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Division of Health Psychology

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Dr. Francis Quinn, Lecturer in Psychology, Robert Gordon University, Aberdeen

As health psychologists, we understand more than most about health behaviours. Does this give total power over our lifestyle? Well the contents of my kitchen cupboards, and my exercise attendance record, beg to differ. Am I just the world’s worst health psychologist? Maybe, but I think as health psychologists we can still struggle with health behaviours, just like most people in Western societies.

Ours is not the only health profession to face these struggles. Physicians tend to exercise no more than others, not get enough sleep, and nearly half eat less than five portions of fruit and vegetables per day (Wiskar, 2012). Would all health psychologists score more highly?

With our science and techniques, does a lack of perfection make us hypocrites, or human? We live in the same obesogenic environment as our patients and participants (Hill and Peters, 1998). We respond to the same psychological processes: habits, prompts, self-efficacy, negative attitudes, ups and downs of self-regulation, cognitive fatigue, and any others you can name. Many of us face long hours and workplace stress at a university or the NHS.

But maybe our human weakness can be a source of strength. We might be a better model to raise self-efficacy if seen to overcome our own struggles, trying and persevering, rather than seeming as if we don’t have any. Seeing exemplary performance can be discouraging and cause task disengagement (Rogers & Feller, 2016). And work with clients and research participants depends on a good relationship. People seen as highly competent – but not perfect – are more likeable (Aronson, Willerman & Floyd, 1966).

Personal struggles also feed into science. The clinical psychologist Marsha Linehan created dialectical behaviour therapy partly as a result of her own borderline personality disorder (Carey, 2011). It’s now recommended in NICE guidelines. Robert Sternberg’s struggles with love and academic achievement motivated his research in these fields (Sternberg, 2014). Personal struggles can inspire ideas that develop into theory, then are tested in research. At the core of many scientific theories are ideas from everyday experience.

Of course a health psychologist must present a positive role model. But being part of the struggle might help us understand it, by inspiring ideas to test scientifically.  Just as a doctor can become ill, or a clinical psychologist can face ups and downs of well-being, a health psychologist won’t always meet guidelines for exercise or portions of fruit and veg or dental flossing. But our science reminds us of the need to set such goals, that the environment will cause us to lapse and that we must keep trying, insights into why we don’t, and gives us some techniques that can help. Part of being a psychologist is being human, sensitive, and imperfect – just like our clients and participants. Maybe this helps us to create useful scientific knowledge, and to use it to help others.

Wed, 28/06/2017 - 18:19

Sarah Golding, PhD student and trainee Health Psychologist (University of Surrey)

How does a trainee health psychologist end up researching livestock farming? By starting with a keen but unspecified interest in a big topic, by being brave enough to approach a potential supervisor to talk through those early, vague ideas, and by being open to where those conversations might lead!

That big topic was antibiotic resistance (when the drugs no longer harm the bugs) and I’d assumed I’d do a typical health psychology PhD: explore GP-patient communication and decision-making, then design an intervention to reduce antibiotic prescriptions. Simple. But then I discovered such work was already well underway, and I realised I needed another angle. I was going nowhere fast, trying to think up alternative projects with GPs, and then my would-be supervisor asked the magic question…who else uses antibiotics? Well, I said. Hospital doctors? Pharmacists? Vets? Vets, she said. I know a vet who is interested in psychology…maybe we could do something with vets?

And so we did, and it’s really good fun, but I’m often asked what psychology has to do with veterinary medicine (including by my participants!). Well, vets are healthcare professionals, who are often highly autonomous practitioners, and they have client relationships to nurture, protect, and negotiate. Farmers are time-pressured people, busy running businesses, managing staff, and making countless decisions that affect their animal husbandry practices. Whichever way you look at it, vets and farmers are people too; they are driven by beliefs, emotions, and biases, just the same as doctors, nurses, and patients are. The same applies to those of us who are pet owners. Ultimately, human psychology is a factor in animal health outcomes. And in the case of antibiotic resistance, that means the psychology of vets, farmers, and pet owners influences human health outcomes too.

There is much debate about the extent to which inappropriate antibiotic use in farming causes antibiotic resistance in human bacteria. There are high profile cases of resistance genes emerging in bacteria carried by livestock, and of these resistant bacteria being passed to humans. But there are also (less well publicised) examples where the resistance has gone the other way, from human to animal bacteria. In reality, genetic mapping studies are complex and hard, and mostly, we just lack the data to say for sure. Ultimately, however, we all share one global microbiome. We therefore need to tackle inappropriate antibiotic use in both humans and animals, as the public (and animal) health risks from resistant infections are real and increasing. Bacteria are not worried about borders, and many are not fussy about which species they live in or on.

Health psychology has an important role to play in tackling this issue – in both humans and animals. Antibiotic resistance threatens both current medical practice and our future food security. My research will provide insight into factors that drive inappropriate antibiotic use in farming, and should inform future interventions to reduce unnecessary prescriptions. Talking to vets and farmers is fascinating. Farming is a whole new world to me, and I’m learning so much. But can I advise on the behaviour of a moo-dy cow? Not a chance!

 

Fri, 16/06/2017 - 13:12

Sam Cockle, PhD Researcher & Trainee Health Psychologist (University of Surrey)

I think most psychology researchers will identify with the challenges involved in recruiting research participants.  However, recruiting participants when the research topic is sensitive poses particular challenges. My own research explores expectations of cancer treatment where there is a real need to balance the need for advert visibility and recruiting participants, with the ethical and moral duty to act with compassion and tact. I need at least 200 participants to validate my newly developed measure of the expectations of cancer treatment.  I’m an optimist, so I thought to myself that although it would be a challenge, I just needed to work at it and I would get the numbers I needed.  The NHS oncology centre staff I had been working with acknowledged that was a lot of participants, but thought that it should be viable. So far so good.

I embarked with positivity through what was a lengthy ethics processes (that’s another story!) until months later I finally had all the necessary approvals. By this point I had been constrained by what staff at the clinic and the ethics committee thought would be appropriate; as an outsider to the oncology centre and to patients’ usual care team, I wouldn’t be allowed to approach patients directly since patients are already encountering lots of new people where another face amongst the many may not be appropriate.  Furthermore, management staff had concerns about the additional workload placed on an already pressured NHS teams to advertise the study.

This has meant taking a very passive approach to advertising my study through adverts and posters in the oncology centre.  As such, there has been little engagement with the study with only one participant recruited since December. So, I took to Plan B, which is to advertise on social media (shameless plug to my research here. Please share!).  This is perhaps not the most ideal method since cancer is more common in older people who may be less likely to use social media.  Recruitment is going far better than in the oncology centre but it is still slower than expected; big pictures and catchy adverts may be good at getting people’s attention on social media but might not be appropriate given the sensitive subject matter.

Although I completely understand some of the ethical concerns in recruiting NHS patients for research purposes, I feel that if recruitment is restricted so much that research becomes unviable, we could be limiting how good best practice is. Where are we left as researchers in health psychology if we cannot recruit effectively? I would be really interested to hear about other people’s experiences of recruiting in this area, or any other where there may be greater sensitivity involved. If anyone has advice I’d be glad to hear it!

Tue, 30/05/2017 - 11:53

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

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