making the
physical environment safer - e.g. tackling
pollution.
 Economic
and regulatory activities - e.g.
trying to get the government to raise tax on
tobacco, etc

The Ottawa Charter for Health Promotion
(WHO 1986) identified the following
features that it believed were necessary for
good health:

· Peace

· Shelter

· Education

· Food

· Income

· A stable ecosystem

· Sustained resources

· Social justice

· Equity
Models
The medical model
2. The behaviour change model
3. The educational model
4. The empowerment model
5. The social change model
1.
Medical model

Prevention
 Primary - before illness starts
 One of the famous stories of early health
promotion concerns the Broad Street pump
in Soho, London. In 1854, Dr. John Snow
plotted cases of cholera on a map of London
and noticed that they clustered around a
water pump on Broad Street.
Medical model

At that time, water in London was provided by a
number of private companies, and Snow
discovered that the death rate from cholera was
much higher for people using water from two of
these companies (71 deaths per 10,000 people)
than the others (only 5 deaths per 10,000 people).
Snow’s observation of the pattern of cases around
Soho allowed him to carry out a natural
experiment. He disabled the Broad Street pump by
removing the handle (hi-tech or what?) and the
cholera epidemic subsided in the area. From this,
Snow was able to show that cholera was carried in
water (Donaldson and Donaldson, 2000.)
Primary Prevention

Genetic counselling. Future parents are
able to get important information about the
possibility of their future child being born
with a genetic disorder. Factors such as the
age of the parents and the results of
biological tests may be taken into account.
Tests can be made on the unborn foetus, but
such techniques are hazardous to the foetus.
Primary Prevention

Immunisation of children would also be a
way of preventing illnesses.
 The analysis of questionnaires about health
behaviour could also be useful in helping
people to adopt a healthy lifestyle.
Secondary prevention

Secondary prevention concerns identifying an
illness fairly early, before there has been much
damage. It used to be thought that an annual
check-up would identify imminent illnesses, but it
is now thought that between 6 and 10 specific tests
can suffice. The American cancer society (1992)
recommended that women should have
mammograms (breast x-ray), but recently, in
Britain, this practice has been called into question.
Colon inspections are recommended for those over
40.
Mammogram
Mammogram
Breast Self-Examination
Cancer and Breast SelfExamination

BSE effective in early detection of Breast
Cancer. Pitts (1991) <30% British women
perform BSE

Meyerowitz and Chaiken (1987) the
effectiveness of Gain and Loss messages.
Gain message worked best. Therefore
campaigns should use a positive message.
Cancer and Breast SelfExamination

The BSE instructions are rather
complicated. a simpler procedure called
`Breast awareness' has been introduced. As
the procedure is simpler, women are more
confident in being able to carry it out. The
procedure produces less false positives. This
is when the person falsely identifies a
problem, or believes they may be
developing breast cancer, when they are not
(Murray and McMillan, 1993).
Colon Cancer
Testicular Cancer

From the time of puberty onwards you
should do a simple quick check of
yourself regularly. This will help you to
know what is normal for you (everyone
is different) and you will be able to
detect any changes early on.
Testicular Cancer

A good place to do this is in, or
immediately after a bath or a shower,
when the muscle in the scrotal sac is
more relaxed.

You could ask your partner to help.

Hold your scrotum in the palm of your
hands, so that you can use the fingers
and thumb on both hands to examine
your testicles.
Testicular Cancer

Note the size and weight of the
testicles. It is common to have one
slightly larger, or which hangs lower
than the other, but any noticeable
increase in size or weight may mean
something is wrong.

Gently feel each testicle individually
Testicular Cancer

You should feel a soft tube at the top
and back of the testicle. This is the
epididymis which carries and stores
sperm. It may feel slightly tender. Don’t
confuse it with an abnormal lump.

