Public Health 3 Flashcards
1
Q
- What is a health needs assessment ?
A
- The first stage of the ‘planning cycle’ for a health service
- This cycle is the process all health services go through for new services and improvements
2
Q
- What is a planning cycle for health services ?
A
- Needs assessment
- Planning
- Implementation
- Evaluation
- Review
- Repeat
3
Q
- What is a Health Need and how is it assessed ?
A
- Defined as a need for health that can benefit from health care or from wider social and environmental changes
- Measured using mortality, morbidity and socio-demographic measures
4
Q
- What are the 4 sociological perspectives of need or Bradshaw’s Need ?
A
- Felt need
- Expressed need
- Normative need
- Comparative need
5
Q
- What is a felt need ?
A
- Individual perceptions of variation from normal health e.g. feeling ill
6
Q
- What is an expressed need ?
A
- Individuals seek help to overcome variation in normal health e.g. going to the GP/and to access services = demand
7
Q
- What is a normative need ?
A
- Based on professional judgement
8
Q
- What is a comparative need ?
A
- Based on needs of people with similar attributes e.g. healthcare services compare + rank patients based on the above categories
9
Q
- What are 2 approaches that can be used during the Evaluation aspect of a health service planning cycle ?
A
- Donabedian approach
- Maxwell’s dimension
10
Q
- What does a Donabedian approach consider when evaluating a health service during its planning cycle ?
A
- Structure – what there is
- Process – what is done
- Outcome – mortality, morbidity, patient related outcome, measure, patient satisfaction focus groups (qualitative)
11
Q
- What are the measurements in a Donabedian approach to evaluation of a health service during its planning cycle ?
A
- Death
- Disease
- Disability
- Discomfort
- Dissatisfactions
12
Q
- What are Maxwell’s Dimension of Quality ?
A
- 3Es and 3As
- Effectiveness – does it produce desire effect ?
- Efficiency – Is the output maximized for impact ?
- Equality – equal access for patients ?
- Acceptability – Operations happen at an acceptable time of day ?
- Accessibility – Patients from far away can access ?
- Appropriateness - Do those who actually need it get it ?
13
Q
What is a health behaviour ?
A
- A behaviour aimed at reventing disease or illness e.g. eating healthily
14
Q
What is an illness behaviour ?
A
- A behaviour aimed at seeking remedy e.g. going to the GP
15
Q
What is a sickness behaviour ?
A
- An activity aimed at getting well e.g. taking prescribed medications or resting exposure in question
16
Q
- What are the 5 models of behaviour change ?
A
- Theory of planned behaviour
- Nudge theory
- Stages of change model
- Health belief model
- Motivational interviewing
17
Q
- What is the Theory of Planned Behaviour Change
A
- Proposes that the best predictor of behaviour is ‘’intention’’ e.g. intend to give up smoking
- 3 factors determine intention in this theory
- A persons attitude e.g. smoko isn’t good
- Subjective norms – perceived social pressure to undertake behaviour e.g. people who are important to me want me to stop smoko
- Perceived behavioral control – a persons appraisal of their ability to perform the behaviour e.g. I can give up smoko
18
Q
- What are the disadvantages to the Theory of Planned Behaviour Change ?
A
- Doesn’t take into account emotions
- Relies on self-reported behaviour (people may lie)
- Lack of temporal element (no timescale)
- Assume the attitudes, subjective norms + perceived behavioural changes can be measured
19
Q
- What is Nudge theory ?
A
- Changing environment to make the best/healthiest option the easiest
- E.g. opt-out schemes, placing fruit next to the checkout instead of the sweats
20
Q
- What are the 6 steps in the Stages of Change Model of behaviour change ?
A
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Termination
21
Q
- Way to remember stages of change model of behavioral change ?
A
- PCP actually makes terminators
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Termination
22
Q
- What are the advantages of the Stage of Change model of behavioral change ?
