Final Exam Flashcards
What is the Health Belief Model?
Decisions about health behavior are based on 4 interacting factors that influence perceptions about health threat: Perceived susceptibility, perceived severity of health threat, perceived benefits and barriers of treatment, and cues to action.
What is the Theory of Planned Behavior?
Specifies relationships among attitudes and behavior, is the most accurate in predicting goal-oriented, rational behaviors.
What factors shape behavioral intentions?
Attitude toward behavior, subjective norm and perceived behavioral control.
Transtheoretical Model (TTM)
Proposes that people pass through 5 nonlinear stages in altering health.
Stages of TTM
Stage 1: Precontemplation
Stage 2: Contemplation
Stage 3: Preparation
Stage 4: Action
Stage 5: Maintenance
Precontemplation Stage
“I have no plans to quit smoking”
Contemplation Stage
“I need to quit smoking”
Preparation Stage
“I’ve seen my doctor and told her I am going to quit smoking. She wrote a prescription to help reduce my craving for nicotine”
Action Stage
“I am actively cold turkey, and it’s week two. So far, so good”
Maintenance Stage
“I’ve been tobacco free now for 6 months”
Health Action Process Approach (HAPA)
Motivational phase (goal-setting)
Volitional Phase (Goal-pursuit)
Primary Prevention
Aimed to prevent disease or injury before it occurs
Secondary Prevention
Aimed at reducing the impact of injury or disease
Tertiary Prevention
Aimed at softening the impact of ongoing chronic illness/disease
Cognitive behavioral interventions
Focus on conditions that elicit health behaviors and factors that help to maintain and reinforce them. (Self monitoring and conditioning)
Conditioning
Discriminative stimuli (you only get a reward if you do…)
Taste aversion/Antabuse
Contingency contracting (consequences for achievement/failure)
Stimulus control interventions
Controlling cues related to reward, arousal, sleep in the environment (social and communication skills, increased knowledge of disease/treatment and managing “illness intrusiveness”
Relapse Prevention
Recognizing early stages of relapse (self monitoring) and mind-body relaxation
Contingency contracting
Identify behavior, the conditions in which it is supposed to occur and consequences for achieving/failing to achieve behavior
Work-site wellness programs
Ideal for promoting health because of convenience for workers, opportunities for social support, follow-through and feedback.
Preventing disease is easier, cheaper and far more desirable than treating disease
Behavior change techniques (BCTs)
Goal setting, avoiding provocative situations, (self) monitoring of target behaviors, information about health consequences, instruction, social support, feedback.
Why do people delay in seeking treatment?
Group/cultural differences, misinterpretation of symptoms, worried about looking silly, worried about “bothering” the doctor, reluctant to disrupt their routine, can’t afford care, fear/phobias, etc.
Gender and physician contact
Women:
More likely to report symptoms and use health services, may be exposed to more illnesses and may be more sensitive to their internal bodily symptoms.
Men:
Over 1/3 would not go to the doctor immediately, only 32% checked for cancer
Socioeconomic status
Predicts both symptom reporting and the shaking of health care.
High SES people report less symptoms and better health than low SES people
When sick, high SES people are more likely to seek health care.
Cultural Factors
Some cultures encourage a strong reaction to symptoms; others socialize members to deny pain and keep symptoms to themselves.
