Poverty and Mental Health Practice: Within and Beyond the 50‐Minute Hour

Despite the high and increasing prevalence of poverty in the United States, psychologists and allied professionals have done little to develop mental health interventions that are tailored to the specific sociocultural experiences of low‐income families. In this article, we describe the sociocultural stressors that accompany the material deprivations of poverty, and the mental health difficulties to which they often give rise. Next, we outline the psychosocial and class‐related issues surrounding low‐income adults’ access to and use of mental health services and suggest a conceptual framework to guide the modification of mental health practice to better accommodate poor peoples’ complex needs. This framework describes opportunities for practice modification at three levels of intervention, beginning at the individual level of traditional individual psychotherapy and subsequently targeting increasingly broad contextual elements of poverty.     

Imagining roles for epigenetics in health promotion research

Discoveries from the Human Genome Project have invigorated discussions of epigenetic effects—modifiable chemical processes that influence DNA’s ability to give instructions to turn gene expression on or off—on health outcomes. We suggest three domains in which new understandings of epigenetics could inform innovations in health promotion research: (1) increase the motivational potency of health communications (e.g., explaining individual differences in health outcomes to interrupt optimistic biases about health exposures); (2) illuminate new approaches to targeted and tailored health promotion interventions (e.g., relapse prevention targeted to epigenetic responses to intervention participation); and (3) inform more sensitive measures of intervention impact, (e.g., replace or augment self-reported adherence). We suggest a three-step process for using epigenetics in health promotion research that emphasizes integrating epigenetic mechanisms into conceptual model development that then informs selection of intervention approaches and outcomes. Lastly, we pose examples of relevant scientific questions worth exploring.     

Self-reported outcomes of a randomized trial comparing three community health worker interventions for diabetes prevention among Cambodian Americans with depression

ObjectiveCambodian Americans have complex, interrelated and persistent medical and mental health problems stemming from genocide and the social determinants of health. We examined changes in multiple domains of self-reported health outcomes from a diabetes prevention trial. Methods: Cambodian Americans with depression and high risk for diabetes (n = 188) were randomized to one of three community health worker interventions: lifestyle vs lifestyle plus medication therapy management vs social services. Assessments were at baseline, 12- and 15-months. Results: The typical participant was 55 years old, female, earned below $20,000 annually, and had 7 years of education. About one-third were taking antidepressant medication and over half had elevated depressive symptoms. Relative to social services, lifestyle and lifestyle plus medication therapy management were both similarly effective at increasing diabetes knowledge, nutrition habits, sleep quality and decreasing pain; 2) lifestyle alone was superior to social services for self-reported health; and, 3) all three groups showed improved anxiety and insomnia. There were no effects on physical activity or physical functioning. Conclusion: Community health worker interventions have multiple benefits beyond delaying diabetes. Practice Implications: Health promotion programs that are designed and delivered appropriately can impact even hard to reach and hard to treat groups.     

Understanding persuasion contexts in health gamification: A systematic analysis of gamified health behavior change support systems literature

BackgroundGamification is increasingly used as a design strategy when developing behavior change support systems in the healthcare domain. It is commonly agreed that understanding the contextual factors is critical for successful gamification, but systematic analyses of the persuasive contexts have been lacking so far within gamified health intervention studies.Objectives and methodsThrough a persuasion context analysis of the gamified health behavior change support systems (hBCSSs) literature, we inspect how the contextual factors have been addressed in the prior gamified health BCSS studies. The implications of this study are to provide the practitioners and researchers examples of how to conduct a systematic analysis to help guide the design and research on gamified health BCSSs. The ideas derived from the analysis of the included studies will help identify potential pitfalls and shortcomings in both the research and implementations of gamified health behavior change support systems.ResultsWe systematically analyzed the persuasion contexts of 15 gamified health intervention studies. According to our results, gamified hBCSSs are implemented under different facets of lifestyle change and treatments compliance, and use a multitude of technologies and methods. We present a set of ideas and concepts to help improve endeavors in studying gamified health intervention through comprehensive understanding of the persuasive contextual factors.ConclusionsFuture research on gamified hBCSSs should systematically compare the different combinations of contextual factors, related theories, chosen gamification strategies, and the study of outcomes to help understand how to achieve the most efficient use of gamification on the different aspects of healthcare. Analyzing the persuasion context is essential to achieve this. With the attained knowledge, those planning health interventions can choose the ‘tried-and-tested’ approaches for each particular situation, rather than develop solutions in an ad-hoc manner.     

