Health

Question 1

McKinstry and Wang Aim

Answer 1

To investigate doctors’ clothing as a form of non-verbal communication.

Question 2

McKinstry and Wang Procedure

Answer 2

• 475 patients from five general medical centres in Scotland participated.
• There were 8 images of a female or a male doctor each dressed different but in a similar pose.
• They were asked which they would feel happiest seeing for the first time (0-5 scale) , whether they have more confidence in one of the doctors, whether they would be unhappy with any, which looked most like their own.
• Finally, they were asked closed questions about doctors’ dress.

Question 3

McKinstry and Wang Results

Answer 3

• The male doctor wearing a suit and tie or the female in a white lab coat was preferred.
• Older patients and those in a higher social class preferred traditionally dressed doctors.
• 64% said the way their doctor dressed was very important.
• 28% ppts said they would be unhappy seeing one of the doctors (informal).
• The female doctor overall received higher ratings.
• 41% said they had more confidence in the formally dressed doctors ability, suggesting the way a practitioner dresses matters to their performance.
• They also said their doctor looked most like the smartly dressed one.

Question 4

McKinlay Aim

Answer 4

Verbal communications: Investigated understanding of maternity words used by practitioners in a maternity hospital

Question 5

McKinlay Procedure

Answer 5

• 87 females using a maternity service.
• Split into those who used maternity services regularly (Utilisers) and those who didn’t (Underutilisers).
• The 13 words chosen were words that some but not all doctors would use as they represented a grey area of verbal communication e.g. enamel, mucus.
• Participants were read the word, heard it in a sentence and were asked to say what it meant.
• Responses recorded were verbatim and were scored independently by two doctors: they were blind - unaware of ppts and the other doctor’s score.
• One year later, doctors on the ward had to indicate the level of understanding they would expect from the patients.
• The inter-rater reliability was high, generally giving the same ratings.

Question 6

McKinlay Results

Answer 6

• Those who underused the service were less likely to understand the words compared to regular users, who only struggled with navel and rhesus.
• Women had far better understanding than doctors anticipated. The comprehension for the word ‘purgative’ however was lower than anticipated.
• Women who already had at least one child were slightly more likely to comprehend words than those attending the hospital in their first pregnancy

Question 7

Verbal Communication: Ley Aim

Answer 7

Investigated the frequency of patients forgetting verbal advice given by their doctors.

Question 8

Ley Procedure

Answer 8

This was investigated by asking patients who had just seen a doctor what their practitioner had told them to do. This was then compared with a tape recording of what had actually been said.

Question 9

Ley Results

Answer 9

• Patients remembered 55% of what was said, they remembered the first thing told, things that were categories, and that they remembered more if they had medical knowledge.
• This means that things such as order, perceived importance and nature of information, patients age, anxiety level and medical knowledge influenced forgetfulness.
• Ley suggested practitioners should state the key information first, giving concrete-specific advice which is categorised and repeat key points.

Question 10

Byrne and Long Procedure

Answer 10

Analysed 2500 medical consultations from a range of countries to investigate style. They found that doctors consistently used either a patient-centred or a doctor-centred style.

Question 11

Byrne and Long Findings

Answer 11

• They found seven different consultation styles ranging from extremely doctor-centred to extremely patient-centred.
• Doctor centred: asked questions that required only brief answers e.g. yes or no; focused mainly on the first problem mentioned; ignored attempts to discuss other problems; controlling; directing; termination.
• Patient centred: open-ended questions e.g. Can you describe the situation when the pain occurs; avoided medical jargon; allowed the participant to participate in decision making; advising; reassuring; seeking patient ideas.

Question 12

Practitioner Style: Savage and Armstrong

Answer 12

Compared consultation satisfaction between patient-centred versus doctor-centred practitioner styles.

Question 13

Savage and Armstrong Procedure

Answer 13

200 patients consented to have their consultation recorded and were randomly allocated to either condition. They used two questionnaires to measure satisfaction.

Question 14

Savage and Armstrong Findings

Answer 14

Overall a high level of satisfaction was found, but it was higher for the directed (doctor-centred) group who were more satisfied with the explanation and with their own understanding.

Question 15

Type I error

Answer 15

Type I: The patient is not ill, but is diagnosed with an illness (False positive).

Question 16

Type II error

Answer 16

Type II: Patient is ill, but is not diagnosed with illness (false negative)

Question 17

Disclosure of Information (Robinson and West) Aim

Answer 17

• If a patient does not disclose all their symptoms or is not honest, it will increase the likelihood of a type one or type two error.
• Robinson and West investigated the difference and effectiveness between a computer questionnaire and a paper questionnaire in eliciting medical histories from patients.

Question 18

Robinson and West Procedure

Answer 18

• Participants were 69 patients of a GU clinic in Northern England randomly allocated.
• Patients completed either computer questionnaire or paper then had a consultation with a doctor in which notes were made. Comparisons were made between:

Number of symptoms reported

Number of previous attendances at GU clinic

Number of sexual partners in the last 12 weeks

Question 19

Robinson and West Findings

Answer 19

• Computer and paper questionnaires yielded more symptoms than consultation
• Mean no. of sexual partners was greater in the computer condition than the paper and the doctor notes.
• This suggests that computers can be used to help patients communicate more comfortably and openly.

