Intervention Efficacy in Health Psychology

Current Trends in Research and Practice in the field of Health Psychology:

In the last few years, the new trends in the field of research of health psychology is mostly in discussion because of its contributions towards the health promoting activities of the physical and mental health and therefore could critically analyse the gaps in the existing research and care services of the mental health (Thielke, Thompson, and Stuart, 2011). Varied meta-analysis conducted in recent time has shown doubtful response about the efficacy and the financial benefits of the intercessions carried out in the field of health psychology (Thielke, Thompson, and Stuart, 2011; Kaplan, 2009). Different problems have been recognised within the interventions that are applied at the time of real therapeutic settings for instance: 1) the fortitude of the level of encroachment of the intercessions within the settings of primary care; 2) specification of the functioning of the health psychologist at the time of integrated care services approach; 3) dismissal of the problems related to reimbursement; and 4) showing acceptance towards the enhanced recommendation of medications which are psychotropic in nature (Thielke, Thompson, and Stuart, 2011). Additionally, researchers seeking healthcare dissertation help can explore these issues to contribute to the evolving discourse on mental health interventions. Moreover, according to the study of Kaplan, 2009 the behavioural aspects of human beings is considered to be playing the most crucial role among the causes of mortality. The outcomes of health and well being can be enhanced by making use of the psychological sciences which would help them to comprehend better about the health promoting and detrimental actions. As the name of the field suggests that health psychology is a branch of behavioural medicines that encompasses varied factors such as human physiology, psychological aspects, conduct and social or cultural factors that have an immense impact upon the well being of an individual (Kaplan, 2009). Moreover, scientists and researchers are working on varied topics of the branch that are of utmost importance for the well being of common people such as eating behavioural disorders and lack of physical activities leading to obesity, anorexia or any other physiological disorders among the youngsters and adults; recent strategies on child immunization or vaccinations; factors that enhancing the rate of suicide among youngsters and the preventive strategies; and varied other topics on public health such as cessation of smoking and drinking (Dombrowski, Avenell, and Sniehott, 2010). In this regard, the study of Saeed, et al., (2005) have highlighted that with the amalgamation of behavioural intervention and biomedical approach an enhanced degree of progress can be made in the field of medicine to achieve the goal of biopsychosocial approach. Therefore, the authors also stated vividly that to maintain the health and well being of human beings along with the prevention of maladies demands the efforts of biomedical paradigm, which identifies the presence or absence of any sickness along with the biopsychosocial paradigm that refers to the complete well being of the health which is measured in terms of mental, physical and social well being (Saeed, et al., 2005). Biopsychosocial practice plays a pivotal role to comprehend the actual meaning of health and maladies and therefore, the functional role of the health psychologist is distinguished at the different setting of care that may include the primary, secondary and tertiary along with a wide range of subspecialists. Moreover, apart from the identification of psychological problems leading to conduct dysfunctions, the central role played by the health psychologist are initiating health promoting activities that will hinder in the process of developing any illness and thereby enhancing the overall quality of life of a patient. The other notable contributions that health psychologist offer for the betterment of health are they can carry out any applied psychological research as an intervention for the treatment management of any disease and augmenting the health care setting by formulating certain health policies (Saeed, et al., 2005; Dombrowski, Avenell, and Sniehott, 2010).

Area of Proposed Health Psychology Intervention:

