Medicine And Books

The Psychology of Preventive Health

BMJ 1996; 313 doi: (Published 26 October 1996) Cite this as: BMJ 1996;313:1090
  1. Simon Enright

    Marian Pitts Routledge, £11.99, pp160 ISBN 0 415 10683 4

    A psyhchologist's skill lies in understanding and influencing aspects of human thought and behaviour. It therefore naturally falls to health psychologists to explain why it is so difficult to encourage people to engage in behaviour which is in the best interests of their own health. Despite the explosion of theories in this area over the past two decades the reader may not be surprised to find that for most of us our health related behaviour defies the most complex theoretical analysis.

    Preventative health has become increasingly important, spurred on by Health of the Nation targets and contractual obligations for screening, so all of us need some understanding of people's decisions about their health related behaviour. Some factors do appear to be crystallising. It seems to be important that we understand the risks and perceive these as serious, that we can personalise these risks, that the benefits of behaving healthily outweigh the costs of doing so, that we feel empowered to act, that we're at the correct “stage of change” — and then, just as all these things seem to come together, we have one more drink and light another cigarette.

    And before we begin to think otherwise, the peculiarities of health related behaviour really do apply to most of us. Pitts describes one study in which 88% of general practitioners stated that it was a good idea to be vaccinated against hepatitis B but of these only 41% had done so. “I haven't got round to it,” explained 81% of the hypocrites.

    Professor Pitts begins by reviewing an impressive array of explanatory models of health related behaviour. She then shows them all to be wanting as she reviews the research in relation to vaccinations, health screening, alcohol, smoking, exercise, sexual behaviour, and accident prevention. The final chapter addresses the politics of preventive health. Pitts points out the danger of assuming that preventive health is the sole responsibility of the individual and describes the small step of logic from believing that individuals have the ability to change their behaviour to blaming them for not doing so. A failure to consider social, political, and economic circumstances when studying health related behaviour renders all other debate futile.

    By writing such a wide review of psychological research in preventive health Pitts has left inevitable gaps. None the less, this well written book, with its comprehensive and up to date references, will act as an excellent introductory text and resource for those involved in preventive health.—SIMON ENRIGHT, consultant clinical psychologist, West Berkshire Priority Care Service, Wallingford, Oxfordshire

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