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Phase 3A > Community and Public Health > Flashcards

Community and Public Health Flashcards

1
Q

what are the 3 principles of the theory of planned behaviour

A

attitudes
subjective norm
perceived behavioural control

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2
Q

how to bridge the gap between intention and behaviour

A 
perceived control 
anticipated regret 
preparatory actions 
implementation intentions (if-then)
relevance to self
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3
Q

what are the 3 health behaviours

A

sick role
illness behaviour
health behaviour

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4
Q

what is the sick role

A

aimed at getting better

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5
Q

what is illness behaviour

A

aimed at seeking remedy

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6
Q

what is health behaviour

A

aimed at preventing disease

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7
Q

what is public health

A

the science and art of preventing disease, prolonging life and promoting health through organised efforts of society

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8
Q

what are the 3 domains of public health

A

health improvement, health protection and improving services

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9
Q

what is health improvement

A

concerned with social interventions

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10
Q

what is unrealistic optimism and what influences it

A

inaccurate perceptions of risk and susceptibility

  1. lack of personal experience with problem
  2. belief that preventable by personal action
  3. belief that if it has not happened by now it is unlikely to
  4. belief that the problem infrequent
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11
Q

what is unrealistic optimism and what influences it

A

inaccurate perceptions of risk and susceptibility

  1. lack of personal experience with problem
  2. belief that preventable by personal action
  3. belief that if it has not happened by now it is unlikely to
  4. belief that the problem infrequent
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12
Q

Maxwell’s Dimensions of service quality

A 
Appropriateness
accessibility 
acceptability 
effectiveness
efficiency 
equity
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13
Q

what is a motivational interview

A

a counselling approach aimed at initiating behaviour change by resolving ambivalence

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14
Q

what is nudge theory

A

change the environment to make the environment the best option the easiest (e.g. placing fruits near the checkouts)

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15
Q

what 3 factors are part of health care evaluation

A

structure
process
outcome

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16
Q

what are the 5 stages of the transtheoretical model of health behaviour

A 
PCPAM 
Precontemplation
contemplation 
planning 
action
maintenance
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17
Q

what is the health belief model

A
  1. belief that they are susceptible to the condition
  2. belief that it has serious consequences
  3. belief that taken action reduces susceptibility
  4. benefits of taking action outweighs the cost
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18
Q

prevention paradox

A

a preventive measure which brings much benefit to the population often offers little to each participating individual

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19
Q

what is the difference between equity and equality

A

equity: giving everyone what they need
equality: giving everyone the same thing

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20
Q

what is horizontal and vertical equity

A

horizontal equity: equal treatment for equal need

vertical equity: unequal treatment for unequal need

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21
Q

cohort study: definition, advantages and disadvantages

A

follows a group of people over a period of time to see what happens to them and what risk factors they were exposure (relative risk = risk in exposed group/risk in unexposed)

advantage: time sequence can be determined, different risk factors and outcomes can be collected simultaneously
disadvantage: high cost, not good for rare disease, drop out rates, large sample size

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22
Q

ecological study: definition, advantages and disadvantages

A

comparing the health of people in a group at different places or at a different time

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23
Q

case series: definition, advantages and disadvantages

A

describes characteristics of a group of people with the same disease or exposure

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24
Q

cross sectional study: definition, advantages and disadvantages

A

snap shot at a given time of a health group e.g. health surveys/prevalence studies

inexpensive, easy to perform, good for providing information on multiple exposures and outcomes, good for assessing health needs of population

can’t determine causality, excludes people who recovered/died quickly

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25
Q

case control study: definition, advantages and disadvantages

A

uses a group of cases with disease and compares to controls without disease and asks about exposure to certain risk factors and calculates odd ratio (outbreak investigations)

quick and cheap to do, can be used for rare conditions

not good for rare exposures, recall bias, difficulty getting suitably matched groups

