2010PSY: Health Psychology

Tutorial 1: Thinking Behaviourally

Email: 2010psy@griffith.edu.au
  Introductions
 How does Health Psychology relate to your
degree
 Process Model
Tutorial 1:  Activity 1: Outcomes vs behaviours
Overview
 Activity 2 and 3: Health-risk and health-
protective behaviours
 Activity 4: Health promotion interventions
  Define health behaviour
 Explain the difference between a health outcome and health
behaviour

Learning  Describe the difference between a health-protective and a health-

risk behaviour
objectives  Understand the range and complexity of influences upon the
uptake and maintenance of health behaviours
 Develop an understanding of what a health promotion
intervention is and how it can be used
  Learning how people's perceptions influence one's own
How does
and others behaviour
Health
Psychology  Learning how to help our clients/patients/participants
relate to your reach their health goals through understanding how
degree? they make decisions

 Learning the skills and strategies to change

people's behaviour
Process Model
of Health
Behaviour
Interventions
Outcomes vs Behaviours
The outcome is the goal that
we are trying to reach by
influencing the behaviour
 Activity 1: Outcome or Behaviour? (15min)

 Below is a list of outcomes and behaviours. In your groups, discuss each variable
and justify why it is an outcome or a behaviour.

 Exercise ​  Sugar consumption​​

 Sitting  Smoking​​
 Weight loss  Tooth cavities ​
 High/Low blood pressure  Diabetes​
 Sleep ​  Alcohol misuse
 Toothbrushing ​
Health-risk and Health-
Protective Behaviours
 Health Protective Health Risk

Two types of
Health
Behaviours
 Behaviours that  Behaviours that
(depends on the increase your health i.e. decrease your health i.e.
outcome of the exercise, eating a smoking, binge drinking,
behaviours) mixture of vegetables sugar intake
and fruits, brushing your
teeth
Facilitators and Barriers
Facilitators  People’s control beliefs and their capability and confidence toward
and barriers of a particular behaviour impacts the likelihood of the behaviour
being performed
performing a  For this next activity, we will be focusing on exploring beliefs
behaviour towards a particular health-risk behaviour
 Activity 2: 1. Choose a health-risk behaviour
Health-risk 2. Complete the following table
behaviours (15mi
n)
Facilitators to initiating this behaviour Barriers to initiating this behaviour

Facilitators/ ​
​
​

barriers to ​ ​

initiating
​ ​
​ ​
Advantages and
Disadvantages
Advantages
and  People’s attitudes toward a particular behaviour impacts the
likelihood of the behaviour being performed
disadvantages  For this next activity, we will be focusing on exploring your beliefs
of performing towards a particular health-protective behaviour

a behaviour
 In Groups:
Research has shown that people who exercise regularly hold
different beliefs about exercise than people who do not exercise on
a regular basis, e.g., they hold more positive expectations about
Activity 3: exercise and perceive less barriers to exercise. Think about the
advantages to exercising and the advantages not to exercise
Exercise
Advantages/ Advantages to exercise Disadvantages to exercise

disadvantages ​
​
​
​

(15min) ​
​
​
​
​ ​

Have any of these beliefs influenced your actual exercise behaviour?

2010PSY: Health Psychology

Tutorial 2: Using Theory to Understand

Health Behaviour

Tutor’s name: Nicholas Browning

Email: 2010psy@griffith.edu.au
Process Model
of Health
Behaviour
Interventions
 • The importance of theory
• Examples of theories that can be used in your
assignment
• Social Cognitive Theory (SCT)
Tutorial 1: • Model, variable definitions and activity
Overview • Health Belief Model (HBM)
• Model, variable definitions and activity
• Theory of Planned Behaviour (TPB)
• Model, variable definitions and activity
• The Health Action Process Model
• Model, variable definitions and activity
  Understand how distal factors (e.g., personality) and proximal
factors (e.g., social, cognitive and motivational factors) influence
health behaviours

