Advances in health psychology critical approaches Christine Horrocks and Sally Johnson (eds)

Reviewed by: Carmel Capewell, The University of Northampton, UK

The focus of this book is looking at how critical health psychology can lead to action and, with it, social change. The contributors all have an interest in health, mainly using qualitative methods in participative and community projects with marginalised groups. Some take an explicitly feminist perspective in their research. Moving away from the traditional bio-psychological model of health psychology, the book emphasises the scholar-activist role enabling a focus on social and contextual issues. The critical approaches in health psychology incorporate the context in which individuals live their lives and the impact this has on health behaviour. This is in contrast with the traditional health psychology approach which decontexualises individual health behaviours and cognition.

Most of contributions to the book emerge from the British Healthcare System (NHS). The book is arranged in four sections. In Part I, contributors provide background on the development and value of critical health psychology. The authors do not deny the place and worth of traditional health psychology but do advance the benefits of an alternative approach. Part II explores in more detail the interactions between individual health decisions and actions through exploring the social, cultural, gender and situational contexts within which such decisions take place. Detailed consideration is given to how people need to be ‘situated’ in a wider context if health behaviours and responses to health prevention campaigns are to be of use. Participants’ voices provide clear examples of the impact of context. In Part III, the implications for global healthcare systems regarding a change of power between professionals and patients makes some excellent points. For example, the idea of the ‘expert’ patient who potentially has greater understanding and expectations of treatment and the type of conversations they’ll want with professionals as a result of being better informed from accessing information via the internet. There is a limited discussion of whether everyone has this interest or ability to access the change. However, the need for medical professionals to reflect on their own practices, particularly when they may avoid issues with which they seem to feel uncomfortable or not have the resources to deal, is made in a discussion about domestic violence. The action focus is seen in Part IV. Examples of how using different methodologies and greater community-based research can help move health psychology away from individual treatment and more into community prevention helps to illustrate the ways in which critical health psychology can achieve policy change through action.

There are effective descriptions of the way in which an individual’s social and cultural context can impact health behaviours throughout the book. For example in chapter 4, Katy Day, uses class to illustrate how critical health psychology approaches explore potential causes behind higher mortality rates and health behaviours (e.g. being overweight and smoking) through listening to people’s voices and stories. This is in contrast to traditional health psychology which uses Socio Economic Status (SES), based on educational level and household income, as another variable to be factored in to explain individual health behaviours.

Critical approaches in health psychology emphasise researching with, rather than on, people. Encouraging people to discuss the reasons why they chose certain actions over others provides insight into how social identity shapes an individual’s actions. The view is that this will lead to more appropriate health prevention programmes. Evaluation of these alternatives is not provided.

The research studies discussed throughout the book are helpful in demonstrating application of the ideas and concepts described. In general, the ethical issues involved in quantitative research are not well covered, with the exception of the implications and benefits of time limitations regarding informed consent.

One of the stated aims of the book is to critique mainstream health psychology. This is done well as the value of mainstream methods is recognised through use of appropriate references, while the benefits to be gained from critical health psychology which adds a different dimension is effectively developed. The benefits of utilising critical health psychology approaches are well made through the use of appropriate and well-described examples. The book provides an increased understanding of the inequalities of healthcare, the ways in which marginalised groups describe themselves and the importance of situating people in context.