Varied research investigation have highlighted that cases of “extreme obesity” are showing a constant upsurge throughout the world and therefore it is becoming a matter of concern for the health and well being of common people under the category of public health (WHO, 2014). According to the definition of WHO, 1998 the term “obesity” or “overweight” can be defined as the physiological condition where excessive amount of lipid or fat gets deposited within the adipose tissues of the body up to a certain abnormal degree that it damages the health of the individual from varied ways. The condition is expressed in terms of body mass index which is the weight in kilograms divided by the square of the height (kg/m²) and the value lies within the range of ≥ 25 kg/m² and ≥ 30 kg/m². According to the estimation provided by the WHO, 2014 among the adult population about 39% belongs to the category of “overweight” that includes 40% women and 38% men. The same survey also highlighted that nearly 15% women and 11% men are under obese category and these rates are persistently rising with the progress of time (WHO, 2014). Certain factors have been associated with the rapid advancement of obesity within the developing and developed nations (demonstrating the highest numbers) such as raised income, easy and enhanced accessibility to processed food, lack of awareness and motivations about the health benefits of routine physical activities, escalating urbanisation and leading a sedentary life style by maximum number of individuals (Teixeira, and Marques, 2017). Moreover, obesity has a direct relation with the genetic and physiological factors for the individual and their family lineage. From the aspect of health psychology the factors that are of crucial concerns are the unhealthy eating behaviours that includes enhanced consumption of cheap processed food items, skipping meals, consumption of diuretics, laxatives, and diet capsules for a prolonged period and avoiding routine physical activities due to lack of time by the individuals mostly youngsters and adults (Teixeira, and Marques, 2017). However, with the advertisement agencies demonstrating about the concept of perfect body shape and size of a woman, many of the youngsters who are overweight or obese suffers from varied psychological distress such as body shaming, social seclusion, poor self esteem, extreme forms of negative behavioural aspects towards life leading to depressive disorder and suicide (Santos, et al., 2017).

Critical Evaluation of key models and theories that guides the intervention:

The theories are considered to be the step by step way of understanding any condition or situation with the aid of pre defined concepts, proposals and definition that helps to comprehend the forthcoming events by evaluating the association the parameters (Lubek, et al., 2018). In health psychology these theories are of immense help as they illustrates and also assist in anticipating any changes within conduct as they act as predictors or operators of the mechanism of action of the fundamental behavioural aspects (Walsh, and Ireland, 2009). The theory that impacts upon the health of human beings belongs to the health behaviour change theories. In the recent times, the Health behaviour change interventions (HBCIs) assist in comprehending that a how a change in the conduct works in principle as it defines the way of action (includes the capability, prospect, and inspiration) in terms of change moderators via the process of causal predictions (Dombrowski, Avenell, and Sniehott, 2010; Walsh, and Ireland, 2009).

The Health Belief Model (HBM) is also referred as the societal emotional health behaviour change model which was formulated to illustrate and to anticipate the conduct in relation to health by promoting the up taking of services for the betterment of health. Within this theory, four interacting factors have been discussed that persuades our insight towards the intimidations of health and well being such as the thoughtful vulnerability; the recognized extreme forms of hazard factors for health status; the recognized beneficial aspects of treatment and the existing barriers towards it; and the indications to act (Rezapour, Mostafavi, and Khalkhali, 2016).

This model was chosen because it assists an individual to recognize their “goals” that is to reduce weight or obesity; the steps of action refers to the intervention that will help to accomplish the weight reduction and recognizing the barriers that might disturb the procedure and intention; and ultimately the level of commitment towards the achievement of goal which will depend upon motivations, will power and education (Resnicow, Teixeira, and Williams, 2017). In this regard a research intervention conducted by the Romano, et al., (2014) highlighted that with the implementation of HBM along with the health coaching (HC) which is considered to be another latest behavioural intervention that has achieved a lot of popularity in the field of public health with regard to the self management of health had achieved successful outcomes among sample size of 16 participants within the study. The study findings highlighted that the 16 participants had attended a 16 week programme and a weight reduction of 3.60% was accomplished by them in comparison to 1.57% by the control gathering that did not attend the programme sessions (Romano, and Scott, 2014). Therefore based on the findings the authors Romano, et al., (2014) recommended that the HBM should be incorporated within the health programmes with preventive approach that will guarantee the adherence to the intervention and accomplishing the goal of weight reduction by the participants.

Another model named the Transtheoretical Model (TTM) of behaviour change is considered to be a potential model with regard to the attainment of health life style by promoting the behavioural interventions among the participants. The model incorporates all aspects such as the psychological, conduct and cognitive procedures along with the principle theories of health psychology and psychotherapy (Michie, et al., 2005). The conduct interventions that will be considered are divided into six major steps such as:

1. Pre-contemplation: This stage is considered to be the denial state or not ready state of the patient as they might feel fatigued after repeated failures to achieve their goal and this might result due to the lack of information about the health condition, obesity and therefore demonstrates resistance or de-motivated. This is considered for six months (Tuah, et al., 2011).

