ASBHDS Flashcards
What is the sociological theory on chronic illness?
Illness work Everyday life work Emotional work Identity work Biographical work
What is illness work?
The work up to diagnosis and following diagnosis to manage physical manifestation of illness.
How an individuals self-conception changes as a result of living with their condition.
What is everyday life work?
Actions and processes involved in managing the condition and its impact.
The daily tasks to keep household going.
Give 4 examples of illness work.
Multiple tests
Uncertainty - diagnosis without clear explanation
Managing symptoms
Emotional impact
Give 3 examples of everyday life work.
- Decisions about mobilisation of resources
- Balancing demands and maintaining independence
- Disguising or minimising symptoms
What is identity work?
Establish and maintain an acceptable identity.
Give 3 examples of identity work?
- Managing actual and imagined reactions of others
- Presentation of yourself to avoid stigma e.g. walking without aid even though painful
- Avoiding sharing some information about illness as fear of being treated differently
What is emotional work?
Work to protect others emotional well-being that made lead to a changed role for the person living with chronic disease.
Give 3 examples of emotional work.
- Demonstrate ability to remain active by taking part in activities as if not ill e.g. run 5k
- Withdrawal from social groups
- Dependence on close others e.g. spouse
What is biographical work?
The interaction between body and identity from the continual or occasional reconstruction of their life.
What is biographical disruption?
Chronic illness leads to loss of confidence in body, leading to loss of confidence in social interaction/self-identity.
Give 2 examples of biographical work.
- Patient tries to re-construct life before diagnosis - e.g. past friendship groups
- Period of uncertainty as loss of previous ‘taken-for-granted’ life
What is the effect of lay referral?
Delays people seeking help When, how and why people see a doctor Use of alternative medicines Use of health services and medication Your role as a doctor in their health
What is scarcity?
Need outstrips resources, prioritisation inevitable.
What is efficiency?
Getting the most out of limited resources
What is equity?
Extent to which distribution of resources is fair
What is utility?
The value that an individual places on a health state
Why are QALYS useful?
- Evaluate cost-effectiveness
- Combine survival + QoL
Compare different uses of resources
What are some problems with QALYs?
Do not distribute resources according to need, but according to benefits gained per cost
Disadvantage common conditions
Technical problems with calculations
Do not assess impact on carers or family
Why is it important to measure health?
Indicate need for healthcare Target resources where needed Assess effectiveness of interventions Evaluate quality of health services Monitor patients' progress
What are the advantages of measuring PROMS?
Aim of many conditions is manage not cure
Patient-centred care
Attention to iatrogenic effects of care
Biomedical testes one part of picture
What is HRQoL, what does it take into account?
Multidimensional test
Physical function, symptoms, global judgements of health, psychological well being, social wellbeing, personal constructs, satisfaction with care
Give 5 advantages of generic instruments.
- Used for broad range of health issues
- Used it no specific instrument
- Comparisons across treatment groups
- Detect positive/negative effects of intervention
- Assess health of populations
Give 4 disadvantages of generic instruments.
Less detailed
Loss of relevance - too general
Less sensitive to changes that occur as a result of intervention
Less acceptable to patients
What is the social learning theory?
- Behaviour is goal-directed
- People motivated to perform behaviours that:
- are valued/lead to rewards
- they believe they can enact
Learn from observing others - peers, family, media, celebs
What is an advantage of social learning theory?
Peer modelling and education
Celebs in health promotion campaigns
What is the health belief model?
Health-related behaviour depends on:
Beliefs about threat - perceived susceptibility and severity
Beliefs about health-related behaviour - perceived benefits and barriers
Cues to action
What are the beliefs about threat in the health belief model?
Perceived susceptibility - their chance of getting infection
Percieved severity - how serious, consequences of getting infection
What are the beliefs about health-related behaviour in the health belief model?
Perceived benefits - how effective intervention is at reducing risk
Barriers - psychological effect, cost
What are cues to action in the health-related behaviour model?
Reminders
How-to information
What are the limitations of the health belief model?
Assumes rational/cognitive decision making based on weighing up pros and cons
Doesn’t incorporate emotional influences
What are the 3 components of the theory of planned behaviour?
Attitude towards behaviour - belief about outcomes
Subjective norm - comply to norm
Percieved control - barriers and facilitators
What is the issue with the theory of planned behaviour, how can this be improved?
