1
Q
3 historical perpsectives of helath and illness
A
1) ancient greece: illness is bodily function
2) hippocrates: idependent of mind; four humors (blood, black, yellow, phelgm etc.)
3) Galen: different disease have diff. effects of body
2
Q
Renaisssance (Descarte)
A
- descarte thought of new model of mind/body relationship that are spearate but interact through the pineal gland
- illness is part of body
- once conclude that animals have no souls = dissection is safe
3
Q
2 aspects of monism
A
1) materialism: only matter is mind (brain)
2) idealism: all is mind and the body is manifestation of mind
4
Q
What happened when the biomedical model gained interest?
A
- identify pathogens that cause disease
- development of physical treatments (e.g. vaccines)
- advance in physical techniques at a fast rate (e.g. cancer treatment)
5
Q
Criticism of biomedical model (4)
A
1) Reductionist: ignores complexity of factors invovled in helath
2) Mechanistic: assumes that every disease has primary biological cause
3) Dualistic: neglects social and psychological aspect of individaul
4) Disease oriented: emphasis on illness over health
6
Q
Criticims of the biopschosocial model
A
- not a real model
- is a reaction against biomedical and attempts to inquire about both psychoanalsis and behaviourism
- not an explicit theory (not that much literature) - is a guiding framework
7
Q
Clinical Health Psychology
A
- most mainstream of HP
- overlap with clinical psychology
- focus on the physical illness and dysfunction - focus on individual
8
Q
Public HP
A
- focus on promotion and prevention at population level
- takes time and difficult to measure
- need to address underlying factors (because 1 thing leads to another)
- more interdisciplinary of HP
9
Q
Community HP
A
- focus on collective level
- seen as outcome of social and political problem
- work with community and action research for empowerment
10
Q
Critical HP
A
- evaluate theories and practice and how they maintain unjust social relations
- focus on concept of power and health differences
- turn critical eye back on discipline
11
Q
Tension - individualism vs. focus on social context
A
individual = perspective of person’s thought, beliefs
social context = focus on gender relationship, politics
12
Q
Tension - realism vs. social construction
A
realism = real causes that need to be fixed
social constructionism = beings in interpretation and symbols attached is important as how people related to illness
13
Q
Tension - empirical vs. theretical
A
empirical = get the evidence then we know what to do (more biases) theroretical = sometimes that's not enough e.g. need to address how to gather evdience, think about issues
14
Q
Core level:
A
- individual and specific factors that can’t change e.g. sex
15
Q
Level 2:
A
- individual and lifestyle e.g. diet, smoking
16
Q
Level 3:
A
- social e.g. suport, peers
17
Q
Level 4:
A
- society with bad food security, water, and sanitation (biggest factor)
18
Q
level 5:
A
- socioeconomic (macro social factors) e.g. dictatorship, hurrican belt
19
Q
Characteristics of Onion Health Framework
A
- wholistic
- concerned with health determinist (not just treatment)
- places each layer in context of neighbours
- interdisciplinary flavor
- no claim for 1 being more important
- complex
20
Q
Describe Yogi studies that contradicted dualism
A
- pulse waves from artery decreased to almost zero (heart rate decreased)
- muscle control and heart sounds dimished
- reduction in oxygen intake
- less discomfort in cold water task (oblivious to external stimulation during mediation)
21
Q
What is Sociohistorical context ?
A
- our sociohistorical context is now different than 100 years ago e.g. consider implications of politics, economics etc.
22
Q
Cross-cultual psychology
A
- fixed system of beliefs, meaning, symbols etc. that group shares (always comparing a set of variables)
23
Q
Cultural psychology
A
- development and dynamic system of signs that exists in changing narrative/stories
24
Q
What are western health belief systems (4)
A
1) classical views
2) christian views
3) biomedicine
4) biopsychosocial
25
Galen Humors (4)
- Blood, yellow bile, black bile, phlegm
26
Christian Ideas (Western)
- revovled around galen humors
- based on religion dominant
- 7 deadly sins associated with pathology (key element of health)
- shift from naturalistic thinking to moral thinking (religion)
27
Biomedicine (western) (2) - what causes illness?
- 1) Positivism (neglects social part of medicine): direct observation gives access to real world
- 2) Individualism (cuase of problem in individual; staying healthy in person's control)
- shift from bodily process to concept of quality of life
28
Example of failed assumption in biomedicine
- Helicobacter pylori - belief that bacteria cannot survive in stomach so scientist drank a beaker of H. Pylori to prove hypothesis
29
Taoism (Chinese)
- balance of yin and yang; misblanace = ill health
| - use acupuncture and herbal medicine
30
Confucianism (Chinese)
- grounded in moral conduct
- belief that destiny and character determines illness
- accept illness instead of help seeking
31
Buddhism (Chinese)
- believe in cause and effect
- comisc justice and retirubtion (you have done something wrong and cosmically you are reaping consequences) - try to figure out what you did wrong)
32
Ayurvedic medicine
- used by 70% of population in India and world
- humans consists of male and female counterparts (need to keep in balance)
- medicine removes blockage of energy flow
- treatment = yoga, diet, mediation, herbs
33
African Health Beliefs
- spiritual influences
- communal orientation
- common attribution of illness to ancestors or supernatural forces (may have offended them and need to fix it)
- role of healer to identify source of malicious infelunces (may also be felt by family e.g. no rain)
34
What is health?