You should be able to feel the firm,
smooth tube of the spermatic cord
which runs up from the epididymis.
Testicular Cancer

Feel the testicle itself.
It should be smooth
with no lumps or
swellings. It is
unusual to develop
cancer in both
testicles at the same
time, so if you are
wondering whether a
testicle is feeling
normal or not, you
can compare it with
the other.
Tertiary Prevention
- containing or slowing down the
damage
Barriers to Primary
Prevention

• we have only limited knowledge about
what behaviours are threatening to our
health, for example, it is only in the last
forty years that we have discovered the very
harmful effects of tobacco smoking
Barriers to Primary
Prevention

• we have a lack of knowledge about how
we develop health-threatening behaviours,
for example, some behaviours to do with
diet or exercise develop over many years
from our childhood

• a number of health behaviours are learnt in
the home, for example, the children of
smokers are more likely to smoke than the
children of nonsmokers
Barriers to Primary
Prevention

• at the time that health threatening
behaviours develop, people often have little
immediate incentive to practice health
enhancing behaviours, for example the
effects of smoking are felt in middle to later
life rather than when people start smoking

• people are often unrealistically optimistic
about their health
3 main reasons why primary
prevention has been
ignored

Traditional structure of medicine

Difficulty of getting people to practice
healthy behaviours

Difficulty in applying methods of attitude
and behavioural change to health
THREE APPROACHES TO
HEALTH PROMOTION

Behaviour change approach

Objective: to bring about changes in
individual behaviour through changes in
individuals' cognitions.

Process: provision of information about
health risks and hazards.
THREE APPROACHES TO
HEALTH PROMOTION

Behaviour change approach

Aim: . to increase individuals' knowledge
about the causes of health and illness. .

Assumption: humans are rational decisionmakers whose cognitions inform their
actions.
THREE APPROACHES TO
HEALTH PROMOTION

Self-empowerment approach

Objective: to empower individuals to make
healthy choices.

Process: participatory learning techniques.

Aim: to increase control over one's physical,
social and internal environments.

Assumption: power is a universal resource
which can be mobilised by every individual.
THREE APPROACHES TO
HEALTH PROMOTION

Collective action approach

Objective: to improve health by addressing
socio-economic and environmental causes
of ill health. .

Process: individuals organize and act
collectively in order to change their
physical and social environments.
THREE APPROACHES TO
HEALTH PROMOTION

Collective action approach

Aim: to modify social, economic and
physical structures which generate ill .
health.

Assumption: communities of individuals
share interests which allows them to act
collectively.
BEHAVIOUR CHANGE
APPROACH

Consider how the issue of smoking is dealt with
by the Health Belief Model (HBM; Becker, 1974).
Smokers deciding whether or not to give up
smoking would be expected to consider:

how susceptible they are to lung cancer and other
smoking-related conditions;
 how serious these conditions are;
 the extent and value of the benefits of giving up
smoking;
 the potential negative consequences of giving up
smoking.
BEHAVIOUR CHANGE
APPROACH

In addition, the HBM acknowledges the role
of cues to action, internal (e.g. a symptom
such as a smoker's cough) and external (e.g.
information, advice or meeting someone
with lung cancer), as well as health
motivation, and the importance of health to
the individual.
BEHAVIOUR CHANGE
APPROACH

The HBM has been applied to a wide range of
health behaviours including the uptake of flu
vaccinations, breast self-examination, antihypertensive regimes, mothers' adherence to
regimens for their children and risk factor
behaviours (e.g. seatbelt use, attendance at health
checkups, diets, etc.). Overall, the 'HBM is
marginally successful in predicting health
behaviours. Each key variable of the HBM tends
to be significantly correlated with the behaviour
under study.
BEHAVIOUR CHANGE
APPROACH

This suggests that the variables identified
by the HBM are relevant ingredients and
contribute to the process which generates
health behaviour. However, our ability to
accurately predict health behaviour on the
basis of the HBM is severely limited.
BEHAVIOUR CHANGE
APPROACH

