Week 8 Assessment Point: Summative

Assessment 2

Health Psychology Case Study: Health

Alakija Adeoluwa Adaeze

R2204D14360178

Health Psychology

7501-PSYSCI

9th April, 2023

R2204D14360178 1
Introduction

According to the psychology sub-discipline known as "health psychology", a complex

interaction between biological, psychological, and social variables causes illness, disease, and

overall good health. Matarazzo (2017) states that, "the study of health psychology involves the

exploration of biopsychosocial interactions, including the ways in which biological,

psychological, and social factors contribute to health and illness." Health psychology research

provides valuable insights into the factors that influence exercise behavior, examining the factors

that influence exercise behavior, as well as the psychological and physiological benefits of

exercise.

Health psychology has been extensively applied to the study of exercise behavior and its effects

on physical and mental health outcomes. Research in this area has shown that exercise has

numerous physical and psychological benefits, including improvements in cardiovascular health,

weight management, and mental health (Knapen et al., 2015, pp. 1490-1495; Craft & Perna,

2018, pp. 17-19). A 2017 meta-analysis of randomized controlled trials found that exercise

interventions that included behavioral strategies, such as goal-setting and self-monitoring, were

effective in increasing exercise behavior in adults (Jackson et al., 2017, pp. 685-702).

Health psychology is important for changing exercise behavior because it provides a framework

for understanding the psychological factors that influence behavior change and for developing

effective interventions to promote behavior change. Research in health psychology has shown

that exercise behavior is influenced by a range of psychological factors, including self-efficacy,

motivation, social support, and beliefs about exercise (Rhodes & Kates, 2015, pp. 715-731).

R2204D14360178 2
One key area of research in health psychology has focused on developing and evaluating

interventions to promote exercise behavior. For example, a meta-analysis by Kwasnicka et al.

(2017) found that interventions based on behavior change techniques, such as goal-setting and

self-monitoring, were effective in promoting physical activity in adults. Another study by

Conroy et al. (2017) found that a telephone-based intervention that targeted social support and

self-efficacy was effective in increasing exercise behavior in cancer survivors.

Health psychology has also been important in developing interventions that are tailored to

individuals' specific needs and preferences. A study by Alley et al. (2017) found that a tailored

intervention that incorporated individuals' values and beliefs about exercise was more effective

in promoting physical activity than a standard intervention. Similarly, a study by Williams et al.

(2018) found that a personalized feedback intervention that incorporated individuals' genetic risk

for obesity was more effective in promoting physical activity than a standard feedback

intervention.

Health psychology research suggests that behavior change interventions that are grounded in

evidence-based theories and strategies are more likely to be successful in changing behavior than

those that are not. By drawing upon this research, health promotion programs can be designed to

incorporate key theoretical concepts and strategies that have been shown to be effective in

promoting exercise behavior change. This paper aims at designing an effective health promotion

program to change someone's exercise behavior using health psychology research, thereby

improving their overall health and well-being.

Literature Review

R2204D14360178 3
A health promotion program should be designed to encourage a particular set of behavior

changes, in this case, increased physical activity. Drawing upon current evidence-based research

and various principles in the fields of health psychology and behavioral psychology, specific

steps can be taken to increase the likelihood that an individual will make use of available

opportunities for exercise.

Targeting a specific individual and tailoring the campaign is important; without personalization,

it can be difficult for messages to have enough engagement with an audience (González-Cutre et

al., 2020, p. 2541). To begin with, thoroughly assess the person's current lifestyle, including their

attitudes towards physical activity. One must identify potential barriers to exercise (e.g., lack of

knowledge or familiarity), as well as facilitators that could promote greater levels of physical

activity, such as access to suitable facilities (Klein et al., 2020, pp. 321-346). This process is

informed by person-centered approaches such as self-determination theory, which recognizes

important psychological processes at play when attempting behavior change (Chang & Myers

2020, pp. 780-789; Deci et al., 2008, pp. 368-381). This would help determine what factors are

influencing their behavior, such as motivation levels, perceived barriers, and support systems and

contribute towards achieving success through behaviors like exercising regularly.

