Health Psychology and Human Diversity Flashcards
1
Q
What are the 5 key components to motivational interviewing?
A
- 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.
2
Q
What are the 4 ways to aid coping?
A
- increase/mobilise social support
- increase personal control
- reduce ambiguity/uncertainty
- stress managment techniques- behavioural, cognitive, physical, non-cognitive, emotional strategies.
3
Q
Give examples of intentional and unintentional non-adherence
A
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
4
Q
How can doctors help patients that are terminally ill?
A
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
5
Q
Stages of adaptation to terminal illness?
A
Denial Anger Bargaining Depression Acceptance
6
Q
Why is it important as a doctor to not presume the sexual behaviour of a patient who identifies themselves as gay?
A
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.
7
Q
Generally, why do LGB population experience poorer health?
A
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.
8
Q
How does discrimination lead to poorer health?
A
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
9
Q
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?
A
- 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’
10
Q
How can stereotyping affect healthcare?
A
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
11
Q
Specific health needs of LGB people?
A
- 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.
12
Q
How to be a good dr to LGBT patients?
A
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
13
Q
Why is it important to tell patients when there is bad news?
A
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
14
Q
Model for breaking bad news?
A
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.
15
Q
Why are health related behaviours important?
A
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.
16
Q
Describe learning theories of health related behaviour?
A
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.
17
Q
Why, in relation to operant conditioning, can it be hard to stop drinking alcohol?
A
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.
18
Q
How can social learning theory be used to help change health related behaviour?
A
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.
19
Q
Negatives of learning theories?
A
Focused on unconscious behaviours. Don’t take into account people’s emotions, their thoughts and feelings on their behaviour.
20
Q
Describe the structure of the health belief model
A
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.
21
Q
Discuss the theory of planned behaviour
A
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.
22
Q
Disadvantages of theory of planned behaviour
A
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.
23
Q
Describe the transtheoretical model (stages of change model)
A
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
24
Q
Why is the IS upregulated in response to stress?
A
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
25
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
26
What valid measures for stress are available?
Stressful life events scale and daily hassle scale
27
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.
28
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
29
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
30
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
31
Psychological stress symptoms?
Depression, anxiety, anger, irritability
32
Behavioural stress symptoms?
Sleep pattern changes, eating pattern changes, increases in unhealthy behaviours
33
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.
34
Pattern of distress a child shows when separated from their caregiver?
initial protest
despair
detachment
35
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
36
Psychological and physiological factors that can open and close gates- gate control theory of pain
fear or anxiety
| medication or physical stimulation
37
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
38
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
39
4 stages to Piaget's model of intellectual development?
Sensori-motor
Pre-operational
Concrete operational
Formal operational
40
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
41
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
42
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.
43
problem with stereotypes?
overlook diversity and individuality
| can be susceptible to predujice as -ve bias- emphasis tends to be on -ve traits
44
good points about stereotypes?
provide helpful shortcuts, can be useful in an unfamiliar situation
energy saving
45
when are we moire likely to rely on our stereotypes?
under time pressure
fatigued
suffering information overload
unfamiliar situation
46
how can we challenge our -ve stereotypes?
get to know members of other groups and reflective practice
47
what is a stereotype (cognitive)?
how we think about a particular group of people, generalisations made a bout the specific group and its members
48
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
49
what is predujice?
emotional component. evaluative and affective. Judge prior to having relevant facts, often based on -ve stereotypes.
50
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
51
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
52
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
53
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
54
why are generalisations even more unhelpful with older people?
as such a diversity in group of old people
55
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
56
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
57
what is associated with fluid intelligence decline?
physical health and organic change in CNS
58
give examples of health related behaviours
```
smoking
drinking
drugs
exercise
healthy diet
screening activities
safer sex
adhering to treatment regimes
```
59
what are the 3 learning theories?
classical conditioning
operant conditioning
social learning theory
60
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
61
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
62
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
63
why can attempt to condition a 3rd stimulus be blocked?
if previous conditioned stimulus is still relied upon
64
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
65
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
66
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
67
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
68
how can classical conditioning explain why a patient smokes?
smoking associated with environement e.g. work environment, or an emotion e.g. anxiety
69
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
70
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
71
how does operant conditioning explain our susceptibility to unhealthy behaviours?
