Chapter 8: Introduction to

Models of Interpersonal
Influences on Health Behavior
Overview

Introduction

 Overview of Theories and Models

Future Directions
Introduction
Introduction

Social connections influence health

• Mechanisms that link individuals’ social

contexts with health effects revolve around
two social processes:
1. Social support
2. Social influence
Introduction

Fundamental assumption

Behavior is shaped by an individual’s social connections

• One of the most consistent findings in public health

literature

• Documented divergent changes in social fabric over the

last two decades, including
– Decreased participation in traditional social groups and
structure
– Growth in social media and virtual communications
Overview of Theories and
Models
Social Cognitive Theory

• Reciprocal determinism: human agency

and the environment interact and influence
each other, resulting in individual and social
changes
– Interaction of personal cognitive factors, human
behavior, and social environmental influences

• Individuals have the capacity to change

and build the environment
Social Cognitive Theory

Concepts include:
– Self-efficacy
• Widely used and modifiable factor
• Sources include personal experiences, persuasion,
vicarious experiences

– Observational learning/modeling
• Potential source of intervention
• Difficult to empirically test
– E.g. media influence on knowledge, beliefs, behaviors
Models of Social Support and Health

• Conceptualize how social support is linked

to health. Two distinct types of support:
– Perceived support
• Expectation that others will provide support
• Consistently associated with better health
– Received support
• Actual provision of support
• Relationship with health more complicated
Models of Social Support and Health

• Support providers should be trained to:

– Assist the support recipient select and articulate
the most helpful form of support
– Ensure that the support recipient believes support
is available when it is needed

• Depending on the context, social

relationships can be:
– Sources of support
– Sources of conflict and stress
Social Networks and Health Behavior

• Social Network Theory

– Focuses on the structure and systems-level
properties of the web of social relationships of
individuals

• Social Network Analysis

– Provides tools for understanding how social
contexts influence decision-making processes
and actions
Social Networks and Health Behavior

• People tend to overestimate the prevalence of

unhealthy behaviors and underestimate the
prevalence of healthy behaviors among peers

• Social network analysis can be used to identify

maximally-effective change agents
– Examples of social network positions include:
• Central members: people with many ties to others
• Bridging members: people who link disparate sub-
groups within a network
Stress, Coping Adaptation, and Health Behavior

• Transactional Model of Stress and Coping

– How individuals experience and handle stress depends
on stressor appraisal and available resources to cope
with stressors

• Stressors can be:

– Acute
– Chronic

• Differential exposure to stress may help explain

health disparities based on socioeconomic status
Stress, Coping Adaptation and Health

• Two Competing Hypotheses:

– Adaptation
• Strong reaction at first exposure to stressor, followed by
adaptation over time that diminish adverse stress
– Accumulation
• Successful coping with stressors during first
encounter(s), but ability to cope is exhausted as
exposure continues

• Recent advances support accumulation

hypothesis
Stress, Coping Adaptation and Health

• It is important to match the coping strategy to

the characteristics and context of the stressor

• “Shift and persist” coping in low SES contexts

– Involves trying different coping strategies in
response to stressors, while maintaining
confidence that the stressor can be successfully
managed or addressed
Interpersonal Communication

Focus on the patient-provider relationship

• Goals of this relationship:

– Accomplish tasks (Task-driven)
– Manage relations (Relational)

• Patient-provider communication influence

health outcomes, both directly and
indirectly
Interpersonal Communication
• Relationship-centered healthcare
– Shared power between providers and patients
– Provider reserves judgment of the patient

• The study of patient-provider relationships can

provide starting points for interventions

• Increased empirical research is needed to

support the link between patient-provider
relationships and health outcomes
Summary & Future
Directions
Summary & Future Directions
• Individual’s relationships influence learning,
emotional responses, feelings of belonging,
decisions, and coping strategies

• Areas for future research include:

– Matching the strategy to the situation
– Understanding the role of social class, race and
ethnicity
– Examining how technology influences social
support, networks, and health behaviors
 Chapter 9:
How Individuals, Environments,
and Health Behaviors Interact:
Social Cognitive Theory
Overview

Overview & Historical Developments

Constructs of SCT

Application of Theory

Future Directions and Summary

Overview & Historical
Developments
Social Cognitive Theory
Social Learning Theory
(Bandura, 1977)
• Behavior is meditated by cognitive processes that
occur through observation of social modeling
– Influenced by:
• Importance of person modeling behavior
• Emotionally charged events