- a social construct (medicine is good answer but can be refused if underlying beliefs and assumptions to not align with biomedical model)
35
How we define health is dependent on:
- philsophical stance
- our culture
- technologies available (e.g. definition of being dead or alive depends on brain activity where before it was if someone stopped breathing)
- historical moment
- social values and norms guiding us
36
How can STIs be transmitted
- vaginal
- anal
- oral sex
37
Types of STIS
- chlamydia, genital warts, gonnorrhea, syphillis & HIV (second 2 more rare)
38
Incidence and Prevalence of STI
- increase in recent years
- especially in conservative governments (getting rid of sex-ed)
- increase birth rate in teens
- increase syphilis in teenage girls
- increase of AIDS in teenage boys
39
Greatest affect aged group for STI
- young people (16-24)
| - account for 12% population; but more than 1/2 diagnosis
40
HIV in Canada
- Has been increasing
- 25% were unaware of their infection
- has been viewed as a chronic illness because you can extend life
41
Knowledge of HIV
- connection between AIDS and awareness
- not due to lack of knowledge
- 1 in 5 in UK not able to identify with main ways of HIV transmission
- 1 in 10 believed incorrectly that unprotected sex between M/F or M/M is way of contraction
- worst knowledge in Southern Africa
42
Condom use and Risk and why are people more hesitant to buy condoms
- best way to protect against STIS
| - in areas where they promote abstinence = more hesitant to buy condoms
43
Factors associated with risk of sexual behaviour and 2 mediations factors
- associated with smoking (lower inhibition and risk-taking), drinking, drug use and poor academic performance
- mediated by on or off campus
- mediated by gender
44
Barriers to use of condoms (Madagascar study)
- gaps in knowledge
- misinformation, negative perception (don't like condoms)
- concerns about social opposition (but is there actual opposition)
45
Risk behaviours (4) that increase chances of getting STI
1) college students (drugs and alcohol predict unsafe sex)
2) pseudosceince and denalism e.g. AIDS is not caused by HIV and antivertrol virals don't work
3) social opposition
4) cultural factros
46
Individual Level Theories
- invovled developing theories about individuals and implemeting intervnetions without their invovled (top-down)
- psychologist develop theory and implement on large group of people
47
Health belief Model (HBM) (4)
- cognition model: perception that predicts behaviours; try to manipulate cognition
1) percieved susceptibility e.g. risk of condition
2) percieved severity e.g. assessment of seriousness
3) percieved barriers e.g. facilitate or discourage behaviour
4) percieved benefits e.g. positive consequences of adopting behaviour
48
Protection Motivation Theory (4)
- coping with health threat: if people are afraid of something they will work to avoid it
- threat and coping appraisal
1) percieved severity of threatened event e.g. HIV
2) perceieved probability of occurance (how vulnerable?)
3) efficacy of recommended behaviour (Do I think condoms are effective?)
4) Perceived self-efficacy (e.g. confidence of using condoms)
- limited empircal evidence to support PMT
49
Theory of Reasoned Action (TRA)
- Based on assumption that indivdiual is likely to do what they intend to do
- bebavioural intentions (deteremined by attitudes toward action/behaviourand are subjective norms)
50
Criticism of Theory of Reasoned Action
- does not take into account political or economic constraints, some things are not under our voluntary conrol - may operate on subconscious principals
51
Theory of Planned Behaviours (TPB)
- most cited theory in psychology
- but some behaviours difficult to control in voluntary way
- perceieved control e.g. how much do I believe I have control over quitting smoking
- reflects past obstacle and success
- stil missing religion, culture etc.
