Health Is a Multi-Factorial Phenomenon - Essay Example

31-10-2006 Changing an individual's beliefs would improve their health Health is a multi-factorial phenomenon. The factors, which influence the health lives within the individual and also in his surrounding (environment) i.e., individuals own personality, family, society, community and work place etc. The widely accepted definition of health is given by World Health Organization (1948) in the preamble to its constitution, which is; 'Health is a state of complete physical, mental and social well being and not merely an absence of disease or infirmity'. In recent years the statement has been augmented to include the ability to lead a 'socially and economically productive life' (WHO, 1978). Oxford English Dictionary defines health as- "soundness of body or mind; that condition in which its function are duly and efficiently discharged". Field of Health psychology: Health psychology is the application of psychological theory and research to health, illness and health care, which deals with individual behavior in the social context. Psychosocial aspects and determinants are kept in consideration to understand the human behavior. It also tries to understand and promote behavioral changes. One basic assumption in health psychology is that to change people's behavior-at least through health promotion interventions-it is necessary to understand the psychosocial determinants of behavior. For example, due to lack of motivation/ willpower when a harmful user fails to stop taking alcohol, requires another kind of intervention than that addict who fails to stop taking drinks because of a lack of family/social support. In the traditional viewpoint absence of disease was known as health. This concept was known as biomedical concept, which has its base in the "germ theory of disease" which dominated medical thought at the turn of the 20th century. The medical professionals of that term were treating the human body as a machine. Any sort of disease was taken as a fault in the machine and the doctor task was to repair the machine. Therefore the health became an ultimate goal of medicine. The criticism then started against the biomedical concept as it was minimized the role of the environmental, social, psychological and cultural determinants of health. The biomedical model, for all its remarkable success in treating disease, was found inadequate to solve some of the major health problems of mankind (e.g., malnutrition, chronic diseases, accidents, drug abuse, mental illness, environmental pollution, population explosion) by elaborating the medical technologies. Developments in medical and social sciences led to the conclusion that the biomedical concept of health was inadequate. The ecologists put forward an attractive hypothesis, which viewed health as a dynamic equilibrium between man and his environment, and disease a maladjustment of the human organism to environment. (Dubos, 1969) believes that man's capacity to adopt himself to ecological changes is not unlimited. Man can adopt himself only in so far as the mechanism of adaptation is potentially present in his genetic code. Human ecological and cultural adaptations do not determine only the occurrence of disease but also the availability of food and the population explosion. The ecological concept raises two issues, viz. imperfect man and imperfect environment. History argues strongly that improvement in human adaptation to natural environments can lead to longer life expectancies and a better quality of life - even in the absence of modern health delivery services. The health applications of psychology were strongly focused on risk perception and risk taking behaviour. The best example may be the health belief model, where the perception of the severity of the risk and the susceptibility for the risk were seen as the primary determinants of health-protective behaviors. Over time, it became clear that people have many reasons for health-related behaviors, of which risk perception is often not an important one. In this multi-causality approach, there is also a growing recognition of many psychosocial and environmental influences on individual behavior. Changes in psychosocial determinants (e.g., self-efficacy) are most effective in creating behavior change when paralleled by changes in the social and physical environment (e.g., removal of barriers). Contemporary developments in social sciences revealed that health is not only a biomedical/ ecological phenomenon, but also one, which is influenced by social, psychological, cultural, economic and political factors of the people concerned. These factors must be taken into consideration in defining and measuring health. Thus health is both a biological and social phenomenon. The area of health psychology includes wider range of health-related behavior such as healthy eating, the doctor-patient relationship, a patient's understanding of health information, and beliefs about illness (Norman, 2000). Health psychologists may be involved in public health campaigns, examining the impact of illness or health policy on quality of life. The broad category of factors that may influence the health of an individual and community health behaviour include- knowledge, belief, values, attitudes, skills, finance, material, time and the influence of family members, friends, co- workers, opinion leaders and even health workers themselves (WHO, 1987). Serious considerations must also be given to the community or social context in which a given type of behaviour occurs. Previous issues such as norms, gender role, ethnic discrimination, poverty, unemployment and educational opportunities may limit the ability of some of the section of community to behave in a healthy manner. The health behaviour can be divided in three category i.e., health behaviour; illness behaviour and treatment behaviour. Health behaviour refers to those activities of people, which they undertake to avoid disease to detect asymptomatic infections through appropriate screening tests. People having good health habits are less likely to develop infection/ disease than persons with poor health habits (Morrison & Bennett, 2006). Illness behaviour refers the way of reaction of the individual reacted towards any