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FPH exam > 2I Disease prevention > Flashcards

2I Disease prevention Flashcards

1
Q

Suggest some challenges when studying the effects of preventative health promotion activities for the early years

A

STUDY DESIGN
- sometimes RCTs are not ethical especially for programmes preventing health problems in young people
- sometimes RCTs are not practical ie the effect of the smoking ban in public places

MEASURING AN ABSENCE
- it is not always possible to model what would have happened if an intervention did not occur
- ie we cannot know what disease occurrence would have been if a vaccine programme was not introduced

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2
Q

Evidence base for early years intervention: what 5 categories do studies for health promotion in the early years normally fall into?

A
  1. education
  2. health and nutrition
  3. socioeconomic benefits
  4. Emotional and social support
  5. combine programmes
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3
Q

Evidence base for early years intervention: Education- what is the evidence

A
  • pre school education can improve children’s social and intellectual development as well as long term outcomes
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4
Q

Evidence base for early years intervention: Education- give a programme example

A

Effective Provision of Preschool Education (EPPE) Project

  • cohort study of 3000 children across Europe
  • considered the effect of preschool education and the home learning environment at the age of 6-7 years
  • children who attended preschool had higher educational and social attainment even after adjusting for social and home circumstances
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5
Q

Evidence base for early years intervention: health and nutrition- what is the evidence

A

LOW BIRTH WEIGHT
- babies with LBW have a greater risk of mortality and risk of long term chronic conditions such as CHD
- LBW is more common in lower socio economic groups
- 2 major modifiable risk factors for low birth weight are maternal nutrition in pregnancy and maternal smoking in pregnancy

BREASTFEEDING
- breastfeeding research has shown many positive effects: reduced infections, reduced SIDS, reduced obesity, reduced maternal breast and ovarian cancer, increased maternal-infant bonding
- prenatal education and support for mothers has been shown to improve breast feeding rates

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6
Q

Evidence base for early years intervention: health and nutrition- give a programme example

A

UK Government Healthy Start Scheme

  • disadvantaged families with young children are provided with vouchers which can be redeemed at local retailers for milk, fruit and veg. They are also given coupons for vitamins.

A department of health evaluation found the scheme was working well, misuse was rare and retailers accepted the vouchers.

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7
Q

Evidence base for early years intervention: socioeconomic benefits- what is the evidence

A
  • UK reports have found families with young children are at increased risk of poverty
  • lack of affordable childcare is one key contributing factor to this
  • many UK government policies have focused on availability of affordable childcare
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8
Q

Evidence base for early years intervention: emotional/social support- what is the evidence

A
  • family support programmes can be at the community level (ie targeting social isolation) or individual (ie home visits after birth)
  • the programmes aim to improve parental wellbeing, improve child physical, emotional and social development and reduce child abuse
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9
Q

Evidence base for early years intervention: emotional/social support- give an example of a programme

A

European early Promotion Project
- cohort study
- 1000 families across Europe
- training healthcare workers to support early parent infant relationship led to fewer psychosocial problems in young children

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10
Q

Evidence base for early years intervention: combined programmes - give an example of a programme

A
  • a UK example form the 1990s is the sure start programme
  • provided childcare, early education, health and family support in disadvantaged areas
  • National Evaluation produced several reports

2005: little benefit seen for children living in areas with sure start local programme compared with control areas

2008: at 3 years children living in areas with sure start local programme had better social development, greater immunisation rates and lower accidental injuries than children in control areas.

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11
Q

Define: pre-determinants of health

A

factors that portend the determinants of health

some things can be both a determinant and a pre-determinant ie income

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12
Q

give an example of predeterminants of health that portend a determinant of health

A

Health characteristic: respiratory health

determiant of health: housing condition

Pre-determinant of health:
- income (ability to afford appropriate housing)
- employment practices (enabling individuals to earn enough to support themselves and their family)
- tolerances of different cultures (affecting employment opportunities)

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13
Q

What are the pre-determinants of health (MPS)

A

MATERIAL
- healthy and sufficient food
- clean water
- good air quality
- income
- housing
- green spaces

POLICY
- minimum wage
- benefits
- childcare
- maternity services
- education

SOCIETY
- social cohesion (the extent to which a society is mutually supportive and minimise inequalities)
- values and attitudes (balance between competitive and co-operative approaches)
- ethnic diversity and tolerance of different cultures
- language ability

