6. Promoting Good Behaviour: Factors in Change Flashcards
Health Tips?
- Change is possible (but difficult).
- Doing it on your own isn’t easy.
- Believe in yourself, prepare for lapses - and you might just succeed.
Who is most
often targeted by primary
prevention programs and
campaigns?
Generally speaking there are two populations that are targeted:
- Young people (depending on the behavior ranges from children to adolescents/university students)
- Parents by extension - Vulnerable people (whoever is identified to be at a heightened risk for developing certain health problems)
- People who smoke, children of parents with cancer history
U.S. CDC’s Anti
Smoking Campaign (Spring, 2012)
- Cost $54 million.
- Ran for 12 weeks.
- Aimed to get 500,000
people to try to quit,
50,000 to quit long term.
Initial impact of campaign?
Ads generated 192,000 extra
calls to CDC toll free quit line
and 417,000 new visitors to CDC
website (triple previous traffic).
Anecdotal evidence that ads had
range of responses.
But 2 largest U.S. tobacco companies reported no impact on 2012 earnings.
CDC’s Final Report on Campaign (2013)
Based on survey of 1000s of adult smokers and non smokers before and after?
80% of smokers and 75% of non smokers recalled seeing at least one of the ads during the 3 month campaign.
An estimated 1.6 million smokers attempted to quit smoking based on the national ad campaign.
More than 200,000 Americans quit smoking immediately following the campaign, with 100,000 likely to quit permanently.
What really works?
Durkin et al. (2009) found that the most successful anti smoking ads are…?
emotionally evocative and contain personalized stories
Health agencies and medical professionals, the mass media , news outlets, and the internet play…?
an important role in disseminating health related information.
Methods for Promoting Change - Providing Information?
The way in which health related information is delivered can play an important role in whether or not it is effective (i.e., persuasive and/or results in actual change).
Methods for Promoting Change - Educational Appeals?
Provide general information (vs. tailored content); assume that people will be motivated to improve a health behaviour if they have the correct information.
Educational Appeals - Not always successful; many
factors that must be considered…?
- Colour & vividness of ad.
- Expertise, likeability, and
relatability of messenger. - Avoidance of jargon & stats.
- Length of message.
- Placement of strong arguments.
- Presentation of both sides.
- Clarity of conclusions.
- Avoidance of extremes.
Message Framing?
Refers to whether the information emphasizes the benefits
(gains) or costs (losses) associated with a behaviour or decision.
Gain framed messages focus on?
Gain framed messages focus on experiencing desirable consequences and/or avoiding negative ones.
E.g., “If you exercise, you will
become more fit and less likely to
develop heart disease
Gain framed messages work best for motivating behaviours that serve to prevent or recover from illness or injury (e.g., using condoms, performing physical therapy).
Loss framed messages focus on?
experiencing undesirable consequences and/or avoiding positive ones.
E.g., “If you do not get your blood pressure checked, you could increase your chances of having a heart attack or stroke , and you won’t know that your blood pressure is good.
Loss framed messages seem to work best for behaviours that occur infrequently and serve to detect a health problem early (e.g., drinking and driving, getting a mammogram).
What would you expect to work best for motivating vaccination behaviour, gain or less framing? The COVID 19 vaccine specifically?
Gain frame is best for preventative measures. Also there is more to gain than positive outcomes for yourself, consider your community.
Yet, some studies indicate other results. There is a lot of inconsistencies. It could be that for different demographics benefit more form gain vs. loss framing.
Methods for Promoting Change - Fear Appeals?
Message framing that assumes instilling fear will lead to change.
Fear Appeals effects tend to be transient (they have an initial impact or motivation but it does often not last long enough to see a flood-though). But more persuasive if?
- Emphasize consequences.
- Include personal testimonial.
- Provide specific instructions.
- Boost self efficacy (feel empowered) before urging them to change.
Fear Appeals - Too much fear can also be problematic why?
Might just turn away from the message, stop listening.
Challenge is when you are delivering a message to the entire population everyone has different thresholds.
Methods for Promoting Change - Behavioural and Cognitive Methods
Behavioural methods focus on helping people manage the antecedents (things that led to the behaviour) & consequences of a behaviour.
Cognitive methods focus on changing people’s thought processes.
Behavioural and Cognitive Methods - One popular intervention?
