Psychology and health:
Summative Assignment – Deadline Monday 3 February 2014 Notes will be sent by email.
health_summative_reading_list.docx (18.567 KB)
This summative assignment contributes 50% towards the module.
Word limit 2500 (not including references or appendices)
In your capacity as a health psychologist you have been asked to advise the Department of
Health about how to design an effective behaviour change intervention aimed at achieving
ONE of the targets listed below. Your 2500 word report should describe the key features of
your intervention and critically evaluate the empirical evidence and (where appropriate)
theories on which the recommendations are based. Examples of proposed intervention
materials can be included in appendices if desired (Note – the word limit does not include
appendices or references).
Choose ONE of the following targets for your proposed behavior change intervention:
Reduce the number of people who smoke
Reduce binge drinking in young people
Reduce the number of people being hurt or killed in road accidents
Reduce the incidence of sexually transmitted infections in young people
Reduce the incidence of skin cancer
Increase the early detection of any single type of cancer – (e.g., skin, breast, testicular,
cervical, colorectal cancer)
Encourage people to lose weight through diet and/or exercise
Psychology and Health
Recently there has been gradual development and establishment of models explaining
and modifying human behavior for better health outcomes. Various models have been
established to deal with inappropriate behavior that jeopardizes the life of humans. These models
impacting behavioral change are based on learning theories arising from stimulus response
theory and cognitive theory (Abraham & Sheeran, 1996). Stimulus response theory believes in
learning results from reinforcements hence reducing physiological drives that stimulate harmful
behavior. Social cognitive theory puts emphasis on role of expectations that a subject has.
Consequences of behavior function through influencing subject expectations regarding a
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particular that he or she may be in (Rosenstock, Strecher & Becker, 1988). Therefore this theory
is a “value-expectancy” kind of theory.
These models have enabled deal with preventive health behaviors, risk-factor behaviors,
screening behaviors, and sick-role behaviors. Preventive health behaviors are like swine flu
inoculation and influenza vaccination while screening behaviors can be in genetic screening
context like Tay-Sachs disease screening (Abraham & Sheeran, 2005). Risk-factor behaviors
include the indirect risk preventive health behaviors like nutrition, medical checkups, dental
checkups, seat belt use, exercise, immunization, and miscellaneous screening exams and direct
risk preventive health behaviors like driving, pedestrian and smoking behavior as well as
personal hygiene. Sick-role health related behaviors requires compliance with behavioral
measure like medication, diet, urine testing, exercise, and foot care as well as compliance with
physiological measures like glycosylated haemoglobin, fasting plasma glucose, fasting
triglycerides, and urine glucose.
Health Belief Model
Health Belief Model, social cognitive theory, self-efficacy, and locus of control were used in
during problems of explaining, predicting, and influencing behavior. The interrelationship
between this model, theory, and variables has been used to come up with a better revised
explanatory model, Health Belief Model. The olden Health Belief Model was based on concepts
of perceived susceptibility, severity, benefits, and barriers. The revised version of the model
incorporates self-efficacy, cues to action and motivating factors.
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The concept of perceived severity addresses an individual’s perception or belief about the
seriousness of a disease. This perception is mostly based on medical information or knowledge
that an individual has. Perceived severity also can be from an individual’s beliefs about the
difficulties a disease or condition would have in general. If a disease also greatly interferes with
important routine activities then depending on an individual its severity may be considered great.
Level of perceived seriousness of a disease varies greatly amongst patients since they affect
individual’s lives differently and their effect on routine activities is different.
Personal risk or susceptibility is significant in pushing people to adopt healthier
behaviors. The greater the perceived risk, the greater the chances of reduced involvement in risky
behavior while the lower the risk of susceptibility, the greater the chances of involvement in
risky behavior. When perceived risk is high, individuals are prompted to take cautious measures
to reduce chances of contracting a disease. It also prompts people to enhance their diets, exercise,
weight, and get rid of smoking and alcohol taking behaviors when they realize they are at risk of
having terminal diseases like cancer especially breast cancer in women.
If people believe they are not at risk of having a particular disease in question, they result
in more unhealthy and risky behaviors. Perceptions by young generation and male gender that
breast cancer only affects the old and females respectively, makes these two categorizes reluctant
to carry out any breast self-examination. These two groups also involve in risky health behaviors
that increase chances of breast cancer occurrence (Miller et al., 2002).
