Public Health and Psychology Flashcards
Determinants of health as established by Lalonde report 1974?
Genes
Environment (physical, social and economic)
Lifestyle
Health care
Describe Dahlgren and whitehead 1991 determinants of health classification
Rainbow model. Individuals placed at centre with various layers of influences on health surrounding them
What are the layers in the Dahlgren-Whitehead model?
Centre=age/sex/constitutional factors Next=individual lifestyle factors Next=social and community networks Next=living and working conditions Outer=general socio-economic, cultural and environmental conditions
Describe the 7 boxes in the living and working conditions element of the Dahlgren-Whitehead model
Agriculture and food production Education Work environment Unemployment Water and sanitation Health care services Housing
Equity vs equality
Equity=what is fair and just
Equality=equal shares
Describe horizontal equity with example
equal treatment for equal need
individuals with pneumonia with all other things being equal should be treated equally
Describe vertical equity with example
unequal treatment for unequal need
individuals with common cold vs pneumonia need unequal treatment
List 5 different forms of health equity
Equal expenditure for equal need Equal access for equal need Equal utilisation for equal need Equal healthcare outcome for equal need Equal health
Classification of health equity?
Spatial ie geographical
and Social -age/gender/class/ethnicity
What are the three domains of public health practice?
Health improvement (societal interventions aimed at preventing disease, promoting health and reducing inequalities) Health protection (control infectious disease risks and environmental hazards) Health care (organisation and delivery of services)
What levels can interventions to improve public health be delivered at? Give example for each
Individual level eg childhood immunisation
Community level eg playground for local community
Ecological (population) level eg clean air act
Primary prevention? example
Prevent disease or injury before it even occurs
eg eating well, exercise regularly
Secondary prevention? example
Reduce the impact of a disease or injury that has already occurred
eg screening for breast cancer, daily aspirin post MI
Tertiary prevention? example
Reduce the impact of an ongoing illness or injury that has lasting effects , reduce mortality
eg stroke rehab programs
Describe the different health behaviours with an example
Health behaviour=prevent disease eg eat well
Illness behaviour=seek remedy eg act of going to doctor
Sick role behaviour=actively aimed at getting well eg taking prescription
Health behaviours=health damaging or health promoting
Why do people engage in health damaging behaviours?
Self-serving bias Unrealistic optimism (inaccurate perceptions of risk and susceptibility)
Perceptions of risk influenced by lack of personal experience, belief preventable by personal action, belief not happened now not likely to, belief problem infrequent
Health beliefs, situational rationality (felt like a good idea at the time), culture variability, socioeconomic factors, stress, age
Describe the needs assessment cycle
Needs assessment-planning-implementation-evaluation
Weighing up need, demand and supply
What is meant by health need?
Need for health. Measured using mortality, morbidity, socio-demographics
What is meant by health care need?
Much more specific than health need. Ability to benefit from health care, depends on potential of prevention, treatment and care services to remedy health problems
Sociological perspective of need?
Felt need (individual perceptions) Expressed need (individual seeks help to overcome variation) Normative need (professional defines intervention appropriate) Comparative need (between severity, range of interventions and cost)
Public health approaches to needs?
Health needs assessment by either epidemiological , comparative, corporate
Describe epidemiological approach for health needs assessment
Define problem
Size of problem; incidence/prevalence
Services available; prevention, treatment, care
Evidence based; (cost) effectiveness
Models of care (quality and outcome measures)
Existing services (unmet need, services not needed)
Recommendations
Problems with epidemiological approach to health needs assessment
Required data may not be available, variable data quality, evidence base may be inadequate, does not consider felt needs of people affected
Describe comparative approach for health needs assessment
Compare services. May examine health status, service provision, service utilisation, health outcomes
Problems with comparative approach for health needs assessment?
May not yield most appropriate level of eg provision should be, data may not be available, data may be of variable quality, may be difficult to find comparable population
Describe corporate approach for health needs assessment
Obtaining views of a range of stakeholders eg opinion leaders, commissioners, providers, professionals, patients, press
Problems with health needs assessment corporate approach
Difficult to distinguish need from demand, groups may have vested interests, may be influenced by political agendas, dominant personalities may have undue influence
What form can be used for domestic violence? What levels of risk
DASH and MARAC (multiagency risk assessment conference) forms
Standard risk=serious harm not likely
Medium risk=potential to cause serious harm but unlikely unless a change in circumstances
High risk=high risk of serious harm
What question format can be used in asking about domestic violence in consultations?
