Chapter 1: What is health psychology? Why is culture important?

term
• Cultural differences predict health more. questions
What is health? • If our friends exercise, we will be more likely to.
• Health (WHO): A state of complete physical, mental and social • Muslims do not eat pork or drink alcohol.
well-being. • Those who live in Victoria, tend to exercise more due to milder
General de nition climate.
• One can view health as a continuum (optimal health at one end • Parents, peers, religion, geography (all components of culture)
and poor health on the other). play a huge role in health.
Subjective spot leans toward
either side at any point in time. How can we de ne culture?
• Unique meaning and information system, shared by a group and
Diversity and Culture transmitted across generations, that allows the group to meet
• Death rates for Black people are signi cantly higher than those basic needs of survival, by coordinating social behaviours, to
of Americans, overall due to heart disease, cancer, diabetes, HIV pursue happiness and well-being, and to derive meaning from life.
and homocide. • Dynamic, beliefs held by cultures can change overtime.
• People of all kinds of life experience various kinds of health and • Individuals change together
de ne it much differently; SES differences, QUEER folk, cultural • Culture has many dimensions (more than just race and ethnicity).
backgrounds, ethnicity, age, etc. Also involves race, religion, age, sex, family values,
• Intersectionality: The various dimensions of one’s life that all geography.
play a role in shaping their unique experiences and Availability Heuristic: Overestimate the actual occurrence of
opportunities. something just based on the extent to which we hear about it.
• Diversity: The many ways individuals and groups of individuals
vary from one another. What are the two key areas of diversity?
• Culture is more often used to capture group characteristics (1) Socioeconomic Status (SES)
(similar). • Poverty and illness tend to go together, often linked by factors
diffbetweendiversityand such as such as access to health care and insurance.
culture • SES is related to a higher occurrence of most chronic and
infectious diseases, also all major causes of mortality and
morbidity.
• Positive correlation between SES and health (more money you
have, the better your health).
(2) Sex
• Many differences in health are due to sex. Example: Older women
are more likely to bene t from exercise than older men.
• Women live longer than men, they report symptoms of illness
more frequently and use health services to a greater extent.
• Not better or worse to be male, female or other
Estrogen (female sex hormone) has a protective effect
against cardiovascular illness in women younger than age
50.
However, women are more likely to be victims of violence,
sexual assault, body image issues and eating/diet problems.
Cross Cultural De nitions of Health
• Western: Health is determined by the absence of disease. Advancing Cultural Competence
Largely based on the physical or biological aspect of life • Many different cultural approaches to health, very important to be
(biomedical approach). culturally aware (competent).
• Chinese: Health is the balance of the of yin and yang (or hot and Purnell Model of Cultural Competence
cold, opposites). Refer to qualities, for optimal health you
should eat and drink and live your life with equal amounts of hot What is Health Psychology?
qualities and cold qualities. Health Psychology: Psychology dedicated to promoting and
• Ayurveda (Indian): The balance of mind, body and spirit. maintaining health and preventing and treating illness.
• Indigenous: Spiritual, mental and physical harmony (harmony Focus on the thoughts, feelings, behaviour and biological
with the spiritual world and nature). processes interacting with each other to in uence health.
• Mexican: Balance of body.types and energies. The Evolution of Health Psychology
• Emerged when humans started dying more from chronic illness
(families, infections).
• Historical archives suggests mind and body were considered one.
Spirits invading the body were considered the reason for
illness, drilling holes into skull to release spirits
(trephination).
 Chinese Taoist and Indian practitioners wrote about
various ways the mind could heal the body and vice versa.
Middle East and Egypt held this same belief.
Greek Philophers challenged these views and thought the
mind and body were seperate entities. Breaks valued
reason and rational thought, focused more on biological
roots of health.
Hippocrates: Greek philosopher that proposed people
get sick due to an imbalance of 4 major bodily uids
(example: If you had a lot of blood, you were cheerful). He
was the father of Western biomedicine.
• Descartes: Strengthened the Greek idea about the separation
of the mind from the body.
