Introduction to health care psychology

Health psychology is a relatively new field which is evolving and developing as one of main areas of applied psychology. Although its early beginnings can be traced to the kindred field of clinical psychology, four different approaches to health psychology have been defined: clinical, public health, community and critical health psychology (Marks, Murray et al., 2005).

Many researchers believe that physical health may be influenced by psychology through a variety of direct and indirect means. There is some evidence that certain negative mental states (such as depression and anxiety) can directly affect physical immunity through production of stress hormones, such as the catecholamines and glucocorticoids. Although this research is widely debated, there is also some indication that negative psychological states may lead to faster disease progression in certain diseases (such as HIV and heart disease) through these direct biological mechanisms. Negative emotional states may also indirectly affect disease processes through their influence on health behaviors. For example, depression has been related to many risk factors for poor health including overeating, smoking, physical inactivity, and poor medication compliance.
 * Clinical health psychology (ClHP) adopts a definition reflecting the fact that the field was originally a branch of clinical psychology: Health psychology is the “…use of psychological principles to promote health and to prevent illness (Taylor 1990).” This approach considers the biological, cognitive, behavioral, emotional, social, psychosomatic and environmental factors as they relate to health, illness and health care at the level of individuals. This approach has adopted what it calls the biopsychosocial model.


 * Public health psychology (PHP) tries to determine causation between psychological factors and health for the population as a whole, and present this information to educators, policy makers, and health care practitioners for the promotion of better public health. It gives prominence to population-level health outcomes and interventions. It is allied to other disciplines in the fields of global and public health including epidemiology, nutrition, genetics and statistics.   Interventions are determined and "targeted" using population health statistics which evaluate health needs of various population groups as perceived by health authorities and policy makers. These interventions are "top-down" and tend to have varying levels of effectiveness across diverse population groups.


 * Community health psychology (CoHP) approach tries to understand what is happening at a local level. Interventions are generated collaboratively with coalitions of stakeholders and are aimed to facilitate community empowerment to improve the physical and/or mental health of local people outside of any formal involvement of the health care system.


 *  Critical health psychology (CrHP) is concerned with the distribution of power and the impact of power differentials on health experience and behaviour, health care systems and health policy. It prioritises social justice and the universal right to health of peoples of all races, genders, ages, and socioeconomic positions. A major concern is health inequalities. The CrHPist is an agent of change, not simply an analyst or cataloguer. The field was developed through the foundation of the Journal of Health Psychology and the International Society of Critical Health Psychology.

Health psychology is both a theoretical and applied field. Many different methods are employed including questionnaires, interviews, controlled studies, and actions designed to bring about change using "action research". Health psychologists conduct health interviews with clients that aim to construct a more holistic picture of each person’s health, one that includes their genes, religious beliefs, social supports, living conditions, emotional state, and beliefs of health, etc. They use this information to work alongside a person’s doctors and therapists to develop a treatment tailored for individual needs or to develop greater empowerment among the community's members so that the community is able to strengthen and sustain its own quality of life.

Understand behavioral factors
Health psychologists seek to identify the behaviors and experiences that promote health, lead to illness. influence the effectiveness of health care, and recommend improvements to health policy in their light. There are many examples of this. Smoking, diet, and regular exercise all contribute to the formation of disease. There are some minor associations between illness and individual characteristics such as personality. For example, it is claimed that individuals with thrill seeking personalities are more likely to drive fast, making them more likely to injure themselves in car accidents. And also that people distrustful of doctors will not get regular checkups. However there are contextual factors in the form of political, economic, cultural, community, social and lifestyle factors that have a more major influence on the health of particular individulas, although they will not generally recognise these.

Factors that lead to the behaviors that cause illness are of interest because they help psychologists to predict who is most susceptible to illness and why. There are many contributing factors that help determine our behaviors, and all of the dimensions of the biopsychosocial model can be applied to understand these interconnectons. Biologically, physical addiction plays an important role in smoking cessation. As does the psychological dependency on tobacco brought about largely by seductive advertising and other forms of tobacco promotion. Psychologically, people with high stress jobs are more likely to develop cardiovascular disease. Socially, people with low incomes have less access to health resources and screening processes. They also are exposed to greater environmental toxigens, lower levels of education, poorer housing, less healthy foods, higher smoking prevalence, and many other toxic socially determined living conditions.

Health psychologists also aim to change health behaviors for the dual purpose of helping people stay healthy and helping patients adhere to disease treatment regimens. Cognitive behavioral therapy and behavior modification are techniques often used for this purpose.

Prevent illness
Psychologists work towards promoting health through behavioral change, as mentioned above, but they prevent illness in other ways as well. Practitioners emphasize education as a large part of illness prevention, as many people do not recognize the risk to illness present in their lives. Or they are unable to implement the knowledge that they have owing to the pressures of their everyday existence. A common example of this is anti-smoking campaigns. Those least able to afford tobacco products consume them the most. It is a method for controlling emotional states, the daily experiences of stress that characterise the lives of deprived and vulnerable people. Health psychologists also aim at educating health professionals like doctors and nurses in communicating with patients in a way that highlights the psychosocial barriers to understanding, memorising and implementing effective strategies for reducing risk factors and making behaviour changes and that will help them to develop appropriate means for communicating information relevant to diagnosis, treatment and prognosis (Ogden, 2004).

Explore the effects of disease
There is much to know about how disease affects our mental well being. When illness or accidents befall a person, their entire life is affected. A psychologically healthy individual who gets severely injured, say, now has many different practical issues to contend with that will in turn affect their psychological wellbeing. Who will take care of them while they recover? If they can’t work, how will they pay for bills or care for dependents? If this person sees themselves as being self-reliant, how do they handle this new identity? What if they cannot pursue their usual hobbies and interests? All of these possibilities can affect a person’s relationships, self-esteem, stress level, happiness and belief system. Many of these issues are economic and social in nature rather than psychological but they have a direct impact on psychological wellbeing.

This important field of study considers how those with terminal illnesses can lead a better life. When there is little hope of recovery, health psychology therapists can improve the quality of life of the patient by helping them recover their mental well-being.

Critical analysis of health policy
Critical health psychologists are exploring how health policy can impact on inequities, inequalities and social injustice. This expands the scope of health psychology beyond the level of individual health to an examination of the social and economic determinants of health experience both within and between regions and nations. The individualism of mainstream health psychology has been critiqued and deconstructed by critical health psychologists and newer qualitative methods and frameworks for investigating health experience and behaviour are advocated (Marks, Murray et al., 2005).