Psychological Aspects of Health and Illness
Introduction
Human behavior plays a major role in the delivery of healthcare. With the exception of acute cases, patients’ behavior has been found to determine the success of interventions administered in a health care setting (Ryan, Huta & Deci 2008, p. 2). It is in light of this knowledge that heath workers are encouraged to switch from the traditional models that solely attribute health and illness to external factors that are beyond the patients’ ability (Hagger, Chatzisarantis & Harris 2006). Research in health psychology has led to the formulation of models and theories that seek to explain the role of human behavior in health care systems. The human believe model, theory of planned behavior, trans-theoretical model of behavior, and self-determination theory approaches will be used to explain the behavior of a HIV positive lady.
The Human Belief Model
The human belief model provides an explanation for why a given individual engages in a behavior that has an effect on his or her health. Notably, this model was proposed by Rosenstock in 1966. However, over the years, it has undergone a series of development to make it more effective in helping to predict human behavior in health interventions (Hayes 2016). It postulates that in order to improve their health, six factors influence how individuals will adopt certain behavior (Ryan et al 2008, p.3). These factors include perceived illness, susceptibility to illness, severity of the ailment, benefits, costs or barriers, and cues to action. Outcome expectancies are influenced by the perceived benefits of engaging in the health behavior.
The human belief model will be used to explain the lady’s behavior. The decision to offer oral sex shows that she believed that it could not make her contract HIV virus. She also thought that the virus can only be contracted when engaging in unprotected vaginal sex, cases of condom burst or when there are sores or open cuts in the mouth during oral sex. When she visits the clinic to inquire on how she would be safely pregnant without exposing the baby is good example of behavioral trait, which shows her awareness of the risk of infecting the newborn with HIV.
The perception that an illness is severe can have an influence on a patient’s behavior. The adoption of new behavior is based on the belief that failure to take action may lead to the illness becoming serious (Hagger et al. 2006). Despite not being disturbed by the fact that she is a carrier of HIV and often times forgetting her status, the lady is keen on visiting a doctor after every six months. Her decision to consistently take her daily medication helps in reducing the severity of the virus by keeping the viral load low. Most importantly, the lady plays a critical role in the management of her health.
A patient may adopt behavior change if he/she feels that it is going to be of benefit to his/her health. These health benefits include stopping, lowering or reducing the risks of the condition (Hagger et al. 2006). The HIV positive lady is faithful in taking her medication; a habit she knows is helping her to keep the viral load low and increasing her life expectancy. This factor can also be used to explain her decision to break up with the boyfriend who shows no commitment.
The Theory of Planned Behavior
The theory of planned behavior will also be used to explain the lady’s actions before and after getting infected with HIV. According to this theory, what determines human behavior is the intention to achieve certain results after adopting it (Ogden 2012, p.481). A person’s attitude, subjective norm, and perceived control influence the intention (Glanz & Bishop 2010). This model helps to explain the behaviors that people have control over (Azjen 2002). The theory has been used in health care to predict health behaviors of patients in relation to interventions.
A person’s attitude plays a major role in influencing his/her behavior. The attitude that a given behavior may lead to desirable health outcomes influences a patient’s decision to adopt it (Glanz & Bishop 2010). Failure to performing the said behavior is interpreted as a cause for raising susceptibility or severity of an illness (Azjen 2002). The lady believes that having casual sex with a person she has not known for long may expose her to HIV or other illness. The decision to use a condom during their encounter explains her intention to protect herself from sexually transmitted diseases.
The planned behavior theory can be used to explain the choice by the lady to seek expert advice before she gets a baby. She has regular visits to a pediatrician nurse who gives her advice on the whole process. In addition, she undertakes her own research on health care provision during pregnancy for HIV positive women. The ultimate goal is to ensure that should she make the decision to have a child, it should not be exposed to the virus. According to Azjen (2002), intention is the best factor that clearly explains the behavior of a person. Her intention to have a healthy child influences the behavior to seek expert advice.
A person’s surrounding environment and the people that he/she associates with have an influence on behavior change. According to the theory of planned behavior, these factors are known as subjective norms, where an individual adopts a new behavior depending on whether the people around readily approve it (Glanz & Bishop, 2010). This concept can be used to explain the lady’s behavior. After the sexual encounter, she consoles herself by acknowledging that almost everyone around her is doing it. The fact that a majority of her friends are getting babies influences her urge to have one, thus explaining her behavior to seek for information concerning pregnancy. Her decision to rephrase the doctor’s visit was as a result of her mum’s negative views of the initial one. People closest to her are seen to influence her behavior.
It is imperative to note that perceived control of behavior is a concept under the theory of planned behavior. It can be used to explain the lady’s actions. The concept explains an individual’s perception on the ability to adopt a desired behavior (Glanz & Bishop 2010). This perception varies with situation (Hagger et al. 2006). This concept can be used to explain the lady’s ability to resist the urge to engage in casual sex on the first night. In addition, she manages to control her emotional attachment to the boyfriend that he broke up with, as the relationship was not adding any value to her. After 2.5 years of living with HIV, she is able to control how much the situation affects her daily life. By virtue of checking on her emotions and all other aspects of her life, she is able to live positively.
In addition, an individual’s perceived power influences the planned behavior. Perceived power represents all the factors that facilitate the adoption of a behavior (Hagger et al. 2006). The lady believes that she should not engage in casual sex with a person that she has not been in a long term relationship with. This belief can be viewed as one that prompted her not to engage in any sexual activity for the first seven months. Moreover, the courage to open up about her HIV status can be explained using this concept.
