Lay Beliefs: Health Promotion

Question 1

Why are lay beliefs important to understand?

Answer 1

Impact on health behaviour
Impact on illness behaviour
Impact on compliance/non-compliance (adherence) with treatment

Question 2

What three broad groups of people have lay beliefs regarding asthma?

Answer 2

Deniers - “I don’t have asthma”
Distancers - “I don’t have proper asthma”
Pragmatists - “Only used preventative medication when asthma was bad

Question 3

What are lay beliefs?

Answer 3

Constructed by people to understand & make sense of areas in their lives about which they have no specialised knowledge
Socially embedded
Medical info may be rejected if incompatible with competing ideas for which people consider there is good evidence
e.g. accepted smoking > lung cancer, but not cervical - people don’t understand link & so don’t believe

Question 4

What is lay epidemiology?

Answer 4

Understanding why & how illness happens
- Combo of personal, familial & social sources of knowledge
- People shortcut ideas of those likely to get heart disease
Why it happened to a particular person at a particular time
System is fallible
- Everyone knows an overweight smoker who always drinks & lives a long, healthy life

Question 5

When lay epidemiology does not fit, what do people refer back to?

Answer 5

“Randomness & fate”

“The last person you would expect”

Question 6

What 3 main perceptions of health do people have?

Answer 6

Negative definition
- Health is the absence of illness
- More commonly held belief in lower socioeconomic groups
Functional definition
- Health is the ability to do certain things i.e. keep living independently
Positive definition
- Health is a state of wellbeing & fitness
- More commonly held belief in higher socioeconomic groups

Question 7

What is health behaviour?

Answer 7

Activity undertaken for the purpose of maintaining health & preventing illness
e.g. quitting smoking

Question 8

What is illness behaviour?

Answer 8

Activity of ill person to define illness & seek solution
- 35% of all symptoms result in the use of ‘lay-care’, the use of OTC medicines
- Most symptoms never get to a doctor,
The ‘Symptom/illness Iceberg’

Question 9

What is sick role behaviour?

Answer 9

Formal response to symptoms, including seeking professional help

Question 10

What is the lay referral system?

Answer 10

The chain of advice-seeking contacts which the sick make with other lay people prior to (or instead of) seeking help from healthcare professionals
Up to 75% visiting a doctor have discussed their symptoms with another person
May discourage/delay help seeking
Helps to understand why people might have delayed seeking help

Question 11

What are determinants of health?

Answer 11

A range of factors that have a powering & cumulative effect on the health of the population
They shape behaviours & environmental risk factors
Main global social causes of ill health:
Poverty, social exclusion, poor housing, poor health systems

Question 12

What is the aim of primary prevention? (primary care)

Answer 12

Aims to prevent the onset of disease or injury
Reduce exposure to risk factors
- Immunisation
- Quitting smoking

Question 13

What is the aim of secondary prevention? (secondary care)

Answer 13

Aims to detect & treat a disease (or its risk factors) at an early stage
Prevent progression
- Monitoring blood pressure
- Screening for cervical cancer

Question 14

What is the aim of tertiary prevention? (tertiary care)

Answer 14

Aims to minimise effects of established disease

• Steroids for asthma
• Beta-blockers for hypertension
• Renal transplants for renal failure

Question 15

What is the difference between health promotion & public health?

Answer 15

Public health - more emphasis on ENDS
Health promotion - more value on MEANS of achieving those
PH = health protection + health promotion?
HP = health education x healthy public policy
‘New’ PH = Reconciling health promotion with public health?

Question 16

Name some health promotion strategies

Answer 16

Medical or preventive
Behavioural change
Educational
Empowerment
Social change

Question 17

Name some dilemmas of health promotion

Answer 17

Ethics of interfering in people’s lives
Victim blaming
Mistaken belief that giving people information gives them power
Reinforcing of negative stereotypes
Unequal distribution of responsibility
Prevention paradox (interventions at population level may not have much effect on individual)

Question 18

How does candidacy link to health promotion interventions?

Answer 18

If people don’t see themselves as a ‘candidate’ for a disease they may not take on board the relevant health promotion message

Question 19

Why do outcomes of health promotion need to be evaluated?

Answer 19

Need for evidence-based interventions
Accountability
- Evidence gives legitimacy to interventions & political support
Ethical obligation
- Ensure no direct or indirect harm
Programme management & development

Question 20

What 3 types of health promotion evaluation are there?

Answer 20

Process evaluation
Impact evaluation
Outcome evaluation

Question 21

What is a health promotion process evaluation?

Answer 21

Focusses on assessing the process of programme implementation
Employs a wide range of mainly qualitative methods

Question 22

What is a health promotion impact evaluation?

Answer 22

Assesses the immediate effects of the intervention

Tends to be the more popular choice, easiest to do

Question 23

What is a health promotion outcome evaluation?

Answer 23

Measures more long-term consequences
Measures what is achieved e.g. reduction of symptoms
Timing of evaluation can influence ‘outcome’ (delay/decay)

Question 24

Demonstrating an attributable effect is difficult. (health promotion) Why is this so?

Answer 24

1. Design of intervention
2. Timing
   - Results may differ depending on when you evaluate
   - Decay - Some interventions might take a long time to have effect
   - Delay - Some interventions wear off rapidly (e.g. giving up smoking)
3. Many potential intervening or concurrent confounding factors
4. High cost of evaluating research - studies likely to be large scale & long term