7. Screening and health promotion

Question 1

public health

Answer 1

reform of physical environment

Question 2

health education

Answer 2

targets individual health behaviour

Question 3

health promotion

Answer 3

broader approach - political/social

Question 4

current health promotions

Answer 4

change for life
top tips for teeth
greater NHS
keep antibiotics working

Question 5

health promotion in action - 5 approaches

Answer 5

medical or preventive 
behavioural change 
educational 
empowerment 
social change

Question 6

medical/preventive

Answer 6

medical issues that can arise

Question 7

behavioural change

Answer 7

convince people to change how they act

• make them feel comfortable
• encourage behaviour change

Question 8

educational

Answer 8

give information

Question 9

empowerment

Answer 9

give patient power and control over their own change

Question 10

social change

Answer 10

public legislations e.g. ban on smoking in public places means people have to change where and when they smoke

Question 11

problems with health promotion

Answer 11

structural critiques - deprived areas have less access to healthcare
focus on individual responsibility
is it ok to just monitor and regulate the pop
reinforces sterootypes in groups

Question 12

concerns and critiques of health promotions

Answer 12

dilemmas and prevention paradox

evaluation

Question 13

victim blaming

Answer 13

-health promotion focuses on individual behavioural change

plays wider socio economic and structural changes

Question 14

fallacy of empowerment

Answer 14

• giving people info about healthy lives doesn’t automatically give them power to change
  unhealthy lifestyles are almost never due to ignorance

Question 15

unequal distribution of responsibility

Answer 15

implementing healthy behaviours in family is often left up to women

Question 16

prevention paradox

Answer 16

interventions that make a difference at population level might not have much effect on the individual
if people on’t see themselves as a a candidate for disease they won’t take on the helath promotion message

Question 17

health promotion evaluation - 3 types

Answer 17

process
impact
outcome

Question 18

process evaluation

Answer 18

assess process of programme implementation
- mainly qualitative methods
how programme works together

Question 19

impact evaluation

Answer 19

assess immediate effects of intervention

easy to do

Question 20

outcome evaluation

Answer 20

measures long term consequences, what is achieved, = reduction of symptoms, improve life, harm reduction

• timing of evaluation can influence outcome, delay and decay of effect = decide right time to assess outcome

Question 21

difficulties with evaluation

Answer 21

Different designs per intervention, time to see effect, confounding factors, high cost, large scale, long term

Question 22

screening process

Answer 22

screen with rapid, cheap test

screen negative = low risk
screen positive = high risk
- diagnostic tests
- disease or no disease

Question 23

purpose of screening

Answer 23

• better outcome for certain conditions
• if treatment can wait until symptoms don’t screen
  find the disease early

Question 24

potential problems with screening

Answer 24

turns those who test positive into patients
- so we must identify conditions that can be treated
no benefit in screening person making them a patient and then not being able to treat the disease

Question 25

5 areas of screening criteria

Answer 25

1. condition 2. test 3. intervention 4. screening programme 5. implementation

Question 26

condition

Answer 26

- must be an important health problem all cost effectiveness primary interventions should have been implemented consider psych implications of condition

Question 27

test

Answer 27

should be simple, safe, precise and validated acceptable to population, cut off and defined test values agreed further investigations for those with positive tests

Question 28

2 types of screening tests error

Answer 28

false positive | false negative

Question 29

false positive

Answer 29

refers well people for further investigation | - unnecessary stress, time and money

Question 30

false negatives

Answer 30

fails to refer people who do actually have an early form of the disease - no treatment until symptoms present, this then affects the success of treatment

Question 31

4 features of high test validity

Answer 31

sensitivity specificity positive predictive value negative predictive value

Question 32

sensitivity

Answer 32

the proportion of people with the disease who also test positive - high sensitivity = good at detecting disease

Question 33

sensitivity equation

Answer 33

no of true positive + no of true negative | a + c

Question 34

specificity

Answer 34

the proportion of people without the disease who also test negative

Question 35

features of sensitivity and specificity

Answer 35

when the same test is applied in the same way in diff populations the test should have the same sensitivity and specificity

Question 36

positive predictive value (PPV)

Answer 36

probability that someone who has tested positive actually has the disease - high false positive = low prevalence - low false positives = high prevalence

Question 37

specificity equation

Answer 37

no of false positive + no of false negatives | b + d

Question 38

PPV equation

Answer 38

a + b | no of true positive + no of false positives

Question 39

negative predicative value (NPV)

Answer 39

proportion of people who test negative who actually do not have the disease

Question 40

NPV equation

Answer 40

no of true negative c + number of false negatives d

Question 41

intervention

Answer 41

must have effective intervention for patients identified through screening - interventions at early/ pre symptomatic phase should lead to a better outcome

Question 42

screening programme

Answer 42

proven effectiveness in reducing mortality and morbidity | evidence that is clinically, socially and acceptable to heath

Question 43

implementation

Answer 43

all other options for managing condition must have been considered adequate facilities for it evidence based info

Question 44

3 evaluation difficulties

Answer 44

lead time bias length time bias selection bias

Question 45

lead time bias

Answer 45

early diagnosis falsely appears to prolong survival - screened patients appear to survive longer but this is only because they are diagnosed earlier - lived longer amount of time knowing they had disease

Question 46

length time bias

Answer 46

screening programmes better at picking up slow growing nonthreatening cases rather than dangerous ones - diseases that are picked up through screening probs wouldn't have caused a big problem

Question 47

selection bias

Answer 47

screening results skewed by healthy volunteer effect, those that are screened regularly are likely to do other things that protect their health

Question 48

informed choice and screening

Answer 48

- promoting informed choice well informed on the pros and cons and can access info on screening to make their decisions

Question 49

difficulty in achieving informed choice

Answer 49

communicating benefits, harms and risks of preventive interventions can be challenging

Question 50

types of screening in the UK

Answer 50

``` national pop screening programmes targeted or risk stratified screening NHS health checks lung health check opportunistic screening screening delivered as part of routine healthcare ```

Question 51

5 determinants of screening

Answer 51

``` test intervention condition screening programme implementation criteria ```

Question 52

screening programmes

Answer 52

``` breast cancer - 50-70 cervical cancer 25-64 AAA abdominal aortic aneurysm - men 65 diabetic eye screening - diabetes 12+ bowel cancer 60-74 ```

Question 53

uptake

Answer 53

proportion of those invited to take up screening

Question 54

coverage

Answer 54

proportion of eligible population who have been screened within a given time

Question 55

factors affecting screening uptake

Answer 55

``` acceptability awareness of benefits convenience accessibility reminders and endorsements ```

Question 56

inequalities in screening

Answer 56

efforts should be made to encourage participation in low uptake areas

Question 57

developments in screening

Answer 57

more targeted screening AI new pop screening programmes