MIS 1st 2x modules

Question 1

Describe the cycle of change

Answer 1

Pre-contemplation
Contemplation
Preparation
Action
Maintenance
Relapse

Question 2

What is unrealistic optimism?

Answer 2

the belief that one is at less risk of experiencing negative events than others.

Question 3

Why do people continue to practise unhealthy behaviours?

Answer 3

1) Perceived/belief of infrequency of an event
2) Event hasn’t appeared yet, it will not appear in the future
3) Lack of experience of an event
4) Event is perceived as preventable by individual action

Perception of own risk is not a rational process.

Question 4

What is the official socio-economic classification in the UK?

Answer 4

NS-SEC: National Statistics Socioeconomic Classification

Question 5

What are the 8 NS-SEC classes?

Answer 5

1) Higher managerial and professional occupations
2) Lower managerial and professional occupations
3) Intermediate occupations (clerical, sales, service)
4) Small employers and own account workers
5) Lower supervisory and technical occupations
6) Semi-routine occupations
7) Routine occupations
8) Never worked or long-term unemployed

Question 6

What are 4 models used to explain social class inequality in healthcare?

Answer 6

Behavioural model - dietary choices, drugs, tobacco
Materialist model - material disadvantage, poverty
Psycho-social model - stressful social conditions
Life course model - as disadvantage accumulates likelihood of further disadvantage increases

Question 7

What is delayed/deferred gratification?

Answer 7

Resisting an initial temptation for a better reward in the future

Question 8

What are the 4 types of doctor-patient relationships?

Answer 8

Default: lack sufficient direction, for example if the patient is given the opportunity to discuss their illness but they refuse to do so, most commonly seen in the elderly who are accustomed to paternalistic consultations.

Paternalistic: high physician control and low patient control, doctor acts as a parent figure and does they believe is in the patient’s best interests, based on the biomedical disease model, the doctor is the expert.

Consumerist: patient has an active role and doctor is more passive and behaves as patient requests and more commonly seen in private healthcare

Mutualistic: active involvement of a patient as a more equal partner in the medical consultation, clinical knowledge of doctor and patient experience are discussed to reach an outcome. Concordant with the biopsychosocial model

Question 9

What is patient-centred care and what is doctor-centred care?

Answer 9

Patient-centred care: biological disease is important, but the perspective of the patient is considered and power is shared. The patient can make decisions about their care. Helps to reduce social distance between patient and worker. Illness model.

Doctor-centred care: biological focus, uses the biomedical disease model, not used in normal circumstances, but is still used in emergency and critical situations, disease model.

Question 10

What is the Health Belief Model in a line?

Answer 10

The health belief model suggests that people’s beliefs about health problems (severity and susceptibility), perceived benefits of action and barriers to action, and self-efficacy explain engagement (or lack of engagement) in health-promoting behavior. A stimulus, or cue to action, must also be present in order to trigger the health-promoting behavior.

Question 11

Behaviour is guided by one’s perception of the threat and possible outcomes. Not the actual threat. Beliefs thought to regulate health behaviour include (3)…

Answer 11

Perceived threat of illness

Perceived susceptibility of the person to the disease

Perceived benefits of performing the behaviour

Question 12

What are the 2 types of health behaviour?

Answer 12

Health behaviour - health promoting e.g. exercise, visiting the doctor, taking meds

Health risk behaviour - increasing risk of disease

Question 13

What do patients have (health) beliefs about?

Answer 13

Causes, consequences, control and outcomes

Question 14

What did Taylor say about modifying health behaviours’ positive impacts (which was down to the individual)?

Answer 14

Reduced number of deaths related to lifestyle factors

Increased QOL and life expectancy

Reduces the amount of money spent on healthcare

Question 15

Differences in health behaviours (2)?

Answer 15

Within individual variation - vary across time in different settings
Between individual variation - between different people from different places

Question 16

What are some determinants of health behaviour?