‘We just need to find space for them to practice so that we can help to make a stronger society’: Perceived barriers and facilitators to employing health psychologists in UK public health and clinical health settings

Introduction

In recent years, health psychology has received significant attention within the health sector, due to its application to understanding influences on health and well-being and translation of health psychology into interventions to support behaviour change. The number of health psychologists in public health and healthcare settings is growing but remains limited, and is it unclear why. This study aimed to explore the views of potential and current employers of health psychologists, to elucidate barriers and facilitators of employing health psychologists in healthcare settings.

Methods

Semi-structured interviews were carried out to explore the experiences of working with and/or employing health psychologists. Opportunities and barriers were explored for increasing access to health psychology expertise in the NHS and public health. Interviews were analysed using inductive thematic analysis.

Results

Fifteen participants took part in interviews. Participants were mid-senior-level professionals working in varied healthcare settings and/or academic institutions. The majority had experience of health psychology/working with health psychologists, whilst others had limited experience but an interest in employing health psychologists. Three key themes were identified: (1) the organizational fit of health psychologists, (2) perception of competition for roles and (3) ideas for changing hearts, minds and processes.

Conclusion

Barriers exist to employing health psychologists in healthcare settings. These barriers include misunderstandings of the role of health psychologists and the need to preserve other disciplines due to perceived competition. Recommendations for change included showcasing the benefits and skills of health psychologists and having transparent conversations with employees and multi-disciplinary colleagues about roles.     

‘Prognostic -Omic Clusters’ (POCs): A novel approach to health and disease

The concept of disease is central to modern medicine and society’s concept of health and illness. Its recognition and nomenclature are based on correlating clinical syndromes, underlying morbid pathologies and pathophysiologies. This conceptualization is being challenged by the advances in the field of “-omics” (e.g. proteomics) where arrays of compounds are assayed. Complex mathematical algorithms of their results reveal clusters that are prognostically important, yet not recognized as disease states (Prognostic -Omic Clusters, -POCs). At a given point in time, they are termed Static-POCs. However, the dynamism of the body’s physiology should be incorporated to this concept. This requires using the patterns of the rates of change of these ‘-omics’ (Dynamic-POCs), a method used in ICU settings. The latter has yielded prognostically important patterns of the rates of change of several physiological parameters. These Static and Dynamic POCs will become apparent in ‘healthy’ individuals, and their progress ought to reveal unique paths of progress towards disease states. This will enable interventions for prevention at a very early stage. The margins between health and diseases will blur, and diseases as a concept will become increasingly redundant with major implications to clinical practice and preventive health.     

Society of pediatric psychology presidential address: opportunities for health promotion in primary care

OBJECTIVE: To set an agenda for health promotion in primary care settings. METHODS: This is a review of the scientific bases of child development as applied to pediatric psychology and health promotion. RESULTS: Primary care is an ideal setting for health promotion because there is a "hidden morbidity" of children with unrecognized and untreated behavioral and developmental problems that, if unresolved, may lead to psychiatric and physical disorders and increased use of the health care system. Although pediatric psychologists endorse the importance of health promotion, there are few examples in the literature involving pediatric psychologists. Recommendations are provided for a proactive agenda for health promotion programs involving pediatric psychologists in primary care. CONCLUSIONS: With conceptual homes in clinical and developmental psychology, expertise in theories of clinical and child development, scientific methods, and collaborative relationships with pediatricians, pediatric psychologists are in a unique position to develop and evaluate health promotion programs for use in primary care.     