A
- Acknowledges the individual stages of readiness
- Accounts for relapse and allows for individuals to move back in stages
- Gives idea of time frame/progression
23
Q
- What are the disadvantages of the Stages of Change model of behavioral change ?
A
- Not all people move through every stage
- Doesn’t account for values, habits, culture and socioeconomic factors
24
Q
- What is the Health Belief Model
A
- The idea that to increase the chance of an individual changing a health behaviour, you need to influence how they perceive 4 factors
- Perceived susceptibility
- Perceived severity
- Perceived benefit
- Perceived barriers
25
25. What is Perceived Susceptibility in the context of the Health Belief Model ?
- More likely to change their behaviour if they are susceptible to the condition e.g. patient needs to perceive they could develop lung cancer in order to stop smoking
26
26. What is Perceived Benefit in the context of the Health Belief Model ?
- A patient is more likely to change if they believe that taking action reduces their susceptibility e.g. if they stop smoking then they will reduce the chance of lung cancer
27
27. What is the Perceived Severity in the context of the Health Belief Model ?
- A patient is more likely to change if they believe that the condition has serious consequences for them e.g. lung cancer is bad for them
28
28. What are Perceived Barriers in the context of the Health Belief Model ?
- A patient is more likely to change if they believe that the benefits outweigh the costs e.g. there are smoking services to help them remove the barriers
29
29. What are the disadvantages to the Health Belief Model ?
- Doesn’t consider the influence of emotions + behaviour
- Doesn’t differentiate between first time or repeated behaviour
- Calls to action are often missing
30
30. What is Motivational Interviewing
- Counselling approach for initiating behaviour change
- Resolves ambivalence (share of mixed feelings) in order to initiate behaviour change
31
31. What are the different levels of Health Promoting Interventions
- Population level e.g. tax of smoko
- Community level e.g. introducing more cycle paths
- Individual level e.g. patient centered approach
32
32. What are the roles of doctors in changing health behaviour ?
- Set and record goals
- Aim for easy changes over time
- Plan explicit coping strategies
- Review progress
- Work with patients priorities
33
33. How does the NCSCT training assessment program provide quality assurance
- Confirming that practitioners have the necessary knowledge + skills to deliver stop smoking interventions
- Ensure the interventions delivered are evidence based
- Practitioners must provide evidence of clinical effectiveness + ongoing continual professional development
34
34. How many ml is 1 unit of ethanol ?
- 10ml
- So 1000ml of a 4.3% beer will have 1000x0.043 = 43ml of ethanol so 4.3 units
- A 750ml of a 12.5% bottle of wine will have 750 x 0.125 = 93.75 ml of ethanol so 9.375 units
35
35. What are the definitions of binge drinking ?
- 6 units for women and 8 units for men in a single session
36
36. What are the 3 domains of public health ?
- Health improvement
- Health promotion
- Improving services
37
37. What does the Health Improvement domain of public health involve ?
- Social interventions aimed at preventing disease and promoting health and reducing inequalities
- E.g. Education, housing, employment and community
38
38. What does the Health Promotion domain of public health involve ?
- Think environmental
- Measures to control infectious disease and environmental hazards
- E.g. infectious disease, chemicals, poison, radiation, emergency response and environmental health hazards
39
39. What does the improving services domain of public health involve ?
- Think systems
- Organizations + delivery of safe, high quality services
- E.g. clinical effectiveness, service planning, audit and educations
40
40. What are the features of a notifiable disease that make it a public health concern ?
- High mortality
- High morbidity
- Highly contagious
- Expensive treatment
- Effective interventions
41
41. List the notifiable diseases
- Meningitis/encephalitis
- Cholera
- Diphtheria
- Typhoid
- Leprosy
- TB
- Whopping cough
- MMR
- Malaria
- Rabies
- SARS
- Scarlet fever
- Small pox
- Tetanus
- Yellow fever
42
42. List the study designs that are retrospective ?
- Case report
- Case series
- Cross-sectional
- Case control
- Cohort
- Randomised control trial
43
43. Which study designs are prospective ?
- Cohort
- Randomised control trial
- Systematic review
44
44. What are the areas of health determinants ?
- Lifestyle
- Genetic
- Environmental
- Health
45
What impacts Lifestyle as a determinant of health ?
