Health CognitionsHealth Cognitions

Bill KleinBill KleinDepartment of PsychologyDepartment of PsychologyUniversity of PittsburghUniversity of Pittsburgh

Pittsburgh Mind-Body CenterPittsburgh Mind-Body CenterSummer InstituteSummer Institute

June 5, 2008June 5, 2008

OutlineOutline OutlineOutline Health Cognitions and Physical Health Cognitions and Physical

HealthHealth Health CognitionsHealth Cognitions

Attitudes and knowledgeAttitudes and knowledge Social cognitionsSocial cognitions Perceived vulnerabilityPerceived vulnerability Perceived control/efficacyPerceived control/efficacy Behavioral intentionsBehavioral intentions Mental representations of illnessMental representations of illness Attribution and blameAttribution and blame

Cognitions and Cognitions and BehaviorBehavior

Cognitions and Cognitions and BehaviorBehavior

Leading causes of death are Leading causes of death are behavioral (e.g., smoking, alcohol behavioral (e.g., smoking, alcohol use, nutrition, high risk sex)use, nutrition, high risk sex)

Need to understand cognitions Need to understand cognitions that underlie these behaviors in that underlie these behaviors in order to change themorder to change them

Health Behavior ModelsHealth Behavior Models Theory of Planned Behavior (Ajzen & Theory of Planned Behavior (Ajzen &

Madden, 1986)Madden, 1986) Health Belief Model (Janz & Becker, 1984)Health Belief Model (Janz & Becker, 1984) Protection Motivation Theory (Rogers, Protection Motivation Theory (Rogers,

1983)1983) Stage Models: Transtheoretical Model Stage Models: Transtheoretical Model

(Prochaska, DiClemente, & Norcross, (Prochaska, DiClemente, & Norcross, 1992); Precaution Adoption Process Model 1992); Precaution Adoption Process Model (Weinstein et al., 1998)(Weinstein et al., 1998)

PBC

Subjective Norms

Attitudes

Intentions Behavior

Theory of Planned Theory of Planned BehaviorBehavior

Theory of Planned Theory of Planned BehaviorBehavior

Problems with ModelsProblems with Models Problems with ModelsProblems with Models Cross-sectionalCross-sectional Role of environmental constraints Role of environmental constraints

and temptationsand temptations Past behaviorPast behavior Interactions and paths often not Interactions and paths often not

specifiedspecified

Attitudes and Attitudes and KnowledgeKnowledge

Attitudes and Attitudes and KnowledgeKnowledge

KnowledgeKnowledge Perceived costs and benefitsPerceived costs and benefits

Framing health messages (Rothman & Framing health messages (Rothman & Salovey, 1997)Salovey, 1997)

Affective orientation toward Affective orientation toward behaviorbehavior

Cognitive dissonanceCognitive dissonance Induced hypocrisy (Stone et al., 1994)Induced hypocrisy (Stone et al., 1994)

Defensive processing of health Defensive processing of health messagesmessages Fear appeals (Hovland et al., 1953)Fear appeals (Hovland et al., 1953) Perceived threat (Croyle et al., 1993)Perceived threat (Croyle et al., 1993) Perceived credibility (Liberman & Chaiken, Perceived credibility (Liberman & Chaiken,

1992)1992) Self-affirmation (Sherman et al., 2000)Self-affirmation (Sherman et al., 2000)

Social CognitionsSocial Cognitions Social CognitionsSocial Cognitions Subjective normsSubjective norms

Injunctive vs. descriptive normsInjunctive vs. descriptive norms

Perceived prevalence/social Perceived prevalence/social comparisoncomparison False consensus and false uniqueness (Suls False consensus and false uniqueness (Suls

et al., 1988)et al., 1988) Norm misperception (Prentice & Miller, Norm misperception (Prentice & Miller,

1993)1993) Threatening social comparisons (Klein & Threatening social comparisons (Klein &

Kunda, 1993)Kunda, 1993)

Prototype perceptionPrototype perception Adolescent prototypes (Gibbons et al., Adolescent prototypes (Gibbons et al.,