Using the telephone to improve health behavior and health service delivery

The technology for using the telephone to deliver interventions to improve health behavior and health care has expanded dramatically and exciting innovations continue to emerge. These developments enable the telephone to be used to deliver individualized services to a broad cross section of target groups, while minimizing logistic and system barriers, and cost. However, as telephone-delivered interventions have proliferated, a number of questions remain concerning the elements that are essential to their effectiveness. We provide a broad overview of telephone interventions, published in the past 10 years to identify gaps in knowledge about these services, and make recommendations for future program development and evaluation.     

Uptake of Medicare Benefits Schedule items by psychologists and other mental health practitioners

This paper provides a background to the mental health policy changes introduced by the Council of Australian Governments (COAG) in 2006. It then considers a major Australian Government COAG reform, the revision of the Medicare Benefits Schedule (MBS), by analysing the month‐by‐month utilisation of the available time‐series data for the 17‐month period (1 November 2006–31 March 2008) when new items for psychologists, social workers and occupational therapists were introduced. There are a number of unique problems associated with monthly time‐series data. Essentially, there is a problem of heterogeneity that arises from the non‐uniformity of the temporal unit of a ‘month’. Second, there is an issue of the population covered by Medicare altering through time. Both of these problems are addressed in the present analysis of the time‐series data. The two groups of psychologists created by the MBS changes dominate the provision of the new services, providing 96.4% of the new services. Psychologists, who are not deemed clinical psychologists in the MBS changes, are the group providing most of the services. Virtually all services are individual, not group, and are provided in a consulting room. The temporal adoption of the new items was continuing to grow by March 2008. Implications of this analysis for psychologists are discussed.     

Ethics and health policies

The aim of this essay is highlight the need to establish an ethical frame of reference to formulate public health interventions. Politics and public health programs are viewed as an interaction between people where their own beliefs, moral values and expectations come together. One of the main reasons for the failure of public health interventions is that often they do not focus on the impact they will have in people's belief system and moral values. Aside from economic and epidemiological considerations, public health interventions must take into account essential human principles as self-determination, autonomy, justice, beneficence and non maleficence, social inclusion, equity, co-responsibility, citizenship, pluralism, solidarity, the right to information, privacy, confidentiality and fair treatment among others. International experiences in the establishment of ethical principles that regulate the medical profession constitute a good starting point to show that is possible to achieve a consensus for an ethical frame of reference to formulate public health policies; furthermore the accomplishment of this ethical framework will make public health more humane and dignified     

Early intervention services in youth mental health

Mental and substance use disorders are leading contributors to the burden of disease among young people in Australia, but young people experience a range of barriers to accessing appropriate treatment for their mental health concerns. The development of early intervention services that provide accessible and effective mental health care has the potential to reduce the individual and community burden associated with mental health problems. Collaborative care arrangements between general practitioners, psychologists and other service providers are a key component of comprehensive and integrated early intervention services, with evidence-based psychological treatments an important part of these collaborative mental health care models. Recently, the Australian Government funded headspace (the National Youth Mental Health Foundation) to promote and support early intervention in youth mental health by establishing accessible and collaborative models of enhanced primary mental health care for young people with emergent mental and substance use disorders. Clinical psychologists in the headspace Community of Youth Service and other settings will play a key role in providing early and effective interventions within multidisciplinary collaborative care arrangements.     

Body image and health: contemporary perspectives

There has been a significant increase in research into body image in men, women and children in the last 20 years. This editorial reviews definitions of the concept of body image, and considers potential health consequences of lowered body satisfaction and increased body concern. The articles that form this Special Issue are contextualized within contemporary research literature around relevant themes. These include sociocultural influences, gender, effects of weight and appearance and perceptual factors. Implications of findings for health psychologists involved in designing health promotion interventions are discussed.     

Reasons for initial and subsequent visits to a public health teen family planning clinic

Survey results of reasons for utilization of family planning services offered at a public health Teen Clinic are reported for 45 first-time and 105 repeat visit teen patients. The sample is drawn from an inner city community with high levels of poverty and teenage pregnancy but low levels of utilization of family planning services. The survey participants reported being aware of other sources of contraceptives in their communities, yet only 14% had ever used these sources. First time teen clinic patients ranked free services, waiver of parental consent, and confidentiality of use of services as the three most important reasons for attending the clinic. Repeat teen clinic patients prioritized free services, the exclusive use of the clinic by teenagers, and comfort with staff as reason for continuing utilization. Additionally, accessibility of family planning services increased in importance between first and subsequent visits. The results suggest different features of clinic services are perceived as important by adolescent clients for initial and subsequent visits but throughout, adolescent's are ‘price sensitive’ to the costs of contraceptives.     

