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Health Psychology

by: Newton Cormier

Health Psychology PSY 320

Newton Cormier
GPA 3.88

Zaje Harrell

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Zaje Harrell
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This 22 page Class Notes was uploaded by Newton Cormier on Saturday September 19, 2015. The Class Notes belongs to PSY 320 at Michigan State University taught by Zaje Harrell in Fall. Since its upload, it has received 56 views. For similar materials see /class/207546/psy-320-michigan-state-university in Psychlogy at Michigan State University.


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Date Created: 09/19/15
Health Psychology 320 Exam Review 2 Material Covered All fair game for exam Questions Chapters 3 4 5 readings films Super SizeMe Food lnc PBS Newshour Harrell Z A T Slane J amp Klump K 2009 Predictors of alcohol problems in college women The role of depressive symptoms disordered eating and family history of alcoholism Addictive Behaviors 34 252257 Prochaska J O DiCIemente C C amp Norcross J C 1992 In search of how people change Applications to addictive behaviors American Psychologist 47 1102 1114 Seo D C Torabi M R amp Weaver A E 2008 Factors influencing openness to future smoking among nonsmoking adolescents Journal of School Health 78 328336 Weschler H Nelson T F Lee J E Seibring M Lewis C amp Keeling R P 2003 Perception and reality A national evaluation of social norms marketing and interventions to reduce college students heavy alcohol use Journal of Studies on Alcohol 64 484494 Wilkinson R amp Pickett K 2009 Obesity wider income gaps wider waists pp 89 102 In The Spirit Level New York NY Bloomsbury Press All Lecture Topics and Research Examples Chapter 3 Outline the individual and collective implications of health behaviors 0 Health Promotion Good physical health and overall wellness are personal and collective achievements 0 Personal The individual develops and maintains good health habit o Collective health professionals educate individuals and communities about how to maintain healthy lifestyles 0 effective health policy enforces health promotion 0 ex making public places nonsmoking Health professionals educate individuals and communities about how to maintain healthy lifestyles 0 Effective health policy enforces health promotion 0 Define health habits o Firmly established health related behaviors that are often performed automatically ie wearing a seat belt regular exercise sleeping behaviors Define the transtheoretical model of behavior change and the related stages and outline the critiques of this model a Transtheoretical model a model that analyzes the stages and processes people go through in attempting to bring about a change in behavior and suggested treatment goals and interventions for each stage 0 Precontemplation occurs when person has no intention of changing hisher behavior Contemplation person is aware that a problem exists and are thinking about it but have not yet made a commitment to take action Preparation person intends to change their behavior but may not yet have begun to do so Action when an individual modifies their behavior to overcome the problem Maintenance when the person works to prevent relapse and to consolidate the gains they have made Some critics say there is little evidence to this model with no strong conclusions and that the stages are not well de ned 0 O O 0 Describe selfdetermination theory a The theory that autonomous motivation and perceived competence are fundamental to behavior change 0 People are autonomously motivated if they experience free will and choice when acting 0 Change is more likely to happen for something personally important competence is similar to selfefficacy Review approaches to attitude change I Educational appeals people will change their habits if they have correct information 0 Fear appeals assumes that if people are fearful that a particular habit is hurting their health they will change their behavior to reduce their fear 0 Message framing messages that emphasize potential problems seem to work better for behaviors that have uncertain outcomes or for health behaviors that need to be practiced only once Can be phrased as positive or negative 0 promotionoriented messages are more successful in getting people to initiate change prevention focus may be more helpful in getting them to maintain change over time attitude change campaigns may induce the desire to change but may not be successful in teaching people exactly how to do so 0 Approaches communications should be colorful and vivid communicator should be expert trustworthy likeable to audience strong arguments at the beginning and end messages should be short clear direct messages should state conclusions explicitly extreme messages produce more attitude change but only to a point o if audience is receptive to changing a health habit should include only favorable points Define classical and operant conditioning Review cognitive behavioral approaches to behavior change I Classical conditioning the pairing of an unconditioned reflex with a new stimulus producing a conditioned reflex eg Pavlov s Dog I Operant conditioning the pairing of a voluntary behavior with systematic consequences 0 Positive reinforcement behavior more likely to occur again 0 Negative reinforcement behavior is less likely to occur again Cognitive behavior strategiesfocus on