Exam 2: Part 1 Flashcards
how many young adults have at least one chronic illness? how much of the population?
1/3 of young adults 18-44 and 50% of the population at a given time
how much health spending does chronic health illness account for in the nation?
3/4 of spending on health
how many deaths are from chronic illness? heart disease and cancer specifically?
70% of deaths and 46% for heart disease and cancer combined
quality of life
an individual or groups perceived physical and mental health over time
HRQOL
health related quality of life
factors considered in HRQOL (4)
- Physical functioning
- Psychological status
- Social functioning
- Symptoms from treatment
CDC core questions for HRQOL (4)
- Is your general health excellent, very good, good, fair or poor
- illness and injury: how many days during the past 30 days was your physical health not good
- for your mental health (Stress, depression, problems with emotions) how many days during the past 30 days were not good for mental health
- how many days in the last 30 did poor physical or mental health prevent us from doing usual activities like self care, work, or recreation
CDC activity limitation questions (5)
Q1: are you limited in any way in any activities because of an impairment or health problems
Q2: What is a major impairment or health problem that limits your activities
Q3: How long have your activities been limited because of your major impairment or health problem
Q4: do you need the help of other persons with your personal care needs, such as eating, bathing, dressing, or getting around the house?
Q5: Due to impairment or health problems, do you need the help of other persons in handling your routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes
CDC symptoms questions for the past 30 days… (5)
Q1: Did pain make it hard for you to do your usual activities such as self care, work, or recreation
Q2: have you felt sad, blue, or depressed?
Q3: have you felt worried, tense, or anxious
Q4 Have you felt you did not get enough rest or sleep?
Q5: Have you felt very healthy and full of energy?
reasons to study HRQOL (5)
- It is related to self reported chronic diseases
- It is related to risk factors for chronic diseases => Body mass index, physical inactivity, smoking
- It is a window into the impact of chronic disease
- It can guide interventions
- It can identify subgroups at particular risk
ways to manage chronic illness (9)
- Self education
- Treatment adherence
- Appointment scheduling and attendance
- Therapy ⇒ physical and or physical
- symptoms and body vigilance
- Proper nutrition and exercise
- Adequate sleep
- Relaxation and stress relief
- Social connection and support
how does chronic illness affect families/communities?
many demands on the person with the illness, their loved ones, and their healthcare team
chronic health behaviors linked to chronic illness (4)
- poor nutrition oo much sodium
- Lack of exercise ⇒ 79% dont meet aerobic and muscle strengthening exercise
- Tobacco use ⇒ 480,000 deaths each year (2,100 youth smoking become daily smokers each day
- Alcohol use ⇒ 88,000 deaths each year
Lazarus illness appraisal
psychology affects how people respond
- What does this disease mean for me?
- How can I cope and what can I do about it?
common psychological responses to illness (3)
- Anxiety ⇒ when there is uncertainty like disturbing symptoms, side effects of treatment, unknown results, etc.
- Depression ⇒ interferes with management and is related to poorer outcomes and worse symptoms of the illness
- Denial ⇒ minimization of the illness used to cope with anxiety and when persists it can interfere with management
what is anxiety related illness associated with?
poorer glucose control, illness management, and surgical outcomes
self concept and esteem related to illness
- body image
- achievement
- social self
- goals and plans
body image related to illness
- Diseases or whole body
- Appearance can change from disease or treatment
- Feeling like out body lets us down
- Negative image increases risk for depression
- Interferes with illness and self care
affected achievements related to illness
Being able to achieve in work, hobbies, and recreational activities
social self and illness
- Feeling like a burden or being abandoned
- if you can fulfill a social role ⇒ parent or spouse
goals/plans influenced by illness
Complicated, delayed, or eliminated
positive responses to illness
- Reordering priorities ⇒ making more time for family, starting work toward a goal, etc.
- Take greater control of health ⇒ better health behaviors
- Enhanced life meaning and relationships ⇒ life seems more clear and relationships get stronger
- Greater empathy and compassion ⇒ for others who also face challenges
- Positive beliefs are associated with better psychological adjustment and health outcomes
health beliefs related to illness (3)
- nature of the illness ⇒ acute or chronic
- cause of the illness ⇒ external or self
- controllability
controllability (illness related)
feeling like someone can do something about their situation
- Better psychological adjustment and health outcomes
coping strategies (2)
- avoidant
- active
active coping consequences
linked to better adjustment (directly to their condition)
- Information gathering
- Taking control
T/F people use a variety of avoidant and active methods to cope?
T => Many factors affect coping strategy
coping and cancer study
top stressors for cancer patients (5)
- Uncertainty about the future
- Limitations about ability, appearance, or life style
- Acute pain, symptoms, or discomfort
- Problems with family or friends (social relationships)
- more than one/other and some have no stress
5 coping patterns (specific to cancer study)
- Seeking or using social support
- Focusing on the positive ⇒ grew as a person in a good way
- Distancing ⇒ kept their feelings from interfering
- Cognitive escape and avoidance ⇒ hoped a miracle would happen, prayed, fantasized, etc.
