Revision Summary Notes

Question 1

What is the biomedical model?

Answer 1

Pathogens, injury and physiological damage causing illness.
Condition outside patients control.
Treated with drugs, surgery etc - medical professions responsibility.
Illness can affect mood.

Question 2

What is the biopsychosocial model?

Answer 2

Combination of factors causing illness.
Individual also responsible for health (lifestyle).
Treat whole person, treatment shared between healthcare professionals and patient.
Illness can affect psychology and psychology can affect illness.

Question 3

What is work?

Answer 3

Nature of tasks, who does them, how, where, consequences and problems involved in managing a chronic illness within the home and wider public life. (Managing both chronic illness and everyday life as part of a single experience).

Question 4

What is illness work?

Answer 4

Work done leading up to the diagnosis and dealing with the physical manifestations of illness, including how the individuals self-perception changes.

Question 5

Give two examples of the types of illness work undertaken by patients with chronic illnesses?

Answer 5

Undergoing multiple tests.
Encountering uncertainty- diagnosis of a condition where they may be no clear structural or pathological explanation, but patient has symptoms.
Addressing issues with eating, bathing, going to the bathroom.
A change in personal relationships.
Attending health services deigned to improve management of
condition/symptoms.

Question 6

What is everyday life work?

Answer 6

Actions and processes involved in managing the condition and its impact.

Question 7

Give two examples of the types of everyday lifework undertaken by patients with chronic illnesses?

Answer 7

Decisions about mobilisation of resources.
Balancing demands on others and remaining independent.
Attempting to minimise or disguise presentation of symptoms.

Question 8

What is identity work?

Answer 8

Establishment and maintenance of an acceptable identity.

Question 9

Give two examples of the types of identity work undertaken by patients with chronic illnesses?

Answer 9

Managing the actual and imagined reactions of others.
Presentation of one’s self to avoid stigma e.g. continuing to walk without the aid of a walking stick although it may cause further deterioration of condition as well as pain (discredited stigma).
Not sharing some or all aspects of one’s illness due to fear of being treated differently e.g. withholding information about current or past mental illness with employer/employees.

Question 10

What is emotional work?

Answer 10

Work done to protect the emotional well-being of others. May also lead to a changed role and/or purpose for the person.

Question 11

Give two examples of the types of emotional work undertaken by patients with chronic illnesses?

Answer 11

Taking conscious decisions to demonstrate continued ability to remain active and partake in activities if one was without an illness e.g. taking part in 5KM run, tasks around the home.
Experiencing social isolation or withdrawing from social circles e.g. spending less time with family and/or friends.
May lead to increased dependency on close others e.g. spouse undertaking greater responsibilities within the home.

Question 12

What is biographical work?

Answer 12

Interaction between the body and identity needed by the reconstruction of their life.

Question 13

What is biographical disruption?

Answer 13

How the experience of chronic illness leads to a loss of confidence in the body and from this follows a loss in confidence in social interaction or self-identity.

Question 14

Give two examples of the types of biographical work undertaken by patients with chronic illnesses?

Answer 14

Patient attempts to reconnect their life prior to diagnosis with the present and future e.g. suddenly taking greater interest in sports, joining social clubs/societies, re-establishing past friendship groups.
During diagnosis and/or post diagnosis, patient may encounter a
phase a period of uncertainty as a result of subsequent loss of
what was previously a `taken-for-granted’ continuity of life.

Question 15

What are lay beliefs?

Answer 15

Socially embedded ideas about health, impacting on patient behaviour and adherence with treatment. Professional concepts are interpreted and made sense of in everyday light.

Question 16

What is the illness iceberg?

Answer 16

Majority of symptoms experiences by patients never get to a doctor - patients do nothing, use lay-care.

Question 17

What is the lay referral system?

Answer 17

Chain of advice-seeking contracts which the sick make with other lay people prior to or instead of seeking help from healthcare professionals.

Question 18

What does the lay referral system influence?

Answer 18

Why people may have delayed seeking help.
Your role as a doctor in their health.
Use of alternative medicines.
How, why and when people consult a doctor.
Use of health services and medication.

Question 19

What is scarcity?

Answer 19

Need outstrips resources. Prioritisation is inevitable.

Question 20

What is efficiency?

Answer 20

Getting the most out of limited resources.

Question 21

What is equity?

