Health Psychology. Michael Murray
when developing and implementing HIV education programmes in the region. (Further discussion on community-based health promotion and education on HIV can be found in Chapter 22.)
Although cultural beliefs play a crucial role in shaping health behaviour, it is important to recognize the social and structural barriers that impact upon people’s ability to utilize health education and services. For example, Lim and Ojo (2017) explored the barriers preventing women from utilizing cervical screening services in sub-Saharan Africa. Findings from this systematic review suggest that despite cultural and linguistic diversity in the region, participants reported similar barriers, such as fear of the procedure and the possibility of a negative outcome, lack of awareness, embarrassment and stigma, lack of spousal support, and other factors such as cost of accessing the service, travel costs, waiting times and negative staff attitudes. Similarly, Skinner and Claassens (2016) explored the factors that influenced initiation and adherence to tuberculosis treatment in South Africa. Poor knowledge, lack of awareness and stigma around tuberculosis and its connection to HIV were raised as key issues. Structural factors such as poverty, lack of access to transport, the need to continue working, and problems related to the poor functioning of health systems were also raised as major constraints to long-term adherence.
Popular Views of Health
Evidence from a series of studies of popular beliefs about health and illness in Western society illustrates the interaction of what can be described as the ‘classic’, the ‘religious’, the ‘biomedical’ and the ‘lifestyle’ approaches to health and illness. Probably the most influential study of Western lay health beliefs was carried out by Herzlich (1973, 2017). She conducted interviews with a sample of French adults and concluded that health was conceived as an attribute of the individual – a state of harmony or balance. Illness was attributed to outside forces in our society or way of life. Lay people also referred to illness in terms of both organic and psychosocial factors. On their own, organic changes did not constitute illness. Rather, for the layperson, ‘physical facts, symptoms and dysfunctions have, of course, an existence of their own, but they only combine to form an illness in so far as they transform a patient’s life’. The ability to participate in everyday life constitutes health, whereas inactivity is considered the true criterion of illness. Herzlich’s study was seminal because it provoked further research into popular health beliefs.
Blaxter (1990) analysed the definitions of health provided by over 9,000 British adults in a health and lifestyle survey. She classified the responses into nine categories:
1 Health as not-ill (the absence of physical symptoms).
2 Health despite disease.
3 Health as reserve (the presence of personal resources).
4 Health as behaviour (the extent of healthy behaviour).
5 Health as physical fitness.
6 Health as vitality.
7 Health as psychosocial well-being.
8 Health as social relationships.
9 Health as function.
In analysing the responses across social classes, Blaxter (1990) noted considerable agreement in the emphasis on behavioural factors as a cause of illness. She commented on the limited reference to structural or environmental factors, especially among those from working-class backgrounds.
However, health beliefs go beyond descriptive dimensions to consider underlying aetiology. In a discussion of social representation theory, Moscovici (1984) suggested that people rarely confine their definition of concepts to the descriptive level. Rather, lay descriptions often include reference to explanations. Lay perceptions of health and illness can be rooted in the social experience of people, in particular sub-cultures. A study of East and West German workers found similar findings to those of Herzlich, but with an added emphasis on health as lifestyle (Flick, 1998). Similarly, in a study of Canadian baby-boomers, Murray et al. (2003) found a very activity-oriented conception of health. In another study, Campbell (2015) explored the meaning of health among older adults in the United Arab Emirates. The narratives suggest that health was embedded in culture and represented as something that is valuable and coming from God. Health was also attributed to the food they eat and was generally perceived to be better in the past.
Complementary and Alternative Medicine
The biomedical perspective has come to a position of dominance throughout the world, reflecting ‘globalization’ more generally. Alternative health care systems tend to be disparaged and marginalized by advocates of biomedicine. Based on a positivist, reductionist perspective, practitioners of biomedicine believe that the material existence of medical science is independent of any patient’s psychological search for meaning, understanding and control. As such, alternative perspectives are seen as basically flawed. In spite of this resistance from orthodoxy, alternative professional systems of health care continue to exist in large parts of the world, especially in Asia. As migrants have moved to other countries they have taken their health beliefs with them. In the major Western metropolitan centres, the availability of health care systems other than biomedicine is extensive. This has fed back into Western ways of thinking about health and illness, especially among those who are disenchanted with biomedicine. Increasingly, complementary and alternative medicine (CAM) is gaining popularity and respectability in Western health care. CAM encompasses all health systems and practices other than those of the established health system of a society.
In the USA, the National Center for Complementary and Alternative Medicine (NCCAM, 2013) categorizes CAM into two sub-groups: (1) natural products and (2) mind and body practices. Natural products often include the use of herbs, vitamins, minerals and probiotics. These products are marketed widely and are commonly sold as dietary supplements. Mind and body practices cover a diverse range of procedures that are often administered by a trained practitioner. Examples include acupuncture, massage therapy, meditation techniques, movement therapies (e.g., Feldenkrais method, Alexander technique, Pilates), relaxation techniques, spinal manipulation, tai chi, qi gong, reiki and hypnotherapy.
Harris et al. (2012) reviewed the 12-month prevalence of CAM use by the general public. They reviewed 51 published reports from 49 surveys in 15 countries. Estimates of CAM use ranged from 9.8% to 76%, and from 1.8% to 48.7% for visits to CAM practitioners. In surveys using consistent measurement methods, CAM rates have been stable, particularly in Australia (49% in 1993, 52% in 2000 and 52% in 2004) and in the USA (36% in 2002 and 38% in 2007). The three highest rates of CAM use in this systematic review were reported in Japan (76%), South Korea (75%) and Malaysia (56%). Posadzki et al. (2013a) conducted a systematic review to examine the prevalence of CAM use among patients in the UK. The review included 89 surveys, with a total of 97,222 participants between January 2000 and October 2011. Findings showed that the average one-year prevalence of CAM use was 41.1%, while the average lifetime prevalence was 51.8%. Herbal medicine was the most popular CAM, followed by homeopathy and aromatherapy.
Herbal medicine
Herbal medicine involves the use of plants and plant extracts to treat illnesses or to promote well-being. This practice has been used for thousands of years, with the first recorded use in China in 2800 bc (Brown, 2007). It is believed that this practice was derived from the Ayurvedic tradition and then later adopted by the Chinese, Greeks and Romans. With the growth of the pharmaceutical industry, herbal medicine can now be produced and marketed on a massive scale. In the UK, about one in three adults takes herbal medicine (Posadzki et al., 2013b), while in the USA it is about 20% (Bent, 2008). Some of the most commonly used herbal products, and their purpose, efficacy and risks, are summarized in Table 6.1.
Table 6.1
Source: Adapted from Bent (2008: 856)
Data sources: † Rotblatt and Ziment (2002), Fugh-Berman (2003) and Ulbricht and Basch (2005);