• Departure from previous models explaining behaviors

as conditional reflexes to positive/negative
reinforcement or punishment
– Skinner
Social Cognitive Theory

Behavioral
Individual’s
behavior
explained by the
interaction and
combination of: Social- Personal
environmental Cognitive

Reciprocal determinism
Social Cognitive Theory

• One of the most- widely applied models

• Various uses:
– Promote adoption of healthy habits
– Reduce habits that impair health
– Behavior change maintenance
– Relapse prevention
– Personal and group level changes
Major Constructs of SCT
Cognitive Influences on Behavior

• Prediction of behavior and behavior change are

regulated by forethought and a personal sense of
control (agency)

• Personal cognitive factors include ability to self-

determine behavior and reflect upon and analyze the
experience
Constructs:
1. Self-efficacy
2. Collective efficacy
3. Outcome expectations
4. Knowledge
Cognitive Influences on Behavior

Self-efficacy
– Unifying and seminal construct of SCT
– Regulates processes that enhance or impede
behaviors
• A high level of self-efficacy indicates increased confidence
in ability to succeed
Formed through:
1. Previous mastery experience
2. Vicarious experience
3. Social persuasion
4. Emotional arousal (best practiced under stress-free
conditions)
Cognitive Influences on Behavior

Collective efficacy
– Applies to situations where individuals do not
have control over the social
conditions/institutions that affect their lives

– Groups can develop social cohesion and take

action for common good

– Perceived collective efficacy fosters groups’

motivational commitment
Cognitive Influences on Behavior

Outcome Expectations

– Expectations about the consequences of

taking action
• Physical outcome expectation
– Pain, pleasure, disease
• Social outcome expectations
– Approval, disapproval, power
Cognitive Influences on Behavior

Knowledge
– Understanding the health risks and benefits of
different practices and the information necessary to
perform the behavior

– “Precondition for change”

• Usually insufficient alone to produce behavior change

– Approaches
1. Describe health risks and benefits
2. Scaffolding or step-by-step presentation
Environmental Influences
• Social-environmental factors are aspects of the
perceived and/or physical environment that
promote or discourage engagement in a
particular behavior

• Social-environmental factors include:

1. Observational learning
2. Normative beliefs
3. Social support
4. Opportunities and barriers
Environmental Influences

Observational Learning
• People learn by observing behaviors and
consequences
– Influenced by:
• Characteristics of the role model
• Characteristics of the learner
1. Attention
2. Retention
3. Production
4. Motivation
Environmental Influences

Normative Beliefs

• Cultural norms and beliefs about the social acceptability

and perceived prevalence of a behavior
– Most individuals overestimate the prevalence of undesirable
behaviors among peers
– Perceptions of peer norms used as standard to compare own
behaviors

• Motivation to comply with social norms influenced by

expected social consequences and self-evaluative
consequences
Environmental Influences

Social Support
• Perception of encouragement and support a
person receives from their social network
1. Emotional
2. Esteem (Validation)
3. Informational
4. Instrumental (Materials or equipment)

• Aids in adherence to new behaviors and

contributes to perceived self-efficacy
Environmental Influences

Barriers and Opportunities

• Attributes of the environment that make
behaviors harder or easier to perform
1. Cognitive
• Example: self-efficacy
2. Environmental
• Example: infrastructure to perform physical
activity
Supporting Behavioral Factors

• Health behaviors can be classified as

either health-enhancing or health-
compromising

• Behavioral constructs include:

1. Behavioral skills
2. Intentions
3. Reinforcement and punishment
Supporting Behavioral Factors

Behavioral Skills
• An individual must know the significance of the
behavior and know how to perform the behavior

• Behavior skill acquisition and self-regulation are

achieved through:
1. Self-monitoring
2. Goal setting
3. Feedback
4. Self-reward
5. Self-critique
Supporting Behavioral Factors

Intentions
• Serve as an indicator of readiness to
perform a behavior
– Specific intentions with a relatively short time
frame are powerful predictors of future
behavior
– Operate through
1. Capacity for forethought
2. Goal setting
Supporting Behavioral Factors