- Behavioral escape avoidance ⇒ avoided people, comforted themselves with eating, drinking, smoking, or drugs, did risky behavior, took out stress on other people
primary coping methods for cancer patients
42% distancing
22% positive focus
19% social support
17% cognitive escape
0% behavioral escape
but more than 1/2 has no primary coping method and most used 4/5 methods
physical therapy
helps a a patient with new physical limitations
occupational therapy
help the patient develop new physical skills for work related tasks and daily living
dietician
identify dietary changes liker educing, eliminating, or increasing foods
social worker
provide information about local resources and services available
psychotherapist
help patients reduce anxiety, depression, and make behavioral changes
social support groups
offered by hospitals or community organizations to share experiences and information with other people dealing with the illness
types of professional support for patients (7)
- physical therapy
- occupational therapy
- dietician
- social worker
- doctor
- psychotherapist
- social support groups
interventions for cancer patients
- Physical exercise
- Walking
- Aerobics
*Weight training - dance
- Behavioral techniques
- Behavior therapy
- Cognitive therapy
- Mind, body, and relaxation techniques
- Biofeedback
- Hypnosis
- Counseling
outcomes of interventions for cancer patients (6)
- Fatigue
- Depression
- Anxiety
- Body image
- Stress
- HRQOL
results of behavioral interventions for cancer patients?
- behavioral interventions improved anxiety and depression
- physical exercise improved fatigue, depression, body image, and HRQOL
- effects are modest but significant ⇒ combined interventions may make broadest improvements
- Physical exercise and behavioral techniques suggest a combination may provide the broadest improvements
heart failure
the hearts decreased function
- coronary artery disease or damage due to infarction
- fatigue, heart symptoms, shortness of breath
what did the study on heart disease patients look at?
prevalence of depression, clinical outcomes, and response to interventions
- ⅓ of patients experienced depression ⇒ 2-3x higher than the general population
- 22-36% average prevalence (depending on assessment technique), increases with degree of physical impairment
- Depression increased risk of additional cardiac events (ischemia and infarction) and mortality (higher if they have high blood pressure)
results of behavioral interventions for heart disease patients?
Behavioral interventions decreased depression and increased physical abilities
→ can’t tell us how interventions brought about improvements
- Could be direct or through behavior such as making it easier for medical adherence
→ may be due to changes in (direct) inflammation and or differences in medical adherence (behavior)
what were the interventions for the heart disease research patients? (4)
- Cognitive behavioral therapy
- Exercise
- Diet changes
- Stress management
who said people don’t develop chronic diseases, families do?
Shelly Taylor
- Happens in the social world of our family and likely friends, coworkers, community groups
ways that illness affects relationships? (6)
- Increased dependence ⇒ on others
- Shift in responsibilities
- Impact on recreation ⇒ with family and friends
- Children acting out in response
- Can make family closer
- Changes in health behaviors can benefit all
social isolation
living alone and having no support network
- increased risk of death following MI by 2-3x ⇒ comparable to high blood pressure or additional cardiac problems
factors of social support (3)
- Social support may have an effect by reducing risk of depression
- Mortality after heart attack review found evidence for a threshold effect
- Bigger is not better after threshold ⇒ after 1 person, a larger network doesn’t get more protection
who are at the greatest risk regarding social support?
greatest risk is those who live alone and have no one to provide psychological support or help in a crisis
As important to assess social resources as other risk factors following a heart attack
- Social connection with other interventions
what can changing health behaviors do?
reduce symptoms and the risk of future events, improve psychological functioning, and reverse some of the disease
examples of health behaviors
- Food, exercise, meditation for reactions to stress
- Slowly getting off medications, self education, decision making, and successful behavior changes
- Priorities shifting in positive ways and doing more hobbies
what is it like to have a chronically ill family member?
- the chronically ill family member often needs a lot of help every day
- tasks of daily living (feeding and bathing), administering medications, transportation of additional medical care
- Very demanding work and often women end up being the caregiver
- often the ill person is a spouse or elder
what are the risks for a caregiver of someone who is ill?
- Risk of depression
- Reduction in self care
- Relationship strain with family member
→ social support and relaxation methods can be helpful for the caregiver
how many deaths in the US are from tobacco use, poor diet, and physical inactivity?
