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Health Cognitions Bill Klein Department of Psychology University of Pittsburgh Pittsburgh Mind-Body Center Summer Institute June 5, 2008. Outline. Health Cognitions and Physical Health Health Cognitions Attitudes and knowledge Social cognitions Perceived vulnerability

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Outline

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  1. Health CognitionsBill KleinDepartment of PsychologyUniversity of PittsburghPittsburgh Mind-Body CenterSummer InstituteJune 5, 2008

  2. Outline • Health Cognitions and Physical Health • Health Cognitions • Attitudes and knowledge • Social cognitions • Perceived vulnerability • Perceived control/efficacy • Behavioral intentions • Mental representations of illness • Attribution and blame

  3. Cognitions and Behavior • Leading causes of death are behavioral (e.g., smoking, alcohol use, nutrition, high risk sex) • Need to understand cognitions that underlie these behaviors in order to change them • Health Behavior Models • Theory of Planned Behavior (Ajzen & Madden, 1986) • Health Belief Model (Janz & Becker, 1984) • Protection Motivation Theory (Rogers, 1983) • Stage Models: Transtheoretical Model (Prochaska, DiClemente, & Norcross, 1992); Precaution Adoption Process Model (Weinstein et al., 1998)

  4. Theory of Planned Behavior Attitudes Intentions Behavior Subjective Norms PBC

  5. Problems with Models • Cross-sectional • Role of environmental constraints and temptations • Past behavior • Interactions and paths often not specified

  6. Attitudes and Knowledge • Knowledge • Perceived costs and benefits • Framing health messages (Rothman & Salovey, 1997) • Affective orientation toward behavior • Cognitive dissonance • Induced hypocrisy (Stone et al., 1994) • Defensive processing of health messages • Fear appeals (Hovland et al., 1953) • Perceived threat (Croyle et al., 1993) • Perceived credibility (Liberman & Chaiken, 1992) • Self-affirmation (Sherman et al., 2000)

  7. Social Cognitions • Subjective norms • Injunctive vs. descriptive norms • Perceived prevalence/social comparison • False consensus and false uniqueness (Suls et al., 1988) • Norm misperception (Prentice & Miller, 1993) • Threatening social comparisons (Klein & Kunda, 1993) • Prototype perception • Adolescent prototypes (Gibbons et al., 1998) • Stereotypes (Weinstein, 1980) • Self-presentation • Appearance vs. health (Mahler et al., 2003)

  8. Perceived Vulnerability I • Conceptualization • Perceived risk (absolute and comparative), perceived probability, perceived likelihood, unrealistic optimism • Role of affect (e.g., “feeling at risk” and regret) • Lay problems with risk estimation • Use of probability (e.g., small vs. large, 50/50 ≠ 50%)

  9. Perceived Risk of Breast Cancer (Lipkus, Klein, Skinner, & Rimer, 2005)

  10. Perceived Vulnerability I • Conceptualization • Perceived risk (absolute and comparative), perceived probability, perceived likelihood, unrealistic optimism • Role of affect (e.g., “feeling at risk” and regret) • Lay problems with risk estimation • Use of probability (e.g., small vs. large, 50/50 ≠ 50%) • Use of heuristics (availability heuristic, base rate fallacy)

  11. Illusory Correlation

  12. Perceived Vulnerability I • Conceptualization • Perceived risk (absolute and comparative), perceived probability, perceived likelihood, unrealistic optimism • Role of affect (e.g., “feeling at risk” and regret) • Lay problems with risk estimation • Use of probability (e.g., small vs. large, 50/50 ≠ 50%) • Use of heuristics (availability heuristic, base rate fallacy) • Matching percentages to labels

  13. EC Verbal Labels (Berry, Raynor, & Knapp, 2006)

  14. EC Verbal Labels (Berry, Raynor, & Knapp, 2006)

  15. Perceived Vulnerability II • Relation to health outcomes • Mammography (McCaul et al., 1996): r = .16 across samples; r = .33 among women with a family history • Condom use (Gerrard et al., 1996) • Processing health information (Radcliffe & Klein, 2002) • Methodological concerns (Weinstein et al., 1998)

  16. Perceived Control/Efficacy • Control perceptions (Langer & Rodin, 1977) • Self-efficacy (Bandura, 1977) • Response efficacy (Rogers, 1983) • Perceived behavioral control (Ajzen, 1991) • Health locus of control (Wallston, 1992) • Biases in control perceptions • Illusion of control (Langer, 1975) • Comparative perceptions (Klein & Kunda, 1994)

  17. Drug Problem Imagine you are making a choice between the following two drug treatments for reducing heart attack risk: Drug A has lung-related side effects 1 out of every 100,000 times. However, when these side effects occur, they are instantly fatal. Overall, then, there is a 1 in 100,000 chance of a fatality if you take this drug. Drug B has lung-related side effects 4 out of every 100,000 times. However, when they occur, there are measures you can take to avoid becoming a fatality. The side effects lead to death about 50% of the time. Overall, then, there is a 2 in 100,000 chance of a fatality. Which drug do you prefer? ________ Klein & Kunda, 1994

  18. Behavioral Intentions • Intentions (Ajzen & Madden, 1986) • Protection motivation (Rogers, 1983) • Willingness (Gibbons et al., 1998) • Contemplation (Prochaska et al., 1992)

  19. Illness Cognition I • Illness Representations (Meyer, Leventhal, & Guttman, 1985) • Cause, consequence, timeline, identity, control • Acute vs. chronic illness • Age differences (Gump et al., 2001) • Unrealistic pessimism regarding coping (Blanton et al., 2001); affective forecasting

  20. Illness Cognition II • Attribution (Seligman, 1975) • Global, stable, internal attributions for negative events associated with earlier illness onset and mortality (e.g., U. S. Presidents, Hall of Fame baseball players) • Characterological blame worse than behavioral blame over time (e.g., Glinder & Compas, 1999) • Counterfactual thinking might promote less adaptive coping (Roese & Olson, 1995)

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