Cognitive behavioural therapy (CBT)
Cognitive Behavioural Therapy (CBT) - Definition?
Evidence based psychotherapeutic intervention that promotes self observation and self monitoring to increase awareness and control of negative thoughts and harmful behaviours.
Cognitive Behavioural Therapy (CBT) - Goal?
Goal:
Regulation of thoughts, attitudes, beliefs, emotions, and behaviours through personal coping strategies.
Self management:
clients can eventually apply these methods themselves.
Cognitive Behavioural Therapy
Applied to Alcohol Abuse?
Identify unhelpful/unrealistic thoughts and beliefs that contribute to the problem behaviour…
“I can’t relax without my alcohol.”
“My friends find me boring when I’m sober.”
Identify triggers (internal/external) that cause you to drink… and removing them!
Negative experiences (or positive like celebrations), specific social situations, locations, etc.
Engage in more realistic and helpful thoughts…
“I know I can’t stop drinking once I start.”
“Lots of people have fun without alcohol.”
“My friends like me for my personality, not my drinking.”
Maintaining health behaviour changes can be difficult… Lapse definition?
An instance of backsliding which does not indicate failure (e.g., a person who quits smoking has a cigarette).
Maintaining health behaviour changes can be difficult… Relapse definition?
Falling back to one’s original pattern of undesirable behaviour; very common when people try to change long term habits (e.g., eating and smoking behaviours).
Maintaining health behaviour changes can be difficult… Abstinence Violation Effect definition?
For some, experiencing a lapse can destroy one’s confidence in remaining abstinent and precipitate a full relapse.
See themselves as a failure can have a full-on relapse.
Methods for Promoting Change - Motivational Interviewing?
A one on one counselling style designed to help individuals explore and resolve their ambivalence in changing a behaviour.
Semi-directive, client-centered therapeutic approach (client is allowed to talk freely for a significant amount of time); originally developed for counselling of alcoholics.
Follows a transtheoretical model of behaviour change in combination with CBT (cognitive behavioural therapy) methods.
Motivational Interviewing tends to be most effective in which stage?
Tend to be most effective in the precontempletion or contemplation stage.
2 Key features of Motivational Interviewing?
Decisional Balance:
Clients list reasons for and against changing behaviour; used for points of discussion.
Personalized Feedback:
Clients receive information on their pattern of problem behaviour, comparisons with norms, and risk factors/consequences of behaviour.
Brief Alcohol Screening and Intervention for College Students
( BASICS): A harm reduction approach.
Designed to help students make better alcohol use decisions based on a clear understanding of the risks associated with problem drinking.
Program is conducted over 2 brief interviews…
(1) Assessing risk of problem behaviours, obtaining commitment to monitor drinking between interviews.
(2) Providing personalized feedback, including comparison to norms, risks, and advice on how to drink safely.
Strategies include: Slowing down, spacing drinks; Different types of drinks; Drink for quality vs. quantity; Enjoy mild effects of alcohol.
One-Year Follow-Up?
Highly effective!
The Skill training group only went to 2 sessions and were compared to two different control groups, in number of days drunk, and number of days of continuers drinking.
Some studies even show a significant effect after a 4 year follow up!
Methods for Promoting Change - Social Engineering?
In addition to changing the individual, we can also change the social environment in order to better support healthy behaviours.
Examples include…
* Nutritional guidelines
* Seatbelt laws, road safety
* School vaccination programs
* Smoking prohibitions
* Taxation of alcohol to increase cost
* Restricting alcohol to adults
* Taxes on sugary drinks
* Eliminating trans fats in foods
* Vaccine mandate / passports
Very often people reject to social engineering with the argument that it infringes on personal freedom.
Social Engineering - Regulation/Prohibition of Drugs?
A traditional approach to preventing substance use/abuse is to regulate, prohibit, and/or criminalize addictive or harmful substances.
- Alcohol
- Tobacco & Marijuana
- Other Illicit Substances
Decriminalization & Harm Reduction?
Evidence indicates that decriminalization does not typically increase the use of drugs.
In contrast to criminalization, a harm reduction approach aims to reduce the negative consequences of substance/drug use; and to treat people who use drugs with respect and dignity.
In order to reduce/remove the effects of social stigma.
In order to better motivate them to be healthy and contributing members of society.
Vancouver’s Downtown East Side (DTES), 1997?