beliefs people have about their health 0 Social skills training 0 Motivational interviewing 0 Relaxation training 0 BroadSpectrum CognitiveBehavior Therapy this approach changes the focus to the target behavior itself the conditions that elicit and maintain it and the factors that reinforce it lower arousal by changing through process Review in detail the sections on social skills training relapse and motivational interviewing 0 Social skills 0 Some poor health habits develop in response to or are maintained by the anxiety people experience in social situations ex smoking drinking overeating 0 Social skills training or assertiveness training individuals are trained in methods that will help them deal more effectively with social anxiety 0 Goals reduce anxiety introduce new skills for dealing with situations that arouse anxiety and provide alternative behavior for the poor health habits o Relapse 0 One of the biggest problems faced in health habit modification occurs both with those who make changes on their own and with those who join formal programs 0 Particular problem with addictive disorders of alcoholism smoking drug addiction and obesity 0 Reasons for relapse Genetics addictive behaviors low self efficacy low social support 0 Consequences of relapse produce negative emotions such as disappointment frustration unhappiness or anger reduced sense of selfefficacy could lead people to feel that they can never control the habit 0 Reducing relapse I Relapse prevention Motivational interviewing 0 Originally developed to treat addiction the techniques have been adapted to target smoking dietary improvements exercise cancer screening and sexual behavior among other habits o The interviewer is non judgemental non confrontational encouraging and supportive 0 Goal to help the client express whatever positive or negative thoughts heshe has regarding the behavior in an atmosphere that is free of negative evaluation What factors motivate and reinforce bad choices 0 People are more likely to have bad health habits if the habit feels good if peers are doing it or if the person doesn t think they can change and has low self efficacy 0 Factor motivating bad choices stress genetics social contexts SE8 workplace lifestyle time management Outline and compare and contrast the theory of planned behavior and the health belief model a Theory of planned behavior health behavior that is the direct result of a behavioral intention o behavioral intentions made up of I 1 attitudes toward the specific action I 2 subjective norms I 3 perceived behavioral control 0 attitudes toward the action are based on beliefs about the likely outcomes of the action and evaluations of those outcomes 0 Health belief model whether a person practices a particular health behavior depending on perception of a personal health threat and whetherthey believe that a particular health practice will be effective in reducing that threat What are some of the venues for behavior change Private therapist office Health practitioner39s office Family Managed care facilities Selfhelp groups Schools Workplace interventions Community based interventions Mass media TelephoneInternet Chapter 4 Physical Activity What individual characteristics are associated with adherence to exercise regimens 0 Self ef cacy Gender boys get more exercise than girls family setting attitude towards exercise weight and value of health 0 Cycle of weight loss and weight gain 0 Convenient and accessible activities 0 Appropriate level of difficulty Longer compliance longer exercise habits 1 Gender 2 Exposure to exercise in families 3 Attitudes towards exercise 4 Value health 5 Weight 6 Self Efficacy individualized programs may increase adherence fit with stage of change for the individual OOOOOOOOOO What characteristics of the setting are associated with adherence to exercise regimens 0 Convenience of exercise appropriate level of exercise and longer compliance lead to regular exercise Necessary Resources Environmental options available outdoors activities are effective Neighborhood perceived as safe Not socially isolated in their surroundings 0000 What characteristics of the intervention are associated with adherence to exercise regimens 0 Social support incentives competition sports lT l quot have the lol owm 5 lage oi tea rune3 oquot the wise or CCl39xl39lol 000000 How has the Internet been used to promote physical activity Review Napolitano et al example from lecture Purpose of the study was to see how the Internet can be used as a tool to promote physical activity Examined the impact of the intervention at 1 and 3 months They found signi cant differences in Physical Activity between control and intervention group at 1 month assessment At 3 month assessment there was no difference between groups in overall PA Short term benefits couldn t maintain long term What is the evidence of disparities between physical activity resources by socioeconomic class Review Estabrooks et al example from lecture Individuals in low and middle SES neighborhoods may have limited access to resources for physical activity community based research and intervention should take into account these structural barriers related to physical activity Healthy Diet Overweight and Obesity Explain the specific health risks associated with a poor diet 0 A poor diet can contribute to diseases like diabetes heart disease cancer How does healthyplategov differ from previous government