Question 20

Delay in seeking treatment (Safer)

Answer 20

Investigated what factors influence patients to delay seeking treatment for a new symptom.

Question 21

Safer Procedure

Answer 21

• 93 patients presenting a new symptom were interviewed about their health behaviours leading up to their current illness.
• Questions were: “What was your very first symptom?” and “When did you decide to see a doctor?”. They were scored on a 9-point scale

Question 22

Safer: what three stages to delay?

Answer 22

Appraisal, illness, utilisation

Question 23

Appraisal delay

Answer 23

number of days elapsed from first noticing symptom up to the day they concluded they were ill

Question 24

Illness delay

Answer 24

number of days from the end of appraisal delay to the day they decide to seek professional help

Question 25

Utilisation delay

Answer 25

the final stage: end of illness delay to time of when they were seen in clinic

Question 26

What predicts length of delay?

Answer 26

the , severity and location of symptoms, the perceived importance of symptoms, awareness that you cannot treat the illness yourself, obstacles to receiving care can all delay treatment.

Question 27

Safer conclusions

Answer 27

Safer et al. concluded a variety of factors (perceptual, situational, appraisal) delay seeking medical treatment. Safer stated that delays come from a failure to appraise the situation adequately.

Question 28

Hypochondriasis

Answer 28

persistent fear of having a serious medical illness. They interpret normal sensations, minor symptoms and bodily functions as a sign of an illness with a negative outcome. For example, a person with hypochondriasis may fear that a bruise is a sign of a serious disease.

Question 29

Barlow and Durand

Answer 29

• Barlow and Durand conducted a case study into Gail, a married 21-year-old female.
• Minor symptoms e.g. headache resulted in extreme anxiety.
• She avoided exercise, laughing and noted anything that could be a symptom.
• Doctors repeatedly reassured her nothing was wrong, so she ended up avoiding going to see any more doctors.

Question 30

Munchausen Syndrome

Answer 30

Factitious disorder characterised by physical or psychological symptoms that are intentionally produced or faked to assume the sick role, be the centre of attention and be cared for. People intentionally produce or pretend to have physical or psychological symptoms of illness.

Question 31

Aleem and Ajarim

Answer 31

• Reported on the case of a 22-year-old woman who attended their hospital in Saudi Arabia with swelling on her body. She had been seen on numerous occasions in the hospital since she was 17 and given various treatments, such as antibiotics and surgical drainage.
• Suspicions were raised by the hospital when it was felt that the ailments she had did not appear to have a physical cause.
• Upon admittance to the psychiatric ward the nursing staff eventually found a needle with faecal material in it in her bed. The patient left the hospital when confronted after becoming very angry and did not return again.

Question 32

Types of non-adherence include:

Answer 32

• Failure to follow treatment (e.g. to take tablets every 12 hours)
• Not engaging in preventative measures linked to health (e.g. stopping smoking)
• Failing to attend further appointments or interviews

Question 33

Problems caused by non-adherence include:

Answer 33

• Wasted money on drugs
• Worsening of health
• Financial costs when appointments are not kept and they are unavailable for others to take

Question 34

Rational non-adherence (Bulpitt)

Answer 34

Rational non-adherence refers to the patient making a reasoned decision due to undertaking a cost-benefit analysis. This means that a reason for non-adherence could be as a result of a well-considered and reasoned thought process that leads the patient to believe non-adherence is more beneficial.

Question 35

Bulpitt Study

Answer 35

Bulpitt looked at the risks and benefits of a drug treatment for hypertension (high blood pressure).

Risks included increased diabetes, gout, and dry mouth but these were either not serious or at a very low rate.

Benefits included reduction in strokes by 40% and coronary events by 44%.

Bulpitt concluded that the benefits from treating hypertension in elderly patients far outweigh the disadvantages. It seems people rationally decide not to take the medication because of the risks whilst ignoring the benefits.

Question 36

The Health Belief Model (Becker and Rosenstock)

Answer 36

The model outlines the factors that explain the beliefs and consequent decisions people make about their health. It assumes that the likelihood that individuals will follow medical advice depends directly on two assessments that they make: Evaluating the threat and a Cost-Benefit Analysis.

Question 37

First belief of The Health Belief Model

Answer 37

The first stage is the evaluation of the health threat which includes:

• the perceived seriousness (the more serious, the more likely adherence)
• the perceived susceptibility (the more vulnerable, the more likely adherence) and cues to action.

Demographic factors e.g. age, socio-psychological variables and cues to action are all modifying factors that influence the perception of the problem. For example, an obese person may be in danger of developing a heart condition, however since they are young they believe they are less susceptible reducing the risk to minor.

Question 38

Second belief of The Health Belief Model

Answer 38

A cost-benefit analysis influences the likelihood of taking action. For example, comparing the perceived benefits (being healthier) against the perceived costs (financial, situational, social). All these factors as well as cues to action interact to predict the likelihood of taking preventative health actions.

