Health beliefs and attributions

  • Theresa M. Marteau


The beliefs and attributions that people hold can influence their health in one of two main ways: first, by affecting their behaviour, such as attendance at a screening programme; the food they eat; whether they take prescribed medication; and secondly, more directly by affecting a physiological system, such as the immune or cardiovascular systems. These two modes of influence are not mutually exclusive. A patient’s health may also be influenced by the beliefs and attributions of health professionals. These may affect patient outcomes in one of two ways: first, by affecting staff decisions about which medical procedures or treatments to use, and secondly by influencing patients’ cognitions. Although there is general agreement among psychologists that health beliefs and attributions are important in explaining and predicting health behaviours and health outcomes, there is less agreement about which beliefs and attributions are important, and how much of the variance in outcomes they predict.


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  1. Affleck, G., Tennen, H., Croog, S. and Levine, S. (1987) Causal attribution, perceived control, and recovery from a heart attack. Journal of Social and Clinical Psychology, 5, 356–64.Google Scholar
  2. Antoni, M.H. (1987) Neuroendocrine influences in psychoimmunology and neoplasia: a review. Psychology and Health, 1, 3–24.Google Scholar
  3. Ajzen, I. (1988) Attitudes, Personality and Behavior, Open University Press, Milton Keynes.Google Scholar
  4. Bandura, A. (1991) Self-efficacy mechanism in physiological activation and health-promoting behaviour, in: Neurobiology of Learning, Emotion and Affect, (ed J. Madden), Raven Press, New York, pp. 229–70.Google Scholar
  5. Bard, M. and Dyk, R.B. (1956) The psychodynamic significance of beliefs regarding the cause of serious illness. Psychoanalytic Review, 43, 146–62.Google Scholar
  6. Becker, M.H. (ed) (1974) The health belief model and personal health behaviour. Health Education Monographs, 2, 324–508.Google Scholar
  7. Becker, M.H. and Rosenstock, I.M. (1984) Compliance with medical advice, in: Health Care and Human Behaviour, (eds A. Steptoe and A. Mathews), Academic Press, London, pp. 175–208.Google Scholar
  8. Blaxter, M. (1979) Concepts of causality: lay and medical models, in Research in Psychology and Medicine, vol. II, (eds D.J. Oborne, M.M. Gruneberg and J.R. Eiser) Academic Press, London, pp. 154–61.Google Scholar
  9. Bradley, C, Brewin, C.R., Gamsu, D.S. and Moses, J.L. (1984) Development of scales to measure perceived control of diabetes mellitus and diabetes-related health beliefs. Diabetic Medicine, 1, 213–18.Google Scholar
  10. Bradley, C, Gamsu, D.S., Moses, J.L. et al. (1987) The use of diabetes-specific perceived control and health belief measures to predict treatment choice and efficacy in a feasibility study of continuous subcutaneous insulin infusion pumps. Psychology and Health, 1, 133–46.Google Scholar
  11. Breslow, L. and Enstrom, J.E. (1980) Persistence of health habits and their relationship to mortality. Preventive Medicine, 9, 469–83.Google Scholar
  12. Brewin, C.R. (1984a) Attributions for industrial accidents: their relationship to rehabilitation outcomes. Journal of Social and Clinical Psychology, 2, 156–64.Google Scholar
  13. Brewin, C.R. (1984b) Perceived controllability of life events and willingness to prescribe psychotropic drugs. British Journal of Social Psychology, 23, 285–7.Google Scholar
  14. Brewin, C.R. (1985) Depression and causal attributions: what is their relation? Psychological Bulletin, 98, 297–309.Google Scholar
  15. Brewin, C.R. and Antaki, C. (1987) An analysis of ordinary explanations in clinical attribution research. Journal of Social and Clinical Psychology, 5, 79–98.Google Scholar
  16. Brickman, P., Rabinowitz, V.C., Karuza, J. et al. (1982) Models of helping and coping. American Psychologist, 37, 368–84.Google Scholar
  17. Bulman, R. and Wortman, C.B. (1977) Attributions of blame and coping in the ‘real world’: severe accident victims react to their lot. Journal of Personality and Social Psychology, 35, 351–63.Google Scholar
