The Psychology of Prescribing
Health and illness beliefs
Patients/clients play an important role in their own health status. Encouraging people to adopt healthy behaviours and lifestyles would be easy if their behaviour was based on logical, rational decisions.
Unfortunately, a willingness to adopt health-related behaviours depends on a range of complex patient/client attitudes to illness, their expectations of health, previous experience of illness and social pressures. Consequently, in examining the question of patient compliance, it is vital to gain an understanding of health beliefs and behaviours.
The Health Belief Model
This model was originally proposed in 1966, but the concept was extended by Becker et al in 1977. According to this extended concept, health behaviour is determined by several fundamental aspects of how an individual views health.
Susceptibility to illness: the extent to which an individual believes they are susceptible to illness, for example, if there is a family history of a disease.
Severity of illness: their evaluation of the seriousness of the disease.
Benefits of healthy behaviour: the extent to which an individual believes it may be worthwhile engaging in an activity that may reduce their chances of developing a particular illness, or the disadvantages of engaging in a specific behaviour, particularly in terms of financial costs or time constraints.
Cues to action: something that happens to prompt a re-evaluation of health behaviours.
A model can act as a useful guideline for examining ways to promote changes in lifestyle and to encourage compliance, where the behaviour of the patient may affect their future health.
Health locus of control
The area of social psychology that explores ways in which patients attribute causes for events in their lives is termed attribution theory and is an element of social learning theory.
As a rule, people tend to attribute causes either internally where causes of behaviour are located within the individual or externally where an outside influence has caused a person to act in a particular way. Pennington et al (1999) suggest that people's tendency to attribute internal and external causes is an attempt to make the social world a more predictable place in which to live. Thus, being in a position to predict how people are likely to behave seems to imply that a certain amount of control over the future is possible.
This theory was applied to a concept of health by Wallston et al (1978) in developing a multidimensional health locus of control scale that has three key dimensions: