BSS Flashcards
Lay Definitions of Health
Absence of disease
What is health behaviour?
‘behaviour patterns, actions, & habits that relate to health maintenance, health restoration and to health improvement’
What are the types of Health Behaviour?
- Preventative
- Illness / ‘sick-role’
What is preventative behaviour?
To prevent or detect disease
What kinds of preventative behaviour?
SELF-DIRECTED (e.g. drinking water, exercise, healthy diet)
PREVENTATIVE MEDICINE (e.g. getting vaccinated, screening attendance, using condoms)
What is ‘sick-role’ behaviour?
Defining ill health, finding remedies and getting well
What types of ‘sick-role behaviour’ are there?
SELF CARE (e.g. OTC medicines, self-help, coping strategies)
HELP/TREATMENT SEEKING & COMPLIANCE (e.g. talking to friends/family, seeking medical advice, therapy)
Why do we examine health behaviour?
significant proportion of morbidity and mortality can be attributed to health behaviours
How do we modify health behaviour?
Understanding behaviour - what influences, how we can change it
How can we begin to understand the causes of behaviour?
psychological approaches - e.g. social cognition models
(help understand, predict, and change health behaviour)
What is the primary determinant of behaviour?
COGNITIVE VARIABLES/COGNITIONS (attitudes & beliefs)
What are cognitive variables?
primarily focused on motivational factors
- perception of RISK of developing health condition
- perceived EFFECTIVENESS of behaviour achieving health goal
behaviour is viewed as rational & product of subjective cost-benefit analysis
What is the ‘Health Belief Model’?
Aimed to establish a systematic method to explain and predict preventative health behaviour
Adapted to many cultures & health behaviour, evidence based - explains variance in health behaviours
What is perceived severity?
How bad is this health outcome for me?
(how treatable is it, knowing people who have survived/died)
What is perceived susceptibility?
How am I at risk of this health outcome or issue?
Family history, friends w cancer, leading a healthy life
What is perceived threat?
Joining together perceived susceptibility and perceived severity?
What are perceived benefits?
physical health, psychological health, social benefits
What are perceived barriers?
cost, social impact, practical barriers
(e.g. difficulty getting screenings, fear of having x condition)
What is the belief in effectiveness of health behaviour?
perceived benefits + perceived barriers
What is self-efficacy?
Individuals need to believe they are capable of and have control over performing the behaviour that will reduce the threat to their health?
What are the limitations of the Health Belief Model?
emphasis on individualism and rational decision making ignores influence of other factors (social, economic, emotional)
does NOT take into account habitual/non-health related reasons for behaviour (social acceptability)
constructs are unobservable - hard to measure
What is Illness Behaviour?
‘the manner in which individuals MONITOR their bodies, DEFINE & INTERPRET their symptoms, take remedial action, utilise sources of help as well as the formal health care system’
going to see a doctor is process
What are the stages of illness behaviour?
- Symptom Interpretation (interpretation/denial)
- Coping (accommodation/self-management)
- Help-seeking decision-making (procrastination/’shopping’ between help sources)
(cycle)
What is a lay diagnosis of symptom experience?
‘The act of bringing meaning to a bodily change through a process of interpretation and evaluation?’
Thinking about if symptoms are normal or not, an illness or not, or serious enough for treatment
How do we normalise/rationalise symptom experience?
Seeking alternative innocuous/benign explanations, often linked to lifestyle factors or age.
May accept something is WRONG, but will offer a logical ‘non-threatening’ explanation
Help-seeking does NOT occur
How do we accommodate cancer symptoms?
Coping, denial
What are structural explanations for not help-seeking?
ACCESS barriers: time, cost, cultural sensitivity, lower classes, social structure
Competing social roles
Social Values: e.g. stoicism, ‘traditional masculinity’
What are cultural knowledge explanations?
Social Construct of Illness
Nature of Symptoms (visibility, recognisability, frequency)
Lay theories
What are lay theories?
What is ‘real’ illness?
Ideas about cause, course and prognosis
Stereotypes about ‘at risk’ groups
Beliefs about treatment
What is lay epidemiology?
‘The processes through which health risks are understood and interpreted by lay (non-professional) people’
What are key aspects of lay epidemiology?
Lived-experience, family history
Media, celebrities
Empirical evidence/health promotion messages
Modification by social norms and values
What are social barriers to the ‘meaning’ of being ill?
The social meanings of being ill, seeking help and becoming a patient
- illness is a moral category
- some diagnoses carry social meaning
- becoming a patient can impact on our identity
- help seeking is negotiated as an act of identity management
What is stigma?
‘A physical/social attribute or form of behaviour that results in a person not being fully accepted as a member of some social groups, being marked out and treated differently.’
What is discredited stigma?
e.g. wheelchair user, facial disfigurement
What is discreditable stigma?
e.g. infertility, epilepsy, HIV
(to tell or not to tell; to lie to not to lie)
What is passing?
Art of concealing a discreditable stigma to control their self image
BY avoiding social contact & stigma signs
What is the traditional model of doctor-patient relationship?
Paternalism
Patients = ‘sick-role’
Doctors = ‘professional role’
What are the different models of doctor-patient relationship?
Paternalistic
Shared (‘mutual’)
Consumerist (‘informed’)
Default (low levels of engagement)
What are the stages in consultations?
- INFORMATION EXCHANGE (symptoms, physical examination)
- DELIBERATION & DIAGNOSIS (deciding on diagnosis)
- DECIDING ON TREATMENT (assessing risk)
When can we use paternalistic medicine?
Acute/emergencies
When can we use shared (mutual) medicine?
Long-term conditions (e.g. asthma, arthritis) when patient has expert knowledge
When can we use informed (consumerist) medicine?
Participation in clinical research
What model to patients want?
Depends - must understand patients’ preferences for STYLE and TREATMENTS
CAN CHANGE
Do socio-demographics influence preference for styles?
Do older people prefer paternalism?
Do middle class people prefer shared decision-making?
Should children be treated paternalistically?
What is shared decision making?
Patient Centred Care and shared decision-making interconnected
What is shared decision making in the NHS?
Patients asking what their options are, pros/cons, how to get support
How can we question shared decision making?
Does shared decision-making…
- put pressure on doctors?
- take more time?
- sometimes increase patient anxiety?
- sometimes unsuitable for all patients/conditions? how do doctors judge?
What is compliance?
When patients follow advice from a doctor
(e.g. taking medication as prescribed, following lifestyle advice)
Different types
- ‘intentional’ / ‘voluntary’ non-compliance
- ‘non-intentional’/ ‘involuntary’ non-compliance
Are patients compliant with medication?
MAX of 50% of patients take medication as prescribed
-> problem on non-adherence
What are the problems of non-adherence?
large costs
causes many hospital admissions (10-25%)
increases length of hospital stay
What are reasons for non-compliance?
concerns about side effects
views about appropriateness of treatment
practical barriers
misunderstandings between patients & doctors
What is patient ‘adherence’?
respecting patients’ involvement and choice about what they do
respecting that patients make rational decisions about whether to follow advice
What is concordance?
agreement about treatment
concordance = patients more likely to adhere
How can a doctor facilitate concordance
- find out/respond to patients’ ideas, concerns, expectations
- identify treatment choices & evaluate research
- address treatment feasibility & discuss w patient
- develop therapeutic doctor-patient alliance
- encourage agreement on treatment action plan
What is the ‘placebo’ response/effect?
positive response of a person to entirely inert substance/intervention OR to active intervention where response is above & beyond expectations
can be deliberate or unintended
What is the nocebo response?
harm rather then benefit is caused
more likely to occur if person has previous experience of adverse effects
What are treatment effects?
‘respectful focus on entirety of a person’s life situation’
- meaning of treatment influences placebo response
- emotional & cognitive care increases placebo response
(role of compassion in healthcare)
What is a Health System?
consists of all organisations, people and actions whose primary intent is to promote, restore or maintain health
What are the 5 main systems for funding health systems?
General taxation
National Health Insurance
Privatised Health Insurance
Out of Pocket Payments
Charitable Donations
What type of system is the NHS?
A social solidarity system
What is a social solidarity system?
UNIVERSAL coverage
FREE at point of delivery
Access based on CLINICAL NEED, not ability to pay
What does the NHS include?
Hospital, GP, Ambulance, Community Health Services
What are the challenged ahead for the NHS?
- Covid-19 & service backlog
- financial control
- behavioural medicine & preventative care
- inequalities in health & health outcomes
- Brexit (staffing, supply chains, R&D, PH response0
What are the challenged ahead for the NHS?
- Covid-19 & service backlog
- financial control
- behavioural medicine & preventative care
- inequalities in health & health outcomes
- Brexit (staffing, supply chains, R&D, PH response0
What is a Profession?
discrete body of knowledge; members control access to
- monopoly over market
autonomy over work conditions and from state & capital
altruism is core motive - performance MORE important than financial reward
What are the professional roles of a doctor?
- politics
- rationing
- research
- legal advice
ACCORDING TO GMC, what are the duties of a doctor?
- knowledge, skills, & performance
- safety & quality
- communication, partnership & teamwork
- maintaining trust
What is knowledge, skills, & performance?
Care of patient comes FIRST
Good standards of practise and care
What is safety & quality?
ACT if patient safety/dignity is compromise
protect & promote health of patients & public
Why do Health Inequities exist?
Lifestyle/Behavioural
Material/Structural
Psychosocial
How does ‘lifestyle’/behaviour influence health?
certain groups are MORE likely to engage in health-harming behaviours and LESS likely to engage in health promoting behaviours
-> smoking, alcohol,
How are there inequities in help-seeking behaviour?
Men are less likely to consult a GP than women
How are there inequities in screening opportunities?
South Asian and lower SES women are less likely to attend breast screening
Why do some people have ‘healthy lifestyles’ whilst others don’t?
Materialist/Structuralist Explanations
Does poverty affect health?
Poverty is the number one cause of ill-health
How does poverty affect health?
- Direct Impact
- Affects people’s choices
- Access/Quality of Services
How does poverty DIRECTLY IMPACT health?
1m unfit homes in UK. Leads to
-> respiratory infections
-> asthma
-> nausea & vomiting
-> fever
-> excess winter deaths
costs NHS £1.4bn/year
How does poverty AFFECT CHOICE?
-> Healthy Diet - more expensive & less available
-> Physical Activity - less outdoor space, crime & anti-social behaviour
How does poverty affect ACCESS TO SERVICES?
Inverse Care Law - ‘those most in need of medical care are least likely to receive it’
What are some psychosocial explanations that can harm your health?
Experiences of anxiety, grief, anger, hopelessness, insecurity, stress, loneliness, fear, lack of control, shame
How can psychosocial stress lead to ill-health?
- impact on mental health
- directly via impact on physiological mechanisms
- indirectly via impact on behaviour (e.g. smoking)
How do psychosocial explains cause inequality?
Certain groups are more likely to experience negative psychosocial states than others
- racism
- poverty
- gendered experiences
