Lecture Content Flashcards
Domestic Abuse Definition
Coercive and threatening behaviour to a person over the age of 16 years who has an intimate or family relationship with the offender. Action may be physical, emotional, financial, psychological or sexual.
Types of injury from domestic abuse
traumatic e.g. miscarriage or broken bone. somatic illness or chronic disease e.g. pelvic pain or headaches. psychological or psychosocial injury e.g. eating disorder or PTSD
Children who live with domestic abuse in environment
Type of emotional abuse to child. Need safe guarding.
Toxic triangle
domestic abuse –> parental substance misuse –> parental mental health problems.
Risk assessment and tool for domestic abuse. Organisations involved
DASH risk assessment. Standard, medium or high. If high must refer to MARAC and IDVAS
Domestic homicide review
a review of the circumstances of death of a person over the age of 16 which could have resulted from violence, abuse or neglect by a person to whom (s)he was related or with whom (s)he was or had been in an intimate personal relationship, or (b) a member of the same household as himself.
Determinants of health
genes, environment (physical, social and economic), lifestyle, healthcare.
Equality definition
equal shares, objective measure.
Equity defintion
what is fair or just, subjuective
2 types of equity and definitions
horizontal = equal treatment for equal needs. Vertical equity = unequal treatment for unequal needs.
Determinants of health equity which can be used to measure health equity
equal expenditure, equal access/allocation, equal utilisation, equal outcomes from needs, equal health.
Dimensions of health equity
Spatial = geographical. Social = age, gender class/socialeconomic status, ethnicity.
3 domains of public health practise
Health improvement, health protection, health care
Definition of health improvement
societal interventions for preventing disease, improve health, prevent inequalities
definition of health protection
concerned with communicable disease and controlling infectious disease risks and
environmental hazards
definition of health care
Improving services and creating an organisation which delivers the best safest care.
3 health behaviour categories and alternative classification with 2
health behaviour, illness behaviour, sick role behaviours or health damaging and health promoting behaviours
Definition of health behaviours
behaviour aimed to prevent disease e.g. healthy eating
Definition of illness behaviour
behaviour aimed at seeking remedy e.g. seeing Dr
sick role behaviour definition
behaviour aimed at getting well e.g. taking prescribed drugs
Impact of poor health behaviours
Increased disease, increased cost (direct on NHS and indirect), increased days off from work
Factors influencing compliance
education, socioeconomic status, symptomatic, misinformation, side effects
Synergy of behaviours
damaging health behaviours co-occur. e.g. smokers more likely to have poor diet or little exercise etc.
Interventions for health behaviours
Population level = health promotion, screening, vaccine. Give people ability to have control over their health. Individual level = patient centred approach responding to their individual needs. Community level = assessing local patterns e.g. A&E admissions, crime rates.
Why do people engage in damaging health behaviours
stress, situational rationality, unrealistic optimism, age, culture, self-serving bias, health beliefs.
Factors which influence a perception of risk
Lack of personal experience, belief it is preventable with personal action, if it has not occurred now it is unlikely to occur to them, problem is infrequent belief.
Unrealistic optimism
continue to do damaging behaviour due to inaccurate perception of risk and susceptibility.
Outcomes of low perception of risk
Poor medicine regime adherence, do not attend appointments.
NICE guidance on behaviour changes
- Planning interventions
- Assessing the social context
- Education and training
- Individual-level interventions
- Community-level interventions
- Population-level interventions
- Evaluating effectiveness
- Assessing cost-effectiveness
Health needs assessment definition
Systematic method for reviewing the health issues facing population. Gives rise to agreed priorities and resource allocation which will improve the health and reduce the inequality in the population.
Needs Led Planning Cycle
Needs assessment –> planning –> implementation. –> education.
Need, demand and supply definition
Need = ability to benefit form an intervention. Demand = what the population ask for. Supply = what the population are provided with.
Difference between health need and health care need
Health care need is more specific needs and is ability to benefit from the health care.
Sociological perspective types of needs and definitions
Felt need = individual perceptions of variation from norm. Expressed need = individual seeds help to overcome variation from norm. Normative need = professionals define an intervention appropriate for expressed need. Comparative need = comparison between severity, range of interventions and cost.
3 approaches for health needs assessment
epidemiological, comparative, corporate.
Concepts of epidemiological approach to health needs assessment
Define problem, Size of problem, Services available, Evidence base (effectiveness/cost), Models of care and measures, Existing services, Recommendations
Drawbacks of epidemiological approach
Required data may not be available, variability in the quality of the data, the evidence based may not be adequate to come to good conclusion, does not consider felt needs of people affected (i.e. biopsychosocial aspect, only looks at biomedical aspect)
Concept of comparative approach to health needs assessment
Contrasts the services received by the population in one area with those of another population (spatial, societal differences). Measure health status, provision of service, use or outcomes
Drawbacks of comparative approach
May not yield what the most appropriate level should be, Data may not be available, variability in quality of data, may be difficult to find a comparable population
Concept of corporate approach to health needs assessment
Based on the demands, wishes and alternative perspectives of stakeholder parties including professional, political, patient, commissioners, press, providers and the public.
Drawbacks of corporate approach
difficult to distinguish the demand, vested interest of groups, political agenda influence, dominant personality or group may have disproportionate influence.
Physical consequences of loneliness
self neglect, earlier death, more risky behaviours, increase in poorer health, physical changes
Recognising loneliness in a consultation
talkative, clingy, frequent attender and trivial symptoms, sensory impairment, recent bereavement, deny boredom, no close family, mobility issues, SINGLE MEN OVER 50
Causes of loneliness
poor health & sensory impairments, transport issues fear of crime, housing issues, poverty, discrimination (sex, gender, race), technology, poor communication, unavailable community services.
Diseases of poverty
psychiatric problems e.g. depression, sleep disorders, substance misuse, infection including STI and TB
Diseases of neglect
Infections including dental, podiatry.
Name for the classification of types of needs
Bradshaw’s Taxonomy of Needs
3 types of evaluation frameworks
Donabedian - evaluate structure, process, output, outcome
Black - priority
Maxwell - 6 dimensions appropriateness, acceptability, accessibility, effectiveness, equity and efficiency.
6 parts to Maxwell’s evaluation
Appropriateness Accessibility Acceptability Efficacy Efficiency Equity
4 parts to Donabedian evaluation
Structure, process, output, outcome.
Name of the criteria for a good screening service
Wilson and Junger
Some points in the Wilson and Junger screening criteria
Condition must be important health problem.
Acceptable treatment for the condition must be available.
Facilities to diagnose and treat condition must be available.
Test in screening should be repeatable.
Test for screening should identify early stage of disease.
Costs should be balanced out against benefit.
Agreed policy on whom to offer screening to and whom to treat from screening results.
Types of bias in a screening programme
Length-time
Selection
Lead-time
Sensitivity
People who have the disease and are correctly identified
Specificity
People who don’t have disease and are correctly excluded.
Positive predictive value
Patients who receive a positive results from screening and on further tests do suffer from disease