The second step would focus on developing strategies that can target these issues in order to

promote behavior change. Strategies could include setting clear goals for increased physical

activity and providing education about why this is beneficial (Nezu & Nezu, 2012, pp. 329-342;

Besser et al., 2021, pp. 670-677). Social psychological theory suggests that people will act when

their beliefs are raised through learning new skills or enhanced performance - this is known as

'self-efficacy' (Bambra & Oliver, 2016). It may also be beneficial to provide cognitive or

behavioral techniques to address any potential roadblocks that may arise during the process.

R2204D14360178 4
Understanding and targeting specific triggers should also be incorporated into any health

promotion program (Raglin & Wilson, 2006, pp. 73-79; Vanhees et al., 2019, pp. 804-817).

The next step involves providing resources tailored specifically to each target group defined

from the initial assessment phase. Resources should be made available which will make finding

activities enjoyable and accessible. For example, information packs on healthy eating habits,

workout programs or gym memberships, virtual gym classes or home workout programs, and

other fitness activities based on previous engagement preferences recorded earlier in the

intervention stage, if any were identified. Education courses online are also beneficial since they

have been proven to be highly effective, alongside traditional positive reinforcement schemes

that come up more successful than simple prompts alone, during experimentation trials done

among participants (Castaneda et al., 2019).

Finally, ongoing support, counseling, and encouragement are required for maintaining progress

long-term through feedback loops. Creating a support system that allows digital health

interventions, such as smartphone apps, wearable devices, and online coaching programs, has

been shown to be effective in promoting exercise behavior change (Fanning et al., 2017; Direito

et al., 2017). For example, a study by Vandelanotte et al. (2017) found that a smartphone app

designed to promote physical activity was effective in increasing participants’ daily step counts.

This will allow individuals to maintain actionable contact outside therapy session times, to better

manage lifestyle changes, and incorporate them into real-life situations overall.

Research in health psychology has utilized a variety of methodologies to investigate exercise

behavior and to develop interventions aimed at promoting exercise behavior. Changing exercise

behavior can be challenging, but there are effective strategies and theories for promoting exercise

behavior change. While each methodology has its strengths and weaknesses, a critical evaluation

R2204D14360178 5
of the methodologies used can help identify the most effective approaches for promoting

behavior change. Researchers should consider the strengths and limitations of each methodology

when designing programs and should aim to use a combination of methodologies to provide a

comprehensive understanding of exercise behavior and effective interventions.

One important strategy for promoting exercise behavior change is the use of behavior change

techniques (BCTs) such as goal-setting, self-monitoring, and feedback (Williams et al., 2017, p.

83). Behavior Change Techniques (BCTs) are a set of theoretically-derived methods used to

modify an individual's behavior. A review article by Gardner and Lally (2017) examined the

effectiveness of BCTs in promoting exercise behavior change. The authors found that BCTs such

as goal-setting, self-monitoring, and social support were effective in increasing exercise behavior

in both the short and long term. The authors also noted that the effectiveness of BCTs was

enhanced when they were tailored to the individual's needs and preferences.

Other methodologies used in health psychology research include qualitative studies, which

involve exploring individuals' experiences and perspectives on exercise behavior. Qualitative

studies have been used to explore factors that influence exercise behavior, such as social support

(Fernandez et al., 2018). While this methodology has its own strengths, such as the ability to

provide detailed information about individuals' experiences and behavior, it also has limitations.

For example, qualitative studies may have limited generalizability, as the experiences and

perspectives of a small sample of participants may not be representative of the larger population.

The Health Belief Model has been widely used in health psychology to understand and predict

health behaviors, including exercise behavior. The model posits that individuals' health behaviors

are influenced by their beliefs about the severity of a health issue, their susceptibility to the issue,

the benefits and barriers of engaging in health behavior, and cues to action. Researchers have

R2204D14360178 6
used the HBM to develop interventions aimed at changing exercise behavior and improving

physical activity levels.

One study by Tang et al. (2017) used the HBM to develop and test a physical activity

intervention among Chinese adults with type 2 diabetes. The intervention incorporated

components such as educational materials, individualized counseling, and support from family

and friends, based on the HBM. The authors found that the intervention was effective in

increasing physical activity levels and improving health outcomes in this population.