Answer 16

psychological factors, social family factors, biological factors e.g. addiction, cultural, religious factors legislation e.g wearing seat belts, health status-motivation, system provision and health service-NHS, socioeconomic groups-e.g.lower the groups the worse the health behaviours, macroeconomics-disposable income.

Question 17

What does the Health Belief Model say? What are additional factors that might affect health behaviours?

Answer 17

A person’s readiness to take health action/to change is determined by 4 main factors:

Perceived susceptibility of disease
Perceived severity of disease
Perceived benefits of taking action
Perceived barriers to performing the action

Revisions/’can be modified later’: cues to action e.g. an event, health motivation, psychosocial-personality and demographic-age.

Additional factors include: attitudes, personality traits, knowledge and beliefs, perceptions of risk, attributions, self-efficacy, other sociological, socio-economic, public health factors.

Question 18

Perceived susceptibility and perceived severity (+health motivation) are influenced by what variables? What are they then called to influence action/health behaviour?

Answer 18

Health Belief model:
Demographic such as age, sex, social class, ethnicity.

Called Personal Health Threat

Question 19

Perceived benefits, perceived barriers (+health motivation) are influenced by what characteristics? What are they then called to influence action/health behaviour?

Answer 19

Health belief model:
Psychological characteristics such as personality, peer pressure.

Called Effectiveness of Health Behaviour.

Question 20

What are the cues to action in the Health Belief Model?

Answer 20

Internal - pain, health problems

External - information in leaflets

Question 21

What is the clinical iceberg?

Answer 21

it recognises the large amount of illness that can go unreported by doctors. Some of these are dealt with through self-treating-largest part of iceberg which doctors don’t see, or no action. In retrospect, patients tend to recognise their symptoms e.g. feeling tired and run down, and cancer.
Very few people go to the doctors with their symptoms and even fewer end up in hospital. Doctors in secondary care see a very selective proportion of symptoms.
People perceived themselves as healthy for their age, lifestyle, disability, age despite symptoms.

An increase in demand would overwhelm healthcare systems. Important to define need; GPs report that half of consultations are trivial and unnecessary. Recently public have been asked to go to the pharmacist with a sore throat rather than GP.
The clinical iceberg is the gap in the need (more) and demand (less) for healthcare (e.g. undetected hypertension).
This theory says that because only 1/3 of patients present their symptoms to a health professional you are never really sure how many people have ill health. It gives an indication that peoples concepts of ill health are different

Question 22

What is the lay referral system?

Answer 22

When symptoms arise, people ask others for advice or deal with them by themselves.
People who give advice are usually women, as they are traditionally carers; discussion about health is more acceptable between women and health features heavily in women’s magazines.
People pay more attention to lay referral
In Kleinman’s model, it is the location of where information is exchanged which is important.

Question 23

What is Parson’s sick role? What are the two roles? What are the x rights and responsibilities? What are the x expectations and rights?

Answer 23

Sick role is temporary (as long as it takes to get better) and universal (irrespective of gender, race or socioeconomic class).

Patient: sick role
Rights:
-not obliged to perform their normal social roles e.g. go to work
-not considered responsible for their own state
Responsibilities:
-the sick are obliged to want to get well as soon as possible
-the sick are obliged to consult and co-operate with medical experts

Therefore, according to Parson’s sick role, someone who is ill gains the right to medical help, sympathy and time off work, but also has duties, to comply with medical treatment and get better as quickly as possible.

Doctor: professional role
The role of a doctor is not equal, but complementary because:
-affective neutrality - remaining emotionally detached and objective in the diagnosis and treatment of disease
-universalism - to treat all patients equally
Functional specificity - the doctor should be concerned only with those matters that directly affect the medical relevance to the patient.
Expectations:
-Apply a high degree of skill and knowledge to the problem of illness
-act for the welfare of patient and community
-be objective and emotionally detached
-be guided by professional practise

Rights:

• granted right to examine patients and enquire into intimate areas of physical and personal life
• granted considerable autonomy in professional practise
• occupies position of authority in relation to patient

Question 24

What are Mechanic’s (1968) 10 variables known to influence consulting behaviour?