Question 39

Self-reports to measure non-adherence

Answer 39

Self-reports involve asking the patient if they adhere to treatment requests. These are subjective and susceptible to response bias.

Question 40

Subjective: self-reports (Riekart and Droter) Aim

Answer 40

Looked at the implications of non-participation in studies using self-report measures to investigate adherence to medical treatment for adolescents with diabetes.

Question 41

Riekart and Droter procedure

Answer 41

• Adolescents with diabetes for more than one year (total of 94 families).
• The adolescents completed a series of questionnaires and interviews while their parents also completed a questionnaire.
• They both had a questionnaire to complete at home with a self-addressed return envelope - if not done within 10 days, they were called to remind them.
• Families were divided into three groups: participants/returners (52), non-returners (28) and non-consenters (14).

Question 42

Riekart and Droter findings

Answer 42

• Significant differences in adherence levels between participants and non-returners.
• Those who returned the questionnaire had higher adherence scores and tested blood sugar more frequently.
• This suggests that when self-report measures are used the results may be distorted if only the results of those that completed the self-report are considered.

Question 43

Objective: pill counting (Chung and Naya) Aim

Answer 43

To investigate if you can electronically assess adherence to oral asthma medication by using a trackcap.

Question 44

Chung and Naya procedure

Answer 44

• 57 with asthma patients
• Underwent a screening period of three weeks and a 12 week treatment period in which they were told to take their medication twice a day, one in the morning and one in the evening approximately 12 hours apart and not at mealtimes.
• They received a three week supply with a week to spare.
• They were dispensed from a bottle fitter with a TrackCap medication monitoring system that registers when the bottle is opened/closed.
• Participants returned every three weeks to have their tablet counts measured.

Question 45

Chung and Naya findings

Answer 45

• On days when patients took exactly 2 tablets, the mean time between doses 12½ hours.
• Median 89% compliance was found from Trackcap, but Median 92% from tablet counts. - Concluded that it is possible to electronically assess adherence with an oral medication using an event monitoring system.
• Compliance was measured by the number of times the cap was opened, the number of days the cap was opened 8 hours apart and number of pills left at the 12 week period.

Question 46

Biochemical tests (Roth and Caron)

Answer 46

Roth and Caron suggested non-adherence could be measured through blood and urine samples.

Question 47

Roth and Caron procedure

Answer 47

• They conducted a study with 116 patients whose antacid regime was monitored.
• Patients estimated their intake average 89%, however actual intake averaged 47%.
• They found that pill counting was inaccurate and that patient self-reports often overestimated when they said they took medicine regularly.

Question 48

Roth and Caron Conclusions

Answer 48

Therefore, Roth and Caron concluded the best measure of non-adherence is objective, quantitative tests, such as biochemical tests to measure non-adherence. They suggested that urine and blood tests taken over a number of months will give a more accurate indication of adherence.

Question 49

Repeat Prescriptions (Sherman et al.)

Answer 49

Investigated if prescription refill history identified poor adherence with asthma medications more frequently than the doctor’s assessment.

Question 50

Sherman et al. Procedure

Answer 50

• 116 children with asthma were interviewed with their parents on a clinic visit.
• Adherence was checked by telephoning the patient’s pharmacy to assess the ‘refill rate’.
• It was assumed that if the medication (the ‘refill’) was not collected from the pharmacy, then it could not have been taken, whereas if it was collected then the original prescription must have been taken.
• Patient adherence was operationalised by calculating the number of doses refilled divided by the number of doses prescribed over a period of up to 365 days.

Question 51

Sherman et al. findings

Answer 51

Adherence was 72%, 61% and 38% for the three different inhalers prescribed to the children.
Checking refills is an accurate way of measuring adherence. Also found doctors are not able to tell if a patient is using their inhaler from consultation alone.

Question 52

Improve Practitioner Style: Ley

Answer 52

Improve practitioner style by changing information presentation techniques. Ley Prepared a booklet of guidelines for doctors on how to communicate more clearly with patients.

Satisfaction: including listening to the patient and finding out what their worries are, etc

Understanding and memory: avoiding jargon, encouraging feedback to increase recall of instructions, etc

C:selecting Content - being aware of the effect of what they say to the patient (e.g. will it cause fear, is the patient particularly vulnerable), etc.

Use simple language, state the key information first, repeat key points (by summarising).

Question 53

Behavioural Techniques: Yokley and Glenwick

Answer 53

Investigated the relative impact of four conditions for motivating parents to take their children to be immunised.

Question 54

Conditions

Answer 54

Four experimental
Two Control
General prompt
Specific prompt
Increased access prompt
Money incentive prompt
Contact control group
No contact group

Question 55

Yokley and Glenwick: Procedure

Answer 55

The participants were an entire population of a medium-sized midwest city (approx. 300,000). The target population consisted of children five years or younger who needed a vaccine. Each condition differed in the type of message on the postcard. Impact was measured over 12 weeks.

Question 56

Yokley and Glenwick: Findings

Answer 56

• The results showed the money incentive group had the biggest impact on attendance, followed by increased access, specific prompt and then general prompt.
• Money incentives have a powerful and immediate impact, however may not be cost-effective, so a specific prompt would be the more cost-efficient.

