Introduction to the special section on multicultural and community psychology: clinical psychology in context

Human behavior occurs in the contexts of culture and community. Yet, clinical psychology has traditionally focused on the individual, neglecting the individual's context. The purpose of this Special Section is to address the underlying conceptual issues in integrating multicultural and community psychology within a common framework. The integration of etic and emic approaches distinguishes the research programs in these articles from others that have solely focused on universal or culture-specific approaches. Issues facing ethnic minority populations are addressed, including identification of risk and protective factors, obstacles to mental health service use, and optimal treatment effectiveness. The integration of culture and community contexts into clinical psychology is necessary for it to remain relevant in an increasingly diverse 21st century.     

Health psychology and social action

This article reviews the main epistemological approaches within health psychology. It considers the approach based on critical realism and various strategies for linking health psychology with social action. It argues that critical health psychology has a distinct contribution to make in promoting public health as part of the broader movement for social justice and health.     

Social history of health psychology: context and textbooks

Health psychology as a field of research and practice formally developed 30 years ago but it was prefigured by sustained debate within social and applied psychology about the nature of psychology and its role in society. This article considers this pre-history of health psychology and how the field has subsequently developed. It considers how its character is shaped by dominant ideas within psychology and is also enmeshed in broader social relations. To illustrate the changing character of health psychology it considers how the field is represented in a selection of popular textbooks. It concludes by considering the growth of some critical approaches within health psychology.     

Health psychology in African settings: a cultural-psychological analysis

African settings provide an important context in which to examine the relationship between cultural beliefs and health. First, research in African settings helps illuminate the sociocultural grounding of health and illness: the idea that beliefs play a constitutive role in the experience of distress. Second, research in African settings helps to illuminate the cultural grounding of health sciences: the idea that theory and practice reflect particular constructions of reality. We examine these ideas in the context of three research examples: the prominent experience of personal enemies; epidemic outbreaks of genital-shrinking panic; and fears about sabotage of vaccines in immunization campaigns.     

Health psychology and public health: theoretical possibilities

Public health has either implicitly or explicitly drawn upon a range of psychological theories. This paper identifies four areas where the application of such theory could be developed, health communication, environmental initiatives, the negotiation of behaviour and participation and empowerment. Recommendations are made regarding content, sources and recipient characteristics that can be used to develop targeted health communication campaigns. Psychology also has a role to play in informing structural approaches to prevention. To facilitate this, a framework which focuses on cues, reinforcer and barriers and an understanding of how behaviour is achieved through negotiation and interaction is outlined. Finally we highlight a role for psychology in approaches that focus on participation and empowerment in relation to health.     

Health psychology and the arts: a conversation

Critical approaches within health psychology continue to explore new methods of working and new theoretical ideas from other disciplines. One area that remains under-explored is the potential links with the arts. This special issue contains a selection of empirical and theoretical reports on the linkages between health psychology and the arts. It includes arts and health projects in clinical, community and educational contexts; projects with young and old people, projects with people from different social and ethnic background and projects using different forms of art. This article introduces the special issue and uses a dialogic format to consider some of the broader issues.     

Health psychology, embodiment and the question of vulnerability

The topic of the body is now firmly on the agenda for psychology, as it has been for sociology for some time. What contribution will health psychology make to this debate? This article argues that the biomedical view of the physical body is inappropriate for a psychology addressing the key concerns of suffering and healing. Instead, health psychology needs to theorize what it means to be embodied in the context of illness and of health care. To do this requires investigation of the practical relationships between staff and patients as well as of experiences of sufferers. By reflecting critically upon the relationship between clinical practice and the conceptualization of the body, a health psychology embracing the idea of embodiment becomes possible.     

Health behavior among Lithuania's adolescents in context of European Union

Aim

To compare health behavior patterns of adolescents in Lithuania with health behavior of adolescents in European Union (EU) in 2001/2002.

Methods

The study was carried out in conformity with the methodology of Health Behavior in School-aged Children: a World Health Organization cross-national study. Three country representative samples of schoolchildren, aged 11, 13, and 15, were surveyed in 25 EU countries and regions in 2001/2002 school year. The study instrument was a standardized questionnaire that included questions on alcohol consumption, smoking, illegal drugs use, physical activity, and other patterns of health behavior. The rate or mean values of the targeted health behavior of Lithuanian students were assessed and compared to those calculated as an average for the EU countries and regions.

Results

We found an early onset of alcohol consumption among Lithuanian boys. Lithuanian boys and girls across all age groups reported being drunk two and more times more often than their peers from other EU member states. Lithuanian 15-year-old boys smoked more often that did their European peers, while girls smoke more rarely. The prevalence of drugs (marihuana group) use among Lithuanian students is relatively low: the prevalence of drug use among 15-year-olds in Lithuania is two times lower than the prevalence in other EU countries and regions (11.2% vs 24.5% for boys and 4.5% vs 18.3% for girls, respectively). Physical activity of Lithuanian adolescents is rather high in comparison with their EU peers, although many students watch television for ≥4 hours a day. Lithuanian students did not eat sweets often, or drank soft drinks (Coca Cola and other), and they ate fruits and had breakfast every school day. With respect to hygienic habits, approximately only one in 3 boys and every second girl brushed their teeth more than once a day.

