HEALTH PSYCHOLOGY ASSIGNMENT

UNIT- II & III

Submitted By: ANVESHA CHOUKSEY

Roll Number: 2110007
Submitted To: Ms. AKANKSHA MENDIRATTA

Question 1. Explain the theories of health behaviour and their implications.

Answer 1.
Health behaviour refers to actions an individual engages in that positively or negatively affect their health.
Health behaviours are the overt behavioural patterns, actions and habits that relate to health maintenance, to
health restoration and to health improvement’ (Gochman, 1997). A useful broad definition would include any
activity undertaken for the purpose of preventing or detecting disease or for improving health and well-being. A
variety of behaviours fall within such a definition including medical service usage (e.g. physician visits,
vaccination, screening), compliance with medical regimens (e.g. dietary, diabetic, antihypertensive regimens),
and self-directed health behaviours (e.g. diet, exercise, smoking). These can be simple personal choices like
hand washing or more complex situations like choosing a place to live that has healthy living conditions.

Health Belief Model

The Health Belief Model (HBM) is an early and influential theory used to understand the reasons behind
people's engagement in health-related behaviours. This psychological framework, developed in the 1950s, was
initially proposed by social psychologists Irwin M. Rosenstock, Godfrey M. Hochbaum, and Marshall Becker,
with the version by Becker and Rosenstock in 1984 receiving the most attention. The HBM has found extensive
use in health promotion and public health research, helping explain why individuals adopt specific health
behaviours and how they can be motivated to change their behaviour.

The model asserts that an individual's practice of healthy behaviour hinges on two key factors:

1. Perceived seriousness of the health problem: Individuals assess the potential organic and social consequences
that may arise if they were to develop or leave the health issue untreated. The more severe they perceive these
consequences to be, the more likely they view it as a threat and take preventive measures.

2. Perceived susceptibility to the health problem: People evaluate the likelihood of them personally developing
the health issue. The higher the perceived risk, the more likely they consider it a threat and take action.

3. Cues to action: Being reminded or alerted about a potential health issue raises the likelihood of perceiving it
as a threat and taking action. These cues can take various forms, including informational input like billboards
about the risks of unprotected sex, a friend or family member falling ill, TV medical dramas illustrating specific
illnesses and symptoms, or reminders for medical appointments.

Research supports the role of cues to action, especially external cues such as informational input, in predicting
health behaviours. Information, often in the form of fear-arousing warnings, can alter attitudes and health
behaviour in areas like dental health, safe driving, and smoking. General information about the negative
consequences of a behaviour is also employed in both preventing and quitting smoking.

Key Characteristics of the Health Belief Model:

1. Understanding Health Behaviour: It offers a framework for comprehending why individuals choose to engage
in or avoid health-related behaviours, serving as a valuable tool for healthcare professionals, researchers, and
policymakers.
2. Tailored Interventions: By considering the model's components, health promotion interventions can be
designed to address an individual's specific beliefs, perceived obstacles, and motivations, making interventions
more effective.

3. Behaviour Change: The HBM can be used to design focused campaigns and interventions to encourage
healthier behaviours and preventive measures.

4. Predictive Value: It has been used to predict and understand various health-related behaviours, such as
vaccination acceptance, smoking cessation, and cancer screening, among others.

5. Communication: It provides a framework for effective health communication, allowing messages and
information to be tailored to align with individuals' beliefs and motivations.

6. Public Health Planning: The HBM can inform public health strategies and policies, emphasizing the
importance of addressing factors like perceived susceptibility, severity, benefits, and barriers when creating
effective health interventions.

However, a major criticism of the HBM is its tendency to overlook the impact of social, cultural, and
environmental factors on health behaviours. It primarily focuses on individual beliefs and perceptions,
neglecting the broader context in which health-related decisions are made. This critique aligns with the broader
perspective of social determinants of health. Moreover, the model may not fully account for why individuals
engage in certain behaviours or make behavioural changes, as it simplifies the decision-making process. It
predominantly concentrates on cognitive factors like perceived susceptibility and severity but often does not
sufficiently consider emotional factors such as fear, anxiety, or self-efficacy, which can play a substantial role
in health decision-making.

Theory of Planned Behaviour

The Theory of Planned Behaviour (TPB) seeks to explain how attitudes and intentions influence human
behaviour. Its primary use is in predicting individuals' actions based on their existing attitudes and behavioural
intentions. The decision to engage in a particular behaviour is driven by the expected outcomes associated with
that action.