Public health emergency declared
overdose deaths, spike in rates of HIV / Hepatitis C.
Insite Supervised Drug Consumption Site, DTES?
Operated by Vancouver Coastal Health and the Portland Hotel Society under a constitutional exception to the Controlled Drugs and Substances Act; opened in 2003
Extensive research has demonstrated an array of benefits:
- reductions in public injecting and syringe sharing
- increases in the use of detox services and addiction treatment
- significant drop in overdose deaths and new cases of HIV infection.
Today numerous safe conceptions sites around Canada.
Some provinces are experimenting with decriminalisation of illicit substances (possession of small amounts is legal, but not to sell or distribute).
In 2020, BC became the first jurisdiction globally to launch? + results
A large-scale province wide safer supply policy.
Allows individuals with opioid use disorder at high risk of overdose to receive pharmaceutical-grade opioids.
A recent study found that the opioid-related hospitalisation rate uncreased by 3.2 per 100,000 after policy implementation, but reasons are unclear
Addiction defintion?
A condition, produced by repeated consumption of a natural or synthetic psychoactive substance, in which a person becomes physically and psychologically dependent on a
substance.
Physical dependence definition?
Exists when the body has adjusted to a
substance and incorporated it into the “normal” functioning of the body’s tissues.
Always occur to some extent since it effects and alters biological processes, on it’s own it does not constitute as an addiction.
Psychological dependence definition?
A state in which individuals feel compelled to use a substance for the effect it produces, without necessarily being physically dependent on it.
When we refer to addiction, should we describe it as a habit, a disease, or..?
A habit is easier to break, minimising the severity and difficulty of giving up the behaviour.
How much responsibility we place on the individual.
Disease, recognise more factors (social, biological, societal) beyond the individual.
Some criticism of the disease model…
- Gives the false impression that alcoholism is solely a biological disorder.
- Strips the user of personal responsibility, may adopt a victim role.
- Transfer responsibility to doctors (must be diagnosed) and caregivers
- May diminish moral stigma, but imposes a disease stigma.
DSM-5-TR and Addiction
Substance-Related and Addictive Disorders
Alcohol, Caffeine, Cannabis, Phencyclidine (PCP/angel dust), Other Hallucinogens (e.g., salvia), Inhalants, Opioids (e.g., heroin, morphine, OxyContin), Sedatives (e.g., sleeping pills), Hypnotics (e.g., some anti-depressants), Anxiolytics (e.g., Ativan), Stimulants (e.g., meth, cocaine), Tobacco, and other (or unknown) substance.
e.g., ‘Alcohol Use Disorder’
Gambling Disorder (and possibly Internet Gaming Disorder
Very few soles behavioural addictions, otherwise it is a use-disorder associated with a substances.
Caffeine is the only one you can be diagnosed with intoxication or withdrawal, but not recognised as a use-disorder.
What psychoactive substances are being used?
Estimated percentage of Canadians 15 years of age and older in 2013 who consumed alcohol, marijuana, and other illicit drugs in the previous year and/or smoke tobacco.
Alcohol
- By far the most commonly used.
- Usage increased during the pandemic.
- 20% of Canadian’s have problem drinking behaviour.
Tobacco
- About same frequency as marijuana.
Marijuana
- Slight increase
Other illicits
- Not as common
Alcohol Use / Abuse is a Complicated Case of Health Compromising Behaviour. Why?
Socially complicated, we like to drink when we are happy or sad.
Alcohol is very normal in social gatherings.
Short-Term Effects of Alcohol?
- Reduced coordination
- Diminished cognitive ability
- Judgment, decision-making
- Aggression / Emotionality
- Accidents
Long-Term Effects of Alcohol?
- Liver damage
- Cardiovascular disease
- Various types of cancer
- Depression
- Alcohol Use Disorder
Alcohol Use Disorder
A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least 2 of the following, occurring
within a 12 month period.
3 mild
4-5 moderate
6 or more severe
(not expected to memorise all of these)
1.
Alcohol taken in larger amounts/for longer than intended.
2.
Persistent desire to cut down.
3.
Time spent in activities trying to obtain or use alcohol.
4.
Craving/strong urge for alcohol.
5.
Recurrent use interfering with work, school, or home.
6.
Continued use despite recurrent social problems caused by alcohol.
7.
Giving up important social or occupational activities to use.
8.
