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Background. Self-categorisation theory and the identity-based motivation perspective suggest that people’s motivation to engage in a particular behaviour is stronger when that behaviour is congruent with their salient social identity. In situations where a certain social identity is made salient, or where people identify strongly with a particular group, the social norm associated with that group may have a strong effect on individual behaviour. This perspective can be used to enhance the understanding of health-related intentions and behaviour. The aim of this thesis is to investigate the usefulness of adding concepts related to social identity to existing social cognitive models of healthy eating. The prediction being made is that members of groups that value healthy eating might be more likely to engage in healthy eating when their membership in that particular group is made salient. Five experimental studies tested the effect of social identity salience and group identification on healthy eating intentions and behaviour. Both intentions and behaviour were measured in each of the five studies, to allow for investigating the existence and potential causes of the intention-behaviour gap for healthy eating. Methods and Results. All five studies included random assignment of participants to conditions, and an experimental manipulation of social identity salience or social image healthiness. In Study 1 (n = 149), conducted among female university students, participants’ female, family, or personal identity was made salient. The results showed that increasing the salience of female or family identity led to stronger healthy eating intentions, but did not increase the likelihood of picking a healthy snack over an unhealthy one. Study 2 (n = 115) did not include a successful manipulation of salient social identity, but it showed a positive association between female identification, measured as a trait, and healthy eating intentions, even after controlling for attitude, subjective norm and perceived behavioural control. Study 3 (n = 156) included a manipulation of social identity salience (female or student) and a manipulation of social image healthiness (images presenting in-group members engaging in either healthy or unhealthy behaviour). The results corroborated the earlier finding that female identification is positively correlated with healthy eating intentions. Also, the results indicated that when participants were shown social images of their in-group members engaging in healthy or unhealthy behaviour, they expressed intentions in line with the social images only if they did not express strong identification with the in-group. Study 4 (n = 87) was conducted in the context of Australian identity and included a manipulation of social images healthiness. The findings provided evidence for the existence of a vicarious licensing effect for healthy eating. Namely, for participants who highly identified with their social group, exposure to pictures of other in-group members engaging in healthy behaviour resulted in choosing less healthy food items from a restaurant menu. Study 5 (n = 117) demonstrated the existence of a vicarious licensing effect in the context of female identity, where participants’ food intake during a taste test was predicted by the interaction of the social image healthiness and their group identification. Conclusions. By examining the predictors of both healthy eating intention and behaviour, the research presented in this thesis sheds light on some of the phenomena potentially underlying the intention-behaviour gap for healthy eating, particularly among women. It appears that the healthy eating norm is internalised by women and translated into healthy eating intentions, to the extent that women who identify more highly with their gender group, and those whose female identity is made temporarily salient, also express stronger healthy eating intentions. The association between female identification and healthy eating behaviour, however, appears to be much less consistent, and in most studies the correlation between healthy eating intentions and eating behaviour was poor, even though a variety of measures of behaviour was used. These findings suggest that actual eating is often not predicted by intentions, but depends on contextual factors, such as being given an opportunity to reinforce the healthy eating goal, or the availability of information about in-group members’ eating behaviour. The results also have implications for health-psychological interventions, in suggesting that people’s response to health-related content (such as social images that may be used in health promotion interventions) may be different depending on their level of group identification. In line with the vicarious licensing effect, individuals who report high levels of group identification might be less likely to respond to interventions aimed at their specific social groups.

Acute Coronary Syndrome (ACS) is common and associated with high mortality. Effective treatments are available but require prompt administration. Studies have consistently demonstrated that delays to treatment are common, with patient decision time accounting for most delay. Interventions aimed at reducing delay have had little success. Evidence suggests that psychological factors, in particular illness representations (Leventhal’s Commonsense Model of Self-Regulation (CS-SRM)) might be important in relation to patient decision time. This thesis describes a two-stage investigation, undertaken within NHS 24, exploring the content and timing of people’s initial presentations with possible symptoms of ACS. The first stage comprised a CS-SRM-guided content analysis of peoples’ initial symptom presentations. The second stage utilised the Illness Perception Questionnaire-revised (IPQ-R) to explore how illness representations relate to patient decision time. Results show that the components of illness representations accounted for 95% of participants’ initial presentations. The components most related to behaviour and outcome were volunteered least (cause, consequences, cure/control and coherence). Decision time for most participants (89%) was out-with the ideal and appraisal time accounted for most of the delay. Appraisal delay was shorter for those with fewer symptoms and high emotion. Illness delay was longer where the person making the call reported high treatment control. Interventions may need to raise awareness of the range of possible presentations and of the consequences associated with delay. Interventions should also provide guidance as to an appropriate time-limit for self-care. Individuals may benefit from being informed about how to respond to strong emotional responses. Interventions aimed at bystanders may need to differ from those for patients. People at high risk of ACS should be informed about how and when to access healthcare out-of-hours.

