Social and Psychosocial Flashcards
What is the biomedical model?
Concept that the mind and body are separate
- body is treated like a machine it is fixed by replacing/ destroying cause of the problem
Criticism of biomedical model
Narrow - ignores social + psychosocial factors
What is the biopsychosocial model?
Health and illness emerge from an interplay of psycho social and bio factors (contributing
Causes of illness)
What is health?
Complete state of mental physical and social wellbeing . -not just the absence of disease
What are psychological factors?
Cognition, emotion, benaviour
What are social factors?
Housing, social class, employment, gender, social support etc.
What are biological factors?
Physiology, genetics pathogens (disease)
What are lay beliefs?
Beliefs of health and illness from people with no medical knowledge
Why are lay beliefs significant?
Impact on compliance + non compliance of treatment
What is the negative definition of health?
Health is the absence of illness
What is the functional definition of health?
A person is healthy if they can do certain things
What is the positive definition of health?
Good health is a state of wellbeing + fitness
What are lay theories?
How people understand their health using cultural, social and personal experience
What is lay epidemiology?
- Trying to understand how and why they have this illness
- constructing a story
Why do people have lay beliefs?
- they misunderstand the illness and who should/can get ill
What is the interplay between lay and medical beliefs ( public and professionals) ?
- Public - are surrounded by complicated medical concepts with no background knowledge/context → so they develop their own beliefs
- professionals - use medical concepts all the time and apply these to different experiences
What is health behaviour?
Impact on health or helps prevent illness
What is illness behaviour?
Activities of ill people to define illness and seek solutions
What is sick role behaviour?
The formal response to symptoms
- patients must act in a certain way to be a patient
Give an example of a health behaviour
Smoking → more prevalent in lower classes
- higher classes = more likely to have positive health definitions and incentives to quit smoking
- lower classes = tend to have unclear or negative definitions of health, smokingmay be used as a coping mechanism
What is illness behaviour?
How people act when they are sick
Describe the illness iceberg
Doctors only see the surface of the illness (top of iceberg above surface)
Most symptoms are never shown to a doctor (rest of iceberg beneath the surface)
Give 5 factors that influence illness behaviour
→ culture → understanding of illness → visibility of symptoms (how obvious) → Frequency and persistance of symptoms → availability of resources (accessibility)
What is lay referral?
When a patient decides whether or not to visit the doctor → they do this by discussing their symptoms with other lay people first
How do lay beliefs affect treatment
→ affect adherence to treatment
→ affects continuity of care and outcomes
Name the 4 types of patients
- Deniers
- distancers
- acceptors
- pragmatists
How do deniers react to illness?
→ they deny having their condition
How do distancers react to illness?
- Deny having the illness and use complex strategies to hide and distance themselves from illness (maybe due to stigma).
How do acceptors react to illness?
→ accept diagnosis + advice
→ believe medication helps control symptoms
→ don’t worry about stigma
How do pragmatists react to illness?
- accept they have a disease but do not accept the severity of it
- use preventative meds when it is bad
What 4 factors influence a patient’s decision to get help 2
→ symptom experience (severity)
→ symptom evaluation (effect on life)
→ knowledge of health issues and treatments
→ experiences and attitudes towards professionals
Define chronic illness
Diseases which current Medical interventions can only control not cure
- no return to normal
Define long term condition
Condition that can’t at present be cured
→ but are controlled by meds or treatments
What is the impact of ltc’s on the NHS?
- 70% off total spend on people with LTC
- biggest challenge for NHS = increasing prevalence
What is the sociological approach to chronic illness?
