Health Psychology Flashcards

Question

NOW: 21st Century - Bio-Psycho-Social Model

Answer 1

- systems approach - BIOLOGICAL, PSYCHOLOGICAL & SOCIAL SYSTEMS INTERACT TO AFFECT HEALTH - Not reductionist, but explains health in terms of the interaction between multiple systems, bio, psycho, social (systems approach)

Answer 2

- Use of health care service, be it GP or hospital, predicted by age of the patient. Positive relationship between age and use of the health service – in other words, as age increases, as does use of the health care service. - Notice however comparable level of use between those in first few years of life, 0-5 years, and those aged 40-45 years, and then how use markedly increases - Young children (0-5yrs): developing immune systems, prone to infections, require more check ups and vaccinations - Older adults (45yrs+): falling immune systems, prone to infections, age-related diseases - Gender related differences in use of the health care service, with females using it more frequently, and this effect seems to be largely accounted for by differential use between late teens and 40’s. Explicable for any number of reasons, including: ∙ Women: pregnancy & childbirth, more in tune with bodily symptoms (better homeostatic mechanisms) ∙ Men: more likely to ignore symptoms, perceived invincibility (especially when young) = women more sensible than men, whereas men = less in tune with their bodily symptoms, they're also stubborn and dumb = tend not to seek medical attention when it is actually needed and this could be attributed to this macho, ego driven sense of self they have

Answer 3

- Attention: ✳︎ INTERNAL FOCUS (IF): -People who are socially isolated/bored -Socially isolating jobs -More likely to notice illness, and to report it -Sensitizers, those who, when then they realise they are ill, seek out information about the illness, and report side effects ✳︎ EXTERNAL FOCUS (EF): -People with active lives (e.g., friends, work) -Focus on the environment -Less likely to notice illness, and to report it -Repressors, those who ignore symptoms and health related information, and blunt their reactions to illness - Mood: positive mood tends to be associated with fewer illness manifestations, or reports of illness

Answer 4

Most people use the health service normally, but for those who don’t can, broadly speaking, be divided into TWO CATEGORIES: Delayers and Overusers

Answer 5

- Appraisal delay: time for an individual to decide they are ill - Illness delay: time between recognising symptoms as illness and deciding to seek treatment - Utilisation delay: time between deciding to seek medical advice and actually doing it - Scheduling delay: time between making appointment and receiving treatment - Appointment delay: time between turning up for appointment and being seen by practitioner

Answer 6

1. MALINGERING: Making believe one is ill for secondary gains (rewards), including: -EMOTIONAL GAINS: Increased attention (Munchausen's Syndrome/MSBP) -PRACTICAL GAINS: --Access to controlled medication --Free from responsibility (sick note) --Financial gains (disability benefit, sick leave) 2. EMOTIONAL PROBLEMS: Stress causes changes in biological systems such as increased heart rate, which is often mistaken for illness ✳︎ Physicians estimate that 2/3 of their time taken up by people with insignificant medical problems or emotional disturbances (Miranda et al., 1991)

Answer 7

- PERSISTENCE OF SYMPTOMS: If symptoms last longer than expected, e.g., a cough that lasts longer than it should - CRITICAL INCIDENT: A sudden change in symptoms/signs e.g., sudden pain, noticing a lump - TREATMENT EXPECTATIONS: We decide that GP can make a difference, e.g., prescribe medication not available over the counter, like antibiotics

Answer 8

- Dr centred: dominant, asks closed/direct questions, concerned only with medical facts, Dr makes decisions, Instructs patient on what to do, patient is passive, asks few questions and takes Dr advice - Patient centred: makes observations, seeks patient's ideas and actively listens, involves patient, joint decision making based on Dr's advice and patient views, patient is active and encouraged to ask questions