1998)1998) Stereotypes (Weinstein, 1980)Stereotypes (Weinstein, 1980)

Self-presentationSelf-presentation Appearance vs. health (Mahler et al., 2003)Appearance vs. health (Mahler et al., 2003)

Perceived Vulnerability Perceived Vulnerability II

Perceived Vulnerability Perceived Vulnerability II

ConceptualizationConceptualization Perceived risk (absolute and comparative), Perceived risk (absolute and comparative),

perceived probability, perceived likelihood, perceived probability, perceived likelihood, unrealistic optimismunrealistic optimism

Role of affect (e.g., “feeling at risk” and Role of affect (e.g., “feeling at risk” and regret)regret)

Lay problems with risk estimationLay problems with risk estimation Use of probability (e.g., small vs. large, Use of probability (e.g., small vs. large,

50/50 ≠ 50%)50/50 ≠ 50%)

Perceived Risk of Breast CancerPerceived Risk of Breast CancerPerceived Risk of Breast CancerPerceived Risk of Breast Cancer

0

10

20

30

40

50

60

70

0 10 20 30 40 50 60 70 80 90 100

(Lipkus, Klein, Skinner, & Rimer, 2005)

Perceived Vulnerability Perceived Vulnerability II

Perceived Vulnerability Perceived Vulnerability II

ConceptualizationConceptualization Perceived risk (absolute and comparative), Perceived risk (absolute and comparative),

perceived probability, perceived likelihood, perceived probability, perceived likelihood, unrealistic optimismunrealistic optimism

Role of affect (e.g., “feeling at risk” and Role of affect (e.g., “feeling at risk” and regret)regret)

Lay problems with risk estimationLay problems with risk estimation Use of probability (e.g., small vs. large, Use of probability (e.g., small vs. large,

50/50 ≠ 50%)50/50 ≠ 50%) Use of heuristics (availability heuristic, Use of heuristics (availability heuristic,

base rate fallacy)base rate fallacy)

Illusory CorrelationIllusory Correlation Illusory CorrelationIllusory Correlation

Breast Breast CancerCancer

No Breast No Breast CancerCancer

High High Antibiotic Antibiotic

UseUse

88 44

Low Low Antibiotic Antibiotic

UseUse

44 22

Perceived Vulnerability Perceived Vulnerability II

Perceived Vulnerability Perceived Vulnerability II

ConceptualizationConceptualization Perceived risk (absolute and comparative), Perceived risk (absolute and comparative),

perceived probability, perceived likelihood, perceived probability, perceived likelihood, unrealistic optimismunrealistic optimism

Role of affect (e.g., “feeling at risk” and Role of affect (e.g., “feeling at risk” and regret)regret)

Lay problems with risk estimationLay problems with risk estimation Use of probability (e.g., small vs. large, Use of probability (e.g., small vs. large,

50/50 ≠ 50%)50/50 ≠ 50%) Use of heuristics (availability heuristic, Use of heuristics (availability heuristic,

base rate fallacy)base rate fallacy) Matching percentages to labelsMatching percentages to labels

EC Verbal LabelsEC Verbal Labels EC Verbal LabelsEC Verbal Labels

VERBAL VERBAL DESCRIPTORDESCRIPTOR

EC EC ASSIGNMENTASSIGNMENT

AVERAGE LAY AVERAGE LAY ESTIMATEESTIMATE

Very CommonVery Common > 10%> 10%

CommonCommon 1-10%1-10%

UncommonUncommon 0.1-1%0.1-1%

RareRare 0.01-0.1%0.01-0.1%

Very rareVery rare < .01%< .01%

(Berry, Raynor, & Knapp, 2006)

EC Verbal LabelsEC Verbal Labels EC Verbal LabelsEC Verbal Labels

VERBAL VERBAL DESCRIPTORDESCRIPTOR

EC EC ASSIGNMENTASSIGNMENT

AVERAGE LAY AVERAGE LAY ESTIMATEESTIMATE

Very CommonVery Common > 10%> 10% 65%65%

CommonCommon 1-10%1-10% 45%45%

UncommonUncommon 0.1-1%0.1-1% 17%17%

RareRare 0.01-0.1%0.01-0.1% 8%8%

Very rareVery rare < .01%< .01% 4%4%

(Berry, Raynor, & Knapp, 2006)