→ it focuses on the impact that chronic illness has on social interaction
- experiences + meanings of chronic illness
- now people manage chronic illness in every day life
Name a functional theory of experience of illness
Talcott Parsons ‘sick role’ 1951
Name an interpretive theory of experience of illness
‘Illness narratives’
‘stigma’
Biograpnical disruption’
What is Parsons ‘sick role’
A temporary, medically sanctioned form of deviant benaviour
→ sick person expected to seek medical help and follow treatment
→ can take blame off sick person with sick note
What are the limitations of Parsons sick role
- Not all illnesses are temporary
- doesn’t acknowledge individual differences
- differences in defining/coping with illness
What is an illness narrative
- Story telling that occurs in the face of illness= as a way to make sense of the illness
What is an illness narrative
- Story telling that occurs in the face of illness= as a way to make sense of the illness
What does ‘work’ mean?
-> the types of activities that people with chronic illnesses engage in to make their lives work
List 5 types of ‘work’ of chronic illness
- illness work
- everyday life work
- emotional work
- biographical work
- identity work
Describe the process of getting a diagnosis - illness work
Pre diagnosis → prolonged uncertainty for patient, back and forth communication
Diagnosis → doesn’t relieve uncertainty, some diagnosis are ambivalent
Post diagnosis → shocking or a relief for some patients
Describe the process of managing the symptoms - illness work
- dealing with physical symptoms before social issues
- interaction between body identity
- changes in body can lead to changes in self concept
What are the 3 consequences of struggling with self management?
Illness work
Poor rates of treatment adherence
Reduced quality of life
Poor wellbeing
What interventions can be used to improve self management?
Deliver interventions over the phone or IRL
Desmond EPP
Advantages of self management interventions
→ coping + management skills
- aims to reduce hospital admissions
- patient entered
Disadvantages of self management interventions
- Responsibility placed on very ill patients
- may give little understanding
What is ‘coping’?
The mental/cognitive process of dealing with illness
What is strategy?
The actions and processes involved in managing the condition
What is the process of normalisation?
When the patient signals a change in their identity → designating their new illness life as their normal life
What is emotional work?
Activities that people do to protecti emotional Wellbeing
- downplaying pain/symptoms
- disrupted friendship
What is biographical work?
→ loss of self
Change in self image, struggle to maintain positive view
Focuses on physical discomfort to minimise broader effect
What are the 3 aspects of biographical disruption
→ disruption of taken for granted benceviours
→ disruption of explanatory systems = explanation for their illness
→ mobilisation of resources - changes patients must make in life
What is ‘biographical disruption’ (bury)?
→ it focuses on people’s experience of the onset of illness as a disruptive event
What are the 3 limitations of biographical disruption?
Doesn’t account for conditions that occurred since birth
Not everyone will view an illness to be equally disruptive - older people may see it as normal and less disruptive
What is identity work?
Illness becomes person’s identity
- they think about who they are and how others view them and their illness
What is stigma? Goffman
Difference between how others view someone and their actual social identity.
What is the effect of stigma?
- Can cut down a person and discredit their social identity
Define discreditable stigma
- Illness that is not visible
- eg HIV or mental health
Define discredited stigma
Visible illness that is well known - sees them apart
Eg disability, known suicide attempt
Describe enacted stigma
A negative experience (prejudice, disadvantage) as a consequence of a condition
Describe felt stigma
Individuals embarrassment/shame associated with the condition
Give 4 social + economic factors that impact health
- life expectancy
- infant deaths
- Morbidity
- disability
What is the inverse care law?
→ the more you need it, the less available it is
Availablity of good medical care tends to vary inversely with the need of the population
Give an example of where the inverse care law is applied.
- > in areas with the most death and sickness
- GPS have more work and less support
- hospital doctors have larger caseloads with less staff
How can we measure health?
- self report data (surveys and census data)
- mortality and life expectancy
What is the relationship between deprivation and ill health?
- Strong association
- more deprived a person is, larger proportion of life spent in ill health, more likely they will die at a younger age
What 4 possible explanations of health inequalities are listed in the black report (1980)?
- Artefact
- social selection
- behavioural cultural
- materialist
What is the artefact explanation?
Health inequalities are due to how we collect statistics
- concerns about data quality
- concerns about methods of measurement
What is a limitation of artefact explanation?
