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Division of Health Psychology

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By Dr Wendy Lawrence PhD CPsychol AFBPsS, Associate Professor of Health Psychology, MRC Lifecourse Epidemiology Unit, University of Southampton

“Overweight and obese adults report low levels of physical activity, high TV viewing and poor sleep duration. These behaviours seem to cluster and collectively expose individuals to greater risk of obesity. Multiple lifestyle behaviours should be targeted in future interventions.”

‘Wow!’  I hear you all gasping.  A breakthrough in obesity research!  This conclusion appears in a recent article in the International Journal of Behavioral Nutrition and Physical Activity.  This paper reports on data from the UK Biobank cohort of >500,000 participants, and demonstrates the value attributed to analyses of huge data sets whether or not they offer any additional insight.  So where is the input from health psychology research as to why such behaviours cluster, and perhaps more importantly how we might target multiple lifestyle behaviours as suggested by the authors – clinical exercise physiologists, public health and health promotion specialists, and health technology and prevention experts from Newcastle, UK and Sydney, Australia? 

As a health psychologist I have a broad understanding of the health behaviour change theories and models we have at our disposal, and have worked on the development of the Taxonomy of Behaviour Change Techniques.  Developing behaviour change interventions within a theoretical framework that best fits with our target behaviour, population and context is what we do.  We know that change is difficult, we know that even “successful” interventions tend to have small effect sizes, and we know that it is not just about targeting lifestyle behaviours.  Individuals make choices based on a wide range of factors; change does not happen in isolation, outside of a social and environmental context.  How many of you have tried to change something?  How successful were you?  For how long?

As the DHP’s Practitioner Lead and lead for the delivery and development of “Healthy Conversation Skills”, I know a little about the challenges and frustrations facing our healthcare workforce as they work to combat obesity.  They are perfectly positioned to support behaviour change; they have regular contact with people and a range of resources and services to draw upon.  However, they frequently have limited experience of, or training in, skills to support behaviour change.  I have been fortunate in recent years to be able to work with many of these practitioners to provide them with such skills, and to see how receptive and excited they are to add these to their tool kit for tackling health issues like obesity.  It has been immensely satisfying to witness increases in confidence in their ability to empower patients to identify first steps to change, to support them to set goals and make plans to achieve these, and to utilise a range of behaviour change techniques to make such changes more likely to happen and be sustained.  And I’m not the only health psychologist working in this way.

So wouldn’t it be helpful if, rather than making sweeping statements about targeting multiple lifestyle behaviours, authors instead sought out their local health psychologist (I’ve checked … they definitely have them in Newcastle and Sydney!) and in collaboration developed more useful conclusions, with clear strategies for future interventions?  In this way, health psychologists can work together with those in public health and prevention research and then perhaps these huge data sets might actually be worth more than the computers on which they’re stored.

Mon, 15/05/2017 - 10:29

By Dr Anita Mehay, Health Psychologist (in training)

I might be one of the few health psychologists specialising in prison health. This might not come as a surprise since prisons are not particularly settings we associate with health psychologists. As a discipline, we tend to focus on medical population groups and contexts such as hospitals, care homes and maybe beyond this, schools and workplaces. But there is a strong case for why we should as a profession, push the boundaries (both physically and theoretical) of where we work.

Consider that there are around 85,000 people held within the 118 prisons in England and Wales. This is a group which are largely deemed as unhealthy with a high prevalence of complex health needs including mental health issues, chronic health conditions, substance abuse and communicable diseases. Although the primary aim of incarceration is not health improvement, prison provides an opportunity to reach this high need and hard-to-reach group since they are a literal ‘captive audience’. Indeed, current policy in England and Wales support the concept of ‘healthy prisons’ in that prisoners should be released in better health and can act as powerful advocates for their families and communities. Therefore, prison health is public health.

With this in mind, I am therefore surprised at how very few health psychologists work within prison settings. My own doctoral research sought to critically examine what opportunities there are for strengthening health where I spent the best part of a year embedded within a single prison and spoke to many young men about their lives in prison and how health fits in with this. What I found was unsurprising in many ways – prison was a restrictive and largely unhealthy place. But what was more interesting were the great lengths they went to overcome the difficulties in maintaining their health by using creative methods; from making healthy meals to undertaking exercises within small spaces and self-managing common health complaints with 'jail remedies'.

Rarely do we see this positivity, creativity, and resourcefulness within the constant slew of negative media portrayals of prisoners as lazy and untrustworthy and purely violent. It is certainly a missed opportunity to understanding, engaging, and utilising their enthusiasm for health whilst they are in prison. Indeed, there are some excellent health initiatives, such as from the Red Cross who train Irish prisoners as health ambassadors and Football Fans in Training (FFIT) which uses professional football clubs to help promote weight loss in overweight and obese men in prison. However, these initiatives are few and far between in light of the need and as such, we still lack the evidence base and theory to truly understand how health promotion works in these contexts.