Reinforcement and Punishment

• Behavior can be modified through the provision or

removal or rewards or punishments
– Tangible
– Social

• Reinforcer: stimulus that strengthens the behavior

• Punishment: stimulus that weakens the behavior
Application of SCT:
CATCH
CATCH

Coordinated Approach to Child Health

• Developed using SCT as guiding

theoretical framework
– Reciprocal determinism: targeted cognitive,
environmental, and behavioral factors that
influence health behaviors related to obesity
prevention
CATCH Components & Activities

1. Classroom curricula
2. Physical education program
3. Cafeteria program
4. Family home materials

• Behavioral capacity: GO, SLOW, WHOA foods

• Intentions: goals for different food categories
• Self-control: preparation of healthy snacks in
school and at home
CATCH Components & Activities

• Social environment: teachers and parents

reinforce consumption of healthy foods and
physical activity

• Self-efficacy: narratives with role models for

students; practice new skills in safe and
supportive environment

• School environment: healthier cafeteria food,

additional physical activity
CATCH Results

• Schools implementing CATCH reduced or

slowed the prevalence of obesity
compared to control schools

– Effective with low-income and diverse

populations

– Behavioral changes maintained at 3-year

follow-up
Future Directions
and Summary
Future Directions
• Interventions need to adequately consider
environmental influences on health behavior

• Programs often rely too heavily on didactic knowledge-

based strategies and require more emphasis on
behavioral capacity

• Consider SCT in the context of the socio-ecological

model

• Development of reliable and valid measurement tools

Summary

• SCT emphasizes the interaction of

cognitive, environmental and behavioral
influences on health behaviors
Reciprocal determinism

• Can be applied to a diverse array of health

behaviors, populations, and settings
 Chapter 10:
Social Support and Health
Overview

Introduction and Historical Perspectives

Conceptualization of Social Support

Theoretical Models

Empirical Evidence and Applications

Introduction & Historical
Perspectives
Introduction

• There is robust evidence linking social

support and health

• Understanding the nature and types of

support and their associations with health
is necessary to develop effective
interventions
Historical Perspectives
• Durkheim (1951) studied suicide rates and social
environment

• Reviews by Cobb (1976) and Cassell (1976) found

social support was important in dealing with
stressful life events and influenced biological
process

• In a longitudinal study, Berkman and Syme (1976)

found a relationship between low social
connectedness and overall mortality
Historical Perspectives

• A community-based epidemiological study

by Blazer (1982) found that functional
social support predicted lower mortality

• In a review of prospective studies House

et al. (1988) concluded available evidence
supported a relationship between social
integration and mortality
Conceptualization of
Social Support
Conceptualizations of Social Support

Social Relationships
1. Structural
• Existence and interconnectedness among differing
social ties and roles
• Measures: density, size, number of social contacts
2. Functional
• Functions provided or perceived to be available
by social relationships
• Measures: actual and perceived support, aid,
resources
Functional Social Support

• Supportive individuals provide different

types of support
1. Emotional
2. Informational
3. Tangible or Instrumental
4. Belonging

– Perceived or received
• Moderate correlation, distinct constructs
Theoretical Models
Social Support Health

Models suggest social support influences

both psychological and behavioral
processes

Linked to multiple health outcomes:

– Health behaviors
– Adherence to medical regimens
– Development and course of chronic diseases
– All cause mortality
Theoretical Models

1. Stress-buffering pathway
– Social support diminishes the negative health
effects of stress

2. Direct effect pathway

– Health-enhancing influence of social support

3. Stress-prevention pathway
– Social support prevents stress
Theoretical Models

Stress-buffering
Social support may decrease exposure to
negative life events and certain stressors; may
decrease association between stress and health
outcomes

• Influence cognitive processes

• Encourage proactive coping
• Decrease exposure to “secondary stressors”
Theoretical Models

Stress-buffering

Matching hypothesis: stress-buffering is most effective

when type of support matches the needs of the stressful
event

– Informational and tangible support most effective

for controllable events

– Emotional and belonging support most effective for

uncontrollable events
Theoretical Models

Direct Effect
Social support is effective more generally regardless of stress levels

• The direct effect of structural measures was seen as representing the

influence of social support on social identity, via:
• direct (e.g., demands from others to behave more healthily)
• indirect (e.g., behaving more healthily because relationships add greater life
meaning)

• Functional support can also have direct effects on outcomes by

promoting a sense of:
• connection
• self-esteem
• control over life due to knowing that one is cared for and supported by
others
Empirical Evidence and
Application
Social Support and Health

