Health Psychology and Human Diversity Flashcards
What are the 5 key components to motivational interviewing?
- express empathy- convey understanding, acceptance and interest in patient.
- avoiding argument- argument increases resistance to change as consolidation of what they are doing wrong in their mind as try to convince dr reasons for doing so.
- rolling with resistance- use humour, highlight that other people can’t do what they can’t do aswell.
- supporting self-efficacy
- develop discrepency- person needs goals to work towards, and must accept that they are at a particular point, which is a certain way off from where they want to be, so with appropriate support, they can move along a cycle of change.
What are the 4 ways to aid coping?
- increase/mobilise social support
- increase personal control
- reduce ambiguity/uncertainty
- stress managment techniques- behavioural, cognitive, physical, non-cognitive, emotional strategies.
Give examples of intentional and unintentional non-adherence
Intentional (assoc. with attitudes, beliefs and expectations)- avoidance of SEs, poor dr-patient interaction, denial of illness threat, stop treatment early when symtoms subside, avoid social stigma
Unintentional-capacity- forget, can’t understand instructions
resource limitations- can’t access prescriptions, lack of social support
How can doctors help patients that are terminally ill?
Discuss illness and treatment
Involve them in decisions- allow control
Try to address fears and anxiety
Empathise
Be calm and mindful
Don’t take anger personally
Help them make most of time they have left
Help them and family work through anticipatory loss and grief
Help them die with dignity- where and how they wish
Stages of adaptation to terminal illness?
Denial Anger Bargaining Depression Acceptance
Why is it important as a doctor to not presume the sexual behaviour of a patient who identifies themselves as gay?
As we cannot infer someone’s sexual behaviour from their identity, often these do not coincide. Sexual attraction includes feeling, behaviour and identity. We must be able to get the patient to talk about their behaviour, as every patient will be different.
Generally, why do LGB population experience poorer health?
They experience discrimination and marginilisation, so more likely to smoke- unhealthy behaviour can be a coping strategy, suffer anxiety and depression- older people more likely to live alone, to have no children to call upon in times of need, may have been rejected by their families, and will be less likely to access services for older people, and may be reluctant to access healthcare if they have received discrimination from authorative figures in the past as drs are seen as authorative figures, so patient may worry about discrimination and trusting the dr, e.g. if received discrimination from teachers.
How does discrimination lead to poorer health?
Increased stress
Low self esteem- less likely to use condoms- STIs
Isoaltion- lack social support, poor housing
Increased conflict
Sub-culture- smoke, drink, drugs
Distrust of authorities so won’t seek h.care as -ve past experiences
Discriminatory healthcare e.g. lesbians refused smear tests
How can drs avoid heterosexism- the assumption that heterosexuality is the only normal and valid form of sexuality and that anyone who is not heterosexual is abnormal?
- don’t assume a patient has an opposite sex partner
- don’t assume a child’s parents are an opposite sex couple
- don’t assume a same sex partner is not ‘next of kin’
How can stereotyping affect healthcare?
Assuming a butch looking woman does not need contraception
Assuming a masculine-looking man does not have anal sex
Assuming a married man does not need an STI test
Assuming a lesbian does not want to have children
Specific health needs of LGB people?
- mental health- but must not presume that a patient’s depression stems from their sexuality, but if it does, counselling to do with their sexuality may be useful
- substance use- increase risk of unhealth behaviours-coping strategy
- cancer- lesbinas must receive smears- many had sex with men, HPV can be transmitted between women. Also higher risk of breast cancer- smoking, alcohol, weight, less breast-feeding and less screening. Men- anal caner risk higher in men who have sex with men, HIV positive men have double this increased risk
- STIs- risk depends on lifestyle- e.g. always having sex after alcohol- TOPB- lack of perceived control- won’t use a condom, and condom use- may be low if low self-esteem. Women can contract STIs from women.
How to be a good dr to LGBT patients?
don’t make asssumtions
language- validate and affirm their identity
coming out
confidentiality- don’t out patient to family and friends if they don’t want you to, check what info. you can pass on and if this is relevant
reflect upon and think about how to deal with your own feelings- don’t let views predudice treatment
Challenge homophobia- challenge collaegue’s behaviour
Why is it important to tell patients when there is bad news?
maintain trust reduce uncertainty prevent unrealistic expectations allow appropriate adjustment promote open communication most want to know their diagnosis lack of info can increase patient uncertainty, anxiety, distress, and dissastisfaction drs find it easier to treat and care for patients if they know their diagnosis
Model for breaking bad news?
