Social psychological factors impacting healthcare engagement.

Nickson, Amy and Sellwood, Bill (2021) Social psychological factors impacting healthcare engagement. PhD thesis, Lancaster University.

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Abstract

Psychological reactance theory posits that when something threatens or eliminates people’s freedom of behaviour, they experience psychological reactance, a motivational state that drives autonomy restoration. Section one reports a quantitative systematic literature review examining the relationship between psychological reactance and healthcare engagement. Six databases were searched (MEDLINE, CINAHL, PsycINFO, Academic Search Ultimate, SocINDEX, Embase) and fifteen studies met requirements for inclusion. Three studies investigated long-term physical health conditions, two investigated antibiotic adherence and ten studies investigated mental health conditions. Psychological reactance was significantly associated with: Adherence in nine studies; attendance in two studies; drop-out in two studies; and treatment satisfaction in one study. Nonsignificant associations between psychological reactance and engagement were reported in six studies. Further research is needed before strong conclusions can be drawn regarding the role of reactance within engagement. Nonetheless, the findings suggest that reactance is an important factor to consider. Section two reports an empirical study investigating the role of psychological factors in engagement with mental health services for people with experiences of psychosis. Factors investigated were: Perceptions of autonomy, control beliefs, psychological reactance and expressed emotion. Participants (N=113) completed an online survey comprising of self-report measures of these variables and engagement. Expressed emotion was not significantly associated with engagement. In a regression model, autonomy, psychological reactance and control beliefs significantly accounted for 46.2% of the variance in engagement; although at the final step, autonomy was the only significant predictor, accounting for 28.2% of the variance in engagement alone. This study demonstrated the utility of measuring perceptions of autonomy in relation to service engagement in psychosis. Findings highlight the importance of considering psychological variables in predicting therapeutic engagement. Section three includes a discussion of issues surrounding the conceptualisation and measurement of engagement, autonomy and psychological reactance constructs.