Background tremendous social and psychological impact. This did

Background
to the history of the field of Health PsychologyThe term health psychology has been officially recognized
as a discipline of the field of psychology since 1978, when the American
Psychological Association (APA) established a Division of Health Psychology
(Division 38). Josep Matarazzo, the first President of the Division, was very
precise about its objectives: ‘We must aggressively investigate and deal
effectively with the role of the individual’s behaviour and lifestyle in health
and dysfunction’ (Matarazzo, 1982). Nevertheless, psychology’s interests in
general health and illness comes from the very beginning of the discipline
itself. As the discipline of psychology developed its
professional and scientific character, psychology’s role in health was
essentially focused on “mental health” (Schofield, 1969). In a period that was characterized
for the advances in medicine, the development and success of vaccines and
antibiotics led to a stronger disconnection between the mental and the physical
domain. During this period, the role of clinical psychologists was set in the
diagnosis and treatment of mental disorders. On the twentieth century, the Second World War had a
tremendous social and psychological impact. This did allow a chance for
psychoanalysis to become the most organized approach to understand and enhance
mental health. It was considered the main approach to the psychological study
of illness for around 50 years. After almost half a century, clinical
psychology became the dominant approach to the study of illness when it came
out with the ideas of behaviour analysis, cognitive psychology and
psychometrics and some aspects from biological psychology (Murray, 2014). Psychology
expanded into the general hospitals and the community put together clinical
psychologists and general medical practitioners in order to broaden
psychologists’ interests into physical health problems. Furthermore, government
reports of society’s unhealthy behaviours encouraged social psychologists to
apply their theories and interventions to health issues. In the United Kingdom, in 1986, the British
Psychological Society established a Health Psychology division whose purposes
were similar to those in the APA. Members in this section were mostly clinical
psychologists; this division had a specific focus on individual behaviour
change and on psychological support for people with physical health problems (Murray,
2017). The clinical heritage within health psychology advocated
the idea of distinct professional training routes with its own training demands
and official titles. This belief led to the growing professionalization of
health psychology. From this point, several MSc programs were set, starting in
London, and arrived to many other regions in the UK. The Health Psychology section
turned into a Special Group in Health Psychology (SGHP) and the posterior
Division of Health Psychology (DHP) in 1997.With the professionalization of health psychology in
the United Kingdom, the more analytical health psychologists went originally
for the study of language, but taking into account as well the importance of
wider social and political processes (Murray, 2012; Murray, 2017). In the UK,
clinical health psychology has come out as a separate discipline within the
field of clinical psychology, leading into a potential conflict with those
health psychologists who don’t have clinical training (Murray, 2017). It is not
clear how the practice of health psychology will evolve in the forthcoming
years. In 2015, Bennet suggested an option that would allocate clinical health
psychologists in primary and secondary healthcare and health psychologists in
illness prevention and public health. Development of health psychology varies depending on
the country. Currently in the UK, being a member of the BPS DHP is a prerequisite
for qualifying as a health psychologist. Furthermore, the professional
activities of the health psychologists are regulated by the BPS (Michie,
Abraham & Johnston, 2007). Health psychology has grown rapidly with an increase
on the evidence that shows the relationship between behaviour and illness and,
and the awareness of the psychosocial aspects of health and illness (Marks et
al, 2015). These days in the UK, patients usually access health services
through the general medical practitioner (GP) in their area, who if needed,
refers them to other health professional for treating their condition. Recent
research has shown how health psychology indeed contributes to health promotion
in primary care settings (Thielke,Thompson & Stuart, 2011), but there is
still work to do for demonstrating its cost-effectiveness across other systems
of care. Philosophies
and theories underpinning the fieldIn the field of health psychology, many theories and
framework have contributed to the actual development of the discipline. In 1946
the World Health Organization (WHO) defined health as: ‘the state of complete
physical, social and spiritual well-being, not simply the absence of illness.’
This definition encompasses social and biological aspects but it seems it
leaves out some important issues that also have an impact on health such as psychology,
culture and economics. For this reason, Marks and his colleagues (2015) gave a
new definition of health that describes it as: ‘a state of well-being with
satisfaction of physical, cultural, psychosocial, economic and spiritual needs,
not simply the absence of illness.’During many years, philosophers, doctors,
psychologists and many others have had much to say about what makes someone
feel well. One of the most known theories about human’s wellbeing is Maslow’s
Hierarchy of Needs. In Maslow’s (1943) hierarchy of needs, he states that
people are motivated towards achieving some needs. These needs are organized
within hierarchical levels forming a pyramid and, starting from the bottom one,
when a person’s need is accomplished, they seek to achieve the next one. Maslow’s
model is divided into basic needs – such as physiological, security, social
acceptance and self-esteem – and growth needs or the need for
self-actualization, which is located on the top of the pyramid (McLeod, 2007). Maslow’s hierarchy framework has had a big influence
when talking about health and human wellbeing. However, as every good piece of
work in research, there are always objections. According to Marks et al (2015),
there are essential elements of human realization that are not mentioned in
Maslow’s theory as, for instance, agency and autonomy – those are what give
people the freedom to make a choice – and spirituality – the feeling that not
everything that matters is in the physical world. Following Maslow’s hierarchy, a number of
psychological theories have attempted to give an explanation to human’s
satisfaction and wellbeing. The ‘Self Determination Theory’, which had an
important impact in psychology, suggested that there are three universal and
innate human needs: competence, autonomy and psychological relatedness (Ryan
& Deci, 2000). However, none of these theories and frameworks has been
enough to fully understand what is needed for a person’s happiness and
well-being. Throughout history, scholars have tried to explain the
nature of a joyful and happy life or, as it’s known in health care, quality of
life (QoL). The World Health Organization (1995) defines Quality of Life as ‘an