2. Contemplation: Within this stage the individuals shows the propensity to change as they became aware of the positivity of the interventions. They also have the idea of the barriers to the intervention such as consumption of unhealthy diet, lack of motivation to perform routine physical activities which may disturb the person to follow the intervention. The beneficial aspect in terms of health and financial expenditure allows the person to carry on with the process for a prolonged period and this is known as behavioural procrastination or chronic contemplation. This is considered for six months (Tuah, et al., 2011).

3. Preparation: It is considered that the individual is ready to uptake the intervention and is considered within another month of time. By this stage the individual is ready with a set of plans by consulting a clinician or a counsellor and demonstrates reliance on the self management approach (Tuah, et al., 2011).

4. Action: In this stage the individuals have adopted the alterations within their way of life. Here it must be mentioned that according to the NICE, (2014) the interventions for the management of obesity depends on the patient’s opinion, the level of risk involved depending on the BMI of the patient, the varied environmental and social parameters that impacts upon the health, presence of any co-morbidities and the past medical or treatment history that can contradict with the adopted interventions. According to NICE, (2014) the interventions that are considered are cognitive behavioural therapies (CBT), sound eating regimen along with routine physical activities. NICE, (2014) guidelines advices to practice at least 30 minutes of routine moderate to greater intensity physical activities for 5 days every week along with dietary interventions specific for every individual for achieving weight reduction. Moreover, scientific evidences have also revealed that healthy dietary intervention in an individual diet pattern results in profound outcome in terms of weight reduction and well being of the person (Brennan, et al., 2018). Moreover, the support of the family and the friends also helps in continuing the determination by the patient. Another significant impact of behavioural weight loss programmes are the significant reduction in the level of psychological distress such as body shaming, social seclusion, poor self esteem, extreme forms of negative behavioural aspects towards life leading to depressive disorder and suicide. Past scientific evidence also highlighted that conduct therapy along with dietary intervention can help the person to achieve 15 to 20 pounds reduction in weight within five months span of time (Brennan, et al., 2018). The CBT on the other hand address the negative or destructive thoughtful patterns of an individual and augments the self esteem of the people to improve their quality of life. The process assists the person to identify the erroneous thought process and in turn encourages the person to uptake the challenge with determination to accomplish the goal. With regard to childhood obesity, the family based intervention is considered to be potential and these are the adjunct therapies to the usual medical intervention for the management of obesity among children and adults (Brennan, et al., 2018).

5. Maintenance: In this stage the person has already made the changes within his or her life style and along with that they must be working to hinder the relapses. People in this stage become more confident and therefore give up less to temptations and try to maintain the adopted change for the future. Here it must be mentioned that individuals should be praised if they could achieve a smaller part of their set goal and that person should be offered relative support depending on their individualised needs and moreover, the person should also be accommodating to changes each time (Tuah, et al., 2011). These are the strategies to hinder the relapses (NICE, 2006).

6. Relapse: In this stage the person has to give a thought about the potential barriers that hindered the success of the intervention. The most vital step at this stage is the re establishment of the goal with renewed determination (NICE, 2014).

The core component of this model is the decision making and balance as proposed by Janis and Mann (1977) and referred it as “decisional balance sheet”. This balance of the decision shows critical alteration from the normal position with progress in the stages of the model that is highly dependent on the positive and the negative outcomes and therefore named the model. The self efficacy component as described by the Bandura’s self-efficacy theory (Bandura, 1977, 1982) reflects the level of confidence and self esteem among the individual to maintain the desired change within their life style for the proposed outcome. The stage of relapse frequently occurs when the tempting feelings of an individual overcomes the conscience of self efficacy to maintain the desired behavioural intervention (Desharnais, et al., 1986).