52
Information-Motivation-Behavioural Skills MOdel (IMB)
- skills are emphasized; not enough to want to do something but need the skills to implement it
- pre-requisites for good actions (relevant information about risks; motivation for safe sex; beahvioural skills (e.g. negotiate condom use)
- motivational interview strategy for buildling up drive to change beahviour in life with decision
53
Common sense model (CSM)
- aka self -regulatory model (SRM)
- Core-construct - illness representation (what is your understanind/perception of illness)
- integrate normative guidelines held by people, to make sense of symptoms and guide coping actions
- no obvious guidance for intervention or evaluation
54
Transtheroretical Model
- aka stages of model change
- influence in literature on health beahviour change
1) precontemplation
2) contempolation
3) preparation
4) action
5) maintenance
6) termination/replase
- mixed results
55
Social cognitive theory
- examines social origins of behaviour (as well as thought process)
1) observational learning
2) self-efficacy: beliefs about own capabilites to infleunces events affect their lives
- application of theory: use of role models in mass media to shape attitudes
56
Evaluation of Individual Theories (for sexual health)
- Meta-analyses suggest that only a small amount of variance is explained by any of the theories in sexual health
57
Most effective and least effect theories of change for STI
Most: attiudinal arguments, educational info, behavioural skills argument, behavioural skills training
Least: induce fear of HIV
58
Critique of Individual-level approach (individualistic bias)
- important process of choice and responsbility all located in indivdiual's head (huge assumption)
- sexual intercourse is joint activity
59
Critique of Individual-level approach (problems of validity)
- null hypothesis significance testing: small samples; students
60
Critique of Individual-level approach (culture, religion, gender)
- they are not part of theories
61
Critique of Individual-level approach (universalism)
- controversial esp. when studies are done in labs
62
Critique of Individual-level approach (complexity of motivation)
- riskiness could be part of motivation, not deterrent e.g. sky diving
63
Role of Food in Society
- social activities full of symbols and meaning (not just surviving)
- changes in society have produced changes in consumption habits e.g. anorexia, obesity
64
Obesity in Canada (trend in general and in youth)
- Prevalance in canada has been declining
| - Prevalence in children and youth increasing
65
Classes of obesity in Canada (3 classes)
Class 1: high risk 30-34.9
Class 2: very high risk 35-39.9
Class 3: extremely high risk 40+
Healthy: 20-25
66
Obesity Health Risks
- hypertension or high blood pressure
- coronary heart disease
- type 2 diabetes
- stroke
- gallbladder disease
- osteoarthritis
- sleep apnea and breathing problems
- some cancers e.g. breast, colon, endometrial
- MHC e.g. depression
67
Obsiety Tredns and Prevalene (world wide)
- significant differences between countries and sub-groups of people
- prevalnce realted to lifestyle e.g. fruit/veg intake; leisure time, physical activity
- sharp increase in most places
68
Describe disease of affluence (obesity)
- total calorie intake increased as food become more processed and energy dense
- problems of obesity become common in developing countires
- associated with lower SES (budget restriction)
69
Food politics (2- tensions)
1) social inequality and obesity
| 2) corporate agenda
70
Food consumption characteristics (4)
1) increasing # ppl eating outside (prepared foods)
2) typical availability food outlets have high calories
3) people eat more than they need; having lower activity levels
4) role of food industry - decides how the food is prepared and what ingreadiants go into
71
The food industry and how does it influence our health?
- advertising and other methods of influence
- corporate interests in encourage high food intake
- additives (e.g. flavouring); not healthy; increase competitiveness (e.g. fat, salty, sugar) - concerned about profit
72
Problems of Sustainability
- contribution of livestock to Greenhouse Gas emissions
- Food transport and CO2 emission
- demand for milk and meat increasing (will eventually be unstainable)
73
Cause of obesity
- genetic predisposition
- culture (kinds of food e.g. more lean cultures)
- diet
- inactivity
- human microbiome (stomach bacteria)
74
Evolutionary perspectives (obesity)
- human evolution history geared toward nomadic lifestyle (groups of ppl who follow food sources and climate) - always active
- current lifestyle different in which genomes evolved
75
2 evolutionary events that influence our increase in food intake
1) agricultural revolution: cultivation of grains lead to large social organization
2) industrail revoltuion: mass trasportation (of people and food); labour savings (less active); mass communication; corporate influence --> control of food shifted to corporation
76
Ecological Model of Obesity
- obesity not a disorder of individual but consequence of interaction b/w person and environmental context
- daily energy of humans need to be increased while consumption needs to be increased
77
Environmental Influences on Food Choices
- micro (family) vs. macro (economy) level infleunces
- physical (close to sotre) and economic (budget); socio-economic influences
- quality of food available
- access to fruit/veg through grocery stores (lower access in poor neighbourhoods; those with access have lower rates of obesity)
78
What is is that change in our environment related to food?
