Health Psychology and Behaviour Change : From Science to Practice

This textbook offers a fresh approach to health psychology through the theory and practice of behaviour change. Using an array of case studies from around the world, it discusses how we can develop and evaluate behaviour change interventions. The book encourages active engagement with contemporary discussions about health behaviours, covering areas of emerging importance such as weight stigma, vaping, nudges, vaccine hesitancy and paleo-inspired lifestyles. With a focus upon critical thinking, this book will equip students for success in their research projects and beyond. Ideal for students of Health Behaviour Change and Health Psychology, this textbook is also relevant to those taking courses in related fields such as Nursing and Public Health. BRIEF CONTENTS CONTENTS LIST OF FIGURES AND IMAGES Figures Images LIST OF TABLES LIST OF BOXES Hot Topic Dig a Little Deeper As an Aside Making Connections Take the Test The Great Debate Case Study PREFACE ACKNOWLEDGEMENTS INTRODUCTION CHAPTER 1 INTRODUCTION TO HEALTH PSYCHOLOGY AND BEHAVIOUR CHANGE Chapter Outline WHAT DO WE MEAN BY ‘HEALTH’? HOW HAS OUR UNDERSTANDING OF HEALTH AND ILLNESS CHANGED? Prehistory Ancient history The Middle Ages The Early Modern period The Late Modern period BOX 1.1 UNDERSTANDING OF DISEASE: FROM BAD AIR TO GERMS CONTEMPORARY MODELS OF HEALTH AND ILLNESS The biomedical model Challenges to the biomedical model BOX 1.2 CONTROLLING FOR PLACEBO EFFECTS BOX 1.3 HOW SUSCEPTIBLE ARE YOU TO PLACEBO EFFECTS? The biopsychosocial model HEALTH IN THE MODERN AGE: THE IMPORTANCE OF BEHAVIOUR CHANGE HEALTH IN CONTEXT: WHEN HEALTH IS LESS IMPORTANT CONCLUSIONS – AND SOME WORDS ABOUT THIS BOOK PART 1 DETERMINANTS OF HEALTH CHAPTER 2 EVOLUTIONARY AND HISTORICAL DETERMINANTS OF HEALTH Chapter Outline THE ORIGIN OF OUR SPECIES EVOLUTION HUNTER-GATHERERS Hunter-gatherer lifestyle Diet Physical activity Childrearing Hunter-gatherer adaptations Food preferences Physical activity Hunter-gatherer health and life expectancy THE AGRICULTURAL REVOLUTION A change in lifestyle Increased inequalities Adverse effects on health THE EPIDEMIOLOGICAL TRANSITION The age of pestilence and famine The age of receding pandemics LIFE TODAY Causes of death Non-communicable disease and rising obesity BOX 2.1 THE ROLE OF MICROBES IN NON-COMMUNICABLE DISEASE BOX 2.2 ARE YOU A HEALTHY WEIGHT? An obesogenic environment The energy expenditure puzzle Infectious diseases: epidemics and pandemics SHOULD WE TRY TO LIVE MORE LIKE HUNTER-GATHERERS? Grains and dairy BOX 2.3 ALTERING OUR GENE POOL: MODERN MEDICINE AND HUMAN EVOLUTION Raw food Calorie restriction Intermittent fasting BOX 2.4 WHEN IT COMES TO DIETING, HOW DO WE KNOW WHAT WORKS? Barefoot running CONCLUSIONS CHAPTER 3 SOCIAL DETERMINANTS OF HEALTH Chapter Outline HEALTH INEQUALITIES BETWEEN COUNTRIES Life expectancy BOX 3.1 GENDER BIAS IN THE DATA Healthcare Living conditions Education Gender disparities Education and health Mothers’ education and child health Education and wealth Economic growth and shrinking inequalities HEALTH INEQUALITIES WITHIN COUNTRIES The relationship between socioeconomic status and health The Whitehall studies Cause or effect? Access to healthcare Lowand middle-income countries The United States Other high-income countries Living conditions Lowand middle-income countries High-income countries Working conditions Health-related behaviours Stress An adaptive response to physical threats Social threats Stress at work Stress at home Stress beyond work and home Gender and stress: ‘fight-or-flight’ or ‘tend-and-befriend’? BOX 3.2 HOW STRESSED ARE YOU? Social support Social status and immune function Ethnicity, discrimination