Lay referral system
Informal network of family, friends and others who offer their own experiences and advice regarding symptoms (can be both helpful and unhelpful)
Structural/institutional Factors
Affordability, history of institutional racism, sexism, classism, physical accessibility/distance to health care facilities and anti-science rhetoric
Overusing health services
Illness anxiety disorder (hypochondriasis) and malingering
Illness anxiety disorder (hypochondriasis)
Condition of experiencing abnormal anxiety over one’s health, often including vague, ambiguous or imaginary symptoms
Malingering
Making believe one is ill to benefit from sick role behavior
Illness representation
How a person views a particular illness, including its label, and symptoms, perceived causes, timeline, consequences and controllability (people can experience the same thing in different ways)
Identity of the illness
Labels, symptoms and social constructions
Explanatory style and psychological disturbances
Explanatory style (optimistic and pessimistic) and psychological health influences the reporting of symptoms
- People who are anxious and those who score low on tests of emotional stability tend to report more physical symptoms
- substantial comorbidity of psychological and physical disorders
Seeking treatment
-Prior experience and expectations affect how people interpret symptoms
-there is a tendency to exaggerate expected symptoms while ignoring unexpected symptoms
-demographic and sociocultural factors play important roles in determining whether a person seeks medical treatment
Delay behaviors
- The delay model proposed by Anderson and colleagues show that noticing symptoms does not automatically lead to treatment
- People have to make a concerted effort to take each step, so intervening factors may interrupt the process
During
Once you get to the doctors office, things can go wrong; many people have reported failure to receive help once they have reported symptoms to a doctor
Factors affecting patient-provider relationship
Continuity of care, communication and overall quality of consultations
Communication
Medical visits are short and rushed, too much medical jargon, patients forget to report symptoms or ask questions, patients are evasive, patients are too passive, doctors usually come from different worlds.
Provider miscommunication
physicians may fail to listen to patients or may treat them like children or medical school faculty, people are not chosen for medical training on the basis of social skills, providers vary in their attitudes about their own role and the patients role in consultation, doctors can be racist, sexist, fat phobic, ablest
Medical gaslighting
Provider dismissal, symptom invalidation, related to both provider and patient traits, can impact perception of the medical field more generally
Patient communication problems
Patients are often uninformed and unprepared to communicate about sensitive health matters, different educational, linguistics and social backgrounds can make communication difficult, different levels of health literacy, incomplete/inaccurate understanding of medical conditions; inability to navigate the health care system, seek preventative care and adhere to prescribed treatment
Improving patient-provider communication
Communication skills training now a fundamental component of medical and nursing education, active listening skills, communication-enhancing interventions for patients, assertiveness coaching
Adherence
Patient willingness to follow a prescribed treatment regimen; success is shown
Non-adherence (noncompliance)
Patient refusal to adhere to treatment regimen, or lack of sustained effort in following treatment, many degrees of non adherence; average rate is 25%
After
Compliance/adherence with medical regimen, patients forget requirements, patients don’t understand instructions, regimen is seen as aversive or disruptive, patient has a negative attitude towards the healthcare provider, cannot afford medicine
What factors predict adherence?
Patient variables, provider variables and treatment regimen variables
Patient variables
Gender, ethnicity, education and income are poor predictors of adherence, having the support of family and friends,, being in a good mood and having optimistic expectations promote experience, perceived control and preference for treatment
Provider Variables
Job satisfaction, number of patients seen per week and communication style all predict patient adherence, personal provider characteristics
Treatment regimen variables
Keeping regimens as simple and short 9n duration as possible, tailoring treatment to fit the patients lifestyle, simple, understandable instructions, involving family members, friends, and others in the patients treatment, providing feedback about progress
Pluralistic systems
patient-centered health care, delivery of health care services that are respectful of patients and are responsive to individual patient preferences, needs and values
Substance Use disorder
Pattern of behavior characterized by impaired control, social impairment and risky use of a drug, involves presence of 3 or more indicators
Behavioral addiction
new category of behaviors such as gambling, that display the characteristics of substance abuse disorders
Drug abuse
Use of a drug to the extent that it impairs the users biological, psychological, or social well-being