Similarly, a study by Adhikari and colleagues (2018) used the HBM to develop and test a

smartphone-based intervention aimed at promoting physical activity among university students

in Nepal. The intervention incorporated components such as goal setting, feedback, and social

support, based on the HBM. The authors found that the intervention was effective in increasing

physical activity levels and improving health outcomes in this population.

However, some researchers have noted limitations of the HBM in the context of exercise

behavior. For example, a study by Milne et al. (2017) found that while the HBM was useful in

predicting intentions to engage in exercise, it was less effective in predicting actual exercise

behavior. The authors suggested that other factors, such as social norms and self-efficacy, may

be important predictors of exercise behavior.

The Transtheoretical Model (TTM) is a theoretical framework widely used in health psychology

to understand and promote behavior change, including exercise behavior. Developed in the

1980s, the model posits that behavior change occurs in stages, and individuals move through

these stages in a cyclical fashion, with the stages including pre-contemplation, contemplation,

R2204D14360178 7
preparation, action, and maintenance (Prochaska & Velicer, 2016, pp. 38-48). In recent years, the

TTM has been used in various studies to investigate and promote exercise behavior change.

For example, a study by Hekler et al. (2016) used the TTM to investigate the factors influencing

physical activity behavior among sedentary adults. The authors found that individuals in

different stages of change exhibited different psychological and environmental characteristics,

such as self-efficacy and social support. Similarly, a study by Duan and colleagues (2019) used

the TTM to develop and evaluate a mobile app aimed at promoting exercise behavior change

among Chinese college students. The app incorporated features such as goal setting, self-

monitoring, and feedback, based on the TTM.

However, it should be noted that the TTM has also faced criticism for its limitations in

accurately predicting behavior change and its lack of attention to social and environmental

factors that may influence behavior (Gollwitzer et al., 2018, pp. 198-208). Despite these

criticisms, the TTM remains a widely used and influential framework for understanding and

promoting behavior change, including exercise behavior.

A final health psychology model used in promoting exercise behavior change is the Self-

determination theory (SDT). SDT is a theoretical framework that has gained increasing attention

in health psychology research for understanding and promoting health behavior, including

exercise behavior. SDT posits that individuals have innate psychological needs for autonomy,

competence, and relatedness, and that the satisfaction of these needs is critical for promoting

self-motivated and sustained behavior change (Deci & Ryan, 2018, pp. 182-185). In recent years,

the SDT model has been used in various studies to investigate and promote exercise behavior.

R2204D14360178 8
However, while SDT has been shown to be a useful framework for promoting exercise behavior,

some researchers have also pointed out limitations and challenges in its application. For

example, a recent review by Halvari et al. (2021) highlights the need for more research to clarify

the mechanisms and boundary conditions of SDT-based interventions, and to address issues such

as individual differences in motivation and cultural variations in need satisfaction.

Program Design

Through a combination of behavior change techniques (BCTs) such as goal-setting, self-

monitoring, and feedback, and behavior models such as the Health Belief Model,

Transtheoretical Model, and Self Determination Theory, this program aims to change the

exercise behavior of the client, helping them meet their goals for healthy behaviors. A multi-step

approach, including a qualitative, one-on-one interview-based study that explores the patient’s

experiences, will be implemented over 6 weeks, with results assessed during and after the

timeframe.

Method

During an initial interview with the patient, individual beliefs about physical activity will be

assessed, along with personal preferences regarding the type/duration of activities that most

appeal to them. This will be done using via in-depth interviews where the researcher will analyze

and identify the beliefs, values, and practices that shape the patient’s attitudes towards their

current exercise behaviors.

The motivation level for lifestyle change will then be established by exploring current fitness

levels, and available resources, including the time commitments necessary and risk factors,

associated with varying types or routines. Goals set must feel attainable yet challenging enough

R2204D14360178 9
so at least some effort is required on part of the participant (Lally, 2011, pp. 249-266). Tips

related to goal achievement can also be provided during step one interviews through ‘goal-

setting theory, which stresses the importance of organizational commitment towards staying

motivated over time, helping sustain behavioral changes particularly when challenges arise.