individual’s perception of their position in life in the context of the culture
and value systems in which they live, and in relation to their goals,
expectations, standards and concerns. It is a broad ranging concept, affected
in a complex way by the person’s physical health, psychological state, level of
independence, social relationships, and their relationship to salient features
of the environment.’ A sixth field on spirituality and religiousness was added
afterwards by the WHOQoL Group (1995). The concept of Quality of Life overlaps
with the concept of subjective wellbeing, which has been defined as: ‘an
umbrella term for different valuations that people make regarding their lives,
the events happening to them, their bodies and minds, and the circumstances in
which they live’ (Diener, 2006). In 2011, Diener and Chan outlined evidence that having
a positive perception of subjective wellbeing adds four to ten years to
someone’s life. According to this data, it can be said that, somehow, there is
an association between mortality and subjective wellbeing. One of the main
purposes of health psychology, then, is to understand the links between
subjective well-being and health (Marks et al, 2015). In order to accomplish this purpose, the relevance of
psychosocial processes and people’s behaviour in health and illness is becoming
more frequently recognized. One of the most broadly used models in health
psychology that is worth to mention here is the Biopsycosocial Model of health.
In contrast to the Biomedical Model, the Biopsychosocial Model proposed by Engel
(1977) suggests that behaviours, thoughts and feelings do influence the
physical state. He argued that psychological and social factors have an impact
on people’s biological functioning and so are determinants of health and
illness. This model describes how psychology, society and behaviour have an
impact on a person’s health situation.  Another important model for exploring the social
health factors that can determine people’s health and wellbeing is the
Dahlgren-Whitehead Rainbow model (1991). This model outlines the relationship
between the individual, their environment and their health. Individuals are
represented in the core layer, and around them there are four layers of
influences on health – from the inner to the outer one they are individual
lifestyle factors, community influences, living and working conditions and general
socio-economic, cultural and environmental conditions. These two frameworks have helped
researchers to build a number of hypotheses about the determinants of health,
their influences on different health outcomes and the interactions between
them. Although the main focus for health psychology used to
be clinical settings, psychologists have become key members of
multidisciplinary teams (Michie & Abraham, 2004). Health psychology is
developing into an increasingly demanded discipline in health care and medical
settings.Current issues concerning health
psychologistsHealth psychologists (HPs) implement the theory,
methods and research of psychology to a more applied context whose aim is to
help people to avoid and manage illnesses, and to promote and maintain health. Health
psychology searches for the best way to communicate to people for promoting
health protective behaviours (Rothman & Salovey, 1997). Health psychologists’ competences are useful at all
levels of the healthcare system. At the level of direct patient care, they help
patients to psychologically adjust to illness and treatment, reducing the
stress associated with the clinical procedures, delivering health education,
facilitating their decision making and delivering health interventions for
promoting healthy behaviours (Hallas, 2007). These health professionals provide
services in both hospital and community, and through the different stages of
the illness, from diagnosis to palliative care. Direct
patient care and educationOn the one to one basis, health psychologists may be
asked to assess patients to recognize the way in which they are dealing with
their condition. Assessment interviews are different depending on the patient’s
healthcare needs but will usually focus on interviews evaluating affection and
mood state, perceptions, attitudes and emotional reactions towards illness, coping
style, social support, cognitive aptitude and their response to the environment
(Butt, 2016). Health psychologists must know how to extract information in
these interviews and communicate it afterwards to other healthcare
professionals, in order to direct them to the medical options that best suit
the patient. Regarding health psychology interventions, these can
be carried out within primary or secondary prevention services (Hallas, 2007). Health
psychologists design and carry out cognitive-behavioural interventions with
individual patients and groups for changing health behaviours. Health behaviours
refer to the actions and behaviours of an individual person, a group or/and an
organization. For example, when someone is stressed at work it could be
attributed to the person’s coping strategies, but it could also be related with
the manager’s decision-making behaviour, which would be the organization in
this case (Kok & Schaalma, 2007). Within the category of health behaviours,
there are included the used of medical services, the adherence to medical
diets, and the self directed behaviours such as nutrition, physical activity,
smoking and consuming alcohol. All these behaviours are usually divided between
health-enhancing and health-impairing behaviours (Bennett, Conner & Godin,
2007). Behaviour management is a key factor for preventing
and dealing with chronic diseases (Matarazzto, 1982). Health
psychologists need to understand and to intervene to changes in both psychological
and behavioural processes on illness and healthcare. Changing
behaviour of patients and health professionals can be advantageous for the
healthcare system (Kaplan, 1990) and should be one of the main goals of health
psychology. Health psychology training to healthcare
professionalsHPs are also employed to train other healthcare
professionals so they can better understand de psychological impact of illness
and treatment and improve the professional – patient communication (Gatchel
& Oort, 2003). The fields of knowledge that HPs could teach may
include the Biopsychosocial Model of health, statistics and methods of research
and theories and techniques of behaviour change (Winefield, 2007). They may as
well use their expertise in intervention design and implementation to support
other healthcare professionals in delivering interventions and developing their
own design (Hallas, 2007). In more applied contexts, health psychologists may
train on skills such as communication and interview, adherence to treatment,
promotion of a healthy lifestyle and handling work stress for health
professionals.

Another important part when it comes to professionals’
education is the supervision from professional health psychologists to other
people training for being one of them (Horn, 2007). Supervision implicates an
exchange of information between the supervisor and the trainee. The supervisor
must identify what the trainee needs and guide him or her in the right way for
understanding, experiencing and reflecting over the acquired knowledge. 

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