Health beliefs & behaviours Flashcards
Why is it important for pharmacists to understand health beliefs?
- So they can provide appropriate interventions e.g smoking cessation, COVID-19 Vaccination
- Understanding theory-based interventions will
help you as pharmacists to help people change their behaviour - Updating healthy behaviour, making sure patients attend appointments & referrals are made.
What is health?
According to WHO
- World Health Organisation (WHO)
‘A state of physical, mental and social well-being
and not merely the absence of disease or infirmity
- infirmity = a state of being old or weak in health ( especially form old age)
what is Disease?
- A pathologic entity characterised usually by at
least two of these criteria: a recognised aetiologic
agent(s), an identifiable group of signs and
symptoms, or consistent anatomical alterations - SYNONYMS = Illness; sickness; an interruption, cessation, or disorder of body functions, systems or organs
What is illness?
- Simplest definition is ‘disease’ but fails to fully take on the social concept of health
- The subjective experience of poor health manifesting
as physical or psychological symptoms but can have
complex causes including combinations of cognitive
and social processes and may or might not reflect an
underlying disease
What determines health? ( determinants)
MODIFIABLE FACTORS:
- Individual lifestyle factors i.e smoking
- Social & community issues
-Living & working conditions
- General socio-economic, cultural & environmental conditions
NON-MODIFIABLE FACTORS:
- Age
- sex
- Hereditary factors
What is the Perception of health or illness
influenced by?
- Disease
- Disability
- Frequency of illness
- Fitness ( ones fitness)
what is belief?
- Something one accepts as true or real; a firmly held
opinion
What do Sociologists (groups) theories look at?
-Beliefs
- Feelings
- Values
- Experiences
- Meanings
What is Sociologists theories
- how we in a society , how we deal w/ social norms & beliefs
- Social values & norms
What are Psychologists (individual) theories?
- Cognition
- Affect
- Volition = will
- What you actively decide
what behaviours are related to health issues?
- A health behaviour = aimed to prevent disease (e.g. eating healthy diet) = PRIMARY PREVENTION
-An illness behaviour = aimed to seek treatment
(e.g. going to see the Doctor) SIGNS & SYMPTOMS , 2NDARY BEHAVIOUR - A sick role behaviour= aimed at getting well
(adhering to prescribed treatment) HAVE THE DISEASE & AIM AT GETTING WELL
How can health behaviours be described?
- Behavioural pathogens’ = health impairing
habits e.g. smoking, excess alcohol - ‘Behavioural immunogens’ = health protective
e.g. exercise, healthy eating
what is primary behaviour?
- Acting on a behaviour to prevent disease
what is 2ndary behaviour?
- Have signs & symptoms of the disease so you take meds to reduce chance of disease progressing or from getting it
Where do patients go for health advice?
- POPULAR = Self care, self-medication Self help groups (independent of HCPs)
- FOLK = Complementary
therapists - PROFESSIONAL = Professional healthcare I.e GPs & surgeries
what is the Clinical symptom iceberg?
- The symptom iceberg describes the phenomenon
that most symptoms are managed in the community without people seeking professional health care. Instead use OTC meds to treat. - GPs, pharmacists often not consulted for symptoms which would respond to treatment
Lay referral
- 75% patients discuss symptoms with another
person before seeking professional advice/ Consult family & friends - Influence of culture
- Access to healthcare facilities/ Distant or lack of access
- Lower consultation rate among ‘self-medicators’
- those who don’t take meds or self-medicate are less inclined to seek medical help for serious illness
- Self-help groups - the ePatient
OTC meds sales in the uk in 2020
- Some may have been referred by the GP to purchase OTC meds
- Pain relief= £658 mil= 2.7% change since 2019
- Cough, cold & sore throat= £344 mil = -28.7% change since 2019
- Vitamins & minerals = £495 mil = 14.3% change since 2019
- Hay fever = £ 140 mil = 5.8% change since 2019
Symptoms and disease knowledge
- Acute symptoms may be perceived as more
serious e.g. severe abdominal pain, high fever,
COVID-19 - Many serious diseases do not have striking acute symptoms at onset/ early symptoms:
Hypertension
Diabetes
Cancers
What are the 5 Zola’s
triggers that influence he timing of seeking medical care (1973)?
- Occurrence of an interpersonal crisis (family
death) s/o cause of death was that particular disease i.e jade goody’s death increases cervical screening - Perceived interference with social or personal
relationships - Pressure from others to consult (sanctioning)
- Symptoms Interference with lifestyle (work, physical
activity) - Time deadline (if it’s not better by Monday..)
what theories do we use as Models of health behaviour and behaviour change?
- Health Belief Model (HBM)
- Social Cognitive Theory
- Integrative model of behavioural prediction
-Reasoned Action Approach (RAA)
-Theory of Reasoned Action (TRA)
-Theory of Planned Behaviour (TPB) - Stages of Change Model (Transtheoretical model)
- Fuzzy Trace Theory
- Theoretical Domains Framework
What is the The Health Belief Model (HBM)
(Rosenstock 1966, Becker 1997)?
- Old but still widely used
- A model of health behaviour used to explain and predict preventative health behaviour and behavioural response to
treatment
What are the components of HBM?
- Susceptibility to illness = What are my chances of developing a certain disease?