Recurrent use in physically hazardous situations.
9.
Continued use despite knowledge of physical or psychological problem resulting from alcohol.
-> The behaviour is interfering with daily life, preoccupation with drinking. Knowledge of the problem but inability to stop.
10.
Tolerance : (1) diminished effect over time or (2) need for greater amounts to achieve same effect.
11.
Withdrawal : severe symptoms when stop using -> nausea, sweating, tremors, insomnia, hallucinations, anxiety, etc.
Alcohol Interventions
- 12 Step Programs & AA?
May be comparable to other
treatments; Inconsistent experimental
evidence of effectiveness across studies.
A lot of variability, but really depends of the individuals within the group.
Alcohol Interventions
- CBT?
Small but statistically significant treatment effect across controlled studies.
Alcohol Interventions
- Motivational Interviewing?
Consistent and significant effects in large majority of studies; outperforms traditional counselling.
(Probably the most consistent and significant effect)
Abstinence or moderation which is best?
The less severe the drinking problem, the better the chances of succeeding in controlled drinking.
Problem drinkers who have the best prospects for controlled draining are those who are young, socially stable, have short history of alcohol abuse, have not experienced severe withdrawal.
For long-term alcohol abusers to pursue a goal of controlled drinking is unrealistic and probably not in their best interests.
High Risk Situations for Relapse
Intrapersonal High Risk Situations?
- Negative emotional states (e.g., anger, depression, boredom).
- Positive emotional states (e.g., celebrations).
- Exposure to alcohol related stimuli or cues (e.g., advertisements).
- Non-specific cravings.
It is the negative stuff in particular that are high risk of relapse.
High Risk Situations for Relapse
Interpersonal High Risk Situations?
- Situations involving other people, especially interpersonal conflict.
- Social pressure, both direct and indirect.
- Exposure to settings and situations that are cues (e.g., passing bar).
It is the negative stuff in particular that are high risk of relapse.
In the media…
Is some alcohol healthy? What have you heard?
(Just discussion, do not need to memorise exactly)
Some studies claim that drinking in moderation is good for you.
Possible benefits, manage stress.
Drinking in social settings, but you receive the benefits of the socialisation and not the drinking.
Is Some Alcohol Healthy?
Previous research has suggested that light to moderate alcohol intake is “protective” against coronary heart disease (CHD) i.e., those who abstain from alcohol are in poorer health.
But who are the abstainers?
- Maybe abstain reuse of illness and or medication
If these people are included for comparison, it could be their underlying illness that is leading to CHD, not their abstinence.
When this error was controlled, no significant difference between abstainers and moderate drinkers in CHD.
But other studies controlling for this have still reported some cardiovascular benefits of moderate drinking.
The Obesity Epidemic?
Since the mid to late 20th century, obesity has increased significantly in North America and around the world.
Obesity definition?
Having a very high amount of body fat in relation to lean body mass, or Body Mass Index (BMI) of 30 or higher; declared a disease by the AMA in 2013 and by the CMA in 2015.
Body Mass Index (BMI)?
A measure of an adult’s weight in relation to their height; specifically the adult’s weight in kilograms divided
by the square of their height in metres (BMI = kg / m²).
Obesity Trends Among U.S. Adults, 1990, 2000, 2010?
Rapid increase!
In 2018, 42.4% of American adults were
obese; 73.6% overweight or obese; no differences by sex or age.
The overwhelming majority of the population is overweight or obese!
Obesity Trends in Canada, 2001
2019?
In 1978, 14% of Canadian adults were obese.
In 2018, most (63.1%) of
Canadian adults were classified as overweight (36.3%) or obese (26.8%).
It is an health epidemic!
Prevalence of Obesity Around the World, 1975-2014.
The rates of obesity have surpassed the rates of starvation.
A Systems Approach
They all play a role…
“Obesity is an end result of the intricate interactions of biology, behavior, and environment.”
The obesity epidemic is driven largely by
environmental & lifestyle factors rather than biological ones.
e.g., today’s stressful lifestyle, high energy/high fat foods, convenience foods, fast food consumption, high energy intake, low-energy expenditure, television watching,
“super sized” portions, food packaging.
Obesity is heritable.
But in most cases of genetic predisposition, risk of obesity is increased by 20 30%.
Healthwashing
Labelling food in a way that it is perceived healthier than it actually is.
