Cambridge A Level Psychology 9990: Health Psychology — Revision Notes

These notes condense Specialist Option 3, Health Psychology, of Cambridge International A Level Psychology 9990 (syllabus for 2024 to 2026). The five topics are the patient–practitioner relationship, adherence to medical advice, pain, stress and health promotion. Three themes run through them: how a problem is explained, how it is measured, and how it is managed or improved.

For full explanations and study details, read the Health Psychology study guide. Then test yourself with the Health Psychology practice questions.

What does the 9990 Health Psychology syllabus contain?

Topic	Explain	Measure	Manage or improve	Key study
3.1 Patient–practitioner	Clothing, jargon, delay, health belief model, Munchausen vs malingering	Questionnaires, interviews	Practitioner style	Savage and Armstrong (1990)
3.2 Adherence	Rational non-adherence, health belief model	Interviews, pill counts, dispensers, blood and urine	Child-friendly devices, contracts, prompts, customising, community interventions	Yokley and Glenwick (1984)
3.3 Pain	Specificity theory, gate control theory, phantom limb	Clinical interview, McGill, VAS, UAB scale	Biochemical, cognitive strategies, acupuncture, TENS	Brudvik et al. (2016)
3.4 Stress	GAS, life events, work, Type A	Heart rate, fMRI, cortisol, questionnaires	Biofeedback, imagery, stress inoculation	Bridge et al. (1988)
3.5 Health promotion	Unrealistic optimism, positive psychology	Psychometric scales	Fear arousal, information, schools, worksites	Shoshani and Steinmetz (2014)

Key terms

Term	Definition
Doctor-centred (directing) style	Doctor controls the consultation and gives instructions
Patient-centred (sharing) style	Doctor seeks patient’s views and decides together
False positive	Diagnosing an illness the patient does not have
False negative	Missing an illness the patient does have
Munchausen syndrome	Feigning illness to gain medical attention and the sick role
Malingering	Faking illness for an external gain
Health belief model	Action depends on perceived susceptibility, severity, benefits, barriers and cues to action
Rational non-adherence	A reasoned decision not to follow advice (side effects, cost, doubt)
Acute / chronic pain	Short-term pain from injury / pain lasting beyond normal healing
Gate control theory	A spinal “gate” opened by pain fibres and closed by large fibres and brain messages
Cognitive redefinition	Reinterpreting pain in a less threatening way
GAS	Alarm, resistance, exhaustion (Selye)
Type A	Competitive, time-pressured, hostile personality
Biofeedback	Real-time feedback on a body process to learn control over it
Stress inoculation training	Conceptualisation, skill acquisition and rehearsal, application and follow-through
Unrealistic optimism	Belief that bad events are less likely to happen to oneself than to others

Measures compared

Measure	Type	Strength	Weakness
Semi-structured interview (adherence)	Subjective	Gives reasons for non-adherence	Patients may overstate adherence
Pill count / electronic dispenser	Objective	Not reliant on honesty	Opening is not proof of taking
Blood or urine test	Biological	Most direct evidence	Invasive, costly, shows recent use only
McGill pain questionnaire	Psychometric	Captures quality as well as intensity	Needs good vocabulary
Visual analogue scale	Rating scale	Quick, quantitative, usable repeatedly	Only intensity; hard for young children
UAB pain behaviour scale	Observational	Usable when self-report is not possible	Behaviour may not match felt pain
Salivary cortisol	Biological	Objective, non-invasive	Varies with time of day and other factors
Life events questionnaire	Self-report	Cheap, quick	Ignores how the person perceives each event