Strong evidence
– Perceived support is directly related to beneficial
influences on biological health (direct effect)

– Perceived support to linked to better health

behaviors (indirect effect)
• Physical activity, smoking and alcohol consumption,
sleep

– Social support is associated with better adherence

to treatment regimens
Social Support and Heart Disease

• Coronary heart disease (CHD) is a leading

cause of death
• Social support is a predictor of
hospitalization and lower mortality
Social Support and Mortality

• Low social integration predicts higher age-

adjusted mortality risk
– Individuals with greater social connections
have 50% greater likelihood of survival
compared to those in low social connections
(Holt-Lunstad, Smith, & Layton, 2010 )

• Perceived support appears to be a more

important predictor of lower mortality than
received support
Additional Consideration

Relationship Quality

• Relationships can buffer negative health

effects of stress

• Relationships may also be the source of

stress, with interpersonal stress being
especially impactful (e.g. marital distress)
Additional Considerations

Technology
• Dramatic shift in communication of social support
• Potential advantages:
– Additional source of support
– Connect people in different places and times
– People with stigmatized conditions can seek
anonymous support
• Potential disadvantages:
– Texting not as effective as talking
– Interferes with face-to-face support
Application: Diabetic Control

• Conducted an RCT to compare guided peer

support with standard nurse care to promote
glycemic control among diabetics

– Intervention: patients paired with age-matched

peers to provide and receive support; 3 hour
group session with nurse; encouraged to have
weekly phone calls with peer support

– Control: 1.5 hour group session with nurse

Application: Diabetic Control

• Results at six-month follow-up:

– Intervention group showed significant
improvements in glycemic control compared
to nurse support only (control) group

– Social support was most beneficial to those

lacking social support resources in their
network
 Chapter 11:
Social Networks and Health
Behavior
Overview

Introduction and Historical Perspectives

Social Network Theory

Applications and Interventions

Summary
Introduction & Historical
Perspectives
Introduction

• Social networks influence health behaviors

– Shift focus from the individual to relationships
with others

• Social networks measure relationships

and treats these ties as objects of study
– Social networks differ from social support
• Social support measures resources individuals
have within their social network and are one
component of social networks
Historical Perspective

• 1934: Moreno developed a social network

of elementary school students

• 1950’s: various SNA/sociometry research

groups were formed

• 1970’s: launch of International Network for

Social Network Analysis
Historical Perspective

• 1980’s: first computer program for SNA;

useful during AIDS epidemic

• 2000’s: access to the internet, big data,

visualization techniques, and new
computing technologies have made SNA
more feasible and meaningful
Social Network Theory
(SNT)
Social Network Theory

Three main components:

1. People take actions based on their network
environment
2. A person’s position in a network influences
his/her behaviors
3. Networks have structure, and these network
properties influence system performance

There is a dynamic relationship between the micro-

and macro-levels of network analysis
Social Network Theory

Network environment

• Homophily is the tendency of individuals to

associate with people similar to themselves

• Derived from:
1. Influence: when an individual changes his/her
behavior to be the same as their network partners
2. Selection: when an individual changes his/her
network to be compatible with his/her behavior
Example Social Network
Social Network Theory

Network environment
• Individuals are influenced by their immediate social network
both in their behaviors and network choices
– High or low thresholds to action

• Exposures are weighted by:

Connectivity to Degree of
Tie strength Tie Distance the same third equivalence in
parties network position

Participating in
Attributes of the
Centrality of ties activities
networks
together
Social Network Theory

Positions in Networks
• Position types:
– Central: prominent position in the network
• Sensitive to community norms and values
– Bridging: connects otherwise disconnected groups
• Access to different subgroups
• May be less beholden to the status quo
• Less constrained by immediate personal network
– Peripheral: individuals free from social norms
• Less constrained in their behavior, so freer to innovate
• Could be issues of isolation
Social Network Theory

Structural or Network Properties

– Homophily
• Networks with high rates of homophily are more
resistant to change
– Reciprocity
• High rates of reciprocity are indicative of trusting
relationship and a cohesive network
Social Network Theory
Structural or Network Properties
– Transitivity
• Friends of friends become friends
• Dense pockets of interconnectedness accelerates behavior
change within clusters and slows it between clusters
– Centralization
• Extent that ties are focused around one or a few nodes
• Central hubs can coordinate activities for the network; may be
less sustainable than less-centralized hubs
– “Small World”
• The distance between any two people in the network is less than
would be expected in a random network of the same size and
density (number of links)
• Six degrees of separation
Social Network Theory