Assumes any problems with data collection have led to an underestimation of inequalities
What is the social selection explanation?
Being sick moves you down the social status ladder, your health status determines your social position
→ sick people move down social hierarchy and healthy people move up
What is a limitation of the social selection explanation?
It doesn’t account for people who are born into alower status, as they are more likely to have poorer health.
What is the behavioural cultural explanation?
Ill health is due to peoples choices I decisions on their own health
What is a limitation of the benavioural explanation?
→ choices can only be made based on availability of options, but lower classes has limited options
→ behavioursare outcomes of social processes not just individual choices
What is one materialist explanation?
Inequalities are due to differential access to material resources eg housing and choices
What is a limitation of the materialist explanation?
Further research is needed to know routes through which material deprivation causes ill health
What is the psychosocial explanation?
Health is influenced more by differences in incomes than the actual income
Inequalities are a problem of social status
What are limitations of psychosocial explanation?
- stress impacts health differently
- stressors are distributed on a social gradient
What is income distribution explanation?
Countries with great income inequalities - greater health inequalities
- income equality → social evaluative threat → stress → poor health
What 4 things can be done to reduce inequalities?
- Strengthening individuals
- strengthening communities
- improving living and working conditions
- promoting healthy macro policies
Define inequality
When things are different (not equal)
Define inequity
Inequalities are unfair and avoidable
Describe how more deprived groups access healthcare
- Higher rates of gp + emergency use
- lower rates of preventative service use
How do more deprived groups view health
-normalize ill health
_manage health as a series of crises
- lack resources and cultural alignment
What are the limitations of current inequities in health care?
Difficult to interpret current evidence as it fails to include inclividud’s that don’t access healthcare
_ doesn’t include different aspects of social disaducuntage
What factors are associated with inequalities in health?
Ethnicity
Gender
Age
Disability
Homelessness
Describe health in males?
Higher mortality rates
More suicide and violent deaths
Describe the health in females? Higher lif
Higher life expectancy
Higher reported poor mental health
Higher rates of disability
How does ethnicity impact health?
- culture and beliefs
List 4 factors that affect health and illness
Social class
Ethnicity
Gender
Deprivation
Why is obesity seen as a disease?
People will take it more seriously
Define obesity
An abnormal or excessive fat accumulation that presents a risk to neaten
What is BMI
Crude population measure of obesity, based on the idea of standard measurements of diseases - ratio of height - weight
Limitation of BMI
Crude at an individual level
What other lifestyle factors affect obesity
Smoking
Alcohol consumption
Diet, fruit and vegetable consumption
Exercise
What is the relationship between BMI and mortality?
- Those with increased BMW nave increased mortality
Higher BMW - higher risk of many conditions
List 5 diseases associated with obesity
(both communicable + non -communicable diseases) Asthma Heart disease Sleep apnea Cancer Type 2 diabetes
What are the effects of obesity in terms of cost?
Loss of income due to days off from work
Costs of dealing with obesity management and treatment
How does society impact obesity?
Societal influences can influence food + what is available based on income and drive
What is involved in weight loss?
Achieving an energy restriction that you can live with
About diet in the short term but exercise is needed to maintain weight loss
What factors affect the maintenance of weight loss?
Personal choice
Social + environmental factors
Training and support
May return to habitual behaviour
What are societies views on weight?
Ideal body types for men and women with pressures to conform to ideal body image
Society focuses on losing weight but focus should be on improving health
What effect does weight stigma have on practice?
Negative impact as it can be a barrier for people with larger weight accessing health
What are health related behaviours?
Anything that may promote good health or lead to illness (positive and negative outcomes)
Why are models of health behaviour useful?
- can predict behaviour given a set of circumstances
- influence behaviour to promote good health
What are the 2 learning theories?
Classical conditioning
Operant conditioning
What are the 2 social cognition models?
Health beliefs model
Incory of planned model
What are 2 integrative models?