Key studies at a glance

Study	Design and sample	Main finding	Evaluate with
Savage and Armstrong (1990)	Randomised; 359 patients of one London GP	Directing style gave higher satisfaction, especially for physical problems and prescriptions	One doctor only; low one-week response rate (58%)
Yokley and Glenwick (1984)	Field experiment; families of 1,133 preschool children, six conditions	Monetary incentives most effective; specific prompts most cost-effective	Large random sample; real health outcome
Brudvik et al. (2016)	Cross-sectional; 243 children aged 3–15 in Bergen	Physicians underestimated pain (mean 3.2 vs children’s 5.5)	Real clinical setting; single snapshot
Bridge et al. (1988)	Randomised trial; 154 women in radiotherapy, three groups, six weeks	Relaxation reduced mood disturbance; imagery added extra benefit	Controlled design; self-report mood measures
Shoshani and Steinmetz (2014)	School intervention vs control, Israel	Reduced distress, increased well-being measures	Applied value; groups not individually randomised

Must-know comparisons

• Specificity vs gate control: specificity sees pain as a direct signal proportional to injury; gate control adds spinal and brain modulation, explaining phantom limbs and psychological effects.
• Biofeedback vs stress inoculation: biofeedback trains control over a body response; stress inoculation trains thinking and coping skills in advance.
• Fear arousal vs information: Janis and Feshbach (1953) found minimal fear changed behaviour most; Lewin et al. (1992) found information in a self-help manual improved adjustment.
• Munchausen vs malingering: internal motive (sick role) versus external motive (money, avoiding duties).

Mini essay plan: “Evaluate ways of improving adherence” [10]

1. Community interventions: Yokley and Glenwick (1984) large field experiment; incentives work but are costly; prompts are cost-effective.
2. Children: Chaney et al. (2004) child-friendly device; ethical care and parental consent needed.
3. Behavioural techniques: contracts and prompts are simple; they treat adherence as behaviour and ignore beliefs (reductionist), unlike the health belief model.
4. Measurement: how adherence is measured (self-report vs objective) affects how effective an intervention appears.
5. Rational non-adherence: if a patient has good reasons, prompts alone will not help; customising treatment addresses the reason.
6. Conclusion: combined approaches that address both behaviour and beliefs are most useful.

Common mistakes and exam traps

• Mixing up the directing and sharing styles in Savage and Armstrong: it was the directing style that gave higher satisfaction.
• Calling the visual analogue scale a “questionnaire”; it is a single rating line.
• Writing that Brudvik et al. found parents overestimated pain; the main finding is that physicians underestimated it.
• Listing GAS stages without the health consequence of exhaustion.
• Forgetting the three phases of stress inoculation training in order.
• Writing “fear appeals work” when Janis and Feshbach found minimal fear was most effective.

Quick self-test

1. What is a false negative diagnosis?
2. Name the five components of the health belief model on this page.
3. What were the six conditions in Yokley and Glenwick (1984)?
4. Which gate control mechanism explains why rubbing a bump reduces pain?
5. What mean pain rating did physicians give in Brudvik et al. (2016)?
6. What did the third group in Bridge et al. (1988) do in addition to relaxation?
7. Name Seligman’s three routes to happiness.
8. What reinforcer did Fox et al. (1987) use in the mines?

Answers: (1) missing an illness the patient has; (2) perceived susceptibility, severity, benefits, barriers, cues to action; (3) general prompt, specific prompt, specific prompt plus access, specific prompt plus money, contact control, no-contact control; (4) large-fibre activity closes the gate; (5) 3.2; (6) imagined a peaceful scene of their own choice; (7) pleasant, good, meaningful life; (8) stamps (tokens) exchangeable for goods.

Frequently asked questions

Is stress in 9990 Health Psychology the same as stress in other courses? The content is set by the 9990 syllabus: GAS, life events, work, Type A, the named biological and self-report measures, biofeedback, imagery and stress inoculation. Learn these rather than topics from other specifications.

How should I use numbers from key studies? Use them to support a point, for example “physicians’ mean rating of 3.2 compared with children’s 5.5 shows underestimation”. Accurate numbers make descriptions more precise.

Official syllabus

Cambridge International AS & A Level Psychology 9990 syllabus for 2024, 2025 and 2026, Specialist Option 3: Health Psychology — cambridgeinternational.org.

Related resources

• Health Psychology study guide
• Health Psychology practice questions
• Specialist Options revision notes