Submission to the 1 Department of Health Understanding and Changing health-related behaviour: The Role of Health Psychology in Creating a Healthier Nation Interventions based on health psychology research have been shown to enhance health care in areas targeted by government policy. Preventing avoidable illness and injury depends upon promoting health-related behaviours. These include preventive behaviours amongst the general population (e.g., dietary change) and adherence behaviours amongst patients (e.g., self care following surgery) as well as the behaviour of health care professionals which may be changed to provide more effective treatment and advise. Changing health-related behaviour involves specifying and targeting the beliefs, motivations and situational constraints which maintain particular behaviour patterns. Evaluating interventions designed to bring about behaviour change may involve controlled trials employing psychological and behavioural measures. Without rigorous evaluation, effectiveness remains in doubt and cost effectiveness cannot be assessed. Trials with longitudinal follow-up have shown that psychological interventions can improve current health care practice by increasing preventive behaviours, improving treatment outcomes and reducing disability. Some brief illustrations are provided below. Health-related behaviour change interventions can reduce unnecessary demand for professional time and therapeutic drugs. Friedman et al (1995), for example, show that behavioural interventions have resulted in substantial savings in US health services (e.g., in hypertension treatment, arthritis care and community services for the elderly). In some cases, such as post-surgical care, the cost offset may be ten times that spent on delivering psychological interventions. However, the development of effective behaviour change interventions rarely generates profit-making products and is, therefore, difficult to fund through the private sector. Recommendation: By funding and promoting funding of (i) research into health-related behaviour change interventions and (ii) national dissemination and implementation of effective interventions the Department of Health would increase the contribution health psychologists are making towards establishing a healthier nation. Heart Disease: Prevention and Patient Care Research into work site interventions designed to reduce cardiovascular disease risk factors have compared programmes which involve (i) screening, i.e., assessing health risk, (ii) education about risk factors and (iii) behaviour change counselling. A trial involving measurement over a 12 month period showed that behaviour change counselling was effective in reducing cardiovascular risk and was the most cost effective approach (Oldenburg et al., 1995). Weinman and colleagues (Petrie et al., 1996) found that the way in which first-time heart attack patients viewed their illness during convalescence in hospital was a better predictor their return to work and attendance at rehabilitation than socio-demographic (e.g. class) or clinical measures (e.g. severity of the heart attack). In a related study, Trzcieniecka-Green & Steptoe (1996) found that a group-based, ten- week stress management intervention improved the quality of life of heart attack and coronary bypass patients. A randomised controlled trial revealed that patients in the intervention showed greater emotional well-being and active involvement as well as fewer disruptions due to chest pain at 6 months. This research, by UK-based health psychologists, highlights the benefits of effective patient education and stress management in coronary care. Submission to the 2 Department of Health Cancer: Prevention, Screening and Doctor-Patient Communication Considerable research has been devoted to the promotion of smoking cessation and interventions based on psychological theory have been found to be effective. For example, Walter et al (1989) reported a six year randomised controlled trial of a school-based intervention to reduce cigarette smoking and decrease the intake of saturated fat and carbohydrates. Children in intervention schools had reduced smoking and dietary risk. Recent work has also shown that smoking cessation can be promoted amongst pregnant women and maintained after birth. Psychological models have been found to be effective in predicting which women will and will not attend for breast (Lechner, et al., 1997) and cervical cancer screening (Orbell & Sheeran, 1993). This provides a basis for designing campaigns to increase attendance. In the case of cervical cancer effective interventions increasing attendance at screening and treatment uptake could dramatically decrease deaths resulting from this cancer. Research into treatment adherence is ongoing in the UK. Poor doctor-patient communication can lead to faulty clinical data, poorer treatment and patient satisfaction and greater likelihood of litigation. Yet in a recent study of senior oncologists in the UK more than one third had received no communication training. Courses lasting for one and a half or three days were found to result in positive