SPIKES
Setting and listening skills- inform face to face, preferably patient 1st, ensure privacy, allow time, no interruptions, find out who patient wants present, introd. yourself and other collageues(ideally no >3), sit down, eyes on same level- eye contact, calm, no physical barriers e.g. computer, tissues available, listening mode- silence and repetition
Patient’s perception- find out what they know already before starting, start with a general qn- what have you been told about this so far?
Invitation from patient- don’t assume they will wan to know everything. Respect decision to decline info. and offer opport. for further discussion, allow for denial.
knowledge- give a warning shot, direct patient to diagnosis- give info in small chunks, allow time for patient to consider and ask qns, check understanding- could ask patient to summarise, avoid jargon, align language with patient- clear and simple explanations, incorporate key terms used by patients e.g. spread
empathy- ask them how they feel, aknowledge emotion to news- i can see this is upsetting, validate/normalise emotion- i can understand how you feel, not surprising, listen to patient concerns, It can be helpful to ask patients what they are most concerned about, as you might be able to help alleviate some of their concerns
strategy and summary- summarise main discussion topics, discuss strategy, agree on next step, be optimistic but avoid false hope, closure- give opportunity to ask qns, offer future availability, if still distressed, ask if they would like anything else- HCP to stay with them, someone contacted, or to be left alone.
Why are health related behaviours important?
in understanding the causes of disease, but also need to be take into account in managing patents with chronic disease, so if you have a patient with cardiovascular disease then modifying lifestyle and behaviour will be an important part of treating and managing the condition.
Tobacco and alcohol use, blood pressure, cholesterol levels and obesity have a particular impact on disease.
Describe learning theories of health related behaviour?
These suggest are behaviours are learned through association and are shaped by our experiences of the environment. Tend to occur without conscious input. Include classical conditioning, operant conditioning, and social learning theory.
Why, in relation to operant conditioning, can it be hard to stop drinking alcohol?
Alcohol associated with a ST reward- we feel better and can releive stress instantaneously, and we are driven by ST rewards, rather than thinking about LT problems to do with our health.
Therefore, in this situation, abstinence from alcohol could be associated with reward e.g. putting money in a jar when she would have bought alcohol, to save up for buying some nice clothes.
How can social learning theory be used to help change health related behaviour?
The theory suggests that we model our behaviour on the behaviour of others and the consequences of this on those people. We are more likely to model our behaviour on someone who is high profile, or who we can relate to- who is like us e.g. peers. So, by using role models in health promotion campaigns e.g. people we can relate to and celebrities, can help change behaviour.
Negatives of learning theories?
Focused on unconscious behaviours. Don’t take into account people’s emotions, their thoughts and feelings on their behaviour.
Describe the structure of the health belief model
This is a social cognition model which incorporates how people think and feel about their behaviour. It encompasses beliefs about the health threat- perceived susceptibility and severity, and how they evaluate the outcome, so beliefs about changing the health-related behaviour- perceived benefits and barriers, and also cues to action e.g. for a heavy alcohol drinker, watching an advert about the risk of certain diseases associated with drinking. All of these factors determine what action will be taken by a patient in terms of their health-related behaviour.
Modifying factors e.g age, sex, personality, can affect their belief about threat and outcome, and cues to action affect the perceived disease threat e.g. education, symptoms, media.
Discuss the theory of planned behaviour
This is a social cognition model that assumes that the strongest predictor of behaviour is behavioural intention. The model suggest are intentions are influenced by our attitudes- what we think about changing the behaviour, subjective norm- what do people close to me think? what do my friends do?, and perceived control- do I think I can change my behaviour.
Disadvantages of theory of planned behaviour
Intentions are frequently not the same as our actual behaviour change. Can tackle this via implementation intentions- concrete plans of action- what you will do, what to do if this goes wrong, as this can help connect the gap between intention and behaviour.
Describe the transtheoretical model (stages of change model)
This looks at the stages people go through when changing their health related behaviour, rather than trying to explain why people have a particular behaviour.
