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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
case control study: definition, advantages and disadvantages
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
26
interventional study: definition, advantages and disadvantages
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
27
summary studies
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
28
how to calculate the relative risk
risk in exposed group/risk in unexposed group
29
how to calculate attributable risk
risk in exposed group minus risk in unexposed group
30
how to calculate number needed to treat/harm
1 divided by attributable risk
31
sensitivity
% correctly identified with the disease
32
specificity
% correctly excluded as disease free
33
positive predicted value
% of having the disease if you have a positive test result true positive/ true positive+ false positive
34
negative predictive value
% of not having the disease if you have a negative test result true negative/ true negative + false negative
35
what can association be due to
``` true association bias chance confounding factors reverse causality ```
36
what is evaluation of a service
evaluation of whether a service is achieving its aims
37
why might health outcomes not be useful to evaluate service
time lag data might not be available might be subject to bias
38
quantitative measures for evaluation
routinely collected data e.g. mortality rates surveys other special studies e.g. epidemiological studies
39
what is health need
the ability to benefit from an intervention
40
what is the epidemiological approach to health needs assessment
determining the needs of a population based on services currently available and the outcomes
41
what is the corporative approach to health needs assessment
determining the needs of a population by asking shareholders what they feel they need
42
what is the comparative approach to health needs assessment
determining the needs of a population by compares the services received by a population (or subgroup) with others
43
qualitative studies
``` interviews focus groups surveys case studies observational studies ```
44
system approach
this approach to error management recognises holes in organisation policies/working conditions cause errors and aims to address this to prevent future errors
45
examples of health improvement
``` Inequalities Education Housing Employment Lifestyles Family/community ```
46
examples of health protection
``` Infectious disease Chemicals and poisons Radiation Emergency response Environmental health hazards ```
47
examples of service improvement
``` Clinical effectiveness Efficiency Service planning Audit and evaluation Clinical governance equity ```
48
what influences health inequalities
``` PROCESS: Place of Residence (rural, urban, etc.) Race or ethnicity Occupation Gender Religion Education Socioeconomic status Social capital or resources ```
49
incidence | prevalence
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
what is bias
A systematic error that results in a deviation from the true effect of an exposure on an outcome
51
what are the 3 types of bias
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
what are lead time and length time bias
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
what is confounding
When an apparent association between an exposure and an outcome is actually the result of another (independent) factor.
54
what are the bradford hill criteria for causation
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
what are the stages of the planning cycle for health services
Needs assessment – planning – implementation – evaluation
56
what is a health needs assessment
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
how can we define health
How do we define ‘health’? Bio-medical Absence of disease Psychosocial Stress and function Lay views Felt and expressed needs
58
WHO definition of health
a state of complete physical, mental and social well being not merely the absence of disease
59
what are Bradshaw's needs
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
3 approaches to a health needs assessment
epidemiological comparative corporate
61
describe an epidemiological HNA. advantages and disadvantages
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
comparative approach HNA advantages and disadvantages
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
corporate approach advantages and disadvantages
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
what is evaluation
process that attempts to systematically assess whether service meets its objectives
65
donabedian approach to evaluation
Structure Process Outcome outcome: 5Ds = death, disease, disability, discomfort, dissatisfaction
66
models of behaviour change
``` Health Belief Model Theory of Planned Behaviour Stages of Change/Transtheoretical Model Social norms theory Motivational Interviewing Social Marketing Nudging Financial Incentives ```
67
what are the features of a communicable disease that make it a public health concern
``` High mortality High morbidity Highly contagious Expensive to treat Effective interventions ```
68
``` notifiable diseases who when what how ```
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
# define: ``` Cluster Suspected outbreak Confirmed outbreak Epidemic Pandemic Endemic Hyper-endemic ```
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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