These behaviours provide ST rewards which we are driven by
72
how can health-related behaviour be changed with operant conditioning?
by associating the change in health behaviour with a reward e.g. not smoking- money that would have been used is put into a jar to save for a holiday
73
limitations of conditioning therapies?
assume involuntary behaviour and based on a simple stimulis- response, no account on cognitive processes, knowledge, beliefs, memory, attitudes etc., and no account of the social contex
74
+ves of conditioning therapies?
allow us to assess why people have particular health-related behaviours, and can devise ways to change unhealthy behaviours e.g. by associating changing the behaviour with a reward
75
describe the experiment used for social learning theory
bobo doll experiments- when children observed an adult being aggressive to the doll, they were more likely to do the same when they played with it if the behaviour of the adult wasn't punished
so people have particular health related behaviours because they have copied other people whose behaviour may have been rewarded or not punished e.g. someone who smokes all their life and lives until their 90s, never getting LC
76
when are we likely to change our health related behaviour based on imitating someone else?
if the person we imitate is rewarded, high status, friendly or similar to us
77
what are social cognition models?
used to asses why people have a health related behaviour, taking into account how people feels, think and behave
78
basis of cognitive dissonance theory ( a social cognition model)?
people experience significant dicomfort if their strongly held beliefs are proved wrong e.g. if a smoker believes smoking only 10 cigarettes a day isn't harmful to his health, and you as a dr inform him of the number of lung cancer deaths experienced by those who smoke this amount and that this is a large figure
79
relevance of cognitive dissonance theory to hcare?
explains why people have an unhealthy behaviour e.g. smoking, due to believing that this behaviour isn't that bad for them, but if we can disprove this belief, then this causes the patient discomfort, and so they will be willing to change their beliefs or behaviour to reduce the discomfort
80
disadvantages of cognitive dissonance theory?
information given to a patient alone is not effective
still going to be affected by other factors
and people can discount this information e.g. putting stickers saying smoking is cool on cigarette packets
81
disadvantages of health belief model?
assumes we are rational and reasoned when weighing up benefits and problems but unsafe sex/chocolate- driven by emotions/ hunger, we only think about the consequences afterwards
incomplete- doesn't consider self-efficacy- whether we believe we are capable of doing something, and broader social factors
decisions- habit/conditioned behaviour, have no control, may be coerced into behaviour
emotional e.g. fear
82
how can barriers to behaviour change in HB model be reduced?
problem-solving or creating action plans
| benefits could be enhanced by education
83
benefits of theory of planned behaviour model?
takes into account social pressures and norms, and how much control a person believes they have over their behaviour, and so relation to self-efficacy
good intentions predictor
84
structure of theory of planned behaviour model
attitude toward behaviour, subjective norm and perceived control e.g. if a patient doesn't think they have any control over their smoking, they won't be inclined to quit, all affect our intention, which the model assumes is our strongest predictor of behaviour
so basically, what I think of the behaviour, what others think, and how easy is it to do
actual, rather than perceived lack of control thought to be direct link between control and behaviour e.g. not having suitable transport to go to a smoking cessation clinic
85
-ves of theory of planned behaviour?
poor predictor of behaviour as big gap between what we intend to do and what we actually do
to tackle this: implementation intentions- concrete action plans of what we will do, when and where and what to do if we run into difficulties
86
positives of transtheoretical model (stages of change)?
recognises that people are at different stages in terms of their willingness to change, so interventions can be targeted to their stage
aknowledges that relapse is common
87
negatives of stages of change model?
people don't always move through the stages consecutively
88
management of patients with substance misuse and other dependence issues?
