Public health peer teaching Flashcards
What are the 4 perceptions that will affect likelihood of engaging in health promoting behaviour, according to the health belief model
Susceptibility to ill health
Severity of ill health
Benefits of behaviour change
Barriers to taking action
7 steps of change/ transtheoretical model
Precontemplation Contemplation Preparation Action Maintenance Relapse
Describe theory of planned behaviour
Attitudes, subjective norm and percieved behaviour control affect intention which affects behaviour
What are the three aspects of communicable disease control?
Surveillance
Prevention
Control
What makes a communicable disease important to public health authorities
High mortality and morbidity
Highly contagious
Expensive to treat
Effective interventions
When do you notify of notifiable disease and how
On clinical suspicion, name, NHS no, DOB, contact details. What disease, diagnosis, samples, outcome.
Written notification, can be telephone first but followed by written.
Notifiable diseases
Acute encephalitis, infectious hepatitis, meningitis, polymyelitis. Anthrax Botulism Brucellosis Cholera Diptheria Enteric fever Food poisoning Haemolytic uraemic syndrome Infectious bloody diarrhoea Invasive GABHS Legionnaires Leprosy Malaria Mumps Measles Meningococcal septicaemia Rubella Plague Rabies SARS Scarlet fever Small pox Tetanus TB Typhus Viral haemorrhagic fever Whooping cough Yellow fever
Is food poisoning a notifiable disease
Yes
Things other than diseases that are notifiable
Infection/ contamination which could be a signficant risk to human health (chichen pox in a healthcare worker), notification of suspected outbreaks/ clusters
Define a cluster (outbreak)
A aggregation of cases which may or may not be linked
Define a suspected outbreak
Occurence of more cases than normally expected within a specific group/ over a given period of time.
2+ cases linked through common exposure/ characteristic/ time/ location
Single case of rare/serious disease
Define confirmed outbreak
Link confirmed through epidemiological/ microbiological investigation
Define epidemic
Occurence within an area in excess of what is expected for a given time period
Define pandemic
Epidemic widespread over several countries
Define endemic
Persistent level of disease occurrence
Define hyperendemic
Persistently high level of disease occurrence
What is health
A state of complete physical, mental and social wellbeing; not merely the absence of disease
What are the three domains of public health
Health protection
Health improvement
Improving service
What does health protection mean
Measures to control infectious disease risk and environmental hazards
What does health improvement mean
Social interventions aimed at preventing disease, promoting health and reducing inequality
What does improving services health domain do
Organisation and delivery of safe, high quality services
What is the inverse care law
The availability of medical or social care tends to vary inversely with the need of the population served
4 categories for the determinants of health
Genetic
Lifestyle
Environmental
Health care
What are genetic determinants of health
Age
Gender
Ethnicity
What are environmental determinants of health
Housing
Socioeconomic status
Access to education
What are lifestyle determinants of health
Smoking status
Wealth
Employment
What are healthcare determinants of health
Access
Quality
Economic factors
What is equity
What is fair and just
What is horizontal equity
Equal treatment for equal need
What is vertical equity
Unequal treatment for unequal need
Define health needs assessment
A systematic approach for reviewing the health issues affecting a population which leads to agreed priorities and resource allocation that will improve health and decrease inequalities
What is the health needs assessment cycle
Needs assessment
Planning
Implementation
Evaluation
Describe epidemiological health needs assessment
Defines problem and size of problem
Looks at current services
Recommends improvements
What are the limitations of epidemiological health needs assessment
Data available may be poor
May be inadequate evidence base
Doesnt consider felt need
Describe the comparative health needs assessment
Compares services recieved by one population to another
What are the limitations of a comparative health needs assessment
Data available may vary in quality. May be hard to find comparable population. Comparison may not be perfect
Describe corporate health needs assessment
Takes into account views of any groups that may have an interest e.g. patients, media, proffesionals, politicians
What are the limitations of corporate health needs assessment
May be hard to distinguish need from demand
Groups have vested interest leading to bias
Dominant individuals may have bias
Define health need
The ability to benefit from an intervention
Define supply
What is provided
Define demand
What people ask for
What are the four types of need
Felt need
Expressed need
Normative need
Comparative need
Define felt need
Individual perceptions of deviations from normal health
Define expressed need
Seeking help to overcome variation in normal health
Define normative need
Professional defines intervention for expressed need
Define comparative need
Comparison between severity, range of interventions and cost
What are the steps in maslows heirachy of needs
Physiological Safety Love and belonging Esteem Self actualisation
What is the egalitarian approach to resource allocation
Provide all care that is necessary and required to everyone
What are the pros and cons of egalitarian resource allocation
Equal for everyone but economically restricted
What is the maximising approach to resource allocation
Based solely on consequence
What are teh pros and cons of a maximising approach to resource allocation
Resources allocated to those likely to recieve most benefit but those with ‘less need’ receive nothing
What is the libertarian approach to resource allocation
Each individual is responsible for their own health
What are the pros and cons of libertarian approach to resource allocation
Leads to more patient engagement but not all diseases are self inflicted
What are maxwells dimension to assessing the quality of service
Access Equity Appropriate Acceptable Efficient Effective
Define health behaviour
Behaviour aimed at preventing disease
Define illness behaviour
Behaviour seeking remedy
Define sick role behaviour
Activity aimed at getting well
Name 6 models of behaviour change
Health belief model Motivational interviewing Transtheoretical model Financial incentives Theory of planned behaviours Nudge theory
Advantages of the transtheroetical model
Acknowledges individual stages of readiness
Accounts for relapse
Temporal element
Disadvantages of transtheoretical model
Some individuals skip stages
Change may be continuous
Doesnt consider values
What things affect intention of planned behaviour
Attitudes
Subjective norms
Perceived behvaiour control
What factors influence relationship between intention and behaviour
Prepatory actions Percieved control Anticipated regret Implementation intentions Relevance to self
Advantages of theory of planned behaviours model
Very applicable
Useful for predicting intention
Takes importance of social pressures into account
What are the disadvantages of theory of planned behaviours
No temporal element, direction or causality
Doesnt consider emotions
Assumes attitudes can be measured
What are the 5 perceptions which are part of health belief model
Susceptibility Severity Motivation Benefits Barriers
Advantages of health belief model
Very applicable
Cues to action
Longest standing model
What things affect action in health belief model
Health beliefs affect likelihood of action which affects action. Cues to action also affect action
Disadvantages of health belief model
Other factors may influence outcome
Doesnt consider emotions
Doesnt differentiate first and repeated behaviours
What is the bolam rule of medical negligence
Would a reasonable doctor do the same?