3/4
- Preventing and managing chronic diseases by modifying health risk behaviors ultimately helps people live longer, healthier lives and keeps health care costs down
- Community approach to prevention includes making the healthy choice the easy choice
key to better health
understanding and changing behavior
examples of acute morbidity and mortality from behaviors (3)
- drinking and driving
- distracted driving
- drug overdose
chronic morbidity and mortality behaviors (6)
- Poor eating habits
- Insufficient exercise
- Smoking
- Drinking
- Drug use
- Unprotected sex
what was the Alameda county study (Belloc and Breslow)
they measured health behaviors and found what the most healthy people did
health behaviors in the Alameda county study (7)
- Smoking ⇒ don’t do it
- Physical exercise ⇒ do it often
- Alcohol consumption ⇒ less than 5 drinks
- Weight ⇒ relative to height, MetLife
- Sleep ⇒ 7-8 hours/night
- Eating breakfast ⇒ almost every day
- Snacking between meals ⇒ rarely or never, once in a while
what were the MetLife findings?
5 (men)-10 (women)% underweight to 10 (women)-20 (men)% overweight
what are physical health indicators?
- Disability, chronic conditions, impairments
- Symptoms
- Energy level
what did the Alameda county study find?
→ 30 year benefit from the health behaviors
- those with the healthiest responses for all 7 were much healthier than those with one or less
- those age 75 or older with all 7 good practices were healthier than those aged 35-44 who did less than 3
- those aged 55-64 with all 7 good practices were healthier than those aged 25-34 who did less than 3
what did the returning Alameda county study find? (Winged, Bergman, and Brand)
higher mortality risk for:
- Those reporting more disability in 1965 (3.0x)
- Small social network (2.1x)
- Ever having smoked (1.9x)
- Men (1.7x) ⇒ higher for men than women
- High alcohol consumption (1.5x)
- Less than 7 or more than 9 hours of sleep (1.3x)
what was insignificant in the returning Alameda county study? (Winged, Bergman, and Brand)
- Weight trend, but not significant
- Eating breakfast and snacking did not matter
overall conclusion from the returning Alameda county study? (Winged, Bergman, and Brand)
mortality risk for those only practicing 0-2 health behaviors is 2.3 times that of those practicing 4-5 of them
what were the %’s from Liu et al. practiced health behaviors?
- Non smoking => 81.6%
- Adequate sleep => 63.9%
- Low alcohol consumption => 63.1%
- Recommended physical activity => 50.4%
- Normal body weight => 32.5%
what were the %’s for multiple health behaviors from Liu et al?
All 5 ⇒ 6.3%
- 4 ⇒ 24.3%
- 3 ⇒ 35.4%
- 2 ⇒ 24.3%
- 1 ⇒ 8.4%
- 0 ⇒ 1.4%
what are the 12 healthy goals for MN in 2020
- Increase fruit and vegetable consumption
- Increase physical activity
- Reduce tobacco use
- Reduce binge drinking
- Improve arthritis management
- Improve asthma management
- Increase colorectal cancer screening
- Improve cardiovascular disease management
- Improve diabetes management
- Reduce deaths from falls
- Reduce obesity
- Increase use of the oral health system
what is the health belief model and what does it suggest?
Belief in health + Belief that behavior can reduce threat = Behavior change
→ someone should be educated about their risk of illness and consequences as well as successful effects for reducing illness
→ Suggests we may be more successful if we understand people’s costs and benefits
what are the 3 components of belief in health in the health belief model?
- values
- vulnerability
- severity
what are the beliefs about behaviors that reduce threat in the health belief model?
- effectiveness
- benefit exceeds costs
health belief model usefulness
- Often used to develop interventions
- Linked to behavior change but only modestly
- Leaves out self efficacy ⇒ person’s beliefs about their ability to make a change
- Leaves out unconscious processes ⇒ very cognitive model for conscious change
- Leaves out non health motivators ⇒ things that influence decision not dealing with health
what is the theory of planned behavior?
attitudes + norms + perceived control = intention = behavior change
Attitude definition
beliefs about outcome
Norms definition
what other think and what others do
theory of planned behavior usefulness
Used to develop interventions
Linked to behavior change but only modestly
Linked to belief change but only modestly
Leaves out unconscious processes
transtheoretical model of behavior
describes the actual steps or changes a person goes through to change behavior
- the person can exit at any stage or can reverse at any time
stages of the transtheoretical model of behavior change
- Precontemplation: person has not even thought about changing behavior
- Contemplation: considers a change might be necessary or desirable in the next 6 months ⇒ needs motivation
- Preparation: gathers needed skills
- Action: takes action to change behavior
- Maintenance: the behavior becomes habitual and requires less effort but still needs to not be relapsed on
stages of change usefulness
- Most popular model, used in many interventions
- Has also received much criticism
- Not always linked to behavior change
- Often not well applied to intervention development ⇒ makes the test of its utility invalid
conclusions for behavioral models as a whole? (5)
- Change involves many factors
- Capturing all of the factors in a single model is difficult
- Testing of various models can be difficult
- A model may better apply to some types of changes than for others
- There are a lot more models