Answer 24

1) Visibility of signs or symptoms
2)Severity of the symptoms
3)how they disrupt family, work and social activities
4)The frequency of the appearance of symptoms
5)the tolerance threshold of those exposed-could be dependent on background
6)the available information, knowledge and cultural assumptions of an individual
7) basic needs that lead to denial e.g. anxiety, guilt and fear may lead to an individual denying the symptoms of a disease
8) Needs competing with illness responses - may feel like their symptoms do not warrant overriding other needs that may be more pressing
9) Normalising symptoms - seeing tiredness as a symptom of working long hours rather than of disease
10) Availability of treatment resources:
physical distance, time, money, effort, stigma, social distance and feelings of humiliation, self blame e.g. smoking, concern that the doctor will form a negative judgement of them if they present with something trivial.

Very Serious Sex Fetishes Turn Into Deep Needs Notably Anal

Question 25

What are Zola’s triggers to consult (1973)?

Answer 25

1) Perceived interference with vocational/physical activity
2) Perceived interference with social/personal relations e.g. skin condition
3) Occurrence of interpersonal crisis
4) Temporising of symptomology - setting a personal deadline after which you consult
5) Sanctioning - pressure from others to consult.

Question 26

What are the 4 types of awareness contexts? Glasser and Strauss (1965)

Answer 26

Suspicious: patient/family believe e.g. they are dying but suspect staff aren’t telling them

Open: everyone knows about the imminent and openly speak about it

Closed: only healthcare team knows and patient/family doesn’t know

Mutual pretence: both know but no one is speaking about it

think its about other things than death too

Question 27

What are learning disability models?

Answer 27

1) Tragedy/charity model
Disabled people depicted as victims of circumstance, offensive, negative victim image, making disabled people the object of pity, patronising, limits choices

2) Medical Model
Aim is to make people more normal, people are disabled by their differences and should be fixed or treated even if there is no pain or illness, has been used to formulate policy

3) Social Model
Disability stems from a failure of society to adjust to meet the needs and aspirations of a disabled minority, major impact of anti-discrimination legislation, if taken to its extreme it would suggest that disability could be eradicated if society adapted, favoured by disabled people

4) Biopsychosocial model
Adapted social model, used by the ICF (WHO body), interaction of the individual’s health condition with the environment they live in. Complex, dynamic relationship between many factors e.g. coping styles, social background, education.

Question 28

What is the Disability Discrimination Act (law)?

Answer 28

DDA makes it unlawful for you to be discriminated against in employment, trade union and qualification bodies, access to goods, facilities and services, the management, buying or renting of land or property, education, regulations dealing with buses, coaches and trains.
DDA 2005 - brought in new measures creating a legal duty for public authorities to actively promote disability equality. A person’s right not to be discriminated on the grounds of disability is protected by the DDA and the HR act.

Question 29

Single Equality Act 2010

Answer 29

116 pieces of legislation under one act. 9 protected characteristics.
Age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex and sexual orientation.

Question 30

Human’s right act

Answer 30

Belong to everyone.

Question 31

What does Ley’s Cognitive Model of Compliance (1981) say?

Answer 31

Understanding and Memory feed into satisfaction. Satisfaction leads to compliance. Understanding and Memory independently lead to compliance too.

Understanding - ensure they understand their condition, leadership from the professional for treatment options

Satisfaction - having sufficient time in consultation to fully discuss relevant issues, seeing the same health professional, good accessibility to health professionals.

Memory - maximise memory for the info give, most important points given early or late in consultation

Question 32

What does Stanton’s model of Adherence say (1987)?

Answer 32

Doctor communication leads to adherence. Increased knowledge and satisfaction leads to adherence. Patient’s belief’s, locus of control, social support, extent of disruption affects adherence. Doctor communication can lead to increased knowledge leading to adherence.

Predictors of adherence:
knowledge of medical regime, satisfaction with provider, perceived social support, extent of lifestyle disruption, internal vs external locus of control

Common reasons of non-adherence

Perceived barriers, susceptibility, benefits and consequences.