recommendations concerning diet The food recommendation is not set up like a pyramid anymore Dairy is recommended as milk low fat More vegetables and fruits are recommended with less grains and no sweets but oils instead 0 Define the obesogenic environment and the toxic environment 0 The Obesogenic environment is composed of factors that support being obese promotes gaining weight and not conducive to weight loss Toxic environmentsthe physical and social environments that influence poor dietare detrimental to health as they do not provide food that is nutrientrich or with vitamins that are essential for the body to grow develop and maintain Therefore people exposed to these environments are likely to consume unhealthy foods that lead to fatigue weight gain possible obesity and diseases like diabetes affecting the longevity and quality of life a person leads Also sedimentaw lives is a factor in toxic environments that serves as a foundation for other unhealthy habits What challenges are associated with efforts to modify diet Tastes are difficult to alter Dietary changes may affect mood and personality Accessibility to healthy food and physical activity Personal motivation vanity rather than health stress levels 0 Low self efficacy Preference for meat Lack of health consciousness Limited interest in food exploration Job status 0000 O 0000 What evidence is there that genes and environment interact in obesity outcomes 0 Genetic factors have been linked to obesity as shown by twin studies Twins raised apart still grew to be very similar in weight 0 Environment also has an effect as a person s taste is developed by what food they grew up eating and what their family eats What are the aspects of interventions focused on healthy diet Be specific with respect to those intervention targeted towards individuals families and communities 0 Individually people need to start by selfmonitoring Also social support and cognitive training and relapse prevention techniques are very useful 0 For family it is easierto change eating habits if everyone is willing Families that have dinner together can have health bene ts and family counseling helps for interventions too Community interventions can help with nutritional education campaigns by advertising in grocery stores and online 0 How is overweight and obesity determined Why is excess weight is a health risk 0 The Body Mass Index BMI is used to calculate whether a person is normal ovenNeight or obese o Overweight increased body weight in relation to height when compared to some standard of acceptable or desirable weight 0 Obesity an excessively high amount of body fat or adipose tissue in relation to lean body mass 0 Excess weight acts as an endocrine organ 0 Ieptinmakes the person feel hungrier released by fat cells 0 Excess weight can also lead to other diseases like cancer heart disease diabetes and a higher mortality rate What factors are related to individual differences in weight 0 1 genetic susceptibility o 2 increasing availability of high fat high energy bonds 0 3 low levels of physical activity 0 The number and size of fat cells an individual has 0 Number is determined in first few years of life by what what you are fed 0 size is determined by eating habits later on Outline types of treatment for obesity and the effectiveness of these treatments 0 Surgery normally works well for very obese people insurance may not cover it 0 Cognitive behaviortherapy screening self monitoring controlled eating adding exercise controlling self talk stress management social support and relapse prevention Works well if relapse prevention is incorporated Dieting works well only if it is a lifestyle change Yoyo dieting is bad Drugs to suppress appetite not good for long amounts of time O 0 Outline biological psychological and social factors that contribute to the obesity epidemic 0 Biological Genetics number and size of fat cells 0 Psychological Low ef cacy and high stress Also being ovenNeight can cause even more psychological stress bullying etc 0 Social Easy access to cheap foods that are unhealthy which also often taste good Lifestyle is also a factor since many people eat while watching TV How does the way that food is produced and marketed affect individual behaviors o The food industry spends 33 billion a year on advertising which many people see including children 0 Portion sizes have increased and healthy foods are not often available in fast food restaurants According to the film Food Inc which tastes are humans hard wired to find appealing 0 salt sugar and fat What public health approaches have been employed to address the obesity epidemic 0 Children can learn new habits easier so training parents to feed their kids healthy food has been employed There have been interventions to reduce the amount of TV watching during meals There has also been criticism of the food industry for their commercials which often target children Workplace weightloss interventions Commercial weight loss programs 0 0 What are examples of the global obesity epidemic o Obesity is higher in many of the developed countries 0 Fat china Accident Prevention Describe the role of motorcycle and automobile accidents as a major cause of death and describe the effectiveness of strategies designed to increase seat belt usage and safetyrelated behavior 0 Safety measures like reducing speed and requiring seatbelts have reduced the number of fatalities For motorcyclists