Lecture 3_ Health promotion and Adherence Flashcards
What are factors which influence health adherence?
- social and economic factors (access, support)
- health care team/system
- characteristics of the disease (readily identifiable changes)
- disease therapies (complexity)
- patient related factors
What are factors contributing to poor adherence?
- mood disorders (possibly perceptiones)
- financial situation
- social support
- lack of organisation or routine around cues e.g. putting water next to bed to remind you to take tablets
- misunderstanding of what is required of them
Tell me about the intervention by Pyne et al (2014) which aimed to improve adherence to antipsychotic medication
- BFM checklist (barriers, facilitatiors, motivation)
- designed to assist clients and health professionals
- extended health belief model
by adding in the patients preferences and experiences - had the pt fill out the BFM checklist, received adhererence progress notes and handouts, discuss progress notes and handouts with the provides, implement adherence tips associated with patient- identified barriers
What was the outcome of the Pyne et al study?
- medications adherence - 1 item patients self-report over past 4 weeks
- PANSS (positive and negative syndrome scale)
- adherence improved at 6 months. no difference at 12 months
- pts stated checklist was too long
What were the tips for adherence provided during the intervention process of the Pyne et al study (may not need to know this)
- specific behavioural strategies (e.g. placing medications near another iteam used daily - toothbrush, pillboxes)
- environmental supports (alarms, cues)
- social supports (friends, family remind)
- cognitive strategies (e.g. reframing schoziphrenia as a chronic disease similar to diabetes, linking adherence to times of health or happiness)
- 18 adherence top handouts were creates
Tell me about the intervention process in the Pyne et al study (aiming to help improve adherence to antipsychotics)
- adherence tips - operationalised change objective to address patient- identified barriers
- patient-identified facilitators and motivators - acknowledged and reinforced by HP
- supplement with questions to generate discussion and clarify what patient means when endorsing a given barrier
- used MI principles: helped client generate a list of options for dealing with barriers, discuss costs/benefits, avoid power struggles, connect client-identified goals with medication adherence
What are “lifestyle diseases”?
- cancer
- cerebrovascular disease (CVD)
- type 2 diabetes
- stroke
What do we know about the relationship between mental health concerns and nutritional intake?
Those with mental health issues:
- LESS LIKELY TO: eat daily fresh fruit or fruit juice, fresh vegetables and salad, meals made from scratch
- MORE LIKELY TO: eat daily chips, chocolate, pre-prepared meals and takeaways
What are the benefits of exercise?
- PSYCHOLOGICAL BENEFITS: reduced anxiety and stress, improved mood, body image and self-esteem
- cognitive and social: older adults, children and adolescents
What were the findings from the US study regarding meeting PA guidelines?
- only 20.6 met PA guidelines
- more males than females met guidelines
- 18-25 years had highest participation rates
- > 65 years lowest participation rates
- low education group had fewer meeting guidelines
What are the possible factors for why we’re not meeting PA guidelines?
- relative socioeconomic disadvantage: least disadvantages more likely to have done sufficient PA compared with most disadvantaged quintile
- health status: those with “excellent” health more likely to have done sufficient PA compared to “poor” self-assessed health
- smoking status: ex-smokers/never smoked 1.2 times more likely to have done sufficient PA compared with current smokers
- BMI: underweight/normal weight more likely to have done sufficient PA compared with obese pop
- sedentary occupations: those 22 hours/wk sitting for work
- watching tv 13 hours a week
How does sleep affect health status?
- reduced sleep sleep related to weight gain, increased calories consumption,
disrupted hormones, neurological changes and decreased energy expenditure - lack of sleep associated with negative health outcomes
- average reported sleep time is 7 hours, 12% . sleep less than 5.5 hours, 8% sleep > 9 hours, 76% sleep less than 5.5 hours report frequent daytime impairments or sleep-related symptoms
What is the relationship between sleep and mental illness?
- disrupted sleep common (e.g. inability to get to sleep)
- pharmacotherapy may make this better, worse or no effect on sleep
- sleep problems common with comrobid physical health associated problem and or mental disorder
- associated with functional impairment and role disability
- sleep hygiene intervention
What do we know about cancer screening and mental health
- ppl with mental health 30% more likely to die from cancer than general population
- low uptake of nationally offered cancer screening tests by ppl with mental illness
- existing screening available - breaskt
What were the themes affecting screening uptake in the UK cancer screening and mental health study?
- lack of knowledge of screening programmes (service users and healthcare providers)
- service users’ belief and concerns about cancer screening
- practical issues - getting to the screening sites
What were the barriers discovered in the UK cancer screening and mental health study?
- Lack of integrated care - mental health staff do not know if someone is overdue for a test and cancer screening is often not considered.
Service user:
healthcare providers) - information processing problems screening process aggravates symptoms travel difficulties vary between individuals.
- Screening professionals motivated to help, but may lack time or training to manage mental health needs.
What do we know about smoking and mental illness?
• Smoking is a key modifiable risk factor that contributes to excess mortality in individuals with mental illness
• Smoke more heavily and extract more nicotine from cigarettes than smokers without mental health problems
• Up to 70% of ppl with MI smoke
• % smokers in MI remained stable despite overall
population rates decreasing
• Moderate to high level of interest in quitting in MI populations
What do we know about physical comorbidity and mental health?
- individuals with severe mental disorders have a reduced life expectancy compared to general population
- mortality rate x2 general population
- mortality gap due to higher prevalence of CVD, type 2 diabetes, obesity
- T2DM requires ongoing careful management: challenge and risk factors for ppl with severe mental illness
- 1 out of 10 with severe mental disorders have T2DM
What are physical comobridities and mental health risk factors?
- commencement of psychotropicss at young age
- psychotropic polypharmacy and inadequate monitoring of side effects
- may lack awareness/insight of the health impacts of obesity
- may be less motivated to weight loss/healthy eating
- social isolation may trigger excessive eating as a compensatory mechanism
What are factors related to reduced life expectancy for affected individuals living with physical co-morbidity and mental health?
AFFECTED INDIVIDUAL:
• reluctance to seek for physical care
• tendency to adopt unhealthy lifestyle behaviours (heavy
smoking, low levels of physical activities, sedentary behaviours)
• inappropriate food intake and poor diet
• alcohol or drug abuse
CLINICIAN:
• medical care given is lower than that provided to people with physical diseases
• e.g., screening for CVD risk factors in these individuals is very rare
• Need to improve physical healthcare provided to people with severe mental disorders
• Need interventions to modify unhealthy lifestyle behaviours
