Health and life

Attribution theory has been applied to the study of health and health-related behaviour. Herzlich (1973) interviewed 80 people about the general causes of health and illness and found that health is regarded as internal to the individual and illness is seen as something that comes into the body from the external world.
More specifically, attributions about illness may be related to behaviours. For example, Bradley (1985) examined patients’ attributions for responsibility for their diabetes and reported that perceived control over illness (‘is the diabetes controllable by me or a powerful other?’) influenced the choice of treatment by these patients. Patients could choose (1) an insulin pump (a small mechanical device attached to the skin, which provides a continuous flow of insulin), (2) intense conventional treatment, or (3) a continuation of daily injections. The results indicated that the patients who chose an insulin pump showed decreased control over their diabetes and increased control attributed to powerful doctors. Therefore, if an individual attributed their illness externally and felt that they personally were not responsible for it, they were more likely to choose the insulin pump and were more likely to hand over responsibility to the doctors. A further study by King (1982) examined the relationship between attributions for an illness and attendance at a screening clinic for hypertension. The results demonstrated that if the hypertension was seen as external but controllable by the individual then they were more likely to attend the screening clinic (‘I am not responsible for my hypertension but I can control it’).

The origins of attribution theory can be found in the work of Heider (1944, 1958), who argued that individuals are motivated to see their social world as predictable and controllable – that is, a need to understand causality. Kelley (1967, 1971) developed these original ideas and proposed a clearly defined attribution theory suggesting that attributions about causality were structured according to causal schemata made up of the following criteria:
■ Distinctiveness: the attribution about the cause of a behaviour is specific to the individual carrying out the behaviour.
■ Consensus: the attribution about the cause of a behaviour would be shared by others.
■ Consistency over time: the same attribution about causality would be made at any other time.
■ Consistency over modality: the same attribution would be made in a different situation.
Kelley argued that attributions are made according to these different criteria and that the type of attribution made (e.g. high distinctiveness, low consensus, low consistency over time, low consistency over modality) determines the extent to which the cause of a behaviour is regarded as a product of a characteristic internal to the individual or external (i.e. the environment or situation).
Since its original formulation, attribution theory has been developed extensively and differentiations have been made between self-attributions (i.e. attributions about one’s own behaviour) and other attributions (i.e. attributions made about the behaviour of others). In addition, the dimensions of attribution have been redefined as follows:
■ internal versus external (e.g. my failure to get a job is due to my poor performance in the interview versus the interviewer’s prejudice)
■ stable versus unstable (e.g. the cause of my failure to get a job will always be around versus was specific to that one event)
■ global versus specific (e.g. the cause of my failure to get the job influences other areas of my life versus only influenced this specific job interview)
■ controllable versus uncontrollable (e.g. the cause of my failure to get a job was controllable by me versus was uncontrollable by me).
Brickman et al. (1982) have also distinguished between attributions made about the causes of a problem and attributions made about the possible solution. For example, they claimed that whereas an alcoholic may believe that he is responsible for becoming an alcoholic due to his lack of willpower (an attribution for the cause), he may believe that the medical profession is responsible for making him well again (an attribution for the solution).

Much research has used quantitative methods to explore and predict health behaviours. For example, Kristiansen (1985) carried out a correlational study looking at the seven health behaviours defined by Belloc and Breslow (1972) and their relationship to a set of beliefs. She reported that these seven health behaviours were correlated with (1) a high value on health; (2) a belief in world peace; and (3) a low value on an exciting life. Obviously there are problems with defining these different beliefs, but the study suggested that it is perhaps possible to predict health behaviours.
Leventhal et al. (1985) described factors that they believed predicted health behaviours:
■ social factors, such as learning, reinforcement, modelling and social norms
■ genetics, suggesting that perhaps there was some evidence for a genetic basis for alcohol use
■ emotional factors, such as anxiety, stress, tension and fear
■ perceived symptoms, such as pain, breathlessness and fatigue
■ the beliefs of the patient
■ the beliefs of the health professionals.
Leventhal et al. suggested that a combination of these factors could be used to predict and promote health-related behaviour.
In fact, most of the research that has aimed to predict health behaviours has emphasized beliefs. Approaches to health beliefs include attribution theory, the health locus of control, unrealistic optimism, self-affirmation theory and the stages-of-change model.

Belloc and Breslow (1972), Belloc (1973) and Breslow and Enstrom (1980) examined the relationship between mortality rates and behaviour among 7000 people. They concluded from this correlational analysis that seven behaviours were related to health status. These behaviours were:
1 Sleeping 7–8 hours a day.
2 Having breakfast every day.
3 Not smoking.
4 Rarely eating between meals.
5 Being near or at prescribed weight.
6 Having moderate or no use of alcohol.
7 Taking regular exercise.
The sample was followed up over five-and-a-half and ten years in a prospective study and the authors reported that these seven behaviours were related to mortality. In addition, they suggested that for people aged over 75 who carried out all of these health behaviours, health was comparable to those aged 35–44 who followed less than three.
Health behaviours seem to be important in predicting mortality and the longevity of individuals. Health psychologists have therefore attempted to understand and predict health-related behaviours. Some of this research has used qualitative methods to explore and understand ‘lay theories’ and the ways in which people make sense of their health. Other research has used quantitative methods in order to describe and predict health behaviours.

In his book The Role of Medicine, Thomas McKeown (1979) examined the impact of medicine on health since the seventeenth century. In particular, he evaluated the widely held assumptions about medicine’s achievements and the role of medicine in reducing the prevalence and incidence of infectious illnesses, such as tuberculosis, pneumonia, measles, influenza, diphtheria, smallpox and whooping cough. McKeown argued that the commonly held view was that the decline in illnesses, such as tuberculosis, measles, smallpox and whooping cough, was related to medical interventions such as chemotherapy and vaccinations; for example, that antibiotics were responsible for the decline in illnesses such as pneumonia and influenza. He showed, however, that the reduction in such illnesses was already under way before the development of the relevant medical interventions. McKeown therefore claimed that the decline in infectious diseases seen throughout the past three centuries is best understood not in terms of medical intervention, but in terms of social and environmental factors. He argued that:
The influences which led to [the] predominance [of infectious diseases] from the time of the first agricultural revolution 10,000 years ago were insufficient food, environmental hazards and excessive numbers and the measures which led to their decline from the time of the modern Agricultural and Industrial revolutions were predictably improved nutrition, better hygiene and contraception. (McKeown 1979: 117)

It’s a nasty topic to start a new blog, but I’d been searching for some unusual (at least to me) ailments and came across genital warts. I’d never heard that term before, but started to search for it and I found a number of websites devoted to the very topic. I started from Wikipedia, National Institute of Allergy and Infectious Diseases (NIAID), and a number of other sites. I found http://genitalwartsguide.org to be a very comprehensive site too.

What are genital warts? I never knew there was such a thing. It turns about that almost 20 million Americans have this problem. Genital warts are caused by human papillomavirus (HPV). The virus is transmitted sexually during sexual intercourse. It causes little bumps (warts) to grow on your genitals or in the scrotum area. The thing looks pretty nasty (pictures of genital warts). Fortunately, it can be treated in a number of ways. I think I’m gonna examine myself today and see if there are any surprises there