- food production is controlled by corporations
- food distribution planned on large scale e.g. grocery stores
- food environment changes depending on degree of affluence (where you can afford to live)
- constant food promotion
79
Describe characteristics of an Obesogenic Environment
- presence of supermarket = lower obesity
- presence of convience stores = higher obesity
- obesity - lower income racial minority
80
Descirbe how Food, Race, Class and the environment influence food inequalities
- 3x less places to drink in rich neighbourhood
| - 4x more supermarket located in white neighbourhood
81
Reasons for environmental inequality
- restating of grocery store buisiness
- cheaper rent for people in commerical locations (more fast food)
- ability of affluent communities to resist unwelcome commercial activitites
82
Food Promotion Infleunce Children
- children view 15 commercials every day
- 98% promote high sugar, fat, sodium
- high exposure to food advertising = leading cause
- coporations do this to compete with other companies
83
TV and Children
- food advertised for fun, taste, - not health
- link b/w amount of TV viewing and obesity and cholesterol levels
- high TV = high junk food consumption
- conflict between interest of coprotation and society
84
Interventions of obesity
- HP use social cognition models but these models dont' include research addressed today e.g. location & affluence
- Inidivudl level interaction e.g. education, health promotion (but need to fight social and corporate infleunces)
- vegetarian diets
- biological interventions e.g. bariatric surgery, obesity pill, probitics
- correct current public health approaches
- community level approachs
- policy level approaches
85
Attitudes to alochol
- societal ambivalence across time
- prohibition in US
- then recieved medical attention that people cannot return to moderate drinking levels (but different in Europe)
- strongest abstinence is AA
86
Attudes to alcohol (global)
- legal almost everywhere except some countires with majortiy Muslim population and religious socieites
- dominant view = alcohol ok in moderation; harmful in excess
87
Extent of Problem
- 3.7% global morality rate and 4.4% with social rpboems
| - Europe has a huge morality rate from drinking
88
Historicl and cultural infelunces of alcohol
- In india, there were colonial infelunces so british empire expanded and had new markets and promoted in india; Ghandi led resistance of abstinence
- Gorbachev in Russia but then levels rose again after he left
- powerful infleuence of international drink companies that infelunce policies
89
Low risk alchohol drinking guidelines
- females max daily; 2 max week = 10
| - males max daily 3; 15 max weekly
90
single occasion Risks associated with alcohol
- not associated with lower levels
- driving, household accidents
- domestic and vioence
- STI from unprotected sex
91
regular drinking risks associated with alcohol
- death from liver cirrhosis
- neurological damage
- CVD and cancer
92
What are some Social problems that result from (drinking)
- dependence
- exacerbate other problems via maladaptive coping
- loss of employment or career prospects
- marital breakdown
- child abuse
93
Risk from drinking during pregnancy
- Fetal alcohol syndrome
- Spontaneous abortion
- Low birth rate
94
Benefits of Alcohol
- "j" shaped functioning (controversial) that people that' dont' drink have more health problems than do drink
- lower coronary heart disease
- potentially less strokes
- J function for dementia and cognitive decline
95
Possible explanation for J function
- non-drinkers include people who gave up drinking because of other health problems
- difficult to establish limits for safe drinking because of inconsistent research
* * conclusions: unclear if light drinking causes benefits
96
Causes of alocohol dependnece
- culture and expecation: enjoyment, stress reduction, increased sociability
97
Why some people develop problem over others?
- genetic theories
- addiction and disease theories
- learning theories
- some theories are more attractive to corporations
98
Genetic theories (alcohol) and some reasons for those who are genetically pre-disposed to liking it
- inherited; destined to be alcoholics (no evidnece)
- biological determism - attractive to drink companies
- twin studies = 30-60% variance
- rate of metabolism
- experience of taste
- no evidnece for "born alcoholics"
99
Addiction theories (alcohol)
- replaced theory of drinkers being morally degenerate
- person loose voluntary control to resist urge
- person not accountable - the alochol is problem
100
Disease theory (alcohol)
- focus on at risk individuals and social risk
- emphasize loss of control
- only addictive to small number of people
101
Alcohol dependence syndrome
- distinction b/w physical addiction and psychological dependence removed (both go together)
- physical dependence (esp. withdrawal)
- crticized for difficulty in associating criteria for diagnosis
102
Learning theories (alcohol)
- problem drinking and normal drink result of same learning process (difference relate to personal histories)
- operant condition - pleasure from addictive substance better than suffering from withdrawal
- pleausre immediate and unplsant next day but the association is delayed
103
Classical conditioning (compensatory conditioned response model)
- when drug taken, physiological mechanism return body to equillibium
- alcohol is depressant and nervous system becomes lower which activates nervous system to be active to reach normal levels = pleasurable
- heavy drinking = larger tolerance
- Overstimulation of system causes withdrawl aymptoms e.g. pub cues but you're not drinking
- lacks strong evidence
104
Social learning (alcohol)
- we learn through imitation
- self-efficacy - lower confidence = more related to alcohol
- parents have strongest influnce of adolescent drinking (peers maintain)
105
Psycho-analytical ideas (alcohol)
- secondary gain (extention of learning theory)
| - e.g. avoiding work, excuse for sexual attention = blame it on the alcohol
106
Population level approaches to prevention (alcohol)
- best way to prevent is not at individual level but how you control the way alcohol is consumed
- higher taxes
- restriction in ads and sponsorships
- limit opening hours of bars
- control which shops sell alcohol
- this is opposite of what drinking companies think - that we can educate people and that we should not penalize majority of sensible drinkers
107
Drinks industry vs. health research - what are the tensions here
- critics of drinks industry that eduction is not effective and main profit comes from drinking above recommended helth limits
- in countries that are more infleunced by drink industry - is there a risk of unpopulariy if you advocate for population-based policies?
108
Facts about alcohol
- 50% world consumption by 10% heaviest drinkers
- 75% variance alcohol dependence within region predicted from consumption (need to lower consumption in order to lower drinking problems)
- taxation if effective
109
Drink industry strategies
- aimed at young drinkers
- lifestyle advertising e.g. sport, fashion etc.