Individual (Micro) and Network (Macro)

Level Interaction
• Important to consider interaction of micro and
macro levels on behavior
– Being central in a centralized network versus being
central in a decentralized network
– Having a heterophilous tie in a network with high rates
of homophily
Applications and
Interventions
Application

Contraception Decision-Making
• Rogers (1979) used SNT to investigate
contraceptive use and adoption in Korean
villages
– Women were more likely to adopt contraception
use as more network partners used contraception
– Centrality was associated with behavior adoption
– Behaviors of village leaders were imitated by
others
Interventions
• The most frequent network intervention is the
identification of opinion leaders
– Individuals identified as change agents or
champions
• In an intervention to promote vaginal birth after a C-
section birth, recruiting physicians identified as network
opinion leaders resulted in a reduction in the number of
C-sections

• The Internet and online communities provide

new opportunities to interact and influence
behavior change
Network Intervention Choices for Various
Theoretical Mechanisms Driving Behavior

• Strategies for Interventions

– Identifying Individuals to be Change Agents
• Leaders or Central Nodes
• Bridges
– Segmentation - Locating Subgroups within the
Network
• Can target a message more specifically to the
subgroups
– Induction – Inducing change using the
network structure
• Word of Mouth (diffusion of information)
• Snowballing (reaching hard to reach groups)
• Matching (homophily)
– Alteration – Changing the network
• Deleting or adding nodes
• Deleting or adding links
Summary
Summary

• Social Network Theory

– Concerned with mechanisms by which
networks influence behavior

• Social Network Analysis

– Networks can be used as a method to
measure or understand constructs in other
theories
Summary

• Systems are composed of units that

interact and are connected in varying
relations
– Range from individual to organizational level
– Account for profound and enduring influences
on health behaviors
– Interventions need to take into account these
relations to capitalize on the opportunity to
improve health outcomes
Chapter 12: Stress, Coping,
Adaptation, and Health
Behavior
Overview

 Introduction

 Historical Concepts

 Transactional Model of Stress and Coping

 Application

 Future Directions and Summary

Introduction
Introduction: Key Terminology
Stress
• Perception that a situation exceeds psychological,
social, or material resources to cope

Stressors
• Demands made by the environment that upset balance
or homeostasis, affecting physical and psychological
well-being and requiring action to restore equilibrium

Resilience
• Resistance to the negative impacts of stress
Introduction

• Stress can contribute to illness through:

– Direct physiological effects
– Indirect effects via maladaptive health behaviors

• Stress does not affect all people equally

• The impacts of chronic stress and acute stress may differ

• An understanding of stress and coping may be helpful in

developing strategies to improve coping and enhance
health
Historical Concepts
Historical Concepts

• Knowledge about stress, resilience, and

coping come from many disciplines:
– Biology, psychophysiology, epidemiology,
psychology, sociology, medicine

• Early work focused on physiological

reactions to stress
– “Fight-or flight”
– General Adaptation Syndrome
Historical Context

• 1960’s/70’s: Identification and

quantification of potential stressors and life
events, e.g., Social Readjustment Rating
Scale (SRRS)

• 1960’s/70’s: Development of the

transactional model
– Posits that different people can appraise
identical events or situations differently
Historical Context
• 1970’s/80’s: Researchers began investigating
chronic and daily exposures to stress
– Chronic stressors: persist over time, affect multiple
life roles, and erode the personal, social, and
material resources needed to cope with stress

• 1990’s: Research on the negative health

impacts of childhood exposure to adversity
– Felitti et al, Adverse Childhood Experiences (ACE)
Historical Context
• Recent research includes:

– The links among coping, disease, personality dispositions and

psychological states

– The effect of chronic stressors on the nervous and endocrine

systems

– The life course perspective, which posits that earlier life events can
influence health later in life

– The integration of biological and social perspectives

– The resilience perspective, which contends that individuals possess

traits/resources that promote recovery after stressor exposure
The Transactional Model
of Stress and Coping
Transactional Model of Stress and Coping

• A classic framework for evaluating

processes of coping with stressful events

• When faced with a stressor, a person:

