Cambridge A Level Psychology 9990: Health Psychology (Specialist Option 3)

Health Psychology is Specialist Option 3 of Cambridge International A Level Psychology 9990. It looks at psychological factors in health: how doctors and patients communicate, why patients do not follow medical advice, how pain and stress are explained, measured and managed, and how health can be promoted. The exam asks you to describe, evaluate and compare theories, studies and treatments, and to apply them to real health settings.

This guide follows the Cambridge International AS & A Level Psychology 9990 syllabus for 2024, 2025 and 2026, covering sub-topics 3.1.1 to 3.5.3 and all five key studies. Pair it with the Health Psychology revision notes and Health Psychology practice questions. For the choice of options, see the Specialist Options overview.

How is Health Psychology examined?

Like every option, it is examined on Paper 3 (three short-answer questions worth 14 marks, then an essay of 6 marks describe and 10 marks evaluate) and on Paper 4 Section A (two structured questions per option on content, key studies and research methods). The syllabus states that topic areas assessed on Paper 3 will be different from those on Paper 4.

Syllabus coverage

Number	Sub-topic	Content
3.1.1	Interpersonal skills	Non-verbal: practitioner clothing, e.g. McKinstry and Wang (1991); verbal: medical terminology, e.g. McKinlay (1975)
3.1.2	Diagnosis and style	Disclosure, false positive and false negative diagnosis, presenting a diagnosis; doctor-centred and patient-centred style, key study Savage and Armstrong (1990)
3.1.3	Misusing health services	Delay in seeking treatment, e.g. Safer et al. (1979), and the health belief model; Munchausen syndrome versus malingering, e.g. Aleem and Ajarim (1995)
3.2.1	Types of and reasons for non-adherence	Failure to follow treatment or attend appointments; rational non-adherence, e.g. Laba et al. (2012); health belief model
3.2.2	Measuring non-adherence	Subjective: clinical and semi-structured interviews, e.g. Riekert and Drotar (1999); objective: pill counts and dispensers, e.g. Chung and Naya (2000); biological: blood and urine samples
3.2.3	Improving adherence	Children, e.g. Chaney et al. (2004); contracts, prompts, customising treatment; community interventions, key study Yokley and Glenwick (1984)
3.3.1	Types and theories of pain	Functions; acute and chronic; phantom limb pain and mirror treatment, e.g. MacLachlan et al. (2004); specificity theory and gate control theory
3.3.2	Measuring pain	Clinical interview; McGill pain questionnaire; visual analogue scale, key study Brudvik et al. (2016); UAB pain behaviour scale
3.3.3	Managing pain	Biochemical; attention diversion, non-pain imagery, cognitive redefinition; acupuncture and TENS
3.4.1	Sources of stress	GAS model and health effects; life events (Holmes and Rahe); work, e.g. Chandola et al. (2008); Type A personality (Friedman and Rosenman)
3.4.2	Measures of stress	Heart rate and fMRI, e.g. Wang et al. (2005); salivary cortisol, e.g. Evans and Wener (2007); self-report questionnaires
3.4.3	Managing stress	Biofeedback, e.g. Budzynski et al. (1969); imagery, key study Bridge et al. (1988); stress inoculation training
3.5.1	Strategies for promoting health	Fear arousal, e.g. Janis and Feshbach (1953); providing information, e.g. Lewin et al. (1992)
3.5.2	Schools and worksites	Healthy eating, e.g. Tapper et al. (2003); health and safety, e.g. Fox et al. (1987)
3.5.3	Individual factors	Unrealistic optimism, e.g. Weinstein (1980); positive psychology, e.g. Seligman (2004); key study Shoshani and Steinmetz (2014)

3.1 What makes a good patient–practitioner relationship?

Interpersonal skills (3.1.1). Non-verbal communication includes what the practitioner wears. McKinstry and Wang (1991) showed patients photographs of doctors in different styles of dress; formal clothing tended to be preferred, especially by older patients, and patients said they would be more confident in a formally dressed doctor. Verbal communication includes medical jargon. McKinlay (1975) tested women on a maternity ward on their understanding of medical terms that staff used with them, and found understanding was often poor, even though staff used the terms anyway.