Question 57

Behavioural Techniques: Watt et al.

Answer 57

Making medical treatment programmes fun and engaging can have positive consequences on the levels of adherence. The Funhaler incorporates incentive toys into a child’s inhaler. If the correct breathing technique is used, the child is rewarded with a fun whistle sound and a spinning toy within the inhaler.

Question 58

Watt et al. procedure

Answer 58

• 32 children with asthma
• Questionnaires were completed after the use of the Breath-a-Tech and then after two weeks of using the Funhaler

Question 59

Watt et al. findings

Answer 59

• Found it was associated with improved compliance compared to a Breath-a-Tech
• 38% more parents medicate their children the previous day and 60% more children took the recommended four or more cycles. This provides support that behavioural techniques can be developed to reinforce positive health behaviours and improve adherence with children.

Question 60

Pain

Answer 60

A sensory or emotional discomfort which tends to be associated with actual tissue damage or threatened tissue damage.

Question 61

Acute

Answer 61

Mild OR severe pain that comes on quickly but lasts only for a brief time. Acts as a warning of damage to tissue or disease. Short duration, less than 6 months. For example, bruise, burns or cuts.

Question 62

Chronic Pain

Answer 62

Constant, recurring pain that lasts for more than 6 months. May be associated with illness or disability. This gets progressively worse and reoccurs intermittently. People experience high levels of anxiety and have feelings of helplessness and depression as the pain doesn’t dissipate. An example would be migraines.

Question 63

Psychogenic Pain

Answer 63

A type of pain that refers to episodes where there is not an organic cause for the pain, but the person is still experiencing it. For example phantom limb pain.

Question 64

Phantom Limb Pain

Answer 64

Pain perceived by the body of a limb is no longer present. It is psychogenetic as the pain is imagined by the mind

Question 65

Specificity Theory (Descartes)

Answer 65

Specificity theory believes the body has a separate sensory system for perceiving pain.

It believes that specific pain receptors transmit signals to a “pain centre” in the brain that produces the perception of pain.

When the body feels pain via one of the senses (e.g. on the skin), this then travels down the neural fibres to the brain where pain is registered in the brain.

The intensity of the pain is directly related to the amount of tissue damage (e.g. a prick from a needle is not as painful as a burn across the entire hand). It therefore believes pain is purely a sensory experience.

Question 66

Gate Control Theory (Melzack)

Answer 66

The nervous system is made up of the central nervous system (the spinal cord and the brain) and the peripheral nervous system (nerves outside of the brain and spinal cord.

In the gate control theory, the experience of pain depends on an interplay of these two systems as they each process pain signals in their own way.

Upon injury, pain messages originate in nerves associated with the damaged tissue and flow along the peripheral nerves to the spinal cord and on up to the brain.

Before the pain messages can reach the brain these pain messages encounter ‘nerve gates’ in the spinal cord that open or close depending upon a number of factors (possibly including instructions coming down from the brain).

When the gates are opening, pain messages ‘get through’ more or less easily and pain can be intense. When the gates close, pain messages are prevented from reaching the brain and may not even be experienced.

Question 67

Self-report measures (clinical interview)

Answer 67

A self-report technique involving a dialogue between practitioner and patient to help with diagnosis. They will discuss the intensity, quality, location and duration. This can be in the form of a semi-structured or unstructured interview. The patient is able to elaborate on their symptoms and describe them in their own words.

Question 68

McGill Pain Questionnaire

Answer 68

Location: diagram of body, mark location of pain

Feel: patient selects one word from each of 20 sub-categories to describe pain (e.g. spreading, radiating, penetrating or piercing)

How does the pain change - selecting words and open questions about what relieves/increases the pain (brief, rhythmic, constant)

How strong is the pain - likert rating scales to describe strength of pain (mild, distressing, excruciating)

Types of pain:
Sensory: burning
Affective: emotionally: frightening
Evaluative: overall intensity: unbearable

Question 69

VAS

Answer 69

Used over a continuum of values. A 10 cm line with descriptors at either end showing alternative ends of the spectrum. The patient marks on the line the level of pain they are experiencing. VAS score can be calculated by measuring the distance from the starting point to the mark.

Question 70

UAB pain behavioural scale

Answer 70

Observers observe target behaviours (body language, mobility, posture, vocal complaints: verbal, vocal complaints: non-verbal) and record how frequently each occurs. There are ten types of target behaviours, each item being scored on a three-point scale (0, 0.5, 1). The higher the score, the more pain. The patient can score between 0 and 10.

Question 71

Paediatric pain questionnaire: Varni and Thompson

Answer 71

Multi-dimensional questionnaire for assessing pain in children with separate forms for patient, parent and clinician.

It measures perceptions of pain intensity, location, affective factors etc. in a child-friendly format.

Firstly, the child circles words that best describes the pain and then the three that describe the pain they are in at the time of completing the questionnaire.

They then rate how they feel on a continuum alongside rating the worst pain they had that week.

They then use four different colours relating to different severities of pain and colour in a picture of themselves.