wearing helmets and re ective gear has helped There are laws with penalties if these are not followed seatbelt laws Also community education programs to increase awareness O 0 car and motorcycle accidents are single greatest cause of accidental death 0 safety measures reduce mortality 0 wearing seat belts highway speeds of 55mph motorcycle helmets Eating Disorders Based on the chapter define anorexia nervosa and outline the underlying etiological factors o Anorexia Nenosa an obsessive disorder amounting to selfstarvation where the individual diets to a point where their body weight is grossly below a good level which threatens their health 0 Genetic factors serotonin dopamine estrogenhypothalamic abnormalities 0 Environmental risks early exposure to stress 0 Depression problems coping with stress personality characteristics psychopathy and alcoholism in the family 0 both anorexia and bulimia hypothalamic abnormalities hyperactive HPA axis Based on the chapter define bulimia nervosa outline the underlying etiological factors 0 Bulimia Nervosa is characterized by alternating cycles of binge eating and purging 0 Person may have issues with control May have an altered HPA axis elevated cortisol or genetic basis 0 preoccupation with dietingDepression psychopathy difficulties working in social settings 0 Alcohol or drug abuse 0 bingeing may be triggered by negative emotions produced by stressful experiences Chapter 5 Health Compromising Behaviors Describe the characteristics of healthcompromising behaviors there is a window of vulnerability in adolescence drinkingobesity smoking drugs began at early age peer culture wanting to fit in be attractive self presentation process effort to appear sophisticated cool tough sawy many of these behaviors are pleasurable development of these behaviors occurs gradually substance abuse of all kinds can be predicted by some of the same factors problem behaviors are related to the larger social structure in which they occur low social classes tend to be more stressful Define physical dependence tolerance craving withdrawal and addiction 0 Tolerance is the process by which body increasingly adapts to the use of a substance requiring larger and larger doses of it to obtain the same effects reaching a plateau o Craving is a strong desire to engage in a behavior or consume a substance o Addiction occurs when a person has become physically or psychologically dependent on a substance following repeated use Withdrawal refers to the unpleasant symptoms both physical and psychological that people experience when they stop using a substance they are dependent on Physical dependencewhen the body has adjusted to the substance and incorporates the use ofthat substance into the normal functioning of the body s tissues 0 0 Alcohol Use Describe the prevalence of alcohol use in the United States Outline and differences in alcohol use patterns by race and gender more than 20 of americans drink at levels that exceed the government recommendations 1 in 2 americans will be in an alcohol related accident in their lifetime alcohol is 3rd leading cause of preventable death alcohol use is linked to high blood pressure stroke cirrhosis of liver cancer fetal alcohol syndrome retardation sleep disorders many americans meet criteria for alcohol abuse and dependence Distinguish between alcoholism and problem drinking Describe some of the prevalence of alcohol use and the social psychological costs of alcohol abuse Alcoholism o physically addicted to alcohol 0 show withdrawal symptoms when stop drinking have high tolerance little ability to control drinking Problem Drinking 0 may not have same symptoms as alcoholism but have substantial social psychological and medical costs from alcohol No physical addiction Both are defined by specific patterns 0 need for daily use of alcohol can t cut down on drinking binge drinking 0 physiological dependence can be manifested in stereotypical drinking patterns drinking that maintains blood alcohol at certain level can function at level that normal drinkers can t increased severity and frequency of withdrawal Learn early in life to associate drinking with pleasant social occasions may develop a social life centered around drinking What are some of the underlying causes related to the development of alcoholism and problem drinking 0 genetic factors 0 modeling a parent s drinking 0 men have been traditionally at a higher risk for alcoholism than women 0 low income can predict alcoholism o a gradual process involving physiological behavioral and sociocultural factors affect alcoholism 0 drink to buffer impacts of stress Summarize treatment approaches for alcoholism and problem drinking identifying key components of these programs 1 Intensive inpatient treatments which involve patients going through detoxification for 1060 days followed by outpatient treatment 2 Cognitive Behavioral Therapy which tries to decrease reinforcing properties of alcohol and modify environment to include activities that do not involve alcohol 3 SelfHelp groups such as AA 4 Providing people suffering from alcoholism with drugs such as natrexone and acamprosate which helps modify neurotransmitters What efforts are made to prevent alcohol abuse Which populations are targeted 1 Social influence programs attempt to steer adolescents away from using alcohol as well as teaching them drinkrefusal techniques Primarily geared toward middle school students 2 Increased