MEDICAL PSYCHOLOGY.

DR RF ODOKONYERO
Makerere University College of Health Sciences
Department of Psychiatry.
rodokonyero@gmail.com
1
BME II presentation, 18th Sept – 30th October 2023
Session 8:
Synopsis of Medical
Psychology
 Psychology

• The study of the human mind, including behaviour and mental

processes.

• So as to: Describe behaviour and mental processes; Explain

them; and Predict their characteristics in specific circumstances.

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 Medical Psychology

• Is the branch of psychology which studies: the psychology of the

patient, the role of the mind in the onset and course of disease;
the relationship of the doctor, staff and the patient; the use of
psychological approach in medical practice.

• To do this, the health worker may use a behavioural, psychoanalytic,

humanist, cognitive, or neurobiological lens – to describe,
understand, explain, or predict how their patients will behave!
 Behaviour

• It is the way someone or something will consciously or

subconsciously respond to a given situation in its
environment. Usually a provocation.
 Health Behaviour

• Any activity a person performs (or fails to perform),

whether they are well or not, in the belief that doing so will
promote, protect or maintain his/her health. The activity
does not necessarily have to be effective.
 Health Behaviour

Related to
Health
(Health
behaviour)

Stimulus Response Behaviour

Not
related to
health
Types of Health Behaviour

Health
behaviour

Health directed Health related

behaviour behaviour

Actions that may have health

Observable acts taken with a
implications, but are not
specific health outcome in mind
undertaken with a specific
e.g., drug compliance
health objective in mind
Types of health related behaviour

Health related
behaviour

Preventive health Sick role behaviour Illness behaviour

behaviour

Person recognizes
Person wants to avoid Employee takes a
signs or symptoms of a
being ill or having a vacation because he is
pending illness e.g.
problem e.g. mother ill; he follows his
mother gives child
takes child for doctor’s advice on the
cough syrup after
immunization medication
hearing her wheeze.
 Health – Mental & Physical

• Biopsychosocial Model
o“health (wellness and illness) is a function of biological,
psychological, and social factors in continual interaction”
 Theories of Health Behaviour

• Theory – a set of inter-related concepts, definitions, and

propositions that explain or predict events or situations
(can also specify relationships among these variables)
 Individual Level Theories

• Health Belief Model

• Theory of Planned Behaviour (TPB), Theory of Reasoned

Action (TRA) & Integrated Behavioural Model (IBM)

• The Transtheoretical Model (TTM)

The Health Belief Model (Rosenstock & Becker, 1974)

Perceived
Perceived seriousness of the Perceived benefits Perceived barriers
susceptibility consequence of of a specific action to taking action
the problem

Perceived threat Outcome expectations

Self efficacy ( perceived ability to carry out recommended action)

TRA/TPB

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The Stages of Change Model (Prochaska & DiClemente, 1984)
 Thank you

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Session 9:
Socioecological Model
(SEM)
 OUTLINE

• Presentation of the theory

• Plenary Discussion of theory

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How can we begin to understand all of the
factors that influence health?


Ecological
Model
Socio-Ecological Model
 Individual

Interpersonal

Institutions

Community

Population/Policy
What is an Ecological Perspective?

A framework that enables us to consider the

influence of
individual and environmental
factors on health & health-related behaviors
 Why the ecological framework?

• Health & health problems are complex

• Health problems are influenced by multiple variables

• These variables interact with each other

• Multiple levels are relevant for understanding &

changing:
• Human behavior
• Complex environments
By focusing on factors beyond the individual, we are…

• Less likely to ‘blame the victim’

• More likely to address the underlying determinants of

health & health behavior

Fall 2006
By focusing on factors beyond the individual, we are…
• Better able to see where action is needed

Upstream action
vs.
Downstream approaches

What do we mean by up/down stream

approaches?
Ecological Framework helps us with…

• Problem analysis

• Intervention design

• Intervention evaluation
 Problem analysis

Public Health Problem Determinants



Population
Community
Organizational
Interpersonal
Individual
 Individual

Interpersonal

Institutions

Community

Population/Policy
 Youth Smoking Determinants

Population/Policy
Lack of law enforcement for selling to minors
Community
Positive attitudes toward smoking
Organizational
Easy availability of cigarettes at stores
Interpersonal
Popular kids smoke/parents smoke
Individual
Lack skills/self-efficacy to ‘just say no’
 Intervention Design

• Prevent or ameliorate existing problems

• Interventions, at their best are…

• Intended to Identify & shape solutions
• Specifying goals, objectives, activities
• Theory-based
• Designed by multi-disciplinary teams
• Targeted at multiple levels
• Able to maintain a broad (ecological) scope
 Individual Level Interventions

• Target of change  Individual Person

• Focus on characteristics of the individual

• E.g., knowledge, attitudes, skills, beliefs…
 Individual Level Interventions

What type of
individual level
What types of strategies intervention
might we use at this level? would be useful in
youth tobacco
prevention?
 Interpersonal Level Interventions

• Target of change  Social influences

• E.g., family, work group, friendship networks…

• Focus on nature of social relationships

• E.g., social norms, access to diverse & supportive
networks/influences
Interpersonal Level Interventions

What type of
interpersonal level
intervention would
What types of strategies
might we use at this be useful in youth
level? tobacco
prevention?
 Organizational Level Interventions

• Target of change  Organization/Institution

• E.g., worksites, schools, agencies, churches…

• Focus on organizational culture

• E.g., norms, rules & regulations, incentives & benefits,
structures
Organizational Level Interventions

What type of
organizational
What types of strategies
level intervention
might we use at this
level? would be useful
in youth tobacco
prevention?
 Community Level Interventions

• Target of change  Social environment

• Focus on community norms, values, attitudes, & power

structures
Community Level Interventions

What type of
community
level
What types of strategies intervention
might we use at this would be useful
level? in youth
tobacco
prevention?
 Population Level Interventions
• Target of change  Local, state, & national laws &
policies

• Focus on government regulations & other regulatory

processes, procedures, or laws to protect health
 Population Level Interventions

What type of
population level
What types of strategies intervention would
might we use at this be useful in youth
level? tobacco
prevention?
 Application

What types of health issues or health behaviors

lend themselves to using the socio-ecological
model?

Are there any issues that don’t?

 Challenges to ecological interventions

• A lot of work – involving several sectors of society

• Difficult to evaluate change at environmental level

• Challenge to translate interest in change into social norms and public

policy
• Powerful norms are hard to change
• Budget cuts – so difficult to undertake wide-range interventions
• Difficult to get certain health issues on public policy agenda
• Still, it’s being done!
E.g., nutrition guidelines, tobacco, fitness, elder transportation
 So…
• The ecological framework emphasizes:
• Relationships among behaviors, socio-political structures &
health

• Applying this framework allows us to:

• Determine & describe public health problems
• Move beyond solely focusing on (& blaming) the ‘individual’
• Assess multi-level determinants of health & how to address them
• Design, implement, & evaluate interventions
 Thank you

Welcome to the Plenary Discussion…

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 THANK YOU

Dr. ODOKONYERO RAYMOND

Makerere University
Department of Psychiatry
+256701547646
rodokonyero@gmail.com