Flashcards in Revision Session + Sample Questions Deck (49):
What are the three main types of knowledge production and the assumptions underlying each?
Positivism - natural history, range & biographical aspects
Critical realism - the real World exists ‘out there’ independent of our experience
Interpretivism - capture & understand meaning of a social action for agent performing it
What does ontology mean?
Ontology concerns our assumptions about the nature of reality.
What does epistemology mean?
Epistemology means theory of knowledge, or how it is we can know anything about the world.
What are the advantages of the scientific method? (4)
- Tightly controlled independent variable allow comparison of effect on dependent variable
- Randomised controlled trial gold standard of medical interventions
- Replicable, reliable, objective
- Evidence based medicine (anecdotal evidence can be proved wrong and turn out to be harmful)
What is the main disadvantage of the scientific method?
- Does not and cannot accommodate inconsistencies, confounding and outliers
Describe the two main ontological positions with their assumptions.
Objectivism/Realism - the social world is objective, out there, independent of us who perceive it
Subjectivism/Idealism/Constructionism - the social world is constructed by us - constructions are built up from the perceptions and actions of social actors.
Describe positivism and interpretivism (positions of epistemology) and the difference between the two.
Relate these two approaches to two different applications in the health field.
Positivism - the application of empiricist natural science to the study of society. Reality is unitary and can only be understood through the scientific approach. Research is conducted in a value-free way: the researcher is independent of the data and detached (doesn't influenced or is not influenced by the research).
Interpretivism - people and institutions are different from material objects and 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 motives, actions and intentions in a meaningful way.
Why is adherence important and what is it?
Adherence is the extent to which a patient’s behaviour, with respect to taking medication, corresponds with agreed recommendations from a healthcare provider. It has three components - persistence, initiation adherence and execution adherence.
Poor adherence to treatment of chronic diseases is a worldwide problem. The consequences of poor adherence to long-term therapies are poor health outcomes and increased health care costs. It compromises the effectiveness of treatment.
What is the average rate of adherence according to the WHO?
Adherence to long-term therapy for chronic illnesses in developed countries averages 50%. In developing countries, the rates are even lower.
Describe three practical/moral steps that should be taken to improve adherence.
- Doctor embark on an iterative reasoning process with the patient (patient centred medicine)
- Acknowledge and engage patient as a moral agent
- Acknowledge patients are embedded in social relationships and that they are accountable to and responsible for others (context of family, community and livelihood)
- Acknowledge intersubjectivity and relational aspects of autonomy and choice
Understand the different points of view in relation to patients paying for their own healthcare or being denied treatment due to their lifestyle behaviours.
CCG’s rationing services due to funding deficit, which has led to the question of should obese patients be refused routine operations across the NHS?
Yes - it will help the NHS save money
No - the NHS is meant to be for everyone. Denying these patients means not adhering to clinical guidelines.
What is meant by sociological perspectives?
This links the individual and the social and explore the relationship between two levels of attribution of responsibility. It applies frameworks to explain varied responses of individuals.
Name two different types of sociological perspectives and the assumptions underlying them.
Social constructionist - shared understanding or construct of death & dying formed through values, norms, social practices & contingencies. Social determinants of mortality To what extent are our beliefs about health largely social constructions? To what extent are our lives driven by our need to deny the uncertainty inherent in life?
Phenomenological existentialist - meaning & significance of individual embodied experiences
Anthropological cultural - cultural thoughts systems integrate their ideas about mortality into their language, religions, values, rituals – cultural death systems.
Biomedical - biological reality, dying trajectories, palliative care, advanced directives, death certification. Population statistics on mortality & morbidity.
This means the social norms, tendencies, habits, resources that are taken for granted and so guide behaviour, i.e. structured determining ways to think/feel/act that become internalised and are seen as part of character.
Explain the term ‘biopower’ in relation to health.
The technologies, knowledges, discourses, politics and practices used to bring about the production and management of a state’s human resources.
Biopower analyses, regulates, controls, explains and defines the human subject, its body and behaviour.
Describe what is meant by ‘medicine as a social ideology’.
Not a body of scientific and neutral truths about the nature of existence. It presents an image of health that fits with the culture of industrial capitalist societies. A new morality/ethics of individualism.
Describe what is meant by the term ‘cultural norms’.
The term 'culture' refers to attitudes and patterns of behaviour in a given group. 'Norm' refers to attitudes and behaviours that are considered normal, typical or average within that group.