Trans theoretical model
Prime theory
How can classical conditioning be applied to humans?
Pairing between an environmental cue and ur can explain cravings as the mind makes expectations based on previous experiences leg. Smelling food at restaurant and being hungry)
- link to drugs alcohol trigger benaviour
How can benaviour be changed according to classical conditioning?
Explain in terms of an example
Break unconscious response to stimulus
Avoid cues or change stimulus pairings
→ aversion therapy in alcohol misuse - pair alcohol with an unpleasant response e.g, nausea
Meds
How can operant conditioning be applied to humans?
Shape behaviour through reinforcement
- punish negative health behaviours
- reward positive health behaviours
Motivational incentives
What are the limitations of learning theories?
- doesn’t explain withdrawal and long term consequences
- doesn’t account for cognitive factors
- no social context
How can social learning theory be applied in health
Role models may carry outharmfull benaviours, those that view them as remodels will do the same
What is cognitive dissonance theory?
Apply to health
People feel discomfort when their actions are inconsistent with their beliefs
- changing benuciours reduces discomfort
→ health promotion = provides info that may cause mental discomfort leading to change
What is the health belief model?
Assumes that health bencuiour is based on a desire to avoid illness and that a specific health action will prevent /cure illness
What are the 6 parts to the health belief model
Perceived susceptibility / severity Perceived benefits/barriers Cut to action Modifying factors (percieved threat) Like good of changing behaviour
What is the theory of planned behaviour?
Sociocognitive constructs that mediate patients intention to carry out behaviour
- attitudes
- subjective norms
- perceived benavioural control, belief on their capacity to engage with benaviour
What does the updated theory of planned behaviour model include?
Past benaviour - meaning data in real world behaviour could be explained more, acts as a good indicator of future behaviour
What are the limitations Of social cognition models?
- assumes people make rationdidecisions before carrying out benaviour
- don’t include emotional influences
- don’t incorporate moral norms
- focus on change but not how to change
What is the trans theoretical model 3.
Aka stages of change model
-represents the stages a person has to go through to change benaviour
What are integrated models?
Integrate more contextual and environmental factors
What are the stages of the trans theoretical model
Precontemplation Contemplation Preparation Action Maintenance -> stable lifestyle if change is embedded) Relapse
What other factors influence the the transtneorerical model?
- Decisional balance (pros vs cons of change)
- confidence
- temptation
What are the strengths of the trans theoretica model?
Recognises the different stages of change and interventions that can be used
Includes relapse
What are the limitations of the trans theoretical model?
- stages may not be followed in the exact order
- steps may be skipped
- doesn’t explain relapse
What are the 4 assumptions that prime theory makes about motivation and health?
- Need to understand moment to moment control of behaviour
- Motivation-al system has plasticity I can be modified)
- Self idenityy is important to benaviour
- Determine motivational system so we can remodel it
What are the 5 main factors of prime theory?
Plans Responses Impulses Motives Evaluations
What is a limitation of prime theory?
- lack of evidence of its efficacy in planning in long term
What are the 3 parts of the com- B model of behaviour?
Capability= physical and psychological Oppurtunity= physical and social Motivation= reflective and automatic
Each factor influences eachother and behaviour, and behaviour also influences behaviour
What is the behaviour change wheel?
Based on the com - B model with sources of benaviour, intervention functions, policy functions
Motivation - enablement, training, coercion
Capability - modelling, restrictions, environmental restructuring
Opportunity -education, persuasion,incertivization
What is nudge theory?
Small behaviour manageable interventions that have a wider impact
- based on assumption that 80% behaviour is automatic
- cues in environment unconsciously shape choices
What is intrapersonal stigma?
A person’s attitudes to their own condition
What is self stigmatization?
Process in which person with mental health diagnosis becomes aware of public stigma
What is interpersonal stigma?
Stigma a person faces from other people
What is structural stigma?
Stigma that people face from institutions