consider biopsychosocial model
Drug problems- medical/ pharmacological tment, assisted detox and substitute prescribing, counselling, motivational speaking, help people to find work, support groups
Alcohol problems- diazepam, vit B amd B1 complex but overdose risk, supportive e.g. nutritional supplements, vit supplements, high dose parenteral thiamine for prevention and t.ment of wernicke-korsakoff syndrme- encephalopathy, relapse prevention- disulfiram- inhibits aldehyde dehydrogenase so toxic acetaldehyde accumulation- nausea for a wk, monitor vital signs, electrolytes. glucose, thiamine, management of withdrawal- aggressive patients, procedure must be in place for dependent drinkers
support must be given before, through and after t.ment
89
what is compliance?
extent to which a patient does exactly what a dr tells them in terms of the medical advice given. Dr an authorative figure, no scope for patient involvement in care and treament
90
what is adherence?
extent to which patient behaviour coincides with the medical advice. more patient-centered, need for agreement between patient and dr, aknowledges patient's right to decide on their tment
91
examples where high rates of adherence?
cancer, arthritis, HIV, Gi disorders
92
examples where low rates of adherence?
pulmonary disease, diabetes, sleep disorders
93
what is the impact of non-adherence?
impact on patient's health- increased hospitilisations, morbidity, and mortality
financial implications- increased consultation times
94
what counts as non-adherence?
not taking enough e.g. exercise, taking too much e.g. painkillers, not taking at prescribed intervals, not taking for prescribed duration*TB, taking medication not prescribed
95
how can we measure adherence?
direct measures: urine or blood test- can provide a direct measure of consumption, but expensive, limited to clinical setting use, affected by metabolism, can still mask non-adherence e.g. patient taked medication right before a blood/urine test but hasn't been taking that previously
observation e.g. of consumption
indirect measures: pill counts- more objective than self/other reports, but still subject to inaccuracy e.g. lost pills
mechanic or electronic measures of dose e.g. record time at which container opened- objectively measures whether dose dispensed, more accurate than other indirect measures, but doesn't measure whether the medication was actually taken
patient self-report- easy to obtain, inexpensive but prone to inaccuracies/bias, tendency to over report adherence
second hand reports from doctors/carers- easy to obtain, depends on familiarity with the patient
96
what are the 5 contributing factors to the multi-dimensional model of adherence?
```
illness factors
patient factors
psychosocial factors
healthcare factors
treatment factors
```
97
describe how illness/disease factors contributes to adherence?
adherence much better if symptoms e.g. arthritis, problems in asymptomatic conditions e.g. hypertension and early type 2 diabetes, preventative tment e.g. aspirin for CVS problems- no trigger to take medication as no current implications of the disease i.e. no symptoms. fluctuating symtoms e.g. asthma- less likely to take tment
how serious? with less serious disease, patients with objectively poorer health more likely to be adherent
more serious disease- patients in poorer health significantly less likely to be adherent, probably think situation is hopeless, if medication causes SEs want to try and have best QOL if they think they're are going to die whether they take the tment or not, more severe disease- more practical, psychological and physical barriers to adherence
98
describe how tment factors contribute to adherence?
preparation- tment setting, waiting time, time of referral, inconvenience or poor reputation
immediate character- complexity of regimen, duration, degree of behaviour change, inconvenience e.g. timings and route of admin, inadequate labels
administration- HCPs supervision, continuity of care
consequences- physical SEs, social SEs, stigma
99
describe how patient factors contribute to adherence?