- taiolored produces e.g. pre-mix cocktailes
110
PH strategies
- counter-adversiting using warning labels
- research limited to participant's assessment
- small budget
111
Sponsorship and advertising bans (PH strategy)
- bas have 5-7% reduction in overall consumption
112
Drink driving laws (PH strategy)
- universally agreed to reduce fatalities
- even has support of drinks industry
- becoming increasingly adopted
113
Health education (PH strategy)
- improves knowledge and attitudes, but no effect on amount actually consumed
- recieves most support from drinks industry??
114
Treatment (alchohol) North America vs. Finland
- strong difference between countires
- Cananda/US = absitence
- UK = return to moderate drinking levels ok
- North America: specialist treatment center with medical orientation
- Finland: viewed as social problem - intervention via social workers
115
Treatment Types
- in patient treatment
- AA
- Counseling and psychotherpay
- CBT
- Brief interventions
116
Tabacoo and Smoking (tax)
- major contributor to economy
- tax consistenly more than cost of treating smoking-related disease
- conflict of interest for governments (tax revenus, policy of discouraging smoking)
117
Prevalence of smoking
- Peaked until 2004 and has now dropped
- UK peaked then decline
- Canada steady decline; 17% in 2011
- industry promotion in developing countrires = increase
- more men than women
- increasing smoking associated with low income, unemployment
118
Lesson from Observing prevalence of smoking
- dramatic changes suggest strong social determinants in smoking
- strong national variation = possibility of culur and political infelunce
119
Health effects of smoking
- 1 in 5 deaths (UK and US)
- more than combined deaths from HIV, drugs, alcohol, cars, suicide, murder
- leading cause of death
- cause disease in every organ of body
- immediate and long term benefits
120
Effects of passive smoking
- risk of canacer, heart, respiratory disease
| - sudden infant death syndrome
121
Tabacco industry strategies
- create doubt in mind of public and lgislature about scientific foundation of effect of smoking
- public denial and knowledge
- target young people
122
Epistemology and Scientific Claims about smoking that tabacco industries use
- Link of helath belief model with tabacoo industry framing of smoking
- individal choice
- shift of responsbility for harms caused by tavacco to consumers
123
Social and economic context that encurage smoking
- effects of promotion in increasing smoking
- encourage experimentation in young adults
- encourage increased consumption
- reduce motivation to quit
- encourage former smoker to resume
- discourage open discussion
- oppoistion muted from those relying on sponsorship
- create enviornment where smoking use is familar and acceptable - warning of health underminded
124
Why not ban advertising of smoking?
- advertising doesn't significantlly infleunce smoking beahviour (who supplies this data?)
- political context - tabacco gets many more funds
125
What explains the resistance of smoking against large scale campaigns to discourage practice?
- resistance of smokers against large scale campaigns to discourage practice
- biopsycholosocial model
126
Biological theory (nicotine)
- nicotine is toxic
- tolerance effects
- absorbed through lungs and mucosal membranes
- addictive (dopamine)
- acute positive effect and withdrawal
- in small amounts = weight loss, reduce irritabiliy, increase alertness
127
Biological theory (cigarettes)
- high energinereed drug-delivery system
| - rapid nicotine delivery to brain
128
Biological theory (addictivness of tabaccoo)
- over 30% who try once become addicted
- genetic factor (50% genetic)
- evolutionary explanastions e.g. depresion, anxiety etc. = refractory smokers
129
Psychological theory
- learning theory (poistive reinfrocenemtn)
- overruled by social reinforcement
- smoking to avoid unpeasant situation
130
Psychological theory (motivating factors)
- affect management model (reduce negative affect; habit; pleasure)
- young adults (boredome; nothing to do)
- arousal theories (sensation seeking)
- low cortical arousal
- smoking and stress
131
Psychological theory (social theory)
- social meaning of smoking = different meaning in diff. settings e.g. opportunity to escape routine at work
- sharing cigarette of imitating, maintaing and strengtehing social bonds
- coping with breakdown of routine e.g. demands of childcare (this life is bad anyways, what is 1 cigarette going to do)
132
Psychological theory (smoking cessation)
- recent prevalence has been reduced (but increasing in developing countires)
- most smokers whish to quit
- most ex-smokers went cold turkey or gradual reduction
133
Cessation: pharmacological approach
1) nicotine replacement therapy
2) Bupropion
3) Vareicline
134
Nicotine replacement therapy
a) gum, nasal spray etc.
b) double chance of quitting
c) methodological problems with randomized control trail
135
Bupropion
a) maintain dopamine levels during cessation
| b) double chance of quitting
136
Varenicline
a) increase dopmaine and block nicotoine
| b) better quitting rate than bupropion
137
Cessation: Social approach
- moving toward taboo
- social gradient in smoking prevalence (woman during hard life circumstance)
- social support (buddy system)
138
Apps and E-cigarettes
- interactive web based interventions show early promise
| - e-cigarettes growing but consequences unkownn
139
Name some big picture-global health implications (3) that influence the life expectancy of a child
1) natural events and disaster
2) epidemics
3) human induced problems (pollution etc.)