– Evaluates potential threats: primary appraisal
– Evaluates his/her capacity to alter the
situation and mange negative emotional
reactions: secondary appraisal
Appraisals
• Primary Appraisal
– Personal risk and threat severity can prompt
coping efforts
– Heightened perceptions of risk can also
generate distress or escape-avoidance
behaviors
• Secondary Appraisal
– Related to perceptions of control over illness
– High perceived control may increase likelihood
of adopting recommended health behaviors
Coping Efforts
• The effects of appraisals are mediated by
coping strategies
– Problem management: directed at changing
the stressful situation; more adaptive for
changeable stressors
– Emotional regulation: directed at changing the
way one thinks or feels about a stressful
situation; more adaptive for unchangeable
stressors
Coping Efforts
• When a stressor is perceived as highly
threatening/uncontrollable, a person is more likely
to use disengaging coping strategies
– Examples: distancing, cognitive avoidance, distraction,
and denial

• Several theoretically driven scales to assess coping

have been developed, including:
– Ways of Coping Inventory
– Multidimensional Coping Inventory
– Coping Orientations to Problems Experienced
Coping Efforts
• There are psychological benefits of active
and/or acceptance coping strategies when
compared to avoidant and/or disengaging
strategies
– Spirituality is an example of an adaptive
coping strategy
• The effects of coping strategies may
depend on a person’s individual coping
style and perceptions of support
Coping Outcomes
• Represent a person’s adaptation to a
stressor and may change over time

• Main categories of coping outcomes:

Emotional Functional Health

well-being status behaviors
Transactional Model of Stress and Coping
Coping Styles

• Coping styles are stable dispositional

characteristics that reflect generalized
tendencies to interpret and respond to
stress (extension of the Transactional Model)
– Considered to be enduring traits
– Can moderate the impact of stress on coping
processes and outcomes
– Can have direct effects on the outcomes of
stressful situations
Coping Styles
Optimism Having positive generalized expectancies for outcomes

Found to be a significant predictor of positive physical health across

outcomes
Benefit Refers to the act of finding benefit in a stressor
finding
Shown to be associated with positive reappraisal and active coping

Informational Unclear whether information seeking is adaptive across situations

seeking and people
Associated with increased knowledge among cancer patients

Social Support Evidence exists for the direct effects of social support on health outcomes
Stress buffering: social support is more effective if stress is present/ worsens
Can be harmful when social ties discourage disclosure/give negative support
Coping and Health Disparities
• Social factors such as racism and discrimination
are thought to have both direct and indirect effects
on health
– Racism may indirectly influence health via
socioeconomic status; it may directly influence health
by acting as a stressor

• The John Henryism hypothesis posits that that

persistent and highly active coping coupled with
severe constraints can result in negative health
effects
Stress, Coping and Human Physiology

• Acute stress involves activation of the

hypothalmic-pituitary-adrenal (HPA) axis
and/or the sympathetic nervous system
– It may lead to enhanced or impaired immune
function

• Chronic stress has clear adverse impact

on immune function
Stress, Coping and Human Physiology

Chronic stress
• Allostatic load model
– Describes the physiological impacts of “wear and tear” that
individuals experience when chronically exposed to
stress/stressors

– Long-term activation of regulatory systems promotes stress

related disease
• The prolonged release of cortisol is an example of a stress
hormone that leads to immune impairment when released
chronically

– Model is not without controversy and requires further testing

Application
Prenatal and Infancy Nurse
Home Partnership Program

• A randomized control trial tested the

program’s effect on reduced risk of child
maltreatment among high-risk mothers
– Provided education and taught effective
coping skills to mothers
– Nurses visited mothers during pregnancy until
age two of child
– Encouraged education completion,
contraception use, and employment
Prenatal and Infancy Nurse
Home Partnership Program

• Results:
– There was a positive impact on mother’s
welfare use, child maltreatment, child injuries,
and criminal behavior during adulthood

– Findings from a 19-year follow-up were mixed

• Found decreased crime involvement among girls,
but not among boys
• No lasting effect on substance use/abuse,
contraception use, number of sexual partners, etc…
Future Directions and
Summary
Future Directions

• There has been a movement toward

longitudinal studies that incorporate
biomarker indicators of allostatic load
– Additional studies are needed

