Block 3 Flashcards
Define lay beliefs
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
3 reasons people seek medical help
- explanation of symptoms - context
- perception of symptoms - frequency and severity
- evaluation of symptoms - cost vs. benefits
What is the dual pathway model?
There are 2 ways that psychological process can influence physical:
- Direct
- Indirect: via a behaviour
Define biopsychosocial model
Holistic approach to designing intervention:
- Bio: virus/bacteria
- Psycho: behaviour, beliefs, coping mechs, culture
- Social: class, employment, ethnicity, education
What are stable factors?
individual difference and personalities that stable across time e.g. response to medical options
5 personality traits in emotional disposition (OCEAN)
Openness to new experiences Contentiousness Extroversion Agreeableness Neuroticism
2 elements to generalised expectancies
- locus of control - internal (self) or external (others, God)
- self-efficacy - self-belief
Define deterministic approach to causality
- inevitability
- validate hypothesis with certainty e.g. TB bacteria means you will have TB
Define stochastic approach to causality
- probability
- asses hypothesis with observations to give a risk of future events e.g. TB is more common in crowded accommodation
Define confounding factor
A factor associated with both the exposure and outcome e.g. sedentary lifestyle, obesity and CHD
What is a mediating variable?
Variable through which exposure wholly or partially exerts its effect
Define reverse causailty
When the cause and effect is the other way round to what you would think it is e.g. mental health and unemployment
Explain Bradford Hill Criteria
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.
Basic outline of hierarchy of evidence
- Top = Systematic reviews. (Best = meta-analysis.)
- Experimental (RCTs and controlled studies)
- Observational (Cohort, then Case-control studies)
- Descriptive studies (cross-sectional)
- Qualitive studies (interviews)
Define chronic illness
“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.
What is the ‘Self Regulatory Model’?
- patients with chronic illness with changes in their illness will try to return to normality
- Representation of disease, interpretation, coping, appraisal, emotional response
5 belief dimensions
Identity, cause, time, consequence, control-care
What is crisis theory?
- find a social and psychological equilibrium. Challenges can influence coping mechanisms
What is ‘Pain Management Programme’?
Reinforces the message of gate theory, and a combination of psychosocial and physical factors. MDT and spread over 6-8 weeks.
What do observational studies do? 2 types?
measure variables of interests in subjects as opposed to actively giving treatments/intervening in any way.
- Descriptive - distribution of variable/prevalence
- Analytical - Exposure and risk factors
Define ecological studies
Studies a group of people. Administrative study which is good for hypothesis generation (association not causation - correlation stats).
Potential bias in ecological studies
Ecological fallacy - might not be on an individual basis
Confounding variables, timing, selective reporting
Define cross-sectional studies
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
Potential bias in cross-sectional studies
Sample selection bias (recruit) Response bias (remove data) Recall bias (memory) Responder/social desirability bias confounding variables Direction of causation
Define case-control studies
Analytical studies comparing control and intervention groups. Retrospective and compare exposures. Prone to recall bias and don’t measure incidence
Odds Ratio equation
OR = odds of being a case if exposed/odds of being a case if not exposed
=AD/BC
95% confidence interval equation
95% CI = (OR/EF, OR x EF)
Define cohort study
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.
4 features of RCTs?
Random allocation, process of randomisation, blinding, placebo effect
2 interpretations of whether new intervention is better than standard?
Better physiological action.
Better in routine practise (e.g. compliance)
What is an ‘as treated approach’?
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.
What is ‘intention to treat approach?’
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.
What is clinical equipose?
Need to be reasonably uncertain of which treatment is better. Otherwise, you’re denying people a good treatment. Eg. Kangaroo Care.
