Difficulty: Intermediate | Prerequisites: Chapter 3 (behaviour change models)
Chapter 4 explores how psychological phenomena like cognitive dissonance and reactance affect health-promoting behaviours, with applied examples in sun safety and sleep. Chapter 5 turns to behaviours that compromise health, focusing on the complexities around obesity, BMI, ecological and community-level thinking, and youth vaping trends.
Health-promoting behaviours (sun safety, sleep) are shaped by psychological forces like cognitive dissonance and reactance, which can either push people toward or away from healthy choices. Health-compromising behaviours are more complicated than individual willpower: obesity is tangled up with systemic issues, BMI is a flawed measure especially for BIPOC communities, and ecological perspectives remind us that health happens in a context, not a vacuum.
Cognitive dissonance
The psychological discomfort that arises when a person holds two contradictory beliefs or when their behaviour conflicts with their beliefs. In health psychology, a smoker who knows smoking is harmful experiences dissonance, which can motivate quitting or, alternatively, rationalising the behaviour.
Psychological reactance
The motivational state triggered when people feel their freedom of choice is being threatened or restricted. In simple terms, telling someone they must do something can make them want to do the opposite. This is why heavy-handed health messaging sometimes backfires.
Body Mass Index (BMI)
A numerical value calculated from a person's weight and height (kg/m squared), used as a screening tool for weight categories. It is a population-level tool, not a diagnostic measure, and it has significant limitations.
Ecological-community perspective
An approach to health that considers multiple levels of influence: individual, interpersonal, organisational, community, and policy. Health behaviours are not just personal choices but are shaped by the environments and systems people live in.
Strengths-based approach
A health promotion strategy that identifies and builds on existing community assets, resources, and capabilities rather than focusing on deficits and problems. Think of it as starting from "what is working" rather than "what is broken."
Deficit-oriented approach
A health promotion strategy that focuses on problems, needs, and risk factors within a community. While it can identify areas for intervention, it can also pathologise communities and overlook their resilience and resources.
Cognitive dissonance can be harnessed for health promotion. When people are made aware of the gap between what they believe ("UV exposure is dangerous") and what they do ("I never wear sunscreen"), the discomfort can motivate behaviour change. This is called the hypocrisy paradigm: you get people to publicly advocate a health behaviour, then remind them of times they failed to follow it.
Psychological reactance works in the opposite direction. If a health message feels controlling or removes choice ("You MUST quit smoking"), people may double down on the unhealthy behaviour to reassert their autonomy. Effective health communication walks a line between urgency and respect for the audience's sense of freedom.
Sander et al. (2020) takeaways: This research examined factors influencing sun-protective behaviours. Key findings include the importance of framing sun safety messages in ways that do not trigger reactance, and that perceived susceptibility and self-efficacy are strong predictors of sunscreen use.
Gloster & Neal (2006) takeaways: Focused on the relationship between knowledge about UV risk and actual sun-protective behaviour. Knowing the facts is not always sufficient to change behaviour; emotional and social factors also play a role. This connects to the broader theme that information alone does not drive health behaviour change.
Key takeaways from the course material on sleep:
Sleep deprivation compromises immune function, cognitive performance, emotional regulation, and cardiovascular health
Chronic sleep loss is associated with increased risk of obesity, diabetes, heart disease, and depression
Practical tips for better sleep include maintaining a consistent schedule, reducing screen exposure before bed, avoiding caffeine late in the day, and creating a cool, dark sleep environment
The framing "sleep is your superpower" underscores that sleep is not a luxury or a sign of laziness but a biologically essential process with measurable health consequences
The term "obesity" is placed in quotation marks in the study guide deliberately. The course examines how obesity has been framed historically and the problems with treating it as a straightforward individual failing.
Why BMI is problematic for the BIPOC community:
BMI was developed using data from predominantly white European populations. It does not account for differences in body composition across racial and ethnic groups. For example, some populations carry more muscle mass at a given height and weight, or have different fat distribution patterns. Using BMI as a universal standard can lead to misclassification and inappropriate health recommendations for people of colour.
Maintenance Phase takeaways:
The course drew on episodes from the Maintenance Phase podcast to raise several points:
The history of the "obesity epidemic" framing involves moral panic and is not purely evidence-based
Weight-loss interventions have very low long-term success rates
Weight stigma itself is a health risk, contributing to stress, avoidance of medical care, and disordered eating
The relationship between weight and health is more complex than "higher weight equals worse health"
Strengths-based approaches focus on identifying what a community already does well and building from those assets. They respect community knowledge and promote empowerment rather than dependence on outside experts.