  18. Carnahan, T.M. (1979) The development and validation of the multidimensional dental locus of control scales Unpublished doctoral dissertation, State University of New York, Buffalo.Google Scholar
  19. Cartwright, D. (1979) Contemporary social psychology in historical context. Social Psychology Quarterly, 42, 82–93.Google Scholar
  20. Chodoff, P., Friedman, P.B. and Hamburg, D.A. (1964) Stress, defenses and coping behavior: observations in parents of children with malignant disease. American Journal of Psychiatry, 120, 743–9.Google Scholar
  21. Coyne, J.C. and Gotlib, I.H. (1983) The role of cognition in depression: a critical appraisal. Psychological Bulletin, 94, 472–505.Google Scholar
  22. Cummings, K.M., Becker, M.H., Kirscht, J.P. and Levin, N.W. (1981) Intervention strategies to improve compliance with medical regimens by ambulatory hemodialysis patients. Journal of Behavioural Medicine, 4, 111–27.Google Scholar
  23. Davidson, A.R. and Jaccard, J.J. (1975) Population psychology: a new look at an old problem. Journal of Personality and Social Psychology, 31, 1073–82.Google Scholar
  24. DeVellis, R.F., DeVellis, B.M., Wallston, B.S. and Wallston, K.A. (1980) Epilepsy and learned helplessness. Basic and Applied Social Psychology, 1, 241–53.Google Scholar
  25. Eisenberg, J.M. (1986) Doctors’ Decisions and the Cost of Medical Care, Michigan, Health Administration Press.Google Scholar
  26. Eiser, J.R., (1986) Social Psychology: Attitudes, Cognitions and Social Behaviour, Cambridge University Press, Cambridge.Google Scholar
  27. Eiser, J.R., van der Plight, J., Raw, M. and Sutton, S.R. (1985) Trying to stop smoking: effects of perceived addiction, attributions for failure, and expectancy for success. Journal of Behavioural Medicine, 8, 321–41.Google Scholar
  28. Farr, R.M. (1977) Heider, Harre, and Herzlich on health and illness: some observations on the structure of ‘representations collectives’. European Journal of Social Psychology, 7, 491–504.Google Scholar
  29. Fishbein, M (1982) Social psychological analysis of smoking behaviour, in Social Psychology and Behavioural Medicine, (ed J. R. Eiser) John Wiley and Sons, Chichester, pp. 179–97.Google Scholar
  30. Fishbein, M. and Ajzen, I.(1975) Belief, Attitude, Intention and Behavior: an Introduction to Theory and Research, Addison-Wesley, Reading, Massachusetts.Google Scholar
  31. French, K. and Raven, B.H. (1959) The bases of social power, in Studies in Social Power (ed D. Cartwright), Institute for Social Research, Ann Arbor, Michigan, pp. 150–67.Google Scholar
  32. Gamsu, D.S. and Bradley, C. (1987) Clinical staff’s attributions about diabetes: scale developments and staff vs patient comparisons. Current Psychological Research and Reviews, 6, 69–78.Google Scholar
  33. Gillespie, C.R. and Bradley, C. (1988) Causal attributions of doctor and patients in a diabetes clinic. British Journal of Clinical Psychology 27, 67–76.Google Scholar
  34. Greer, S., Morris, T. and Pettingale, K.W. (1979) Psychological response to breast cancer: effect on outcome. Lancet, ii, 785–7.Google Scholar
  35. Haefner, D. and Kirscht, J.P. (1970) Motivational and behavioural effects of modifying health beliefs. Public Health Report, 85, 478–84.Google Scholar
  36. Herzlich, C. (1973) Health and Illness: A Social Psychological Analysis, Academic Press, London.Google Scholar
  37. Hewstone, M. (ed) (1983) Attribution Theory: Social and Functional Extensions, Blackwell, Oxford.Google Scholar
  38. House, W.C., Pendleton, L. and Parker, L. (1986) Patients’ versus physicians’ attributions of reasons for diabetic patients’ noncompliance with diet. Diabetes Care, 9, 434.Google Scholar
  39. Ickes, W.J. and Kidd, R.F. (1976) An attributional analysis of helping behaviour, in New Directions in Attribution Research, vol.1, (eds J.H. Harvey, W.J. Ickes and R.F. Kidd), Erlbaum Associates, Hillsdale, New Jersey, pp. 311–34.Google Scholar
  40. Janoff-Bulman, R. (1979) Characterological versus behavioral self-blame: inquiries into depression and rape. Journal of Personality and Social Psychology, 37, 1798–1809.Google Scholar
  41. Janz, N.K. and Becker, M.H. (1984) The health belief model: a decade later. Health Education Quarterly, 11, 1–47.Google Scholar
  42. Johnston, M. and Marteau, T.M. (1987) The health beliefs of the health professionals, in Clinical Psychology: Research and Developments, (ed. H. Dent), Croom Helm, London, pp. 126–31.Google Scholar
