Session 1 - Biopsychosocial Model & Social Context of Illness

Question 1

What is the medical model regarding the link between chronic illness and disability?

What are the disadvantages of this model?

Answer 1

• Disability is a deviation from medical norms
• Disadvantages are direct consequences of impairment and disabilities.
• Medical intervention is required
• Lack of recognition of social & psychological factors
• Stereotyping and stigmatizing language

Question 2

What is the social model surrounding the link between chronic illness and disability?

What are the disadvantages of this approach?

Answer 2

• Problems are a product of the environment and its failure to adjust.
• Disability is a form of social oppression
• ‘Special needs’ is only special in a particular context.
• Overly drawn view of society
• Failure to recognise the realities.

Question 3

What are the international classifications of Impairments, Disabilities and Handicaps?

Answer 3

Impairment: concerned with abnormalities in the structure or function of the body

Disability: concerned with performance of activites

Handicap: concerned with broader social and psychological conseuqences of living with impairment and disability.

Question 4

What are the key components of the International Classification of Functions, Disability and Health?

Answer 4

Body structures and functions

Activities (including difficulties/limitations)

Participation (and involvement in life situations).

Question 5

What is meant by a NEGATIVE definition of health?

Answer 5

Absence of illness

Question 6

What is meant by a FUNCTIONAL definition of health?

Answer 6

The ability to do certain things

Question 7

What is meant by a POSITIVE definition of health?

Answer 7

A state of wellbeing and fitness

E.g SMOKING - those who adopt this approach are more likely to see quitting as a rational choice.

Question 8

What are two distinct issues associated with lay epidemiology and illness?

Answer 8

1. Understanding why and how illness happened.
2. Understanding why it happened to a particular person at a particular time.

Question 9

What is meant by HEALTH BEHAVIOUR in the context of lay beliefs?

Answer 9

Activity undertaken for the purpose of maintaining health and preventing illness.

Question 10

What is meant by ILLNESS BEHAVIOUR in the context of lay beliefs?

Answer 10

The activity of an ill person to define illness and seek a solution.

Question 11

What is meant by SICK ROLE BEHAVIOUR in the context of lay beliefs?

Answer 11

The formal response to symptoms, including seeking formal help and action of the person as a patient.

Question 12

What is meant by the symptom or illness iceberg?

Answer 12

The idea that most symptoms experienced by a patient never get to a doctor because either they do nothing about them, or they try and remedy matters using OTC medication.

Question 13

List some factors that influence illness behaviour (8)

Answer 13

• Culture e.g. stoical attitude
• Visibility of symptoms
• Extent to which symptoms disrupt life
• Frequency of the symptoms
• Tolerance threshold
• Information and understanding
• Availability of resources
• Lay referral

Question 14

What is meant by LAY REFERRAL?

Answer 14

The chain of advice-seeking contacts which the sick make with other lay people prior to, or instead of, seeking help from health care professionals.

Question 15

Adherence to treatment - outline the 3 broad groups and what is meant by these.

Answer 15

1. Deniers & Distancers = either ‘deny’ having a condition, or say that theirs isn’t the ‘proper’ one. Often claim that symptoms don’t really interfere with everyday life.
2. Acceptors = accept advice completely.
3. Pragmatists = use preventative mediciation when symptoms require it.

Question 16

What is the WHO definition of health?

Answer 16

A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Question 17

When talking about the causes of the association between ill-health and deprivation, what is meant by

ARTEFACT?

Answer 17

Observed associations are not genuine, instead they exist because of the ways in which health and deprivation are measured.

Question 18

When talking about the causes of the association between ill-health and deprivation, what is meant by

SOCIAL SELECTION?

Answer 18

Health determines socio-economic status instead of the other way around.

In other words, if you are in poor health you are less likely to be able to work and so more deprived.

Question 19

When talking about the causes of the association between ill-health and deprivation, what is meant by

BEHAVIOURAL / CULTURAL causes?

Answer 19

The notion that people in deprived areas are more likely to smoke, eat poor diets and not exercise.

Question 20

When talking about the causes of the association between ill-health and deprivation, what is meant by

PSYCHOSOCIAL causes?

Answer 20

The idea that the stress of working in poorly paid, low status jobs with little autonomy creates biological changes in the body which in turn change to patho-physical changes.