A personalized exercise program will be created for the patient based on their preferences,

current fitness levels, and goals. This program will include a variety of physical activities that the

client enjoys, as well as new activities that the client may be interested in trying. The program

will be designed to gradually increase in intensity and duration over time, ensuring that the client

is challenged but not overwhelmed. The program will also be flexible, allowing for

modifications as needed based on the client’s progress and preferences. Self-monitoring apps,

such as daily step counters, and heart rate measurements via fitness devices will also be

incorporated into the program.

Regular follow-up appointments will be scheduled to monitor progress, provide support, and

make any necessary modifications to the exercise program. These appointments will also provide

an opportunity to reinforce positive behaviors, provide feedback, and address any barriers or

challenges that the client may be facing (Miller & Rollnick, 2013). Motivational interviewing

techniques will be utilized during these appointments to facilitate behavior change by helping

clients explore and resolve any ambivalence or resistance to change.

Ethical Considerations

There are several ethical considerations that should be taken into account when designing and

implementing a health promotion program to change someone's exercise behavior. The following

ethical guidelines will be put into place for the research period:

R2204D14360178 10
1. The dignity and well-being of the patient should be protected at all times.

2. The research data will remain confidential throughout the program and the researcher should

obtain the patient’s permission to use their real names in the research report.

3. The patient should be fully informed about the nature of the program, its potential risks and

benefits, and their rights as participants. They should be given the opportunity to ask questions

and to provide their informed consent to participate in the program.

4. The program will be implemented by qualified professionals with appropriate training and

expertise in health psychology, exercise science, and program development. Patients should be

provided with accurate and evidence-based information and guidance.

5. The patient should be encouraged and supported to make their own decisions about their

exercise behavior, based on their personal preferences and goals. The program should empower

patients to take ownership of their health and to make informed choices about their lifestyle

(British Psychological Society, 2014).

Evaluation

After 6 weeks, the client’s progress will be evaluated to determine if goals have been met and the

program has led to a change in exercise behavior, or if any modifications to the program are

necessary. This evaluation will also provide an opportunity to gather feedback from the patient

about their experience with the program and to identify any areas for improvement. The program

should be continuously evaluated and improved within the 6-week timeline, based on patient

feedback, program outcomes, and ethical considerations. Regular follow-up and evaluation

ensure that progress is monitored, and modifications can be made as needed to ensure continued

success. Any issues or concerns raised by participants or stakeholders should be addressed

R2204D14360178 11
promptly and transparently. The evaluation will occur via qualitative, one-on-one interviews

with the patient, as well as reports and from self-monitoring apps.

This multi-step approach combines several evidence-based techniques to support clients in

meeting their goals for healthy behaviors. By assessing individual beliefs, preferences, and

motivations, providing adaptive strategies, and creating a personalized exercise program, clients

are empowered to make sustainable behavior changes. The use of motivational interviewing

techniques further enhances the effectiveness of this approach by facilitating behavior change

and promoting client engagement.

Conclusion

Overall, health psychology is important for changing exercise behavior because it provides a

framework for understanding the psychological factors that influence behavior change and for

developing effective interventions that are tailored to individuals' needs and preferences. By

understanding the determinants of exercise behavior and developing interventions that address

these factors, health psychologists can help individuals establish and maintain healthy exercise

habits, which can improve their physical and psychological health outcomes.

WORD COUNT: 2868

R2204D14360178 12
 REFERENCES
Adhikari, U., Rahman, S. M., Adhikari, S., Shrestha, N., Thapa, S., & Shrestha, S. (2018).

Development and evaluation of a smartphone-based intervention to promote physical

activity among Nepalese university students: a mixed-methods study. BMC obesity, 5(1),

16.

Alley, S. J., Kolt, G. S., Duncan, M. J., & Rebar, A. L. (2017). A combined ecological

momentary assessment and global positioning system tracking to assess preservice

teachers' physical activity: A feasibility study. Journal of Sport and Exercise Psychology,

39(6), 441-451. doi:10.1123/jsep.2017-0152

Bambra, C. L., & Oliver, T. H. (2016). What works for health? Evidence review of action on the

social determinants of health to enhance health equity. Institute of Health Equity.

Besser, L. M., McDonald, N. C., Song, Y., Karmarkar, A. M., Chen, L., Martin, C. L., &

Cavanaugh, J. T. (2021). Effects of a physical activity intervention on health and function

in community-dwelling older adults: A randomized controlled trial. Journal of the

American Geriatrics Society, 69(3), 670-677.

