HEALTH- The Patient -Practitioner Relationship& Adherence

Question 1

Define Non-verbal communication

Answer 1

• Any interactions that take place other than talking, for example body language, clothing.

Question 2

What was the aim of Mckinstry and Wang

Answer 2

• Aimed to investigate whether patients think the way their doctor dresses is important, what their preference is and whether patients think the way the doctor dresses influences their effectiveness as a doctor

Question 3

What did McKinstry and wang carry out their study and what was the result

Answer 3

• They showed pictures of 2 doctors to the participants
• One doctor was dressed formally (white coat over a suit or skirt)
• The other doctor dressed informally (jeans)
• Patients were asked to rate how confident they are in each doctors ability
• They found that formally dressed doctor received a higher rating than the informally dressed doctor especially from older patients.

Question 4

Argyle suggested that non-verbal behaviours have 4 major uses

Answer 4

• To assist speech (Help by showing when you want to say something or emphasize)​
• As replacements for speech (e.g. raised eyebrow can replace a verbal question)​
• To signal attitudes ( e.g. trying to look cool and unworried by standing in a relaxed position)​
• To signal emotional states (e.g. you can tell when someone is happy or angry by the way they sit or stand)

Question 5

Define Verbal communication

Answer 5

• Any interaction that involves talking

Question 6

Describe Doctor centered diagnosis

Answer 6

This is where the doctor dominates the discussion by asking all the questions and giving advice and the patient simply expresses what is bothering them
- Doctor mainly gathers info
- Doctor asks direct questions, closed questions about medical facts
- Doctor makes decisions and instructions
- Patient is expected to be passive and ask few questions

Question 7

Describe patient-centered diagnosis

Answer 7

This is where the patient talks about what is bothering them and their needs while the doctor listens and adjusts their responses to match
- Doctor listens and reflects
- The doctor offers observations and seeks the patient’s ideas. They are encouraging and indicate understanding
- The doctor involves the patient in the decisions
- Patient is expected to be active, ask questions and influence consultations.

Question 8

What influences doc-patient discussions

Answer 8

• Characteristics of the practitioner e.g Gender
• Characteristics of the patient

Question 9

what are heuristics

Answer 9

• These are the logical decisions we make everyday

Question 10

What are the two types of Heuristics

Answer 10

• Availability Heuristic: Judging the probability that something will happen based on the availability of information about it.
• Representative Heuristic: Judiging people and events based on what we think is typical for that group or event (E.g stereotype or expectation)

Question 11

Describe a Type I error

Answer 11

• A type I error often referred to as a “false positive” and is the process of incorrectly. It occurs when the patient is healthy, but the doctor misdiagnoses them as bein unwell

Question 12

Describe a Type II error

Answer 12

• This is a type I error and is the false acceptance of the null hypothesis. This is known as a false negative and implies that the patient is free of a disease when they are not, which is a dangerous diagnosis.

Question 13

What are the problems of disclosing information to doctors

Answer 13

• Robinson and West illustrated that patients don’t always fully inform doctors of all their symptoms or other information due to getting info from self-reports
• The study investigated a genitourinary clinic and saw that people were more prepared to reveal more symptoms to a computer than to a doctor
• They concluded that it was probably the impersonal nature of the computer that caused patients to be more open, hence more valid responses.

Question 14

What are Lay consultations

Answer 14

• When we seek medical advice from friends, families and co-workers

Question 15

Reasons why people under-use health services.

Answer 15

• symptoms persist longer and adopt a “wait and see” attitude.
• Critical incident and more pain is experienced.
• ## Treatment expectation- we only seek treatment if it will cure

Question 16

What are the 3 stages that can account for the delay in seeking treatment according to Safer et al.

Answer 16

• Appraisal delay: The patient takes time to judge a symptom and decide whether or not there is something wrong.
• Illness delay: The time between when the patient decides they are ill and when they decide to seek medical care
• Utilisation delay: Time between deciding to go and turning up for surgery. Consider whether the costs of care (time, money, effort) are worth it.

Question 17

State 3 other factors that affect delay

Answer 17

• Patients characteristics: gender, age, culture
• Illness factors: Development speed of the symptoms

Question 18

Safer et al. investigated the effect of the following predicting factors on each of the stages of delay:

Answer 18

• sensory or perceptual experience of the symptom
• Self - appraisal processes
• Coping response to symptoms
• emotional reactions to the health threat e.g fear and distress
• The imagined consequence of the symptoms
• situational barriers to receiving care e.g cost

Question 19

What is the alternative explanation for delay

Answer 19

• The Health Belief Model

Question 20

Describe the factors that the health belief model can be applied to non-adherence

Answer 20

• being less likely to adhere to medication for a minor illness
• being less likely to adhere to medication if they believe they are not at risk of illness
• not adhering if they dont feel confident in the treatment

Question 21

Give an example of the subjective method of measuring adherence

Answer 21

• Clinical interviews: The Medical Adherence Measure
• semi-structured
• items assess patients in terms of their knowledge of their treatment regimen.
  + allows an insight into the patients thoughts and feelings about their treatment
  -Social desirable answers

Question 22

Describe medical dispensers as an objective measure

Answer 22

• They have the correct tablets placed at certain containers for each day of the week
• The doctor will check at the end of the week if there are any tablets left in the dispenser