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26
Q

interventional study: definition, advantages and disadvantages

A

intervention is done on a group of people and the outcome is studied e.g. randomised control study

causality, randomised minimises confounding factors

expensive, large number of participants/drop outs, unethical

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27
Q

summary studies

A

systematic review: finds all the studies on a review, assesses the quality, interprets to come to a conclusion

meta analyses: combined statistical analysis of data from similar studies to produce a single result

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28
Q

how to calculate the relative risk

A

risk in exposed group/risk in unexposed group

29
Q

how to calculate attributable risk

A

risk in exposed group minus risk in unexposed group

30
Q

how to calculate number needed to treat/harm

A

1 divided by attributable risk

31
Q

sensitivity

A

% correctly identified with the disease

32
Q

specificity

A

% correctly excluded as disease free

33
Q

positive predicted value

A

% of having the disease if you have a positive test result

true positive/ true positive+ false positive

34
Q

negative predictive value

A

% of not having the disease if you have a negative test result

true negative/ true negative + false negative

35
Q

what can association be due to

A 
true association
bias 
chance 
confounding factors
reverse causality
36
Q

what is evaluation of a service

A

evaluation of whether a service is achieving its aims

37
Q

why might health outcomes not be useful to evaluate service

A

time lag
data might not be available
might be subject to bias

38
Q

quantitative measures for evaluation

A

routinely collected data e.g. mortality rates
surveys
other special studies e.g. epidemiological studies

39
Q

what is health need

A

the ability to benefit from an intervention

40
Q

what is the epidemiological approach to health needs assessment

A

determining the needs of a population based on services currently available and the outcomes

41
Q

what is the corporative approach to health needs assessment

A

determining the needs of a population by asking shareholders what they feel they need

42
Q

what is the comparative approach to health needs assessment

A

determining the needs of a population by compares the services received by a population (or subgroup) with others

43
Q

qualitative studies

A 
interviews
focus groups 
surveys 
case studies
observational studies
44
Q

system approach

A

this approach to error management recognises holes in organisation policies/working conditions cause errors and aims to address this to prevent future errors

45
Q

examples of health improvement

A 
Inequalities
Education
Housing
Employment
Lifestyles
Family/community
46
Q

examples of health protection

A 
Infectious disease
Chemicals and poisons
Radiation
Emergency response
Environmental health hazards
47
Q

examples of service improvement

A 
Clinical effectiveness
Efficiency
Service planning
Audit and evaluation
Clinical governance
equity
48
Q

what influences health inequalities

A 
PROCESS:
Place of Residence (rural, urban, etc.)
Race or ethnicity
Occupation
Gender
Religion
Education
Socioeconomic status
Social capital or resources
49
Q

incidence

prevalence

A

Incidence- Number of new cases in a population during a specific time period.
Prevalence- Number of existing cases at a specific point in time

50
Q

what is bias

A

A systematic error that results in a deviation from the true effect of an exposure on an outcome

51
Q

what are the 3 types of bias

A

Selection bias
Non response of certain groups, allocation bias (different participants in different groups)

Information bias
Measurement bias, observation bias, recall bias (doesn’t remember or recall correctly), reporting bias (don’t report truth because feel judged)

Publication bias
Trials with negative results less likely to be published

52
Q

what are lead time and length time bias

A

Lead time bias= Early identification doesn’t alter outcome but appears to increase survival
e.g. patient knows they have the disease for longer
Length time bias= Disease that progress more slowly is more likely to be picked up by screening (i.e. symptom free and around for longer), which makes it appear that screening prolongs life.

53
Q

what is confounding

A

When an apparent association between an exposure and an outcome is actually the result of another (independent) factor.

54
Q

what are the bradford hill criteria for causation

A

Temporality - most important - exposure occurs before outcome (people smoke before developing lung cancer)

Dose-response - more risk of outcome with more exposure (the more you smoke the higher the risk of lung cancer)

Reversibility - if you take away the exposure then the risk of disease decreases or is eliminated (stop smoking and you have a decreased risk of lung cancer after 10 years or so)

Consistency - the association is seen in different geographical areas, using different study designs, in different subjects (smoking is associated with lung cancer in dogs, mice and people, all over the world). Repeatability of the result.