Question 72

Wong-Baker Scale

Answer 72

Wong-Baker FACES Rating Scale uses a series of faces ranging from a happy face at 0 (no hurt) to a crying face at 10 (hurts worst). Child chooses the face corresponding to their perceived pain.

Face 0: is very happy because he doesn’t hurt at all

Face 2: hurts just a little bit

Face 4: hurts a little more

Face 6: hurts even more

Face 8: hurts a whole lot more

Face 10: hurts as much as you can imagine, although you do not have to be crying to feel this bad

Question 73

Medical techniques to manage pain

Answer 73

Surgical treatments are used when medication doesn’t relieve pain. Surgical treatments include cutting nerve pathways or making lesions in special centres in the brain. This is only recommended for people with terminal illnesses.

Question 74

Drugs

Answer 74

One treatment is analgesic/painkillers which are a group of drugs used to achieve relief from pain (analgesia). The drugs act in various ways on the central nervous system. For example, peripherally acting analgesics act on the peripheral nervous system e.g. ibuprofen

Question 75

Attention Diversion

Answer 75

Diversion of attention from the pain by refocusing (e.g. listen to music) or directing attention to something other than the pain. This will help close the gates and reduce the perception of pain.

Question 76

Non-pain Imagery

Answer 76

The patient thinks of a scene far removed from the situation they are currently in that is where they are experiencing the pain. This could be a relaxing environment, somewhere like a park or beach that they can immerse themselves in and this acts as a distraction against the pain.

Question 77

Cognitive Redefinition

Answer 77

An individual alters their thinking to replace thoughts of apprehension about the pain with other more positive thoughts. For example, the patient may replace thoughts like “this is really going to hurt” with “this is not the worst pain in the world”. It suggests the brain has a significant impact on how pain is perceived.

Question 78

Acupuncture

Answer 78

Fine metal needles are inserted under the skin at certain sites.

The therapist will have a ‘map’ of the body and use this to guide the placement of the needles.

This results in the body producing pain-relieving substances, such as endorphins.

Question 79

Stimulation Therapy/TENS

Answer 79

A mild electric current is passed between electrodes which are placed on areas of the body where you are experiencing muscle pain.

The impulses reduce the pain signals passing along nerves which helps an individual relax.

This helps to reduce the perception of deep muscle pain or pain in muscles due to anxiety and stress.

Question 80

Physiology of stress and effects on health: the GAS Model (Selye)

Answer 80

This is how the body responds to an external stressor. According to this model, there are three phases the body goes through when responding to stress.

Question 81

Selye stages

Answer 81

Alarm: the stressor upsets the homeostasis of the body - our bodies release hormones, such as cortisol and adrenaline to provide instant energy
Resistance: the body adapts to the stressor and arousal declines, but is still above normal
Exhaustion: when long-term stress is not removed - the body’s energy reserves become depleted.

Question 82

Chandola et al. Aim

Answer 82

Investigated the factors linking work stress with coronary heart disease (CHD). Work stress can be caused by long hours or job security

Question 83

Chandola et al. Procedure

Answer 83

• 10308 London male and female civil servants.
• Processed data from the Whitehall II study: data collection began in 1985 and concluded in 2004.
• Data gathered about job strain was collected using self-report postal questionnaires and a clinical examination recorded biological risk factors (coronary heart disease (CHD), blood pressure, cortisol levels and waist circumference) and behavioural factors (diet, exercise, alcohol consumption and smoking), additionally non-fatal heart attacks and deaths due to heart disease during the study were recorded.

Question 84

Chandola et al. Findings

Answer 84

Results showed that work stress was associated with lack of exercise and poor diet

Work stress was more common in those under 50

The more stress that was reported, the more likely there was to be a report of CHD.

Question 85

Life Events: Holmes and Rahe

Answer 85

Live events are experiences that disrupt an individual’s usual activities causing a substantial readjustment. For example, marriage, divorce, illness or injury.

They found that stress from such events tended to build up.

Using medical case histories and interviews, Holmes and Rahe developed the Social Readjustment Rating scale which ranked life events based on how stressful they are from most to least.

Using 394 ppts they were able to rank events from least to most stressful. Those who scored over 300 in one year are found to have suffered more illness due to stress.

Question 86

Personality: Friedman and Rosenman Overview

Answer 86

Causes of stress come from the individual. Investigated the influence of personality type on stress - those susceptible to CHD have certain personality similarities. Type A are competitive, have time urgency and a high level of anger/hostility whereas Type B are less competitive, work slower and do not enjoy control

Question 87

Friedman and Rosenman study

Answer 87

A longitudinal study looked at 3000 healthy men who were assessed to determine personality type and then followed up throughout the following nine years - 70% of those that died (257) were Type A (most likely to be susceptible to stress).

Question 88

Physiological Measures of Stress

Answer 88

Blood, Urine and Saliva samples or Blood pressure tests

Question 89

Wang et al. Aim

Answer 89

Used an fMRI to analyse which areas of the brain are activated under stressful situations. An fMRI is a neuroimaging procedure that measures brain activity by detecting changes in blood flow.