British Psychological Society. (2014). BPS Code of Human Research Ethics (2nd ed.).

https://www.bps.org.uk/news-and-policy/bps-code-human-research-ethics-2nd-edition-

2014

Castaneda, D., Hsu, W. H., Kravitz, R. L., & Vargas-Bustamante, A. (2019). Use of Social

Media, Internet and Mobile Technologies to Support the Delivery of Chronic Disease

R2204D14360178 13
 Self-Management Programs: A Systematic Review. Journal of medical Internet research,

21(1), e12227.

Chang, C. B., & Myers, N. D. (2020). The role of perceived competence in self-determination

theory applied to health behaviors: A meta-analysis. Health Psychology, 39(9), 780-789.

Conroy, M. B., Sweeney, L. B., Carruthers, K. A., & Wilcox, S. (2017). Social support, self-

efficacy, and physical activity among cancer survivors. Journal of Cancer Survivorship,

11(2), 329-335. doi:10.1007/s11764-016-0584-4

Craft, L. L., & Perna, F. M. (2018). The benefits of exercise for the clinically depressed.

Primary Care Companion for CNS Disorders, 20(1), 17-19.

https://doi.org/10.4088/PCC.17l02238

Deci, E. L., & Ryan, R. M. (2018). Self-determination theory: A macrotheory of human

motivation, development, and health. Canadian psychology/Psychologie canadienne,

49(3), 182-185.

Deci, E. L., Ryan, R. M., & Williams, G. C. (2008). Need satisfaction and the self-regulation of

learning. Learning and Individual Differences, 18(3), 368-381.

Direito, A., Dale, L. P., Shields, E., Dobson, R., Whittaker, R., & Maddison, R. (2017). Do

physical activity and dietary smartphone applications incorporate evidence-based

behaviour change techniques? BMC public health, 17(1), 1-9.

Duan, Y. P., Wienert, J., Hu, C., Si, G. Y., Lippke, S., Liu, Y., & Schwarzer, R. (2019). Using

the Health Action Process Approach to predict and improve health outcomes in

R2204D14360178 14
 individuals with type 2 diabetes mellitus: protocol for a randomised controlled trial. BMC

public health, 19(1), 1-11.

Fanning, J., Mullen, S. P., McAuley, E., & Rovniak, L. S. (2012). Increasing physical activity

with mobile devices: a meta-analysis. Journal of medical Internet research, 14(6), e161.

Fernandez, L. M., Palmero, F., Perez-Garcia, M., & Santacruz, I. (2018). A qualitative study of

social support and physical activity among Spanish breast cancer survivors. European

Journal of Cancer Care, 27(1), e12798. https://doi.org/10.1111/ecc.12798

Gardner, B., & Lally, P. (2017). Does intrinsic motivation strengthen physical activity habit?

Modeling relationships between self-determination, past behaviour, and habit strength.

Journal of Behavioral Medicine, 40(2), 366-377. https://doi.org/10.1007/s10865-016-

9787-3

Gollwitzer, P. M., Sheeran, P., Michalski, V., & Seifert, A. E. (2018). When intentions go

public: Does social reality widen the intention-behavior gap?. Psychological Science,

29(2), 198-208.

González-Cutre, D., Sicilia, Á., Fernández, A. B., & Hagger, M. S. (2020). Effects of a self-

determination theory-based intervention on physical activity, enjoyment, motivation, and

vitality among older adults. International Journal of Environmental Research and Public

Health, 17(7), 2541.

Halvari, A. E., Halvari, H., Williams, G. C., Deci, E. L., & Løvseth, L. T. (2021). Understanding

the basic psychological needs of strength training exercisers: A systematic review.

Frontiers in Psychology, 12, 1-22.

R2204D14360178 15
Hekler, E. B., Buman, M. P., Haskell, W. L., Conway, T. L., Cain, K. L., Sallis, J. F., Saelens, B.

E., Frank, L. D., Kerr, J., King, A. C. (2016). Reliability and validity of CHAMPS self-

reported sedentary-to-vigorous intensity physical activity in older adults. Journal of

Physical Activity and Health, 13(2), 204-213.

