HaDSoc Session 4 Flashcards
What are lay beliefs based on?
What happens to those around a person and themselves over their life course e.g. things they’ve read, TV, culture, social norm
Why do lay beliefs have to be considered?
Potential gaps between lay and medical concepts so same terms used have difference in understanding; impact on behaviour; impact on compliance
What is the negative definition perception of health?
Health equates to the absence of illness
In which group is a negative definition perception of health more commonly seen?
Lower SES
What is the functional definition of health perception?
Health is the ability to do certain things
What group of the population commonly uses a functional definition of health perception?
Elderly
What is the positive definition of health perception?
Health is a state of wellbeing and fitness that can be worked towards and maintained
Which population group more commonly uses a positive definition of health perception?
Higher SES
What might happen if medical information is incompatible with competing ideas for which people believe there is good evidence?
Info rejected or synthesis of new knowledge may be altered to fit but then it does not quite correlate with original information
What factors impact a person’s wider social and cultural perceptions of health?
How much control they think they can assert over their health, how much control they can assert on everyday life
What is candidacy in lay beliefs of health?
Identify risk factors for a disease depending on personal, familial and social sources of knowledge
What does the ‘Uncle Norman’ explanation in lay epidemiology explain?
Find exceptions to candidacy leading to a reliance on randomness and fate
Why is there a general reluctance to accept an explanation for illness that rests on personal behaviours?
Easier to believe it is out of your control
What is a positive health behaviour?
Activity undertaken for the purpose of maintaining health and preventing illness
How does the positive definition of health explain why higher SES have lower rates of smoking?
Incentives more evident for those who can expect to stay fit and healthy so quitting is a rational choice
How does the negative perception of health explain why smoking rates are higher in lower SES?
Incentives to quit less clear and focus on improving immediate environment and engaging in normalised behaviour so smoking is rational
What is illness behaviour?
Activity of an ill person to define illness and seek solution
What is the symptom/illness iceberg?
Explanation that most symptoms never get to a doctor as 50% of people with a symptom will not seek advice
What factors lead to the development of the illness iceberg?
Stoical culture, visibility/salience of S/S, disruption to life, ref quench and persistence of symptoms, lay-referral, availability of resources, information and resources, tolerance threshold
What is sick role behaviour?
Formal response to symptoms that includes seeking formal help and action of a person as a pt
What is lay referral?
Chain of advice seeking contacts sick people make with other lay people prior to OR INSTEAD of seeking help
What inhibits help-seeking in lay referral?
Powerful social sanctioning of hypochondriac behaviours
What do people base the choice of when to seek medical advice on?
Symptom experience, symptom evaluation, knowledge of disease and Tx, experience of and attitudes towards HCPs
What are lay beliefs?
How people understand and make sense of health and illness without specialised knowledge
What symptom experience leads to early presentation?
Significant and rapid onset
Why do insidious onset symptoms lead to delayed presentations?
Pt develops explanations for S/S with previous activities until this becomes inadequate
How does the knowledge of a disease and its treatment delay presentation?
Pts has trouble interpreting symptoms, tries to self-manage, doesn’t recognise variation in symptoms, is an atypical sufferer, experiences an unfamiliar outcome
What are ‘deniers’ and ‘distancers’?
Deniers: deny condition
Distancers: deny having proper condition
Both despite formal diagnosis
How do deniers and distancers manage their condition?
Use complex strategies to hides S/S and claim they do not impact on everyday life. Don’t take medication or attend clinics
Why do ‘deniers’ and ‘distancers’ not take treatment or attend clinics?
Tx relies on accepting identity
Describe ‘accepters’ when considering lay beliefs.
Accept diagnosis and Dr’s advice completely, proactively control S/S with Tx as part of everyday life and without stigma
Describe ‘pragmatists’ when considering lay beliefs.
Accept diagnosis but manage as a series of acute episodes, using Tx in relation to severity
Why do ‘pragmatists’ not use preventative therapy?
Use Tx in relation to severity
What is medication behaviour tied to?
Beliefs about condition, social circumstances, threat to identity
Give some examples of determinants of health.
Culture, physical environment, socio-economic environment, mass media, behaviour and coping skills, genetics
What does ‘The Health Career’ diagram show?
Individuals are unlikely to be able to directly control many of the determinants of health
How has health promotion evolved over time?
From reforming physical environment (sanitation) to health education (individual health behaviours) to health promotion (social and political aspects)
What is health promotion?
Process of enabling people to increase control over and improve health emphasising social and personal resources as well as physical capacities
What are the principles of health promotion?
Empowering, participatory, holistic, intersectoral, equitable, sustainable, multi-strategy
What are the structural critiques of health promotion?
Material conditions lead to ill health being marginalised and focus on individual responsibility leading to blame
What are surveillance critiques of health promotion?
Concerns with increasing monitoring and regulating of the population (nanny-state)
What are consumption critiques of health promotion?
Lifestyle choices are tied with identity construction e.g. Health promotion favours higher SES
What are the five approaches to health promotion?
Medical/preventative, behaviour change, educational, empowerment, social change
How can social change be used in health promotion?
Make behaviour the deviant norm e.g. Smoking ban
What is primary prevention?
Prevent onset of disease/injury by decreasing exposure to risk factors
Give some examples of primary prevention of disease.
Immunisation, avoid environmental risk factors, take appropriate precautions re communicable disease, decrease risk from health related behaviours
What is secondary prevention of disease?
Detect and that disease/risk factors early to prevent progression
Give some examples of secondary disease prevention.
Screening, mentoring and treating hypertension, statins
What is tertiary disease prevention?
Minimising effects of an established disease
Give some examples of tertiary disease prevention.
Maximising remaining capabilities of disabled, renal transplant, skills training in cerebral palsy
What are the dilemmas in health promotion?
Ethics of interfering in people’s lives, victim blaming, fallacy of empowerment, reinforcing of negative stereotypes, unequal distribution of responsibility, The Prevention Paradox
What are the ethical implications of health promotion interfering in people’s lives?
Increased anxiety if health promotion met by feeling of powerlessness, rights and choices impeded
Why is victim blaming a problem in health promotion?
Focus on individual behaviour change plays down the wider SE and environmental factors
What is ‘fallacy of empowerment’?
Giving people information does not give them power and can be die powering if circumstances create constraints on choice of behaviour
How does the fallacy of empowerment account for unhealthy lifestyles?
Due to adverse circumstances and wider SE factors, not ignorance
What is the argument for unequal distribution of responsibility in health promotion?
Implementing healthy behaviours in family often left to women
What is The Prevention Paradox?
Interventions effective at population level might not have much effect on an individual
How is The Prevention Paradox linked with lay beliefs?
If people don’t see themselves as a candidate they may not respond to health promotion messages, especially if they have an awareness of anomalies/randomness of disease
Why is evaluation of health promotion necessary?
To provide evidence base, accountability and as an ethical obligation to ensure no direct/indirect harm and allow for management and development of programme
What different methods of evaluation can be used for health promotion?
Process/formative/illuminative; impact; outcome
How do process/formative/illuminative evaluations of health promotion work?
Wide range of mainly qualitative methods assess how intervention is being put into place
How does measuring impact evaluate health promotion?
Assesses immediate effects of intervention
How does measuring outcome evaluate health promotion?
Measures long-term consequences to see what is achieved by intervention
How does timing influence evaluation of health promotion by outcome?
Delay: some interventions take a long time to act. Decay: some interventions wear off rapidly
What are the difficulties in evaluating health promotion?
Intervention design e.g. Multi-strategy, possible lag time, potential confounders, high financial cost due to timescale