The theory of reasoned action (TRA; Fishbein and
Ajzen, 1975) and its revised version, the theory of
planned behaviour (TPB; Ajzen, 1985) propose
that behaviour is informed by attitudes towards the
behaviour as well as subjective norms about the
behaviour, that is what significant others think one
should do. These variables (and in the case of the
TPB an additional variable: perceived control over
the behaviour) combine to generate an intention to
behave in a particular way, which is then used to
predict actual behaviour.
BEHAVIOUR CHANGE
APPROACH

Attitudes and subjective norms are based upon
beliefs held by the individual. So, for example, a
woman's belief that birth control pills are a
potential health risk and her belief that her friends
and relatives would not approve of her taking such
a risk are thought to generate a negative attitude
towards taking birth control pills, as well as social
pressure not to take them; thus giving rise to the
intention to refrain from the use of birth control
pills and, hopefully, to consider other forms of
contraception.
BEHAVIOUR CHANGE
APPROACH

The TRA and TPB have been used to
predict numerous health behaviours,
including smoking, alcohol consumption,
contraceptive use/safer sex, health screening
attendance, exercise, food choice and
breast/testicle self-examination. Overall,
the evidence suggests that TRA and TPB do
contribute to our understanding of the
antecedents of health relevant behaviours.
BEHAVIOUR CHANGE
APPROACH

However, it is important to bear in mind that
the TRA and TPB do not actually predict
behaviour but only the intention to behave.
Unfortunately,
correlations
between
intention to behave and actual behaviour are
not perfect. They tend to range between
0.45 and 0.62.
A study using the TRA
(Rise, 1992)

Rise (1992) used the TRA as a theoretical
framework in order to study 'condom behaviour'
defined as 'a decision based upon consideration of
the expected consequences of using or not using
condoms'. A postal questionnaire about condom
use was completed by 1,172 Norwegian
adolescents aged 17 to 19 years and all nonvirgins.
A study using the TRA
(Rise, 1992)

The following variables were measured:
– The intention to use condoms at the next intercourse
–
–
–
–
(behavioural intention). .
Beliefs about condom use, e.g. 'condoms protect me
against sexually transmitted diseases' (behavioural
beliefs).
Evaluation of behavioural beliefs and outcomes, e.g.
'How much do you fear STD?' (values).
Significant others' evaluation of the respondent's
condom use (normative beliefs).
,
Importance of significant others' evaluation (motivation
to comply). Previous/habitual condom use (prior
behaviour).
A study using the TRA
(Rise, 1992)

Rise (1992) observed that past behaviour was by
far the strongest predictor of intention to use
condoms at the next intercourse. Next came
subjective norm followed by attitude. All
relationships were statistically significant.
Behavioural beliefs related to pleasure and
sensation (e.g. 'Condom use reduces my physical
pleasure') discriminated best between intenders
and non-intenders whereas traditional risk
appraisal beliefs (e.g. 'Condom use protects me
against STD') did not discriminate. Among
normative beliefs, sexual partners' expectations
had the best discriminatory power. '.
CRITICISMS OF SCMS






1 SCMs are only concerned with cognitively
mediated behaviours.
2 SCMs do not take into account the direct effect
of impulse and/or emotion.
3 SCMs assume that the same variables inform
different health behaviours.
4 SCMs assume that the same variables are
relevant for diverse groups of people.
5 SCMs focus exclusively upon mental
representations of the social world and do not
take into account the direct effects of material,
physical and social factors.
6 SCMs do not address the issue of joint decision
making.
Criticisms of the behaviour
change approach

. is unable to target the major socioeconomic causes of ill health;

. operates top-down;

. assumes that there is a direct link between
knowledge, attitudes and behaviour;

. assumes homogeneity among the receivers
of health promotion messages.
SELF-EMPOWERMENT
APPROACH