Learning  Understand the importance of using theories to inform

intervention development
objectives
 Describe key social cognition and stage-based models of health
behaviour and how they apply to health behaviours
 Class Discussion:
 Why is theory important?
Activity
  Have a guide to follow for the development of research studies –
What is the theory based campaigns are shown to be more effective
compared to atheoretical campaigns
importance of  Uses previous research on how social and psychological variables
using theory fit together and influence each other
for intervention  Gives us a structure (the how and the why) to test our hypotheses

development?  Advances the field through a deeper understanding of the

interactions of what influences behaviour
Social Cognitive
Theory (SCT)
  Behaviour is determined by three types of individual expectancies:
 Situation-outcomes expectancies: beliefs about how events are
connected; whereby a person connects a situation (behaviour) to
an outcome; for example, smoking to heart attack
 Outcome expectancies: beliefs about the consequences of
SCT: Variable performing a behaviour; can be positive or negative; e.g.,
Explanations believing that stopping smoking would reduce the risk of heart
attack.
 Self-efficacy expectancies: beliefs about one’s ability to perform
the behaviour; e.g., the extent to which the person believes they
can stop smoking.
  Choose a health behaviour.
 Come up with:
Activity:  3 situation-outcome expectancies (beliefs);
Applying SCT  3 outcome expectancies (beliefs); and
 3 self-efficacy beliefs
Health Belief Model
(HBM)
Health Belief
Model
 Rosenstock 1974; Becker et al. 1977; Strecher et al. 1997.

Perception of threat:
• I believe that coronary heart disease is a serious illness contributed to being
overweight: perceived severity.
• I believe that I am overweight: perceived susceptibility.

Behavioural evaluation:
HBM: Variable • If I lose weight, my health will improve: perceived benefits (of change).

Explanations • Changing my cooking and dietary habits when I also have a family to feed will
be difficult, and possibly more expensive: perceived barriers (to change).

Cues to action (added in 1975, Becker and Maiman):

• That recent TV programme on the health risks of obesity worried me
(external).
• I regularly feel breathless on exertion, maybe I should lose some weight
(internal).

Health motivation (added in 1977, Becker et al.):

• It is important to me to maintain my health.
Theory of Planned
Behaviour (TPB)
 Theory of Reasoned Action (TRA)

Attitudes
TPB Model
Based on theTheory of
Reasoned Action (TRA) Intention Behaviour
(Ajzen and Fishbein 1970;
Fishbein and Ajzen 1985)
Subjective
Norms
 General orientation towards health behaviour
“good-bad”, “useful-useless”, “harmful-beneficial”

Self-reported health
TPB Model behaviour
Based on the Theory of Attitudes
Reasoned Action (TRA)
(Ajzen and Fishbein Stated volitional motives
1970; Fishbein and “I plan…/I intend.../ I expect...” Intention Behaviour
Ajzen 1985)
Subjective
TRA: Variable Norms

definitions
Evaluation of significant others’ evaluation:
“my parents think…”,”my friends think…”

Source: Ajzen and Fishbein (1980)

 I intend to do at least 20 minutes of vigorous exercise on at
least three days of the week over the next fortnight.
Extremely Very likely Likely Unlikely Very Extremely
likely unlikely unlikely


Examples of
For me, doing at least 20 minutes of vigorous exercise at least
Intention, Attitude, three days of the week over the next fortnight is…
and Subjective

Good Bad
Norm
Questionnaire Those people who are important to me think I should do at least
Items 20 minutes of vigorous exercise at least three days of the week
over the next fortnight.
Strongly Mostly Agree Disagree Mostly Strongly
agree agree disagree disagree


 How many pre-drinking sessions would you
attend in a typical month? _____________​

Example
Behaviour
Questionnaire
Items
 Attitudes

TPB: Variable Subjective Intention Behaviour

definitions Norms

Note the direct

Perceived
link to behaviour
Behavioural
Control

Perceptions regarding level of volitional

control “I believe I can control…” and “easy-difficult”

Source: Ajzen (1985, 1991)

 It is mostly up to me whether 1 2 3 4 5 6
or not I reduce my alcohol Strongly Strongly
consumption during pre- disagree agree
drinking sessions over the next
four weeks.