and health BOX 3.3 STIGMA AND DISCRIMINATION SOCIAL DETERMINANTS OF HEALTH BEHAVIOURS Knowledge Key health promotion messages BOX 3.4 CAPABILITY, OPPORTUNITY OR MOTIVATION? BOX 3.5 EHEALTH LITERACY More complex behaviours Early life experiences Life-history theory Temporal discounting Locus of control Cognitive resources INCOME INEQUALITY AND HEALTH Explanations for effects Social comparison Trust and social cohesion Social capital Political ideology Measuring income inequality: the Gini coefficient Evidence for effects BOX 3.6 EVIDENCE-BASED POLICY IMPLICATIONS FOR INTERVENTION CONCLUSIONS CHAPTER 4 INDIVIDUAL DETERMINANTS OF HEALTH Chapter Outline GENETICS When genes have a direct effect on health: cystic fibrosis When genes predispose toward health conditions: breast cancer BOX 4.1 WHY DO LETHAL GENE MUTATIONS PERSIST IN A POPULATION? BOX 4.2 TO SCREEN OR NOT TO SCREEN? Complex gene-health relationships: obesity Monogenic obesity Syndromic obesity Polygenic obesity BOX 4.3 BLAMING YOUR GENES: EFFECTS OF GENETIC DETERMINISM ON WEIGHT STIGMA AND WEIGHT LOSS-RELATED BEHAVIOURS Epigenetics BOX 4.4 EPIGENETICS AND NATURAL SELECTION BOX 4.5 EPIGENETICS AND HEALTH INEQUALITIES Genes, sex and ethnicity GENE-BASED INTERVENTIONS Gene therapy Genetic screening Genes and personalised medicine BOX 4.6 N-OF-1 TRIALS BOX 4.7 DO YOU HAVE VEGETARIAN GENES? THE NEW SCIENCE OF NUTRIGENOMICS PERSONALITY Models of the personality-health relationship Type A personality and hostility Neuroticism BOX 4.8 THE BIG FIVE BOX 4.9 PERSONALITY, NATIONALITY AND DISEASE Conscientiousness BOX 4.10 EFFORTFUL CONTROL Approach and avoidance Unknown Reward sensitivity and health-related behaviours Behavioural inhibition and health-related behaviours BOX 4.11 IS THERE SUCH A THING AS AN ADDICTIVE PERSONALITY? Coping BOX 4.12 ARE YOU HIGH IN REWARD SENSITIVITY? Locus of control Interpreting research on personality and health PERSONALITY-BASED INTERVENTIONS Can we change personality? Personality and personalised medicine COGNITIVE VARIABLES Attitudes Values Outcome expectancies Self-efficacy Perceived behavioural control CONCLUSIONS PART 2 THEORIES OF HEALTH BEHAVIOUR CHAPTER 5 SOCIAL COGNITION THEORIES OF BEHAVIOUR AND MOTIVATION Chapter Outline THE IMPORTANCE OF THEORY Criteria for a good theory Types of theory BOX 5.1 EVALUATING THEORY CONTINUUM THEORIES BOX 5.2 WHAT’S THE DIFFERENCE BETWEEN A THEORY AND A MODEL? The health belief model The model The evidence BOX 5.3 TESTING THEORIES OF BEHAVIOUR CHANGE: CROSS-SECTIONAL, PROSPECTIVE AND EXPERIMENTAL STUDY DESIGNS Key limitations The theory of planned behaviour The theory The evidence Key limitations BOX 5.4 THE ROLE OF INTENTIONS BOX 5.5 HOW DO YOU FEEL ABOUT IT? DISTINGUISHING BETWEEN AFFECTIVE ATTITUDES AND ANTICIPATED AFFECT BOX 5.6 THE QUESTION-BEHAVIOUR EFFECT: SIMPLY ASKING SOMEONE ABOUT THEIR INTENTIONS CAN INFLUENCE THEIR BEHAVIOUR Protection motivation theory The theory The evidence Key limitations BOX 5.7 SHOULD WE BE USING FEAR TO TRY TO CHANGE PEOPLE’S BEHAVIOUR? Social cognitive theory The theory BOX 5.8 DO YOU FEEL ABLE TO EAT PLENTY OF FRUIT AND VEGETABLES? The evidence Key limitations Continuum theories: summary STAGE THEORIES The Rubicon model of action phases The model The evidence Key limitations BOX 5.9 FOCUSSED ATTENTION Transtheoretical model The model The evidence Key limitations Stage theories: summary THEORIES OF MOTIVATION Self-determination theory The theory 1. Organismic integration theory 2. Basic psychological needs theory 3. Cognitive evaluation theory 4. Causality orientations theory 5. Goal contents theory The evidence Key limitations CRITIQUE OF SOCIAL COGNITION THEORIES Similarities and differences Limitations Automatic