140
Natural events and disasters
- what are the measures in place to deal with these events e.g. emergency services
141
Epidemics
- what are the biological things that effect us on a large mass scale
- do you have the tools to combate this e.g. vaccines
142
Human induced problems
- how does pollution, global warming, depletion of water effect our health
143
Complexity of macro-social context (4) that influence our helath agency
- political and economic system - you have the resources to be healthy
- system of disrimintation e.g. social class
- cultural & religious discourse that influence health
- literacy, education for people to engage in health promotion
144
Describe Globalization (2 examples)
- interconnected global economy
- economic factors create contet for human phenomena e.g. impact of financial crisis affects everyone globallly e.g. someone loose their job, people's kids can't afford school etc.
1) financial crisis
2) global debt
145
How do we know there are corporate Global Infelunces to our health?
- high alcohol rates correlated with high intake of unhealthy food suggest underlying risk factor of market and regulatory environment - need to address market (use similar strategies)
146
Describe the patttern of population Growth (include largest, highest fertility, and family planning implications)
- explotential growth with limited resources
- largest = china and india
- highest fertility = souther africa
- family planning can reduce CO2 emissions (along with solar, wind and carbon capture)
147
Describe the pattern of Increasing longevity
- life expectancy increase every 3 months and social systems not designed to cope
- impact on health care system
148
Percentage of world living in poverty and name some insufficient daily needs
- 80% popultion in developing countries
- 1.5 billion live less than 1.25$ a day
- lack clean drinking water, sanitation, health services, modern medicine, diet, housing, income generation
149
Health consequences of poverty (3)
- malnutirtion
- reporductive risk
- infectious disease
150
Poverty Reduction and UN goals (3)
- goal for many international organization
| - UN Goals: 1/2 of poverty reduce, reduce child mortality, decelerate AIDS
151
Poverty and Health Bidirectional
- bi-directional infelunce on economic well-being and health inextricably
- if you don't have tools to be healthy, then it goes down but if your health goes down you have less opportunity to get tools to be healthy
152
Where is health the worst (describe some characteristics)
- Southern Africa:
- 2/3 live in absolute poverty
- 1/2 lack clean water
- 70% without proper sanitation
- 40 mil children not in primary school
- 51 life expantancy
- malaria and TB increasing
153
What is the health gradiant? (within country inequalities)
- health gradiant found in all countires - higher up = longer life
- key concept of SES and longeivity
- same patter in all countires
154
Where is the largest health gradiant in Canada?
- largest is first nations and canadians
155
The Whitehall studies - describe findings
- explore social class and psychosocial factors of disease
- men with lowest grades in civicl service more likely to die
- women in higher pecking order = higher health which reflect stress of work
156
How can work strain be buffered?
- social support, effort-reward balance, job security, organizational stability
157
Social Determinants of Health (and what is it against? (2))
- connection b/w social conditions and helath
- competes again germ theory and social darwanism
- focus intervention on environment
158
Possible explanations for black report (unhealthy = unhealthier because of labour) (4)
1) artefact of measurement
2) natural and social selection
3) structualist explanations e.g. economic = social determinant
4) cultural/behavioural differences
159
Describe the pattern of social inequality and health
- increasing in western countries because of neo-liberalism (1%)
- health garident is present everywhere but changes to become more or les steep
- health is not fixed
160
How does SES impact health?
- mediators of ses on health are usually behavioural e.g. diet, excercise, smoking
- some psychological mediators e.g. self efficacy, self-esteem
- defined by occupation, education and income
161
How does the Econological/system theory approach see disadvantages of SES
- disadvantages accumulate over time with low SES = compounding effect
- are percieved
- influence the developmental systems of Bronfenbrenners systems
162
4 stages of bronfenbrenner deveelopmental infeunces
Microsystems: families, schools
Mesosystem: peer groups
Exosystems: parental support, parental workplaces
Macrosystems: political philsophy and social policy
163
Describe some class, race and gender health inequalitites
- racisim, gender discrimination, coprorate glovatlization, degredation of envionment, dangerous workplaces, destruction of public sector
164
Reducing inequalities
1) strengthening indiiduals
2) strenthening comunitites
3) improving acces to essential facilities and service
4) encouraging economics and cltural change
165
Quliative research in psychology
- dedicated journals
| - specific division of APA in 2012
166
Purpose of qual research
- carefully design research question to give answers specifically in applied health
- generalizability and extensive knowledge claims (e.g. most pariticpant said)
167
Readical departures from quantitative relationships (3)
1) no causal realtionship ever - more interested in process relationshisps
2) no variables
3) no prediction of outcomes - qualitative not interested in prediction
168
2 types of qualitative research
1) types of data: e.g. interviews, focus groups, etc. = type of data collection NOT data analysis
2) type of analysis e.g. content analysis and thematic analysis
169
Qualitative data examples
- interviews, focus groups, media articles, online forums, policy documents, naturalistic data e.g. data already available
170
Epistemology
- theory of knowledge (approach to knowledge may differ)
- disagree with philosophers of science who ask e.g. what is a good way of accessing knowledge
- instead look at what you want to find and try to think like that
171
Positivism
- think humans are part of natural world and study of humans should be like study of natural sciences (qual methods disagree with that)
172
Content analysis
- large data sets are captured
- need to know inter-rater relability
- don't need to generalize the whole population
173
Ethnographic methods
- common in anthro/sociology
- systematic understanding of culture from insider's perspective
- join the subjects of study and is either overt or cover (tell people they are researcher)
174
Grounded theory
- Need lit review?