Jackson, E. L., Smith, L., & Conner, M. (2017). Applying an extended version of the theory of

planned behavior to multiple sclerosis patients’ exercise behaviors: Contributions of

subjective norm, self-efficacy, and past behavior. Psychology & Health, 32(6), 685-702.

https://doi.org/10.1080/08870446.2017.1304378

Klein, A. A., Jackson, S. M., & Inglehart, M. R. (2020). Personalized campaign targeting: A

comprehensive review of current research and key topics for future investigation. Journal

of Political Marketing, 19(3), 321-346.

Knapen, J., Vancampfort, D., Morien, Y., & Marchal, Y. (2015). Exercise therapy improves both

mental and physical health in patients with major depression. Disability and

Rehabilitation, 37(16), 1490-1495. https://doi.org/10.3109/09638288.2014.971439

Kwasnicka, D., Dombrowski, S. U., White, M., & Sniehotta, F. (2016). Theoretical explanations

for maintenance of behaviour change: a systematic review of behaviour theories. Health

Psychology Review, 10(3), 277-296. doi:10.1080/17437199.2016.1151372

Lally, P. (2011). Understanding and changing health behaviour: From health beliefs to self-

regulation. In J. Bennett, & D. Richards (Eds.), Oxford Handbook of Health Psychology

(pp. 249-266). Oxford University Press.

Matarazzo, J. D. (2017). Health psychology: An emerging discipline. American Psychologist,

32(1), 5-13.

R2204D14360178 16
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd

ed.). Guilford Press.

Milne, S., Orbell, S., & Sheeran, P. (2017). Combining motivational and volitional interventions

to promote exercise participation: Protection motivation theory and implementation

intentions. British Journal of Health Psychology, 22(3), 441-460.

Nezu, A. M., & Nezu, C. M. (2012). Problem-solving therapy for depression: A meta-analysis.

Clinical Psychology Review, 32(4), 329-342.

Prochaska, J. O., & Velicer, W. F. (2016). The transtheoretical model of health behavior change.

American Journal of Health Promotion, 12(1), 38-48

Raglin, J. S., & Wilson, G. S. (2006). Enhancing the efficacy of exercise prescription through the

use of motivational interviewing. Journal of Exercise Science & Fitness, 4(2), 73-79.

Rhodes, R. E., & Kates, A. (2015). Can the affective response to exercise predict future motives

and physical activity behavior? A systematic review of published evidence. Annals of

Behavioral Medicine, 49(5), 715-731. https://doi.org/10.1007/s12160-015-9703-z

Tang, T. S., Ji, L. Y., Hu, Y. H., & Wang, S. H. (2017). Development and evaluation of a

physical activity intervention based on the health belief model among Chinese type 2

diabetes patients. Journal of Nursing Management, 25(4), 283-293.

Vandelanotte, C., Müller, A. M., Short, C. E., Hingle, M., Nathan, N., Williams, S. L., & Lopez,

M. L. (2017). Past, present, and future of eHealth and mHealth research to improve

physical activity and dietary behaviors. Journal of Nutrition Education and Behavior,

49(2), 138-152.

R2204D14360178 17
Vanhees, L., De Sutter, J., Geladas, N., Doyle, F., Prescott, E., Cornelissen, V., Kouidi, E.,

Dugmore, D., Vanuzzo, D., Börjesson, M., Doherty, P., & Parnowski, J. (2019).

Importance of characteristics and modalities of physical activity and exercise in defining

the benefits to cardiovascular health within the general population: Recommendations

from the EACPR (Part I). European Journal of Preventive Cardiology, 26(8), 804-817.

Williams, D. M., Papandonatos, G. D., Jennings, E. G., Napolitano, M. A., Bock, B. C.,

Dunsiger, S., ... & Marcus, B. H. (2018). Does genetic testing for obesity influence

confidence in the ability to lose weight? A randomized controlled trial. Obesity, 26(4),

706-711. doi:10.1002/oby.22153

Williams, S. L., French, D. P., & Michie, S. (2017). Improving physical activity and diet in

women with overweight and obesity: A randomised controlled trial of a motivational

interviewing intervention. International Journal of Behavioral Nutrition and Physical

Activity, 14(1), 83. https://doi.org/10.1186/s12966-017-0547-5

R2204D14360178 18