This essay will explore the success of health promotion in providing individuals with information that either changes their health behaviours or prevents them from developing health behaviours that may put them at risk of experiencing negative health outcomes in the future.
The Cancer Research UK leaflet will be reviewed and evaluated within this essay as well as the campaigns that have been run in the attempt to address the rising numbers of individuals who suffer from skin cancer in the UK will be investigated, while skin cancer does not account for the majority of cancer-related deaths, it is the most common form of cancer. The leaflet Cancer Research UK, (2009), states “Being Sun Smart can reduce your cancer risk” and this leaflet has been distributed to GP surgeries, schools, colleges, hospitals and also online.
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Health behaviour has been defined by Kasl and Cobb (1966) as ‘any activity undertaken by a person believing his self to be healthy for the purpose of preventing disease or detecting it at an asymptomatic stage’. According to the World Health Organisation, (1948) health is ‘a complete state of physical, mental and social well-being and not merely the absence of disease or infirmity’. Whilst Medics would define health as the absence of disease, illness and injury and the social scientist state, it is the ability to function in a normal social role (cited in Albery and Munafo 2007).
The social cognitive theory looks at cognitive processes of beliefs and attitudes in relation to individuals making decisions of their health, whilst self efficacy looks at an inviduaulas self belief of their ability to control health behaviours, some of the other theories are health belief model, protection motivation theory, unrealistic optimism and habit (Albery and Munafo 2007).
Health psychology is the academic discipline that aims to identify psychological processes in the experience of health and illness looking closely at the causes of health and illness as well as the consequences. Psychologists are interested in the factors involved in acceptance, change adaptive or maladaptive response to health behaviour (Albery and Munafo 2007).
Skin cancer caused by overexposure to the sun is a topic most vastly spoken of in health promotions especially in regards to how people should protect them-selves from the disease. The ultra-violet type B (UVB) in sunlight damages the DNA in the skin cells, this damage could occur before cancer develops (Cancer Research UK, 2009). There are two types of cancer, non melanoma skin cancer – basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), a history of sunburn or leisure exposure to sunlight increases the risk of BCC, risk is particularly high when individuals in childhood have had over exposure to the sun (Research UK, 2009). The risk of SCC is related to sun experience during the period of an individual’s life, this could also result in people who work outdoors such as farm workers, gardeners and building site workers having an increased risk (Research UK, 2009).
Rogers, Weinstock, Narris, Hinckley, Feldman, Fleischer and Coldiron, (2010) research study revealed that UVB is the key risk for skin cancer, Ultraviolet Light (UVA) generated in sun beds causes damage to the skin and there is growing evidence that UVA possibly causes skin cancer their research found that sun beds could increase the risk of non melanoma skin cancer and a strong link was found relating to sun beds and squamous cell skin cancer.
In the UK, 84,500 non-melanoma skin cancers were recorded in 2007 even though other studies have shown that approximately at least 100,000 cases are diagnosed every year (Rogers et al, 2010). According to the British Association of Dermatologists children, from 0 to 14 years, and teenagers, from 15 to 19 years, show the most rates of skin cancers of any European country. Besides this the number of melanoma raised four times in UK teenagers from 1978 to 1997 and Australia has the highest rate of skin cancer diagnosis in the world, approximately four times the rates recorded in the United States, the UK and Canada (Rogers et al, 2010).
The aims and objective of the leaflet is for people to be sun-smart, the leaflet calls attention to the risk of dangerous daily sun exposure and recommends sun protection to be made a daily habit, for individuals and their families by becoming aware that too much sun exposure can lead to damage or cause skin damage. Thus when individuals are being sun smart they prevent themselves from skin diseases, by means of gaining knowledge through health promotions of skin cancer, people are more likely to reduce their risk of getting skin cancer.
Rosenstock’s (1974) health belief model (HBM) provides evidence in how individuals cognitively signify the part of their behaviour that is more important for predicting self-protective health behaviour. HBM was formerly developed by Rosenstock, (1974) and combined by Becke, Drachman, & Kirscht, (1974); the HBM was created for description of the part of belief-based psychological issue in health-related decision making and health behaviour. Jackson and Aiken (2006) conducted a study on appearance-based sun-protective intervention for young women; the study included the women approving paleness image norms of female media figures and fashion models, women were shown these images as well as the advantages tanning carries, health beliefs of photo-aging and skin cancer and self efficacy for sun protection results showed an instant raise in sun protective awareness, the tendency to be emotionally affected if not protected, benefit and intention for protection was high and reduced inclination to sunbathe and few hours sunbathing.