Conclusions

There are health behavior differences between adolescents in Lithuania and those in other EU countries. The disparities among health behavior of young people in EU countries and regions require Lithuanian and EU health policy to develop initiatives aimed at decreasing health behavior inequalities.Lithuania’s joining the European Union (EU) was the most significant event for the country in 2004 and one of the most important steps in the integration of Lithuania into the international community. In this context, a critical and objective assessment of population health is needed to determine the level of health in Lithuania within the EU context (1).Good health implies longer, healthier, and more productive life, higher quality of life, and better basis for steady economic growth and sustainable development of the country (2). Therefore, investment in the health of youth is doubtlessly a key priority in all EU countries. Early investments in health typically pay off later in life (3).Over the last decades, dramatic social, political, and economic shifts, along with medical and public health interventions, have radically altered the profile of adolescent health around the world. Presently dominant negative social, behavioral, and environmental factors, such as smoking, alcohol consumption, and drugs use, affect young people’s health and are the triggers for chronic non-communicable diseases in the future (4).The Health Behavior in School-aged Children (HBSC) study carried out in Europe and North America showed an early onset of smoking and alcohol use, high consumption of sweets and soft drinks, low consumption of fruits and vegetables, and frequent skipping of breakfast among the adolescents (5). It also showed that most young people did not meet the recommended physical activity guidelines and that many reported spending long hours on doing homework, watching television, and on a computer. The European School Survey Project on Alcohol and Drugs (ESPAD) study showed that cannabis use among youth in most countries was increasing and that the differences in the cannabis use rates between the western European countries and North America were diminishing (6).Many European countries have undergone social and political changes as well as economic transition. Health has suffered most where economies were unable to ensure an adequate income for all, where social systems have collapsed, and where natural resources have been poorly managed, as evidenced by a health gap between the western and eastern parts of the EU region. Reduction in health inequalities, including disparities in health behavior, between the countries and regions is the first target of the “Health for All” initiative (3).Our aim was to compare health behavior patterns of adolescents in Lithuania and those in other EU countries.     

Health psychology for children: a step-child/stepping stone

This paper presents the position that health psychology for children is not given proper attention in mainstream health psychology, which is primarily adult in orientation. It is proposed that the neglect of child-related problems in the recent Proceedings of the National Conference on Training in Health Psychology exemplifies the general orientation of mainstream health psychology, which views children's health problems primarily in terms of their effect on adult health rather than as problems that need current and immediate attention. We propose that applying a developmental perspective to the health psychology field would be one way of highlighting the fact that children's problems are unique and that children need to be viewed as something other than potential consumers of adult health psychology services or as agents for the prevention of adult health problems.     

Live organ donation: social context, clinical encounter, and the psychology of communication

Organ transplantation is increasingly available to the thousands of patients who suffer from end-organ failure. There has been an attendant increase in demand for living donor participation. This combined with a bioethical focus on autonomy increases the burden of decision on donor candidates. The authors review the history of living donor participation in organ transplantation and explore the psychological dynamics of the clinical encounter between donor and transplant surgeon. The field of communication psychology lends to the understanding of coercion and to the importance of donors possessing a status of patient-hood in the classical Hippocratic condition.     

Health psychology and discourse: personal accounts as social texts in grounded theory

Traditional social psychology has largely located the origins of the social in the mental and emotional processes of individuals. Interview and questionnaire approaches have focused on the personal account as a route to cognitive processes and personality structures. In contrast, qualitative approaches like grounded theory have highlighted the importance of discourse in the constitution of the social world, and the function of talk and text in the construction of meaning. It is argued here that the use of such approaches, informed by insights from discourse analysis and current thinking on textuality, can enable analysts to read the personal account as a socially constructed, and constructing, text. This article uses examples from psychosocial oncology and from original research on the treatment experiences of a group of cancer patients to discuss new ways of reading personal accounts as social texts.     

Health and disease in context: a community-based social medicine curriculum.

Despite the increasing attention paid to the role of social forces in determining health, most physicians finish their training ill-prepared to address these issues. The authors describe their efforts to fill that training gap for internal medicine residents at Oregon Health and Science University through a community-based social medicine curriculum, designed in 2006 in conjunction with community partners at Central City Concern (CCC), an organization addressing homelessness, poverty, and addiction in downtown Portland, Oregon. The challenge was to develop a curriculum that would (1) fit within the scheduling constraints of an established categorical internal medicine residency program, (2) give all internal medicine residents a chance to better understand how social forces affect health, and (3) help show how they, as health professionals, might intervene to improve health and health care. The authors maintain that by developing this curriculum with community partners--who took the lead in deciding what residents should learn about their community and how they should learn it--the residency program is providing a relatively brief but extremely rich opportunity for residents to engage the personal, social, and health-related issues experienced by clients served by CCC.The authors first provide a brief overview of the curriculum and describe how the principles and practices of community-based participatory research were used in its development. They then discuss the challenges involved in teaching medical residents about social determinants of health, how their academic-community partnership approaches those challenges, and the recently established methods of evaluating the curriculum.     

Commentary. Health and behavior CPT codes: an opportunity to revolutionize reimbursement in pediatric psychology

Recently accepted codes in the Current Procedural Terminology system permit licensed pediatric psychologists to deliver psychological services utilizing billing codes that focus on improving medical and physical health. They potentially allow pediatric psychologists to obtain third-party reimbursement for services within a biopsychosocial model of care without requiring a concurrent psychiatric diagnosis. These codes represent a potential major paradigm shift whereby the services of a pediatric psychologist are provided and billed within the context of physical health care. Information is provided on the history of these codes along with detailed information regarding their utilization. Future directions for implementation, teaching, and research are provided along with a strong encouragement for use of these codes by pediatric psychologists.