Understanding eating interventions through an evolutionary lens

Health psychologists aim to improve eating behaviour to achieve health. Yet the effectiveness of healthy eating interventions is often minimal. This ineffectiveness may be in part because many healthy eating interventions are in a battle against evolved mechanisms (e.g., hedonic and related systems) that promote the consumption of energy-dense foods. Such foods, once rare, are now abundant in our obesogenic society, and consequently the evolved desire for energy-dense foods can now easily lead to the overconsumption of sugary, processed, and unhealthy foods. However, humans have other evolved mechanisms that also impact eating behaviour. In this article, therefore, we review eating interventions through an evolutionary lens, and describe evolved mechanisms that are relevant to eating behaviour. We discuss how using this lens could help health psychologists design more effective eating interventions and policies. By learning to work with human nature, eating interventions can more effectively promote healthier eating and healthier lives.     

Differential effects of health knowledge and health empowerment over patients’ self-management and health outcomes: A cross-sectional evaluation

Objective

The role of health knowledge and empowerment in explaining behavioral and health outcomes was treated in depth in the literature, but the combined effect of these constructs has been somehow neglected. This study presents an empirical, a priori, cross-sectional evaluation of the differential effects of health knowledge and empowerment on patients’ self-management and health outcomes.

Methods

This study relies on a cross-sectional design involving a total of 209 Fibromyalgia patients. Structural Equation Modeling techniques were employed to analyze the model relationships.

Results

Knowledge and three empowerment dimensions were found to positively impact health outcomes. However, these relationships were not mediated by self-management. Self-management, operationalized in terms of physical exercise and drug intake, was found to be a strong predictor of health outcomes.

Conclusion

Despite the lack of support for the mediating role of self-management, a strong impact of knowledge and empowerment over health outcomes was observed. Theories of health literacy and empowerment may benefit from this result by integrating both dimensions in an overall model of behavioral and health outcomes change.

Practice implications

Results from this study suggest that health interventions targeted to chronic patients should focus simultaneously on knowledge and empowerment, rather than favoring one of these individual constructs.     

Australian psychologists' knowledge of and attitudes towards animal‐assisted therapy

Background: Research on registered psychologists’ knowledge of and attitudes toward Animal‐Assisted Therapy (AAT) is virtually nonexistent. Aim: To explore Australian psychologists' knowledge of and attitudes toward AAT. Materials and Methods: This paper presents a thematic analysis of qualitative data collected from 9 psychologists speaking about AAT during individual interviews. Results: The first research question explored psychologists’ knowledge of AAT and identified 3 key themes: AAT use across the client lifespan in various health settings; training is inadequate; and efficacy studies are lacking. The second question exploring psychologists’ attitudes towards AAT identified further themes: AAT enhances therapeutic relationships; AAT used purposefully or incidentally is effective; and there are barriers to AAT implementation. Conclusion: Whilst AAT is deemed to be a useful intervention by some psychologists, its evidence base and training in such interventions are lacking.     

What can health psychologists learn from health economics: from monetary incentives to policy programmes

Abstract

Health economists and health psychologists share many common goals, such as reducing the number of smokers, improving the therapeutic outcome for children with attention deficit hyperactivity disorder, and helping disadvantaged groups gain better access to health services, but there has been little collaboration between the disciplines. Health economists, in fact, have played the greater role in shaping the American health care system. This, we believe, is a serious oversight on the part of psychologists, who have much to contribute to health policy development through their understanding of cognitive and emotional processes. It is our hope that this paper will encourage health psychologists to engage in dialogue and seek collaboration with (health) economists, as well as conceive of novel ways to apply economic models and methodologies in their own practices.