- Smoking status
- Wealth
- Employment
46
How does genetics impact determinants of health ?
- Age
- Gender
- Ethnicity
47
How does environment impact determinants of health ?
- Housing
- Socioeconomic status
- Access to education
48
How does healthcare impact determinants of health ?
- Economic factors
- Access
- Quality
49
Pneumonic for remembering influences on health inequalities ?
- PROGRESS
- Place of residence
- Race or ethnicity
- Occupation
- Gender
- Religion
- Education
- Socioeconomic status
- Social capital/resources
50
What is the inverse care law ?
- Availability of medical and social care tends to vary inversely with the need of the population served
51
What does equality mean ?
- Treating everyone the same and giving everyone equal shares e.g. giving £100 to the ricj and £100 to the poor
52
What does equity mean ?
- About being fair and just e.g. giving everyone what they need to be successful e.g. giving £500 to the poor and nothing to the rich
53
What does Horizontal mean in the context of health inequalities ?
- Equal treatment for equal need e.g. all people with pneumonia deserve equal treatment
54
What does Vertical mean in the context of health inequalities ?
- Unequal treatment for unequal need e.g. individuals with pneumonia deserve different treatment from those with a common cold e.g. areas of proper health may need higher expenditure on health services
55
What are the types of error ?
- Sloth
- System error
- Lacking skill
- Fixation
- Bravado
- Playing the odds
- Poor team working
- Mis-triage
- Error of inherited thinking
56
What is an adverse event ?
- An event where a patient comes to harm
57
What is a Near Miss ?
- An event which has the potential to cause harm but fails to develop further: avoids harm
58
What is the bucket model of error ?
- Error evolves due to interaction between personal environmental and physical factors as well as organizational
- Systems approach is the recognition that we need to look at our systems rather than individual people
- 3 bucket model looks at situations leading to error
59
What are the 3 buckets of error ?
- Self – poor knowledge, fatigue, little experience and currently capacity to do task
- Context – equipment failure, physical environment, inadequate handover, team, support leadership
- Task – task complexity, novel task, overlapping tasks, multitasking
60
What are Never Events ?
- A serious preventable patient safety incident that should not occur if available preventable measures have been implemented
- E.g. Wrong chemo route, wrong surgical site or escape of sectioned patient
- Results in reputation loss, care quality commission investigation and financial penalty
61
What are the 3 types of Public Health Interventions ?
- Primary – preventing the disease
- Secondary – catching a disease in its early/preclinical stage e.g. cervical screening
- Tertiary – preventing complications of disease e.g. diabetic foot care
62
What are the 2 general approaches to public health interventions ?
- Population = preventative measures e.g. legislation of dietary salt reduction
- High risk = identifying individuals above a chosen cut off and treating e.g. screening for HTN
63
What is the prevention paradox ?
- Preventative measures which bring much benefit to the population often offers little to each individual
- E.g. screening a large number of people only helps a small number
64
What is a false positive ?
- Disease is identified by a screen in a person who has not disease
65
What is a true positive ?
- Disease identified correctly by a test or screen in someone who has the disease
65
What is a false negative ?
- When a test or screen fails to identify someone with disease
66
What is a true negative ?
- When a disease is not present and a test or screen identifies it correctly
67
What is sensitivity ?
- The proportion of people with the disease who are correctly identified by screening test
68
What is specificity ?
- The proportion of people without the disease who are correctly excluded by the screening test
69
What is the positive predictive valve ?
- The proportion of people with a positive test result who have the disease
70
71. What is the negative predictive valve ?
- Proportion of people with a negative test result who don’t have the disease
71
