Semester 2 Flashcards
Define cognition
The mental activity through which human beings acquire and process knowledge, including the functions of perception, learning, memory language acquisition, problem solving, thought and imagination
Define cognitive development
The gradual transition from an infant to adult mental capacity
Define development
The sequence and interplay of physical, psychological, cognitive and social changes that humans undergo as they grow older
What impacts human development?
Individual differences
Affected by social, emotional and environmental factors as well as development across the lifecourse
However, there are universal stages occurring among all normally developing individuals, regardless of culture and experiences
What does Piaget state about cognitive development?
Schemas are the building blocks of developmental change
What are schemas and their different classifications?
Schemas are mental structures created of organized memories, thoughts and strategies we use to interpret our world
Physical schemas are our initial, action based schemes developed via interactions with the world
Mental schemes are what develop as we begin to mentally interact with the world
What is assimilation?
Occurs when we incorporate new experiences into existing similar structures and behaviours
What is accommodation?
Our schemes change to accommodate new information learnt
What are the 4 stages of development (according to Piaget) and their age ranges?
Sensorimotor stage (Birth-2yo)
Preoperational Stage (2-7yo)
Concrete operational stage (7-11yo)
Formal operational stage (12+)
What are defining features of the sensorimotor stage?
- Substage is reflexive schemes stage (grasping, sucking, rooting, looking)
- Maturation of motor skills makes these ‘reflexes’ purposeful
- Attain object permanence
- Can imitate immediately (9mos) and remotely (18-24 mos)
What are the defining features of the preoperational stage?
- Beginning of symbolic thought shown by movement from imitation to imaginative play
- Egocentrism
- Appearance as reality
What are the defining features of the concrete operational stage?
- Thinking becomes logical, flexible and organized
- Develop conservation: knowing the physical properties of an object don’t change when nothing is added or removed
What are the defining features of the formal operational stage?
- Thinking becomes abstract
- Increased capacity for flexible/scientific thinking
- Egocentrism returns due to increased awareness of others’ perceptions
How does vygotsky believe children develop?
- They are a product of their culture
- Undergo internalisation: absorbng information from a sociocultural context
- Language important as the culture is embedded
What is Vygotsky’s theory of proximal development/scaffolding?
The zone of proximal development is the zone where children can do something with help or guidance from a peer or adult- bridges the gap between what they can and can’t do, so development should be focussed in this region
Scaffolding occurs when teacher/parent adjusts the amount/type of support to match child’s developmental level
How does experience and culture shape development?
- Difference in schooling and culture impacts concrete operational task performance
- Previous experience influences children’s understanding
- Formal operational stage not reached by many tribal societies as they’re more likely to think only about what they’ve experienced
What are the stages in health understanding and their age ranges?
Prelogical stage: 2-6yo
Concrete logical stage: 6-12yo
Formal logic stage: 12+
What are defining features of the prelogical stage?
- Phenomism: the relationship between cause and illness is ‘magical’
- Contagion: Understand need for temporal or spatial proximity to source for illness development
What are defining features of the concrete logical stage?
Contamination: Understand illnesses can have multiple symptoms and can be transmitted through physical sources
Internalization: View illness as developing by internalizing external contaminants
What are the defining features of the formal logic stage?
Physiologic: Cause is a non or malfunctioning organ or process
Psychophysiologic: acknowledge that additional contributors may be psychological
Why is it important to consider cognitive development level in health promotion?
It is important to aim ads towards those more affected by it.
Also important to get these messages across young as future illnesses may be prevented from developing.
How is cognitive development important in medical procedures?
Children with lower levels of development can misunderstand, making everything more frightening. Children's preparation depends on: - Developmental level - Type of procedure - Prior experience - Cultural/ethnic background - Family dynamic - Support systems
How can health professionals help prepare children of varying cognitive levels for treatment?
Introduce play specialists to help children understand their illnesses in a fun context Tours of major sites Videos about procedures involved Interactive books or iPads Puppet shows Medical plays with hospital equipment Books with popular figures Board games Art therapy Relaxation or coping techniques
Why have play specialist programmes been less successful than they could otherwise be?
