Health Psychology & Behaviour Change Cheat Sheet

Health psychology applies psychological science to understand and improve health, illness, and healthcare by examining the interplay of biological, psychological, and social factors, and by developing effective strategies for health promotion and behaviour change.

Core Principles

The biopsychosocial model integrates biological, psychological, and social factors to understand health, contrasting with the purely biological biomedical model.
Health promotion focuses on enabling people to increase control over and improve their health, encompassing policy, environments, community action, personal skills, and service reorientation.
Health behaviour theories (e.g., HBM, SCT, TPB, PMT, TTM) aim to explain, predict, and design interventions for health behaviours, addressing the intention-behaviour gap.
Dual-process models distinguish between reflective (deliberate) and impulsive/automatic systems, highlighting that most daily health behaviours are driven by the automatic system.
Effective behaviour change interventions must address multiple levels, including individual determinants, environmental factors, and policy, often integrating various Behaviour Change Techniques (BCTs).
Stress is transactional, arising from the appraisal of demands versus resources, with chronic stress leading to allostatic load and negative health consequences.
Coping strategies (problem-focused, emotion-focused, avoidant) are context-dependent and effortful, with 'goodness-of-fit' being crucial for effectiveness.
The 'Big Four' health behaviours (tobacco, diet, physical activity, alcohol) account for a large proportion of preventable mortality, and changing them involves overcoming numerous barriers.

Action Steps

Define health psychology and distinguish it from related disciplines by understanding its focus on psychological and behavioural processes in health, illness, and healthcare.
Apply the biopsychosocial model to understand health, recognizing the interaction of biological (genetics, physiology), psychological (beliefs, emotions), and social (support, culture) factors.
Utilize health behaviour models like the Health Belief Model (HBM) or Social Cognitive Theory (SCT) to identify targets for intervention, such as perceived susceptibility, self-efficacy, or outcome expectations.
Implement 'if-then' plans (implementation intentions) to bridge the intention-behaviour gap by specifying when and where a behaviour will be performed.
Design interventions using the Behaviour Change Wheel (BCW) framework, which links the COM-B model (Capability, Opportunity, Motivation, Behaviour) to intervention functions and policy categories.
Measure stress using multi-method approaches, combining self-report measures (e.g., PSS-10) with physiological measures (e.g., cortisol, heart rate variability) for a comprehensive understanding.
Select appropriate coping strategies based on the controllability of the stressor: problem-focused for controllable stressors and emotion-focused for uncontrollable ones.
Address the 'Big Four' health behaviours (tobacco, diet, physical activity, alcohol) through multi-level interventions that consider environmental influences, policy, and automatic processes, not just individual knowledge.

Key Terms

Health Psychology: The study of psychological and behavioural processes in health, illness, and healthcare, aiming to promote health, prevent illness, and improve healthcare systems.
Biopsychosocial Model: A model that integrates biological, psychological, and social factors to understand health and illness, contrasting with the biomedical model.
Health Promotion: The process of enabling people to increase control over, and to improve, their health, as defined by the WHO Ottawa Charter.
Intention-Behaviour Gap: The discrepancy between people's intentions to behave healthily and their actual follow-through behaviour.
Dual-Process Models: Models that distinguish between a reflective (deliberate, controlled) system and an impulsive/automatic (fast, effortless) system that influence behaviour.
COM-B Model: A framework identifying Capability, Opportunity, and Motivation as necessary conditions for behaviour, serving as a diagnostic tool for intervention design.
Behaviour Change Wheel (BCW): A systematic framework that links the COM-B model to intervention functions and policy categories for designing effective behaviour change interventions.
Stress as Transaction: Lazarus & Folkman's view that stress arises from the person-environment relationship, involving primary appraisal (threat assessment) and secondary appraisal (resource assessment).
Allostatic Load: The cumulative physiological toll of repeated stress, representing the 'wear and tear' on the body from chronic overactivation or inadequate shutdown of stress systems.
Coping: Constantly changing cognitive and behavioural efforts to manage specific external and/or internal demands appraised as taxing or exceeding resources.
Behaviour Change Technique (BCT): An observable, replicable, and irreducible component designed to alter causal processes that regulate behaviour; the 'active ingredient' of an intervention.

Pro Tips

When designing interventions, remember that 'no single theory is sufficient'; effective health promotion draws on multiple models targeting both motivation and volition.
For behaviour change, focus on 'nudges' and 'choice architecture' that alter environments to make the healthy choice the easy choice, leveraging automatic processes.
Recognize that relapse is the norm, not the exception, in behaviour change; maintenance requires ongoing support, coping planning, social support, and environmental management.
When measuring stress, remember that self-report captures perceived stress (aligning with the transactional model), while physiological measures capture biological activation; multi-method approaches are strongest.

Pitfalls to Avoid

Interventions targeting only the reflective process often fail because most daily health behaviours are driven by the impulsive/automatic system.
Assuming individual-level approaches alone are sufficient for behaviour change; environments must be redesigned to support healthy defaults.
Ignoring the intention-behaviour gap; interventions must bridge intention and action through planning, environmental support, and habit formation.
Using single studies as definitive evidence; systematic reviews and meta-analyses provide stronger foundations for practice.
Failing to match coping strategy to the situation; problem-focused coping is most effective when the stressor is controllable, while emotion-focused is useful when it is not.

Real World Examples

A person intends to exercise more but fails to follow through.: This illustrates the intention-behaviour gap, which can be addressed using implementation intentions ('If it is 7 am on Monday, then I will go to the gym') or environmental restructuring (e.g., placing workout clothes by the bed).
An individual experiences high job demands with low control.: This situation, according to Karasek's Demand-Control Model, leads to job strain and elevated stress, highlighting the need for interventions that increase decision latitude or social support.
Public health campaigns aim to reduce smoking rates.: Effective strategies include policy changes like plain packaging and tax increases (environmental restructuring), alongside education and persuasion BCTs, recognizing that individual-level education alone is insufficient.

Timeline

Pre-1970s: Biomedical model dominated health understanding, with disease understood purely in biological terms.
1977: George Engel proposed the biopsychosocial model, integrating biology, psychology, and social factors.
1978: The APA established Division 38 (Health Psychology), marking institutional recognition of the field.
1980-Now: Rapid growth in health psychology research, training programmes, and clinical applications worldwide.
1983: Prochaska & DiClemente developed the Transtheoretical Model (Stages of Change).
1991: Ajzen proposed the Theory of Planned Behaviour (TPB), focusing on determinants of behavioural intention.
1998: McEwen introduced the concept of Allostatic Load to capture the cumulative physiological toll of repeated stress.
2011: Michie et al. developed the Behaviour Change Wheel (BCW) framework.

People

George Engel: Proposed the biopsychosocial model.
Albert Bandura: Key figure in Social Cognitive Theory, emphasizing self-efficacy.
Icek Ajzen: Developed the Theory of Planned Behaviour (TPB).
Prochaska & DiClemente: Developed the Transtheoretical Model (Stages of Change).
Lazarus & Folkman: Developed the transactional model of stress and coping.
McEwen: Introduced the concept of Allostatic Load.
Michie et al.: Developed the Behaviour Change Wheel (BCW).
Thaler & Sunstein: Pioneers in 'nudge' theory and choice architecture.