Block 3

Question 1

Define lay beliefs

Answer 1

Beliefs of non-medical professionals. Assumptions about the world, things we believe to be true. Often complex roots, ideas about how disease/illness should be treated, who should do so etc.
Socio-cultural context e.g. religion, personal experience

Question 2

3 reasons people seek medical help

Answer 2

1. explanation of symptoms - context
2. perception of symptoms - frequency and severity
3. evaluation of symptoms - cost vs. benefits

Question 3

What is the dual pathway model?

Answer 3

There are 2 ways that psychological process can influence physical:

1. Direct
2. Indirect: via a behaviour

Question 4

Define biopsychosocial model

Answer 4

Holistic approach to designing intervention:

1. Bio: virus/bacteria
2. Psycho: behaviour, beliefs, coping mechs, culture
3. Social: class, employment, ethnicity, education

Question 5

What are stable factors?

Answer 5

individual difference and personalities that stable across time e.g. response to medical options

Question 6

5 personality traits in emotional disposition (OCEAN)

Answer 6

Openness to new experiences
Contentiousness 
Extroversion
Agreeableness
Neuroticism

Question 7

2 elements to generalised expectancies

Answer 7

1. locus of control - internal (self) or external (others, God)
2. self-efficacy - self-belief

Question 8

Define deterministic approach to causality

Answer 8

• inevitability

- validate hypothesis with certainty e.g. TB bacteria means you will have TB

Question 9

Define stochastic approach to causality

Answer 9

• probability

- asses hypothesis with observations to give a risk of future events e.g. TB is more common in crowded accommodation

Question 10

Define confounding factor

Answer 10

A factor associated with both the exposure and outcome e.g. sedentary lifestyle, obesity and CHD

Question 11

What is a mediating variable?

Answer 11

Variable through which exposure wholly or partially exerts its effect

Question 12

Define reverse causailty

Answer 12

When the cause and effect is the other way round to what you would think it is e.g. mental health and unemployment

Question 13

Explain Bradford Hill Criteria

Answer 13

Determines causality vs causation. To be causality, must:
“SSC To Do Reading CBA.”
Specificity, Strength and Consistency of the association.
Temporality, Dose and Reversibility of the exposure.
Coherence of theory, Biological plausibility and analogy of the hypothesis.

Question 14

Basic outline of hierarchy of evidence

Answer 14

1. Top = Systematic reviews. (Best = meta-analysis.)
2. Experimental (RCTs and controlled studies)
3. Observational (Cohort, then Case-control studies)
4. Descriptive studies (cross-sectional)
5. Qualitive studies (interviews)

Question 15

Define chronic illness

Answer 15

“The experience of living with a long term condition for which there is no other cure, which may be managed with drugs and other treatment.”

1 in 3 live with chronic illness.

Question 16

What is the ‘Self Regulatory Model’?

Answer 16

• patients with chronic illness with changes in their illness will try to return to normality
• Representation of disease, interpretation, coping, appraisal, emotional response

Question 17

5 belief dimensions

Answer 17

Identity, cause, time, consequence, control-care

Question 18

What is crisis theory?

Answer 18

• find a social and psychological equilibrium. Challenges can influence coping mechanisms

Question 19

What is ‘Pain Management Programme’?

Answer 19

Reinforces the message of gate theory, and a combination of psychosocial and physical factors. MDT and spread over 6-8 weeks.

Question 20

What do observational studies do? 2 types?

Answer 20

measure variables of interests in subjects as opposed to actively giving treatments/intervening in any way.

1. Descriptive - distribution of variable/prevalence
2. Analytical - Exposure and risk factors

Question 21

Define ecological studies

Answer 21

Studies a group of people. Administrative study which is good for hypothesis generation (association not causation - correlation stats).

Question 22

Potential bias in ecological studies

Answer 22

Ecological fallacy - might not be on an individual basis

Confounding variables, timing, selective reporting

Question 23

Define cross-sectional studies

Answer 23

Samples subjects at one particular point in time. Can be descriptive or analytic. Good for prevalence, but doesn’t touch incidence or exposures. Good for hypothesis generation, but detects association, not causation. Measure difference in means between groups

Question 24

Potential bias in cross-sectional studies

Answer 24

Sample selection bias (recruit)
Response bias (remove data)
Recall bias (memory)
Responder/social desirability bias
confounding variables
Direction of causation

Question 25

Define case-control studies

Answer 25

Analytical studies comparing control and intervention groups. Retrospective and compare exposures. Prone to recall bias and don’t measure incidence

Question 26

Odds Ratio equation

Answer 26

OR = odds of being a case if exposed/odds of being a case if not exposed

=AD/BC

Question 27

95% confidence interval equation

Answer 27

95% CI = (OR/EF, OR x EF)

Question 28

Define cohort study

Answer 28

Long and expensive. Prospective or retrospective. Follows a group of subjects that have something in common over time. Analytical. Looks at and compares the outcomes of exposed and unexposed subjects. Good for threshold effects, dose response and interaction exposures.

Question 29

4 features of RCTs?

Answer 29

Random allocation, process of randomisation, blinding, placebo effect

Question 30

2 interpretations of whether new intervention is better than standard?

Answer 30

Better physiological action.

Better in routine practise (e.g. compliance)

Question 31

What is an ‘as treated approach’?

Answer 31

Only analyses people who completed all treatment and follow-up. Loses some of the randomisation, as compliers are likely to be fundamentally different from non-compliers = selection bias and confounding.

Question 32

What is ‘intention to treat approach?’

Answer 32

Takes everybody into account, disregarding the problems associated with non-compliance. These are more relevant to clinical practice! This is the approach used in clinical trials. They give smaller effect sizes.

Question 33

What is clinical equipose?

Answer 33

Need to be reasonably uncertain of which treatment is better. Otherwise, you’re denying people a good treatment. Eg. Kangaroo Care.