Health Promotion International, Vol. 14, No. 1, 94-96,
March 1999
© Oxford University Press 1999
Resource Reviews |
Psychology and Health Promotion
Paul Bennett and Simon Murphy (eds) Health Psychology Series. Open University Press, Bucks (UK) 1997, £14.99 paperback. isbn 0335 197655; £45.00 hardback. isbn 0335 197665.
Faculty of Social Sciences and Health Studies, University College of Ripon and York St John, York, UK This is a welcome and useful text. It provides a lively outline of the relationship between psychology and health promotion, and moves a step beyond the well established introductory level market. Clearly, targeted towards an insightful audience (advanced undergraduates, health promotion specialists, etc.) its approach is economic but accomplished, and provides a relevant synthesis of policy, theory and practice.
The development of the biopsychosocial model in psychology has refined our understanding of the complex and sometimes contradictory nature of human behaviour. Health and illness can be considered from different perspectives and different systems, and at different levels of organization. Social systems such as culture and family are as significant, for example, as cognitive, motivational and emotional aspects of psychology. Likewise, our biological system continually adjusts to accommodate our external, physical and psychological state.
Part of the defining qualities of health psychology, for example, are attempts to integrate educational and scientific contributions both to the promotion and maintenance of health and the prevention and treatment of illness. Interests range from the micro (e.g. the effects on the immune system resulting from stress) to the macro (e.g. culture, ethnicity and society).
Those with a background or interest in health promotion will most likely recognize some of the psychological contributions in the book. The Yale model of communication, the effects of fear appeals, the relationship between self-efficacy and health status, decision-making and behavioural change models, causes and effects of stress are among those discussed. Until now, however, any attempt at deriving a well organized synthesis of the role of psychological theory in relation to health promotion has not been particularly easy.
Organized in four sections, the book allows the reader to dip in at any point. Taken in sequence, these sections discuss: mediators of health and health behaviours, facilitating individual change, population change, and lastly, future considerations.
The opening section begins with a broad-brush critique over influential social and environmental variables. Depending on your perspective, the sheer density of statistics and supporting references, will either distract from the flow and readability, or provide a rich source of data. Thereafter, and from my perspective, the book becomes rather more accessible. Key experiments and developments within psychology are described and we are taken on a rapid-paced journey through classical, operant and social learning theories. Examples of the application of principles deriving from these theories are then outlined. Health locus of control, the health belief model, reasoned action and planned behaviour; stage theories, risk prevention and dispositional optimism and a critique of cognitive models are all contained within a few pages. From this description it is possible to infer the scope of the book.
While depth may be lacking, what results is a skilfully managed approach of open-minded scepticism. The reader is eased through a complex array of cognitive, social and environmental processes. To my mind this works well and results in a confident, honest and clear exposition of the strengths and limitations of psychological knowledge.
Facilitating population change requires an appreciation of the relationship between public policy and health promotion. To this end a profile of environmental initiatives is presented. Thematically, the attempt is to show how psychological theory informs strategies for health enhancement and the prevention of health damaging behaviours. Consideration is given, for example, to the effects of taxation, advertising and legislation. Topical issues such as the promise of peer-led interventions are discussed. Whether the conceptual links between psychology and policy are as easy for the non-psychologist to grasp is a moot point, but the framework for comprehension is clear, with suggestions for further reading.
Media usage is the bread and butter of health promotion. Despite this, the success of media campaigns can best be described as varied. Evaluating strategy within the context of theory enables the authors to consider likely reasons for successes or failures. The authors conclude that mass campaigns probably need to give way to more refined and targeted messages. Understanding the process of message dissemination and interpretation is needed, but theoretical frameworks are suggested which could help facilitate this process. Motivating then maintaining change presents different challenges. As suggested, it may be timely to consider interventions that entail structural as well as individual behavioural outcomes.
Finally, we are invited to reflect on the purpose of health promotion. Distinctly separate theories are argued to be unrealistic and lacking in cohesion. To their credit, the authors willingly engage with a variety of theoretical perspectives and working models, in their attempt to find a means to embrace individual, family and societal complexities. The importance of the way we conceptualize health promotion is reflected in the way we measure health status. The authors argue that until techniques are developed which enable an examination of perceptions of health in social contexts, outcome measures will remain flawed. Moreover, promoting health through partnership, rather than imposition, needs to be taken seriously and integrated into future planning and promotion strategies.
Overall, this book represents good value for money. Its extensive bibliography reflects an approach that is predominantly theoretical, but framed within a context which highlights the relationship of theory to practice. Health promotion is more that psychology, but the explicit relationship is authoritatively documented and beneficial.
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