This distinction between mind and body paved the way
for helped medical science evolve (due to dissections of
dead bodies - helped us learn about human anatomy).
• Early 20th century = Psychology started to play a part in the
examination of health
• Freud’s role in health psychology: The rst to bring attention to
the possibility that illness could have psychological cause.
Noticed when his patient’s psychological distresses were
cured, so were there physical ailments.

• Behavioural Medicine: Looks at non-biological in uences on

health.
• Epidemiology: In uence the eld of health psychology and
medical sociology. A branch of medicine that studies the
frequency, distribution and causes of different diseases with an
emphasis on the role of the physical and social environments.
• Morbidity: The number of cases of disease that exist at a given
point in time.
• Mortality: The number of deaths related to a speci c cause.
Chapter 3: Cultural Approaches to Health
• Western biomedicine has strong ties to technology.
• The invention of the microscope allowed blood, saliva and other
• One’s religiosity has been a major focus of health psychology.
bodily uids to be examined. Gave a better understanding of
Example: The Māori of New Zealand have different priests
structure & function on the cellular level.
who help health the min, the spirit and family bonds.
• Louis Pasteur: Proved that viruses and bacteria could cause
• Culture in uences what gets de ned as a problem, how the
disease (one of the most signi cant events of the 19th century).
problem is understood and which solutions to the problem are
• Wilhelmina Roentgen: Discovered that passing high charged
acceptable.
waves of energy through the body and then onto a sensitive
We all need to learn diverse cultures to be culturally
photographic plate created accurate images of the body’s
competent.
interior (X-Rays).
• Evil Eye: The name for a sickness transmitted, usually without
Ability to look at the body from within.
intention, by someone who is envious, jealous or covetous.
• Closer examinations to the body became possible in the 20th
Many Latino and Asian Indian mothers try to make sure their
century due to the MRI and CAT scans.
children do not get this illness by placing black dots on their
Closer examinations of the brain.
child’s forehead.
• Western biomedicine places an emphasis on what can be
Traditional World Medicine
observed.
• Our ancestors probably believed that our bodies worked
Example: Cancer cells = moving away from positive health.
because of magic.
• Medicine is biomedical (chemical methods of healing). The
Cures consisted of potions, rings, charms and bracelets
chemical composition of drugs can mirror naturally occurring
that rid the body of harmful spirits and demons.
substance (opioids and opiates).
Believed one’s eyes are the sights of power and magic,
• Surgery is biomedical, rst practiced by the early Egyptians and
whereas animal eyes were used in treatment.
Aztecs.
• Health beliefs and practices are largely tied to religion, ethnic
identity and nationality (qualities not given much attention in
Reliance on technology, evolution of pharmacology and surgery =
Western medicine).
main approach of Western Healing.
Western cultures have historically tried to suppress non-
western beliefs (residential schools and Zew Zealand
Traditional Chinese Medicine (TCM)
Māori practices).
• Traditional Chinese Medicine: Holisitc system of medicine and
Western Biomedicine
approach the alto and healing originating in China approximately
• Western Biomedicine: A system in which medical doctors and
4,000 years ago. Major treatments include acupuncture and the
other healthcare professionals (such as nurse, pharmacists and
use of herbs.
therapists) treat symptoms an diseases using drugs, radiation or
Important role in sustainable agriculture and food systems.
surgery.
Help to balance temperature and promote health
One of the most dominant forms of health care.
prevention and preservation.
Reliance on technology and scienti c complex
Inexpensive and more focused on tness rather than
procedures.
illness.
Views the body as a bio mechanical machine with distinct
Body is treated as a whole and connected to all other
parts, searching for the smallest unit responsible for the
parts.
illness (reductionist).
Macroscopic (as opposed to Western biomedicine).
‣ This approach neglects the personal and social
Disease are thought to be causes by imbalances in yin and
dimensions of health/illness.
yang (too much heat or wind).
What are the Greek roots of Western biomedicine?
• Tao: A major Chinese philosophical approach to life and the
• Hippocrates: The rst to separate medicine from religion and
universe. Transacted it mean a way of life or order o f the
myth and to bring scienti c and analytical reasoning to health
universe and can be also seen as a state of being.
care.