Understanding and recall- patient undertanding of what they have been told in consultation, and of their illness, body and tment regimes
recall- remembering tment name, how much dose. Recall influenced by knowledge, anxiety, number of statements
but enhancing knowledge isn't enough, depends on their beliefs and lifestyle
Beliefs- HBM- extent of adherence depends on perceived disease severity and suceptibility, and barriers and benefits to tment prescribed
Better adherence if believe condition serious, perceive more benefits, fewer barriers, more motivated
beliefs about illness- severe, symptoms
beliefs about medication- necessity, harmful effects, stigma, conflict with activities e.g. drinking alcohol, tolerance
100
describe how psychosocial factors contribute to adherence?
psychological health: less likely to adhere if reduced mental capacity or depressed state. Could try and give emotional encouragement
social support: socially isolated- less likely to adhere, social support good, family support-cohesive families better. social context- homelessness
101
describe how healthcare factors contribute to adherence?
setting- primary vs secondary setting, inital vs follow up consultation, regular follow-up, waiting times, venue accessibility
prescriber- belifs and attitudes towards tment, 'new prescribers'-pharmacists, nurses
dr-patient interaction- perceived manner, +ve behaviours- eye-contact and smile, communication, perceived competence
102
interventions to tackle non-adherence?
address practical barriers- resources and capacity
address perceptual factors influencing motivation e.g. discussing patient's beliefs.
but few approaches truly patient-centered, and may lack theoretical input- difficult to tell why some interventions work and some do not
improving adherence: specific action plans
clear written info, both written and verbal reenforcement
electronic reminders
counselling and support
discussing illness severity
give appropriate feedback
non-confrontational asking of patient about barriers to adherence
discuss adherence at time when tment is prescribed
103
what is concordance
negotiation between patient and dr over tment regimes, consultation process, help patient agree, dr must understand their views, patient's beliefs and priorities respected, patient active- decisions made in partnership with dr
joint plans between patient and dr
104
why does concordance lead to better adherence?
patient involved in decisions
patient's beliefs can be taken into account
barriers to adherence can be addressed
promotes patient trust and satisfaction with care
105
tensions in concordance?
between evidence-based medicine and patient-choice
| between individual rights and responsibilities
106
3 stages of the sexual response cycle?
desire
arousal
orgasm
107
what sexual dysfunctions assoc. with sexual arousal?
men- erectile disorder
| women- sexual arousal disorder
108
problems with orgasm?
men- rapid ejaculation, inhibited orgasm
| women- orgasmic dysfunction
109
other sexual dysfunctions in women?
vaginismus- involuntary spasm, primary or secondary
dyspareunia- painful sex
sexual aversion and lack of sexual enjoyment
110
why is it important to treat anxiety and depression in chronic illnesses?
Compromises quality of life
Patients cope less well with treatment
Association with poor HRB e.g. drinking, smoking (HRB= health related behaviour)
Association with lower adherence to treatment
Increased risk of morbidity and mortality
111
why might patients not share their psychological problems?
May wish to avoid being judged as inadequate or failing to cope
May wish to avoid complaining/presenting additional burden
Fear of stigma associated with mental illness
Believe psychological problems are inevitable in their condition
Fear of consequences e.g. more medication
Doctor’s poor communication skills
Lack of time in consultations
112
why might HCPs not ask about psychological problems?
May believe psych problems are outside of their role/fear of overwhelming distress of the patients
Reluctance to label patients as having psychological difficulties
113
when is CBT used?
depression, anxiety, eating disorders, schizophrenia, phobias
114
what do psychoanalytic/psychodynamic therapies achieve?
| (example of formal psychotherapy?
Address unconscious conflicts and resolve previous painful experiences
explores feelings, using experience of therpaist and relationship- transference and coutnertransference, but therapist tries to remain as neutral as possible
Suitable for: interpersonal/personality problems
and people with the capacity to tolerate mental pain and interest in self-exploration , as attempts to enhance insight of difficulties and incorportate previous painful experiences
115
what type of therapy might be suitable for a patient to help them cope with an immediate crisis where already motivation and willingness to problem solve?
humanistic/client-centered thereapy- relies on general counselling skills- warmth, empathy, unconditional +ve regard
116
why is it important to explain to a child why they are being separated from their parents in hospital?
as often they think they are being punished so must be reassured that this is not the case to reduce their distress
117
how can a dr demonstrate good communication with a child?
