How Do We Know What We Know? Flashcards
What are the philosophies talked about in this lecture? (3)
Ontology
Epistemology
Axiology
What two research approaches are discussed in this lecture?
Deductive approach
Inductive approach
What is meant by deductive approach? What type of knowledge is it often allied to? What type of data? What type of ontological position?
A theory and hypotheses are put forward and tested
Positivism (scientific principles)
Quantitative data
Objectivism
What is meant by inductive approach? What type of knowledge is it often allied to? What type of data? What type of ontological position?
Theory is developed as a result of collecting data
Interpretivism
Qualitative data
Constructionism/subjectivism
What is ontology? What are the two main ontological positions?
Ontology concerns our assumptions about the nature of reality.
Objectivism/Realism
Subjectivism/Idealism/constructionism
What is objectivism?
The social world is objective, out there, independent of us who perceive it
What is subjectivism?
The social world is constructed by us - constructions are built up from the perceptions and actions of social actors
What is epistemology?
Theory of knowledge, or how it is we can know anything about the world.
What three philosophies make up epistemology?
Positivism
Interpretivism
Pragmatism
What is positivism?
The application of empiricist natural science to the study of society
Reality is unitary, it can only be understood through the scientific approach. The researcher is independent/detached of the data that are collected - neither influences nor is influenced by the research.
What is interpretivism?
Contrasting to positivism, it argues that people and institutions are different from material objects/the natural world and therefore require a different approach. People are ‘social actors’ who interpret their everyday social roles in accordance with the meanings they give to these roles. The goal of research is to understand the subjective meanings and reality of social actors in order to make sense of their actions.
What is axiology?
A branch of philosophy that studies judgements about values.
There are different views on the influence and role of values in research - either strive to be objective or acknowledge that you are subjective (i.e. reflexivity).
Define reflexivity.
Recognise and acknowledge that research cannot be ‘objective’ and value-free; being self-reflective about how our values influence the research process and products.
What influences knowledge production and legitimation? (5)
Theory Values Practical considerations Ontology Epistemology
What are health beliefs affected by? (5)
Age Culture Ethnicity Gender Socio-economic status
What three main components make up HSPH, as shown on a Venn diagram in this lecture.
Sociology of medical education
Health promotion and improvement
Social determinants of health
What is neoliberalisim?
People make choices yet not under the conditions of their choosing. Neoliberalists accept the unknowability of the world - they can’t conceive of changing the world or its structure. They accept they need to change themselves and adapt in order to cope responsively.
What does adherence to long-term therapy for chronic illnesses in developed countries average?
50%
Non-communicable disease and mental disorders, HIV/AIDS, TB - together these represented how many % of burden of all diseases worldwide in 2001?
54%
What are the consequences of poor adherence to long-term therapies? (3)
Poor health outcomes
Increased health care costs
Compromises the effectiveness of treatment
What does compliance mean? Why is this no longer used as much (what replaced it)?
How much the patient did what they were told by the doctor
Too judgemental - replaced by ‘adherence’
What does adherence mean?
The extent to which a patient’s behaviour, with respect to taking medication, corresponds with agreed recommendations from a healthcare provider
What are the three components of adherence?
(i) persistence
(ii) initiation adherence
(iii) execution adherence
What is meant by persistence?
The length of time a patient fills their prescriptions
What is meant by initiation adherence?
Does the patient start with the intended pharmacotherapy?
What is meant by execution adherence?
The comparison between the prescribed drug dosing regimen and the real patient’s drug-taking behaviour. This includes dose omissions and the so-called ‘drug holidays’ (3 or more days without drug intake).
What is meant by concordance?
A process of the consultation in which prescribing is based on partnership.
Healthcare professionals recognise the primacy of the patient’s decision about taking the recommended medication, and the patient’s expertise and beliefs are fully valued. The patient’s opinion should be taken into account and discussed.
Contrast ‘compliance’ to ‘concordance’.
Compliance focuses on the behaviour of one person (the patient), whereas concordance requires the participation of at least two people.
What types of non-adherence are there?
Unintentional
Intentional
Why might a patient unintentionally not adhere? (3)
Forgetfulness
Regimen complexity
Physical problems
What is the reason for intentional non-adherence?
The patient decides to take no/less medication after making a benefit-risk analysis. This is influenced by patient’s beliefs about medication, patient’s self efficacy, and patient’s knowledge of disease.
What affects adherence? (3)
Patient factors
Disease features
Drug characteristics
Adherence for medication for rheumatoid arthritis ranges between…?
30-80%
Patients with lower health literacy are more likely to…? (3)
A lower functional status than other patients
A poorer self-reported adherence to medication
Visual and memory problems
How might you identify people with low health literacy? (4)
People who had difficulty with recall
People who self-identified as not being able to read or write
People who used excuses (e.g. they have left their glasses behind)
Those with performance issues/lack of adherence to exercises or medication
How might you help a patient with low health literacy to understand? (8)
Non-medicalised jargon Reassuring Visual cues Basing dialogue on patient’s own experience Recall and feedback Participative inquiry Attending to non-verbal cues and facial expressions Amount of information
