Health Flashcards
1
Q
McKinstry and Wang Aim
A
To investigate doctors’ clothing as a form of non-verbal communication.
2
Q
McKinstry and Wang Procedure
A
- 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.
3
Q
McKinstry and Wang Results
A
- 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.
4
Q
McKinlay Aim
A
Verbal communications: Investigated understanding of maternity words used by practitioners in a maternity hospital
5
Q
McKinlay Procedure
A
- 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.
6
Q
McKinlay Results
A
- 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
7
Q
Verbal Communication: Ley Aim
A
Investigated the frequency of patients forgetting verbal advice given by their doctors.
8
Q
Ley Procedure
A
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.
9
Q
Ley Results
A
- 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.
10
Q
Byrne and Long Procedure
A
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.
11
Q
Byrne and Long Findings
A
- 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.
12
Q
Practitioner Style: Savage and Armstrong
A
Compared consultation satisfaction between patient-centred versus doctor-centred practitioner styles.
13
Q
Savage and Armstrong Procedure
A
200 patients consented to have their consultation recorded and were randomly allocated to either condition. They used two questionnaires to measure satisfaction.
14
Q
Savage and Armstrong Findings
A
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.
15
Q
Type I error
A
Type I: The patient is not ill, but is diagnosed with an illness (False positive).
16
Q
Type II error
A
Type II: Patient is ill, but is not diagnosed with illness (false negative)
17
Q
Disclosure of Information (Robinson and West) Aim
A
- 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.
18
Q
Robinson and West Procedure
A
- 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
19
Q
Robinson and West Findings
A
- 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.
20
Q
Delay in seeking treatment (Safer)
A
Investigated what factors influence patients to delay seeking treatment for a new symptom.
21
Q
Safer Procedure
A
- 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
22
Q
Safer: what three stages to delay?
A
Appraisal, illness, utilisation
23
Q
Appraisal delay
A
number of days elapsed from first noticing symptom up to the day they concluded they were ill
24
Q
Illness delay
A
number of days from the end of appraisal delay to the day they decide to seek professional help
25
Utilisation delay
the final stage: end of illness delay to time of when they were seen in clinic
26
What predicts length of delay?
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.
27
Safer conclusions
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.
28
Hypochondriasis
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.
29
Barlow and Durand
- 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.
30
Munchausen Syndrome
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.
31
Aleem and Ajarim
- 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.
32
Types of non-adherence include:
- 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
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Problems caused by non-adherence include:
- Wasted money on drugs
- Worsening of health
- Financial costs when appointments are not kept and they are unavailable for others to take
34
Rational non-adherence (Bulpitt)
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.
35
Bulpitt Study
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.
36
The Health Belief Model (Becker and Rosenstock)
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.
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First belief of The Health Belief Model
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.
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Second belief of The Health Belief Model
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.
39
Self-reports to measure non-adherence
Self-reports involve asking the patient if they adhere to treatment requests. These are subjective and susceptible to response bias.
40
Subjective: self-reports (Riekart and Droter) Aim
Looked at the implications of non-participation in studies using self-report measures to investigate adherence to medical treatment for adolescents with diabetes.
41
Riekart and Droter procedure
- 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).
42
Riekart and Droter findings
- 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.
43
Objective: pill counting (Chung and Naya) Aim
To investigate if you can electronically assess adherence to oral asthma medication by using a trackcap.
44
Chung and Naya procedure
- 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.
45
Chung and Naya findings
- 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.
46
Biochemical tests (Roth and Caron)
Roth and Caron suggested non-adherence could be measured through blood and urine samples.
47
Roth and Caron procedure
- 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.
48
Roth and Caron Conclusions
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.
49
Repeat Prescriptions (Sherman et al.)
Investigated if prescription refill history identified poor adherence with asthma medications more frequently than the doctor's assessment.
50
Sherman et al. Procedure
- 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.
51
Sherman et al. findings
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.
52
Improve Practitioner Style: Ley
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).
53
Behavioural Techniques: Yokley and Glenwick
Investigated the relative impact of four conditions for motivating parents to take their children to be immunised.
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Conditions
Four experimental
Two Control
General prompt
Specific prompt
Increased access prompt
Money incentive prompt
Contact control group
No contact group
55
Yokley and Glenwick: Procedure
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.
56
Yokley and Glenwick: Findings
- 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.
57
Behavioural Techniques: Watt et al.
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.
58
Watt et al. procedure
- 32 children with asthma
- Questionnaires were completed after the use of the Breath-a-Tech and then after two weeks of using the Funhaler
59
Watt et al. findings
- 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.