```
smile when appropriate
be calm
speak simply and clearly
act out-role play
maintain good eye contact
quick fixes- rewards like stickers
give choice
```
118
what 3 key things determine action in health belief model?
cues to action e.g. media, education
beliefs about health threat
beliefs about health-related behaviour
119
what is the job of the health professional in motivational interviewing?
NOT to impose change, but to try to help patients move to a position where they themselves feel motivated to change
120
most age-sensitive component of intelligence?
processing speed
121
what model shows that the long term stress response is damaging?
General adaptation syndrome:
Alarm- mobilisation to meet and resist stressor
Resistance- adapt and resist stressor, but stress hormones remain high
Exhaustion- defensive resources depleted, risk of illness and death
122
what model shows stress as a process?
transactional model of stress
123
problem with stress being just a physiological response?
helps understand why stress can impact directly on health BUT not a complete explanation of stress as only bio, no account of differences between people, assumes all stressors produce same response, effects all seen as outcomes after exposure to stressors
124
problem with stress being considered as from the outside?
objective way to measure stress, correlation between daily hassles and life events with subsequent morbidity and mortality, and incorporates different impact of different stressors BUT
recall bias- ill people more likely to recall stressful events
short vs long term stressors
individual differences
125
what factors influence effect of stress on individuals?
features of stressor- novelty, unpredictability, how important, control
individual differences: how stressed already, personality characteristics, resources, coping strategies
126
what happens with the physiological stress response that can be damaging to health?
up-regulation of CVS, so risk of physical damage e.g. athersclersosi and MI
127
what are the +ves and -ves of the transactional model of stress?
+ves: recognises social and psych factors
accounts for variation in response to stressors
suggests ways to help people manage their stress
-ves: complex model, difficult to prove
128
what do patients have to cope with?
illness related: diagnosis e.g. shock, depression
treatment
physical impact
hospitilisation- loss of control, loss of privacy
socioeconomic: financial if work affected, social e..g. housing, relationship problems
adjustment: identitiy change, chronic nature of illness, aknowledging own mortality with a chronic illness
other life events: family, personal, workplace, financial
129
2 coping styles:
emotion focused and problem focused
emotion:change emotion- behavioural e.g. talking to friends- social, cognitive approaches- focus on +ve aspect of the problem
problem: change problem or resources e.g. reduce demands of a stressful situation e.g. finding out how to cope, or expand resources
130
how can uncertainty be reduced to increase coping?
effective communication, peer contact, be responsive to individual preferences
131
what is anxiety?
response to threat
132
what is depression?
response to loss, failure or helplessness
133
how can psychological problems be managed?
support in coping (prevention)
counselling and psychological therapies e.g. CBT- formal psychotherapy for depression
medication e.g. antidepressants
134
how to communicate well with a patient with a disability?
talk to their relatives
longer consultation times
treat like any other patient but make allowances for their disability
135
how to communicate well with a deaf patient?
```
speak clearly
good eye contact
sign language
don't shout
suitable setting- no background noise
don't rush consulation
presence of an interpreter- check their understanding of medical terms
```
136
how to communicate well with a blind patient?
use body language
speak naturally and clearly
use everyday language
identify yourself
give information in different formats- large print, braille, audio tapes
inform them about where they can find information in a suitable format
137
importance of a secure attachment?
influences brain development
better social competence, peer relations, self reliance, physical and emotional health
ensures child knows they are worthy of love and care
138
stages of social development in infancy (Schaffer)?
newborns show preference for human faces to inanimate objects, first social smile at 6 wks
3mnths- distinguish strangers from non strangers, allow any adult to care for them, preference for non-strangers
7-8mnths- specific attachments, wary of strangers, show signs of distress if key people are missed
139
describe attachment styles shown by strange situation
secure- calmed when mother returns, but stressed otherwise, shows mother is quick to respond to child's needs
insecure- avoidant- no response to mother's departure or return, so mother doesn't respond to upset child and encourages independence
ambivalent- little bit stressed before, and still stressed when mother returns, result of mother discontinuity
disorganised- child may rock or freeze when mother returns, so child maltreatment
140
behavioural changes when attachment figure is absent?