processes Emotions Social factors Personality and individual differences Critique: summary BOX 5.10 HOW MANY THEORIES OF BEHAVIOUR CHANGE ARE THERE? CONCLUSIONS CHAPTER 6 HABITS AND OTHER AUTOMATIC PROCESSES Chapter Outline AUTOMATIC VERSUS CONTROLLED PROCESSING BOX 6.1 DUAL-PROCESSING ACCOUNTS OF HEALTH BEHAVIOUR TRAINING VERSUS CUEING INTERVENTIONS HABITS What are habits? How do habits develop? BOX 6.2 HABITS, AUTOMATICITY AND ADDICTION How prevalent are habits? Measuring habits BOX 6.3 HOW STRONG ARE YOUR HABITS? Key characteristics of habits Habits are resistant to changes in attitude Habits can be disrupted by shifts in cueing Habits can be disrupted by interrupting the execution of the behaviour Attentional resources are needed to inhibit a habit Habits influence attention to new information Habits may moderate the relationship between intentions and behaviour Stress promotes a reliance on habits Intervention: breaking bad habits Cue avoidance Life events Vigilant monitoring Counter-conditioning Point-of-decision prompts Intervention: creating good habits Rewards Consistency Simplicity Clarity of cues BOX 6.4 MOTIVATION, INTENTION AND THEORY SELECTION Changing habits through training and cueing IMPLEMENTATION INTENTIONS What are implementation intentions? Evidence for the effects of implementation intentions How do implementation intentions work? Increased cognitive accessibility of relevant situational cues Increased automaticity of the behaviour Enhanced memory for the behaviour When do implementation intentions work? Motivation/intention Ease of behaviour Self-regulatory ability Habits Engagement and plan specificity Number of implementation intentions Types of implementation intention interventions Volitional help sheets Action planning versus coping planning Digital reminders With social cognition theories With mental contrasting Summary COGNITIVE BIAS MODIFICATION Attention and attentional bias modification Automatic action tendencies Approach-avoidance training Cue specific inhibitory control EVALUATIVE CONDITIONING BOX 6.5 USING EVALUATIVE CONDITIONING TO CHANGE ATTITUDES Summary PRIMING Goal priming SOCIAL NORMS BOX 6.6 NUDGES AND CHOICE ARCHITECTURE BOX 6.7 DESCRIPTIVE NORMS AND THE THEORY OF PLANNED BEHAVIOUR EASE OF BEHAVIOUR Proximity Defaults CONCLUSIONS CHAPTER 7 CRAVING, WILLPOWER AND SELF-REGULATION Chapter Outline CRAVING What is craving and how does it relate to behaviour? Conditioning-based explanations of craving The evidence The elaborated intrusion theory of desire Intrusive thoughts Elaboration Termination of elaboration Effects on behaviour The evidence The grounded cognition theory of desire The theory Explanatory power and evidence Controlling cravings Nicotine replacement therapy Cue avoidance Response prevention Visuospatial tasks Mindfulness-based decentering Promoting desire for healthy foods Summary WILLPOWER What is willpower and why is it important? Measuring willpower Self- and informant-report measures Delay of gratification task (aka the ‘marshmallow test’) Delayed discounting Willpower as cool cognition: the hot/cool framework The theory Strategies for improving self-control Willpower as a muscle: the limited resource model Tiring with use Strengthening with practice Glucose as fuel From limited resource to energy conservation Criticisms and controversy Willpower as motivation: the process model The theory Explanatory power and evidence Improving willpower SELF-REGULATION Control theory The theory The evidence Improving self-regulation Tracking devices Effortless self-regulation CONCLUSIONS CHAPTER 8 ADDICTION Chapter Outline WHAT DOES IT MEAN TO BE ADDICTED? Definitions of addiction Addiction according to the DSM-5 Summary BOX 8.1 CAN WE BECOME