The goal of this approach to health promotion is to
empower individual people to make healthy
choices. Self-empowerment can be defined as the
process by which groups and individuals increase
their control over their physical, social and
internal environments. In order to facilitate selfempowerment, participatory learning techniques
allow people to examine their own values and
beliefs and explore the extent to which factors
such as past socialization as well as social location
affect the choices they make (Homans and
Aggleton, 1988).
SELF-EMPOWERMENT
APPROACH

Group work, problem-solving techniques, clientcentred counselling, assertiveness training and
social skills training as well as educational drama
are forms of participatory learning. The selfempowerment paradigm, with its emphasis upon
self-awareness and skills, resonates with what
Stroebe and Stroebe (1995) refer to as the 'therapy
model' of health promotion which deploys a wide
range of psychological techniques such as
cognitive restructuring, skill training and selfconditioning in order to help individuals act upon
their intentions to adopt health behaviours.
SELF-EMPOWERMENT
TECHNIQUES

Participatory learning
 Group work
 Problem solving
 Client-centred counselling
 Assertiveness training
 Social skills training
 Educational drama
Self-empowerment

Self-empowerment is particularly popular within
health education for young people. For example,
peer pressure has been identified as a powerful
obstacle to the adoption of healthy practices by
young people. Here, self-empowerment techniques
encourage young people to make independent
decisions by developing their psychological
resources to resist peer pressure, the so-called 'say
no' technique. This has been attempted through
assertiveness training, social skills training,
inoculation to persuasive appeals and life skills
training, with limited success (Hopkins, 1994).
Self-empowerment

A range of HIV-preventive interventions for
young people are informed by a selfempowerment rationale (Abraham and
Sheeran, 1994).
Self-empowerment

These include rehearsal of communication
and interaction sequences which might be
involved in condom purchase or sexual
negotiation, questioning and challenging
sexual scripts which do not allow space for
negotiation of contraceptive use, peer
education programmes, as' well as groupbased cognitive-behavioural programmes
aiming to identify and then modify personal
obstacles to HIV prevention.
Self-empowerment

All of these involve reflexive selfappraisal
as well as the acquisition of new skills.
Abraham and Sheeran (1994) argue that
such empowerment-based interventions can
be effective in increasing perceived selfefficacy which has been shown to be a
powerful predictor of intention formation
and behaviour (e.g. Bandura, 1992).
Self-empowerment

Thus, Abraham and Sheeran (1994) move
beyond the more simplistic behaviour
change/information giving approach, to
manipulate social change model variables
through empowerment techniques. Indeed,
these authors also acknowledge the
importance of power relations and cultural
resources which require change at a
community level.
An example of an empowermentbased intervention (Lugo, 1996)

The Resource Sisters Program was an
empowerment education project for
pregnant women in orange County, Florida
(Lugo, 1996). The programme focused on
areas which had high rates of low birth
weight babies, infant mortality, substanceexposed new-borns and poverty.
An example of an empowermentbased intervention (Lugo, 1996)

It was implemented in an inner city area, a
rural section of the county and a quasisuburban area. The programme was
designed (a) to employ and enhance the
natural skills of women from the
community (peer counsellors) to assist other
women and foster collective problem
solving; (b) provide outreach and case
management through home visits; (c) to
develop ongoing peer support groups.
An example of an empowermentbased intervention (Lugo, 1996)

Local women were recruited and trained to
become peer educators. The intensive threeweek group training covered empowerment,
resources, needs assessment, case
management, women's issues, problem
posing, prenatal health, labour and delivery
and group facilitation.
An example of an empowermentbased intervention (Lugo, 1996)

Trained peer counsellors visited women in
their homes who had been identified as high
risk (medically, demographically and/or
psychosocially) by the state screening
programme. These visits provided an
opportunity for individual needs assessment
and case management, as well as to
encourage the women to attend support
group meetings.
An example of an empowermentbased intervention (Lugo, 1996)

The evaluation showed that around 20% of
women who had been contacted came to at
least one support group meeting.
Participation was greatest in' the rural
community and was lowest among white
women. Over 40% of women who had
come to one group meeting returned several
times. Thus, obtaining a high level of initial
participation seemed to be a challenge.
An example of an empowermentbased intervention (Lugo, 1996)