- Severity of illness = What are the chances of me having less severe illness because of the behaviour i am uptaking?
- Cost/ barriers involved in treatment i .e ‘stopping smoking will make me irritable’ ‘peer pressure’
- Benefits in carrying out treatment ‘saving money’
- Cues to take action ‘breathlessness’ ‘public health campaign’
- Health motivation ‘I am worried that smoking might be harmful to health’-
- Perceived control ‘I am confident that I can stop smoking’
HBM cues
2 types
- INTERNAL CUES = e.g. symptoms such as
breathlessness ( How are there ongoing habits causing problems to their health?
- EXTERNAL CUES = seeing an advert for smoking cessation ( prompts people to seek help)
what is the Social Cognitive Theory (Social learning
theory?
- Based on premise that people learn through:
Own experience
Observation of actions and results of others
what is the Social cognitive theory based on ?
- The theory is based on the fact that the following
affect health behaviour and decisions: - People understanding of the risks of their behaviour
- That they feel that they can control their health
habits (perceived self-efficacy) - Know expected outcome benefits (pain, pleasure,
wins) - Health goals (plans people set themselves) – short
term (reasonable) goals most successful - Perceived barriers and facilitators (weather &
exercise, structure of services in local area)
What is the integrative model of behavioral prediction?
- Combines 3 diff models = The theory of planned behaviour (TPB) Reasoned
Action Approach (RAA) and Theory of reasoned action (TRA) - Follows social cognitive theory
- Theoretical approach identifying a set of variables that can account for health related behaviour
- Healthcare professionals can use this in shared decision making
- Attempts to link beliefs and attitudes with health behaviour
1. Attitude – stop smoking, more money for holidays
2. Subjective norm – care about what parents think
3. Perceived behavioural control – possible to act on their beliefs - Takes for granted that peoples behaviour is rational and that
behaviour can be described as reasoned.
What is the Stage models of health behaviour
(Transtheoretical model TTM)?
- Describe how people move through stages as
they change their behaviour. - It has four properties:
1. A classification system for each stage
2. Ordering of stages (people may move either
way)
3. People in the same stage face similar barriers
4. People in different stages face different
barriers
What is the Stages of Change Model (SOC)?
Components:
1. Pre-contemplation – no intention to change = most diff category
2. Contemplation – considering making a change i.e willing to cut down on or give up smoking.
3. Preparation – making small changes
4. Action – actively engaging in a new behaviour i.e working w/ GP’s & pharmacists to improve
5. Maintenance – sustaining change over time = Most challenging aspect in change= Stable behaviour
What is the Framework of theories
- Selecting from such a
large number (88 theories) of potentially relevant, sometimes
overlapping, theories can be challenging. - TDF is a theoretical framework of determinants of behaviour
- It combines 33 theories and consists of 14
domains (or potential factors that determines a
behaviour) - More easier & practical to use.
What types of theories are there?
- Motivational theories
- Action theories
- Organisation theories
What are the 14 behavioural domains of the TDF?
- Knowledge
- Skills
- Social/ professional role & identity
- Beliefs about capabilities
- Beliefs about consequences
- Motivation & Goals
- Memory, attention & decision processes
- Environmental context & resources
- Social influences
- Emotion
- Behavioural regulation
- Nature of the behaviour
Theoretical Domains Framework
TDF domains (ref) Definition (ref)
1- Knowledge = An awareness of the existence of something
2- Skills= An ability or proficiency acquired through practice
3- Social/professional role and identity= A coherent set of behaviours and displayed personal qualities of an individual in a social or work setting
4- Beliefs about capabilities = Acceptance of the truth, reality, or validity about an ability, talent, or
facility that a person can put to constructive use
5- Optimism/ pessimism = The confidence that things will happen for the best, or that desired goals will be attained
6- Beliefs about consequences = Acceptance of the truth, reality, or validity about outcomes of a
behaviour in a given situation
7- Reinforcement = Increasing the probability of a response by arranging a dependent relationship, or contingency, between the response and a given
stimulus
8- Intentions = A conscious decision to perform a behaviour or a resolve to act in a certain way
9- Goals = Mental representation of outcomes or end states that an individual wants to achieve
10- Environmental context and
resources= Any circumstance of a person’s situation or environment that discourages or encourages the development of skills and abilities, independence, social competence, and adaptive behaviour
11- Memory, attention and decision processes =
The ability to retain information, focus selectively on aspects of the
environment, and choose between two or more alternatives
12- Social influences = Those interpersonal processes that can cause an individual to
change their thoughts, feelings, or behaviours
13- Emotion = A complex reaction pattern, involving experiential, behavioural, and physiological elements, by which the individual attempts to deal with
a personally significant matter or event
14- Behavioural regulation = Anything aimed at managing or changing objectively observed or
measured actions
What is the COM-B model of behaviour?
simplified into 3 =
- Motivation
- Opportunity
- Capability
- recognises that behaviour is part of an interacting system involving capability, opportunity, and motivation.
- Interventions need to change one or more parts so that it works differently and minimise the risk of it reverting.
- An individual must have adequate capability, opportunity, and motivation for a behaviour (e.g. adherence to medicine-taking) to take place
Changing health behaviour that pharmacies offer
- Smoking cessation
- New medicines service
- Weight loss
- Patient Medicine Reviews
- Helping patients understand how to take their medicines and get the most out of them