Question 23

Describe pill counting as an objective measure

Answer 23

• By asking the patient to bring all medication at each medical review
• count how many pills have remained at a certain period
  -relies on the patient bringing all their medication
  -unsure of whether they actually take their medication
  -cannot track the pattern in which medication was taken

Question 24

Describe the Track Cup

Answer 24

• This tracks how often a bottle opens allowing you to track whether the bottle was opened at the right times during the day
  +Improves tracking the pattern
  -Does not provide evidence that the medicine is being taken
  -expensive

Question 25

Describe biological measures

Answer 25

• Blood samples and urine samples.
• They provide the accurate reading of certain drugs in the patients system
  +Highly reliable
  +Valid as it does not depend on the patients honesty
  -Expensive and cannot be performed on a large scale

Question 26

Ways of improving adherence

Answer 26

Prompts: Through text messages, emails, calls e.t.c
Contracts: A patient will sign agreeing to the terms
Customise treatment: Fitting it in a way that fits their lifestyle to make it more convenient

Question 27

Describe the main theories and explanations for Yockley and Glenwick

Answer 27

• Research showed that community interventions such as prompts had positive influence on the number of children being immunised

Question 28

Describe the aim Yockley and glenwick

Answer 28

• To evaluate the effectiveness of 4 different conditions for motivating parents of preschool children to get their immunised

Question 29

The 4 conditions were
(IV) :

Answer 29

• A mailed general prompt
• A mailed specific prompt
• A mailed specific prompt and expanded clinic hours to increase access and convenience
• A mailed specific prompt and a monetary incentive, in the form of a cash lottery

Question 30

Describe the sample in Glenwick and Yokley

Answer 30

• Entire population of immunisation-deficient pre-school clients
• ages 5 and under
• all from a public health clinic in America
• 1,133 out of the 2,101 were found to be in need of at least ONE immunisation
• Even number of boys and girls
• 64% were caucasian
• Mean number of immunisations was 5.2

Question 31

what are the 3 DVs collected in the study

Answer 31

• The n.o of target children receiving one /more than one immunisation
• Number of target children attending the clinic for any reason
• the total number of immunisations received by the target children

Question 32

What were the 2 control groups in Yockley

Answer 32

• The contact and no-contact group
  (No prompts for either group)

Question 33

Describe the general and specific prompt group

Answer 33

General: General immunisation info urging parents to get their children immunised

Specific: Had the named target child and specific instructions
were also given the clinics hours and location

Question 34

Describe the increase access group and the Monetary incentive

Answer 34

Access group: received extra out of hours sessions where childcare facilities were present. Parents could leave their children there

Monetary incentive: Specific prompts plus an additional cash lottery that offered 3 cash prizes.

Question 35

When were the measures collected

Answer 35

• The effect of all conditions was measured after 2 weeks
• There was a follow-up measure taken 2-3 months later

Question 36

What were the results in Yockley

Answer 36

• As expected, the monetary incentive group had the highest response, followed by the increased access group, then specific group and finally general prompt
• They found the specific prompt was the most cost-effective method and monetary being the least
• During the follow-up, the monetary and specific prompts were the most-cost effective intervention

Question 37

Evaluate the study of Yockley

Answer 37

+Large scale with a large sample which was representative so high generalisability
+Longitudinal study increased validity with follow-ups
+There were several controls such as correct immunisations and accuracy of prompts
+Application to everyday life from results
-Lacks generalisability to other cultures
-Use of children may have caused ethical concerns such as informed consent
-Participant attrition
-Confidentiality was not kept and sent to the health organisations.

Question 38

State the aim in savage and armstrong

Answer 38

• The aim of this research was to compare the effectiveness by directing and sharing styles of consultation by a G.P on patients satisfaction

Question 39

Describe the sample in Savage

Answer 39

• Random sampling
• The random number generator was used to select 4 patients for the surgeries
• ages 16-75
• Several symptoms except life-threatening ones
• in total 200 completed al parts of the study
• Patients were given consent forms

Question 40

Describe the IV in savage

Answer 40

• a set of cards was randomly allocated to either give a directing or shared style of consultation.
• The cards were faced down on the doctors desk and turned over at an appropriate time.

Question 41

How was the DV collected in savage

Answer 41

• At the end of the consultation, patients filled in a satisfaction questionnaire
• The time of the consultation was recorded along with the demographics

Question 42

What were the results in Savage

Answer 42

• There was no significant difference in the mean length of consultations between the 2 styles
• There was an overall high satisfaction with only 3 patients showing negative consultations
• Those that received a directing style were more satisfied and felt that the doctor understood them.

Question 43

What was the conclusion in Armstrong

Answer 43

The directing style leads to higher patient satisfaction in terms of understanding the problem and the quality of explanation

Question 44

Evaluate the study by Savage

Answer 44

+ Field study increases validity as patients were not aware they were involved in a study
+ Use of closed questionnaires gathered quantitative results for comparisons
+ Use of questionnaires immediately after the consultations as well as once a week improved the validity as it saw the changes overtime
+ Standardised such as having the same doctor and the same prompts for each IV
+ Application to everyday life and is useful for surgeries and doctor advising,
-Sample is weak as patients were from the same surgery over a 4 month period
-Lack of qualitative research