ADDICTED TO SUGAR? THEORIES OF ADDICTION The self-medication model The theory The evidence Opponent process theory The theory Limitations Incentive-sensitisation theory Aims and key insights Theory and evidence BOX 8.2 STRESS, CRAVING AND DOPAMINE The cognitive processing model The theory Implications for intervention PRIME theory of motivation BOX 8.3 THE PROBLEM WITH TRADITIONAL THEORY DEVELOPMENT AND TESTING IN PSYCHOLOGY Aims The theory BOX 8.4 CRAVING IN THEORIES OF ADDICTION BOX 8.5 PRIME THEORY AND DUALPROCESSING MODELS Implications for understanding and treating addiction CONCLUSIONS PART 3 BEHAVIOUR CHANGE IN PRACTICE CHAPTER 9 DEVELOPING BEHAVIOUR CHANGE INTERVENTIONS Chapter Outline INTERVENTION DEVELOPMENT The Behaviour Change Wheel (BCW) BOX 9.1 WHY DON’T YOU DO MORE EXERCISE? BOX 9.2 HOW CAN GOVERNMENTS REDUCE COMMUNITY DISEASE TRANSMISSION? APPLYING COM-B TO COVID-19 BOX 9.3 INTERVENTION ACCEPTABILITY BOX 9.4 CALCULATING COST-EFFECTIVENESS BOX 9.5 TESTING FOR MODERATION Intervention Mapping (IM) MINDSPACE Developing an intervention directly from theory Adapting an existing intervention Interventions based on practical expertise Comparison of approaches EVALUATION FRAMEWORKS Clinical trial phases Experimental Medicine (EM) BOX 9.6 TESTING FOR MEDIATION Multiphase Optimization Strategy (MOST) Sequential Multiple Assignment Randomised Trial (SMART) CONCLUSIONS CHAPTER 10 EVIDENCE AND EVALUATION Chapter Outline THE IMPORTANCE OF A SCIENTIFIC APPROACH BOX 10.1 CRITICALLY ANALYSING THE EVIDENCE OBSERVATIONAL STUDY DESIGNS Descriptive studies Case reports and case-series reports Prevalence and surveillance studies Analytical studies Cross-sectional studies Prospective studies Cohort studies Case-control studies EXPERIMENTAL METHODS Laboratory experiment Field experiment N-OF-1 TRIALS AB, ABA and ABAB designs Multiple baseline and changing criterion designs Data analysis for n-of-1 trials Advantages of n-of-1 trials INTERRUPTED TIME-SERIES DESIGN META-ANALYSES Advantages of meta-analyses Potential pitfalls Recommendations and the iterative protocol for evidence base accumulation (IPEBA) THE RANDOMISED CONTROLLED TRIAL BOX 10.2 WHEN DOES AN EXPERIMENT BECOME A TRIAL? Explanatory versus pragmatic trials Blinding Allocation concealment Randomisation Unrestricted randomisation Restricted randomisation: blocking Restricted randomisation: random allocation rule Restricted randomisation: biased coin and urn Stratified randomisation Minimisation Primary outcomes, secondary outcomes and trial registration Sample size calculations and clinically significant effects Control group treatments Standard care No-treatment and wait-list Alternative types of control group Multi-armed RCTs Process evaluation Assessing implementation Assessing mechanisms of impact Assessing context Assessing trial procedures Methods Scope Per-protocol versus intention-to-treat analyses Choice of approach Per-protocol analysis: defining adherence Intention-to-treat analysis: last observation carried forward Intention-to-treat analysis: multiple imputation Variations of RCT study designs Cluster RCTs and clustering effects BOX 10.3 USING EXPERIMENTAL METHODS TO TACKLE SOCIAL PROBLEMS: A NOBEL PRIZE-WINNING APPROACH Stepped wedge cluster RCTs Patient preference trial Crossover trial Feasibility and pilot studies (also known as ‘exploratory studies’) MEASURING BEHAVIOUR CHANGE AND OTHER IMPORTANT VARIABLES Self-report measures Peer, teacher and carer report measures Observational measures in the field Behavioural measures in the laboratory BOX 10.4 USE OF DECEPTION IN RESEARCH Performance-based measures in the laboratory Physiological measures Technology-based measures in the field REPORTING RESEARCH CONCLUSIONS