‘Natural’ Cheetos… wtf
Gluten free rice :D omg
The Health Halo Effect?
The tendency to judge an entire food item as healthier based on one or more narrow attributes that are perceived as healthy.
The Health Halo Effect
Food is considered healthier when…
It is labelled “low calorie ”, “organic ”,
or “all-natural”.
It comes from a restaurant seen as healthier, e.g., Subway.
The Health Halo Effect
Does it apply to entire menus?
Wilcox et al. (2009) examined how consumers’ food choices differed when healthy items were included on a menu.
Vicarious nutritional goal fulfillment and
Status quo bias?
Individuals were more likely to make
indulgent food choices (e.g., French fries over backed potatoes) when a healthy item (e.g., salad) is available compared to when it is not.
Vicarious nutritional goal fulfillment?
- Imagine eating the salad, subconsciously satisfying their goal of eating healthy.
- People higher in self-control are even likely to choose the french fires
Status quo bias?
- The more choices people are given the more likely they are to choose the most common item ‘fries’
Community-level factors associated with higher risk of obesity…
- Lower socioeconomic status
- Lower percentage of college/university graduates
- Fewer grocery stores and farmers’ markets
- Low satisfaction with safety and public transportation
- Reduced accessibility to sports facilities
Lifestyle Factors in Obesity
Behaviours implicated in obesity across the lifespan…
- Unhealthy diet
- Physical inactivity
- Poor sleep
- Screen time, sedentary behaviour
- Stress (cortisol)
- Interpersonal factors, behaviours run in social networks/importance of social support.
Which Diets Work…
E.g., A recent study of 25,000 adults (over a decade) revealed an increased risk of premature death for those on a…?
A low carbohydrate diet. Research has also suggested that going low carb may lower levels of serotonin and be problematic for those with pre-existing depression (more suicidal ideation).
Fad or “crash” diets are often problematic and can be unhealthy.
- We often overlook the psychological effects of these diets!
Which Diets Work Best?
Sustainable, balanced diets that provide optimal amounts of all essential nutrients for the body’s metabolic needs are best.
Which Diets Work…
What is most predictive of poor health and obesity?
Processed sugar appears to be more predictive of both poor health and obesity than most dietary fat.
Even saturated fat in low to moderate levels does not contribute to increased cholesterol, but sugar does because it is inflammatory.
Canada’s New Food Guide
Eat well. Live well.
Focus on a healthy and balanced diet and more on how to prepare food.
In the media…
Is gluten really bad for you? And does gluten sensitivity even exist?
The popularity of going “gluten-free”
But many people have no idea what gluten is.
- Placebo effect, people expect a benefit.
- When cutting out gluten, they are also cutting out many simple carbohydrates which will result in weight loss.
One Study Problem!
Peter Gibson, professor of gastroenterology: 2011: Published results of a study
suggesting that non-celiac gluten
sensitivity “may exist.”
He always doubted his findings because there were many uncontrolled factors. So he ran more studies demonstrating that?
2013: Published results suggesting that there is no such thing.
2018: Showed fructans induce symptoms of gluten sensitivity, not gluten.
Low FODMAP diet, reduce fructans, very good for irritable bowl syndorme.
Long-term gluten consumption in adults without celiac disease?
Study
Long-term gluten consumption in adults without celiac disease and risk of coronary heart disease.
Leaving out nutritionally dense food items, such as healthy grains.
The promotion of gluten-free diets among people without celiac disease should not be encouraged.
An Alternative to Dieting and Weight Control:
The “Healthy At Every Size” Approach?
An alternative to the weight-centered/weight control approach; focuses on weight-neutral outcomes (e.g., health behaviours).
HAES represents a movement to promote size acceptance, to end weight discrimination, and to reduce the cultural obsession with weight loss and thinness.
Weight Stigma can lead to?
Weight stigma is a factor in both weight gain and poor health; stigma predicts mortality
Weight Stigma why poor health outcomes?
The solution?
- Numerous mechanisms, including increased stress & poor coping.
- Weight stigma and anti-fat bias in health care also lead to poorer treatment and inadequate care for patients with obesity (blame every health problem on the overweight).
- Internalization of weight biases has been shown to interfere with weight management interventions.
We need to change the attitudes and behaviours of those who stigmatize!
What is sedentary behaviour?
