What is the meaning of the terms ‘structure’ and

‘agency’ and what is their relevance for health?

 Agency (individuals) – The capacity of individuals to
act independently and make their own free choices.

 Structure (society) – The influence of society and its

structure on the choices and opportunities available.

 The relationship between individuals (agency) and

society (structure) is important for explaining human
action  potentially explaining health behaviors
 Define a lay belief?
 People’s ‘common sense’ understanding and
knowledge about health and illness. Generally
rooted in people’s own experiences, not always
different from medical understanding

 Give an example description of someone’s lay belief.

 A patient comes into the GP surgery and is worried

about their cough. They report seeing the TV adds
saying if you have had a cough for more than 3
weeks you should go see the doctor, and is worried
about lung cancer.
Monica is a 75 year old lady who bases a lot of her own knowledge about
COPD from previously being admitted to hospital. This is an example of a
patients lay knowledge coming from “personal knowledge and
experience”. List FIVE other sources of lay beliefs/knowledge.

1. Previous medical encounters  very similar to the

example given here

2. Folk knowledge

3. Media & internet

4. Spiritual beliefs

5. Alternative & complementary medicine

List THREE reasons lay beliefs
are important to doctors.
1. Helps to better understand people’s illness related
behaviour

2. Gain insight into patient needs and their

expectations of doctors

3. More satisfied patients and doctors

 What is the ‘lay referral’
system?
 When a patient seeks advice from others before
consulting a doctor.
 List the FIVE ‘triggers’ to seeking medical help
1. Temporalizing of symptomatology
2. Sanctioning
3. Interpersonal crisis
4. Interference with social or personal relations
5. Interference with vocation or physical activity
 Why do patients delay
seeking help?
 Perceptions before the event eg. I am not the typical
patient/victim; it won’t happen to me

 I am still able to do my day to day activities so it

won’t happen to me/I am well

 Fear

 Caring responsibilities
Expert Patient Programme
 List FIVE benefits of the Expert Patient Programme
1. Patients conditions improve or stay stable
2. Patients will have more confidence in seeking
health and social care services for them
3. Patient contribute towards improving health
services
4. Patients require fewer visits to GPs and outpatient
clinics  saves NHS resources
5. Patients and health professionals work together to
find the best solutions
List FIVE potential problems with the
Expert Patient Programme
1. Isn’t possible to ensure participation of all social
groups

2. May intensify the exclusion and marginalisation of

the most disadvantaged groups

3. More pressure placed on patient organisations

4. No corresponding strategy to challenge professional

attitudes

5. Is the Expert Patient Programme just to save NHS

resources?
 Define what a health
behaviour is.
 Behaviours that are related to the health status of
the individual.
 List the THREE types of health behaviour
1. Good health behaviours eg. Sleeping 7-8 hours,
exercise, healthy eating
2. Health protective behaviours eg. Attending health
screening* easy way to link screening here
3. Health impairing habits eg. Smoking, drinking,
eating fast food a lot etc.
 What is the dual pathway
model of health?
 Two broad ways in which psychological processes can
influence physical health

 What is the bio-psycho-social model of health?

 “Bio” = viruses, bacteria & genetics

 “Psycho” = stress, behaviour, emotions, beliefs

 “Social” = class, employment or income, ethnicity

List the FOUR determinants of
health behaviour
1. Background factors
2. Stable factors
3. Social factors
4. Situational factors
 What are some “background factors”?
 Employment
 Ethnicity
 Culture
 Education etc.
Stable factors are down to the individual & their
personality; define “stable factors”

 Variations between people in psychological activities that,

within people, produce responses that are stable across
time and context

 What THREE ways do stable factors “influence appraisal”?

1. They determine if/how much an event is important

2. The provide a generalised framework for understanding

and evaluating the event (threat vs. challenge)

3. They make available/suggest potential responses

 Stable factors are split into
three “types”; what are they?
1. Emotional dispositions  present
2. Generalised expectancies  future
3. Explanatory styles  past
 Emotional disposition = psychological processes involved in
experience & explanation; list the FIVE personality traits.
1. Openness to new experiences
2. Conscientiousness
3. Extroversion
4. Agreeableness
5. Neuroticism
 Generalised expectancy 
locus of control & self-efficacy
 What does locus of control mean?
 Expectation that future outcomes will be determined by
factors that are either internal/self or external/powerful
others/chance
 List THREE things that people with an internal locus of
control believe
1. They are responsible for their own health
2. Ill health can be avoided by good health
behaviours/taking care of themselves
3. Ill health results from negative health behaviours eg.
Eating too much fat, not exercising enough
 Generalised expectancies 
what is self-efficacy?
 Belief in one’s self to organise and carry out an action, and the
expectation that the action will lead to a good/desirable
outcome
 Explanatory styles  what are the two types?
1. Opitmism = the expectation of a positive future outcome
despite current negative event. Associated with better
physical health/illness recovery
2. Attributional style = causal explanation of negative events as
self (internal vs. external), time (permanent or temporary?)
and global situation
 Social cognition theories
 what do they mean/do?
 Attempt to explain the relationship between social
cognition (beliefs, attitudes and goals) and behaviour

 List THREE Social Cognition Theories

1. Health belief model

2. Theory of planned behaviour

3. Transtheoretical model of change

Health-Belief Model
 *MCQ; In the theory of planned behaviour, “control
beliefs and self efficacy” lead to which of the following?
A. Behavioural attitude
B. Subjective norm
C. Perceived behavioural control
D. Perceived threat
E. Perceived efficacy
 Thank-you!
 Any questions?

 Good luck with your revision 