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14
Q

Methods of encouraging individual behaviour change (name 3)

A
  • motivational interviewing
  • CBT
  • incentives
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15
Q

Methods of encouraging individual behaviour change: motivational interviewing

A
  • developed by Rollnick and Miller in 1990’s
  • style of counselling based on stages of change model
  • person centred method that aims to explore why a person may be ambivalent about behaviour change
  • growing evidence base in a number of areas including eating disorders, drug misuse and smoking cessation
  • key characteristics of motivational interviewing are:
    1. use EMPATHY and reflective listening
    2. HIGHLIGHT DISCREPANCY between persons most deeply held values (‘be good) and current (‘unhealthy’) behaviour
    3. ‘ROLL WITH RESISTANCE’ (ie respond with understanding rather than confrontation)
    4. BUILD THE PERSONS SELF EFFICACY that they can effect the change
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16
Q

Methods of encouraging individual behaviour change: CBT

A
  • aims to break habitual cycles of unhealthy behaviours and replace them with healthy ones
    -similar technique to motivational interviewing but also uses CONGNITIVE EXERCISES such as imagining scenarios of being offered a cigarette and how the person might response
17
Q

Methods of encouraging individual behaviour change: incentives

A
  • personal financial methods may be used to encourage individual behaviour change:

ie vouchers to encourage smoking cessation in the UK

Financial rewards for achieving healthy weight targets in Italy

  • Research suggests that financial incentives can be effective in the short term and in the long term if combined with other health promotion advice
  • moral concerns however:
    1. bribery
    2. overly paternalistic
    3. Is it a good use of public money?
18
Q

Definition: social marketing

A
  • using the methods used in commercial marketing to sell a health message in order to benefit individuals and society
19
Q

The 7 steps to the social marketing process

A

IRCOMSE

  1. IDENTIFY THE TARGET GROUP
    - traditional health approaches often segment groups by risk or disease categories (ie diabetic)
    - social marketing tends to group people by psychographic classification (attitudes, values and beliefs), lifestyle characteristics and consumption patterns
  2. RESEARCH TARGET GROUP
    - surveys and focus groups are used to assess attitudes and beliefs, habits and lifestyles, needs
  3. COMPETITIVE ANALYSIS
    - the competition in this context may include the tendency to continue current behaviours and the influence of unhealthy industries (ie tatics of tobacco industry)
  4. OBJECTIVES
    - need clear objectives of the campaign ie is it to raise awareness of effect behaviour change
  5. DEVELOP THE MESSAGE
    - the message needs to be thoroughly pre-tested with the target group to ensure that it is credible
  6. SELL THE MESSAGE
    - sell the message through a mixture of considerations (the 4 Ps)
  7. EVALUATE
    - the campaign should be evaluated to monitor success and guide refinements
20
Q

4 Ps of social marketing

A

PRODUCT
- it must be clear exactly what is being ‘sold’
- for an MMR vaccine this could be the procedure (vaccine delivery), the service (visit to a nurse), the outcome (measles immunity)
- each of these will have different appeals to different groups

PRICE
- this is the relationship between costs and benefits of the programme to the behaviour change
- ie some people do not see measles as a serious disease so do not value immunity
- should consider the opportunity cost

PLACE (where you sell the product and the distribution channels you use)
- the channel used will effect who has exposure to the message
- the type of message will also affect which channels should be used

PROMOTION (how you advertise your product or service)
- can be achieved through various media/ advertising
- can include events, emails, texts, merchandising, sponsorship

21
Q

Strengths and weaknesses of social marketing

A

STRENGTHS
- based on an objective understanding of the target group (not the health promoters perceptions)
- clear objectives are integral to the approach
- makes use of techniques that have been shown to be commercially effective

WEAKNESSES
- assumes that the individual is able to chose to change the behaviour (ie behaviour is a choice and socioeconomic factors are not a barrier)
- danger of only displaying partial information in an effort to change behaviour (ie just say no is a much catchier message than a rounded exploration of positives and harms)
- can be more resource intensive