Any activity involving sitting, reclining, or lying down that has a very low energy expenditure.
Risks of a Sedentary Lifestyle?
May be a distinct risk factor for premature death and adverse health INDEPENDENT of low physical activity (they are measured differently).
Associated with risk of depression.
Watching TV for an hour reduces lifespan by 22 minutes (on average), whereas smokers shorten their lives by 11 minutes on average per cigarette.
The effects of sedentary behaviour are easily reversible! You can do this baby girl!
How Much Exercise Do You Need?
According to Health Canada…
It is recommended that adults get at least 2 1/2 hours of moderate to vigorous physical activity each week.
People are more likely to be successful with any exercise program by making physical activity a permanent part of their lifestyle.
Revisiting the Status-Health Link?
People of lower socioeconomic status, Indigenous peoples, and other minorities tend to have poorer health habits than other Canadians.
LOW S.E.S -> Poor Health Behviours (mediating variable) -> Increased Morbidity & Mortailty
- Higher rates of smoking, alcohol abuse, smoking/drinking during pregnancy.
- Lower rates of vigorous exercise, healthy eating; higher rates of obesity.
Why do we observe the Stutus-Helath Link?
- Poorer knowledge about risk factors for disease.
- Living in environments that do not encourage healthy behaviours.
- Barriers to accessing health services; etc.
Interpreting Symptoms - Prior Experiences?
Prior experiences and expectations can either help or hinder people’s interpretations of symptoms.
Interpreting Symptoms - Commonsense Models of Illness?
People also rely on their commonsense models, which include…
* Illness identity (name, symptoms).
* Causes and underlying pathology.
* Timeline or prognosis.
* Consequences (seriousness, effects, outcome).
In the media…
“The worried well” ?
Refer to those who are unnecessarily anxious about their health (in the absence of a related diagnosis). They tend to misuse health services -> increasing the burden on the healthcare system.
Concerns about the worried well have re-emerged during COVID-19.
From a doctor: “One of my least favourite types of patient is the worried well. Treating them seems to me like a bottomless pit of meaningless medicine, with little progress or reward.”
Lay Referral Network?
Before people decide to seek medical attention for their symptoms, they typically get advice from friends, relatives, or co-workers (their “lay referral network”).
Can and often does give good advice, but higher risk for bad advice too than healthcare workers.
These people may…
- Help interpret a symptom.
- Give advice about seeking care.
- Recommend a remedy.
- Recommend talking to someone else.
Lay Referral Network - Going Online?
Nearly 3/4 of Canadians go online to find health-related information, and over half use the internet to self-diagnose.
Self-diagnose is where the real problem lies.
Medical TV Shows?
80 recommendations were randomly selected from The Dr. Oz Show and The Doctors (each), which were then evaluated by experienced evidence reviewers.
Approx. 1/3 to 1/2 of the recommendations made were based on good science.
Accessing Health Services?
The majority of Canadians (15+) who need health care (over 70%) do not report any difficulties with access.
BUT Canadians do experience longer- than-average wait times and continue to perform below the international average in access to care (among rich developed nations).
Accessing Health Services - What groups report more difficulties?
Women, LGBTQIA+ Individuals, Indigenous people, Immigrants, Low-income Canadians.
Those reporting poor or fair health -> the people who need care the most have difficulties accessing it.
How is gender related to health services use?
Women and gender-nonconforming people report more difficulties accessing and using health services
- Women and people with uteruses use health services more frequently (menstrual and fertility care). Greater tendency for men to not seek out help -> gender norms.
- Lack of physician training on reproductive & gender-related health care.
- Women and gender-nonconforming people more often report not feeling respected by doctors and nurses (assuming symptoms are due to pyschological issues).
- They are also less likely to be adequately treated by doctors.
- Financial limitations (lower wages, unemployment).
What is the impact of misgendering?
Misgendering within the health care system can significantly affect the mental health of trans and nonbinary individuals and limit future engagement with the health care system.
It is associated with more negative emotion, less identity strength/coherence, and higher felt trans stigma.
How is SES related to health services use?
Lower SES Canadians use medical services less than upper SES.
Canadians with lower income and education WHO DO use medical services are more likely to make 4= doctor visits per year (as well as more ER visits) than higher SES Canadians.
Interpretation; as they break those barriers they access healthcare more as it expected since lower SES startically have worse health.