Stages: pre-contemplation- happy with their behaviour, never considered change, may get angry if change suggested
contemplation- reflect upon benefits and barriers to changing behaviour
planning- how do we go about changing behaviour
action
maintenance
relapse
Why is the IS upregulated in response to stress?
In the short term to repair damage, and in the long term to prepare body to fight infection, but immune function can become suppressed after a prolonged period e.g. due to cortisol- stress hormone, suppressing thymus gland
What model is used to show the damaging effects of long term stress?
General Adaptation Syndrome model: stages of bodies’s response to stress: alarm, resistance, exhaustion
What valid measures for stress are available?
Stressful life events scale and daily hassle scale
Describe the transactional model of stress
This shows stress as a process, aknowledging that what 1 person finds stressful may not be found stressful by someone else, and that there may be different degrees of stress experienced by different people to the same stressor. The model assumes that this is because of people’s differing appraisal of a particular stressor, and their ability to cope with them.
Based on the transactional model of stress, when do people exhibit a stress response?
When their demands (stressors) are appraised as being greater than their resources or skills to cope
Describe the process of appraisal that takes place int he transactional model of stress
Primary appraisal- how threatening do we perceive the stressor to be
Secondary appraisal- assess our resources and skills to cope
Reappraisal- may reconsider situation once we have tried to cope with it
Physical stress symptoms?
Feeling dizzy or faint
Chest pains- HR increased as SNS activated
Breathlessness- resp. rate increased as increased met. activity of tissues- produce more CO2, detected by central chemoreceptors
Headaches
Stomach problems- energy diverted away from digestion to other more important functions
Psychological stress symptoms?
Depression, anxiety, anger, irritability
Behavioural stress symptoms?
Sleep pattern changes, eating pattern changes, increases in unhealthy behaviours
How can stress impact on health?
Immune system
Physical damage
Mental health- -ve thinking habits- cognitive distortions
Unhealthy behaviour
may exhibit signs of learned helplessness- give up, become depressed, so less likely that people will engage in health protecting behaviours, will be motivated to change unhealthy behaviours, or to seek medical or psychological support.
Pattern of distress a child shows when separated from their caregiver?
initial protest
despair
detachment
Describe good practice in hospitals when children must stay there away from their caregiver?
Maximise opportunities for parent/carer access
Encourage children to bring attachment objects e.g. teddy
Maximise continuity of care with staff for children
Create home-like environment
Psychological and physiological factors that can open and close gates- gate control theory of pain
fear or anxiety
medication or physical stimulation
Why is it important to identify people with chronic illnesses that are also suffering from psychological problems?
Assoc. with -ve health related behaviours e.g. alcohol and smoking
Further compromise QOL
Tend to cope less well with treatment, have lower adherence, and increased risk of morbidity and mortality
Descibe CBT
This assumes that when anxiety or depression, people get stuck in -ve cycles of thinking, creating -ve views of themself, the world around them and their future. So aims to break these cycles, challenge maladaptive thoughts and beliefs and behaviours. Cognitive techniques used so patient examines and challenges their thought processes, and behavioural- role play and gradual exposure to feared situations
4 stages to Piaget’s model of intellectual development?
Sensori-motor
Pre-operational
Concrete operational
Formal operational
Describe the components of the biopsychosocial model
this is a holistic approach, sees patients as real people rather than a disease. Recognises that there is a causal influence of biological, psychological and social factors on health and illness, health related behaviour and in response and treatment after diagnosis.
Biological factors: physiology, pathogens, genetics
Psychological: emotions, thoughts and cognition, behaviour, stress, anxiety, depression, lifestyle choices
Socail: social class, diet, living conditions, social support- important coping mechanism, employment
describe the biomedical approach to health and illness
mind and body are independent, all diseases can be explained by physiological processes, and so treatment does not consider the person as a whole, but is focused on eradication of the pathology, and the patient is not responsible for their own health. Little causal role of psychology
describe the biopsychosocial approach to health and illness
mind and body influence one another, are part of a dynamic system, disease is multi-factorial, so all of these must be considered in treatment e.g. psychiatric therapy, exercise, diet change, psychology is very important and responsibilty for health rests with the patient as well as others in society and HCPs.
problem with stereotypes?
overlook diversity and individuality
can be susceptible to predujice as -ve bias- emphasis tends to be on -ve traits
good points about stereotypes?