Objective of the Research Proposal:

Therefore in the proposed research study the aims and objectives will be to study the efficacy of the behavioural intervention programme for the reduction of weight among the focus group of populace within a stipulated period of time (6 months). The next section of the study will detail about the methodology that will be adopted for evaluating the proposed health psychological intervention underlying six essential stages of the principle theory of TMM of behaviour change. The section will also brief about the ethical considerations required for this study to conduct along with the limitations that may be faced during the study period and the evaluation of the proposed health psychological intervention for the betterment of the health of the focus group populace.

Aim: To study the efficacy of the behavioural intervention programme for the reduction of weight among the focus group of populace (obese populace) within a stipulated period of time (6 months).

Study design:

For the study, the randomised control trial (RCT) will be chosen as it will help to diminish the inclusion of any form of bias within the study design to assay the efficacy of any proposed intervention. Here two groups will be categorised where one will receive the proposed health psychological intervention and the other group will receive the standard treatment (or placebo) (Spieth, et al., 2016).

The intervention will be conducted via a randomised control trial (RCT) involving at least 20 participants selected randomly including identical ratios of both the gender to minimize the gender bias within the study design. The participants will be chosen based on the electronic health records of a hospital within the UK (Romano, and Scott, 2014). The participants will be within the age range of 18 years to 60 years (adults) demonstrating the condition of obesity as per the WHO, (2014) guidelines, however the participants having other associated co-morbidities for a prolonged period of time such as high blood pressure, cardiovascular diseases, cerebrovascular diseases, history of smoking will excluded from the study as there results may show variability within the outcome (Romano, and Scott, 2014). During the inclusion and exclusion of participants based on the pre decided criteria the demographic details of the participants such as age, gender, residence, financial status, occupation and the socioeconomic background will be documented via a questionnaire. The audit will be considered closed after the age and gender based ratio for each gathering will be achieved. The study will involve pre and post briefing after the conduction of the intervention for a very short period of time may be half an hour (Romano, and Scott, 2014).

Proposed intervention:

The interventions that will be considered are cognitive behavioural therapies (CBT), sound eating regimen along with routine physical activities. NICE, (2014) guidelines advices to practice at least 30 minutes of routine moderate to greater intensity physical activities for 5 days every week along with dietary interventions specific for every individual for achieving weight reduction. Moreover, integrated care approach will be adopted for the participants to offer them with good co-ordination in between the following factors: public health, community care, health, and other neighbourhood services (Goodwin, Stein, and Amelung, 2017). The process of care planning develops based on the individual needs of the patient and the central part of the care approach is the involvement of the multidisciplinary care approach which will involve a social worker who will offer the emotional support via CBT approach, a registered dietician who will provide a proper diet regimen, a trained physiotherapist who will train the routine physical activities, and the utilization of apps for continuous monitoring (Herring, Wagstaff, and Scott, 2014). The integrated care approach is considered for the intervention as it helps to give better health outcome by coordination among the staff members and offers coherence of care (Goodwin, Stein, and Amelung, 2017). The CBT was taken into the plan of proposed intervention as it is scientifically evident that the emotional distress can act as a pivotal cause for certain unhealthy additions such as excessive drinking, smoking, etc. The varied forms of social pressures such as from parents, friends or the economic or cultural issues demonstrate a potential impact upon the life style of an individual (Rothbaum, Meadows, Resick, and Foy, 2000). Therefore, this model will help to identify the participants the varied factors or barriers that are affecting their psychological condition and in turn their life style and the behavioural intervention, CBT will strengthen their thinking and to overcome their unhealthy addictions. Moreover, it will offer the participants with encouragement to adhere to the habits of healthy eating and routine practice of physical activities as per the guidelines; however that will depend upon the tolerance limit of every individual (Brennan, et al., 2018).

The ultimate stage is the maintenance of the altered way of life. The relapse prevention strategies will be used to motivate the participants to keep a persistent focus on their goal and positive outcomes that is reduction is weight for a prolonged period of time (Kemppainen, Tossavainen, and Turunen, 2013).