  43. Jones, E.E. and Nisbett, R.E. (1977) The actor and the observer: divergent perceptions of the causes of behavior, in Attribution: Perceiving the Causes of Behavior, (eds E.E. Jones, D.E. Kanouse, H.H. Kelley, R.E. Nisbett, S. Valins and B. Weiner), General Learning Press, Morristown, New Jersey.Google Scholar
  44. Joseph, J.G. Montgomery, S.B., Emmons, C.A. et al. (1987) Magnitude and determinants of behavioral risk reduction: longitidinal analysis of a cohort at risk for AIDS. Psychology and Health, 1, 73–95.Google Scholar
  45. Kahneman, D. and Tversky, A. (1979) Prospect theory: an analysis of decision under risk. Econometrica, 47, 263–91.Google Scholar
  46. Kamen, L.P. and Seligman, M.E.P. (1987) Explanatory style and health. Current Psychological Research and Reviews, 6, 207–18.Google Scholar
  47. Kaplan, R.M., Atkins, C.J. and Reinsch, S. (1984) Specific efficacy expectations mediate exercise compliance in patients with COPD. Health Psychology, 3, 223–242.Google Scholar
  48. Kelley, H.H. (1967) Attribution theory in social psychology, in Nebraska Symposium on Motivation, (ed. D. Levine), University of Nebraska Press, Lincoln, Nebraska.Google Scholar
  49. Kelley, H.H. and Michela, J.L. (1980) Attribution theory and research. Annual Review of Psychology, 31, 457–501.Google Scholar
  50. Kiecolt-Glaser, J.K., Glaser, R., Williger, E. et al. (1985) Psychosocial enhancement of immunocompe-tence in a geriatric population. Health Psychology, 4, 25–41.Google Scholar
  51. King, J.B. (1982) The impact of patients’ perceptions of high blood pressure on attendance at screening: an attributional extension of the health belief model. Social Science and Medicine, 16, 1079–92.Google Scholar
  52. Kirscht, J.P. (1983) Preventive health behavior: a review of research and issues. Health Psychology, 2, 277–302.Google Scholar
  53. Kok, G., De Vries, H., Mudde, A.N. and Strecher, V.J. (1990) Planned health education and the role of self-efficacy: Dutch research. Health Education Research, 5.Google Scholar
  54. Kristiansen, C.M. (1985) Value correlates of preventive health behavior. Journal of Personality and Social Psychology, 49, 748–58.Google Scholar
  55. Labs, S.M. and Wurtele, S.K. (1986) Fetal health locus of control scale: development and validation. Journal of Consulting and Clinical Psychology, 54, 814–19.Google Scholar
  56. Landrine, H. and Klonoff, E.A. (1992). Culture and health-related schemas: a review and proposal for interdisciplinary integration. Health Psychology, 11, 267–76.Google Scholar
  57. Lau, R.R. and Ware, J.E. (1981) The conceptualisation and measurement of a multidimensional health-specific locus of control scale. Medical Care, 19, 1147–58.Google Scholar
  58. Lau, R.R. Hartman, K.A. and Ware, J.E. (1986) Health as a value: methodological and theoretical considerations. Health Psychology, 5, 25–43.Google Scholar
  59. Levenson, H. (1973) Multidimensional locus of control in psychiatric patients. Journal of Consulting and Clinical Psychology, 41, 397–404.Google Scholar
  60. Leventhal, H. and Nerenz, D. (1985) The assessment of illness cognition, in Measurement Strategies in Health Psychology, (ed P. Karoly), Wiley and Sons, New York, pp. 517–54.Google Scholar
  61. Levin, A. and Schulz, M.A. (1980) Multidimensional health locus of control and compliance in low and high participation hemodialysis. Unpublished Msc thesis, University of Wisconsin, Madison.Google Scholar
  62. Levy, S.M. and Wise, B.D. (1987) Psychosocial risk factors, natural immunity, and cancer progression: implications for intervention. Current Psychological Research and Reviews, 6, 229–43.Google Scholar
  63. Lewis, F.M., Morisky, D.E. and Flynn, B.S. (1978) A test of construct validity of health locus of control: effects of self-reported compliance for hypertensive patients. Health Education Monographs, 6, 138–48.Google Scholar
  64. Ley, P. (1982) Satisfaction, compliance, and communication. British Journal of Clinical Psychology, 21, 241–54.Google Scholar
  65. McClelland, D.C. and Jemmott, J.B. (1980) Power motivation, stress and physical illness. Journal of Human Stress, 6, 6–15.Google Scholar