Background: With the increasing incidence in stroke and the resultant high prevalence of residual disability resources are not adequately meeting the needs of the patients. Furthermore patients continue to express dissatisfaction with their care. New interventions are being developed and evaluated. However, when offered these new interventions, patients may refuse or not participate fully. A stroke workbook intervention was developed through a line of research examining the role of perceived control in recovery. During the randomised controlled trial (RCT) evaluating its efficacy patients failed to fully participate in the activities proposed in the workbook. Why, when there is such a dearth of treatment available, do stroke patients not fully participate in or adhere to the interventions offered? Methods: Three studies were conducted, a predictive study using the intervention group of the RCT exploring the demographic, clinical and psychological factors predicting adherence; a predictive study using one of the intervention groups from a larger 2x2 RCT to examine the predictors of adherence to an easier intervention (video); and a third longitudinal study examining the efficacy of an even simpler intervention (letter) on increasing adherence to the video. The theoretical framework of Leventhal's Self Regulation Model was used to develop the letter intervention and to explain the findings. Results: Five types of adherence behaviours emerged from the three studies, all with their own difficulties of definition, measurement and their individual predictor variables. Gender, impairment and illness representations were all predictive of adherence. An easier intervention promoted adherence especially for men and the more impaired. Women appeared to adhere more readily to the complex intervention. These gender differences may be associated with illness representations. A theoretical-based letter does not increase adherence per se but may increase the amount of adherence to an easier intervention. Conclusion: Adherence behaviour is not one type of behaviour and is associated with measurement difficulties. The Self-Regulation model appeared to offer some logical explanations to the findings. The findings have clinical implications and could possibly be associated with patients' satisfaction with care.

Previous studies have found a relationship between attributions of blame and traumatic events such as crime, illness, and accidents/disasters, albeit inconclusive as to the benefits or detriments of self- and other-blame on adjustment outcome (e.g., Janoff-Bulman, 1979; Joseph, Brewin, Yule & Williams, 1991,1993; Derry & McLachlan, 1995; Frazier & Schauben, 1994). The effects of attributions of blame on the adjustment outcome of family members bereaved through murder has been neglected. Therefore, little is known about such benefits to adjustment in this population. In addition, no longitudinal research has been conducted so little is known about this process of adjustment. A retrospective longitudinal study investigated emotional state and event-related impact, attributions of blame, control and just world cognitions, revenge and disabling distress. Thirty-four family members, recruited from "Families of Murdered Children", were interviewed and completed four psychological measures. They were followed up six and twelve months later. On all three occasions, subjects showed high levels of negative emotional state and event-related impact, especially older, female and support seeking subjects. Self-blame and feelings of revenge were linked to higher levels of negative emotional state and event-related impact, especially in female subjects. Control and just world cognitions were not related to emotional state and event-related impact. Negative emotional state at Time 1 was predictive of poor overall adjustment at Time 2 and Time 3, while gender was predictive of poor overall adjustment at Time 2. Subjects suffering from distress that interfered with their daily lives at Time 3 had higher negative emotional state and event-related impact at Time 1, Time 2 and Time 3. In order to further investigate the effects of blame attributions on mood, a randomised between-subjects laboratory study was conducted. Eighty-seven undergraduates were assigned to one of three writing conditions (self-blame, other-blame and no blame/control) with mood being assessed before and after writing. Results showed that negative mood had been cognitively induced, however, no condition effects occurred. The mood effect was greater for women than men. Implications for theory, practice and future research in relation to the main findings are discussed.

The Self-Regulation Model (Leventhal, Nerenz & Steele, 1984) highlights the roles of patients' illness representations, coping, emotional reactions and appraisal of coping in the progression of chronic disease. This thesis incorporates previous literature on adherence, panic-fear and selfmanagement interventions into the model in order to (a) investigate coping with asthma and (b) develop an intervention aimed at improving asthmatic control. New measures of asthmatic control and illness representations of the consequences of having asthma were developed in order to operationalise the model. A cross-sectional study investigated factors influencing asthmatic control in a sample of 35 adult asthma sufferers recruited through a single general practice. Coping was poor, adherence being low and less than 50% of participants reporting current Peak Flow monitoring or medical contact during the previous 12 months. Good coping appeared to be a response to poor asthmatic control, rather than prophylactic. Good asthmatic control was associated with low perceived consequences, recent medical contact, moderate panic-fear and low general avoidance coping. These results imply that asthmatic control may be improved by encouraging sufferers to maintain regular contact with outpatient services and to implement prophylactic coping. Since epidemiological and clinical evidence suggested asthmatic control to be poor in young adults, an intervention was developed to improve asthmatic control in this group by modifying illness representations, coping and panic-fear. The intervention was evaluated in a randomised controlled study of 50 student asthma sufferers identified initially through an epidemiological screening of 2,979 students. It led to increased Preventer medication use and Peak Flow monitoring and decreased distress over the condition. However, the coping process changed and asthmatic control improved even in the control group, perhaps because self-monitoring of asthmatic control for the study constituted a change in coping. This unanticipated result was entirely compatible with the Self-Regulation Model. The thesis dearly demonstrates value of the Self-Regulation Model in understanding asthma self-management and developing clinical interventions.