symptom/ disease. Generally, people who detect the symptom may wait and watch if the symptom persist or worsen. If the symptom continues the affected person may ask a friend or acquaintance for advice before seeking medical help. Treatment behaviour refers to those activities use to cure and restore health (Brannon and Feist, 2004). It is important for patient to take medication as directed, return for tests for cure and cooperate ion efforts to identify untreated cases. The internal or individual factors, which affect the health of a person, are basically the attitude, personality type, emotional factors, different habits, and traits. Emotion is a strong feeling of the whole organism. It motivates human behaviour. Emotional states determine human behaviour. Disorders of emotions interfere with human efficiency i.e., lack of concentration, appetite, sleep etc. Attitude is acquired characteristics of an individual. They are more or less permanent base of behaving. It includes three components; (a) a cognitive or knowledge element; (b) an affective of feeling element and (c) a tendency to action. The condition of anybodies health largely depends on attitude. Habits are an accustomed way of doing things. They are formed. There are both good and bad habits. Good habits like- hygienic practices, physical activity, regular breakfast, regular and proper tooth-brushing, using a seat belt, fruit consumption, promotes health, while bad habits like- improper hygienic practices, drug/ alcohol dependence etc. ruins health (Steptoe and Wardle, 2001). Human personality is a bundle of traits i.e., tendency to behave in a consistent manner in variable situations. It includes certain physical and mental characteristics of a given individual. It determines to some extent the individuals behaviour or adjustment to his surroundings. Personality traits incorporate components- physical, emotional and intelligence. The responsibility of health rests not only on the individual but also upon the community and its surrounding. All people whether rural or urban have their own belief and practices concerning health and disease. Now it is widely recognized that cultural factors such as- belief, values, family structure, religion, eating/ food habits, customs/ ritual etc. deeply involve in all the affairs of individual, including health and disease. There are a large number of studies linking socio- economic factors to incidence of disease. Income, occupation and education are the major components, which positively correlated with health status. Lower class people are more vulnerable to infectious disease than their counterpart upper and middle strata individuals. When an individual is faced with problems, failure he employs certain defense mechanism (ways or devices) to achieve health such as- rationalization, projections, compensations, escape mechanism, displacement and regression etc. In the light of above finding and theories it seems that in the twentieth century causes of death changed and the widely determining factor for health was explained in terms of healthy behaviour. Health behaviors can be predicted by health beliefs such as the attributions about causes of health and behaviour, perceptions of risk and the stages of change model. In particular, the integration of these different types of health beliefs in the form of models (health belief model, protection motivation theory, theory of reasoned action, theory of planned behaviour, health action process approach) was came inexistence (Ogden, 2004). The health belief model was developed in 1950. It attempted to explain and predict a given health-related behavior from certain patterns of belief about the recommended health behavior and the health problems that the behavior was intended to prevent or control. The model postulates different conditions, which explain and predict a health-related behavior. Gradually the model was modified and changed. The Health Belief Model relates largely to the cognitive factors predisposing a person to a health behavior, concluding with a belief in one's self-efficacy for the behavior. A systematic, quantitative review of studies that had applied the Health Belief Model among adults into the late 1980s found it lacking in consistent predictive power for many behaviors, probably because its scope is limited to predisposing factors (Harrison, Mullen, and Green, 1992). One study that specifically compared its predictive power with other models found that it accounted for a smaller proportion of the variance in diet, exercise, and smoking behaviors than did the theory of reasoned action, theory of planned behavior, and the PRECEDE-PROCEED model (Mullen, Hersey, and Iverson, 1987). In 1975 theory of reasoned action (TRA) was developed to examine the relationship between attitudes and behavior. It looks at behavioral intentions rather than attitudes as the main predictors of behavior. According to this theory, attitudes toward a behavior (or more precisely, attitudes toward the expected outcome or result of a behavior) and subjective norms (the influence other people have on a person's attitudes and behavior) are the major predictors of behavioral intention. TRA works most successfully when applied to behaviors that are under a person's volitional control. The health-education implications of this theory allow one to identify how and where to target strategies for changing behavior (e.g., prevention of sexually-transmitted diseases and health fitness behaviors). The theory of planned behavior (TPB) was developed in 1988, which is an extension of the theory of reasoned action. The TPB takes into account that all behavior is not under volitional control and behaviors are located at some point along a continuum, which extends from total control to a complete lack of control. Control factors include both internal factors and external factors. Internal factors includes- skills, abilities, information, and emotions where external factors include - situation or environmental factors. The components of the model, as they relate to behavioral intention, include attitude toward the behavior, subjective norms, and perceived behavioral control. However, the health belief model continued to be the most frequently applied model in published