The TPB is characterized by several features that explain its widespread adoption as a model for behaviour
prediction and change. Firstly, it uniquely focuses on determining the factors that influence behaviour, and it
can be applied to study various behaviours of interest. Secondly, it comes with well-established tools and
methods to measure its theoretical components reliably and accurately. Thirdly, the theory provides a clear
structural model that serves as a conceptual framework for understanding the determinants of the behaviour in
question. This model can be empirically tested using techniques like multiple regressions and structural
equation modelling. Lastly, the TPB has gained substantial support from numerous empirical studies.

The primary aim of the TPB is to comprehend an individual's voluntary behaviour by examining the
fundamental motivations that drive their actions. According to the TPB, a person's intention to perform a
behaviour is the key predictor of whether they will actually carry out that behaviour. Additionally, the
normative aspect, which encompasses social norms related to the behaviour, also plays a role in determining
whether the individual will engage in the behaviour. According to this theory, the intention to perform a specific
behaviour precedes the actual behaviour. This intention, known as behavioural intention, is crucial to the theory,
as it is shaped by attitudes toward the behaviour and subjective norms. The TPB suggests that stronger
intentions lead to greater efforts to perform the behaviour, consequently increasing the likelihood of the
behaviour being carried out.

Stages of Change Model

The widely recognized stage model, known as the Transtheoretical Model or the Stages-of-Change Model, is
notable for its ability to encompass and draw from various theoretical models. This theory was developed by
James Prochaska, Carlo DiClemente, and John Norcross in 1992 and 1994. It posits that individuals go through
a dynamic process involving five stages when making behavioural changes, and these stages can involve both
progress and regression. The stages are pre-contemplation, contemplation, preparation, action, and maintenance.
To illustrate, consider the following stages a smoker goes through when attempting to quit smoking.
  Pre-contemplation stage: In the pre-contemplation stage, individuals have no intention of quitting
smoking.

 Contemplation stage: During the contemplation stage, people become aware of the issue and
contemplate quitting, but they haven't taken any action yet.

 Preparation stage: The preparation stage involves both thoughts, like planning to quit within the next
month, and actions, such as learning about effective quitting methods or sharing their intentions with
others.

 Action stage: In the action stage, individuals make noticeable changes in their behaviour, like quitting
smoking or using nicotine replacement therapy.

 Maintenance stage: In the maintenance stage, individuals work on sustaining the changes they've made
and resisting the temptation to revert to their old habits. After Nathan's father had a heart attack, he
rapidly moved from the pre-contemplation stage to the preparation and action stages.

Prochaska and his colleagues assert that individuals transition from one stage to another in a spiral pattern rather
than a linear one, making this model better at capturing the time factor in behaviour change compared to other
models (Velicer & Prochaska, 2008). Relapses can push individuals back to a previous stage or even all the way
back to contemplation or pre-contemplation. From that point, individuals may go through the stages multiple
times until they successfully achieve the desired behavioural change. Therefore, relapses are a natural part of
the process and can serve as valuable learning experiences, assisting individuals in progressing through the
various stages again. Prochaska initially developed the transtheoretical model to understand addictive
behaviours such as smoking, and the journey to quit smoking involved cycling through several stages.

Question 2. Describe various barriers to health with relevant examples.

Answer 2.
Given the realization that providing information alone doesn't often lead to changes in health behaviours,
extensive research has delved into the determinants of healthcare behaviours. Much of this research has centred
around the predictive capacity of demographic factors, like age and gender, in influencing people's health
beliefs and behaviours. While comprehending how demographic variables impact health behaviours is crucial
for crafting targeted and effective health promotion programs, health psychologists must also grasp the
individual determinants of behaviours, as they work with clients on a personal level.

Typically, there's limited immediate motivation to adopt healthy behaviours. Healthy habits tend to form during
childhood and adolescence when individuals are generally in good health. Smoking, poor dietary choices, and a
lack of exercise don't seem to have any immediate impact on health, and few children and adolescents worry
about their health in middle age. As a result, unhealthy habits often gain a foothold.