What is the bolitho rule of medical negligence
Would that be reasonable?
What are the four key questions when it comes to medical negligence
Was there a duty of care?
Was there a breach in that duty?
Was the patient harmed?
Was the harm due to the breach in duty of care?
Name some types of error
Fixation and loss of perspective Communication breakdown Poor team working Playing the odds Bravado Timidity Ignorance Mistriage Lack of skill System error Sloth
Explain how the swiss cheese model works
A series of latent failures and absent defenses lead to active failures and unsafe acts
What is the three bucket model of error
Self
Context
Task
Error is due to interaction of personal, environemtnal and physical factors
Define a never event
A serious, largely preventable patient safety incident that should not occur if available, preventative measures should have been implemented
Examples of never events
Wrong route chemo
Wrong site surgery
Escape of mental health patient
Consequences of never event
Financial penalties, CQC visit, reputation loss
Define screening
Identifying apparently well individuals who have or at risk of having a particular disease
Give four examples of screening
Newborn
Breast cancer
Cervical cancer
Bowel cancer
What are wilsons criteria
Requirements that screening must fulfil for it to be effective
Wilsons criteria: Disease
Important
Natural history known
Early treatment better than late
Wilsons criteria: test
Acceptable for the population
Facilities available
Simple, safe, precise and validated
Wilsons criteria: outcomes
Ongoing feasibility
Treatment available
Cost benefit analysis
Ranking of study designs
Systematic review/ meta analysis RCT Cohort Case control Cross sectional Case series Case report/anecdote
Describe cross sectional study design
Snapshot data of those with and without disease to find associations at a single point in time
Pros and cons of cross sectional studies
Quick, cheap, few ethical issues but prone to bias and no time reference
Describe case control studies
RETROSPECTIVE observational study which looks at a certain exposure and compares similar participants without the disease
Pros and cons of case control (patients notes)
Good for rare diseases, inexpensive but it can only show association and is unreliable due to recall bias
Describe cohort studies
Longitudinal PROSPECTIVE study which takes a population of people recording their exposures and conditions
Pros and cons of cohort studies
Can show causation and have less chance of bias but large amount lost to follow up and they are expensive
Describe randomised control trial
Similar participants randomly controlled to intervention or control groups to study the effect of the intervention
Pros and cons of RCTs
Can infer causality and have less bias but time consuming, expensive and ethical issues can interfere
Factors to assess causality (bradford hill criteria)
Biological plausability Temporal relationship Dose response relationship Strength of association Specificity Consistency Altered by experimentation Coherence with existing themes Consider reverse causality
Define confounder
Risk factors, other than those being studied that influence the outcome
Do confounders affect the exposure or outcome
Both
Define bias
A systematic error that results in a deviation from the true effect of an exposure on an outcome
Describe selection bias
Discrepancy of who is involved
Describe publication bias
Some trials are more likely to be published than others
Name four types of information bias
Measurement bias
Observer bias
Recall bias
Reporting bias
What is measurement bias
Different equipment may give different values
Describe recall bias
Past events incorrectly remembered
Describe reporting bias
Responder doesnt tell the truth
Define incidence
Number of new cases in a population during a specific time period
Define prevalence
Number of existing cases at a specific point in time
What is attributable risk
Number of cases that are specifically due to one risk factor.
Total - Number of cases that would have happened anyway
How are the attrituble risk and number needed to treat related
NNT=1/attributable risk
Define sensitivity
% correctly identified with the disease
Define specificity
% correctly excluded as disease free
Define positive predictive value
% of those with a positive test that actually have the disase
Define negative predictive value
% of those with a negative test who are actually disease free
Define chance
Possibility that there is a random error
Define reverse causality
Outcome results in exposure
Name 5 factors that can cause association
Bias Chance Confounding Reverse causality True association
What is lead time bias
Early identification doesnt alter outcome but appears to increase survival
What is length time bias
Disease that progresses more slowly is more likely to be picked up by screening, whih makes it appear that screening prolongs life
Name the 9 bradford hill criteria for causation
Temporality Dose response Strength Reversibility Consistency Plausability Coherence Analogy Specificity
What is the planning cycle for health services
Needs assessment
Planning
Evaluation
implementation
What are bradshaws needs
Felt need
Expressed need
Normative need
Comparative need