However, there are cases where an increased perception of susceptibility does not
necessarily lead to increased practice in healthy behaviors. People have knowledge on high risk
of disease occurrence but still end up ignoring scientific facts and going about their activities like
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uninformed people. Research shows that although women have overly and insistently been made
aware of high risk of breast cancer due to diet and hormonal changes irrespective of age, very
few put emphasis on frequent breast self-examination (Hyman et al., 1994).
Combination of perceived seriousness and susceptibility leads to perceived threat which
in most cases leads to behavioral change. The high risk of reoccurrence of breast cancer is a
perceived threat which is important since it prompts more health-enhancing, risk-reducing
behaviors in individuals (Janz & Becker, 1984).
Concept of perceived benefits is about an individual’s opinion on the value and
usefulness of a certain behavior in reducing risk of developing a disease. Most people
incorporate new healthier behaviors if they feel that they will reduce their chances of developing
and curing a particular disease. On the other hand, if a person does not consider that a particular
behavior is viable enough in protecting them from developing a disease then there are minimal
chances of practicing it (Lu, 2001).
Early detection of breast cancer leads to greater chances of survival for individuals.
Regular breast self-examination is an effective measure since it enables early detection of breast
cancer hence increasing chances of survival. This positive correlation between perceived benefits
of increased chances of survival and regular breast self-examination is what prompts most
women to undertake self-examination regularly. Women who believe that breast self-
examination does not benefit them then do not engage in this action.
Change is not an easy thing and perceived barriers address issues that are considered to
bar necessary healthier changes. Perceived barriers are an individual’s evaluation of all possible
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obstacles that hinder them from adopting a better healthier behavior. These barriers therefore
play a major role in determining if a behavior change is adopted. For a behavioral change to be
assimilated, individuals most believe that its benefits outweigh consequences of old behaviors
which are significant in overcoming barriers (Manfredi et al., 1977).
Threat of breast cancer, high perception of developing it, and the seriousness of the
disease are aspects that would motivate women to carry out regular breast self-examination for
early detection and higher chances of survival. Despite all these, barriers to performing breast
self-examination regularly have greater impact over this behavior than the threat posed by breast
cancer. These barriers varies and include fear of not performing breast self-examination
correctly, fright of knowing one has cancer, difficulty in starting and adapting to the new
behavior to make it a habit, interferences that breast self-examinations have on other activities,
and embarrassment (Kelly, 1979). These barriers amongst others determine if a woman will
proceed with adopting a regular breast self-examination hence are they are very significant and
should be addressed to ensure positive health conditions.
This construct is about an individual’s belief in their ability to do something or carry out
a certain advised action. Generally, people do not risk performing new behaviors unless they
believe in their own ability to perform them. Individuals may believe in the viability of a new
behavior to improving a condition, perceived benefits, but this can be hindered by their
perception of not being capable enough to carry out that action, perceived barrier (Hallal, 1982).
According to perceived barriers to performing breast self-examination, fear of not being
able to correctly implement this behavior is considered a barrier to adopting regular breast self-
examination behavior in most women (Harrison, Mullen & Green, 1992). Therefore, a woman
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has to believe that she can correctly perform breast self-examination in order to outweigh that
particular perceived barrier. Perceived self-efficacy is therefore necessary since it impacts on
whether perceived benefits and perceived severity outweigh perceived barriers (Tanner-Smith &
Cues to action
These are external factors that prompt individuals to adopt healthier behavioral changes.
They can be events, people or things which strongly pressure individuals to change their
behaviors accordingly. They include media campaigns, advice from others, time-framed
postcards from medical practitioners, illness of a close relative, death of world icons or close
relative, and media reports among others (Stillman, 1977).
Increased adoption of breast self-examination globally is impacted by mass media reports
and campaigns sensitizing on the reality and threats that the disease posses. Currently media has
been at the forefront of creating awareness through national and international initiatives which
have been a boost to adoption on self-examination by many women. Death of world icons or
close relatives also motivates individuals to undergo regular checkups to ensure increased
chances of survival. Therefore, external forces are quite significant in motivating healthier
behavioral changes and should hence be positively manipulated.