Issues raised and discussed by the women in
the groups commonly included personal
violence, stress, relationships, parenting,
physiological and emotional changes during
pregnancy and concerns with basic survival
(food, housing, etc.). The groups were a
forum for discussion of individual choices,
decision making and self-care, as well as
collective problem solving.
An example of an empowermentbased intervention (Lugo, 1996)

The groups developed social cohesion
which was demonstrated by contact among
participants outside the group meetings.
Peer counsellors reported an increased sense
of empowerment and options since working
with the programme. However, after the
first year of the programme there were no
significant differences between clients' and
non-clients' low birth weight rates.
An example of an empowermentbased intervention (Lugo, 1996)

Lugo (1996) draws attention to the fact that
the programme was externally imposed, as
an alternative model for providing statemandated case management for at-risk
pregnant women.
Criticisms of the selfempowerment approach

it is assumed that rational choices are
healthy choices;

strong reliance upon simulation;

inadequate concept of power.
COLLECTIVE ACTION
APPROACH

The aim of collective action is to improve
health by addressing socio-economic and
environmental causes of ill health within the
community. Thus, this approach recognises
the close relationship between individual
health and its social and material contexts,
which consequently become the target for
change. Individuals. act collectively in order
to change their environment rather than
themselves.
COLLECTIVE ACTION
APPROACH

For example, in one German city, the
community group identified weight as a
health problem in the community and
decided to approach butchers in the city
with the request to develop a new low-fat
sausage (Conner, 1994).
COLLECTIVE ACTION
APPROACH

In addition, the Healthy Cities Project aims
to develop new ideas in public health. For
example, research into the impact of poor
housing on health (Hunt, 1993) found that
levels of mould in the air had a direct and
independent effect upon the health of
children living in the dwellings. This study's
findings were used to campaign for changes
in housing conditions.
Collective action as
community empowerment

Outreach health education with intravenous
drug using communities at risk of HIV
infection provides a good example of the
collective action approach. Community
outreach strategies aim to achieve
subcultural change among target
constituencies.
Collective action as
community empowerment

Outreach involves the use of key members
of the target community as indigenous
workers who communicate a series of
complementary risk reduction messages to
other members of the community. In
addition, such strategies can be incorporated
within existing self-help initiatives which
aim to achieve wider social and political
change.
Collective action as
community empowerment

For example, the Junkiebonden, a federation
of Dutch self-help groups, aims to initiate
community change through campaigning
for the modification of local and national
drug policy.
Collective action as
community empowerment

The Junkiebonden was involved in the
setting up of the first syringe exchange in
the Netherlands in 1984. Since then, it has
distributed education and prevention
materials to drug users and sex workers
through outreach techniques. The
Junkiebonden was set up from within the
drug-using community and is run predominantly by current-drug users.
Collective action as
community empowerment

Evaluation of the needle exchange
programme in Amsterdam has been
positive. Since the establishment of the
needle exchange network, the number of
injectors has remained constant whilst the
number of people joining treatment schemes
has increased. The rate of HIV infections
decreased.
Problems associated with the
collective action approach

vulnerable to lack of funding and to official
oppositions;

danger of creeping professionalisation;

problematic concept of 'community'.
THE 'IDEOLOGY OF
HEALTH PROMOTION'

Health promotion is concerned with
strategies for promoting health. It is
assumed that (a) good health is a universally
shared objective; (b) there is agreement on
what being healthy means; (c) there is a
scientific consensus about which behaviours
facilitate good health.
THE 'IDEOLOGY OF
HEALTH PROMOTION'

However, there have been criticisms of this
contemporary 'ideology of health
promotion'. Evans (1988) was concerned
that such an ideology can begin to drive
health promotion interventions which
instead ought to be informed by scientific
evidence (both biomedical and
psychosocial).
THE 'IDEOLOGY OF
HEALTH PROMOTION'