provide helpful shortcuts, can be useful in an unfamiliar situation
energy saving
when are we moire likely to rely on our stereotypes?
under time pressure
fatigued
suffering information overload
unfamiliar situation
how can we challenge our -ve stereotypes?
get to know members of other groups and reflective practice
what is a stereotype (cognitive)?
how we think about a particular group of people, generalisations made a bout the specific group and its members
what is the basis of our stereotypes?
due to how we store memories, organise our knowledge in schemata- so stored as mental representations within groups of related information. We remeber what fits into a schema
what is predujice?
emotional component. evaluative and affective. Judge prior to having relevant facts, often based on -ve stereotypes.
what is discrimination and how can it affect LGBT health?
behavioural component. Act upon prejudice so behave differently with people from different groups because of their group membership.
Results in uptake of unhealthy behaviours in LGBT pop. and a reluctance to seek health advice and support if they have received discrimination from professionals in the past
which part of our intelligence tends to decline with age?
fluid intellignece: problem solving without prior knowledge or experience ST memory and processing speed, how we process new information
what part of our intelligence remains fairly intact with ageing, unless dementia?
crystallised intellignece: LT memory and reflects experience, highly learnt skills and general knowlege, retrieving knowledge
clinical management of older patients?
recognise their impairments, must check their capacity, but may not be a decline in cognitive function so musn’t patronise patient.
Should allow for more time for information to be considered as decline in fluid memory, so reduced processing speed
check expectations- may want dr to be the expert and provide solutions for the patient and to make decisions for them
why are generalisations even more unhelpful with older people?
as such a diversity in group of old people
People often presume old age to be a period of stagnation, how is this a false presumption?
old age is a period of great and often unanticipated change during which people must adapt rapidly to enforced limitations e.g. health decline, bereavement
what can be used to test fluid intelligence?
IQ tests
indicate old people mentally disadvantaged, but behaviour contradicts this as crystallised intelligence intact
tests may overlook real world skills
what is associated with fluid intelligence decline?
physical health and organic change in CNS
give examples of health related behaviours
smoking drinking drugs exercise healthy diet screening activities safer sex adhering to treatment regimes
what are the 3 learning theories?
classical conditioning
operant conditioning
social learning theory
what are learning theories of health related behaviour?
associative learning- we learn the relationship between 2 events that occur together and then our behaviours are learnt unconsciously
how can classical conditioning be extinguished?
by presenting the conditioned stimulus- that associated with the unconditioned stimulus, producing an conditioned response, repeatedly without the unconditioned stimulus e.g. Pavlov’s dogs: present a bell repeatedly without presenting the food afterwards
what is classical conditioning determined by?
the nature of the stimulus, stimulus order and timing- so neutral stimulus must be presented very shortly before unconditioned stimulus
why can attempt to condition a 3rd stimulus be blocked?
if previous conditioned stimulus is still relied upon
describe the theory of Pavlov’s dogs
dogs would salivate at times other than when presented with food, so Pavlov wrung a bell- neutral stimulus, shortly before presenting dogs with food, and this stimulus became conditioned so that ringing the bell would cause the dogs to salivate- a conditioned response, as the dogs associated the bell- now a conditioned stimulus, with the presentation of food- unconditioned stimulus
problem with conditioned behaviours e.g. smoking on a work break as associated with environment or emotion e.g. anxiety
can become habit- these are difficult to break
where is classical conditioning seen in healthcare setting?
anticipatory nausea or vomiting by patients before visiting a hospital as the hospital environement is assocaited with this response from a previous bad expereience e.g. chemotherapy
how can we alter an unhealthy behaviour by getting rid of classical conditioning?
we can establish association of behaviour with an unpleasant response e.g. taking medication with alcohol so symptoms of nausea produced are associated with the alcohol.
We can also break and unconscious response e.g. elastic band around a packet of cigarettes
how can classical conditioning explain why a patient smokes?
smoking associated with environement e.g. work environment, or an emotion e.g. anxiety
give an example of how operant conditioning came about?
Skinner: rat in a box with a leverm if lever pushed then would be given a pellet- reward, so rat kept touching the lever
how are behaviours more quickly learned in operant conditioning?
by +ve reinforcement so giving a reward or removing a punishment. Learn from consequences of our behaviour