Obstacles to Healthy Behaviour often encompass:

1. Absence of Intent for Healthy Behaviour: Some behaviours, like opting for the elevator instead of the stairs,
may seem more convenient and effortless in the short term. Eating, particularly when it involves sugary or high-
fat foods, can be an enjoyable activity. Pleasurable yet risky behaviours with addictive qualities can be
challenging to quit, with cigarette smoking being a prime example. Many common preventable diseases are a
result of behaviours that are both pleasurable and don't immediately impact the individual's well-being. People
can carry excess weight for years without noticeable health effects, reducing their motivation to alter their
eating or exercise habits. These observations underscore the significance of primary prevention in health
promotion. Some unhealthy behaviours, once established, can be exceedingly difficult to change. Changing a
health behaviour necessitates commitment and planning on the part of individuals, making it less likely. Fear of
confronting the true risks of certain behaviours may also deter people from admitting they have a problem.

2. Bad Habits: Although health is a priority for most individuals, they often make inaccurate assessments of
their health risks. When people underestimate their personal risk, they have less incentive to safeguard
themselves or modify their existing precautions. There are exceptions to this rule; for instance, most smokers
are aware of the risks associated with smoking, even though they may deny that it will affect them personally.
People often recognize that a family history of a health issue elevates their risk. However, except for smoking
and family history, the perceived links between preventive health behaviours and susceptibility to illness are
typically inaccurate.

3. Emotional Barriers: Emotions can either lead to or perpetuate unhealthy behaviours. Unhealthy behaviours
can be pleasurable, automatic, addictive, and resistant to change. Moreover, attempts to use threatening
messages to change health behaviours can result in psychological distress, causing individuals to react
defensively, and distorting their perception of health risks. People may perceive a health threat to be less
relevant than it actually is and may wrongly believe they are less vulnerable or dissimilar to others with the
same habit. Continuously engaging in risky behaviour may lead individuals to downplay their risks and feel a
false sense of security.

4. Instability: Health behaviours have only modest correlations with each other. For example, an individual who
exercises regularly may not necessarily wear a seatbelt. As a result, health behaviours often need to be
addressed individually. Health habits are also unstable over time; a person may quit smoking for a year but then
resume the habit during a high-stress period. The independence and instability of health behaviours can be
attributed to several factors. Different health behaviours are influenced by distinct factors, and the same health
behaviour may be controlled by different factors for different individuals. The factors governing a health
behaviour may also change over the course of the behaviour's history. For example, peer group pressure might
be significant in initiating smoking, but over time, stress reduction may become the primary motivator to
continue smoking. Furthermore, the factors governing a health behaviour may change throughout a person's life.
In childhood, regular exercise is practised because it is integrated into the school curriculum, but in adulthood,
this behaviour must be adopted intentionally. To sum up, health behaviours are influenced and sustained by
various factors, which can vary among individuals and change over time and life stages. Consequently,
interventions targeting health habits have placed considerable emphasis on children and adolescents, as they are
the group that stands to benefit most (Patton et al., 2012).
5. Socialization: Early socialization, particularly the influence of parents as both teachers and role models, has a
profound impact on health habits. Parents instil certain habits in their children, like regular teeth brushing and
daily breakfast consumption. However, in many families, even these fundamental health habits are not instilled.
Families dealing with parental separation or chronic stress may neglect health habits. Additionally, as children
transition into adolescence, they sometimes disregard the early teachings they received from their parents.
Adolescents are also exposed to behaviours like alcohol consumption, smoking, drug use, and risky sexual
behaviour, particularly if their parents are not closely monitoring them and their peers engage in these activities.

6. Teachable Moments: Certain times are more conducive to modifying health practices, and health promotion
efforts capitalize on these "teachable moments." Many such moments occur during early childhood. Parents can
instil basic safety behaviours, such as looking both ways before crossing the street, and fundamental health
habits, like choosing milk over soda during meals. Other teachable moments are integrated into the healthcare
system. Pediatricians, for instance, can leverage these visits to educate motivated new parents about accident
prevention and home safety. Interventions with children indicate that behaviours like selecting healthy foods,
regular teeth brushing, using car seats and seat belts, engaging in exercise, crossing streets safely, and
responding appropriately during real or simulated emergencies are manageable for children as young as three or
four years old, provided the behaviours are explained clearly. Teachable moments are not confined to childhood
and adolescence. Pregnancy serves as a teachable moment for quitting smoking and improving dietary choices.
The period immediately following childbirth is also an opportune time to increase physical activity and regular
exercise since many new mothers aspire to regain their previous level of fitness and appearance. However,
barriers to physical activity need to be addressed, as new mothers may face numerous new responsibilities,
leaving them with little time for activities seen as optional. Adults who have been recently diagnosed with
coronary artery disease are especially motivated to change contributing health habits like smoking and poor
dietary choices.