Evans drew attention to programmes
directed at lifestyle changes which are not
unequivocally justified by biomedical
research evidence, such as the
recommendation to reduce cholesterol
levels in the blood to prevent heart disease.
THE 'IDEOLOGY OF
HEALTH PROMOTION'

Evans worried that 'by increasingly
promoting presumably nonrisky behaviours,
we may be contributing to a type of mass
hypochondriasis resulting in an increasingly
diminished freedom in human lifestyle and
quality of life’. This, he suggested, can
result in an unhealthy obsession with
exercise, an inability to enjoy a meal, as
well as a reduction in spontaneity of
lifestyle.
THE 'IDEOLOGY OF
HEALTH PROMOTION'

Lupton (1995) developed a critique of the
discourse of risk prevalent in contemporary
health promotion. She proposed that 'risk, in
contemporary societies, has come to replace
the old-fashioned (and in modern secular
societies now largely discredited) notion of
sin'.
THE 'IDEOLOGY OF
HEALTH PROMOTION'

This is achieved through the practice of
health risk appraisals and screening
programmes. Lupton likens these practices
to religious confessions where sins are
confessed, judgement is passed and penance
is expected. Lupton points out that risk
discourse attributes ill health to personal
characteristics such as lack of will power,
laziness or moral weakness.
THE 'IDEOLOGY OF
HEALTH PROMOTION'

In this way those 'at risk'. become 'risk
takers' who are responsible for their own ill
health as well as its effects upon others and
society as a whole.
THE 'IDEOLOGY OF
HEALTH PROMOTION'

Lupton argues that risk discourse can have
detrimental consequences for those
positioned within it: being labelled at risk
can become a self-fulfilling prophecy since
people may feel reluctant to seek medical
advice for fear of being reprimanded.
THE 'IDEOLOGY OF
HEALTH PROMOTION'

Also, it can give rise to fatalism, as well as
anxiety, uncertainty and fear, as, for
example, for women 'at risk' of breast
cancer who can experience their 'at risk'
status as a half-way house between health
and illness (Gifford, 1986, cited in Lupton,
1995).
Three points about health
behaviour:

Behaviours can change over time

Health habits are not strongly
interdependent

Health behaviours are not governed by a
single set of attitudes; you may not smoke
because it irritates you, and you might diet
because you wish to be attractive.
There are three types of
health behaviour
– Health behaviour refers to activity that a well
person would engage in, in order to prevent
illness
– Illness behaviour concerns the behaviour
someone would engage in, in order to find out
what is wrong with him or her and to procure a
remedy.
– Sick-role behaviour concerns the behaviour a
patient engages in, in order to overcome their
illness.
Cues in the Environment

Many bad health practices are triggered by
cues in the environment, with which the
behaviour has been associated with in the
past. For example, the sight of an open
packet of cigarettes might be enough to
trigger the action of lighting up, despite a
bad cold. (Hunt et al 1979).
The impact of the family upon
children's health behaviour.

Children pick up the good health behaviours
(e.g. diet, exercise, not smoking, etc) of
other family members. Modelling and
reinforcement play a part in this process.
(Baranowski & Nader, 1985).
The impact of the family upon
children's health behaviour.

Sick role behaviour could be determined in
the family. A study of female college
students accessed whether they had been
encouraged during adolescence to adopt the
sick role for menstruation or had seen their
mothers get upset over menstruation. These
women reported more menstrual symptoms,
disability and attended clinic more often in
adulthood compared with other students
(Whitehead et al, 1986).
Yale Model of Communication
Yale Model of Communication