Concepts of perceived susceptibility, perceived severity, perceived barriers, and
perceived benefits are modified by variables like culture, education level, previous experience,
skill, and motivation among others. These individual characteristics influence perceptions hence
determining if healthier behavioral changes will be adopted by individuals (Champion & Scott,
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Education level determines the level of awareness of the severity of developing breast
cancer and benefits of early detection in individuals. For women with lower education levels, the
real danger of breast cancer if not known to them therefore they do not undertake breast self-
examination. Women who have past experience with any kind of cancer either directly or
indirectly understand that they are highly susceptible to developing cancer therefore regularly
engage in breast self-examination to increase chances of survival due to early treatment (Strecher
& Rosenstock, 1997).
Concepts of perceived susceptibility and perceived benefits of the Health Belief Model
were majorly used to distinguish breast self-examination (BSE) practitioners from non-
practitioners. Hallal focused on these concepts using a purposively sampled number of 207
women from settings like social, recreational, service, employment and religious among others
that are non-health based. An instrument developed by Stillman was used to assess perceived
susceptibility and perceived benefits beliefs for the study. A questionnaire categorized into two,
“practice BSE” against “never practice BSE” was administered on beliefs and practice of breast
Cues to action are those factors which trigger undertaking breast self-examination in most
women. Generally these factors range from age, sex, gender, education, personality, and
knowledge depending on health or risk factors under consideration (Champion, 1994). In this
case age, gender and knowledge on the increasing rate of breast cancer cases as well as the need
for undertaking preventive and curative measures trigger this action. Research showed there was
a positive correlation between perceived susceptibility, perceived benefits and practice of breast
self-examination. Correlation of perceived benefits to breast self-examination was twice of
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perceived susceptibility with both concepts accounting to 10% variation in the practice
(Champion & Huster, 1995). Belief in self-efficacy of early breast cancer detection strongly
correlates to the ability and necessity of performing breast self-examination amongst many
Perceived susceptibility concept on breast cancer argues that women who perform breast
self-examination regularly are aware that there are chances of suffering from breast cancer due to
the high rate of increased cancer cases worldwide. Perceived benefits makes women carry out
breast self-examination due to awareness that early detection of presence of lumps or breast
pains can be treated through chemotherapy to prevent it from spreading to other body parts or
extreme measures like cutting of the breast (Stein et al., 1992). Therefore, the belief that advised
action on healthy eating and lifestyle habits as well as treatment measures in reducing the risk
that full blown breast cancer could have pushes most women globally to carry out breast self-
examination regularly and seek medical advice. Seriousness and consequences of having breast
cancer also motivates some women to carry out breast self-examination. Risks of full blown
breast cancer leading to cutting of breast, higher chances of spreading to arms, and ultimately an
early death scare women into regular breast self-examination to prevent these possible
occurrences. Self efficacy concept and belief that early detection of breast cancer can be treated
hence sustaining and increasing life span of a patient who is doomed to an early grave. This
belief motivates many women to undertake regular breast self-examination to ensure that they
save their lives and impact them positively when they can.
However, this research is limited by the nature of purposive sample and retrospective
design which hinder interpretation and generalization of results to an entire population. The
dichotomization of the dependent variable that categorizes women as “practicers” completely
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disregards the frequency in which women carry out breast self-examination over a particular life
span. A perceived barrier, like fright that arises due to breast self-examination results is a reason
that hinders women from taking part in this activity (Champion et al., 2003). Embarrassment and
shame associated with getting a mammogram especially in elderly women also prevents women
from undergoing any breast cancer check up. Personal opinions on financial and psychological
costs associated with given advice on the action to take to prevent or cure breast cancer also
limits many women from self-examination since they are already believe that they cannot meet
Therefore, throughout the breast self-examination research and analysis, perceived
susceptibility, perceived severity, and perceived efficacy are constantly associated with breast
self-examination age, gender, knowledge, and practice.
Enhancing self-efficacy will ensure that necessary behavioral changes are adopted by
individuals since it leads to perceived benefits, perceived susceptibility, and perceived severity
outweighing perceived barriers. Performance accomplishments, vicarious experience, verbal
persuasion, and physiological states have a great influence on sources of self-efficacy
information (Aiken et al., 1994). Performance accomplishments are based on personal mastery
experience while vicarious experiences are acquired through observing performances of others.