```
bed wetting
detachment
increased aggression
separation anxiety
clinging behaviour
```
141
physical changes when attachment figure absent
changes in HR and body temp
less sleep
depression
142
3 phases of behaviour after separation, in children, from their caregiver?
protest- distressed, cling to caregiver
despair- helplessness, intermittent crying
detachment- more interested in surroundings
143
why is most distress seen in children ages 6mnths to 3 yrs if separated from their caregiver?
can't keep image of caregiver in their mind
think they are being punished
lack ability to understand abstract concepts
limited language
144
implications for health outcomes of separation from caregiver
less adherence to tment as stressed and anxious, so can impede recovery
experience more pain as anxiety high
may suffer adverse effects of stress on health
145
criticisms of attachment theory?
too simplistic- trad family model
no assessment of quality of substitute care
only focused on mothers
no exploring of multiple attachment figures fomed
146
sensori-motor stage of piaget's theory of childhood cognitive development- child's thinking structured differently to in adults, not just a smaller brain!
0-2yrs
```
world experienced through sneses
develop motor coordination
no abstract concepts
develop body schema
permanence understood at about 8 mnths- understand that objects still exist when they can't see them
```
147
pre-operational stage of theory?
2-7yrs
language development, imagination
egocentricism- can't see things from other people's point of view
lack concept of conservation
classification by a single feature
148
concrete operational stage?
```
7-12yrs
achieve conservation
think logically- concrete not abstract
classification by multiple features
see things from other persepectives
```
149
formal operational stage?
12yrs +7
abstract logic
hypothetic-deductive reasoning
150
problems with piaget approach?
focus on what a child cannot do, underestimate, overestimate adults
partial info given to a chuld if deemed they can't understand a concept, but child will try and make sense of it anyway so can be damagin
151
Vygotsky's theory of social development?
cognitive development requires social interaction
| zone of proximal development- gap between what they can udnerstand on own and what can be achieved by help of others
152
child cognitive theories implications for practice?
don't assume average ability, assess their understanding
young children lack theory of mind, may think others know how they feel so assume drs know they're in pain
danger of using metaphors
difficulty thinking about future
153
what NOT to do when talking to a child?
stand over a child, use force
expect same things at different ages
rush
express frustration, avoid blame and criticism
promise things you can't deliver, be truthful
154
how to break bad news?
SPIKES
155
describe the gate control theory of pain
Pain is experienced in brain through complex pathways in body from damage/disease source. (Like a telephone exchange)
Different types of pain fibres have been identified, fast, slow, hot, cold, blunt, sharp.
Two important neural relays or gates for messages to pass through. Located in dorsal horn of spinal cord.
Gate Control Theory - says that pain is a result of a 2-way process or communication between the brain and the tissue damage.
The extent that the gate is open or closed affects the number of pain messages that are received. (The more open the gate, the more pain is felt and vice versa.)
Factors that influence the gate can be physical or psychological
156
how can gate in gate control theory of pain be closed?
Things that close the gate:
Physical e.g.: Medication; counter stimulation
Cognitive e.g.: distraction; positive beliefs – control; positive emotions
Behavioural e.g: exercise; relaxation; active life
157
why might someone not engage in a pain management programme?
She may not want to accept pain is chronic and not ‘curable’ and see going to the clinic as ‘giving up’ on a cure. She may therefore want to continue to pursue medical treatment such as surgery or drugs.
She may not want to go to a service that is ‘psychological’ as they think that implies the pain isn’t ‘real’ that ‘it’s all in the mind’, or not want the stigma of being treated by a psychologist.
She may be engaged in insurance claims or employment tribunals, and therefore it may not be in their financial interest to engage with a programme that encourages them to be more active as this could jeopardise the claim.
She may not be prepared to join in with group sessions.
She may still be convinced that pain means damage and not be prepared to take part in exercises.
