Health Psychology. Michael Murray
or mixed methods data to learn about the thoughts, feelings and lived experiences of the research participants to produce a set of findings that are out of the mould. They argue that the voices of patients are crucially important in the production of new theories and therapies.
Transparency
A key issue in designing and reporting research studies in health psychology is transparency. This refers to the ability to accurately and openly describe in full detail the participants or patient population (P), intervention (I), comparison (C) and outcome (O) (‘PICO’). Above, we have mentioned the CONSORT and TREND guidelines that were designed to improve transparency of the descriptions of interventions. Intervention studies are typically designed to compare one, two or, at most, three treatments with a control condition consisting of standard care, a waiting list control, a placebo, or no treatment.
The standard designs are simple because precious resources must be stretched across a large number of trials. Rarely, if ever, does an intervention include only one technique, with practically all trials including two or more techniques in combination. If an intervention domain such as smoking has, say, 500 techniques, then there would be 2.5 million possible two-technique combinations, 124 million three-technique combinations and 62 billion four-technique combinations! These eye-watering figures may help to explain why replication so often fails. Which specific combination is used in any individual case, and in what order, depends on the subjective choices of the practitioner. Only if the ‘PICO’ description is fully detailed and transparent can an independent investigator have the opportunity to reproduce a replica of the study.
Type I Error
The probability of falsely rejecting an incorrect H0, leading to the false conclusion that there is a statistically significant effect (a false positive). A Type I error is detecting an effect that is not present. At the .05 significance level, the probability of a Type I error is .05. When making multiple statistical tests it is necessary to reduce the risk of a Type I error by using a higher level of significance (e.g., .01, .001, or .0001) or by making a correction such as the Bonferroni.
Type II Error
The probability of falsely retaining an incorrect H0 (a false negative); failing to detect an effect that is present.
Uncontrolled variable
An uncontrolled variable is the bête noire of any research study. This is a background variable that, unknown to the investigator, operates within the research environment to affect the outcome in an uncontrolled manner. As a consequence, the study will contain the risk of producing a false set of findings.
Future Research
1 More studies using qualitative and action research methods will help to broaden the focus on quantitative research in health psychology.
2 More research is needed on the health experiences and behaviour of children, ethnic minority groups, disabled people and older people.
3 The evidence base on the effectiveness of behaviour change interventions needs to be strengthened by larger-scale randomized controlled trials.
4 More extensive collaboration with health economists is needed to carry out cost-effectiveness studies of psychosocial interventions.
Summary
1 The principal research methods of health psychology fall into three categories: quantitative, qualitative and action research.
2 Quantitative research designs emphasize reliable and valid measurement in controlled experiments, trials and surveys.
3 Qualitative methods use interviews, focus groups, narratives, diaries or texts to explore health and illness concepts and experience.
4 Action research enables change processes to feed back into plans for improvement, empowerment and emancipation.
5 A top-down research approach is when a theorist, director or senior professor decides on the nature of the research to be carried out, the research goals, the questions or hypotheses to be investigated, and the methods used. Critics argue that the top-down approach tends to produce confirmation biases and group-thinking, which constrain creativity and innovation.
6 The ‘bottom-up approach’ uses an open-ended approach with qualitative or mixed methods data to learn about the thoughts, feelings and lived experiences of the research participants. The voices of patients and their families are viewed as crucially important in the production of new theories and therapies.
7 A hierarchy of evidence has been proposed which places meta-analyses and systematic reviews at the top of the hierarchy and qualitative research at the bottom. Multiple sources of evidence may be synthesized in systematic reviews and meta-analyses, which is helpful in appraising the state of knowledge in particular fields. However, qualitative methods about lived experience provide a necessary counterweight to descriptive methods that are purely quantitative in nature.
8 Evaluation research to assess the effectiveness of health psychology interventions has generally been too small-scale and of low quality. There is a need for large-scale studies that are methodologically rigorous to evaluate interventions.
9 Interventions need to describe completely, using a taxonomy, so that we can compare and contrast interventions across studies, replicate the intervention in other settings and advance the science of illness prevention by enabling theory testing in the practice of health care.
10 Health psychology has yet to show its full potential by conducting high-quality research with a full gamut of methods and disseminating the findings across society.
Part 2 Theories, Models and Interventions for Health Behaviour Change
In Part 2 we review the theories, models and interventions for health behaviour change that are most relevant to the major causes of illness and premature death. We consider the environmental influences that affect these health-relevant behaviours and the factors that make these behaviours so resistant to change. We review interventions that offer the best opportunities for behaviour change and practical recommendations on how knowledge from health psychology can be applied to improve current systems of health care.
In Chapter 8 we review the principal theories and models of health behaviour. We illustrate their application to sexual health, the topic of our next chapter. Although the models have yielded disappointing results, they continue to dominate the research in the field. Our critique of the approach indicates the need for fresh lines of inquiry.
In Chapter 9, we focus on sexual health, and the prevention of unintended pregnancies and sexually transmitted infections.
In Chapter 10 we examine the part played by food, diets and dieting in the changing patterns of illnesses and deaths associated with the obesity pandemic. The sub-optimal food environment has generated high levels of obesity, diabetes, cardiovascular diseases, cancers, osteoporosis and dental disease.
In Chapter 11 we discuss theories and research concerned with alcohol consumption and the causes, prevention and treatment of drinking problems.
In Chapter 12 we document the extent of smoking, its major health impacts and the factors that help to explain its continued popularity. Three main theories, the biological, psychological and social, are outlined.
In Chapter 13 we review evidence on the increasing prevalence of sedentary behaviour and its potential impact on health. We consider the social and psychological factors associated with participation, the various meanings of different