Yin and Yang: Mutually independent, constantly interactive
Humoral Theory: Hippocrate’s argued that our
and potentially interchangeable forces. Each contain the
personalities were a function of the level of certain bodily
seed of the other. The circle represent s the supreme
uids or humours. If you had a lot of black bile you would
source (Tao).
be sad or melancholic.
Yin: Means “shady side of the hill”. Traditionally thought of
• Mesopotamia developed an of cial system based on a
as darkness, the moon, cold and female.
diagnostic framework. A lead physician coordinated treatments
Yang: Means “sunny side of the hill” . Traditionally though
and combined religious rites and empirical treatments such as
of as light, the sun, hot and male.
drugs and surgery.
• In Egypt, the pharaohs also had a line of physicians called the Iri.
• William Harvey: An Enligh physician, rst described the
circulation of blood and functioning of the heart it the Western
world in 1628.
• 10 vital organs are divided into 5 pairs (phases) containing one Contemporary World Medicine
solid yin organ and one hollow yang organ. • Curanderismo: Hollisitc system of healing practiced by many
Yin (heart, liver, pancreas, kidney and lungs), more vital Latin Americans and blending spirituality and Western
than yang organs (basically most important organs are yin). approached to health and healing.
‣ Dysfunctions of yin cause greatest health problems. Of ce is in the community (often in a house).
Yang (gallbladder, small intestine, large intestine and No appointments, fees or forms, patient pays whatever
bladder). they believe/can.
• Someone who is healthy has a balance of yin and yang, if Relies heavily on the patient’s faith and herbs, fruits, eggs
someone is sick, their forces are out of balance. and oils.
• Energy (qi): Chinese word to describe the natural energy of the Two sources of illness (1) natural (2) supernatural (when
universe. The main goal of TCM is to balance this force of the they are not in balance, illness occurs).
body and to increase it if needed when one is ill. ‣ Believe germs cause illness yet there are spiritual
• The ve elements of wood, re, earth, metal and water each link aspects that do too.
to a speci c organ. Based o Judeo-Christian customers.
For example: The heart is ruled by re. Treatment surrounds the natural support systems/
• Doctors treat the controlling element. community already in place (collectivist).
Example: Someone eats too much salt, which causes Three levels of treatment (1) material, (2) spiritual (3) and
kidney disorder. The kidney and bladder (water) control the mental.
heart and small intestine ( re). Kidney disorders cause
heart disorders and high blood pressure. Indigenous Health Practices
• Meridians: 12 precise patterns in the body in which qi ows. • The Medicine Wheel: A circular symbol broken into four areas
Connect or attaches organs. Blocking these connections can (quadrants). Each area has different colours assigned to them,
cause illness by bringing about hyperactivity of certain organs most often yellow, red, black and white. Different nations
and under activity of others. practice this differently.
• Treatments: Acupuncture, herbs, dietary changes and exercises. All aspects of life are interconnected.
Each quadrant have four different attributes assigned to
Ayurveda: Traditional Indian Medicine them.
• Ayurveda: Ancient system of medicine that focuses on the body, a. Four directions
the sense organs, the mind and the soul. It originated in India b. Four states of being
approximately 4,000 years ago. c. Four sacred medicines
Four causes of mental illness (1) Diet (incompatible or d. Four seasons
unclean foot) (2) disrespect to gods, elders or teachers (3) e. Four elements
mental shock due to emotions such as excessive fear/joy f. Four stages of life
(4) faulty bodily activity. Importance of the circle: Represents the circle of life, self-
Considers a biopyschosocial approach awareness (balance), knowledge. Reminder that
Macroscopic and holistic (similar to TCM). everything ows in a cycle (continuous on).
Collectivist orientation (well-being of the individual is tied
to the well-being of the community) Are complementary and alternative (CAM) approaches valid?