Examples of
If I wanted to, I could reduce 1 2 3 4 5 6
my alcohol consumption during Strongly Strongly
pre-drinking sessions over the disagree agree

PBC (self-
next four weeks.

efficacy) Reducing my alcohol

consumption during pre-
1
Strongly
drinking sessions over the next disagree
2 3 4 5 6
Strongly
agree

Questionnaire four weeks is up to me.

Items I am capable of exercising at

least 6 times in the next two
1
Strongly
2 3 4 5 6
Strongly
weeks disagree agree

I am confident I can exercise 1 2 3 4 5 6

at least 6 times in the next two Strongly Strongly
weeks disagree agree
Let’s check your
understanding…
Attitudes

Create a fictional character

and behavioural scenario
(e.g., Jenny wants to increase Subjective Intention Behaviour
her daily vegetable intake to Norms
three veggies a day) and
apply the social cognition
constructs of the TPB
Perceived
Behavioural
Develop a story of this person Control
and if they are likely to
develop strong or weak
intentions and likelihood to do
the behaviour
  Jenny wants to increase her daily vegetable intake and eat at least
3 vegetables each day

Activity:  She thinks it’s a good thing to do for her health

 Most of her friends eat at least 3 vegetables each day and thinks
Applying the she should to
TPB  Jenny is lacking the confidence to eat at least 3 vegetables each
day and not sure she is capable
 Q: how likely would this person be to enact this behaviour?
TPB Model
Belief elicitation
 Qualitative Interviews or Elicitation Survey (Phase 1) + Quantitative Survey
(Phase 2)

Phase 1: Interview Questions

 Advantages and disadvantages of doing [target behaviour] (behavioural
beliefs)
 People/groups who would approve and disapprove of doing [target
TPB Model behaviour] (normative beliefs)
 Easy and difficult to do [target behaviour] (control beliefs)
Belief elicitation Hamilton, K., Cleary, C., White, K.M., & Hawkes, A. (2016). Keeping kids sun safe: exploring parents’ beliefs about
their young child’s sun-protective behaviours. Psycho-Oncology, 25, 158-163. doi:10.1002/pon.3888.
Hamilton, K., Hatzis, D., Kavanagh, D. J., & White, K. M. (2015). Exploring parents’ beliefs about their young child’s
physical activity and screen time behaviours. Journal of Child and Family Studies, 24, 2638-2652.
Hamilton, K., Peden, A.E., Pearson, M., & Hagger, M.S. (2016). Stop there's water on the road! Identifying key beliefs
guiding people’s willingness to drive through flooded waterways. Safety Science, 86, 308-314.
doi:10.1016/j.ssci.2016.07.004.

Phase 2: Quantitative Survey

(Hamilton et al., 2017, Psycho-Oncology; Hamilton et al., 2016, British Journal of Health Psychology; Hamilton &
White, 2011, Journal of Science and Medicine in Sport)
  Let’s choose a behaviour!

Behavioural beliefs: List what you believe are

Activity: the advantages / disadvantages of…
TPB Model Normative beliefs: List any individuals or groups of
Belief elicitation people who would approve / disapprove of you…

Control beliefs: List any circumstances or factors that

might prevent or discourage / help or encourage
you to…
 Salient Behavioural, Normative, and Control
TPB Model Beliefs
Belief elicitation Sun Safety Screen Time Nutrition
Provide peace of mind Improve mental health Improve my child’s health
(from qualitative Take up time/energy Increase parent distress Resistance from child
research) Spouse/partner Promote healthy habits Other family

Other family Spouse/partner Spouse/partner

Friend Lack of time Child food preferences

Have a rule in place Inconvenient

Lack of accessibility
 TPB: Measuring Beliefs
Control beliefs: Having plenty of 1 2 3 4 5 6 7
How likely is it that money Highly Highly
the following would unlikely likely

Questions
help you to binge
drink?
Open bar 1 2 3 4 5 6 7

that come Highly

unlikely
Highly
likely

from beliefs Normative beliefs:

How likely is it that
Partner 1
Highly
2 3 4 5 6 7
Highly

elicited the following people

would approve of you
binge drinking?
unlikely likely

Friends 1 2 3 4 5 6 7
Highly Highly
unlikely likely

Behavioural beliefs: Result in an enjoyable 1 2 3 4 5 6 7

If you engage in experience Highly Highly
binge drinking it unlikely likely
would…?