Drug ingestion or administration
Orally, rectally, injection, inhalation, absorption through skin
Physiological effects of administration
Injected or inhales; stronger or more immediate effects than swallowed, drug lipid solubility effects blood-brain barrier passage and placental barrier permeation
Dependence
A state in which the use of a drug is required for a person to function normally
Withdrawal
Unpleasant physical and psychological symptoms that occur when a person abruptly seizes using certain drugs
Neural sensitization theory
Addiction is the result of efforts by the body and brain to counteract the effects of a drug to maintain an optimal internal state
tolerance
State of progressively decreasing responsiveness to a frequently used drug, neuroadaptation
Psychoactive drugs
psychoactive drugs affect mood, behavior and cognition by altering the function of neurons in the brain (stimulants, depressants, opiates, etc)
Biomedical models
often assumed that addicts inherit a biological vulnerability to physical dependence
Concordance rate
Rate of agreement between a pair of twins for a given trait
Withdrawal-relief hypothesis
Drug use serves to restore abnormally low levels of key neurotransmitters
- support; depression, anxiety, low self-esteem are associated with neurotransmitters deficiencies
-shortcomings; does not explain why addicts begin taking a drug in the first place, or why relapses are common even long after withdrawal symptoms have subsided
Generic reward efficiency syndrome
certain addictions occur when brain’s reward circuitry malfunctions and leads to powerful cravings, addiction is motivated by pleasure seeking
support
People who dependent on one substance are more likely to be be addicted to others
Shortcomings
environmental factors may be better predictors than previous drug use, common liability to addiction, even when unpleasant side effects occur
Wanting and liking theory (incentive-sensitization theory)
repeated drug use sensitizes the brains reward system to drug-related cues; become conditioned stimuli
Social learning models
addiction viewed as behavior shaped by learning, social and cognitive factors, persons identification with a particular drug plays a key role in the initiation and maintenance of an addiction
Social control theory
The stronger a persons attachment to family, school and other social institutions, the less likely the person will be to break any social norm
Peer cluster theory
Peer groups strong enough to overcome the controlling influence of social institutions
At risk drinking
Two or more episodes of binge drinking in the past month, or consuming an average of two or more alcoholic drinks per day in the past month
Physical long-lasting effects of alcohol consumption
Disrupts intracellular communication and gene regulation of cell functions, brain shrinkage and inhibition of neurogenesis, major effects on hippocampus, interference with thiamine absorption (muscle cramps, atrophy, sleeplessness, fatigue, irritability, anorexia, gut, heart problems)
Korsakoff’s syndrome
memory disorder related to alcoholism
Alcohol use disorder
Maladaptive drinking pattern in which drinking interferes with role obligations
- diagnosis: person who meets 3 or more of 11 drinking criteria
treatment and prevention of alcohol use disorder
Drug treatment, aversion therapy and relapse prevention programs/ self-help groups
Drug treatment
Detoxification agents, opiate antagonists to reduce alcohols reinforcing properties
aversion therapies
Behavioral therapy that pairs an unpleasant stimulus (emetic drug) with an undesirable behavioral (drinking)
relapse prevention programs/ self-help groups
Controlled drinking, self-help groups, drink refusal training, coping and social skills training
Clinical Pain
pain that requires some form of medical treatment
Acute pain
Sharp, stinging pain that is short-lived and usually related to tissue damage (burn, fracture, overused muscle)
Recurrent pain
Episodes of discomfort interspersed with periods in which the individual is relatively pain free, that reoccur for more than 3 months
Chronic pain
Pain that lasts 6 months or longer- long past the normal healing period
Referred/reflective pain
pain in an area of the body that is sensitive to pain but caused by disease or injury in an area that has few pain receptors
Hyperalgesia
Condition in which chronic pain sufferer becomes more sensitive to pain over time
Long term potentiation
A process involving persistent strengthening of synapses that leads to a long lasting increase in signal transmission between neurons “learning to know” the pain
Measuring pain
(EMG)- assesses the amount of muscle tension that pain sufferers experience
indicators of autonomic arousal- HR, creating rate, BP
self-report measures, pain response preference questionnaire (PRPQ), Children’s anxiety and pain scale (CAPS) and Children’s fear scale (CFS)
Target behaviors
Include vocal complaints, facial grimaces, awkward postures and mobility
Measuring pain tolerance
Pressure pain threshold test, cold pressor pain tolerance test, quantitive sensory testing
A delta fiber
Large, myelinated, fast, acute pain
Substance P
neurotransmitter secreted by pain fibers in the spinal cord upon tissue injury
Enkephalins
endogenous opioids found in nerve endings of cells in the brain and spinal cord