Notion of basic elements (earth, air, ether, Fire and Water). • Complementary and Alternative Medicine: Generally describes
‣ All about balance of the elements. any healing philosophies and therapies that mainstream Western
These elements combine to form three major forces (vatta , (conventional) medicine does not commonly use.
pitta and kapha). • Approximately 38% of North Americans use some form of
‣ Vatta: (Air & Ether) Directs nerve impulses, complementary medicine.
circulation, respiration and elimination. Yoga, chiropractor, massages, etc
‣ Pitta: (Fire & Water) Responsible for metabolism in • CAM use is treaters by women, people with higher educational
the organ and tissue systems as well as cellular levels, people who have been hospitalized in the past year, and
metabolism. former smokers.
‣ Kapha: (Water & Earth) Responsible for growth and • Stigma in the West surrounding CAM
protection. • Belief system plays a huge role.
Treatment: Puri cation, surgery, drugs, diets, herbs, Scienti c evidence is not needed when you have faith. To
minerals, massage, colour, gem therapy, homeopathy, successfully treat and in uence people with different
acupressure, music, yoga, aromatherapy and meditation. beliefs, we have to know rst what they believe.
Chapter 7: Models of Behaviour Change What are the key theories of health behaviour change?
This chapter discusses how health psychologists explain why we • Social Cognitive Theory: Behavioural change theory that posits
don’t do all that we should and why we do some of what we that characteristics of people (their attitudes and beliefs), their
should not. environments and their health behaviours all interact and
determine whether each person perform as a health behaviour.
What are healthy behaviours? Suggests that the most central determinant of health behaviour
• Healthy Behaviours: Any speci c behaviours that maintain and change is self-ef cacy.
enhance health. Can range from mundane (brushing your teeth) • Transtheoretical Model: Major theory of health behaviour
to critical practices (not practicing safe sex). Can be episodic change that identi es different stages we process through as we
(getting a u shot) or long-term (eating healthy). think about, attempt to and nally change a speci c behaviours.
Example: Wearing a seat belt. Draws on common themes from different intervention
• In the 1970’s, health educators begun to focus on the theories (reward & punishment, humanists,
institutions and social conditions that impede or facilitate psychodynamic).
individuals reaching optimal health. DiClemente & Prochaska (1982): Found that smokers
• Health Education: A discipline dedicated to teach people to who were attempting to quit utilized various processes at
limit behaviours detrimental to their health and increase different times. Identi ed behaviour change unfolds in a
behaviours that are conductive to health. series of stages.
• Being physically active is one of the most bene cial health 1. Pre-contemplation: The stage when people are not aware that
behaviours you can perform. they are practicing a behaviour that is unhealthy or do not
intend to take any action to change a behaviour (especially not
What determines health behaviours? in the next 6 months).
For example, some teenage smokers are so con dent
about their own health that they do not believe smoking is
a problem for them and have no intention of quitting.
People in this stage avoid reading, thinking or talking
about their unhealthy behaviours.
2. Contemplation: The stage when people recognize they may be
doing something unhealthy and then intend to change (within the
next month). Here they are more aware of the bene ts of changing
and are also very cognizant of the problems that changing may
involve.
For example, a smoker in this stage it might mean not
• Biological Factors: We are born with many predispositions that spending time with the buddies they always used to
can in uence the types of health behaviours that we practice. smoke with.
We inherit metabolic rates, which determine how we 3. Preparation: The stage in which the person is ready to take
break down and process what we eat. action to change the behaviour. They generate a plan and have
The likelihood of becoming addicted to smoking or speci c ideas of how to change. Example, someone who wants to
drinking has a biological basis. drink less may give away all the alcohol in the house or have a chat
• Psychological Factors: Personality traits and characteristics play with their doctor about seeking help.
a role in determining health behaviours. This stage in characterized by commitment.
