Public Health Flashcards
What is a health needs assessment?
A systematic method for reviewing the health issues facing a population. Leading to agreed priorities and resource allocation that will improve health and reduce inequalities.
How can you demonstrate a health needs assessment as a diagram?
Needs assessment > planning > implementation > evaluation > begin cycle again
Define need
The ability to benefit from an intervention.
Define demand
It’s what people ask for
Define supply
It’s what we actually provide.
What is a health care need?
A need for healthcare – the ability to benefit from health care
Depends on the potential of prevention, treatment and care services to remedy health problems.
What are the 3 different approaches of health needs assessments?
Epidemiological
Comparative
Corporate
What does an epidemiological approach to a health needs assessment involve?
Define problem
Look at the size of the problem – incidence/prevalence
Services available – prevention/treatment/care
Evidence base – effectiveness and cost-effectiveness
Models of care – including quality and outcome measures
Existing services – unmet need; services not needed
Recommendations
What are some potential sources of data for an epidemiological HNA?
Disease registry
Hospital admissions
GP databases
Mortality data
Primary data collection (e.g. postal/patient survey)
What are the advantages of an epidemiological HNA?
Uses existing data
Provides data on disease incidence/mortality/morbidity etc.
Can evaluate services by trends over time
What are the disadvantages of an epidemiological HNA?
Quality of data variable
Data collected may not be the data required
Does not consider the felt needs or opinions/experiences of the people affected
What are the 4 sociological perspectives of need?
- Felt need – individual perceptions of variation from normal health
- Expressed need – individual seeks help to overcome variation in normal health (demand)
- Normative need – professional defines intervention appropriate for the expressed need
- Comparative need - comparison between severity, range of interventions and cost
What does a comparative approach to a health needs assessment involve?
Compares the services received by a population (or subgroup) with others:
Spatial
Social (age, gender, class, ethnicity)
i.e. COMPARES THE SERVICES FOR A PARTICULAR HEALTH ISSUE IN TWO DIFFERENT AREAS
What factors might a comparative HNA examine?
Health status
Service provision
Service utilisation
Health outcomes (mortality, morbidity, quality of life, patient satisfaction)
What are the advantages of a comparative HNA?
Quick and cheap if data available
Indicates whether health or services provision is better/worse than comparable areas (gives a measure of relative performance)
What are the disadvantages of a comparative HNA?
May be difficult to find comparable population
Data may not be available/high quality
May not yield what the most appropriate level (e.g. of provision or utilisation) should be
What does the corporate approach to a health needs assessment involve?
Ask the local population what their health needs are
Uses focus groups, interviews, public meetings etc.
Wide variety of stakeholders e.g. teachers, healthcare professionals, social workers, charity workers, local businesses, council workers, politicians
What are the advantages of a corporate HNA?
Based on the felt and expressed needs of the population in question
Recognises the detailed knowledge and experience of those working with the population
Takes into account wide range of views
What are the disadvantages of a corporate HNA?
Difficult to distinguish “need” from “demand”
Groups may have invested interests
May be influenced by political agendas
What are the 3 main types of health related behaviours and provide an example of each? (6 marks)
Health behaviour – behaviour aimed to prevent disease (e.g. eating healthy)
Illness behaviour – behaviour aimed to seek remedy (e.g. going to the doctor)
Sick role behaviour – any activity aimed at getting well (e.g. taking prescribed medications, resting)
What are the 4 factors of the health belief model?
Perceived susceptibility
Perceived severity
Perceived benefits
Perceived barriers
According to the 4 factors of Health Belief Model give examples of what will make individuals change their behaviour?
Believe they are susceptible to the condition in question (e.g. heart disease)
Believe that it has serious consequences
Believe that taking action reduces susceptibility
Believe that the benefits of taking action outweigh the costs
Which factor of the health beliefs model has been shown to be the most important?
Perceived barriers
This is all about the patient having poor self-efficacy (i.e. not being able to stick to a behaviour change they have made)
What are some criticism for the health belief model?
Doesn’t consider the influence of emotions and behaviour
Does not differentiate between first time and repeat behaviour
Cues to action are often missing
What are some examples of cues to action which may influence behaviour change?
Cues can be internal or external
Internal = increase in pain, decrease in ADLs
External = reminders in the post, reminders for GP apts, pressure from families etc.
What are some factors for poor compliance to medication? (3)
Side effects (warn them)
Comorbidities (esp. mental health/dementia)
Polypharmacy
Complex drug regimes
Poor understanding of disease state
Social factors – i.e. they have dependants/act as carers for someone else so they don’t prioritise their own health
What is a cohort study? One limitation?
Prospective
Population free from disease initially
Follow up on exposed and non-exposed group and see what the outcome is
Limitation = very expensive
What is the theory of planned behaviour?
Proposes that the best predictor of behaviour is INTENTION i.e. “I intend to give up smoking”
According to theory of planned behaviour, what are the 3 factors that influence our intentions and give an example of each with reference to smoking cessation? (6 marks)
A persons attitude - e.g. I do not think smoking is a good thing
Subjective norms (the perceived social pressure to undertake the behaviour) – e.g. people who are important to me want me to give up smoking
Perceived behavioural control (a persons appraisal of their ability to perform the behaviour) – e.g. I CAN give up smoking
What are some criticisms of the theory of planned behaviour?
