Behavioural and Social Science

Question 1

What is the impact of behaviour on disease?

Answer 1

• Accounts for 50% of premature deaths from the 10 leading causes of mortality.
• 40% of cancers are linked to behaviour.
• 80% of cases of heart disease, stroke and diabetes could be avoided if lifestyle risk factors were appropriately managed.

Question 2

What did a behavioural study in Alameda Country (USA) show?

Answer 2

That people over 75 years who carried out all of the healthy behaviours were in similar health to those aged 35-44 who followed less than three.

Question 3

What can heath behaviours be?

Answer 3

Either enhancing or compromising.

Question 4

What are the three types of health behaviour?

Answer 4

1) Risky (causing disease)
2) Promoting/protective
3) Illness related (adherence to treatment, appointment attendance)

Question 5

Why do risky health behaviours have immediate positive reinforcement?

Answer 5

Because you get pleasure or acceptance from peers for the decision, and the behaviour started at a time where there was no immediate impact on health.

Question 6

What is a negative reinforcer?

Answer 6

Where some risky health behaviours have a physiological response which can positively reinforce and sustain behaviour.

Question 7

What are two cognitive theories that explain promoting and preventative behaviours?

Answer 7

1) Health belief model

2) Theory of planned behaviour

Question 8

What is the most important factor in preventing change?

Answer 8

Perceived barriers

Question 9

What is the effect of fear arousal on health behaviour?

Answer 9

A meta-analysis of fear appeals showed that fear only has an impact on a person if their self-efficacy (belief/confidence that a person can perform a behaviour) is high.

Question 10

How can self-efficacy be improved?

Answer 10

With fear and an action plan.

Question 11

What are the six constructs for the Health Belief Model?

Answer 11

1) Perceived susceptibility
2) Perceived severity
3) Perceived barriers
4) Cues to action
5) Self-efficacy
6) Perceived benefits

Question 12

What are the three constructs of the theory of planned behaviour?

Answer 12

1) Attitude towards act or behaviour
2) Subjective norm
3) Perceived behavioural control

Question 13

What does the theory of planned behaviour state?

Answer 13

That if the three constructs are positive/favourable then a person will develop a behavioural intention and will be more likely to carry out that behaviour.

Question 14

What is the biopsychosocial model of health and illness?

Answer 14

It considers the effect of biological, social and psychological factors on health and illness.

The relative importance of each factor is dependent on the health issue and the availability of health care resources.

Question 15

What is alcohol use disorder?

Answer 15

Where a person is having problems controlling the intake of alcohol, have a continued use despite problems arising from drinking, development of tolerance, development of withdrawal symptoms and drinking which can lead to becoming involved with risky behaviour.

Question 16

What is the mesocorticolimbic pathway?

Answer 16

A dopaminergic pathway involved in reward. Alcohol and other drugs enhance dopaminergic transmission in this pathway which positively reinforces continued intake of the substance.

Question 17

What is the concordance of alcoholism in twins?

Answer 17

In most (but not all) studies, monozygotic twins have a higher concordance for alcoholism than dizygotic twins.

Question 18

How is the domapine D2 receptor gene associated with substance abuse?

Answer 18

The gene is associated with domapine receptor density.

• A1 allele is associated with reduced number of binding sites and an increased likelihood to develop substance abuse.
• A2 allele is associated with increased number of dopamine binding sites and a reduced likelihood to develop substance abuse.

Question 19

What seems to be involved in the protective mechanism against the development of AUD and in adverse alcohol drinking behaviours?

Answer 19

Two growth factors:

• BDNF (brain-derived neurotrophic factor)
• GDNF (glial cell-line derived neurotrophic factor)

Question 20

What are orexins?

Answer 20

Also called hypocretins, they are neuropeptides synthesised in the hypothalamus and modulate many neurotransmitter systems.

They are involved in feeding behaviour, neuroendocrine regulation, the sleep-wake cycle and reward-seeking.

They have the potential to be involved in alcohol withdrawal symptoms possibly via epigenetics.

Question 21

What is the McKeown thesis?

Answer 21

That the population growth since the late 18th century was due to improving economic conditions rather than to better hygiene, public health measures and improved medicine.

Question 22

What are the social determinants of health?

Answer 22

The conditions in which people are born, work, live, and age and the wider set of forces and systems shaping the conditions of daily life.

These forces and systems include economic polices and systems, development agendas, social norms, social policies and political systems.

Question 23

What is the Black Report?

Answer 23

A report into health inequality carried out in 1980. It examined the association between social class (measured my occupation) and health. It demonstrated that both mortality and morbidity from almost all causes were on a gradient with worse health for those lower down the social scale.

Question 24

What are the Whitehall Studies?

Answer 24

A cohort study into mortality and morbidity in British civil servants from the 1960s onwards.

The study identified the role of psychological mediators.

Question 25

What are the limits to cultural/behavioural explanations for health?

Answer 25

They don’t account for why culture/behaviour is difference in different social groups (what WHO calls the ‘causes of causes’).

Also doesn’t account for the material constraints on behaviours.

Question 26

What does inequality mean for health?

Answer 26

It causes ill health for everyone e.g. inequality in the richest societies.