22
Q

Give 7 reasons/benefits to involving community in health promotion programmes

A
  1. BETTER HEALTH OUTCOMES
    - patients who are involved with treatment decisions are more likely to comply with treatment
  2. EMPOWERMENT
    - process of participation can empower communities to understand their own situation and take control over factors affecting their lives.
    - this can enhance peoples sense of wellbeing
  3. BETTER DECISIONS
    - involving communities and service users can develop more appropriate, responsive and effective services
  4. INTEGRATED APPROACHES
    - communities that are not restricted in their thinking by organisational boundaries can develop cross cutting solutions to complex issues
  5. BETTER ACCEPTANCE
    - people are more likely to be accepting of programmes they have been involved in designing
  6. OWNERSHIP AND SUSTAINABILITY
    - community participation is necessary if health programmes are going to be widely owned and sustainable
  7. DEMOCRACY
    -community participation in decision making, planning and action is a right
23
Q

levels of community involvement model

A

-Brager and Specht
- health ladder that describes different levels of community involvement
- criticised as top of the ladder is not always bets, depends on what is appropriate in the situation

  1. HAS CONTROL
    organization asks community to identify problems and make all key decisions on goals and means. Organization is willing to support at ay stage if requested.
  2. HAS DELAGATED AUTHORITY
    Organization identifies a problem and presents it to the community. It defines the limits and and asks community to make key decisions which they will accept
  3. JOINT PLANNING
    Organization develops a tentative plan which is open to change by the community
  4. ADVISES
    Organization develops a plan and invites questions. It is willing to change if absolutely necessary
  5. IS CONSULTED
    Organization tries to promote a plan, it seeks to develop support to facilitate acceptance
  6. RECIEVES INFORMATION
    community is informed of plan
  7. NONE
    Community is told nothing
24
Q

What is deprivation

A

the state of not having something that people are generally considered to need

25
Q

Give some manifestations of deprivation (6)

A
  • deprivation can manifest itself in a multitude of ways
  • there are many measures of deprivation which often consider multiple manifestations of deprivation

HOUSING (temporary accommodation, damp, overcrowded, poorly maintained)

EDUCATION (lack of quality education)

INCOME (low income)

EMPLOYMENT (insecure employment, low status posts, hazardous jobs)

ENVIRONMENT (high crime, poor access to facilities)

SOCIAL EXCLUSION (isolation, poor social support, abusive relationships)

26
Q

Define absolute poverty

A
  • lack the basic material necessities for life (income is below a certain level)
27
Q

Define relative poverty

A

-income <60% of national median income

28
Q

what is a strategic partnership

A
  • long term collaborations, often delivered through a shared accountability model with joint commitment to goals, risk and performance
29
Q

Give example of health strategic partnerships

A
  • strategic partnerships in healthcare have changed over recent years
  • previous local strategic partnerships have largely evolved into the now statutory Integrated Care Partnerships
  • these bring together NHS, local authorities and other organisations with a role in health (ie NGOs, voluntary sector)
  • take collective responsibility for planning services, improving health and reducing inequalities
  • ICSs aim to provide more integrated care for todays often more complex needs
30
Q

Give examples of targets using donabedians framework

A

STRUCTURE
- to have 90% of nursing posts filled

PROCESS
- 80% of GP practices maintain a register of their diabetic patients

OUTPUT
- 98% of patients seen within 4 hours of arrival at A+E

OUTCOME
- cancer mortality reduced by 10% in 2020 compared to baseline in 2010

31
Q

Give examples of targets set at different levels

A

INDIVIDUAL
- PDP agreed with manager

ORGANISATIONAL
- local authority setting target for proportion of affordable housing

NATIONAL
- national CO2 emissions reduction targets

INTERNATIONAL
- WHO health for all targets

32
Q

What does SMART stand for

A

Specific
Measurable
Achievable
Relevant (ie to practice now, looking at lung cancer deaths actually will mainly reflect services 30 years ago not todays practice)
Timed

33
Q

Give 6 advantages and 4 disadvantages of target setting

A

ADVANTAGES
- clearly sets priorities
- number and domains can be adjusted to meet am organisations priorities
- provides a focus for improvement
- can help attract managerial attention to target areas
- opportunity for sharing good practice and learning
- create a level playing field for all organisations under comparison

DISADVANTAGES
- often the data is unavailable for meaningful health outcomes
- can lead to gaming or distortions of practice (ie redesignating A+E trolleys as bed to meet waiting time targets)
- can lead to areas that are important but not amenable to targets being neglected
- if targets are externally or top down set they can disengage clinicians

FPH exam (24 decks)

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