The Yale Model of Communication holds
the following specific implications for
designing health promotion campaigns:
– 1. It is important that the source of the
information is perceived as credible by the
audience.
– 2. When the audience is positive towards the
communicator and the message it is best to use
a one-sided argument.
Yale Model of Communication
– 3. • A low level of fear arousal is necessary in
order to trigger perceived threat, but too much
fear will cause high levels of tension, leading to
avoidance (e.g. Janis and Feshbach 1953).
– 4. The message should be short, clear and
direct.
– 5. The message should be colourful and vivid
rather than full of technical terms and statistics.
Yale Model of Communication
– 6. • If a message is complex, or the audience
not very well-informed, then conclusions need
to be explicitly stated. Otherwise, it is better to
let the audience reach its own conclusions.
– 7. • Certain individuals (for example, with low
selfesteem) are easier to persuade than others,
but they are as likely to be influenced by
negative health messages (from advertising and
the media) as by health promotion messages.
Yale Model of Communication
– 8. • If possible, it is best to involve the audience
in active participation in the communication
process as the effects of the message will last
longer.
Fear Appeals

Early study (Lashley & Watson, 1921)
– Study of health education films, warning of the
risk of VD to First World War soldiers from
prostitutes. Films were graphic and had story
lines.
Fear Appeals

Findings
– Storylines are too risky as often the story is
remembered but not the health message
– Must be frank (not flippant) about sex.
– Fear arousing effects do not have desired effect.

Baggaley (1991) - media campaigns on
AIDS make the above mistakes.
Fear Appeals

Janis and Feshbach (1953)
– Minimal fear appeal - 36% conformity (evidence
based on self-report).
Strong fear appeal - 8% conformity
Illustrated lectures (15 mins) on dangers of tooth
decay and need for oral hygiene.
Criticism

Fear appeals could lead to the person
putting up a resistance to the message. The
use of an Ego defence mechanism could be
an explanation.

Effects are short lived (Leventhal and
Hirschman, 1982)

A message needs to tell of appropriate
behaviour as well (Leventhal, 1970).

Fear appeals may induce learned
helplessness.
Fear Appeal and Self-Efficacy

The technique of combining the fear
message with a self-efficacy message is a
common theme in current research, and it
appears that the most effective combination
is to have a high fear message with a high
self-efficacy message (Witte and Allen,
2000). What commonly appears in health
education messages, however, is a high fear
message with little or no self-efficacy
message.
Fear Appeal and Self-Efficacy

A review of messages designed to
encourage breast self-examination (BSE)
found that the leaflets had an unbalanced
proportion of threat to efficacy information.
BSE is a technique that women can use to
screen themselves for breast cancer, and the
alternative screening technique is to use the
hi-tech medical procedure called
mammography.
Fear Appeal and Self-Efficacy

Interestingly, in the leaflets analysed in the
study, the arguments in favour of screening
by mammography were very strong,
suggesting that there was an underlying aim
to encourage the women to seek out medical
procedures rather than take control of their
own health (Kline and Mattson, 2000).
Learning theory and health
behaviour.

Reinforcement
– If the health behaviour is rewarding then the
behaviour is likely to continue. For example, a
child might be given a penny for brushing her
teeth. An example of a negative reinforcement
would be a tablet alleviating a headache.
Learning theory and health
behaviour.

Extinction
– The taking away of a reward might cause the
health behaviour to cease. For example, if the
child is no longer given a penny for brushing
her teeth, then she might stop; however smiling
should prove to be an effective substitute for
the money.
Learning theory and health
behaviour.

Punishment
– If good health behaviour is producing
unpleasant side-effects then the behaviour is
likely to cease.

Modelling
– Observing others - Bandura (1965).
Coronary heart disease and
excessive drinking

Drinking associated with social and cultural
norms (Bennett and Murphy, 1994)

In Glasgow, campaign based on safe
number of units, replaced with one that
concentrated on social costs of drinking too
much (Leather, 1981)
Accidents

Chip pan fire campaign (Compe 1989)
– The campaign produced a 25% reduction in
chip pan fires in some areas. 12% reduction
overall. Campaigns are most effective if they
contain information about what to do rather
than what to think or what to be scared of.
The end