descriptions of programs and studies in health education and health behavior in the early 1990s. It has since been displaced in frequency of application by the trans- theoretical model of stages of change. To develop effective intervention health psychologists adopt following steps; Gather knowledge with the intention to adopt necessarily corresponding actions, which consists of three levels: cognitive, behavioural, and situational. The focus is on cognitions that instigate and control the action, i.e., a volitional or self-regulative process which is subdivided into action plans and action control. For particular health behaviour, the intention has to be transformed into detailed instructions of how to perform the desired action. If, for example, someone intends to lose weight, it has to be planned how to do it, i.e., what foods to buy, when and how often to eat which amounts, when and where to exercise, and maybe even whether to give up smoking as well. The volition process is hardly influenced by outcome expectancies, but more strongly by self-efficacy, since the number and quality of action plans are dependent on one's perceived competence and experience. Self-efficacy beliefs influence the cognitive construction of specific action plans, for example by visualizing scenarios that may guide goal attainment. These post decisional pre-actional cognitions are necessary because otherwise the person would act impulsively in a trial-and-error fashion and would not know where to allocate the available resources. Once an action has been initiated, it has to be controlled by cognitions in order to be maintained. The action has to be protected from being interrupted and abandoned prematurely due to incompatible competing intentions, which may become dominant while behaviour is being performed. Daily physical exercise, for example, requires self-regulatory processes in order to secure effort and persistence and to keep other motivational tendencies at a distance (such as the desire to eat, socialize, or sleep) until these tendencies can prevail for a limited time period. At the time of action is being performed; self-efficacy determines the amount of effort invested and the perseverance. People with self-doubts are more inclined to anticipate failure scenarios, worry about possible performance deficiencies, and abort their attempts prematurely. People with an optimistic sense of self-efficacy, however, visualize success scenarios that guide the action and let them persevere in face of obstacles. When running into unforeseen difficulties they quickly recover. To perform intended health behaviour an action, just as is abstaining from risk behaviour. The containment of health-detrimental actions requires effort and persistence as well, and therefore is also guided by a volitional process that includes action plans and action control. If one intends to quit smoking or drinking, one has to plan how to do it. For example, it is important to avoid high-risk situations where the pressures to relapse are overwhelming; and Finally, situational barriers as well as opportunities have to be considered. If situational cues are overwhelming, meta-cognitive skills fail to protect the individual and the temptation cannot be resisted. Actions are not only a function of intentions and cognitive control, but are also influenced by the perceived and the actual environment. A social network, for example, that ignores the coping process of a quitter by smoking in his presence, creates a difficult stress situation, which taxes the quitter's volitional strength. If, on the other hand, a spouse decides to quit too, then a social support situation is created that enables the quitter to remain abstinent in spite of lower levels of volitional strength. The action phase can be summarized along three levels: cognitive, behavioural, and situational. The cognitive level refers to self-regulatory processes that mediate between the intentions and the actions. This volitional process contains action plans and action control and is strongly influenced by perceived self-efficacy, but also by perceived situational barriers and support. Findings of the study carried out by Verplanken & Faes (1999) indicates that forming implementation intentions was effective in changing complex everyday behavior, in this case establishing a healthier diet. Findings of the study showed that the effect of implementation intentions was additive to the prediction of healthiness of eating by behavioral intentions. There was no significant interaction between behavioral intentions and the implementation intentions manipulation, which might be attributed to the fact that all participants intended to eat healthily. Health promotion is the process of enabling people to increase their control and improve the health. It is not directed against any particular disease, but is intended to strengthen the host through variety of interventions. Health promotion incorporates- health education, environmental modifications, nutritional interventions and lifestyle and behavioural changes. *************** ] References: 1. Brannon, L. and Feist, J. (2004) Health Psychology: An Introduction to Behaviour and Health (5th Edition) Thompson/Wadsworth: UK. 2. Dubos,R.(1969) WHO Chronological. 23. 3. Harrison, J. A.; Mullen, P. D.; and Green, L. W. (1992). "A Meta-Analysis of Studies of the Health Belief Model." Health Education Research. 4. Morrison, V. & Bennett, P. (2006). An introduction to Health Psychology, London: Prentice Hall. 5. Mullen, P. D.; Hersey, J.; and Iverson, D. C. (1987). "Health Behavior Models Compared." Social Science and Medicine. 6. Norman, P. (2000). Understanding and Changing Health Behaviour. London: Psychology Press. 7. Ogden, J. (2004) Health Psychology: A Textbook, 3rd ed. 8. Steptoe, A. & Wardle, J. (2001). Locus of control and health behaviour revisited: A multivariate analysis of young adults from 18 countries. British Journal of Psychology, 92, 9. Verplanken, B. & Faes, S.(1999), Good intentions, bad habits, and effects of forming implementation intentions on healthy eating, European Journal of Social Psychology ,Eur. J. Soc. Psychol. 29. 10. WHO (1978) Health for all, Sr. No. 1. 11. WHO (1987). Technical Report, Sr. No. 755. ******************* Read More