Question 3. Explain the characteristics of Health Behaviour (Health Compromising Behaviour).

Answer 3.
Health-compromising behavious are actions that individuals engage in, which can harm their current or future
health. Many of these behaviours are habitual and some, like smoking, are addictive, making them challenging
to break. Nevertheless, with the right interventions, it's possible to modify even the most stubborn unhealthy
habits. When someone successfully changes a detrimental health behaviour, they often make other positive
lifestyle changes, reducing their risk and promoting a disease-free middle and old age.

Key characteristics are shared by many health-compromising behaviours including:

➔ Adolescence is a vulnerable period for these behaviours. Actions like excessive drinking, smoking, illicit
drug use, unsafe sex, and risk-taking leading to accidents or premature death often begin during early
adolescence, sometimes clustering together in a problem behaviour syndrome. Historically, adolescent
boys were more prone to these patterns, but girls are increasingly at risk.

➔ Many of these behaviours are influenced by peer culture, as children learn from and emulate their peers,
particularly those they admire.

➔ The desire to be attractive to others becomes significant in adolescence and plays a role in the
development of eating disorders, alcohol consumption, tobacco and drug use, tanning, unsafe sexual
encounters, and susceptibility to injury. Exposure to peers' risky behaviour, like reckless driving,
encourages risk-taking.

➔ Several of these behaviours offer pleasure and serve as coping mechanisms for stressful situations, while
some represent thrill-seeking activities that provide their own rewards.

➔ Health-compromising behaviours are dangerous, as they are associated with major causes of death, with
some, like smoking and obesity, being risk factors for multiple chronic diseases. Adolescents who adopt
 these patterns are less likely to practice good health habits and exercise in midlife, setting the stage for
an unhealthy later life.

➔ These behaviours develop gradually as individuals are exposed to, experiment with, and eventually
engage in them regularly. Thus, various interventions are essential at different stages, such as
vulnerability, experimentation, and regular use.

➔ Substance abuse, whether involving cigarettes, food, alcohol, drugs, or risky sexual behaviour, is
influenced by some common factors. Adolescents engaged in risky behaviours often experience
conflicts with their parents. Those with a propensity for deviant behaviour and low self-esteem are also
more likely to engage in these behaviours. Adolescents who combine long work hours with school are at
increased risk of alcohol, cigarette, and marijuana abuse. Substance abuse often correlates with poor
academic performance and family issues.

➔ Early puberty, low IQ, a challenging temperament, and a tolerance for deviant attitudes predict
unhealthy behaviours. Good self-control reduces vulnerability, while poor self-regulation makes it easier
to succumb to substance use.

➔ Co-occurring mental health disorders like depression or anxiety can exacerbate these behaviours,
making them more challenging to treat. Furthermore, behaviours like smoking or excessive drinking
may start as experiments but can turn into addictions. There might be shared brain circuitry underlying
these seemingly different behaviours, particularly those related to reward and pleasure or pain.

➔ Lower-class children and adolescents are more exposed to these problem behaviours and may use them
as coping mechanisms for the stressors associated with a lower social class. Engagement in these health-
compromising behaviours contributes to the strong connection between social class and various causes
of disease and mortality.

Question 4. What is health promotion? Explain different ways of health promotion.

Answer 4.
Health Promotion is a process through which mainly is a philosophy that believes that good health and wellness
is a personal and collective achievement. Health Behaviours and Health Habits Health behaviours are
behaviours undertaken by people to enhance or maintain their health. A health habit is a health behaviour that is
firmly established and often formed automatically, without awareness. These habits usually develop in
childhood and begin to stabilize around age 11 or 12 (Cohen, Brownell, & Felix, 1990). Wearing a seat belt,
brushing one's teeth, and eating a healthy diet are examples of these behaviours. Although a health habit may
develop initially because it is reinforced by positive outcomes, such as parental approval, it eventually becomes
independent of the reinforcement process. For example, you may brush your teeth automatically before going to
bed. As such, habits can be highly resistant to change. Consequently, it is important to establish good health
behaviours and to eliminate poor ones early in life.

Stakeholders for Health Promotion

➔ For the individual, it involves developing a program of good health habits.
➔ For the medical practitioner, health promotion involves teaching people how to achieve a healthy
lifestyle and helping people at risk for particular health problems offset or monitor those risks.
➔ For the health psychologist, health promotion involves the development of interventions to help people
practice healthy behaviours.
➔ For community and national policymakers, health promotion involves emphasizing good health and
providing information and resources to help people change poor health habits.

Successful modification of health behaviours will have several beneficial effects.

➔ First, it will reduce deaths due to lifestyle-related diseases.
 ➔ Second, it may delay the time of death, thereby increasing life expectancy.
➔ Third and most important, the practice of good health behaviours may expand the number of years
during which a person may enjoy life free from the complications of chronic disease.
➔ Finally, modification of health behaviours may begin to make a dent in the more than $3.0 trillion that is
spent yearly on health and illness (National Health Expenditures, 2014).

Programs for Health Promotion

1. Providing Information
People who want to lead healthful lives need information—they need to know what to do and when,
where, and how to do it. For example: In reducing dietary cholesterol, people need to know what
cholesterol is and that it can clog blood vessels, leading to heart disease. They also need to know where
they can have their blood tested for cholesterol levels, what levels are high, how much cholesterol is in
the foods they currently eat, which foods might be good substitutes for ones they should eliminate from
their diets, and how best to prepare these foods.

There are several sources of information to promote health.

One source of health information is the mass media: TV, radio, newspapers, and magazines can promote
health by presenting warnings and information, such as advice to help people avoid or stop smoking.
This approach has had limited success in changing behaviour (Flay, 1987; Maes & Boersma, 2004). One
reason for the limited success may be that many people just don’t want to change the behaviour at issue.
But when people already want to change an unhealthful habit, programs conducted on TV can be more
effective, especially if they are combined with other methods (Freels et al., 1999; Maes & Boersma,
2004). For example, a program on TV, called Cable Quit, was successful in helping people stop smoking
by showing them how to prepare to quit, helping them through the day they quit, describing ways to
maintain their success, and giving them opportunities to call for advice (Valois, Adams, &
Kammermann, 1996). Of those who started the program, 17% continued to abstain from smoking a year
later.

Another source of health promotion information is the computer, particularly via the Internet. People
anywhere in the world who are already interested in promoting their health and have access to the
Internet can contact a wide variety of websites. Some are huge databases with information on all aspects
of health promotion, while others provide detailed information on specific illnesses, such as cancer and
arthritis, or support groups for health problems. People can learn how to avoid health problems and, if
they become ill, what the illness is and how it can be treated.

A third source of health promotion information is medical settings, particularly physicians’ offices,
which offer some advantages and disadvantages. Two advantages are that many individuals visit a
physician at least once a year, and they respect healthcare workers as experts. Three disadvantages are
that medical personnel have tight schedules, feel a lack of expertise to help, and worry that they may be
intruding in patients’ personal lives (Schroeder, 2005). For reasons like these, medical staff don’t
provide enough health promotion advice.

2. Motivational Interviewing
A one-on-one technique called motivational interviewing, a counselling style designed to help
individuals explore and resolve their ambivalence in changing a behaviour, was originally developed to
help people overcome addictions, such as alcohol and drugs (Miller & Rollnick, 1991; Miller & Rose,
2009). The counsellor uses a style that leads the client, rather than the counsellor, to voice arguments for
behaviour change.
 Two important features of the process are decisional balance and personalized feedback. In decisional
balance, clients list their reasons for and against changing their behaviour so that these can be discussed
and weighed. In personalized feedback, clients receive information on their pattern of the problem
behaviour, comparisons to national norms for the behaviour, and risk factors and other consequences of
the behaviour.

The course of motivational interviewing can take one session or several and typically leads the client to
identify many of the elements of theories we’ve previously discussed, such as the benefits and barriers
(decisional balance) to the behaviour change. They then work through identified problems that have
made the behaviour hard to change in the past. Research has revealed promising outcomes of
motivational interviewing, such as in helping patients follow the medication directions their physician
prescribed and getting sexually active people to use condoms (Resnicow et al., 2002). Decisional
balance and feedback are critical components of the process, particularly in helping college students
reduce heavy drinking (LaBrie et al., 2006; Walters et al., 2009).

