Health psychologists argue that one's disposition - that is, personality - and their beliefs about health play a significant role in their behaviour. One’s beliefs are relatively stable mental schemas that are created throughout life through learning. One’s beliefs give meaning to perceptions, they help one make sense of the world around them and ultimately guide behavior. However, many beliefs are not very rational. Many people are not very willing to change their beliefs and they approach situations with a preconceived opinion, which influences health behaviors. 

When we discuss health behaviours, we refer to health-impairing habits - which would include smoking, drinking, and a sedentary lifestyle - and health-protective behaviours - which would include a healthy diet, regular exercise and regular health check-ups.  Psychologists assume that human beings are rational information processors. It is assumed that if we are presented with a good argument regarding the dangers of drinking two to three glasses of alcohol on a daily basis, we would change our behaviour. This, however, is not the case for all behaviours. Later in this chapter, we will examine some of the theories for obesity, addiction, and stress behaviours.  In this section, we are going to look at health beliefs that may influence behaviour: risk perception and self-efficacy.

Risk perception

Risk perception can be defined as the extent to which an individual feels that they are at risk of developing a health problem. Risk perception is often related to family experience.  If no one in your family has ever had breast cancer, you may feel like you are at low risk to get it.  If your grandfather was overweight and never had any heart problems - and was a happy man! - you may not be worried about the fact that you have put on a few kilos (or pounds) too many.

Psychologists suggest that one of the reasons that we have this irrational perception of risk is due to optimism bias. We tend to overestimate the number of our health-protective behaviours and underestimate the significance of our health-impairing habits.

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First, try to put these health and safety risks in order from "biggest risk" to "lowest risk."  Be able to justify your decision.

I find that this is an interesting activity for the class to do either as a whole or in small groups. Then, have them work in pairs to find the actual risk level.  In addition to the fact that students are often way off in their estimations of risk, it is also a good experience for them to do some searching online - there are major inconsistencies in the way that risk is reported.

Then it is time for some research. Try to find for each one of the health problems above, the chance of developing the problem.  When doing your research, which factors seem to make a difference in one's level of risk?

In generating a list of potential factors, students usually include: age, gender, family history (genetics), type of work, socioeconomic status, access to health care, diet, and level of exercise/fitness.

In a study carried out by Hoppe and Ogden (1996), the researchers wanted to see if the level of unrealistic optimism would be affected if participants focused on their health-impairing habits rather than their health-protective behaviour. In their study, the risk-increasing behaviour was "unsafe sex" and the risk-decreasing behaviour was "safe sex."  The sample consisted of heterosexual participants only. 

The participants were asked to complete a questionnaire under one of two conditions. In the "risk increasing" condition, they were asked questions that would most likely be answered negatively - for example, "since being sexually active how often have you asked about your partners’ HIV status?".  In the risk-decreasing condition, they were asked questions that would most likely be answered positively - for example, "since being sexually active how often have you tried to select your partners carefully?" 

The results showed that when focused on risk-decreasing questions, their own sense of risk was lower - that is, their level of optimism was higher.

Self-efficacy

Albert Bandura (1997) defined self-efficacy as one's belief in one's ability to succeed in specific situations or accomplish a task.

Neupert et al (2009) studied the role of self-efficacy in exercise behaviour. The sample was made up of a group of older adults, all committed to begin a strength-training program. Levels of self-efficacy were measured before and six months into the program. The study found that the participants who had higher self-efficacy at six months were more likely to be exercising twelve months later. Findings indicate a correlation between self-efficacy and exercise behavior. One's beliefs developed during an exercise program are important for commitment to continue. This shows the potential importance of the feedback given by a trainer or coach.

Based on the concept of self-efficacy, Ajzen (1985) proposed the theory of planned behaviour.  The theory outlines three factors that predict behavioural intentions, which are then linked to behaviour.

• Attitude towards behaviour – it can be negative or positive, for example, “exercise will make me feel better and be healthier” or “exercise is too much work and does not really help”.
• Subjective norms – this means whether a behaviour will be executed depends also on what one’s significant others’ (like friends and family) attitude towards the behaviour is. Simply, if one’s parents exercise regularly and believe it is part of a healthy lifestyle, he is more likely to exercise as well. 
• Self-efficacy – This means the level to which someone believes he is able to execute the behaviour and persevere. For instance, if one does not believe he will be able to make time for exercise, or that it will be too uncomfortable or painful, then he won't exercise.

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In writing their responses, students should consider why simply planning to walk is not always a good indicator of how much walking an individual will do.  Some of the things that students mention in this activity are: the weather during the time of the study, the clothes one has to wear for work and whether they are suitable for walking, the amount of free time an individual has for exercise, whether they are single or not (are there family responsibilities?), whether there are good sidewalks in the neighborhood or is it safer to drive?

The Theory of Planned Behaviour is a holistic theory that looks at several factors that influence behaviour - so the role of self-efficacy alone is difficult to measure. Also, although the theory seems to indicate causation, the research is correlational in nature and thus causation can only be implied, not firmly established. 

The theory also ignores environmental and cultural factors in explaining one's behaviour. Even if one has a high sense of self-efficacy, fresh fruit and vegetables may not be readily available or more expensive than they can afford. Or, one might have a very negative attitude towards drinking and a high level of self-efficacy, but will drink because she is looking to be accepted by a group. 

Personality and health problems

When discussing personality, psychologists usually apply the Five Factor Model of personality. The five factors are dimensions used to describe an individual's personality. 

Openness to experience:  One's level of intellectual curiosity and willingness to try new things.

Conscientiousness:  Characterized by impulse control. A person with a high level of conscientiousness is goal-directed, likes to plan, is able to delay gratification, and follows norms and rules.

Extraversion:  One's level of engagement with the external world.

Agreeableness: One's level of concern for others over oneself as well as optimism with regard to human nature. 

Neuroticism: One's tendency to experience negative emotions, such as anger, anxiety, or depression.  Those with high levels of neuroticism are more prone to stress.

Health psychologists use the Five-Factor Model to determine if specific personality traits may play a greater role in the development of health impairing habits than others.  Ingledew and Ferguson (2006) investigated the role of personality in predicting safer sex in university students by administering a standardized personality test as well as a questionnaire about their sexual behaviours in the last year.  The researchers concluded that the traits of agreeableness and conscientiousness were the greatest predictors of safer sex practices.

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When having students share their predictions, have them justify why they made the choices they did.

As for the article, there are several ways that the student may respond. Here are some discussion points that are worth addressing:

• Despite decades of attempts, no single addictive personality common to everyone with addictions has ever been found. “What we’re finding is that the addictive personality, if you will, is multifaceted,” says Koob. “It doesn’t really exist as an entity of its own.”
• The whole range of human character can be found among people with addictions, despite the cruel stereotypes that are typically presented. Only 18% of addicts, for example, have a personality disorder characterized by lying, stealing, lack of conscience, and manipulative antisocial behavior.
• While those who are the most impulsive and eager to try new things are at the highest risk, the odds of addiction are also elevated in those who are compulsive and fear novelty. It is extremes of personality and temperament—some of which are associated with talents, not deficits—that elevate risk.
• Giftedness and high IQ, for instance, are linked with higher rates of illegal drug use than having average intelligence.
• Addictions and other neurodevelopmental disorders rely not just on our actual experience but on how we interpret it and how our parents and friends respond to and label the way we behave.

Checking for understanding