Question 90

Wang et al. Procedure

Answer 90

32 ppts - stress condition (25) control condition (7).

Participants completed a high-stress mental arithmetic task where they had to restart if an error occurred and where they were prompted repeatedly for faster performance.

The low stress condition counted aloud backwards from 1000.

Self-reports were taken of anxiety/stress, effort, difficulty and frustration during the task as well as + heart rate and saliva sample after each task.

Question 91

Wang et al. Findings

Answer 91

• Results show that stress induces negative emotions and that the ventral right prefrontal cortex plays a key role in the response to stress. scale).
• Compared with baseline, all measures showed an increase for the low stress task and an even higher increase for the high stress.

Question 92

Physiological: Sample Tests: Evans and Wener

Answer 92

Looked into how easily/frequently personal space is intruded upon and how this may result in stressful travel experiences.

Question 93

Evans and Wener Procedure

Answer 93

• 139 adult commuters ppts.
• Two measures of crowding were taken: car density (total number of passengers divided by total number of seats) and seat density (total number of people sitting on the same row as the participant divided by the total number of seats in the row (five)).
• Salivary cortisol was collected from each ppt via a chewable swab.
• They also used self-reports to record levels of stress.

Question 94

Evans and Wener Findings

Answer 94

• Results showed car density was inconsequential for levels of stress, but seating density significantly affected self-reported stress and levels of cortisol.
• Therefore concluding that the ease and frequency of personal space intrusion may be a key underlying process of travel stress.

Question 95

Psychological measures: self-report questionnaires: Holmes and Rahe

Answer 95

• Developed the social readjustment rating scale (SRRS) to examine events and experiences that cause stress.
• There were 43 life events (both positive and negative) with a corresponding stress score.
• At the top of the list (rank 1 with a mean value of 100) was ‘death of spouse’; at the bottom of the list (rank 43 and a mean value of 11) was ‘minor violations of the law’.
• The person’s total SRRS score is calculated by adding the value of all the events that have happened in the previous 12 months together.
• Holmes and Rahe found that people scoring 300 life change units or more were more susceptible to both physical and mental illness, ranging from sudden cardiac death to athletics injuries.

Question 96

Psychological measures: self-report questionnaires: Friedman and Rosenman

Answer 96

• Friedman and Rosenman devised the Type A personality questionnaire.
• There are short and long versions, some requiring yes/no answers and others scoring on a 1-4 scale.
• A typical ‘yes/no’ questionnaire assesses these behaviours with questions being: - ‘Do you find it intolerable to watch others perform tasks you know that you can do faster?’ - ‘Do you feel guilty when you relax when there is work to be done?’
• According to Friedman and Rosenman, people with high scores are more likely to suffer from coronary heart disease and other stress-related illnesses. This is supported by their research into the link between Type A personality and CHD with 70% of the participants who died being a Type A personality.

Question 97

Medical Techniques: Biochemical

Answer 97

Drugs - quick and easy. Antidepressants most widely prescribed: e.g. SSRIs like Prozac (regulate serotonin levels in the brain to elevate mood).

Anti-anxiety drugs are also used as they decrease arousal and relax the body by reducing tension in the muscles. Benzodiazepines and beta-blockers are an anti-anxiety drug that release inhibitory neurotransmitters meaning the brain is less aroused.

Question 98

What is biofeedback?

Answer 98

Biofeedback: a technique in which a mechanical device monitors the status of a person’s physiological processes e.g. heart rate and reports it back to the individual allowing the person to gain voluntary control over these processes. The patient can then learn to do relaxation to reduce the physical processes and therefore hope to reduce the experience of stress. Budzynski found this technique was effective in helping to reduce tension headaches

Question 99

Budzynski procedure

Answer 99

• Budzynski et al. assessed the effect of biofeedback in reducing tension headaches which are associated with tensed scalp and neck muscles. Each participant had electrodes attached to their head. There were three conditions and each of the 15 participants was randomly allocated to one:

The experimental group were told the tone reflected the level of muscle tension and they were told to relax as much as possible.

The ‘constant low tone irrelevant feedback’ group were told to relax (and the low tone would not change).

The silent group were told to relax (and there was no tone feedback).

Question 100

Budzynski findings

Answer 100

Over the 20 trials there was a significant difference between the three groups, particularly in the percentage decline. The feedback group showed a 50% decrease, the no feedback group a 24% decline and the irrelevant feedback group a 28% increase in forehead muscle tension.

Question 101

Psychological: Imagery: Bridge et al. Aim

Answer 101

Imagery involves creating a detailed mental image of an attractive and peaceful setting or environment. It can be used to promote relaxation, which can lower blood pressure and reduce other problems. Bridge et al. looked at the effect of relaxation and imagery on the stress levels of women undergoing treatment for cancer (breast).

Question 102

Bridge et al. Procedure

Answer 102

• He used a randomised control trial with 139 female outpatients who had radiotherapy.
• They were allocated to either relaxation, relaxation plus imagery or control.
• Initial stress levels were measured by profile of mood states and the Leeds general scales for depression and anxiety, and initial scores were the same in all groups.
• After 6 weeks of intervention these measures of mood states were taken again.