The findings of the research investigation will be analysed using three blind group analysis and the data will be coded for the reduction of interviewer’s bias. Participants who will be able to achieve reduction of weight about 10 to 15% within the stipulated time period relative to their initial weight will be considered successful. For statistical analysis, logistic regression model will be used to comprehend the correlation between the behavioural intervention programme and the reduction in weight (Honjo, Iso, Inoue, Tsugane, and JPHC Study Group, 2010).

Evaluation of the findings

The stage of evaluation is considered to be the most crucial for the health care professionals as they will be able to comprehend better that what works better for the patient based on scientific evidence based practices. The stage of evaluation is the procedure of assessment that is autonomous, thorough of the either finished or ongoing stage of the intervention and helps to assess that up to what extent the proposed intervention has accomplished it’s goal which definitely impacts the process of decision making (Menon, et al., 2009). The process of supervision of the progress or advancement can be made while the intervention is proceeding by setting short term goals or can also be measured at the end by measuring the level of adherence to the care plan and the level of education (Hubley-Kozey, Robbins, Rutherford, and Stanish, 2013). Moreover, it is the job role of the nurses to comprehend the efficacy of the intervention on a consistent basis as if required alterations or modifications can be introduced to achieve a prolonged sustenance of the intervention (Kemppainen, Tossavainen, and Turunen, 2013). The utilization of apps for continuous monitoring process of evaluation of the participants will be done. The evaluation of the success of the proposed intervention using the above mentioned model will be conducted at the end of the programme based on the adherence level of the participants to the care plan and information offered (Kemppainen, Tossavainen, and Turunen, 2013). Moreover, the documentation of any structured plan, recordings of the sessions with the participants, assessment reports of the treatment approach along with their effectiveness will be kept which may act as a guideline for any similar study up taken in the future.

Post briefing

The participants will be involved in a follow up post intervention questionnaire which will be maximum of 10 minutes about their experience and their intention to continue the proposed change for a prolonged period of time. In this session, the participants will be also briefed about the findings of the investigation and further suggestions will be provided on how to sustain the modifications (Romano, and Scott, 2014).

Ethical consideration for the study

The participants will be offered prior information about the proposed intervention and their probable outcomes on their health at the end of the study. Informed consent will be obtained from each and every participant before conducting the study. The participants will be briefed about the rules and regulations such as they can withdraw their participation from their study at any point of time without any financial liability. The researchers will always maintain an empathetic attitude towards each participant irrespective of their caste, gender, age and cultural values (Nardini, 2014). The privacy and the confidential data of every participant will be secured via safeguarding the findings and respect will be shown towards every participant throughout the study even if they want to withdraw their participation. Codes will be assigned by the researchers to the identity of the participants and the data generated from the investigation to ensure the process of anonymity (Nardini, 2014). Moreover, the researchers should always consider the health and well being of the participants above any research purpose throughout the investigation. According to the Data Protection Act, 2018 of the UK, the findings generated from any research investigation can be stored for a minimum period of 3 years or if required up to 10 years. The electronic form of the findings will be stored within a password protected system and the hard copy of the research investigation will be stored within a locked cabinet in a secured building (Data Protection Act, 2018). This process will be taken to ensure any unauthorised access to the findings, illegal processing of the data or any kind of accidental damage. Moreover, after the utilisation of the data the memory system will be pulverised or damaged to destroy the data of the participants (Data Protection Act, 2018).

Limitations

For the power calculation of a RCT investigation, the sample size should be large, however the recruitment of large sample size for a small scale study will be difficult. The distribution of participants in an identical ratio depending on age and gender will be also difficult to achieve however, the nearest ratio will be planned to accomplish to reduce the selection bias. The study may involve high financial expenditure for the exact representation which will be a constraint for the conduction of the study and the study involves a large span of time so all the participants may not continue till the end of the investigation (Spieth, et al., 2016).

Conclusion

The study has detailed about a proposed health psychology intervention for the reduction of obesity (5 – 10%) among the focus group populace via a RCT investigation with the aid of health behaviour change interventions. It has also discussed about the evaluation strategies and the probable limitations that may be faced by a researcher while conducting the study to achieve the pre decided goal.

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