Describe three different binaries and how these relate to medical practice.
Patient and doctor
Objectivism and subjectivism
Positivism and interpretivism
Suicide rates are highest in which of the groups below...?
Men aged 35-49
If a doctor finds out that a patient is experiencing domestic violence which of the following should they do..?
Suggest referral for domestic violence advocacy and treat symptoms
Self-management in the context of chronic illness refers to...?
Health professionals supporting people to self-care
What describes the social model of disability?
Disabling environments prevent people from participating in social activities such as work
The bottom 50% of households own approximately how much of the UK’s wealth?
Which of the items below is a key finding of the Whitehall II study?
Social position affects health outcomes
What is a ‘social’ risk factor for diabetes?
Which disease is the single biggest cause of severe physical disability in the UK?
In order to obtain valid consent for a biomedical intervention the doctor must...
Offer the patient adequate information
What best describes ‘temporalising’ as a trigger to seeking medical help (according to Zola)?
Setting a personal deadline
Which one of the following is not recognized as a level of society?
The global village
The nation state
What are social norms?
Rules and expectations about interaction that regulate social life
In idealized views of science, the experimental method is said to involve...
Isolating and measuring the effect of one variable upon another
Define the social determinants of health.
These are the complex, integrated and overlapping social structures and economic systems – such as social environment, physical environment, health services, and structural and societal factors - that are responsible for health inequities. They are shaped by the distribution of wealth, power and resources throughout local communities, nations, and the world.
Describe what is meant by health inequities.
The unfair, unjust and avoidable causes of ill-health.
Define the health inequity loop.
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Define the Inverse Care Law.
Health care resources tend to be distributed in inverse proportion to need – those who need healthcare the most get less, whilst those who have the least need get most of the resources.
Provide three reasons why knowing and understanding the social determinants of health is important for doctors.
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Provide the names of three policy documents relating to the social determinants of health
Black report 1982 – “spending an ever increasing amount of GDP on health services whilst not being able to demonstrate that the higher spending is related to better health”
Acheson Report 1998 Independent Inquiry into inequalities in health DOH
WHO 2008 Closing the gap in a generation: health equity through action on the social determinants of health.
Name the three most deprived areas in England.
Tendring district, north east Lincolnshire, blackpool -
Hackney, Newham & Tower Hamlets - London
What is the child poverty rate in Tower Hamlets as compared with the London average?
49% compared to 37% for London average
Name three policy documents related to health and wellbeing in Tower Hamlets.
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How does the Black Report 1980 use class descriptors?
Social classes are segments of the population sharing broadly similar types and levels of resources, with broadly similar styles of living and some shared perception of their collective condition.
I. Professional (eg accountant, doctor, lawyer)
II. Intermediate (eg manager, schoolteacher, nurse)
IIIn. Skilled non-manual (eg clerical worker, secretary, shop assistant)
IIlm. Skilled manual (eg bus driver, butcher, coal face worker, carpenter)
IT. Partly skilled (eg agricultural worker, bus conductor, postman)
V. Unskilled (eg laborer, cleaner, dock worker)
What is the difference between absolute poverty and relative poverty?
Relative poverty – a standard which is defined in terms of the society in which an individual lives, so it differs between countries and over time. An income-related example would be living on less than X% of average UK income.
Absolute poverty - a set standard which is the same in all countries and which does not change over time. An income-related example would be living on less than $X per day.
What is childhood poverty?
Childhood poverty - UK in 2010 the Labour Government defined a child as being poor when it lives in a household with an income below 60% of the UK's average (£272 a week before housing costs).
Describe the meaning of social exclusion.
Social exclusion - relating to the alienation or disenfranchisement of certain people within society, i.e. in poverty where people lack many of the opportunities that are available to the average citizen. Unless the poorest can keep up with growth in average incomes, they will become more excluded from the opportunities that the rest of society enjoys. This reduces overall social cohesion in our society.
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Describe how the sociological term ‘field’ relates to subjectivity.
Relationships between people and their experiences, and the location which they occupy, are composed of various social and cultural fields.
A field is the landscape that gets used in a particular way.
Each field has its own rules & regulations, procedures, assign roles & positions, regulates behaviours, & what can be said, and produces hierarchies.
Identity or subjectivity is shaped by operations in that field.
What is a discourse?
Type of language associated with an institution
What is the Life course perspective?
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