CHAPTER 11 BIAS AND BARRIERS Chapter Outline BIAS IN SCIENCE Publication bias Lack of replication BOX 11.1 UNDEAD THEORIES OF BEHAVIOUR CHANGE P-hacking, HARKing and other ‘questionable’ research practices Selective scrutiny Conflicts of interest BOX 11.2 THE (APPARENT) HEALTH BENEFITS OF RED WINE AND DARK CHOCOLATE: SCIENCE OR MARKETING? BOX 11.3 THE CORPORATE PLAYBOOK: HOW BIG BUSINESS PROTECTS ITS PROFITS ADDRESSING BIAS IN SCIENCE Pre-registration Registered reports Data sharing repositories Bayesian analyses Addressing conflicts of interest Summary BARRIERS TO THE ADOPTION AND USE OF EVIDENCE-BASED INTERVENTIONS Conflicting values BOX 11.4 WHEN IDEOLOGY TRUMPS SCIENCE: FROM TOBACCO SMOKE TO CLIMATE CHANGE Competing government priorities Avoiding policy U-turns Doing something now Keeping key voters happy Keeping donors happy Misinformation From those with vested interests In the news BOX 11.5 ARGUMENTS AGAINST VACCINATION, NOW AND THEN On social media Motivated reasoning BOX 11.6 HOW CAN WE CHANGE PEOPLE’S MINDS? Misunderstanding of science and statistics BOX 11.7 RELATIVE RISKS VERSUS ABSOLUTE RISKS CONCLUSIONS CHAPTER 12 CHANGING BEHAVIOUR Chapter Outline CATEGORISING BEHAVIOUR CHANGE INTERVENTIONS By type of behaviour By population or setting By mode of delivery By type of strategy By underlying psychological process or theory Summary HEALTHY EATING Recommendations and relationship with health Group differences in healthy eating CASE STUDY 1 FOODT BRAIN TRAINING APP: HELPING PEOPLE RESIST ‘UNHEALTHY’ FOODS CASE STUDY 2 TAXING SUGARY DRINKS IN MEXICO Healthy eating in children Innate predispositions Individual differences BOX 12.1 ARE YOU A SUPERTASTER? Taste exposure Encouraging children to eat using modelling Encouraging children to eat using rewards Pressuring children to eat Restricting what children eat CASE STUDY 3 THE FOOD DUDE HEALTHY EATING PROGRAMME IN THE UK AND IRELAND PHYSICAL ACTIVITY AND EXERCISE Recommendations and relationship with health Group differences in physical activity CASE STUDY 4 THIS GIRL CAN: INCREASING PHYSICAL ACTIVITY AMONG WOMEN OBESITY Obesity prevalence and group differences Determinants of obesity Obesity and physical health Obesity, mental health and weight stigma CASE STUDY 5 TEN TOP TIPS: A HABIT-BASED INTERVENTION FOR WEIGHT MANAGEMENT CASE STUDY 6 MINDFUL EATING IN RESTAURANTS: A WEIGHT MANAGEMENT INTERVENTION FOR WOMEN BREASTFEEDING The benefits of breastfeeding Recommendations and group differences Reasons for not breastfeeding CASE STUDY 7 NOSH: PAYING WOMEN TO BREASTFEED SMOKING AND VAPING A brief history Intervention approaches Vaping and other tobacco and nicotine products CASE STUDY 8 PLAIN PACKAGING IN AUSTRALIA ALCOHOL Harms Group differences and recommendations BOX 12.2 CAN ALCOHOL BE GOOD FOR YOUR HEALTH? Binge drinking Intervention approaches CASE STUDY 9 REDUCING RISKY SUBSTANCE USE IN SOUTH AFRICA: A BRIEF INTERVENTION USING MOTIVATIONAL INTERVIEWING VACCINATIONS How vaccines work Vaccine development Vaccination, herd immunity and vaccine hesitancy CASE STUDY 10 IMPLEMENTATION INTENTIONS FOR IMMUNISATION: PROMPTING FLU VACCINATION AMONG EMPLOYEES BOX 12.3 HOW CAN WE PERSUADE PEOPLE TO WEAR FACE MASKS? SAFE SEX Types of sexually transmitted infections HIV and AIDS CASE STUDY 11 THE SONAGACHI PROJECT: COMMUNITY EMPOWERMENT FOR SEX WORKERS CONCLUSIONS: KEY ISSUES FOR HEALTH PSYCHOLOGY AND BEHAVIOUR CHANGE Theory is important, but not always essential We rarely have perfect evidence, so must act on the best evidence we have Context is critical, and absent from most theories of behaviour change A complete theory of behaviour change may never be possible To tackle big issues, we need to work across disciplines REFERENCES INDEX