- Tensions?
- strict list of steps
- use data from interview or focus groups
- don't need to do lit review = begin analysis early in process and as you learn you change the process of analysis - themes emerge from data
- tension with positivism (because this is a constructiveist view)
175
Positive view in grounded theory
- themes are already there before analysis and research pulls out themes
176
Constructive view in grounded theory
- there are no themes, the research creates the themes and justifies them
177
Historical analysis
- human experience is socially and historically located
- experience deteremined by history e.g. available funding, assumed etiology at time, and social discourse
- importance of reflexivity about history of own discipline
178
1) Interpretive phenomenological analysis (IPA)
| 2) Narrative analysis
1) explored lived expereinces - subjective perspective of the individual
2) - makes meaning of illness through data in form of stories
- understand experience of illness seen in relativiety to person's life e.g. back pain paper
179
Discourse Analysis
- study of language used in social interaction and construct social reality
- focus on conversational context
- purpose of statements e.g. patient-doctor comunication
180
1) Discursive psychology
| 2) Foucauldian discourse analysis
- 1) focus on context and action orientation of discourse - what is the purpose of the statement?
2) focus on power and politics
- larger societal discourse shape how we act and define ourselves e.g. smoking/anorexia
181
Analyitcal features of discourse analysis (4)
- choice of categories
- attribution of agency
- positioning
- identificiation of discursive reporatories
182
Action reserach and participatory action research
- research engaged with community to effect positive change
- working with community identify, increase capacity and empower individuals
- work with community
183
Community based psychological research
- work together to empower comunity
- put community before research
- tension with AR and PAR (because they put the research before the community)
184
Approaches to understanding lay representations of illness (4)
1) cognitive approaches - intrapsychic
2) phenomenological approaches - intrapsychic
3) discursive approaches - interpersonal
4) social approaches - forcudian anaylsis
- different apporaches work at different levels (intrapsychic, interpersonal and societal levels)
185
Cognitive approaches
- appraisal of threat
- coping with threat
- consequence of coping is evaluated
- self-regulation model of illness
- CSM extension
186
Common sense model (CSM) (5 dimensions of illness perception)
1) identify; signs, symptoms, labels etc.
2) consequences: physical, social, economic
3) causes
4) time line: percieved time frame for development
5) cure/control: extent to which illness is responsive to treatment
187
Evaluation and Development of Congitive model
- not universal = construtivenis view
| - illness representaions reflect interpersonal and cultural experiences
188
Crticism of the CSM
- is a standard assesment instrument
- but based on info-processing model of humans
- doesn't take into accoutn social and culture
189
Phenomenological approaches
- want to tap into people's experience (not just input output like CSM)
- concerned with subjective experience of world
- use open ended quetions ( not as society focused - looks at personal experiences)
190
Interpretive phenmenological analsis (IPA)
- double hermeneutic: trying to make meaning of patient making sense of the world
- no presumed structure to sbuejctive experince
- use verbal reports as primary source of information
191
Example of IPA with women living with type 1 diabetes
1) relationship with body
2) personal challenges
3) impact on relationships
4) changing and adpating
192
Social meaning of prosthesis use (3 sources of information because people criticze interviews too much )
1) semi structure interveiw
2) email interview
3) internet discussion groups
193
4 themes of prosthesis results
1) prothesis use and social rituals e.g. meeting up with someone for coffee
2) being a leper; reaction of others
3) social meaning of concealment and disclosure
4) feeling and experience regarding romantic and sexual relationships
194
Illness narratives
- originally from sociollogy and antrho
- focus on construction of world and how ppl make sense of their world based on these narratives
- narrative gives meaning to events, enables control and intervention etc.