Perceived Vulnerability Perceived Vulnerability IIII

Perceived Vulnerability Perceived Vulnerability IIII

Relation to health outcomesRelation to health outcomes Mammography (McCaul et al., 1996): r Mammography (McCaul et al., 1996): r

= .16 across samples; r = .33 among = .16 across samples; r = .33 among women with a family history women with a family history

Condom use (Gerrard et al., 1996)Condom use (Gerrard et al., 1996) Processing health information (Radcliffe & Processing health information (Radcliffe &

Klein, 2002)Klein, 2002) Methodological concerns (Weinstein et al., Methodological concerns (Weinstein et al.,

1998)1998)

Perceived Perceived Control/EfficacyControl/Efficacy

Perceived Perceived Control/EfficacyControl/Efficacy

Control perceptions (Langer & Control perceptions (Langer & Rodin, 1977)Rodin, 1977)

Self-efficacy (Bandura, 1977)Self-efficacy (Bandura, 1977) Response efficacy (Rogers, 1983)Response efficacy (Rogers, 1983) Perceived behavioral control Perceived behavioral control

(Ajzen, 1991)(Ajzen, 1991) Health locus of control (Wallston, Health locus of control (Wallston,

1992) 1992) Biases in control perceptionsBiases in control perceptions

Illusion of control (Langer, 1975)Illusion of control (Langer, 1975) Comparative perceptions (Klein & Comparative perceptions (Klein &

Kunda, 1994)Kunda, 1994)

Drug Problem

Imagine you are making a choice between the following two drug treatments for reducing heart attack risk:

Drug A has lung-related side effects 1 out of every 100,000 times. However, when these side effects occur, they are instantly fatal. Overall, then, there is a 1 in 100,000 chance of a fatality if you take this drug.

Drug B has lung-related side effects 4 out of every 100,000 times. However, when they occur, there are measures you can take to avoid becoming a fatality. The side effects lead to death about 50% of the time. Overall, then, there is a 2 in 100,000 chance of a fatality.

Which drug do you prefer? ________

Klein & Kunda, 1994

Behavioral IntentionsBehavioral Intentions Behavioral IntentionsBehavioral Intentions Intentions (Ajzen & Madden, Intentions (Ajzen & Madden,

1986)1986) Protection motivation (Rogers, Protection motivation (Rogers,

1983)1983) Willingness (Gibbons et al., 1998)Willingness (Gibbons et al., 1998) Contemplation (Prochaska et al., Contemplation (Prochaska et al.,

1992)1992)

Illness Cognition IIllness Cognition I Illness Cognition IIllness Cognition I Illness Representations (Meyer, Illness Representations (Meyer,

Leventhal, & Guttman, 1985)Leventhal, & Guttman, 1985) Cause, consequence, timeline, Cause, consequence, timeline,

identity, controlidentity, control Acute vs. chronic illnessAcute vs. chronic illness Age differences (Gump et al., 2001)Age differences (Gump et al., 2001)

Unrealistic pessimism regarding Unrealistic pessimism regarding coping (Blanton et al., 2001); coping (Blanton et al., 2001); affective forecastingaffective forecasting

Illness Cognition IIIllness Cognition II Illness Cognition IIIllness Cognition II Attribution (Seligman, 1975)Attribution (Seligman, 1975)

Global, stable, internal attributions Global, stable, internal attributions for negative events associated with for negative events associated with earlier illness onset and mortality earlier illness onset and mortality (e.g., U. S. Presidents, Hall of Fame (e.g., U. S. Presidents, Hall of Fame baseball players)baseball players)

Characterological blame worse than Characterological blame worse than behavioral blame over time (e.g., behavioral blame over time (e.g., Glinder & Compas, 1999)Glinder & Compas, 1999)

Counterfactual thinking might Counterfactual thinking might promote less adaptive coping (Roese promote less adaptive coping (Roese & Olson, 1995)& Olson, 1995)