Psychology and Health
Introduction
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 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.
Perceived severity
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.
Perceived susceptibility
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 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).
Perceived benefits
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.
Perceived barriers
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 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.
Perceived self-efficacy
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 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 & Brown, 2010).
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.
Modifying variables
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, 1993).
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).
Breast cancer
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 self-examination.
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 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 women.
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 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 these costs.
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.
Recommendations
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 positively manipulated by health officials and individuals to ensure that behavioral changes are adopted for the benefit of an individual.
Conclusion
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.
References
| 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.
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