195
Narrative typologies (restrictive)
- work to minimize illlness experince, emphasie that it is temporary and easy to beat
- more difficult to maintain this narrative if illness is chronic
196
Narrative typologies ( chaos)
- loss of sense of order of life, unable to cope
| - illness takes over too much
197
Narrative typologies (quest narrative)
- illness is challenge to be met; think of illness as something to be overcome
198
Narrative typologies (resstructive linear narrative)
- future is controlled through present actions
| - seem optomistic about the future
199
Narrative typologies (chaotic linear narrative)
- no prospect of exerting control
| - give up
200
Narrative typologies (polyphonic narrative)
- emphasize on present rather than future (future is too uncertain)
- focusing on the present to meet challenge
201
Therapeutic effects of writing
| - What is Autoethnography
- positive effect of writing or telling about illness reported by many research participants in narrative research
- growth of creative writing and drama classes in hospital and classess
- Autoethnography: researcher's writing about own experience
202
Purpose of discursive approaches
- life of person e.g. how they interact with others
- verbal reports but mental objects are diffcult to represented
- what does the person say "e.g. assigning blame" - don't focus on psychological state (what is going on in their head when they say something) but instead on the discourse itself
- what does the person actually SAY
203
Foucauldian discourse psychology
- focus on internalization of dominant discourses e.g. how does society think about this based on what they say and how does if affect our bodys and how we feel
204
Social approaches to health and illness
- interaction between science and common sense
- process and engagement between individual and social world
- persons not passive to environment
205
Bias (in positivist perspective)
- bad experimenter
| - dishonest research
206
Bias (in constructionist perspective )
- inevitable component of knowledge production
207
Examples of bias
1) funding of research
2) setting standard statistical threshold
3) publication bias
208
What are some responses to adherence
- take medication as prescirbed
- don't take it
- don't take correct dosage
- don't take at correct times
- stop taking before course is complete
209
What are the conseuences of non MA
- die from inapprorpraite use
| - nursing home admission
210
what are some factors associated with non MA
- patient characteristcs
- disease characteristics
- treatment factors - complexity?
- intepersonal factors (GP-patient)
- social-organizational
211
Describe the carhacteristics of the non adherent patient?
- low social support, socially isolated, no luck identify personality thought
- healht belief model (severity?) and social learning theory (self-efficacy) play a part
212
How do asymptomatic, prognosis, or obvious symptoms influence MA
- asymptomatic = less MA
- obvious = more MA
- poor prognoiss = less MA
213
How do complexity of treatment influence MA
- more complicated = less mA
| - less complicated = more MA
214
How do interperonsal factors influence MA
- patients prefer patient-cenetered styles = more MA
- job satisfaction = increase in MA
- more empathetic GP = more MA
- more positive views = more communication with GP = more MA and recieve more attention from GP
215
How do social settings influence MA?
- high support = high MA
| - higher cohesive familes with low conflict = high MA
216
How does modern medicin influence MA
- if you are not educated you may be more ignorant and be non complaitn
- or there is a increased focus on compliancy so it leads to resistance
217
What is the reactance theory
- that indivudals believe they have the right to control their behviour so if GPs push compliancy then they may become resistant to prevent loss of other freedoms
218
What is the difference between complaint vs. consumerist attidues and the relationship between GP and patient? concsequences of too much adherence focus?
- younger patients are more consumerist
- older patients are more complaitn (accepting) - consumerist stance (asking for more information) is more resisted by GP's
- preoccupation with adherence will lead to decline of authority of GPs
219
What is concordance?
- move to a more patient-cnetered model and emphasizes mutual repect between GP and patient
- potential for medical neglect
220
what are 4 aspects to the lived experience of chronic illness that influence MA
1) self regulation
2) fear of medication
3) identity control
4) meaning of illness
221
Describe how people with chronic illness regulate their medciation?
- actively monitor and adjust their medication (this is there way of non MA by adjusting to personal needs) as opposed to some who reckless ignore medical advice
- non MA is a rational process
222
Describe the self regulatory model of illness in general?
- is dynamic and the inconcsistency from person to person empahsize individual health beliefs and treatment rationales
223
Some people are non MA because of fear? What are some fears?
- fear of side effects
- dependency
- loss of identity
- reduce effectivness
- interfer with lifestyle
- sign of weakness
- doesn't fit helath belief model
224
What are some factors that infliuence the resistance to medcinein taking?
- there is distrust
- lack of social support
- cautionary effects of medicine?
225
How does the pharmeaceutical industry infleunce construction of disease and medicin?
- heavy promotion of drugs to promote health
- consider problems serious and convince ppl that medication is required
- biase for research to favours those sponsored by medical companies
226
What are the implications of medical error?
- more people die each year from medical error than car accides, breast cancer and AIDS
- many moe experience adverse events that may go underreported
227
What are some possible reasons for medical errors? (4)
1) shortage of nurses
2) stress from overwork
3) lack of teamwork
4) too little time for patients
228
What are some reasons for medical silence (reporting errors)?
- arn't aware of error
- arn't aware of need to report
- lack of feedback when reporting
- percieve patient as unharmed
- scared of reprecussions
- don't want to loose self-esteem (dont' want to admit)
- Don't know how to report
- Too busy to report
229
What is patient empowerment?
- fostering mastery and potential for self-care
- recognizin the social determinants of illness and increaing patient control and coping
- patient is not an passive sufferer
- note possibility to evade responsbility
Health Psychology
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