Health Psychology 12 marks questions answered

1. Evaluate research which has investigated the doctor patient relationship.

Firstly, Byrne and Long (1979) carried out research investigating the two main styles of patient-practitioner relationship. The research was useful because it led to more research being done on the approaches and taught doctors how to make patients involved in consultations. This also makes the study valid because the researchers investigated what they set themselves to. Internal validity is high because the results were not affected by extraneous factors, such as gestures or facial expressions since the interviews were taped. Therefore, findings were not likely to be affected by subjectivity and bias because only the voices were heard. However, the study has low external validity because the study was carried out in western countries and cultures, making the findings ungeneralizable because different cultures and countries may obtain other results if the research was conducted there. Also, the study was unethical because real diagnosis and information of real patients was disclosed without their consent, therefore they could not be debriefed because they did not know they were being recorded or knew the aim of the study. This could make the results more realistic and reliable because patients were not likely to be affected by demand characteristics, but they were deceived. On the other hand, Savage and Armstrong found out that people preferred a doctor-centred style more, therefore Byrne and Long’s findings may not be as reliable.

Secondly, Savage and Armstrong (1990) carried out research comparing the patient-centred style with the doctor-centred style. Their study had external validity because the study was carried out in a real setting with real patients, making it ecologically valid and realistic, which could produce more reliable results. Also, the patients were selected randomly, therefore no bias could have affected the sample, making it very varied (the participants were aged from 16 to 75). Having a varied sample, makes the results more generalisable to different ages and generations. However, the sample was not very generalisable because the study was conducted in inner London, making it hard to apply findings to other cities in the UK and other countries in the world. Also, the results could have been hard to generalise since the results were averaged, excluding individual differences. Furthermore, the patients gave consent to have their consultations recorded, making the study ethical, however demand characteristics may have affected the results since patients knew they were being recorded and could have changed their responses to please both the doctor and researchers.

Thirdly, Mckinlay (1975) carried out research on the understanding of 13 technical terms by lower-class women in a maternity ward. The study had high ecological validity because it was carried out in a real setting with real patients who were visiting gynaecologists/obstetricians for their pregnancy. This is likely to make the results more realistic and reliable as the women could not have been affected by demand characteristics. However, the results have low external validity because the study was conducted in Britain with low class women only, making it hard to generalise and apply them to other countries, men (gender differences) and people in different classes (higher class may be more educated). Moreover, the study was unbiased because doctors who were marking the definition, were doing it independently and did not the other doctor’s methods of marking or their score. Also, the answers of the patients were recorder in verbatim, therefore they could not be affected by tone of voice or accents. On the other hand, the scores may have been affected by subjectivity because the data was qualitative, thus the doctors needed to interpret it (different people may have different interpretations).

Additionally, Ley (1988) carried out research on the amount of information remembered by patients after a doctor’s consultation. The study was useful for practice because it led to the development of manuals for doctors on how to communicate with patients, which led to a 70% increase in recall recently. This makes the research valid, because Ley was able to find out the factors that affected recall, and use these to help practitioner improve their relationships with patients. Also, the experiment had high ecologically validity because the research was carried out in real settings and situations with real patients, making the results more likely to be realistic as participants could not be affected by demand characteristics easily. On the other hand, patient may have been affected by social desirability because of the fear of getting judged for their diagnosis, so they have not told all the information they recalled, saving themselves from getting embarrassed, and overall altering the findings. In this case a computer could have probably gathered more honest and accurate information. Also, the findings were ungeneralizable because the study was conducted in one specific place, thus not applicable to other parts of the world.

In conclusion, research conducted to investigate patient practitioner relationship has been useful for the development and improvement of these interaction as they inferred important factors such as methods on how to help patients recall information more easily, what patients expect more doctor and how often medical jargon should be used. Overall, this type of research has shown to have very low generalisability because the studies are almost always conducted in western and developed countries, leaving out important parts of the global population. However, they seem to have high ecological validity since they are carried out in real situations with real patients, making results have mundane realism and reliability.

2. Psychological studies of health and safety may be interesting, but their usefulness is questionable. Evaluate what psychologists have learned about health and safety including a discussion of the usefulness of what has been found.

What psychologists have learned about health and safety is mostly based on the workplace, meaning that the results cannot be easily generalised and are not useful to the wider population. However, safety campaigns have been carried out in the normal societies, making the findings more useful to people.