taxes on alcohol 3 Restricting advertising and promotion of alcohol 4 Removing misleading claims about alcohol 5 Increasing government focus on alcohol as a major youth problem How does relapse relate to the process of addiction treatment and recovery It often takes many times for a person to actually quit drinking and not relapse There are normally several cycles of relapse and recovery Alcoholics need to understand that this is normal and not give up They need to practice coping skills Describe the prevalence of binge drinking among college students Use examples from your text and lecture o 45 of college students have been involved in occasional binge drinking a If you are a college student who drinks odds are 710 that you have engaged in binge drinking College women are beginning to drink as heavily as men among college men consumption highest in small same sex groups among college women consumption is highest in large mixed sex groups there has been large scale public health effort to decrease heavy binge drinking in college students How have social marketing campaigns influenced alcohol use on college campuses 0 Have made little difference on large college campuses more effective on smaller campuses where student population is smaller and students are more familiar with each other What are some of the health benefits associated with moderate alcohol consumption 1 Moderate alcohol consumption may increase lifespan 2 Reduces risk of coronary heart disease reduced risk of heart attack lower risk of dying after a heart attack and decreased risk of heart failure less thickening of arteries 3 Lowers blood pressure 4 Increase of lipoprotein good cholesterol 5 Fewer strokes How do family factors influence the relationship between eating disorders and alcohol problems A person is more likely to have an eating disorder if they have a family history of alcoholism How does coping relate to alcohol use Reviewthe protective aspects of coping in the context of drinking described in lecture When people are stressed or depressed they tend to relax by drinking alcohol which can lead to an addiction Religiousness and spirituality seem to reduce the chance of a person drinking The protective mechanisms are not well understood 0 Drinking to celebrate a positive occasion is okay 0 Drinking to cope with a negative feeling is bad Smoking Describe the prevalence and health costs of smoking in the United States 0 smoking remains a critical public health issue 0 single most preventable cause of death 0 15 deaths in the US 0 20 of people smoke o 30 of all cancer deaths decline in smoking among women has lagged behind men men and women with no post secondary education and lower SES are more likely to smoke o smokers have more accidents and injuries at work take off more sick time and use more health benefits than nonsmokers What are the synergistic effects of smoking 0 smoking enhances the impact of other risk factors in compromising health 0 the blood of smokers coagulates more easily than that of non smokers o nicotine increases reactivity of stress Nicotine Paradox o smokers engage in less physical activity as long as they continue smoking Describe the physiological psychological and social factors that determine smoking in adolescents and adults 0 It runs in families with genes and spreads through social ties Starts with experimentation and leads to more smoking If someone s parents smoke they are more likely to sta1t An increase in stress and depression can lead to smoking Outline how social learning relates to smoking 0 Often people smoke when their friends smoke or at parties since others are doing it Self identity and self image if they are closer to that of a smoker the person is more likely to be a smoker Describe gender differences in smoking cessation patterns 0 Women are less likely to quit 0 Men are more successful at quitting cold turkey 0 Women are more likely to report that they smoke to regulate negative affect and depressed mood 0 Women report a greater concern with weight gain which is a barrier to smoking cessation How does smoking prevalence differ based on socioeconomic status 0 men and women with no post secondary education and lower SES are more likely to smoke What are the aspects of smoking that appeal to youth 0 makes them seem rebellious and independent Explain the use of social influence interventions in smoking cessation and prevention and evaluate their effectiveness Modeling people observe models who are enjoying risky behavior fears of negative consequences are reduced Behavioral Inoculation Can reduce smoking rates for as long as 4 years but experimental smoking may be more affected than regular smokers Social support can help a person stop smoking and imagining themselves as a non smoker can help Teaching smokers how to relax Without smoking is good Describe the use of social engineering strategies in smoking cessation and prevention and evaluate their effectiveness Health Psychology 320 Exam Review 3 Material Covered Chapters 8 9 10 film and news clips Chapter 8 Define the social and psychological factors that influence the recognition and interpretation of symptoms neuroticism pervasive negative way of viewing the world marked by negative emotions selfconsciousness and a concern with bodily processes people with this recognize their symptoms quickly and report their symptoms quickly They often erroneously believe they have serious diseases