Therefore, health psychologists surely have a role to play, not just in prison groups but also other groups and settings which are not traditionally seen as appealing or worthwhile? Indeed, for some, prisons should solely be a place of punishment and thus there is no impetus to consider this group as ‘worthy’ of our attention in this way. The reality is that this moral argument has served no purpose to anyone; reoffending rates are still unacceptably high whereas working with this group to improve health can have a powerful impact on improving public health as well as lowering crime rates. The task is great and challenging – but the impact is potentially colossal.

Sat, 29/04/2017 - 11:55

By Hannah Ballance MSc, MBPsS
DHP Support Officer & Health Psychologist in training at Staffordshire University

We spend 3 years or more completing an undergraduate degree, 1 or 2 years on a Masters, and then up to 6 years completing Stage 2. I am now fast approaching the cut-off time for completing my stage 2 and there are a few questions I keep asking myself. Mainly - what is the point?!

So maybe my thinking is all part and parcel of the process, but although I was drawn to the health psychology profession following my undergraduate degree, and enjoyed my MSc when I ventured in to the taught route for Stage 2 (see info on the taught and independent routes), little did I know what I was getting myself into!

I certainly didn’t realise it would be a long and often exhaustive process. Fulfilling the five competencies required to pass your stage 2 is easier said than done when finding opportunities to gain practice experience is often difficult. You may be lucky enough to secure a training place, such as with the NHS Education for Scotland trainee health psychologist placements, but these are few and far between. To take this path I have had to find novel ways to demonstrate the competencies. Consultancy opportunities like this one from the DHP are great, but surely more opportunities to help Stage 2 trainees are out there?

My personal experience as a distance learner can mean it feels quite isolated once lectures have finished. Staying in contact with your cohort and getting involved with university life helps but this is difficult when trying to hold down jobs and meet personal commitments. I have also been plagued by endless self-doubt throughout the process. How come everyone else seems to know what they are doing and I don’t? The training pathway requires the investment of large amounts of money, but it is the time and sacrifices I have had to make which have hit me hard.

But for me, the finish line is within sight. I know I should be excited that I will soon be able to use my developed skill set to make a difference but it just doesn’t feel that way right now. I am wondering what is now in store for me? As a trainee, I worry I will not have enough practical experience that my skill set in therapy techniques are not great enough and I will struggle to find a job. What impact can I have and can I really make the difference I want in improving peoples’ lives? I know I am not alone as during the joint EHPS/DHP conference in Aberdeen last year I discovered health psychologists everywhere are battling to get their voices heard, to demonstrate to policy makers and commissioners the value and impact our research and practice can make.

For now, I keep focused on why I wanted to do this in the first place - to make a difference to people’s lives. But when things get tough, what support is out there for trainees like me? The DHP has a trainee resource page which has helped and as has reaching out to other trainees (for example, through PSYPAG). But overall I want to ask for the health psychology professionals of today and tomorrow…How can stage 2 trainees support each other? What can Health Psychologists/the wider profession do to help trainees more and how?

I don’t regret the choices I have made but wish the path was clearer moving forward.
 

Fri, 14/04/2017 - 17:23

By Sarah Renouf and Natalie Bisal, Research Health Psychologists, Health and Lifestyle Research Unit, Queen Mary University of London

Undoubtedly, smoking is one of the biggest causes of death and illness where every year around 100,000 people in the UK die from smoking, with many more living with debilitating smoking-related illnesses. Health psychologist like us focus on providing behavioural support through one to one and group work as well as using aids to support quitting, such as Nicotine Replacement Therapy (NRT) or Champix, a tablet which dulls cravings and decreases the pleasurable effect of smoking. Our clinic regularly provides a combination of support which is effective in increasing the chance of successfully quitting. But a new kid of the block has appeared which has challenged our thinking of smoking cessation; the e-cigarette.