  66. McNeil, B.J., Pauker, S.G., Sox, H.C. and Tversky, A. (1982) On the elicitation of preferences for alternative therapies. New England Journal of Medicine, 306, 1259–62.Google Scholar
  67. Manstead, A.S.R., Proffitt, C. and Smart, J.L. (1983) Predicting and understanding mothers’ infant-feeding intentions and behavior: testing theory of reasoned action. Journal of Personality and Social Psychology, 44, 657–71.Google Scholar
  68. Marby, J.H. (1964) Lay concepts of etiology, Journal of Chronic Diseases, 17, 371–86.Google Scholar
  69. Marteau, T.M. (1987) Health related beliefs, attitudes and attributions: issues in measurement. Proceedings of the Health Psychology Section, British Psychological Society, pp. 32–7.Google Scholar
  70. Marteau, T.M. (1989) Framing of information: its influence upon decisions of doctors and patients. British Journal of Social Psychology, 28, 89–94.Google Scholar
  71. Marteau, T.M. and Baum, J.D. (1984) Doctors’ views on diabetes. Archives of Diseases of Childhood, 59, 566–70.Google Scholar
  72. Marteau, T.M. and Johnston, M. (1986a) Determinants of beliefs about illness: a study of parents of children with diabetes, asthma, epilepsy, and no chronic illness. Journal of Psychosomatic Research, 30, 673–83.Google Scholar
  73. Marteau, T.M. and Johnston, M. (1986b) Doctors taking blood from children: a suitable case for treatment? British Journal of Clinical Psychology, 25, 159–60.Google Scholar
  74. Marteau, T.M. and Johnston, M. (1987) Health psychology: the danger of neglecting psychological models. Bulletin of the British Psychological Society, 40, 82–5.Google Scholar
  75. Marteau, T.M. and Riordan, D.C. (1992) Staff attitudes to patients: the influence of causal attributions for illness. British Journal of Clinical Psychology, 31, 107–110.Google Scholar
  76. Marteau, T.M., Johnston, M., Baum, J.D. and Bloch, S. (1987) Goals of treatment in diabetes: a comparison of doctors and parents of children with diabetes. Journal of Behavioural Medicine, 10, 33–48.Google Scholar
  77. Meyer, D., Leventhal, H. and Gutmann, M. (1985) Common-sense models of illness: the example of hypertension. Health Psychology, 4, 115–35.Google Scholar
  78. O’Leary, A., Shoor, S., Lorig, K. and Holman, H.R. (1988). A cognitive-behavioral treatment for rheumatoid arthritis. Health Psychology, 7, 527–42.Google Scholar
  79. Peterson, C. (1986) Explanatory style as a risk factor for illness. Unpublished manuscript, University of Michigan.Google Scholar
  80. Rippetoe, P.A. and Rogers, R.W. (1987) Effects on components of protection motivation theory on adaptive and maladaptive coping with a health threat. Journal of Personality and Social Psychology, 52, 596–604.Google Scholar
  81. Rodin, J. and Langer, E.J. (1977) Long-term effects of a control relevant intervention with the institutionalised aged. Journal of Personality and Social Psychology, 35, 897–902.Google Scholar
  82. Rokeach, M. (1973) The Nature of Human Values, Free Press, New York.Google Scholar
  83. Rosengren, J. (1961) Some social psychological aspects of delivery room difficulties. Journal of Nervous and Mental Diseases, 132, 515–21.Google Scholar
  84. Rotter, J.B. (1954) Social Learning and Clinical Psychology, Prentice-Hall, Englewood Cliffs, New Jersey.Google Scholar
  85. Rotter, J.B. (1966) Generalised expectancies for internal versus external control of reinforcement. Psychological Monographs, 80, (1, whole no. 609).Google Scholar
  86. Sampson, E.E. (1981) Cognitive psychology as ideology. American Psychologist, 36, 730–43.Google Scholar
  87. Schenkel, R.J., Rogers, J.P., Perfetto, M.A. and Levin, R.A. (1985–6) Importance of ‘significant others’ in predicting cooperation with diabetic regimen. International Journal of Psychiatry in Medicine, 15, 149–55.Google Scholar
  88. Schlenk, E.A. and Hart, L.K. (1984) Relationship between health locus of control, health value, and social support and compliance of persons with diabetes mellitus. Diabetes Care, 7, 566–74.Google Scholar
  89. Schwartzer, R. (1992) Self-efficacy in the adoption and maintenance of health behaviors: theoretical approaches and a new model, in Self-Efficacy: Thought Control of Action, (ed R. Schwartzer), Hemisphere Publishing Corporation, Washington, pp. 217–43.Google Scholar