hypochondriacs only 45 population but use medical care extensively situational factorsBoring situations make people more aware of symptoms Medical Students disease is when they study each illness students feel like they have it individual differences whether the person monitors environment for threatrelevant information monitor more likely to visit a provider w fewer symptoms vs blunter people who ignore threatrelevant info people who are more focused on themselves vs being externally focusedmore distracted influence experience of symptoms stress and mood higher stress or bad mood makes a person more likely to feel like they have an illness box 81 study women experience symptoms differently if they interpret them as pre menstrual look below Premenstrual symptoms 0 women experience before amp during menstrual cycle 0 PMS syndrome PMT tension PMDD dysphoric disorder mood changes most severe women close to menstrual cycle interpret vague discomfort as premenstrual symptoms are ignored at different times in the menstrual cycle There may be an exaggeration of symptoms which are natural body fluctuations Review cultural differences in the recognition of symptoms study examined acute heart attack symptoms in a multiethnic sample of lay individuals Gender of character in the prompt was manipulated telephone surveys were conducted in english cantonese mandarin and punjabi gt found Chinese were less likely to Identify symptoms as heart related and least likely to make recommendation to seek emergency care No effects for gender book Anglos vs Mexicans Anglos reported symptoms that were new while Mexicans reported symptoms that occurred frequently Define illness representations and illness schema and explain how they influence the interpretation of symptoms 0 lllness RepresentationsHow people organize their implicit commonsense beliefs about their symptoms and illnesses 0 They can influence people s preventative health behaviors their reactions when they experience symptoms or are diagnosed their adherence and their expectations for future health 0 They are acquired through the media personal experience orfrom family and friends who have experienced the same symptoms 0 Commonsense modelsquot include the identity the causes the consequences time line controlcure and coherence 0 most people have at least 3 models of illness 0 acute illness believed to be caused by specific viral or bacterial agent and is short durationflu chronic illnesscaused by multiple factors including health habits and is long in duration often with severe consequencesheart disease 0 cyclic illness marked by alternating periods during which there are either no symptoms or many symptomsherpes Define the lay referral network and describe its function 0 Lay referral network an informal network of family and friends that offer interpretations of symptoms 0 May be cultural specific 0 important with limited resources 0 may recommend home remedies or incorporate superstitious beliefsquot The Internet is also a lay referral network 1 in 3 American adults may use unconventional therapy or complementary medicine chiropractic massage etc in the course of a year 0 0 Most out of pocket 0 o Often go to unconventional therapy when are not happy with the conventional poor communicationresultsetc Identify demographic and cultural factors related to the utilization of health services 0 very young and old use health services most frequently 0 both illness frequency and use of services declines in adolescence and young adulthood 0 women more than men and pregnancychildbirth does not completely account for difference possible explanations o 1 better homeostatic mechanisms women more sensitive to bodily disruptions o 2 social norms men expected to be toughmacho o 3 economic factors women often parttime workdon t work so lose less income if sick 0 and women may be at an economic disadvantage which can cause poorer hea h o 4 women s medical care more fragmented often visit several Dr s for basic needs 0 lower social classes use medical services less gap has narrowed somewhat with medicare and medicaid 0 biggest gap is in preventable health services contributes to poorer health through life 0 cost is a factor and limited availability of services for the poor 0 sick more often die earlier 0 social psychological factors perceived threat and belief that health measure will be effective in lowering the threat social interference How and why do people misuse health services 0 Abusing health services occurs when people seek out health services for problems that are not medically significant 0 stress and emotional responses to it can create a number of physical symptoms 0 Worried well people concerned about physical and mental health that are inclined to perceive minor symptoms as serious they use 1 health services more than others outside group amp 2 overuse service 0 Somaticizers 0 individuals that express distress and conflict through bodily symptoms I ex convert anxiety into physical symptoms 0 esp likely to somaticize when have experienced a threat to selfesteem o hypochondriasis may be an interpersonal disorder associated with insecure attachment that gives rise to seeking care from others 0 Medical disorders are perceived as more legitimate than psychological ones 0 illness brings secondary gains reinforce not returning to good health ex time off work attentioncare from others 0 delay behavior contributes to high rate of death