Doesn’t take into account emotions
Relies on self-reported behaviour (i.e. people may lie)
Lack of temporal element (there is no timescale on it)
Assumes that attitudes, subjective norms and perceived behavioural control can be measured
How would you help people acting on their intentions for the theory of planned behaviour?
Perceived control
Anticipated regret
Preparatory actions
Implementation intentions
Relevance to self
What are the 6 stages of the stages of change model (aka Transtheoretical model)? Give an example for each
Pre-contemplation – haven’t thought about stopping smoking
Contemplation – thinking about stopping smoking
Preparation – goes to the doctor/pharmacy, gets a prescription for NRT/Champix to prepare them for stopping. Sets a stop date. Throws away cigarettes
Action – stops smoking on quit date, uses medications to help them
Maintenance – continues with abstaining from smoking by going for regular reviews, picking up more medication etc.
(relapse) – potential for relapse after a “trigger” type event
What are some advantages of the stages of change model (aka TTM)?
Acknowledges individual stages of readiness
Accounts for relapse/allows patient to move backwards in the stages
Gives an idea of time-frame/progression (albeit arbitrary)
What are some criticisms of the stages of change model (aka TTM)?
Not all people move through every stage
Change might operate on a continuum rather than through discreet changes
Doesn’t take into account values, habits, culture, social and economic factors
What impact does social norms theory have on health behaviours?
Note - you can get a 6 marker on this question
Social norms = behaviours and attitudes that are most common in a group
One of the most important factors influencing behaviour
Sometimes belief or norms is different to actual norms – allows people who want to do high risk behaviours to think they’re just doing what everyone else is doing (but is often not the case)
Providing the truth about social norms could decrease high risk behaviours – e.g. only 20% of people smoke
However – DOESN’T work when the risky behaviour is the social norm (drinking alcohol, obesity)
Why do patients continue high risk behaviours despite knowing the risks?
Unrealistic optimism**
Justifies behaviour with other things
Doesn’t have the willpower to stop
What is meant by unrealistic optimism?
Theory for why patients engage in risky behaviours
Individuals continue to practice health damaging behaviours due to inaccurate perceptions of risk and susceptibility
i.e. they are aware of the risks but “don’t think it would happen to them”
What are the factors of unrealistic optimism that influence people’s perception of risk?
Lack of personal experience with the problem
Belief that it’s preventable by personal action
Belief that if not happened by now, it’s not likely to
Belief that the problem is infrequent
Give examples of how health promoting interventions can be applied at a population, community and individual level
Population level – cigarette and alcohol tax
Community level – introducing more cycle paths to make cycling safer, having to pay a fee for bringing a car into an area (London), building an outdoor gym in a particular town
Individual level – patient centred approach to care. The care responds to their individual needs
What is the definition of domestic abuse?
Controlling, coercive, threatening behaviour, violence of abuse between those aged 16 or over who are or have been intimate partners or family members
Includes – psychological, physical, sexual, financial and emotional abuse
Which tool can be used to assess domestic abuse?
DASH tool (Domestic abuse and Sexual Harassment tool)
What do you do if you think someone is at medium/standard risk of domestic abuse?
In these cases it’s their CHOICE what they do
Give them contact details for domestic abuse services and let them decide what to do
What do you do if you believe someone is high risk for domestic abuse?
Refer to MARAC/IDVAS wherever possible with consent
In HIGH RISK – you can break confidentiality if you don’t get their consent, but always try and get consent first
What is HARK
The four HARK questions were developed as a framework for helping identify people who have suffered domestic abuse, and found to be a sensitive tool. This stands for:
Humiliation
Afraid
Rape
Kick
How are most opioids excreted from the body?
Renal excretion
Which opioid do 10% of the population don’t have the enzyme to metabolise it?
Codeine
Which opioid do 10% of the population metabolise very quickly?
Codeine
Which people in the population are codeine not prescribed to? What is the SE for taking it?
Infants
Pregnant women
SE - Resp depression
Allodynia meaning
A pain response from a non-painful stimulant i.e. soft feather touch causing pain
Central sensitisation meaning
A state in which the central nervous system amplifies sensory input across many organ systems i.e. when a hug or a pat on the back hurts someone
What is the antidote to opioid toxicity?
Naloxone - give it slowly
Define malnutrition
Deficiencies, excesses or imbalances in a
person’s intake of energy and/ or nutrients. It covers 2 groups of conditions: undernutrition and overweight/obesity
What are some early influences on feeding/eating behaviour on children?
Maternal diet and taste preference development
Role of breastfeeding for taste preference and body weight regulation
Parenting practices
What are the 3 core principles of the NHS?
- That it meets the needs of everyone
- That it is free at the point of delivery
- That it is based on clinical need, not ability to pay
What is Health inequality?
The preventable, unfair differences in health status between individuals that arise from the unequal distribution of social, environmental and economic conditions within societies, which determine the risk of people getting ill.
What is the inverse care law?
The principle that the availability of good medical or social care tends to vary inversely with the need of the population served.
i.e. The more you need health care, the less there is available