HARK
H=humiliation eg does partner make you feel bad about yourself
A=afraid eg what does your partner do that makes you feel scared
R=rape=ever forced to do anything your not comfortable with
K=kick eg does your partner threaten to hurt you
Cut off between child abuse and domestic abuse
16 years=domestic abuse
6 most common causes of visual impairment
cataracts, diabetic retinopathy, retinitis pigmentosa, glaucoma, age related macular degeneration, hemianopia
3 types of cane for visually impaired people
Symbol cane; hold to notify of condition
Guide cane; find obstacles on the ground and help measure depth of steps
Long cane; avoid obstacles and navigate, ball on end, used in sweeping motion
What is Charles Bonnet syndrome?
“Phantom visions” Brain tries to compensate for not seeing by creating visual hallucinations=side effect of sight loss. Affects up to 50% of people who lose their sight, especially in early stages.
Describe the Donabedian model
Used for evaluation of health services
Structure, process, [output], outcome
NB/outputs frequently all come under process
Donabedian framework: describe structure
What is there- buildings, staff, equipment
eg number of ICU beds per 1000 population
Donebadian framework: describe process
What is done
eg number of patients seen in A&E-the process through which patients go in to A&E-where and when first seen, who triages, assessing priority etc
Donebadian framework: describe outcome
Classification of health outcomes: mortality, morbidity, quality of life/PROMs (patient reported outcome measures) and patient satisfaction
Can also use 5Ds: death, disease, disability, discomfort, dissatisfaction
Problems with measuring health outcomes
Cause and effect link may be difficult to establish as many other factors may be involved
Time lag between service provided and outcome may be long
Large sample sizes may be needed to demonstrate statistically significant effects
Data may not be available
May be issues with data quality (CART-completeness, accuracy, relevance, timeliness)
Describe Maxwell’s dimensions of quality to be used in assessment in quality of health care
3Es and 3As
Effectiveness (desired effect?), efficiency (output maximised for given input?), equity (patients treated fairly)
Acceptability (acceptable to patients?), accessibility (geographical, costs, waiting times etc?), appropriateness (relevance?)
What methods can be used in evaluation of health care
Qualitative-via observation, interviews, focus group, review of documents. Consult relevant stakeholders
Quantitative- via routinely collected data, review of records, surveys, special studies
Mixed
Overview of evaluating health services: general framework?
Define what the service is
Aims/objectives of service-are they stated and are they appropriate
Framework: structure, process, outcome (+/- dimensions of quality)
Methodology to be used: quali/quanti/mixed
Results, conclusions and recommendations
Name 4 models of behaviour change
Health belief model, theory of planned behaviour, stage models (transtheoretical/stages of change), motivational interviewing, social marketing, nudging (choice architecture, make best choice the easiest eg fruit at checkouts), financial incentives, social norms
Describe the health belief model
Change if the individual believes they are susceptible to the condition, the condition has serious consequences, taking action will reduce their susceptibility, benefits of taking action outweighs the costs
Also contributed to by health motivations/self efficacy and cues to action
Longest standing model. Successful for range of health behaviours eg breast self exam. Perceived barriers are the most important factor for addressing behaviour change
Critique of health belief model?
Alternative factors may predict health behaviour
Cognitive based model-doesn’t consider influence of emotions
No differential between 1st time and repeat behaviour
Cue to action often missing
Describe the theory of planned behaviour
Proposes best predictor of behaviour is intention.
Rational choice model. Major determinants=attitudes, subjective norms, perceived behavioural control.
Can predict for wide range of behaviours eg smoking
Accounts for social pressures and norms
Under the theory of planned behaviour, what determines intentions?
Person’s attitudes to the behaviour, subjective norms (perceived social pressure) and perceived behavioural control (appraisal of self’s ability to perform the behaviour)
What techniques can be employed to help bridge the gap between intention and behaviour?
Perceived control, anticipated regret, preparatory actions, implementation intentions, relevance to self
Critique of theory of planned behaviour?
Lack of temporal element and lack of direction or causality
Rational choice model
Habits and routines undermine model
Assumes attitudes, subjective norms and perceived behavioural control can be measured
Relies on self reported behaviour
Describe the transtheoretical model/stages of change model of behaviour change?
Discrete stages and with each stage a greater inclination to change
5 stages=pre-contemplation, contemplation, preparation, action (6months), maintenance (6months)
Progress and relapse. Temporal element and acknowledges individual stages of readiness
Allows interventions to be tailored to each stage/each individual
Critique of transtheoretical model?
not all people go through every stage
change may operate on a continuum rather than discrete stages
doesn’t account for values, habits, culture, social and economic factors
Basis of the social norms model?
Misperceptions of how peers think and act, need to alter perceptions of these pseudonorms.