Although the use of e-cigarette has risen dramatically over the past 10 years and is now the most popular smoking cessation aid in the UK, our knowledge and the research has not kept up with this development. Many people report that e-cigarettes can help address the habitual side to smoking that other medications can’t, such as the throat hit and hand-to-mouth action. However, there have been a spate of conflicting opinions of the harms of e-cigarettes from various media reports as well as from major health organisations such as NICE - which makes it difficult for the public to understand whether or not e-cigarettes are a useful way to quit smoking or a harmful alternative. Health psychology research has perhaps been surprisingly slow to react to this proliferation of e-cigarette use considering our focus on behavioural habits. Recent research is now emerging which highlights the potential positive impact of e-cigarettes where they are 95% less harmful than regular cigarettes and are associated with increased success rates of quit attempts. Despite these developments, the profession in general has been decidedly slow to adapt to developments, experts such as Professor Peter Hajek and Professor Robert West (who have been vocal supporters of the e-cig option) are the exception rather than the norm. More research is needed into the long-term effects of e-cigarettes and their potential in certain populations, such as pregnant women or those with mental health problems, where the greatest impact on their health might be seen. Health psychologists need to adapt to this ‘new kid on the block’ and are uniquely placed to explore the potential of e-cigarettes and investigate contexts in which they may not be helpful as well as explore barriers including some individuals discomfort with the idea of replacing one habit for another.

Within our clinic, we try to take an active role in adapting to these new developments where we seek to understand the concerns of e-cigarettes where our role can be one of educator to highlight the evidence which is emerging of the good safety record and benefits of e-cigarettes. We are also looking at using the proliferation of e-cigarette use to draw more people into our clinic, for example, we are currently partnering with local e-cigarette shops to make our service more attractive to quitters. We are also involved in research, including an ongoing trial comparing the effectiveness of e-cigarettes to NRT to increase our knowledge in this area. However, services like ours increasingly suffer threats to government funding which severely undermines our ability to continue this work and the long-term aim to reduce deaths and illness from smoking-related diseases – however something has to change if we are to continue to help address this health concern.

Tue, 28/03/2017 - 11:45

By Professor Chris Armitage

With the exception of five years “abroad”, I have lived and worked full time in the so-called “Luddite triangle”   I am often (e.g., in my own home) accused of being a “Luddite”.  On the face of it, my decision to negotiate life without a smartphone, Facebook or a Twitter account, probably justifies this response.  On the other hand, my early adoption of iPod, unwavering insistence on Apple computers and addiction to gaming that is managed through abstinence, implies that perhaps people (e.g., my family) shouldn’t rush to judgement.  May it further be noted that I also chose not to “invest” in laser discs, Sinclair C5’s or a pager. 

Like the Luddites, I do not object to new technology per se, simply the unthinking introduction of new technology without adequate consideration of acceptability, feasibility and worth.  In my opinion, new technology frequently is unthinkingly seen as the solution to a raft of problems, including the funding crisis in the NHS.  Clearly, new technology will have a role to play in tackling the social and economic problems we face, but it should not be deployed unthinkingly.  At the time of publication in 2013, Abroms et al.  identified more than 400 smoking cessation apps (just one form of new technology), none of which had been subject to a randomised controlled trial, much less developed with an eye to theories and methods that health psychologists take for granted.  What should have been an influential review published in the same year http://tinyurl.com/m932tpl concluded that: “Multiple mobile phone based applications are available for healthcare workers and healthcare consumers; however, the absolute majority lack an evidence base.” (p. 130, Bastawrous & Armstrong, 2013). 

Although the picture since 2013 has changed somewhat, the pace of change in relation to using health psychology to inform interventions (electric or acoustic) is not matching the pace of the development of new technologies.  The seeming willingness to embrace new technologies in spite of the lack of evidence is not trivial: fundamentally, new technology is a form of medical intervention, and new drugs and new surgical procedures are not rolled out until they have been shown to be safe, clinically effective and cost-effective.  As an aside, perhaps the seeming willingness to embrace new technologies is because of the lack of evidence.  After all, evidence can be messy and prompt the search for more and better evidence rather than providing a solution.  

So, why this new technology gold rush?  One explanation lies perhaps in the same processes that underpin “brain image bias” (McCabe & Castel, 2008 ), the finding that scientific explanations are more persuasive when accompanied by images of brains.  Like images produced by fMRI scans, new technology is striking, memorable and appealing.  Like the neuroscience underpinning the fMRI scans, the behavioural science underpinning new technology innovations can be good, bad or indifferent.  What sticks in the memory is the scan or the gizmo.  Maybe behavioural scientists should learn something from neuromarketing: a carefully-designed behavioural intervention that is effective if delivered via a leaflet is liable to be usurped by an app with no such underpinning evidence. 

It is true that Luddites smashed new technology, but they did not do so unthinkingly in opposition of new technology per se.  They did so through a combination of disenfranchisement, a legal system that benefitted employers over employees and because the new technology had been implemented without adequate consideration of acceptability, feasibility and potential consequences.  Maybe I am a Luddite after all. 

Tue, 14/03/2017 - 11:38

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