Question 103

Bridge et al. Findings and Conclusion

Answer 103

Findings showed that mood disturbance scores were significantly less in the intervention groups; women in the imagery and relaxation group were more relaxed than those receiving relaxation training only; mood in the control group was worse.

Bridge et al. concluded that patients with early breast cancer benefit from imagery and relaxation training.

Question 104

Preventing Stress: Meichenbaum

Answer 104

Meichenbaum believes a way to manage stress is to inoculate yourself from it. Stress inoculation training (SIT) is a type of cognitive behavioural therapy that attempts to get the patient to recognise cognitions that trigger a stressful experience and then employ intervention strategies to help relieve the stress. SIT proposes that stress occurs whenever the perceived demands of a situation exceed the perceived resources that are available to the individual.

Question 105

Stages of SIT

Answer 105

Conceptualisation: trainer talks to the person about their stressful experiences, their negative thought patterns are identified

Skill acquisition: the person is educated about the physiological and cognitive aspects of stress and techniques used to manage (e.g. replacing negative thoughts)

Application and self follow-through: application of new skills through a series of progressively more threatening situations to prepare the person for real-life situations.

Question 106

Janis and Feshbach Aim

Answer 106

Janis and Feshbach (1953) conducted a laboratory experiment on fear arousal to promote oral hygiene. The aim was to test if level of fear would have a behavioural consequence in relation to the participants’ brushing of teeth.

Question 107

Janis and Feshbach Procedure

Answer 107

There were four groups: a minimal fear group, a moderate fear group, a strong fear group and a control group with 50 students in each.

They assessed the effectiveness of a dental hygiene lecture in which each varied in terms of the level of fear. Emotional reaction + conformity measured through self-report questionnaires given before, immediately after, and 1 week after the fear presentations

Question 108

Janis and Feshbach Findings

Answer 108

It was found that although the immediate impact was strongest in the high-fear group as it aroused the most fear, the minimal fear presentation was most effective in conformity to dental hygiene behaviour.

The minimal fear presentation group showed 50% increase in conformity to recommended dental hygiene recommendation whereas 28% in the high-fear group reported change, suggesting that low levels of fear are best.

Question 109

Fear arousal: Cowpe Aim

Answer 109

Aim was to test the effectiveness of advertising campaigns that combined both fear arousal and providing information on highlighting the dangers of chip-pan fires.

Question 110

Cowpe Procedure

Answer 110

Two 60 second adverts made showing the cause of chip pan fires (overfilling and inattendance). Shown in ten UK regions between 1976-1984.

Question 111

Cowpe Findings

Answer 111

Between 7% and 25% drop (measured through fire brigade statistics) in fires and high levels of awareness of the dangers of chip pan fires reported via questionnaires.

Question 112

Yale model of communication

Answer 112

Several factors that influence how likely one is to change behaviour: three aspects of communication: communicator, communication and audience. Also: source, message, medium, target, situation.

Question 113

Yale model of communication Factors

Answer 113

The source of the message - is the presenter of the message credible, an expert, trustworthy?

The message itself - is it clear and direct; colourful and vivid; is it one-sided or two-sided?

The medium - is the message personal; done via television, radio or printed?

The target audience - who is the target audience? School children; communities?

The situation - where will the message be presented? In the home; a medical surgery?

Question 114

Providing information: Lewin Procedure

Answer 114

The effect providing information has on health behaviours.

Believes that if people want to live healthier lives, they need to know what to do by being provided with information.

176 patients who recently suffered a heart attack were randomly allocated to either a self-help rehab programme focused on improving cardio-vascular health or the control group (standard care plus a placebo package of information and informal counselling).

Patients were assessed at 6 months and 1 year.

Question 115

Providing information: Lewin Findings

Answer 115

Psychological adjustment was better in the rehabilitation group at one year. They also had significantly less contact with their general practitioners during the
following year and significantly fewer were readmitted to
hospital in the first six months (less than 10% readmission compared with 25%).

Question 116

Health Belief Model

Answer 116

People are likely to practise healthy behaviours if they believe by not doing so they are susceptible to serious health problems. Leventhal demonstrated this with an experiment on cigarette smokers who were exposed to a high-fear appeal. They changed their attitudes and intentions regarding smoking more than those shown a moderate-fear appeal.

Question 117

Schools (Tapper et al.): What was included in the package

Answer 117

A Food Dude adventure video with six 6-minute adventure episodes

A set of Food Dude rewards

A set of letters from the Food Dudes (for praise and encouragement)

A Food Dude home-pack (to encourage children to eat fruit and vegetables in the home context as well as at school)

A teacher handbook and support materials.

Question 118

Tapper Aim

Answer 118

To evaluation the effect of a whole school Food Dudes programme on healthy eating.

Question 119

Schools (Tapper et al.): Procedure

Answer 119

The main intervention lasted 16 days during which the children watched the Food Dudes episodes and listened to their teacher read out the Food Dudes letters. Children received rewards when they eat fruit and vegetables presented to them: sticker for tasing, sticker or small prize for eating a whole portion. This was followed by the maintenance phase where there are no videos/letters and the rewards are more intermittent.