Verbal persuasions are applied by medical practitioners during health education to promote
adoption of a particular new behavior. Physiological state also negatively or positively impacts
the self confidence or efficacy of an individual regarding his or her ability to perform a certain
behavioral change (Yarbrough & Braden, 2001). These aspects of self-efficacy should be
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positively manipulated by health officials and individuals to ensure that behavioral changes are
adopted for the benefit of an individual.
Constructs of perceived susceptibility, perceived benefits, perceived barriers, perceived
self-efficacy, perceived severity, cues to action and modifying factors applied by Health Belief
Model are significant approaches in ensuring adoption of behavioral changes for the health
betterment of an individual. Therefore, individuals, scientists, and medical workers should
ensure to manipulate these constructs to enhance the health of an individual.
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Abraham, C., & Sheeran, P. (1996, 2005). The Health Belief Model. In M. Conner & P. Norman
(Eds.), Predicting health behaviour: Research and practice with social cognition models.
Maidenhead: Open University Press.
Aiken, L. S., West, S. G., Woodward, C. K., Reno, R. R., & Reynolds, K. D. (1994). Increasing
screening mammography in asymptomatic women – evaluation of a 2nd-generation,
theory-based program. Health Psychology, 13(6), 526-538.
Champion, V., & Huster, G. (1995). Effect of interventions on stage of mammography adoption.
Journal of Behavioral Medicine, 18(2), 169-187.
Champion, V., Maraj, M., Hui, S., Perkins, A. J., Tierney, W., Menon, U., et al. (2003).
Comparison of tailored interventions to increase mammography screening in nonadherent
older women. Preventive Medicine, 36(2), 150-158.
Champion, V., & Scott, C. (1993). Effects of a procedural belief intervention on breast self-
examination performance. Research in Nursing & Health, 16(3), 163-170.
Champion, V. L. (1994). Strategies to increase mammography utilization. Medical Care, 32(2),
Harrison, J. A., Mullen, P. D., & Green, L. W. (1992). A metaanalysis of studies of the health
belief model with adults. Health Education Research, 7(1), 107-116.
Hyman, R. B., Baker, S., Ephraim, R., Moadel, A., & Philip, J. (1994). Health belief model
variables as predictors of screening mammography utilization. Journal of Behavioral
Medicine, 17(4), 391-406.
Janz, N. K., & Becker, M. H. (1984). The health belief model – a decade later. Health Education
Quarterly, 11(1), 1-47.
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Hallal, J. C. (1982). The relationship of health beliefs, health locus of control, and self concept to
the practice of breast self-examination in adult women. Nurs Res 31:137-142.
Stillman, M. J. (1977). Women’s health beliefs about breast cancer and breast self-examination.
Nurs Res 26:121-127.
Manfredi, C., Warnecke, R. B., Graham, S., et al. (1977). Social psychological correlates of
health behavior: Knowledge of breast self-examination techniques among black women.
Soc Sci Med 11:433440.
Kelly, P. T. (1979). Breast self-examinations: Who does them and why. J Behav Med 2:31-38.
Lu, Z. Y. J. (2001). Effectiveness of Breast Self-Examination nursing interventions for
Taiwanese community target groups. Journal of Advanced Nursing, 34(2), 163-170.
Miller, A. B., To, T., Baines, C. J., & Wall, C. (2002). The Canadian National Breast Screening
Study-1: Breast cancer mortality after 11 to 16 years of follow-up – A randomized
screening trial of mammography in women age 40 to 49 years. Annals of Internal
Medicine, 137(5), 305-312.
Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988). Social-learning theory and the health
belief model. Health Education Quarterly, 15(2), 175-183.
Stein, J. A., Fox, S. A., Murata, P. J., & Morisky, D. E. (1992). Mammography usage and the
health belief model. Health Education Quarterly, 19(4), 447-462.
Strecher, V. J., & Rosenstock, I. M. (1997). The Health Belief Model. In K. Glanz (Ed.), Health
behavior and health education: Theory, research and practice (2 ed.). San-Francisco:
Tanner-Smith, E. E., & Brown, T.N. (2010). Evaluating the Health Belief Model: A critical
review of studies predicting mammographic and pap screening. Social Theory & Health,
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Yarbrough, S. S., & Braden, C. J. (2001). Utility of health belief model as a guide for explaining
or predicting breast cancer screening behaviours. Journal of Advanced Nursing, 33(5),