  90. Sherr, L. (1987) An evaluation of the UK government health education campaign on AIDS. Psychology and Health, 1, 61–72.Google Scholar
  91. Silver, R.L. and Wortman, C.B. (1980) Coping with undesirable life events, in Human Helplessness, (eds J. Garber and M.E.P. Seligman), Academic Press, New York, pp. 271–341.Google Scholar
  92. Sonne, J.L. and Janoff, D.S. (1982) Attributions and the maintenance of behaviour change, in Attributions and Psychological Change: Applications of Attributional Theories to Clinical and Educational Practice, (eds C. Antaki and C.R. Brewin), Academic Press, London, pp. 83–96.Google Scholar
  93. Stone, G.C. (1979) Psychology and the health system, in Health Psychology (eds G.C. Stone, F. Cohen and N.E. Adler), Jossey-Bass, San Francisco, pp. 47–75.Google Scholar
  94. Strickland, B.R. (1978) Internal-external expectancies on health-related behaviors. Journal of Consulting and Clinical Psychology, 46, 1192–211.Google Scholar
  95. Taylor, C.B., Bandura, A., Ewarr, C.K., Miller, N.H. and DeBusk, R.F. (1985) Exercise testing to enhance wives’ confidence in their husbands’ cardiac capability soon after clinically uncomplicated acute myocardial infarction. American Journal of Cardiology, 55, 635–8.Google Scholar
  96. Taylor, S.E., Lichtman, R.R. and Wood J.V. (1984) Attributions, beliefs about control and adjustment to breast cancer. Journal of Personality and Social Psychology, 46, 489–502.Google Scholar
  97. Tennen, H., Affleck, G. and Gershmann, K. (1986) Self-blame among parents of infants with perinatal complications: the role of self-protective motives. Journal of Personality and Social Psychology, 50, 690–96.Google Scholar
  98. Timko, C. and Janoff-Bulman, R. (1985) Attributions, vulnerability, and psychological adjustment: the case of breast cancer. Health Psychology, 4, 521–44.Google Scholar
  99. Turk, D.C., Rudy, T.E. and Salovey, P. (1986) Implicit models of illness. Journal of Behavioural Medicine, 9, 453–74.Google Scholar
  100. Wallston, K.A. and McLeod, E. (1979) Predictive factors in the adherence to an antihypertensive regimen among adult male outpatients. Unpublished manuscript, School of Nursing, Vanderbilt University.Google Scholar
  101. Wallston, K.A. and Wallston, B.S. (1982) Who is responsible for your health? The construct of health locus of control, in Social Psychology of Health and Illness, (eds G.S. Sanders and J. Suls), Lawrence Erlbaum, Hillsdale, NJ, pp. 65–95.Google Scholar
  102. Wallston, B.S. and Wallston, K.A. (1984) Social psychological models of health behavior: an examination and interaction, in Handbook of Psychology and Health, vol. IV: Social Aspects of Health, (eds. A. Baum, S. Taylor, and J.E. Singer), Lawrence Erlbaum, Hillsdale, NJ, pp. 23–53.Google Scholar
  103. Wallston, K.A., Maides, S. and Wallston, B.S. (1976) Health-related information seeking as a function of health-related locus of control and health value. Journal of Research into Personality, 10, 215–22.Google Scholar
  104. Wallston, K.A., Wallston, B.S. and DeVellis, R. (1978) Development of the multidimensional health locus of control (MHLC) scales. Health Education Monographs, 6, 160–70.Google Scholar
  105. Wallston, K.A., Wallston, B.S., Smith, S. and Dobbins, C.J. (1987) Perceived control and health, in Applications in Health Psychology, (eds M. Johnston and ) T Marteau. Transaction Books, New Brunswick, pp. 5–25.Google Scholar
  106. Weinberger, M., Cohen, S. and Mazzuca, S.A. (1984) The role of physicians’ knowledge and attitudes in effective diabetes management. Social Science and Medicine, 19, 965–9.Google Scholar
  107. Weiner, B. (1979) A theory of motivation for some classroom experiences. Journal of Educational Psychology, 71, 3–25.Google Scholar
  108. Weinstein (1988) The precaution adoption process. Health Psychology, 7, 355–86.Google Scholar
  109. Winett, R.A. (1985) Ecobehavioral assessment in lifestyles: concepts and methods, in Measurement Strategies in Health Psychology, (ed. P. Karoly), John Wiley and Sons, New York, pp. 147–81.Google Scholar
  110. Wynne, G., Marteau, T.M., Johnston, M. et al. (1987) Inability of trained nurses to perform basic life support. British Medical Journal, 294, 1189–9.Google Scholar

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