Would you expect wait times to vary by social status?
Low-income Canadians tend to have longer wait times in hospitals than their high-income counterparts.
Immigrants in Canada also report longer wait times than non-immigrants.
How are Indigenous people affected by accessing health care?
Language and culture have been cited as key barriers to accessing health care systems.
Canada’s health care system poorly equipped for addressing and accommodating the unique cultural needs of Indigenous people.
Practitioners are also poorly educated on the social and economic determinants of Indigenous peoples’ health.
Lack of transportation and childcare services; lack of services in area.
Also: Racism, discrimination, stigma.
Social stigma can also interfere with the use of health services?
Stigma may arise due to belonging to a stigmatized group, being diagnosed with a stigmatized disease or disorder, or just being sick.
People with HIV/AIDS?
Many diseases and illnesses are stigmatized, making things more difficult for patients…
Moral judgement, people are blamed for contracting the disease.
Intersecting with other stigmas, for example higher rates of HIV for intravenous drug users.
Fear over physical content based on inaccurate beliefs.
Higher stigma leads to higher rates, bc people do not get tested stopping both treatment and prevention.
People with Disabilities in health care?
People with disabilities (physical, cognitive) face numerous barriers to accessing healthcare; stigma is widespread.
There persist many incorrect assumptions about health and health care needs.
People with disabilities are often excluded from healthcare initiatives, for example save sex practices.
In what other groups might we see evidence of stigma interfering with the use of health services?
No need to memorise the whole list!!
- Older adults
- Visible minorities; Immigrants; Refugees
- Neurodivergent people
- People who are overweight
- People who have miscarried
- People seeking/having abortions
- People with mental illness
- People who smoke, use drugs/alcohol
- Sex workers
According to the World Health Organization… Health is? + includes…
A Human Right!
Includes the right to control one’s health/body and the right to a health system that offers equal opportunity to attain health.
Patient Behaviour & Style
What are some things the patient can do that may be problematic or impede communication?
Some examples;
- Wait too long to see doctor.
- Be a passive consumer; not listen.
- Insist procedures are unnecessary.
- Express too much concern.
- Describe symptoms inaccurately.
- Omit or falsify information.
- Insist on procedures, medications, or certifications that are unnecessary.
- Fail to follow recommendations.
Practitioner Behaviour & Style
What are some things the practitioner can do that may be problematic or impede communication?
Doctor centered:
- Not listen, ignore the patient.
- Focus on the first problem mentioned.
- Ask only yes-or-no questions.
- Depersonalize the patient – no eye contact, cold or neutral emotion.
- Use too much medical jargon.
- Use baby talk, elderspeak, or overly simplistic explanations.
- Display negative stereotypes.
Patient-Centred Communication?
Care providers try to see the problem and treatment as the patient does (empathy), and in so doing enlist the patient’s cooperation.
Is empathy bad for the provider -
Compassion Fatigue?
Emotional exhaustion due to frequent/difficult patients.
Closely related to burnout.
Both have been associated with empathy, i.e., positive correlations
Is empathy bad for the provider -
Burnout?
Condition that results from chronic work strain; involves 3 main components:
1. Emotional Exhaustion
2. Depersonalization (bitter towards patients)
3. Low Sense of Personal Accomplishment (stop feeling a sense of reward from your job)
Both have been associated with empathy, i.e., positive correlations
Is empathy bad for the provider?
Many argue that too much empathy contributes to burnout. Others suggest that empathy may make work more meaningful for the listener.
More evidence for a negative correlation between empathy and burnout.
What are 2 possible explanations?
- Empathy makes work more meaningful.
- Burnout causes a decline in empathy.
Is there a “right” kind of empathy?
Clinical empathy:
Understanding the inner experiences and perspectives of the patient as a separate individual, and communicating this to them.
Adherence/Compliance?
The extent to which a patient follows medical advice or instructions.
- Average (overall) rate of adherence is 60%.
- Average rate of nonadherence is 40% (range = 20 to 80%).
- Adherence to recommended lifestyle changes is very low! (generally not given enough information on how to implement the changes)
- Depend on a variety of complex factors…
Enhancing Patient Adherence
Make it SIMPLE?
- Simplify regimen.
- Impart knowledge.
- Modify patient beliefs.
- Patient communication.
- Leave the bias.
- Evaluate adherence.