3. Behavioural and Cognitive Methods

Behavioural methods focus directly on enhancing people’s performance of the preventive act by
managing its antecedents and consequences. The antecedents for health-related behaviour can be
managed in many ways, such as by using calendars to indicate when to perform infrequent preventive
actions and reminders not to eat high-calorie foods or drink too much. The consequences for health-
related behaviour can be managed by providing reinforcers when the person practices healthful
behaviours, such as flossing teeth or not smoking. But the effectiveness of reinforcement depends on the
types of reward used and the age of the individual (Sarafino, 2001). People differ in their reward
preferences; one person might like to receive a CD of rock music, but someone else might prefer
classical. The consequences need to be matched to the person, which can be done by having the person
fill out a questionnaire (Sarafino & Graham, 2006).

Some evidence suggests that reward preferences change with age: kindergarten children tend to prefer
material rewards (a charm, money, candy) over social rewards such as praise, but this preference seems
to reverse by third grade (Witryol, 1971). For adults, monetary rewards seem to be very effective in
encouraging health behaviours, such as stopping smoking in pregnancy and breast self-examination
(Lumley et al., 2009; Solomon et al., 1998).

Cognitive methods can be applied to change people’s thought processes, such as to enhance their self-
efficacy for quitting smoking. Therapists often teach behavioural and cognitive methods to clients so
they can apply them themselves—an approach called self-management (Sarafino, 2011). Although each
behavioural and cognitive method helps in changing a behaviour, such as eating more healthfully, they
appear to be most effective when combined and used together, particularly when the individuals monitor
their own behaviour and keep records of it (Michie et al., 2009).

4. Maintaining Healthy Behaviours

When people change a long-standing behaviour, their success usually has some setbacks, or lapses
(Sarafino, 2001). A lapse is an instance of backsliding—for instance, a person who quits smoking might
have an occasional cigarette. Lapses should be expected; they do not indicate failure. A more serious
setback is a relapse, or falling back to one’s original pattern of the undesirable behaviour. Relapses are
very common when people try to change long-term habits, such as their eating and smoking behaviours.
Psychologists G. Alan Marlatt and Judith Gordon (1980) have proposed that for many individuals who
quit a behaviour, such as smoking, experiencing a lapse can destroy their confidence in remaining
abstinent and precipitate a full relapse. This is called the abstinence violation effect. Because these
people are committed to total abstinence, they tend to see a lapse as a sign of a personal failure. They
might think, for instance, ‘‘I don’t have any willpower at all and I cannot change.’’ Programs to change
behaviour can reduce relapses by training individuals to cope with lapses and maintain self-efficacy
 about the behaviour and by providing ‘‘booster’’ sessions or contacts (Curry & McBride, 1994; Irvin et
al., 1999).

PROMOTING HEALTH IN SCHOOLS AND RELIGIOUS ORGANIZATIONS

Schools and religious organizations have unique opportunities to promote health for two reasons. First, they
have access to virtually all children and adolescents in developed nations during the years that are probably
most critical in the development of health-related behaviours. Second, they can reach many minority and
immigrant adults who are at high risk of serious illnesses, such as heart disease and cancer. Are health
promotion programs in schools and religious organizations effective? Many have been (Campbell et al., 2007;
Katz, 2009). Some programs in schools have been designed to promote a broad range of health behaviours—for
example, nutrition, exercise, tobacco and alcohol use, and sexual activity—which improved the children’s
health behaviour and physical condition (Katz, 2009; Maes & Boersma, 2004). The most effective programs for
promoting health in schools are comprehensive and involve the children’s family and community over a long
period.

WORKSITE AND COMMUNITY-BASED WELLNESS PROGRAMS

One-third of small worksites and 50% of large worksites offered comprehensive programs, which focus on
lifestyle change and screen employees for health promotion needs. Workers with poor health habits in the
United States cost employers substantially more in health benefits and other costs of absenteeism than those
with good habits. These savings offset and often exceed the expense of running a wellness program (Goetzel &
Ozminkowski, 2008).

Psychologists who study or administer such programs are called occupational health psychologists (Quick,
1999). Worksite wellness programs vary in their aims, but often apply self-management methods and address
some or all of several risk factors: hypertension, cigarette smoking, unhealthful diets and overweight, poor
physical fitness, alcohol abuse, and high levels of stress. These risk factors do not seem to be equally
changeable. For example, although self-management can be sufficient for dietary and exercise behaviours,
smoking often requires counselling and pharmacological treatment to overcome nicotine dependence, too
(Cahill, Moher, & Lancaster, 2008; Emmons et al., 1999).