Diagnosis and style (3.1.2). Making a diagnosis involves deciding what to disclose and how. A false positive is diagnosing an illness the patient does not have; a false negative is missing an illness they do have. A false negative can be dangerous if treatment is delayed, while a false positive can lead to unnecessary worry and treatment. Practitioners can be doctor-centred (directing), where the doctor takes control and gives clear instructions, or patient-centred (sharing), where the doctor asks for the patient’s views and decides together.

Key study: Savage and Armstrong (1990). In an inner London general practice, 359 patients consulting one GP were randomly given either a directing or a sharing style for the part of the consultation about treatment, advice and prognosis. Patients completed a satisfaction questionnaire immediately afterwards and again a week later (response rates 89% and 58%). Patients who received the directing style reported significantly higher satisfaction on almost all measures, especially those with physical problems and those given a prescription. There was no significant difference for longer consultations, for psychological or chronic problems, or where the main treatment was advice. This challenges the assumption that sharing is always better, but it involved only one doctor, so the findings may reflect his personal style.

Misusing health services (3.1.3). People may delay seeking help. Safer et al. (1979) interviewed patients waiting at clinics and divided delay into stages, such as noticing a symptom and deciding one is ill, and deciding to seek care. The health belief model offers an alternative explanation: whether a person acts depends on perceived susceptibility, perceived severity, perceived benefits against perceived barriers, and cues to action. Munchausen syndrome is repeatedly feigning or inducing illness to gain medical attention and the sick role, with no external reward. Essential features include feigned illness, pathological lying and moving from hospital to hospital; supporting features can include extensive medical knowledge and many scars from past procedures. Malingering is faking illness for an external gain, such as avoiding work or obtaining compensation. Aleem and Ajarim (1995) is the suggested case report.

3.2 Why do patients not adhere to medical advice, and how can adherence improve?

Types and reasons (3.2.1). Non-adherence includes failing to follow treatments (missing doses, stopping early) and failing to attend appointments. It wastes resources and can make illnesses worse. Rational non-adherence is a reasoned decision not to adhere, for example because of side effects, cost or doubt about whether the treatment works; Laba et al. (2012) studied how such medication features influence adherence choices. The health belief model explains non-adherence when perceived benefits do not outweigh perceived barriers.

Measuring non-adherence (3.2.2). Subjective measures include clinical and semi-structured interviews; they are cheap and give reasons, but patients may overstate adherence. Objective measures include pill counting and electronic medication dispensers that record each opening; they do not rely on honesty, though a dispenser being opened does not prove the pill was taken. Biological measures test blood or urine for the drug; they are the most valid, but are invasive, costly and show only recent use.

Improving adherence (3.2.3). For children, making treatment enjoyable helps: Chaney et al. (2004) gave children with asthma an inhaler spacer designed as a toy (the “Funhaler”) and found adherence improved compared with the standard device. Individual behavioural techniques include contracts (a written agreement with rewards), prompts (reminders) and customising treatment (fitting it to the patient’s routine).

Key study: Yokley and Glenwick (1984). In a public health setting, families of 1,133 preschool children who were behind on immunisations were randomly assigned to six conditions: a general prompt; a client-specific prompt; a specific prompt with increased clinic access; a specific prompt with a monetary incentive; a contact control; and a no-contact control. All interventions except the general prompt showed some improvement over the controls. The monetary incentive produced the largest effect, followed by increased access, the specific prompt and the general prompt. Specific prompts alone were the most cost-effective. The large sample and random allocation are strengths; the use of children’s health records raises issues of consent through parents.