Plausability – existence of reasonable biological mechanism for the cause and effect lends weight to the association
Coherence – logical consistency with other information
Analogy - similarity with other established cause effect relationships
Specificity – the relationship being specific to the outcome of interest

55
Q

what are the stages of the planning cycle for health services

A

Needs assessment – planning – implementation – evaluation

56
Q

what is a health needs assessment

A

HNA provides a systematic approach to assessing health needs to reduce inequalities in health and inform decision making and action planning to improve health.

57
Q

how can we define health

A

How do we define ‘health’?

Bio-medical
Absence of disease

Psychosocial
Stress and function

Lay views
Felt and expressed needs

58
Q

WHO definition of health

A

a state of complete physical, mental and social well being not merely the absence of disease

59
Q

what are Bradshaw’s needs

A

Felt need – individual perceptions of variation from normal health

Expressed need – individual seeks help to overcome variation in normal health (demand)

Normative need – professional defines intervention appropriate for the expressed need

Comparative need – comparison between severity, range of interventions and cost

60
Q

3 approaches to a health needs assessment

A

epidemiological
comparative
corporate

61
Q

describe an epidemiological HNA. advantages and disadvantages

A

Very top down
Define your issue, assess the size of it (incidence/prevalence), assess the services available for this issue, assess if this is matching the evidence base for effectiveness and cost-effectiveness, assess the care (using quality and outcome measures e.g. QOF) and assess for any unmet need and any unneeded services - using all of this, make recommendations
Problems with this – data – may not be available/high quality, doesn’t consider felt needs, reinforces biomedical approach

62
Q

comparative approach HNA advantages and disadvantages

A

Basically you take two populations/areas and compare the services received by one of them, with another – fairly quick and cheap, and can measure the variation
Problems – data not available/high quality, difficulties finding a comparable group, and also it’s possible that neither group is using the ideal services! No assessment against current evidence.

63
Q

corporate approach advantages and disadvantages

A

Collect the views of the “stake holders” e.g. The patients/service users, GPs, other health professionals etc – ask them what they think is needed.
Problems – blurs the difference between need and demand. Vulnerable to influence by political and personal views etc.

64
Q

what is evaluation

A

process that attempts to systematically assess whether service meets its objectives

65
Q

donabedian approach to evaluation

A

Structure
Process
Outcome

outcome: 5Ds = death, disease, disability, discomfort, dissatisfaction

66
Q

models of behaviour change

A 
Health Belief Model
Theory of Planned Behaviour
Stages of Change/Transtheoretical Model
Social norms theory
Motivational Interviewing
Social Marketing
Nudging
Financial Incentives
67
Q

what are the features of a communicable disease that make it a public health concern

A 
High mortality
High morbidity
Highly contagious
Expensive to treat
Effective interventions
68
Q 
notifiable diseases 
who 
when 
what 
how
A

who: registered medical practitioners/ labs
when: clinical suspicion of a notifiable disease
what: case details + details of the disease/contamination
how: PHE with written notification or telephone if urgent

69
Q

define:

Cluster
Suspected outbreak 
Confirmed outbreak
Epidemic
Pandemic
Endemic
Hyper-endemic
A

Cluster = An aggregation of cases which may or may not be linked

Suspected outbreak = Occurrence of more cases than normally expected within a specific place/ group over a given period of time. 2+ cases linked through common exposure/ characteristic/ time/ location . SINGLE case of rare/ serious disease

Confirmed outbreak = Link confirmed through epidemiological/ microbiological investigation

Epidemic = Occurrence within an area in excess of what is expected for a given time period

Pandemic = Epidemic widespread over several countries

Endemic = Persistent level of disease occurrence

Hyper-endemic = Persistently high level of disease occurrence

Phase 3A (9 decks)

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