The programmes are well evaluated by those who turn up
However, they are often poorly attended, and the same programme is offered to children 3-12. This encompasses a broad range of developmental stages, and is therefore unlikely to work for the majority
How is cognitive development crucial to chronic illness among adolescents?
Adolescents have greater concerns with chronic illness due to the:
- type and degree of impairment
- Visibility of impairment
- Uncertainty
- Irregular effects
- Treatment, and pain associated
This is due to their perception that they always have an audience
It is exacerbated by social media and online doctors
What is a chronic illness?
An illness that interferes with daily functioning for more than 3 months in a year, with hospitalization for more than 1 month a year
At diagnosis, it must be a combination of both
They are typically managed, but unable to be cured
What are the negative vs. positive reactions elicited due to chronic illness?
Negative: - Depression - Anxiety - Acting out (depends on seriousness, developmental stage and coping strategies)
Positive:
- Empowerment
- Feelings of having escaped death
- Priority change
- Improved relationships
- Lifestyle changes
What are the three different coping strategies?
Primary
Secondary
Emotional
What are primary coping strategies?
They’re problem focussed: They attempt to change their or others’ lives to fix the problem
What are secondary coping strategies?
They’re attitude focussed, and involve changing an attitude towards a problem (best if the issue is out of one’s control)
What factors affect perception of treatment and illness?
Social and emotional development
Biological Functioning
Mental Age
Family functioning/support
How does social/emotional development affect illness/treatment perception?
At concrete stages, illnesses are attributed to causes- germs, being bad etc
in formal operational stage, we become more aware of the complexity of health, as well as internal and external factors
How does biological development and mental age affect perception of treatment?
Biological development affects this especially as when we are adolescents we are much more concerned with appearances
Mental age needs to be considered, as just because someone is older doesn’t mean they understand
Why are families important when treating illness?
The children often are present for treatment with their family
Their own understanding of treatment is limited
They rely on the family to get them care
Families must manage many issues
They must also address how the issues impact the family functioning as a whole
What can cause non adherence?
Poor doctor-patient communication
Complexity of treatment
Beliefs
Type of regime
How can families be advised as to how to get their child well?
Education (good for complex and short term treatment, important when diagnosing)
Modelling (good for complex or patient-administered treatment)
Use of incentives for their children
Workshops involving support, problem solving and multi-family training
What is important regarding adherence when it comes to adolescents?
Anticipate inadequate compliance
Promote autonomy
Actively follow up regarding adherence
What is health psychology?
The application of psychological principles to health areas, involving the study of psychological processes in health, illness and healthcare
What are the aims of health psychology?
To understand, explain and predict health and coping behaviours to develop interventions and promotions, as well as understand and treat the psychological consequences of diseases
How can psychological factors affect physical health?
Impact on psychological processes: eg. patient-physician relationship affects distress and stress response, likelihood of correct diagnosis, treatment adherence and amenability.
Beliefs affect amenability to treatment
Impacts on psych wellbeing too.
What are the health behaviour models developed to explain or predict health behaviours?
- Health belief model
- Theory of reasoned action
- Theory of planned behaviour
- Transtheoretical model
- Protection motivation theory
- Health action process model
- Levelthal’s self-regulatory model
- Social cognitive theory
What does health psychology attempt to understand, predict, and develop interventions for?
Psychological influences on health Health promoting and risk behaviours Illness behaviours, symptom perception and coping Adherence Stress Emotions and health Placebo effect Pain management and relief P-P relationship Genetic testing Coping with death and dying
What is a placebo?
An inert substance that stimulates a treatment without the specific agent
What is the placebo response?
The improvement in health brought about by the nonspecific effects due to treatment context, not the active component of the treatment
What is the placebo effect?
The changes observed while taking a placebo
It’s broader than the placebo response as it involves natural recovery as well
What do placebo trials do?
- Give information about the best ways to enhance active treatments
- Test effectiveness of new drugs above placebos
What is the observed placebo effect in terms of pain medication?
Open administration, where patients see themselves receiving treatment, has a greater analgesic effect than hidden medication
How do psychological mechanisms impact the placebo response?
Involves expectations of improvement
- Influenced by suggestion, treatment appearance, previous experience, social learning and PP relationship
Flow on effects lead to activation of reward systems, reducing anxiety and the stress response
What does classical conditioning have to do with the placebo response?
