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									                                                                                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: s.c.s.abraham@sussex.ac.uk 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


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,

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,

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,

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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