Answer 9

= it seems to depend on the illness - Beaver et al (1996): Breast Cancer Patients: -Benign Tumour - Most preferred collaborative, decision making (patient centred) -Malignant Tumour - Most wanted GP to make the decision (doctor centred) = WHY? - -Doctor Knows Best: Maximise chance of correct decision by leaving to expert -Avoid Responsibility: Less guilt if wrong decision is made

Answer 10

``` - McInstry et al, 1991 ► Showed participants images of the same doctor, in this case a male doctor, dressed in various ways, and asked how much confidence they'd have in this person, and to what extent they’d think, if they got this doctor, the consultation would be a success = Traditionally dressed doctors were rated most highly, especially by older & professional-class patients = A male Dr SHOULD WEAR: ∙ White coat: 15% ∙ Suit: 44% ∙ Tie: 67% = A male Dr SHOULD NOT: ∙ Wear Jeans: 59% ∙ Have an earring: 55% ∙ Have long hair: 46% = Results indicated that patients rated formally dressed doctors, such as those in suits and ties, most highly, and were less likely to have confidence in doctors that wore white coats. Over half of those surveyed indicated that doctors should not wear jeans or have long hair. ```

Answer 11

- 77% of patients, when presented with a GP wearing a white coat, formal dress (suit and tie), surgical scrubs and casual dress (jeans and shirt), preferred the GP wearing the white coat. Trust and confidence were also greater for GPs wearing white coats, and patients reported being more likely to divulge sensitive information to GPs wearing white coats

Answer 12

✳︎ Other non-verbal behaviours: →Eye contact →Age →Tone of voice →Gender →Situational factors, like items in the surgery ✳︎ Argyle (1975): ∙ 4x as powerful/effective as verbal communication ∙ Different types of non-verbal behaviours INTERACT to affect perceived consultation success

Answer 13

►PRIMACY EFFECT: - Extra importance given to the first bit of information heard by the physician, e.g., ‘high blood glucose’ - HCP can ignore/distort the interpretation of later information to fit with immediate diagnosis ►PATIENT KNOWLEDGE: - Frequency of GP visits ........... KNOWN MALINGERER? ►SELF-REPORT: - In the absence of obvious symptoms, Dr must rely on what patient says… - Can patients always articulate the problem? - Is what the patient says reliable (do we always disclose everything)?

Answer 14

►Robinson & West (1992): - Assessed patients visiting urino-genital clinic - Self-disclosure of ‘sensitive data’ to doctor or to a computer = Found that patients were more likely to disclose sensitive information online than in the doctors office. More likely to disclose information online due to the anonymity of the computer and impersonal nature. Less worried about being socially scrutinised. = Information provided in the doctors office not always reliable.

Answer 15

►Donovan & Blake (1992): - Rates of patient non-adherence range between… 15-93% - Adherence tends to be higher among individuals experiencing more severe illness symptoms - NOT ALWAYS...Terminal cases?

Answer 16

- Taking sporadically (e. g., meant to be daily, but taking every other day, every two days) - Skipping doses (e.g., meant to take two, twice a day, but only taking one) - Purposely altering the plan (e.g., to fit with lifestyle) - Alternating between periods of adherence and non-adherence (is it still there?) - In the case of multiple medications, skipping one and not the other - Not adhering to food/drink/rest recommendations

Answer 17

1. Self-report: Ask the patient 2. Therapeutic outcome: Is the patient getting better? 3. Health worker estimates: Ask the HCP 4. Pill count: Have the correct number of pills been used? 5. Electronic methods: Data recorders in pill bottles 6. Biochemical tests: Blood & urine tests ►Problems: 1. Would you admit non-adherence? 2. Even non-adherers get better 3. Dr’s incorrectly predicted adherence 41% of the time (Paterson et al., 2000) 4. Just because pill is gone doesn’t mean it was consumed 5. Expensive & should be reliable, BUT patient can remove pill & not consume 6. Time consuming/expensive and lots of confounds

Health Psychology Flashcards

30/9/19 (41 cards)