Be a waste of money 1 2 3 4 5 6 7
Highly Highly
unlikely likely
Does intention always
lead to behaviour?
The Health Action
Process Approach
MOTIVATIONAL PHASE VOLITIONAL PHASE
  Risk Perception: Beliefs regarding personal risk or susceptibility to
certain outcomes or conditions.
 Outcome Expectancies: Beliefs about whether performing the behaviour
will result in desired outcomes.
 Task Self-Efficacy: Perceived ability to perform the behaviour.
 Intention: Intention to engage in the behaviour in the future.
HAPA: Variable  Maintenance Self-Efficacy: Perceived ability to cope with barriers
encountered when performing the behaviour.
Definitions  Action Planning: A specific plan about when and how to perform the
behaviour.
 Coping Planning: Planning how to overcome barriers that are
encountered in performing the behaviour.
 Recovery Self-Efficacy: Perceived ability to get the behaviour back on
track after a relapse.
 Action control: a concurrent self-regulatory skill - monitoring one’s
progress, comparing performance with goals, investing more effort if
needed.
  Create a fictional character and behavioural scenario (e.g., John
Let’s check your intends to go hiking once a week) and apply the volitional
constructs of the HAPA
understanding…  Develop a story of this person and if they are likely to act on their
intention
  John intends to go hiking once a week
 John believes he is capable of going hiking and believes he has the
ability to cope with barriers that may be encountered when
performing the behaviour
Activity:  He does not however have a plan on how to go hiking each week
or a plan to overcome anticipated barriers
Applying  John makes a plan on where and when he will hike each week and
HAPA a plan of an alternative behavior to overcome any barriers that
prevent him doing his hike
 John realises that he may falter on his plans to go for a hike each
week, so he keeps a calendar to record each of his hikes
Q: how likely would this person be to act on their intention?
2010PSY: Health Psychology

Tutorial 3: Mapping behaviour change

techniques

Email: 2010psy@griffith.edu.au
Process Model
of Health
Behaviour
Interventions
  Understand and explain what a behaviour change
technique/method is

Learning  Understand and describe a range of techniques/methods that are

used to change individuals' and populations' health behaviour
Objectives
 Understand how specific behaviour change techniques can be
applied to theory
  What are behaviour change techniques/methods?
Class  Why do we use behaviour change techniques/
Discussion methods?
  Motivational interviewing interventions

 Information provision and communication persuasion: Attitude change, Using

the mass media
 Cognitive strategies

 Confidence and self-efficacy interventions: Modelling, Behavioural practice

 Social influence interventions

Intervention  Problem solving approaches

 Goal setting interventions

Techniques  Planning and implementation intentions

 Monitoring intervention

 Building habits

 Environmental interventions

 Public health interventions

 Using new technology

Information Provision
  Giving information
 Knowledge translation and improving health literacy
 Provide individuals with health information on the consequences
of behaviours such as smoking, alcohol consumption or preventive
care use, with the intention of changing health behaviour through
better health knowledge.
Information  Influence outcome expectancies / attitudes – needs to be
personally relevant
provision  A popular strategy as wide reach… but
 Often not sufficient to change behaviour and therefore need other
strategies such as self-efficacy and norms
 Eg., Fact sheets
  For this activity, we will focus on attitude change using
information provision
Activity 1:  How can we increase adolescents' physical activity?
Information  What benefits are there to physical activity?
 What information could you provide them to influence their
Provision behavioural beliefs?
Confidence and self-
efficacy interventions
  Come up with two examples of how modelling a
Activity 2: particular behaviour can be used as a strategy to
Modelling promote self-efficacy
Activity 3:  Come up with two examples of how practicing a
particular behaviour can be used to increase self-
Behavioural efficacy towards a particular goal
Practice  Eg. Developing strength in your legs after knee surgery
Theory of
Planned
Behaviour and
Social
Cognitive
Theory
Process Model
Goal Setting
Interventions
  Develop a SMART goal towards your chosen behaviour
 Specific – time and place
Activity 2:  Measurable – how will you know you have accomplished it

SMART Goals 

Achievable – helps to build self-efficacy
Relevant – needs to be personally meaningful
 Timley – consider the time it will take to achieve the goal
Planning and
Implementation
Intentions
  Think about your behaviour, where could you
implement the behaviour within your day?
Activity 3:
 Where?
Planning
 When?