- The placebos can become a conditioned stimulus after repeated pairings with active treatment
- Especially seen in endocrine and immune disorders
What enhances the placebo response?
- Open administration
- Communicating effectiveness
- Communicating price
- Communicating novelty
- Branding
- Type of treatment: Surgery> injection > capsule > pill
- More doses/frequency
- Colour
- Attention, empathy, reassurance, high prestige of doctor
- Personalization and patient involvement in treatment plan
What are the clinical implications of placebo treatment?
- Active treatments can be enhanced by using the features discovered for placebos
What are nocebo effects?
Adverse consequence of placebos that are also found in the active drugs
What causes nocebo effects?
Patient expectation of side effects from active treatment can cause more or more intense side effects
This is due to increased neural activity in pain areas
Activation of CCK in the brain, leading to hyperalgesia.
How can nocebo effects be elicited through conditioning?
Association of previously neutral stimuli with harmful stimuli
How can nocebo effects be minimized?
Framing of information in positive light
Counter-conditioning
What is treatment adherence?
The extent to which a person’s behaviour correspond with the agreed upon recommendations from a healthcare provider
Can be intentional or unintentional
What is medication adherence?
Conforming with the provider’s recommendation in terms of timing, dosage and frequency of meds, taken in the right way and for the prescribed length of time
Why is adherence important?
- Large impact on health outcomes
- Prevents additional healthcare expenditure
- Prevent antibiotic resistance
- Reduces extra appointments
- Fewer hospital admissions and mortality
What are some general factors that influence treatment adherence?
Disease type Time Age Language proficiency Treatment factors Psychosocial factors PP Relationships
How does disease type affect treatment adherence?
Those with more serious diseases are more likely to adhere, as they feel they will gain more
Eg. HIV, cancer etc.
How does time affect treatment adherence?
Levels of adherence drop over time
How does age affect treatment adherence?
Those who are younger and older tend to have poorer adherence
How does english proficiency affect treatment adherence?
If patients don’t understand, they may not be able to adhere, even if it is unintentional
How do treatment factors affect treatment adherence?
Lower adherence can be due to:
- Complexity
- Side effects
- Cost
- Duration
- Frequency
- Storage
- Lifestyle
- Lack of immediate benefit
How do psychosocial factors affect treatment adherence?
- Personal beliefs, memory, understanding, emotions, stress, support and norms affect adherence
How do personal beliefs affect treatment adherence?
A person’s beliefs about the illness (its identity, their control, its cause, timeline and consequences) impacts adherence.
Also: beliefs about medication, self efficacy, their locus of control and any perceived barriers
How does a good PP relationship influence treatment adherence?
- Revealing perceived barriers
- Suiting treatment to patient lifestyle
- Improve understanding of illness, treatment plan
- Enhance self efficacy and trust, promoting return visits
How can patients’ adherence be improved?
- Address false perceptions
- Link treatment to ilness
- Personalize the regime
- Simplify and write down the course of treatment
- Involve their spouse, or have the write a behavioural contract
- Self-monitoring
- Using pill organisers, prompts, reminders and calls
- Use interpreters if necessary
What are simple, straightforward techniques that can be used to enhance adherence?
- Use simple language, with no jargon
- Use teach-back approach
- Give concrete instructions
- Address serial position effects
- Repeat key info
- Use body language
- Written instructions
- Ask open ended questions, and paraphrase what they’ve told you
Why is it more difficult to adhere to lifestyle changes than to medication?
It takes more time and effort, and has more barriers
What are predictors of adherence to lifestyle changes?
Self-efficacy and perceived control
- Intention
- Perceptions of barriers, susceptibility, benefits and seriousness
- Cues to action
- Stage of behaviour change
- Norms and social support
- Emotions and enjoyment
How can self-efficacy be improved?
Performance experience Vicarious experience Persuasion Imaginal experience Psychological state
What are ways of increasing intention?
- Target the predictors. These include:
- Attitude towards/expectations of behaviour
- Self efficacy and perceived behavioural control
- Perceived seriousness and susceptibility
- Subjective norms
How can you reduce the gap between intention and behaviour?
- Make action plans
- Set cues to remind the patient to take action
- Self monitor the behaviour
- Set rewards