She may not speak English at all or well enough to participate in group work.
She may have a hearing deficit that makes group work difficult.
She may have a learning difficulty that makes group work difficult.
She may be too depressed to take part.
She may not be able to get transport, or have other practical difficulties
158
types of psychological problems seen in a patient diagnosed with cancer?
Responses may vary considerably between individuals
However they often include grief-like responses (e.g. shock, denial, anger, guilt, helplessness, despair, depression, bargaining and acceptance). There may also be some relief at getting a diagnosis and ending uncertainty.
159
what factors can lead to complications of grieving after bereavement?
Expression of grief discouraged (e.g. having to ‘be strong’ for others)
Ending of grief discouraged (e.g. guilt over ‘getting over’ the person
160
health needs more common in LGB population?
Mental health (high risk of eating disorders, panic attacks, anxiety, depression, thoughts of self harm)
Substance use (high levels of smoking, excessive alcohol consumption, recreational drug use)
Cancer (risk of cervical cancer to lesbian women often ignored; men who have sex with men are more likely to contract anal cancer, especially if HIV positive)
Sexually Transmitted Infections (higher risk of STIs although this depends on pattern of sexual behaviour)
161
what are the biopsychosocial and biomedical models concerned with factors affecting?
health and illness
162
psychology contribution to biopsychosocial model?
cognition
emotion
behaviour
163
what is a health related behaviour?
anything that promotes good health or lead to illness
164
how can the relapse stage of the transtheoretical model be addressed?
identify and avoid high risk situations
improve coping skills
encourage that relapse is normal
165
3 key strategies for changing health related behaviour
Information – health education, health promotion
Behavioural skills and resources e.g. smoking cessation programmes, exercise advice
Incentives to change e.g. financial incentives
166
what is Motivational interviewing?
cognitive-behavioural technique aiming to help patients indentify for themselves their own arguments for change, and so identify and change behaviours that increase risk of health problems or prevent optimal management. Supportive talk therapy
want to increase internal motivation
167
stress management techniques?
* Cognitive strategies - e.g. cognitive restructuring, hypothesis testing
* Behavioural strategies – skills training e.g. assertiveness, time-management
* Emotional strategies – counselling, emotional disclosure, social support
* Physical strategies – relaxation training, biofeedback, exercise
* Non-cognitive strategies – drugs
168
why do people have sexual problems?
Precipitating factors: life events, physical, psychological, partner's problems
Predisposing factors: false beliefs and concepts, unrealistic expectations, early sex trauma, physical vulnerability, poor comm skills
perpetuating: self- loss of confidence, spectating, guilt and shame
partner- pressure to perform, criticism, bdown in comm
169
what is ley's model of compliance?
understanding, memory and satisfaction all impact on compliance, and understanding and memory affect satisfaction
170
5 stage grief model to adjust to death and dying?
```
Denial
Anger
Bargaining
Depression
Acceptance
```
171
RFs for poor outcomes in bereavement?
Prior bereavements, mental health
Type of loss – young person, mature of death, caring status
Lack of social support, stress from other crises
Expression of grief discouraged
Ending of grief discouraged
172
behavioural techniques in CBT?
graded exposure to feared situations
role play
activity scheduling
reinforcement and reward
173
cognitive techniques in CBT?
education
monitoring of thoughts
examining/challenging -ve thoughts
behavioural experiments
174
main components of pyschosexual therapy?
educative coounselling
modify attitudes or beliefs
facilitate commun
175
physical tments for male SD
```
oral tehrapy
penile implant- surgery
self injection therapy
local therapy
mechanical therapy e.g. ring
```
176
physical tment for female SD
lubricants
oestrogen
testosterone
177
approaches to managing chronic pain?
```
BASICID
behaviour- improve behavioural functioning
affect- psychological interventions
sensation- learning how to control muscle groups voluntarily
iamgery- alter perception of pain
cognitions
interpersonal relationships
reducing drugs
```
