Unit 4 - Prescribing Partnerships

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.

Reflection

What criticisms could be made of the Health Belief Model, if this is considered in the context of elements such as rationality, emotions and socio-economic factors?

For example, although 'severity' is included in the model, this doesn't encompass feelings of fear or denial.

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.

Link to another Unit

You will find more on this subject in 'Management of change' in Unit 5. Prescribing in Practice.

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:

Health is controlled by the individual (internal)

Health is controlled by the
individual (internal)

If I take care of myself, I can avoid getting high blood pressure

Health is controlled by
chance (external)

‘No matter what I do, if I'm going to get high blood pressure, I will get high blood pressure’

Health is controlled by chance (external)

Health is controlled by powerful others

Health is controlled by
powerful others
(such as healthcare professionals)

‘It's nothing to do with me — I can only do what the doctor tells me’

 

Make Notes

Are individuals always influenced by 'external' or 'internal' factors? Do you think this could be a temporary state of mind, owing to health status at a particular time, or is the concept of 'internal' or 'external' forces representative of stable personality traits?

Further Reading

Further reading

Ogden, J. (2004) Health Psychology (3rd edition). Milton Keynes: Open University Press.

Pennington, D.C. et al (1999) Social Psychology. London: Hodder Arnold.
Chapter 5, 'Social cognition LL: the attribution approach'.


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