 How?
  An implementation intention is a self-
What is an regulatory strategy in the form of an "if-then plan" that
implementation can lead to goal attainment/behaviour change
intention?  Fills the intention-behaviour gap
  Choose a health behaviour that you would like to change
 Create an implementation intention plan to get started in changing
the behaviour.
 This is an “action plan”.
Activity 4:  If _____ (situation), then I will ______ (behaviour)

Implementation
Intentions  Now consider some barriers that you may encounter in changing the
behaviour.
 Create an implementation intention plan for how to overcome these
barriers.
 This is a “coping plan”.
 If _____ (barrier), then I will ______ (strategy to overcome barrier)
The Health
Action Process
Approach
Process Model
Monitoring
Interventions
  Three steps are relevant for effective
monitoring interventions:
Effective  Setting a goal that is suitable for monitoring;
monitoring
 Designing the monitoring strategy; and
interventions
 Processing the obtained information.
  Sarah is an office worker who wants to increase her daily physical
activity (behaviour)
 One of the many reasons she would like to exercise more is to lose
Activity 5: weight (outcome)

Scenario  What specific strategies might Sarah be able to implement to

monitor whether she is achieving her goal across time?
Health Action
Process
Approach
Environmental
Interventions
  An environment that encourages healthy behaviours
should:
1. provide cues to action – or remove cues to unhealthy
Environmental 2.
behaviours;
enable health behaviours by minimising the costs and
Interventions 3.
barriers associated with them;
maximise the costs of engaging in health-damaging
behaviours.
  Using the three environmental factors listed on the
previous slide (cues to action, minimising the costs of
Activity 6: healthy behaviour, increasing the costs of unhealthy
Creating behaviour), think of some ideas to change these
environmental factors for each of the following
environmental behaviours:
interventions  Reducing texting while driving
 Increasing sunscreen use
 A behaviour of your choice
Health Belief
Model
  Motivational interviewing interventions

 Information provision and communication persuasion: Attitude change, Using the

mass media
 Cognitive strategies

 Confidence and self-efficacy interventions: Modelling, Behavioural practice

 Social influence interventions

Intervention  Problem solving approaches

 Goal setting interventions

Techniques  Planning and implementation intentions

 Monitoring intervention

 Building habits

 Environmental interventions

 Public health interventions

 Using new technology

Intervention Example
2010PSY: Health Psychology

Tutorial 5: Managing stress and coping

Email: 2010psy@griffith.edu.au
 Email: 2010psy@griffith.edu.au

Exam: See your examination timetable

• 80 MC question (.5 of a mark each)
Email and • Modules 1, 2 and 3 (tutorial, lectures,
exam info and textbook)
• No questions on specific statistics
  Strategies for coping with stress
 Relaxation

 Cognitive Interventions

 Acceptance and Commitment Therapy

Tutorial
Outline  Putting them into practice
 Making a plan for how you will cope with the
upcoming exams

 What is quality of Life?

 Exam Information and example questions

  Describe what is meant by stress appraisal

Learning  Identify various strategies for coping with stress

Objectives  Apply stress coping strategies

 Describe what is meant by quality of life

Understanding stress
  Stress is a subjective experience!
 Lazarus 1993: Stress is a result of an interaction between an
individual’s characteristics and appraisals, the external or internal
Remember: event (stressor) environment, and the internal or external
resources that a person has available to them. Motivational and
cognitive variables are considered central.
  How do you appraise stress?

Class  Reflect on your experience with the assignment you have just
Discussion submitted, or the upcoming exam, how did you/do you cope and
manage stress?
E.g. appraisals
Strategies
  The goal of relaxation is to enable one to relax as much as possible,
particularly in stress events.
 Relaxation skills are best learned through three phases:
 1.Learning basic relaxation skills;
 2.Monitoring tension in daily life;
Relaxation  3.Using relaxation at times of stress.
Training
 Two strategies for changing cognitions are frequently employed.
Self-instruction training (Meichenbaum, 1985):
 Targets surface cognitions;
 Involves interrupting the flow of stress-provoking thoughts;
 Replaces them with stress-reducing thoughts or positive ‘self-talk’;
 reminders of techniques, i.e., ‘take it easy, relax, deep breathe’

Cognitive  reassurance, i.e., ‘keep calm, you’ve dealt with this before’.

Cognitive restructuring:
Interventions  Identifies and challenges the accuracy of stress-provoking thoughts;
 Considers them as hypotheses, not facts;
 Assesses their validity without bias;
 Asks key questions such as:
 What evidence is there that supports or denies my assumption?
 Are there any other ways I can think about this situation?
 Could I be making a mistake in the way I am thinking?
 ACT uses acceptance, mindfulness, commitment and behaviour
change processes to increase psychological flexibility, established
through focus on five related core processes:
 Acceptance: allowing oneself to be aware of thoughts, feelings,
and bodily sensations as they occur;
Acceptance  Cognitive defusion: seeing that thoughts are simply thoughts,
feelings are feelings, memories are memories, sensations are
and sensations;
Commitment  Contact with the present moment: 1) observe and notice present
environment and in private experience (i.e., thoughts and
Therapy emotions) 2) label and describe the present, without excessive
judgement;
 Values: relate to the motivation for change;
 Committed action: developing strategies for achieving desired
goals. Clients are then encouraged to define goals in specific areas
and to progress towards them.
How do you cope with
stress?
 Think about behavioural examples of each of the 4 coping
taxonomies and how you might engage in them to cope with a
stressful event...
Coping  Problem-focused coping (problem-solving function)
Taxonomies  Emotion-focused coping (emotion regulating function)
 Attentional/approach, monitoring, vigilant, active
 Avoidant, blunting, passive
Coping  Which coping styles are most useful in which circumstances?
Taxonomies
  Make an action plan of how you intend to incorporate coping
strategies into your study routine for the exam
 Where, when, how?
Activity:  If _____ (situation), then I will ______ (behaviour)
Action Plan  If _____ (barrier), then I will ______ (strategy to overcome barrier)
Quality of life
 In Groups:
1. Consider the list of statements on quality of life (taken from the
World Health Organisation’s questionnaire WHOQOL-BREF).
2. For each statement, indicate
- whether this statement would be most important to your
Activity: What quality of life (1),
- whether this would be neutral to your quality of life (2) or,
is Quality of - whether it would be least important to your quality of life (3).

Life? 3. In your group, discuss the statements every one of you ranked
as most important and try to agree on a list of 5 statements that
capture quality of life best.
4. Share your 5 statements with the class.
Statement Importance Statement Importance
To what extent do you feel that physical
Do you have enough energy for everyday
pain prevents you from doing what you
life?
need to do?
How much do you need any medical Are you able to accept your bodily
treatment to function in your daily life? appearance?
Have you enough money to meet your
How much do you enjoy life?
needs?
To what extent do you feel your life to be How available to you is the information that
meaningful? you need in your day-to-day life?
To what extent do you have the opportunity
How well are you able to concentrate?
for leisure activities?
How safe do you feel in your daily life? How well are you able to get around?
How healthy is your physical environment? How satisfied are you with your sleep?
How satisfied are you with your ability to How satisfied are you with your capacity for
perform your daily living activities? work?
How satisfied are you with yourself?
 QoL is a broad concept. Research has identified 6 domains:
 physical health: pain, discomfort; energy/fatigue; sleep,
rest;
 psychological health: positive feelings; self-esteem;
thinking, memory, learning and concentration; bodily
image and appearance; negative feelings;
 level of independence: activities of daily living (e.g., self-
care); mobility, medication and treatment dependence;
Quality of life 
work capacity;
social relationships: personal relationships; practical
social support; sexual activity;
 environment: e.g., physical safety and security; financial
resources; home environment; availability/quality of
health/social care; learning opportunities; leisure
participation/opportunities;
 spirituality, religious and personal beliefs.