Deficit-oriented approaches focus on what is wrong or lacking. They can be useful for identifying needs, but they risk stigmatising communities and framing health disparities as the community's fault rather than addressing structural causes.
The exam may ask you to compare these two approaches or to identify which one a given intervention exemplifies.
Key statistics to know:
Youth vaping rates (high school and middle school students) rose sharply in the mid-to-late 2010s
More recent data show some decline, but rates remain concerning
Vaping is often marketed as safer than cigarettes, but it carries its own health risks including nicotine addiction, lung injury, and exposure to harmful chemicals
The rapid rise in youth vaping prompted the designation of it as an epidemic by health officials
Students often think cognitive dissonance always leads to behaviour change. It does not. People can also reduce dissonance by changing their beliefs ("Smoking is not that bad") or by adding new cognitions ("My grandfather smoked and lived to 90").
Students frequently treat BMI as a reliable individual health measure. BMI is a population-level screening tool. It says nothing about body composition, fitness level, or metabolic health for any one person.
Students sometimes assume strengths-based and deficit-oriented approaches are mutually exclusive. In practice, effective programmes often draw on both, but the starting point and framing matter for community trust and engagement.
Students may think vaping is harmless because it is "not smoking." Vaping still delivers nicotine (which is addictive) and exposes users to chemicals whose long-term effects are not fully understood.
Cognitive dissonance and psychological reactance are likely to appear as scenario-based questions. Know how each one works and be able to identify which is operating in a given example.
The critique of BMI, especially for BIPOC communities, is a major course theme. Expect questions testing whether you understand the limitations of BMI as a measure.
Know the difference between strengths-based and deficit-oriented approaches. A question might describe an intervention and ask you to classify it.
Vaping statistics may appear as factual recall. Know the general trajectory (sharp rise, recent plateau or decline) and the age groups most affected.
True or False: Psychological reactance describes the tendency to comply more readily when given a strong health warning. (False, it describes the tendency to resist)
Fill in the blank: BMI was originally developed using data from predominantly ______ populations. (White European)
True or False: A strengths-based approach begins by identifying a community's problems and deficits. (False, it begins with assets and capabilities)
Fill in the blank: Cognitive dissonance occurs when a person's ______ conflict with their ______. (Beliefs/attitudes, behaviours, or two contradictory beliefs)
True or False: Vaping is considered risk-free because it does not involve tobacco combustion. (False)
Q: A public health campaign tells university students, "You have no choice: you MUST get vaccinated." Many students respond by refusing. What psychological concept explains their response?
A: Psychological reactance. The message threatens their perceived freedom of choice, triggering resistance rather than compliance.
Q: Explain why BMI may not be an appropriate health measure for all racial and ethnic groups.
A: BMI was developed on white European populations and does not account for differences in body composition, muscle mass, or fat distribution across racial and ethnic groups. This can lead to misclassification and inappropriate health recommendations for BIPOC individuals.
Q: A community health programme in an underserved neighbourhood begins by surveying residents about what health resources and practices already exist in the community. Is this a strengths-based or deficit-oriented approach?
A: Strengths-based. It starts from existing community assets rather than cataloguing problems.
Q: How can cognitive dissonance be used to promote sun-protective behaviour?
A: Using the hypocrisy paradigm: have people publicly advocate for sun safety, then remind them of times they failed to protect themselves from UV exposure. The resulting dissonance motivates them to align their behaviour with their stated beliefs.
Cognitive dissonance and reactance from Chapter 4 connect to the patient-provider communication issues in Chapter 9, where provider behaviours can trigger reactance. The ecological-community perspective from Chapter 5 relates to the social determinants of health introduced in Chapter 2 and the weathering concept in Chapter 6. The critique of BMI connects to broader themes of health equity and structural racism discussed throughout the course.
Related Terms / Search Tags
cognitive dissonance, hypocrisy paradigm, psychological reactance, health messaging, sun safety, sunscreen, UV exposure, Sander et al., Gloster and Neal, sleep hygiene, sleep deprivation, obesity, BMI, body mass index, BIPOC, weight stigma, Maintenance Phase, ecological model, ecological-community perspective, strengths-based, deficit-oriented, asset-based, community health, vaping, e-cigarettes, JUUL, youth vaping statistics, nicotine addiction, PSY 320, health psychology MSU