Intention behaviour gap - good predictor of intentions but poor predictor of behaviours
Improve by concrete plans of action - what i will do, when and where.
What are the 5 stages of change?
PCPAM Precontemplation Contemplation Preparation Action Maintenance
What happens in the precontemplation stage?
Not considered change - e.g. do not think need to lose weight
What happens in the contemplation stage?
Thinking about change e.g. maybe i should lose weight
What happens in the preparation stage?
Take action in near future e.g. i will start exercising regularly
What happens in the action stage?
Make attempts
What is the prevention paradox?
Interventions that make a difference at population level might not have much effect on individual.
What is the artefact explanation for inequalities?
Due to the way statistics are collected, problems particularly with measurement of social class.
What is the social selection explanation of inequalities?
Direct causation from health to social position - sick people move down hierarchy and healthy move up.
What is the behavioural-cultural explanation of inequalities?
Ill health is due to peoples choices, decisions, knowledge and goals.
- Disadvantaged background - engage in more health-damaging behaviours
- Advantaged background - health-promoting behaviours
What is the materialist explanation of inequalities?
Arise from differential access to material resources
- Lack of choice in exposure to adverse conditions
- Low income, unemployment, poor housing
Give 4 examples of primary prevention strategies.
- Immunisation
- Prevent contact with environmental risk factors
- Precautions
- Reduce risk of health-related behaviours
What is secondary prevention?
Detect and treat diseases at an early stage to prevent progression and complications.
Give 2 examples of secondary prevention.
Screening for cancer
Blood pressure treatment and monitoring
What is tertiary prevention?
Minimise the effects of established disease.
What is sensitivity?
proportion of people who have the disease who the test correctly identifies as positive.
What is specificity?
proportion of people without the disease who test negative.
What is positive predictive value?
Probability that someone who has tested positive actually has the disease.
What is a factor in positive predictive value?
Prevalence of disease
What is negative predictive value?
Proportion of people who are negative who do not have the disease.
Give 5 reasons for non-adherence.
Forgetting Fear of ADRs No longer feeling unwell Concern about safety or effectiveness Confusion about directions
What is concordance?
Patient and doctor working together on prescribing agreed treatment.
What is the benefit of concordance?
Patient empowered as feelings discussed and respected.
Greater likelihood of adherence as patient played a role in process.
What is adherence?
The extent to which a persons’ behaviour corresponds with agreed recommendations from a healthcare provider.
What is the impact of stereotypes and stigma in clinical settings?
Diagnosing symptoms - symptoms missed due to attributes linked to an illness
Patient disclosure - patient reluctant to disclose symptoms in order to avoid stigma and being judged
Healthcare professionals approach - capacity/ time constraints.
What is an adverse event?
injury caused by medical management and that prolongs hospitalisation, produces disability or both
What is a preventable adverse event?
An adverse event that could be prevented given the current state of medical knowledge.
Give 6 things that could make health delivery safer?
Avoid reliance on memory Make things visible Review and simplify process Checklists Standardise common processes and procedures
What is first order problem solving?
Doing what it takes to continue patient care task, no more or less.
- meets immediate needs
- minimises time away from patient care
Where do first order problem solvers seek help?
Ask for help from people socially close rather than best equipped to help
- Preserve reputation
- Minimise difficult encounters
What is second order problem solving?
Forward thinking about how to adapt a system in order to prevent problem recurring.
- reduce likelihood of error recurring and causing harm
What are active failures?
Acts leading directly to patient being harmed - slips, lapses, mistakes and violations
Sharp-end
What are latent conditions?
Predisposing conditions which increase likelihood of active failures
Give 4 examples of latent conditions?
Poor training Lack of checks built into process Too few staff Time pressures Fatigue Poor supervision
What is the swiss cheese model?
Some hols due to active failures, some due to latent conditions. The more layers/defences then the less likely an active failure will be the result.
What is systems approach?
Identifying underlying latent factors - not about blame (root cause analysis)
What are 3 ways that systems approach can be applied?
5 whys
Fishbone diagram
Timelines
What system can be applied when seeking continual assessment?
Plan, Do, Study, Act - what changes are we going to make based on findings?
Give 4 barriers to speaking up.
Hierarchal relationships
No certainty that will lead to improvements
Provoke hostility and reduce quality of working relationships
Difficult to assess if something is really a problem