NICE defined transition points for behaviour change?
Leaving school, entering workforce, becoming a parent, becoming unemployed, retirement, bereavement
Define allodynia
Perception of pain to a non painful stimulus (chronic pain-sensitisation)
Define hyperalgesia
Minimally painful stimulus produces disproportionate response (Chronic pain-sensitisation)
3 opioid receptors? Where?
MOR, KOR, DOR (mu, kappa, delta)
CNS, less so PNS. Occupy sites in vas deferens, knee joint, GI tract, heart and immune system
Describe 5 negative effects of opioids
GI system-constipation and nausea
Resp system-resp depression, sleep apnoea, CO2 retention
CNS- dizziness, sedation, hyperalgesia
MSK-fracture risk
Immune system-mu receptor on immune cells leads to apoptosis
Addiction and misuse, depression
Endocrine system-hypogonadism (opiate induced androgen deficiency), decreased fertility, ED
Non pharm management of chronic pain?
Physical eg wt loss, smoking cessation, stretching, physio
Psychological eg CBT, counselling, meditation
Complementary eg massage and reflexology
Occupational eg work place based review
Analgesic ladder?
Non-opioid eg NSAID, COX-2 inhibitors, paracetamol
Mild opioid eg codeine
Strong opioid eg morphine
Adjuvants=anti convulsants, anti depressants, lidocaine patches
Name 5 factors that promote excessive energy intake
Genetics, employment (shift work), early developmental factors, TV viewing/advertisements, characteristics of food (energy density, macronutrient composition, satiety/satiation, portion size), decreased physical activity, sleep, environmental cues, psychological factors
Define malnutrition
Deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients
What are three early influences on feeding behaviour?
Maternal diet during pregnancy and breast feeding.
Influence of parents to consume new food
Parental feeding practices and infant feeding patterns
Briefly describe the impact of maternal diet on feeding behaviour
Taste and olfactory systems can detect flavour in utero
Foetus swallows amniotic fluid (by third trimester=1L a day)
Amniotic fluid and human milk transmit volatiles from maternal diet providing early chemosensory experience (esp garlic, chilli, anise)
Neonates orientate towards odour of own amniotic fluid and mother’s breast milk
Regarding feeding behaviour influences, advantages of breast feeding?
Acceptance of novel foods during weaning, less picky eaters in childhood, have a diet richer in fruit and veg
Early experiences of breast milk/amniotic fluid shown to last after 10 years of age
Describe paradoxical effect of parents using coercion when feeding
Coercion/persuasion/contingencies to encourage children to consume new food= using other food as an incentive to eat novel food increases liking for the reward not the novel food (reduces liking for novel food)
Describe 3 features of “healthful” eating behaviours
Responsive feeding-recognise hunger and fullness cues Provide variety of food Avoid pressure to eat Authoritative parenting Not using food as a reward
What are non-organinc feeding disorders (NOFEDs)?
Feeding aversion/refusal, food selectivity, fussy, failure t advance to age appropriate foods, negative mealtime interactions, high prevalence in under 6s
Parents have often used maladaptive feeding practices
Name the eating disorders
3 distinct= anorexia nervosa, bulimia nervosa, binge eating disorder.
OSFED= other specified feeding or eating disorder
Define eating disorder
Clinically meaningful behavioural or psychological pattern re eating or weight associated with distress/disability/substantially increased risk of morbidity or mortality
Define disordered eating
Restraint, strict dieting, disinhibition, emotional eating, binge eating, night eating, weight and shape concerns.
Inappropriate compensatory behaviours that do not warrant a clinical diagnosis
Name 5 challenges/disadvantages of diets
Risk factor for development of eating disorder
Loss of lean body mass not just fat mass
Slows metabolic rate and energy expenditure
Chronic dieting may disrupt normal appetite responses and increase subjective sensations of hunger
LT wt loss challenging-normal pattern is wt loss, plateau then wt gain
Non-obese dieters at increased risk of fat overshooting
Wt cycling (repeated diet relapse) may accelerate wt gain
In epidemiology, what factors contribute to association rather than a causative link?
Bias-studies finding associations more likely to have been published resulting in publication bias
Chance
Confounding
Reverse causation eg people who are already unwell don’t drink coffee
2 methods of approaching epidemiological intervention?
Population approach: preventative measure seeking to shift risk factor distribution curve eg dietary salt restriction through legislation
High risk approach: seeks to identify individuals above a chosen cut off and treat them eg screening for hypertension and subsequent treatment
Describe the prevention paradox
Preventive measure which brings much benefit to population often offers little to each participating individual eg seat belt use