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Pain
A sensory or emotional discomfort which tends to be associated with actual tissue damage or threatened tissue damage.
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Acute
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.
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Chronic Pain
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.
63
Psychogenic Pain
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.
64
Phantom Limb Pain
Pain perceived by the body of a limb is no longer present. It is psychogenetic as the pain is imagined by the mind
65
Specificity Theory (Descartes)
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.
66
Gate Control Theory (Melzack)
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.
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Self-report measures (clinical interview)
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.
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McGill Pain Questionnaire
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
69
VAS
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.
70
UAB pain behavioural scale
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.
71
Paediatric pain questionnaire: Varni and Thompson
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.
72
Wong-Baker Scale
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
73
Medical techniques to manage pain
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.
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Drugs
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
75
Attention Diversion
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.
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Non-pain Imagery
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.
77
Cognitive Redefinition
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.
78
Acupuncture
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.
79
Stimulation Therapy/TENS
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.
80
Physiology of stress and effects on health: the GAS Model (Selye)
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.
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Selye stages
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.
82
Chandola et al. Aim
Investigated the factors linking work stress with coronary heart disease (CHD). Work stress can be caused by long hours or job security
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Chandola et al. Procedure
- 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.
84
Chandola et al. Findings
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.
85
Life Events: Holmes and Rahe
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.
86
Personality: Friedman and Rosenman Overview
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
87
Friedman and Rosenman study
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).
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Physiological Measures of Stress
Blood, Urine and Saliva samples or Blood pressure tests
89
Wang et al. Aim
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.
90
Wang et al. Procedure
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.
91
Wang et al. Findings
- 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.
92
Physiological: Sample Tests: Evans and Wener
Looked into how easily/frequently personal space is intruded upon and how this may result in stressful travel experiences.
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Evans and Wener Procedure
- 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.
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Evans and Wener Findings
- 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.
95
Psychological measures: self-report questionnaires: Holmes and Rahe
- 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.
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Psychological measures: self-report questionnaires: Friedman and Rosenman
- 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.
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Medical Techniques: Biochemical
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.
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What is biofeedback?
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
99
Budzynski procedure
- 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).
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Budzynski findings
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.
101
Psychological: Imagery: Bridge et al. Aim
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).
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Bridge et al. Procedure
- 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.
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Bridge et al. Findings and Conclusion
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.
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Preventing Stress: Meichenbaum
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.
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Stages of SIT
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.
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Janis and Feshbach Aim
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.
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Janis and Feshbach Procedure
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
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Janis and Feshbach Findings
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.
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Fear arousal: Cowpe Aim
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.
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Cowpe Procedure
Two 60 second adverts made showing the cause of chip pan fires (overfilling and inattendance). Shown in ten UK regions between 1976-1984.
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Cowpe Findings
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.
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Yale model of communication
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.
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Yale model of communication Factors
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?
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Providing information: Lewin Procedure
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.
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Providing information: Lewin Findings
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%).
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Health Belief Model
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.
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Schools (Tapper et al.): What was included in the package
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.
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Tapper Aim
To evaluation the effect of a whole school Food Dudes programme on healthy eating.
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Schools (Tapper et al.): Procedure
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.
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Schools (Tapper et al.): Findings
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.
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Worksites (Fox et al.) Aim
Fox et al. studied the use of a token economy at two open-pit mines (coal and uranium)
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Procedure Fox et al.
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.
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Fox et al. Findings
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.
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Communities (Five city project; Farquhar et al.) focus
Longitudinal (6 years) programme investigating the feasibility and effectiveness of a community-wide education programme at reducing cardiovascular disease.
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Farquhar et al. Procedure
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).
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Farquhar et al. Findings
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%).
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Weinstein Aim
Investigated the impact of unrealistic optimism on health beliefs.
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Weinstein First Study Procedure
- 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.
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Weinstein First Study Findings
Overall, the participants rated their own chances to be above average for positive events and below average for negative events.
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Weinstein Second Study Procedure
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.
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Weinstein conclusions
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
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Transtheoretical model: Prochaska et al.:
Model of behavioural change that assesses, through a series of six stages, whether a person is ready to change to a new, healthier behaviour.
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Six Stages
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
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Processes of change
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
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Health change in adolescents: Lau et al.: Aim
Investigated the stability and change of health beliefs and behaviour in adolescents.
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Lau et al. Procedure
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.
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Lau et al. Findings
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.