3.3 How is pain explained, measured and managed?

Types and theories (3.3.1). Pain has a protective function: it warns of damage and encourages rest. Acute pain is short-term and linked to injury; chronic pain lasts beyond normal healing, usually more than three months. Phantom limb pain is pain felt in a limb that has been amputated. Mirror treatment places a mirror so the patient sees the reflection of the intact limb in the position of the missing one; moving the intact limb can reduce phantom pain. MacLachlan et al. (2004) is a suggested case study. Specificity theory proposes dedicated pain receptors and a direct pathway to a pain centre in the brain, so pain is proportional to injury. It cannot explain phantom limb pain or why attention changes pain. Gate control theory (Melzack and Wall) proposes a “gate” in the spinal cord: activity in large fibres (such as rubbing) and messages from the brain (attention, mood) can close the gate, while small pain fibres open it. This explains psychological influences on pain.

Measuring pain (3.3.2). A clinical interview gives rich detail but is subjective. The McGill pain questionnaire asks patients to choose words describing sensory, affective and evaluative qualities of pain. A visual analogue scale (VAS) asks patients to mark intensity on a line from “no pain” to “worst pain”. The UAB pain behaviour scale is an observational measure: a trained observer rates behaviours such as vocal complaints, grimacing, mobility and posture.

Key study: Brudvik et al. (2016). At an accident and emergency department in Bergen, Norway, 243 children aged 3 to 15 rated their own pain with age-adapted scales, while parents and physicians independently rated it on a numeric rating scale. Mean ratings were 5.5 (children), 4.8 (parents) and 3.2 (physicians). Agreement between child and parent was moderate, but agreement with physicians was low, and physicians underestimated pain across all ages and conditions. Only about 42% of children with severe pain received pain relief. The authors concluded that parents’ ratings should be listened to when a child cannot self-report. The study used a real clinical setting, but the cross-sectional design gives a single snapshot.

Managing pain (3.3.3). Biochemical treatments include opiates such as morphine and non-opioid painkillers. Cognitive strategies include attention diversion (focusing on something else), non-pain imagery (imagining a pleasant scene) and cognitive redefinition (thinking about pain in a more rational, less threatening way). Alternative treatments include acupuncture (fine needles at specific points) and TENS (transcutaneous electrical nerve stimulation), which may work by closing the pain gate.

3.4 What causes stress, and how is it measured and managed?

Sources (3.4.1). Selye’s General Adaptation Syndrome (GAS) has three stages: alarm (fight-or-flight arousal), resistance (the body copes, with stress hormones still raised) and exhaustion (resources run out, raising the risk of illness). Long-term stress can suppress the immune system and contribute to cardiovascular disease. Causes include life events: Holmes and Rahe’s Social Readjustment Rating Scale gives life events values in life change units, with death of a spouse highest at 100. Work is another source: Chandola et al. (2008), using data from the Whitehall II study of British civil servants, linked work stress to coronary heart disease. Type A personality (Friedman and Rosenman) is competitive, time-pressured and hostile, and was linked to a higher risk of heart disease.

Measures (3.4.2). Biological measures include heart rate recording and brain imaging. Wang et al. (2005) used fMRI during a stressful mental arithmetic task and found increased blood flow in the right prefrontal cortex that related to self-reported stress and cortisol. Salivary cortisol is a hormone measure: Evans and Wener (2007) found that train commuters seated closer to others (more crowded around them) had higher cortisol. Psychological measures are self-report questionnaires, such as Holmes and Rahe’s life events scale and tests of Type A personality. Biological measures are objective but costly and can be affected by other factors; self-reports are cheap but open to bias.

Managing stress (3.4.3). Biofeedback gives a person real-time information about a body process, such as muscle tension, so they learn to control it; Budzynski et al. (1969) used muscle-tension (EMG) biofeedback with tension headaches. Stress inoculation training (Meichenbaum) has three phases: conceptualisation, skill acquisition and rehearsal, and application and follow-through.