The big ve are good indicators. 4. Action: The stage where people are actually changing their
‣ Boys higher in extra version are more likely to behaviour. The change has to have taken place over the past 6
attempt unsafe cliff jumps and practice unsafe water months and should involve active efforts to change the behaviour.
activities. Example, frequent trips to the gym characterizes someone who is
‣ Conscientiousness and agreeableness are predictors in this stage.
of health behaviours and cognitive attitudes/ 5. Maintenance: The stage in which people try to not fall back into
tendencies. unhealthy behaviours (or relapse). They may still be changing their
• Social Factors: The media messages we are exposed to have a behaviours and performing new ones, but they are not doing it as
strong impact on the types of health behaviours we perform. often. Temptation to relapse is reduced. Example, a store acne
The culture we line in and what we are surrounded by give us a from smoking lasting from 6 months to 5 years.
lot of information about what is acceptable and what is not. 6. Termination: The stage where people are no longer tempted by
Watching movies with tobacco use had an effect on the unhealthy behaviour they have changed. Example, the ex-
teenager use (Mejia et al., 2017). Exposure to smoking in smoker no longer craves a cigarette.
lms increases the likelihood of future smoking. 20% of former smokers and alcohol addicts reached this
• Dimensions often interact to predict health outcomes. Both stage.
individual difference factors and social factors predict health
behaviour.
• Health Belief Model (HBM): A major theory of health behaviour • HBM, TPB & TTM are the most widely cited models of health
that suggests that our beliefs relating to the effectiveness, east behaviour change in health psychology.
and of doing (or not doing) a certain behaviour will determine • The models discussed do not explicitly factor in changes in
whether we do (or not do) the behaviour. mindset overtime and do not address how beliefs or interiors
Value-expectancy theory are translated into action (intention-behaviour gap).
Suggests individuals will perform a healthy behaviour if • HBM has not been as rigoursly quanti ed as the TPB.
they believe they are susceptible to the health issue, • TPB does not recognize emotional elements such as the
believe there will be severe consequences, believe perceived susceptibility to illness (as does the HBM).
behaviour will be bene cial (outweighs the drawbacks). • TTM has been criticized for suggesting individuals cannot move
Self Ef cacy: De ned as the conviction that one can back or progress forward without skipping steps.
successfully execute the behaviour required to produce
the outcome. Models with self-ef cacy (or the related construct of perceived
It is not enough to just know what behaviours will behavioural control) would be more effective than the models that
ef ciently reduce severity and susceptibility, but one did not include it.
has to be con dent that one can actually do the
behaviour. • Interventions: Speci c programs designed to assess of
Perceived barriers are the most powerful component of behaviours, introduce ways to change them, measure whether
the model across studies. change has occurred and assess the impact of the change.
‣ For example, recently immigrated people might be The ultimate goal of health psychological interventions is
less likely to seek healthcare due to language to decrease the number of deaths due to preventable
barriers. diseases, delay the time of death and improve the quality
• Theory of Planned Behaviour (TPB): A major theory of health of life.
behaviour that involves the intention to change, attitudes Top 10 Qualities for Successful Interventions
towards action, subjective norms regarding the action and self- (1) Intervention should be Based on Theory
ef cacy. A theory helps focus attention on the most important
Intention: A person’s subjective probability that they will factors that need to be addressed for the behaviour
perform the behaviour in question (probability of your change at hand.
doing something). (2) Intervene at the Appropriate Level
‣ In uenced by attitude towards the action (beliefs (3) Size Matters
and evaluation). (4) Interventions should target people at risk
‣ Subjective norms regarding action (normative (5) Interventions should be appropriate for the risk/risk factors
beliefs: what others thing you should do and your (6) Be sure your intervention does only what you want it to do
motivation to comply with others preferences). (7) Preventing dropouts should be a priority
‣ Perceived control (self-ef cacy) (8) Be ethical
(9) Be culturally sensitive
(10) Prevent Relapse

• Culture and TPB: How mothers of different races and ethnicities

make decisions to continue breast feeding after 6 months post
birth.
Intentions were similar, however components of the model
were stronger for certain groups than others.
Attitude best predicted intentions for white mothers,
subjective norms for black mothers and perceived control
for Latina mothers.
• Health Action Process Approach (HAPA): Health behavioural
model that has two main phases; factors in uencing intention to
act and the processes that take place after the intention leading
up to the behaviour.