Question 27

What is the difference between isolation and loneliness?

Answer 27

Isolation = having few social contacts

Loneliness = refers to the experience

Question 28

What is social capital?

Answer 28

The networks of relationships among people who live and work in a particular society enabling that society to function effectively.

Question 29

What contributes to civil capital?

Answer 29

• Civil participation (the propensity to vote and take action on issues).
• Social networks and support.
• Social participation.
• Reciprocity and trust (giving and receiving favours, trusting other people and institutions like government and police).
• Views about the neighbourhood.

Question 30

What causes low social capital?

Answer 30

• High residential turnover
• Concentrated disadvantage (high population density, high non-owner occupier leads to fear, distrust, uncertainty and dependency).

Question 31

What is perception?

Answer 31

The interpretation of sensory input, organising the input and assigning meaning.

Question 32

What is the biomedical model of symptoms perception?

Answer 32

It assumes a one to one ratio between psychological change and symptoms reports.

Question 33

What are the three factors that can explain the variation in symptom reporting and healthcare utilisation?

Answer 33

1) The attention we pay to our internal bodily states.
2) Attribution
3) Emotions

Question 34

Are we more or less likely to detect changes in our internal states in an unstimulating environment?

Answer 34

More likely as there is less competition places on our limited attentional capacity.

People who live alone or who are unemployed report more symptoms.

Question 35

What are schemas?

Answer 35

Structures in our long-term memory that allows us too store information into meaningful categories. They are influenced by past learning and new assimilated knowledge

Question 36

What will people generally have schemas about?

Answer 36

• Which illnesses they are vulnerable to.
• Which symptoms indicate potential illness.
• Which illnesses compromise a threat to their overall health.

Question 37

What is medical student disease?

Answer 37

Up to 1/3 of medical students worry they have an illness they have just studied.

Question 38

What are lay diagnosticians?

Answer 38

Patients that make their own common-sense interpretations of their symptoms based on their lay illness schemas.

Question 39

What are the five domains of illness schemas?

Answer 39

1) Identity = symptoms associated with a specific illness are given a label.
2) Cause = understanding of the aetiology.
3) Timeline = expected duration.
4) Consequences = impact of symptoms.
5) Cure and control = steps needed to manage symptoms.

Question 40

What was high distress related to in asthma patients in a study?

Answer 40

Tendency to label a wide range of symptoms as signs of asthma.

Question 41

What are the three reasons for delays in help seeking?

Answer 41

1) Appraisal delay = questioning if they are actually ill (the time taken to attribute a symptom to an illness).
2) Illness delay = questioning if they need medical attention.
3) Utilisation delay = time taken between symptom detection and presenting to a health care service (deciding they are going to get treatment).

Question 42

What is the definition of illness according to Talcott Parsons?

Answer 42

The disturbance in the normal functioning of the total human individual including both the state of the organism as a biological system and of his personal and social adjustment.

Question 43

How does Talcott Parsons describe the doctor-patient relationship?

Answer 43

As a gatekeeper relationship. The doctor deciding on treatment and when the patient can re-enter everyday life.

Question 44

What is involved in the traditional consultation process for acute conditions?

Answer 44

The doctor mainly asks closed questions which leads to identifying the disease and prescribing a treatment that the patient must accept.

Question 45

What are the Stewart and Roter degrees of control?

Answer 45

Terms used to describe when the doctor or patient has high or low control.

• Patient and doctor low control = default.
• Patient high and dr low = consumerist
• Doctor high patient low = paternalism
• Dr and patient high = mutuality

Question 46

What are patient-centred consulations?

Answer 46

Where the doctor is willing to become involved in the full range of difficulties patients bring to their doctors and not just their biomedical problems.

Patients experience illness and this needs to be understood.

Question 47

What does the GMC say about shared decision-making between a doctor and a patient?

Answer 47

It is for the patient, not the doctor, to determine what is in the patient’s own best interests. You may wish to recommend a treatment or a course of action, but you must not put pressure on patients to accept your advice.

Question 48

What is patient preference for involvement associated with?

Answer 48

• Younger age (<60 years)
• Female
• Higher socio-economic status
• Type of problem (higher for psychological illness)
• Simpler treatment choice

Question 49

What are the positive effects of patient participation that have been observed?

Answer 49

• Improved self-esteem
• Reduced depression
• Increased adherence with drug treatments

Question 50

What is compliance?

Answer 50

The extent to which the patient’s behaviour matches the prescriber’s recommendations.

Question 51

What is adherence?

Answer 51

The extent to which the patient’s behaviour matches agreed recommendations from the prescriber.

Question 52

What is concordance?

Answer 52

Concordance is based on the notion that the work of the prescriber and patient in the consultation is a negotiation between equals and that the aim is a therapeutic alliance between them. This alliance may, in the end, include an agreement to differ. Its strength lie in a new assumption of respect for the patient’a agenda and the creation of openness in the relationship, so that both doctor and patient together can proceed on the basis of reality and not of misunderstand, distrust or concealment.

This has a greater emphasis on patient autonomy.

Question 53

In which situation is concordance not appropriate?

Answer 53

Clinical trials.