Housing these interventions in workplaces has several advantages. Worksite programs are convenient to attend,
are fairly inexpensive for employees, can provide participants with reinforcement from the employer and
coworkers, and can structure the environment to encourage healthful behaviour, such as by making healthy food
available in the cafeteria (Cohen, 1985). Although the number of employees who participate in worksite
programs is not as high as one would hope, over 60% of American workers do (USDHHS, 2004). And the
number of workers who participate and stick with the programs increases markedly if the employer actively
recruits them (Linnan et al., 2002).

ELECTRONIC INTERVENTIONS FOR HEALTH PROMOTION

Electronically-delivered psychosocial interventions are being developed to promote health. Internet-based
programs use the World Wide Web to deliver interventions, and computer-based programs use software that is
loaded on individual computers (Tate, 2008). Table 6.9 presents some examples of electronic interventions with
evidence of success in changing several health-related behaviours. Internet-based programs are particularly
useful because they are easily accessed by enormous numbers of people around the world, but nearly 50% of
people who begin using them drop out (Bennett & Glasgow, 2009). Providing personal contact and incentives
and reminders to use the programs can reduce drop out rates. (Go to .)

HEALTH SCENARIO IN INDIA

Health policies, programmes and practices mirror the culture, society and political scenario, and India is a good
case in this regard. Ayurveda was the basis of daily living and treatment of diseases for ages. In addition,
Siddha and Unani-Tibb have also been practiced. The Western notion of health and illness has not been the only
way towards medical care (Khare, 1996). After the arrival of the British, Western medicine started dominating
the scene and became the official health care programme of the country. After the political independence, there
was a rapid expansion of health care infrastructure and medical institutions.

India has the largest rural health care network in the world with 24 thousand PHCs and 3,000 community health
centres. In 1998, there were about 670 thousand hospital beds for a 900 million population. These investments
have brought down the infant mortality rate to 85 and enhanced the life expectancy from 32 years in 1947 to 63
years in 2001. In 1982 when the Government of India reformulated the National Health Policy and adopted
officially WHO declaration of ‘Health for All by 2000’, many significant changes were introduced at the policy
level (Chatterjee, 1993). It brought forth the role of community and social sciences in promoting public health
care. The New Health Policy was supposed to be a corrective devise to mould it in the direction of community-
based services. Non-governmental Organizations (NGOs) were expected to play a major role in this endeavour.
In the context of these developments, creation of rural health infrastructure facilities became a major activity in
the 1980s and a massive expansion of Sub-health Centres took place with emphasis on maternal and child care,
family welfare and hygiene education. This rapid expansion did compromise in quality in many ways. Nobody
knew what kind of training these CHWs should be imparted and very soon these workers began to perceive
themselves as village medical practitioners. Later on, Indian Medical Association opposed this scheme and
termed these CHWs as quacks, who were indeed more popular than the medical doctors in many places. In 1981
when the Government of India transferred this scheme to the states, many states who did not commit to this
scheme initially started backing out.

Lack of availability of state fund made this scheme almost defunct, with CHWs demanding stipend for their
work and often resorting to mass protest. These workers were rechristened as Multipurpose Health Workers,
and later as health guides. This most ambitious scheme of the government lost its direction and relevance in the
present time. In 1990s, a major shift in the policy took place in which the management of health was turned
over to local self-government, namely, panchayati raj. Initially there was a lot of enthusiasm and hope that it
will make health services more accountable to the local communities.

Another major development was privatization of the medical education and treatment. The government opened
up the health sector for the private enterprises in a hope that while they will cater to the better-off section of the
society, the government will be able to concentrate on the health of the poor strata of the society. The pressure
of international agencies, like WHO and World Bank, paved the way for this shift in policy. With the complete
breakdown of government health care programme, health is now turning into a most lucrative industry. The
brunt of this fallout is mostly experienced by the poor who have nowhere to go for treatment. On one hand,
where Kerala has shown the way to successfully provide universal health care, the Bihar, Madhya Pradesh,
Rajasthan and Uttar Pradesh (BIMARU) states have witnessed a total collapse (Baru, 2003).

It is important to note that modern public health interventions are merely the manifestation of colonial gene
which our health planners have inherited (Bagchi and Soman, 2005). The apathy of the colonial rulers is
matched only by the shocking indifference of the Indian political leaders who paid scant attention to the quality
of health care. Now in the present era, profits and markets are shaping health services. Health is being
considered as individual responsibility rather than a systemic service expected of the state.

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