changes in oncologists ratings of their own communication skills and practice (Fallowfield et al., 1998). Further trials are needed but these results suggest that investment in communication skills training is likely to be cost effective. Accidents: prevention Child cyclists are over-represented in road accident statistics (e.g. 1,446 cyclists aged 8-19 were seriously injured or killed in the UK in 1995). These accidents are frequently school-related and result in serious head injuries (Quine et al., 1998). Use of cycle helmets can prevent or lessen the head injuries but less that 13% of child cyclists wear helmets consistently (Sissons-Joshi et al., 1994). Recently, health psychologists have developed and evaluated theory-based promotion of cycle helmet wearing. Controlled trials suggest that these interventions are effective in school settings (Quine et al., 1999). Widespread implementation could, therefore, reduce the number of seriously injured child cyclists. Sexual Health Education in Healthy Schools In a comprehensive review of interventions designed to promote safer sexual behaviour, Fisher and Fisher (1992) concluded that those based psychological theory were most effective. Similarly, a meta-analysis of twelve controlled trials of theory-based HIV-preventive interventions led Kalichman et al (1996) to conclude that such interventions were effective and worthy of routine implementation. Randomised controlled trials of general sex education programmes informed by psychological theory are ongoing in UK schools (e.g., the SHARE programme, Wight et al., 1998). If these prove to be effective, investment in national implementation could reduce the incidence of unwanted pregnancies and sexually transmitted infections amongst young people. Prepared by Professor Charles Abraham, Chair of the British Psychological Society Division of Health Psychology, Centre for the Study of Health-Related Behaviour, School of Social Sciences, University of Sussex, Brighton BN1 9SN. Email: email@example.com January 1999 In collaboration with Dr. Susan Michie, King’s College London, Professor John Weinman, King’s College London, Professor Marie Johnston, University of St Andrew’s, Dr. Fiona Jones University of Hertfordshire and Dr. Sheina Orbell, University of Sheffield. Submission to the 3 Department of Health References Fallowfield, L., Lipkin, M. & Hall, A. (1998) Teaching senior oncologists communication skills: results from phase 1 of a comprehensive longitudinal program in the United Kingdom. Journal of Clinical Oncology, 16, 1961-1968. Fisher, J. D. & Fisher W. A. (1992) Changing AIDS risk behaviour, Psychological Bulletin, 111, 455-474. Friedman, R., Sobel, D., Myers, P., Caudill, M. & Benson, H. (1995) Behavioral medicine, clinical health psychology and cost offset, Health Psychology, 14, 509-518. Kalichman, S. C., Carey, M. P. & Johnson, B. T. (1996) Prevention of sexually transmitted HIV infection: a meta-analytic review of the behavioral outcome literature. American Behavioral Medicine, 18, 6-15. Lechner, L., de Vries, H. & Offermans, N. (1997) Participation in a breast cancer screening program: influence of past behaviour and determinants on future screening participation. Preventive Medicine, 26, 473-482. Oldenburg, B., Owen, N., Parle, M. & Gomel, M. (1995) An economic evaluation of four work site based cardiovascular risk factor interventions. Health Education Quarterly, 22, 9-19. Orbell, S. & Sheeran P. (1996) Health psychology and uptake of preventive health services: a review of 30 years research on cervical screening. Psychology and Health, 8, 417-433 Petrie, K.J., Weinman, J., Sharpe, N. & Buckley, J. (1996) Predicting return to work and functioning following myocardial infarction: the role of the patient's view of their illness. British Medical Journal, 312, 1191-1194. Quine, L., Rutter, D. R. & Arnold, L. (1998) Predicting and understanding safety helmet use among schoolboy cyclists: a comparison of the theory of planned behaviour and the health belief model. Psychology and Health, 13, 251-269. Quine, L., Arnold, L. & Rutter, D. R. (1999) Use of the elaboration likelihood model of persuasion to promote helmet-wearing in school-age cyclists. Paper presented at the 1st Annual Conference of the British Psychological Society, Division of Health Psychology. Bangor. Sissons-Joshi, M., Beckett, K. & Macfarlane, A. (1994) Cycle helmet wearing in teenagers – do health beliefs influence behaviour? Archives of Disease in Childhood, 71, 536-539. Trzcieniecka-Green, A. & Steptoe, A. (1996) The effects of stress management on the quality of life of patients following acute myocardial infarction or coronary bypass surgery. European Heart Journal, 17, 1663-1670. Walter, H. J., Vaughan, R. D. & Wynder, E. L. (1989) Primary prevention of cancer among children in cigarette smoking and diet after six years of intervention. Journal of the National Cancer Institute, 81, 995-999. Wight, D., Abraham, C., & Scott, S. (1988) Towards a psycho-social theoretical framework for sexual health promotion. Health Education Research, 13, 317-330.
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