Answer 21

The extent to which distribution of resources is fair.

Question 22

What is effectiveness?

Answer 22

The extent to which an intervention produces desired outcomes.

Question 23

What is utility?

Answer 23

The value and individual places on a health state.

Question 24

What is opportunity cost?

Answer 24

Once you have used a resource in one way, you no longer have it to use in another way.

Question 25

What are QALYs used?

Answer 25

Compare resources taking into account both const-effectiveness and impact on quality of life.

Question 26

Give 3 disadvantages to using qalys.

Answer 26

Controversy about the values they embody.
Do not distribute resources according to need, but according to the benefits gained per unit of cost.
May disadvantage common conditions.
Technical problems with their calculations.
QALYs may not embrace all dimensions of benefit; values expressed by experimental subjects may not be representative.
QALYs do not assess impact on carers or family.
If based on RTCs then more problems eg atypical care, atypical patients, sample sizes.

Question 27

How could you address some areas of uncertainty created by using RCTs to calculate QALYs?

Answer 27

Statistical modelling.

Question 28

Give 3 reasons why we measure health.

Answer 28

To have an indication of the need for healthcare.
To target resources where they are most needed.
To assess the effectiveness of health interventions.
To evaluate the quality of health services.
To use evaluations of effectiveness to get better value for money. To monitor patients’

Question 29

Give 3 reasons why we use patient-based outcomes.

Answer 29

Increase in conditions where aim is managing rather than curing.
Biomedical tests just one part of picture.
Need to focus on patient

Question 30

What does the health-related quality of life (HRQoL) measure?

Answer 30

Physical function, symptoms, global judgements of health, psychological well-being, social well-being, cognitive functioning, personal constructs, satisfaction with care.

Question 31

Give 2 advantages of using generic measurements of quality of life

Answer 31

Used for a broad range of health problems.
Used if no disease-specific instrument.
Enable comparisons across treatment groups as can be use with any population including healthy people.
Can be used to detect unexpected positive/negative effects of an intervention.
Can be used to assess the health of populations.

Question 32

Give 2 disadvantages of using generic measurements of quality of life.

Answer 32

Generic nature means inherently less detailed.
Loss of relevance if too general.
Can be less sensitive to changes that occur as a result of an intervention.
May be less acceptable to patients.

Question 33

What is classical conditioning?

Answer 33

A behaviour is associated with environmental or emotional cues. Eg cues with connecting to using drugs/alcohol can trigger behaviour and lead to relapse when quitting.

Question 34

How can you change someone’s health behaviour taking classical conditioning into account?

Answer 34

Avoid cues/change association with cues - aversive techniques, or break unconscious response in habits.

Question 35

What is operant conditioning?

Answer 35

Behaviour is shaped by consequences (receiving or withdrawing of reward or punishment).

Question 36

How can you change someone’s health behaviour with operant conditioning?

Answer 36

Shape behaviour through reinforcement eg motivational incentives or withdrawal of privileges.

Question 37

What is social learning theory?

Answer 37

Goal directed behaviour that people are motivated to perform if it is behaviour they value and that they believe they can enact. What behaviours are rewarded and how likely it is we can perform a behaviour is learnt from others. Modelling if more effective if the models are high status or similar to us.

Question 38

What is the health belief model?

Answer 38

How beliefs about health threat (perceived susceptibility and severity), beliefs about health-related behaviour (perceived benefits and barriers) and cues to action lead to a behaviour,

Question 39

Give 2 limitations of the health belief model

Answer 39

Assumes cognitive/rational decision making, but it could be a habit or coercion.
Doesn’t incorporate emotional influences.
Reasoning often only happens after the risky behaviour.

Question 40

What is the theory of planned behaviour?

Answer 40

Attitude towards behaviour, subjective norm and perceived control lead to an intention and/or a behaviour.

Question 41

What is the intention behaviour gap?

Answer 41

The theory of planned behaviour is a good predictor of intention but a poor predictor of behaviour (translating intentions into behaviour) - the intention behaviour gap.

Question 42

What are the 5 stages of change (important determinants of health behaviour at different times)?

Answer 42

Precontemplation.
Contemplation.
Preparation.
Action.
Maintenance.

Question 43

What is the COM-B model?

Answer 43

Capability and opportunity feed into motivation which then influences behaviour, behaviour can influence capability, motivation and opportunity.