How Do We Know What We Know?

Question 1

What are the philosophies talked about in this lecture? (3)

Answer 1

Ontology
Epistemology
Axiology

Question 2

What two research approaches are discussed in this lecture?

Answer 2

Deductive approach

Inductive approach

Question 3

What is meant by deductive approach? What type of knowledge is it often allied to? What type of data? What type of ontological position?

Answer 3

A theory and hypotheses are put forward and tested
Positivism (scientific principles)
Quantitative data
Objectivism

Question 4

What is meant by inductive approach? What type of knowledge is it often allied to? What type of data? What type of ontological position?

Answer 4

Theory is developed as a result of collecting data
Interpretivism
Qualitative data
Constructionism/subjectivism

Question 5

What is ontology? What are the two main ontological positions?

Answer 5

Ontology concerns our assumptions about the nature of reality.
Objectivism/Realism
Subjectivism/Idealism/constructionism

Question 6

What is objectivism?

Answer 6

The social world is objective, out there, independent of us who perceive it

Question 7

What is subjectivism?

Answer 7

The social world is constructed by us - constructions are built up from the perceptions and actions of social actors

Question 8

What is epistemology?

Answer 8

Theory of knowledge, or how it is we can know anything about the world.

Question 9

What three philosophies make up epistemology?

Answer 9

Positivism
Interpretivism
Pragmatism

Question 10

What is positivism?

Answer 10

The application of empiricist natural science to the study of society
Reality is unitary, it can only be understood through the scientific approach. The researcher is independent/detached of the data that are collected - neither influences nor is influenced by the research.

Question 11

What is interpretivism?

Answer 11

Contrasting to positivism, it argues that people and institutions are different from material objects/the natural world and therefore require a different approach. People are ‘social actors’ who interpret their everyday social roles in accordance with the meanings they give to these roles. The goal of research is to understand the subjective meanings and reality of social actors in order to make sense of their actions.

Question 12

What is axiology?

Answer 12

A branch of philosophy that studies judgements about values.

Question 13

There are different views on the influence and role of values in research - either strive to be objective or acknowledge that you are subjective (i.e. reflexivity).
Define reflexivity.

Answer 13

Recognise and acknowledge that research cannot be ‘objective’ and value-free; being self-reflective about how our values influence the research process and products.

Question 14

What influences knowledge production and legitimation? (5)

Answer 14

Theory
Values
Practical considerations
Ontology
Epistemology

Question 15

What are health beliefs affected by? (5)

Answer 15

Age
Culture
Ethnicity
Gender
Socio-economic status

Question 16

What three main components make up HSPH, as shown on a Venn diagram in this lecture.

Answer 16

Sociology of medical education
Health promotion and improvement
Social determinants of health

Question 17

What is neoliberalisim?

Answer 17

People make choices yet not under the conditions of their choosing. Neoliberalists accept the unknowability of the world - they can’t conceive of changing the world or its structure. They accept they need to change themselves and adapt in order to cope responsively.

Question 18

What does adherence to long-term therapy for chronic illnesses in developed countries average?

Answer 18

50%

Question 19

Non-communicable disease and mental disorders, HIV/AIDS, TB - together these represented how many % of burden of all diseases worldwide in 2001?

Answer 19

54%

Question 20

What are the consequences of poor adherence to long-term therapies? (3)

Answer 20

Poor health outcomes
Increased health care costs
Compromises the effectiveness of treatment

Question 21

What does compliance mean? Why is this no longer used as much (what replaced it)?

Answer 21

How much the patient did what they were told by the doctor

Too judgemental - replaced by ‘adherence’

Question 22

What does adherence mean?

Answer 22

The extent to which a patient’s behaviour, with respect to taking medication, corresponds with agreed recommendations from a healthcare provider

Question 23

What are the three components of adherence?

Answer 23

(i) persistence
(ii) initiation adherence
(iii) execution adherence

Question 24

What is meant by persistence?

Answer 24

The length of time a patient fills their prescriptions

Question 25

What is meant by initiation adherence?

Answer 25

Does the patient start with the intended pharmacotherapy?

Question 26

What is meant by execution adherence?

Answer 26

The comparison between the prescribed drug dosing regimen and the real patient’s drug-taking behaviour. This includes dose omissions and the so-called ‘drug holidays’ (3 or more days without drug intake).

Question 27

What is meant by concordance?

Answer 27

A process of the consultation in which prescribing is based on partnership. Healthcare professionals recognise the primacy of the patient’s decision about taking the recommended medication, and the patient’s expertise and beliefs are fully valued. The patient’s opinion should be taken into account and discussed.

Question 28

Contrast 'compliance' to 'concordance'.

Answer 28

Compliance focuses on the behaviour of one person (the patient), whereas concordance requires the participation of at least two people.

Question 29

What types of non-adherence are there?

Answer 29

Unintentional | Intentional

Question 30

Why might a patient unintentionally not adhere? (3)

Answer 30

Forgetfulness Regimen complexity Physical problems

Question 31

What is the reason for intentional non-adherence?

Answer 31

The patient decides to take no/less medication after making a benefit-risk analysis. This is influenced by patient’s beliefs about medication, patient’s self efficacy, and patient’s knowledge of disease.

Question 32

What affects adherence? (3)

Answer 32

Patient factors Disease features Drug characteristics

Question 33

Adherence for medication for rheumatoid arthritis ranges between...?

Answer 33

30-80%

Question 34

Patients with lower health literacy are more likely to...? (3)

Answer 34

A lower functional status than other patients A poorer self-reported adherence to medication Visual and memory problems

Question 35

How might you identify people with low health literacy? (4)

Answer 35

People who had difficulty with recall People who self-identified as not being able to read or write People who used excuses (e.g. they have left their glasses behind) Those with performance issues/lack of adherence to exercises or medication

Question 36

How might you help a patient with low health literacy to understand? (8)

Answer 36

``` Non-medicalised jargon Reassuring Visual cues Basing dialogue on patient’s own experience Recall and feedback Participative inquiry Attending to non-verbal cues and facial expressions Amount of information ```