The Trans-theoretical Model
The trans-theoretical model can be used to explain the lady’s behavioral changes. The model was formulated from existing theories and represents the stages involved in the change process (Ryan et al 2008, p.4). The change process has five crucial stages, which are pre-contemplation, contemplation, preparation, action, and maintenance (Solhi, Ahmadi, Taghdisi, & Haghani 2012, p. 946). These stages will be used to predict the lady’s behavior change prior and after contracting HIV.
The pre-contemplating stage in this lady’s case will consist of the time period between meeting the Zambian guy at the club to the encounter that exposed her to HIV. This stage is characterized by ignorance of the ensuing problem or consequences of a yet to be committed action (Hashemi, Rakhshani, Navidian, & Mosavi 2013). After being introduced to the guy, the lady develops a close relationship that sees them texting and making calls regularly. She gets a dinner invitation and thereafter, engages in oral sex. On the second day, she is not able to resist the urge to have casual vaginal sex, but uses a condom; ignorant of the danger she is putting herself in. When she falls sick, she is diagnosed with HIV. The lady is shocked as she was convinced that the condom could protect her. The resulting emotional instability affects her daily life to a large extent.
Her behavior changes after 2.5 years of living a stressed life represents the contemplating stage. This is the second stage of the model and involves a conscious decision to have a behavior change (Hagger et al. 2006). The positive test for HIV left her shocked and in a deep state of emotional instability. After living a life full of stress and confusion, she decides to accept her condition. This change in behavior can thus be categorized into the contemplating stage of the trans-theoretical model.
She then makes plans to improve her life. The lady is thinking to focus on her career. In addition, the boyfriend who she loves very much is part of her plans, as she wants them to grow together. Moreover, she has vacation ideas over the summer and an idea of writing her own book. The change in behavior can be explained using the trans-theoretical model. This adoption of new behavior, as seen in her plans, represents the preparation stage of this model. The stage is defined by the vivid conscious to change and make calculated plans to effect the change (Hashemi et al 2013).
In her blog, she not only publicly declares her HIV status, but also gives the direction of her life. She admits what has happened and shoves it behind to focus on this new journey of her life. She welcomes the public to walk with her and feel free to support and ask questions. Behavior change studies argue that the action stage of the trans-theoretical model is characterized by publicly modified change (Hagger et al. 2006). The behavior change seen in this lady can be attributed to the action stage.
The lady is able to sustain the behavior change that she adopts. In the November 11, 2011 article, she explains the strides that she has made in the 8 months that she had not gotten in touch with her readers. Within this period, she was busy making concerted efforts towards improving her life all-round. While doing so, she also keeps updating her blog. Such changes are consistent with the maintenance stage of the trans-theoretical model. Notably, this stage is characterized by consistency in implementing the desired behavior change for more than a period of 6 months (Hashemi et al. 2013). Presently, she is leading a normal life without the distraction that comes with being diagnosed with HIV.
The Self Determination Theory
Crucially, the behavior changes in the lady can be explained using the self-determination theory. The theory focuses on different processes that elicit an individual to initiate behavioral changes (Ntoumanis, Ng, Thøgersen-Ntoumani, Deci, Ryan, Duda, & Williams 2012). There is the existence of an autonomous motivation that catalyzes change and ensures that the acquired behavior is maintained (Ryan et al. 2016). This theory has been widely used in health care settings, especially during the administration of interventions such as in weight and diet management (Ntoumanis et al. 2012). It endeavors to explain why people change and maintain certain behaviors.
There is an autonomous effort by the lady to change her goals in life. The desire for change is seen to start after the 2.5 years of living with HIV. She decides to free herself from constant worry, but focuses on growing her life. She has an inbound motivation to grow her career, start a family, write a book, and even go for vacations as opposed to sitting back and crying about HIV. Autonomy is a great aspect of the self-determination theory (Ntoumanis et al. 2012). She has a burning desire to realign her life back to normalcy. The decision to break up with the boyfriend, who she claims is emotionally attached to, is a necessary change that is aimed at improving her life. She is not only motivated in acquiring the new behaviors, but is also keen to maintain them going forward.
Her self determination to change is driven by utmost belief in her competence. An individual’s belief in personal ability is a major motivation to behavioral change (Ntoumanis et al. 2012). There must be considerable confidence in oneself to develop a solid plan for catalyzing change (Niemiec, Ryan, Patrick, Deci, & Williams 2010). The lady believes that she has the necessary skills that play a pivotal role in propelling her career to greater heights. Most importantly, she is also almost solely involved in planning for their wedding, showing trust in her capabilities. When her boyfriend commits himself to her, she says that he had realized that she “is too good to let go.” The use of these words shows confidence on her part and capability to make a good girlfriend.
Relatedness is another concept under the self-determination theory. According to the theory, it is the feeling of being understood and knowing that you have people around you who care for you (Niemiec et al. 2010). After visiting a doctor for advice on the process of getting pregnant, she feels that she is not well understood. To this end, she decides to use the pediatrician nurse whom she has established a relationship with. Moreover, the lady has a caring mother whom she regularly consults. For instance, the lady decided to rephrase the doctor’s visit upon listening to her remarks. She also feels loved and cared for by her boyfriend whom she goes ahead to marry. When she is tasked with the duty of reading and providing feedback on the book “Hot Mess,” there is a feeling of being understood and that there is someone out there who acknowledges her.
Conclusion
The application of behavior change theories is a major milestone in proving health care provision. The models show how individuals can be motivated to adopt behavioral changes that are beneficial to their health. The lady presents a good case study of how a conscious decision to change can lead to improved health. She is able to accept that she has HIV. The lady does not let the condition prevent her from enjoying life to the fullest. After being diagnosed with HIV, she goes into denial mode. This situation adversely affects her self-confidence. However, at the end of the study, the lady re-energizes and takes full control of her life.
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