Jackson and Aiken findings are reliable with previous research targeting advantages of tanning (Hill et al., 1993; Hillhouse & Turrisi, 2002; Jones & Leary, 1994) and past study which aims more at personal threat of photo-aging (Mahler et al., 2003). Mermelstein & Reisenberg, (1992); Miller et al., (1990); Rodrigue, (1996) suggested that earlier sun protective usage maintains the function of health beliefs in sun protection, their study supported Ronis’s (1992) who argued that apparent vulnerability to severity of a health threat is necessary in order for health behaviours to be undertaken. However, the message in the leaflets has not such threaten message that could make someone to undertaken healthy behaviour.
The leaflets main target group is families, but the leaflet should also be developed to take into account different groups of users as it mentions those most at risk, such as fair skin people who are more likely to get sun burn, red or fair hair people, people with lots of moles or freckles, individuals or family history of skin cancer and a history of sunburn, but the presentation of the leaflet being more family orientated due to the pictures it employs seems as if it is more directed to appeal to families, but the fact that the people most at risk that it notes do not only fall under the family target group, this leaflet should also be made to appeal to the general public as well as young single people who may love sun bathing but have the hair and skin colour that may put them at risk and individuals who may have skin conditions that put them at risk (Rogers, et al. 2010).
Rogers, et al. (2010) study found individuals with pale skin, coloured eyes and hair are more likely to get burn than tan, and have a higher risk of sun damage than dark skinned people, in addition Albinism people also have high risk of sun damage, due to albinism being an innate genetic form in which the skin creates no melanin at all. Albino individuals have extremely white skins and pale blonde hair which puts them at greater risk than any normal individual to getting skin cancer as their skin has no natural protection against the sun. These people should be more informed on how to prevent themselves from skin disease caused by over exposure to the sun. One way of them being informed is by implementation intention, which will help them to plan and take action about their health more importantly.
Gollwitzer, (1993) states that implementation intentions are formed when a response is recognised by an individual which leads to the achievement or successful completion of the goal whilst also identifying situations where this response can be successfully applied, people then plan possible ways of how to undertake behaviours.
Studies have shown and established that the configuration of an implementation intention have the outcome of making the prospect that somebody will undertake behaviours, and put into practice their goal intentions when a situation arises, considerably better then with control subjects (Koestner et al., 2002; Sheeran, 2002). Through this way people that are more at risk will use this method of information to change their health, because the threat is more convincing and so it will result high self efficacy increase the probability of adaptive behaviour being undertake.
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The leaflet takes into account peoples different perceptions of their likely hood of getting skin damage due to overexposure to the sun as it provides information of types of people most at risk, times of the day exposure is more damaging, the adverse affects of using sun beds, the need to report any unusual changes in the skin that people may ignore, the fact that sunscreen alone is not enough protection to use as a means to stay in the sun for long periods. In addition the language used were every straightforward for anybody to understand, but persuasive communication may have not evokes fear for individuals to adapt behaviour change.
Weinstein (1982) emphasized that the motive for people’s persistence practise of unhealthy behaviours is due to incorrect perceptions of risk and susceptibility with their unrealistic optimism. In another words people believe that nothing bad will happen to them so they fall short of doing something. Weinstein (1982) conducted a study where participants had to compare their probability of experiencing different forms of health problems presented to them to their peer’s probability of getting them. The findings indicated majority of the participants assumed that they were less likely to get health problems, which Weinstein (1982) implied was due to the phenomenon of unrealistic optimism, Weinstein (1987) explained four cognitive aspects that add to unrealistic optimism; lack of personal experience with the problem, the conviction that the problem is avoidable by protective action, the conviction that if the crisis has not yet become visible, it will not emerge in the future, and the belief that the dilemma is infrequent, all these factors show that individuals perception of risks is not a rational process.
Ouellette and Wood, (1998) state why some people might undertake health behaviours and others not may be put down to habits, this consists of repetitive behaviours conducted in similar environmental situation where people consistently undertake certain behaviours without consciously thinking or planning them. Also Verplanken, (2005) stated that when a behaviour becomes a habit or habitual in nature it is the most excellent predictor of future behaviour. Verplanken and Aart (1999) defined habits as ‘learned sequences of acts that have become automatic responses to specific cues, and are functional in obtaining certain goals and end-states (cited in Albery and Munafo 2007).