Firstly, Reason (2000) established two types of errors in the workplace: theory B, which refers to any system errors and theory A, which refers to any individual errors committed by the employees. The study can be considered reductionist because it does not take into account the fact that both theories may overlap and cause an accident in the workplace e.g. the Herald of Free enterprises accidents can be blamed on the poor communication between the supervisors and employees but also on the negligence by the assistant boatswain to close the gate. Thus, Reason (2000) may not be considered as useful to organisations or the population because there usually are more factors to an accident and categorising them may develop disputes or employees taking less/more responsibility in their workplace based on how dangerous their working environment is.

However, Theory A has been studied thoroughly through the years to determine factors, which may increase the risk of accidents happenings because of individual error. Farmers and Chambers (1926) stated that there may be a personality that is more prone to accidents, however, they failed to uncover its characteristics. Therefore, even though the research brought up a new idea, it cannot be considered as useful to society because anyone could be more prone to accidents until proven wrong. Also, the research may be outdated since it was carried out more than 90 years ago when safety overall was lower. Furthermore, Donaldson and Donaldson found out that children and older people are more likely to be part of pedestrian accidents and have a higher risk to fall due to longer abilities to respond and recover. The research is valid because it tries to decrease the number of traffic accidents involving these types of people, making the environment safer. On the other hand, the study may not be as useful when talking about health and safety at work because old people and children are not likely to work in developed societies; thus, it is ungeneralizable.

Secondly, token economy has been found to be an effective behavioural modification method to reduce accidents in the workplace. This is based on the classical conditioning belief that positive reinforcement leads to a behaviour being learned and repeated. Fox et al (1987) investigated the effectiveness of this method by conducting a study on open-cast miners, who were to receive points if they took safety precautions at work. This resulted in a large decrease in accidents in days taken off for injury. Thus, the research can be thought to be useful because it demonstrates that token economy works if employees are offered rewards, – both non-financial or financial – which may increase the overall health and safety in organisations, where workers may feel unprotected or unmotivated. This is further supported a study conducted by Haynes, Pine and Finch (1982), which found out a 25% decrease in bus drivers accidents once they were given rewards for their safe behaviour.  On the other hand, a weakness of both studies is that they only included men, meaning that gender bias may have affected the results, and these cannot be generalised to other genders. Also, token economy has little real-world application because it would be sustainable for a business to continuous offer rewards to its employees in order to keep them productive and attentive to their work. Lastly, we cannot be sure that the change in behaviours was made because of the prizes or because it was learned by the employees. Thus, this makes token economy and the research conducted around it less useful to society because psychologists cannot be sure that the good behaviour will maintain once the rewards are not offered.

Thirdly, psychologists have found that reorganising shift work reduces the number of accidents caused by individuals in the workplace. A slow rotation of shifts was found to be the most effective because the worker’s circadian rhythms are able to adapt to their working hours and be more productive at work. Even though shift work produces negative effects on the body either way, it can be said that these findings are useful to organisations, which need employees to work 24h and find them to be stressed and unmotivated. In fact, Czeisler et al (1982) conducted a research in a chemical plant after these problems were reported. The researcher introduced a forward slow shift rotation, therefore workers had the same working hours for 21 days and these went from morning to afternoon to evening. After 9 months it was found that the employees reported less stress, better sleep and productivity. Thus, the research was ecologically valid and reliable because it studied real workers and found out useful information, which can be used across the population. On the other hand, a correlation is made between the change of shifts and the wellbeing of employees because external factors are not considered; thus, it can be said that the results are not as reliable and useful because they do not determine the cause and effect. Furthermore, it is hard to determine whether the forward cycle or slow rotation was better because both methods were used, and no independent groups were used to investigate which one had more of an impact on the employee’s wellbeing. Therefore, it is hard to judge whether the research was overall useful because it only gives an insight into how to make shift work better but does not highlight the different consequences of different methods.

In conclusion, psychologists have found useful information about health and safety (mostly in the workplace), which can help organisation and society learn more safe behaviour through campaigns such as Cowpe et al’s. The researcher found out that overexposing people to adverts makes them less likely to accept and change their behaviour, but it is effective when the just number of adverts is shown. The study proved to be valid because the campaign was successful with a reduction of chip pan fires from 7% to 25%, thus making the research useful for other health promotion campaigns. Also, the adverts were shown around 7 different television areas in the UK, making the results more generalisable. However, it could be argued that cultural bias may have affected the results, meaning that the usefulness of the research to the wider population decreases. Moreover, self-report measures were used, which makes the findings more likely to be affected by social desirability and demand characteristics, making the research less reliable and useful since the information is likely to be somewhat false.