Question 21

When talking about the causes of the association between ill-health and deprivation, what is meant by

MATERIAL causes?

Answer 21

This is looking at the direct effects of poverty and focuses on a lack of choice.

Question 22

What are the infant mortality and life expectancy rates in England and Wales?

Answer 22

Infant Mortality: <5 per 1000

Life Expectancy: c.80 years.

Question 23

What is meant by the

BIOMEDICAL MODEL?

Answer 23

• That illness is understood in terms of biological and physiological processes.
• That individuals are not to blame for their conditions.
• That treatment involves physical intervention, and is the responsibility of the medicial profession.
• That there is a limited role for psychology.

Question 24

What is meant by the

BIOPSYCHOSOCIAL MODEL?

Answer 24

• That illness can be caused by a combination of biological (bacteria), psychological (stress) and social (employment) factors.
• That the individual has a responsibility in their own health (because of the numerous factors).
• That the whole person should be treated (not just the physical changes.
• That the responsibility for treatment is shared between the doctor and patient.
• That psychological factors are important when looking at the cause of illness, and not just considering consequences.

Question 25

What is meant by the sociological approach to chronic illness?

Answer 25

That the focus is on how chronic illness impacts on social interaction and role performance, notably the negotiation and management that living with a chronic illness requires, both individually, and through social networks.

Question 26

What is an illness narrative?

Answer 26

The story-telling and accounting practices that occur in the face of illness.

Question 27

There are 5 different types of ‘work’ associated with chronic illness.

What is meant by ILLNESS WORK?

Answer 27

• The period leading up to getting the diagnosis and/or dealing with the physical manifestations of illness.
• How an individual’s self-conception changes as a result of living with their condition.

Examples: undergoing multiple tests, enountering uncertainty, addressing issues with ADLs, changes in personal relationships and attending health services.

Question 28

There are 5 different types of ‘work’ associated with chronic illness.

What is meant by EVERYDAY LIFE WORK?

Answer 28

• The actions and processes involved in managing the condition and its impact.
• It refers to the daily tasks that someone may complete to keep the household going.

Examples: mobilisation of resources, balancing demands and remaining independent.

Question 29

There are 5 different types of ‘work’ associated with chronic illness.

What is meant by IDENTITY WORK?

Answer 29

• The establishment and maintenance of an acceptable identity.

Examples: managing the actual and imagined reactions of others, presentation of one’s self to avoid stigma, being secretive about certain elements of ilness.

Question 30

There are 5 different types of ‘work’ associated with chronic illness.

What is meant by EMOTIONAL WORK?

Answer 30

• The work people do to protect the emotional well-being of others that may lead to a changed role and/or purpose for the person living with a chronic illness.

Examples: taking conscious decisions to demonstrate continued ability to remain active, experiencing social isolation

Question 31

There are 5 different types of ‘work’ associated with chronic illness.

What is meant by BIOGRAPHICAL WORK?

Answer 31

• The interaction between the body and identity necessitated by the continual or occasional reconstruction of his/her life.

Examples: taking a greater interest in sports, joining clubs, re-establishing past friendships.

Question 32

What is meant by STIGMA?

Answer 32

A component of Identity Work - a negatively defined condition, attribute, trait or behaviour conferring ‘deviant’ status.

Question 33

What is meant by DISCREDITABLE and DISCREDITED stigma?

Answer 33

Discreditable: nothing seen, but if found out…, e.g. mental illness, HIV+

Discredited: a physcially visible characteristic or well known stigma which sets them apart e.g. physical disability, known suicide attempt.

Question 34

What is meant by an ENACTED and FELT stigma?

Answer 34

Enacted: the real experience of prejudice, discrimination and disadvantage as the consequence of a condition.

Felt: the fear of enacted stigma that also encompasses a feeling of shame. Often associated with selective concealment.

Question 35

How can we measure access to healthcare?

Answer 35

Utilisation studies = measure the receipt of services

BUT…this doesn’t take into account those who don’t access healthcare either because they cannot or do not know how to.

Question 36

When thinking about deprivation and patterns of access, what is commonly seen amongst deprived groups?

Answer 36

1. Higher rates of use of GP services and emergency services
2. Under-use of preventative services and specialist services