The information in the leaflet takes into account threatening messages can lead to change in behaviour, for example the leaflet states take extra care with children, young skin is delicate and it also highlights skin cancer is very common in the UK. Self-affirmation studies have shown people lessen the tendency to refuse to accept threat information, Narris and Napper (2005) carried out a study using information on alcohol, smoking and breast cancer in young women. The finding revealed that participants who had self affirmed were more knowledgeable of the health message to change their behaviour, moreover the precaution adoption process model (PAPM) has discovered how people take decision to undertake health protective action into behaviour (Albery and Munafo 2007).
PAPM develops in stages from individuals making decision which they are unaware of the health threats, to engaging in behaviours that maintain the removal of the threat. People usually compare themselves with others even when they know the health risk (Conner and Norman 2009). For example individual who smoke may have a belief that they have a reduced risk of disease because they do not smoke as much as other stereotypical smoker by relative assessment of other from themselves (Weinstein and Sandman 2002). Beck and Lund (1981) study on protection motivation theory (PMT) manipulated dental students’ viewpoint about tooth decay using persuasive communication, their findings showed that the knowledge that they have raised fear of the severity tooth decay terrible costs, their self-efficacy was associated to behavioural intentions.
5) How can leaflet be improved to take account of your critical evaluation?
In conclusion the leaflet can be improved by taking into account individuals more at risk of getting cancer, for example fair skin individuals that tends to get more burned in the sun are at greater risk than any other group and young adults should be focused on as well. The leaflet was more focused on families and children; however the leaflet on a whole, is very informative about cancer and were to go for more information. By implementing and improving the leaflet which could be done through using protection motivation theory (Rogers, 1975), PMT is famous and most practiced form of modern health psychology in individuals attitudes and consequently their behaviour, this can be done with fear appeal, through persuasive communication with the role of threat and fear experience of things that individuals have knowledge of, their attitude will be changed and belief acceptance. Also with the individual self-efficacy belief in his or her ability to succeed in this particular situation, their response could be a defence mechanism of self-protection which can decrease the health threat or a high level of efficacy which means their behaviour may change.
Norman, Boer and Seydel, (2005) studies on (PMT) has shown to be very effective in predicting health-related cognitions and behaviour for example, breast self-examination, smoking, and sexual risk behaviours how it helps individuals to be motivated to take self protective action toward their health when been threaten with their life. Rippetoe and Rogers (1987) presented women with information regarding breast cancer and looked at the outcome of this information on the mechanism of the PMT and their association to the women’s intentions to carry out breast self-examination (BSE). Their finding showed that the most excellent predictors of intentions to pursue BSE is the response efficiency, participants considered that BSE could help them establish cancer early on, participants severity in thinking that Breast cancer is unsafe and complicated to treat in its highly developed stages and self-efficacy, (belief in one’s ability ) caused participants to carry out BSE effectively.
Nevertheless, there is limitation with this study although PMT is less criticized then the HBM, still other criticisms of HBM is connected to the PMT. The PMT believes people are based on reason information processors, but it does not take into account some part of illogicality in fear factor. Also it does not provide a description for habitual behaviours. Schwarzer (1992) disapproved of the PMT for not undertaking how attitudes could change.
PAPM offers several contributions to health psychology; it proposes a range of explanations tailored for each stage. PAPM only simply needs a particular question to measure a person’s stage thus its development is appropriate for application for individual as well as group situations (Weinstein & Sandman, 2002). PAPM is a useful model for explaining any alteration or modification of individuals behaviour, these kind of changes can happen deliberately, with no intention, or change quickly in circumstances of mental illness (Weinstein & Sandman, 2002).
However PAPM has some limitation to the model, predominantly to health behaviours it has not been tested mostly, also mainly the empirical evidence is limited to limited behaviours. The model does not provide itself easily to actions that need slow growth of behaviour like diet or exercise (Weinstein & Sandman, 2002). Other weakness with PAPM is that it makes equivalents to every stage of the model that need to be tailored for succession, beside the stages are not described well. Lastly, the stage on interventions is very expensive and resource demanding once measured up to a standard intervention it is geared towards the entire population.
The HBM has some limitation as well; it is very particular on the conscious processing of information, but ignores emotional issue such as fear and denial and it has been recommended that substitute factors probably will predict health behaviour, like outcome expectancy and self-ef¬cacy Seydel, Taal, & Wiegman, 1990; Schwarzer (1992). Also Schwarzer (1992) has further criticized the HBM for its static approach to health beliefs and suggests that within the HBM, beliefs are described as going on simultaneously with no space for change, and development or process.
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