• Adverse childhood experiences have been

included in the Behavioral Risk Factor
Survey – more information will emerge
Summary
• The relationships between stress, coping,
adaptation, health, and the life course are complex
– Current knowledge comes from a range of disciplines

• There is consistent evidence that chronic

stressors can be detrimental to health

• Coping strategies are likely influenced by

personality, cognitive, socioeconomic, and
situational factors
 Chapter 13:
Interpersonal Communication in
Health and Illness
Overview

 Introduction

 Conceptualization of Relationship-Centered
Healthcare

 Key Functions of Provider-Patient Communication

 Communication Predictors of Health Outcomes

 Future Directions and Summary

Introduction
Introduction

Interpersonal communication is associated with:

Quality of Illness Adaptation

Disability Death
life symptoms to illness

Interpersonal communication and health are

influenced by social determinants, such as:

Education Income Employment Occupation Place

Introduction

Key Assumption of Interpersonal

Communication Theories:
Relationships between people are at the
heart of behavior, and expectations
regarding behavior are products of these
relationships
Introduction

• Provider – Patient interactions may

influence health in various ways:
– Promote or inhibit the disclosure of
illness behaviors
– Influence adherence to medical
regimens and decision-making
– Support and enhance the chances of
behavior change
 Conceptualization of
Relationship-Centered
Healthcare
Relationship-Centered Healthcare

• Promotes shared power between providers and

patients

• Recognizes the mutual interplay in communication

between patients, providers, and families

• Validates importance of:

Shared
Relational Self- Reciprocal Difference and Authentic
decision-
processes awareness processes diversity participation
making
Relationship-Centered Healthcare

• This model has been embraced in medical

education and practice, although clinical
implementation is challenging

• New technologies may both help and

hinder communication. Examples:
– Exam room computers
– Videoconferencing
– Email
Key Functions of
Provider-Patient
Communication
Provider - Patient Communication

Key functions
1. Relational
– Fostering healing relationships and
responding to emotions

2. Task-driven
– Making treatment decisions, exchanging
information, and enabling self-management
Relational Functions

• Relationship-centered care assumes a

desire for relationships based on trust,
respect, engagement, and support

• Strong relationships can indirectly improve

health through:
– Continuity of care
– Patient satisfaction
– Commitment to treatment plans
Relational Functions
• Validating and responding to emotions
– May be difficult when emotions are not expressed
explicitly
– Requires provision of clear and understandable
disease-specific information
– May reduce patient anxiety and depression

• Effective communication can:

– Encourage better quality of life
– Alleviate distress
– Facilitate patient’s ability to cope
Task-Driven Functions

• Focused on information exchange

– Based on reciprocal efforts of clinicians and
patients
– Improved by active patient participation,
supportive communication, and understandable
care information

– Shaped by:
• Family members, friends, and other relationships
• Individual concerns and beliefs about illness
• Provider and patient literacy
Task-Driven Factors
• Making treatment decisions
– Shared decision-making to address treatment options, risks
and benefits, self-efficacy, expectations and understanding,
and follow-up

• Enabling patient self-management

– Navigational help, supporting patient autonomy, and guidance
on better self-care

• Managing uncertainty
– Making meaning of medical information
– Uncertainly can arise from too little, too much, or the wrong
kind of information
Communication Predictors
of Health Outcomes
Communication Predictors of Health

• There are a lack of theoretical models that

explain how and why communication
predicts health outcomes

• Communication processes occur during,

immediately after, and weeks and months
after patient-provider interactions
Communication Predictors of Health

• Communication predicts:
– Satisfaction
– Adherence
– Malpractice

• Social environments can facilitate or

impede behavior changes depending on
the context
Communication and Health Pathways

• Communication can influence health

through direct and indirect pathways:
– Communication increases patient knowledge
on how to follow medical regimens
• Example of direct pathway: chemical agents treat
diseases and improve health
– Communication affects motivation and
cognitive processes
• Example of indirect pathway: Motivation can
influence health-related behaviors
Future Directions and
Summary
Future Directions
• Better understanding of the link between
communication processes and health through
– Longitudinal studies
– Development and improvement of theoretical
models and measures

• Explore additional variables related to patient-

provider encounters, especially:
– Social environments
– Media environments
– Healthcare system
Summary

Six communication functions:

Establish and Exchange and Validate and

maintain manage respond to
relationships information emotions

Enable patient
Manage Decision-
self-
uncertainty making
management