Key study: Bridge et al. (1988). In a randomised controlled trial lasting six weeks, 154 women receiving radiotherapy for early breast cancer were allocated to a control group (encouraged to talk about themselves), a relaxation group (taught to concentrate on muscle groups) or a relaxation-plus-imagery group (also taught to imagine a peaceful scene of their own choice). The intervention groups had tapes and were asked to practise for at least 15 minutes a day; 15 dropped out. At six weeks, total mood disturbance was significantly lower in both intervention groups, with the combined group more relaxed than the relaxation-only group; mood in the control group worsened. Women aged 55 and over benefited most. There was no difference between groups on separate depression and anxiety scales.

3.5 How can health be promoted?

Strategies (3.5.1). Fear arousal uses frightening messages to change behaviour. Janis and Feshbach (1953) gave high-school students talks on dental hygiene with strong, moderate or minimal fear appeals; the minimal fear appeal produced the most change in reported behaviour. Providing information helps people know how to improve their health; Lewin et al. (1992) gave heart attack patients a self-help rehabilitation manual and found better psychological adjustment than in patients given standard information.

Schools and worksites (3.5.2). Tapper et al. (2003) evaluated the Food Dudes programme, which used peer-modelling videos and rewards to increase children’s fruit and vegetable eating. Fox et al. (1987) introduced a token economy in two open-pit mines, giving workers stamps for safe working periods that could be exchanged for goods; days lost to accidents fell and stayed lower over years.

Individual factors (3.5.3). Unrealistic optimism is believing that bad events are less likely to happen to you than to others. Weinstein (1980) found that college students rated their own chances of negative events as below average and positive events above average, which helps explain why people ignore health advice. Positive psychology studies what makes life worth living. Seligman (2004) described three routes: the pleasant life (positive emotions), the good life (engagement using one’s strengths) and the meaningful life (serving something larger than oneself).

Key study: Shoshani and Steinmetz (2014). This school-based intervention in Israel taught a positive psychology programme to middle-school students in their classes, and compared them with a control group who did not receive it. Students completed psychometric questionnaires on mental health and well-being before and after the programme. The intervention group showed reduced psychological distress symptoms, such as anxiety and depression, and gains in measures such as self-esteem and optimism, which the control group did not show. The study suggests positive psychology can be applied in schools. Because whole classes or schools take part together rather than randomly allocated individuals, differences between groups other than the programme could act as confounding variables, and self-report questionnaires are open to social desirability bias.

How should you evaluate Health Psychology research?

• Application to everyday life: most studies lead directly to changes in practice (consultation style, prompts, imagery).
• Individual and situational explanations: non-adherence and delay reflect both personal beliefs (health belief model, unrealistic optimism) and situations (cost, access).
• Subjective versus objective data: compare self-reports, pill counts and blood tests for adherence; VAS and UAB scale for pain.
• Reductionism versus holism: gate control theory and the GAS combine physical and psychological factors more holistically than specificity theory.
• Ethics and use of children: Brudvik et al., Chaney et al. and Shoshani and Steinmetz all involve children, requiring parental consent.

Frequently asked questions

What are the five Health Psychology key studies in 9990? Savage and Armstrong (1990) on consultation style, Yokley and Glenwick (1984) on immunisation, Brudvik et al. (2016) on pain assessment, Bridge et al. (1988) on relaxation and imagery, and Shoshani and Steinmetz (2014) on positive psychology in schools.

What is the difference between Munchausen syndrome and malingering? In Munchausen syndrome the person feigns illness to gain medical attention and the sick role, with no external reward. In malingering the person fakes illness for an external gain such as money or time off work.

Why does gate control theory replace specificity theory? Specificity theory cannot explain phantom limb pain or why mood and attention change pain. Gate control theory includes messages from the brain that open or close the gate, so it accounts for these psychological effects.

Which measure of adherence is most valid? Biological measures such as blood or urine tests are usually the most valid, because they detect the drug directly. They are also the most invasive and expensive.

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 revision notes
• Health Psychology practice questions
• Specialist Options overview