Question 120

Schools (Tapper et al.): Findings

Answer 120

Teachers and parents evaluated the programme positively and the children were enthusiastically engaging with the curriculum and had improved attendance alongside lower achieving children becoming more confident.

At a four month checkup, the children were still eating significantly more fruits and vegetables than before.

Question 121

Worksites (Fox et al.) Aim

Answer 121

Fox et al. studied the use of a token economy at two open-pit mines (coal and uranium)

Question 122

Procedure Fox et al.

Answer 122

Workers could earn tokens for working without time lost injuries, not being involved in equipment damage and for making adopted safety suggestions.

They lost tokens for injuries, damages or failure to report injuries/accidents.

The tokens could be exchanged for thousands of items in a store.

Question 123

Fox et al. Findings

Answer 123

This resulted in a large decline in lost days due to injuries, lost time injuries and costs of accidents/injuries.

The reduction in costs far exceeded the cost of running the token economies.

The system continued to be used at one mine for 12 years (until closure) and used at the other for at least 11 years where improvements were maintained.

Question 124

Communities (Five city project; Farquhar et al.) focus

Answer 124

Longitudinal (6 years) programme investigating the feasibility and effectiveness of a community-wide education programme at reducing cardiovascular disease.

Question 125

Farquhar et al. Procedure

Answer 125

There were two treatment communities: Salinas and Monterey. There were three control cities: Modesto, San Luis Obispo and Santa Maria where only morbidity and mortality events were monitored.

Those who resided in randomly selected households in the 4 surveyed cities were eligible to participate with each survey comprising approximately 1800 - 2500 participants.

Questionnaires given (e.g. health attitudes, knowledge and behaviour, measures of CHD risk) and physiological measures taken (e.g. height, weight, blood pressure, heart rate, etc.).

Urine samples were also taken to assess cholesterol levels.

During the six years, the Community Education Programme was given to the two experimental cities via the media (television + radio) and community education (e.g. classes, seminars and group projects).

Question 126

Farquhar et al. Findings

Answer 126

Knowledge of CVD risk increased in all four groups, improvements in the treatment groups was significantly greater.

CHD and all-cause mortality risk cores were maintained or continued to improve in intervention cities whilst levelling out/rebounding in the two control cities.

Results showed reductions in cholesterol levels (2%), blood pressure (4%), resting pulse rate (3%) and smoking (13%).

Question 127

Weinstein Aim

Answer 127

Investigated the impact of unrealistic optimism on health beliefs.

Question 128

Weinstein First Study Procedure

Answer 128

• 258 college students rated their own chances of experiencing 42 events (18 positive/24 negative).
• Positive events included ‘owning your own home’ and negative events were ‘developing cancer’.
• The events were scored ‘compared to other students studying here and the same sex as you’ on the following scale: 100% less, 80% less, 60% less, 40% less, 20% less, 10% less, average, 10% more, 20% more, 40% more, 60% more, 80% more, and 100% more.

Question 129

Weinstein First Study Findings

Answer 129

Overall, the participants rated their own chances to be above average for positive events and below average for negative events.

Question 130

Weinstein Second Study Procedure

Answer 130

The second study used 120 female college students to list factors they thought would influence their own chances of experiencing 8 future events. When a second group of students read it they reported less unrealistic optimism for the same 8 events.

Question 131

Weinstein conclusions

Answer 131

This led the researchers to conclude that the unrealistic optimism was only experienced people focus on their own chances of achieving these outcomes and don’t realise that others may have just as many factors in their favour

Question 132

Transtheoretical model: Prochaska et al.:

Answer 132

Model of behavioural change that assesses, through a series of six stages, whether a person is ready to change to a new, healthier behaviour.

Question 133

Six Stages

Answer 133

Pre-contemplation: no intention in next six months
Contemplation: intends to change in six months
Preparation: intend in near future (30 days) have plan of action
Action: taken action
Maintenance: behaviour sustained 6+ months
Termination: 100% changes, no chance of relapse

Question 134

Processes of change

Answer 134

Activities a person can complete to move through the different intervention stages - there are ten processes.

Consciousness raising: Involves increased awareness about the
causes, consequences, and cures for a particular problem behaviour

Self re-evaluation: Combines both cognitive and affective
assessments of one’s self-image with and without a particular unhealthy habit

Self-liberation: The belief that one can change and the commitment and recommitment to act on that belief

Question 135

Health change in adolescents: Lau et al.: Aim

Answer 135

Investigated the stability and change of health beliefs and behaviour in adolescents.

Question 136

Lau et al. Procedure

Answer 136

Baseline questionnaires on alcohol consumption, eating habits, exercise, sleeping, smoking and wearing seatbelts were gathered.

The study required the questionnaire to be completed again after 1, 2 and 3 years - this resulted in the sample dropping from 947 parent-child pair participants to 532.

Question 137

Lau et al. Findings

Answer 137

Results showed a substantial change in health behaviour while at college. Found that peers have a strong impact on the performance of health behaviours, but parents were more important as sources of influence over beliefs and behaviours.