and disability from heart attacks 0 delay time between when person recognizes symptoms and when person seeks treatment 0 Appraisal Delay the time it takes a person to decide that a symptom is senous o Illness Delay the time between the recognition that a symptom implies an illness and the decision to seek treatment 0 Behavioral Delay the time between actually deciding to seek treatment and actually doing so 0 Medical Delay Scheduling and Treatment the time between making an appointment and receiving appropriate care 0 People delay because of the expense of the treatment fear of the doctor bad mood they think the treatments will be painful and the nature or severity of the symptoms How does the use of medical care vary based on access to resources 0 Less highquality medical services available to poor many poor people only receive medical care in the ER Biggest gap between richpoor seen in preventative care 0 Less likely to use health care if they are busy Chapter 9 Define patient empowerment What are specific examples of patient empowerment 0 Patient Empowerment Changing the relationship of individuals healthcare providers and the health care system 0 patients are consumers more critical skeptical want to shop aroundquot 0 Individual Change 0 Be educated about treatment options Connect to a network of receptive health providers Collaborate regarding new treatment possibilities and options Get a second opinion quot a to and 39 39 a 39 a 39with a mutually respectful community Full participation in decisions that affect one s life Focus on the strengths of an individual in recovery and wellness rather than pathology a structural change 0 evaluations on howthe visit went 0 Shape the HIVAIDS research agenda 0 Address stigma 0 Be vocal and engage in civil disobedience to call attention to the epidemic raise awareness and effect change mobs marches protests and public acts 393 O O O O O 0 What criteria do patientconsumers use to judge the adequacy of their medical care 0 often judge technical quality on basis of manner in which care is delivered In reality the technical quality of care and the manner in which care is delivered are unrelated 0 provider who is warm confident and friendly is perceived to be both nice and competent o satisfaction declines when physicians express uncertainty about a condition 0 This can occur when a patient is referred to many specialists How does the medical setting influence the quality of patientprovider communication 0 Medical offices do not promote effective communication since the visits are short and the waiting times are long a Doctors are often interrupted by nurses etc a Patient is in discomfortpain Describe how patient and provider behaviors influence communication in the medical setting Important symptoms may be overlooked if patient does not tell doctor because they don t feel they are important Patients that write down questions before the appt or receive a message from the physician that they can ask questions have more satisfaction Patient may not know their doctor well so it is almost like talking to a stranger patients sometimes mislead Drs when explaining their symptoms neurotic patients often present an exaggerated picture of their symptoms and makes it hard for physicians to gauge accurately patients place emphasis on different symptomscues about their illness than the physician does nonverbal communication can affect perceptions of provider Describe the characteristics of private care feeforservice care and health maintenance organizations Private feeforservice care is when patients would go to the doctor and then get a bill which they paid out of pocket and the doctors did not have to deal with insurance because they were paid right away HMO s are basically insurance companies that handle medical billing pay a monthly rate and use health services at reduced or no additional cost It is also called managed care What are some barriers to effective care in medical settings Colleague orientation when doctors want referrals from colleagues because that is what makes them more money They may not care as much whether the patient is satisfied or not because that does not directly affect their income as much HMO people feel passed along not able to make relationships with provider Faulty Communication A of patients cannot repeat their diagnosis within minutes of discussing it Neurotic patients exaggerate symptoms Anxiety impairs retention of information Embarrassment may lead patients to give faulty cues about their history and practices 40 of patients over 50 years of age have difficulty understanding prescription information 0000 0 What are forms of faulty communication lnattentiveness when physicians don t pay attention to the patient enough or interrupt it prevents patients from expressing other concerns Also physicians are often interrupted by nurses and others Use of Jargon when physicians use words patients cannot understand it frustrates and confuses the patient Baby Talk doctors may resort to simplistic explanations if they underestimate what their patients will understand This can make patients feel helpless and can stop questions Nonperson treatment depersonalization of patient may be employed when a person is very stressed out to keep them quiet so they do not mess up the doctor However it may confuse the patient Stereotypes of patients negative stereotypes may contribute to poor communication and less treatment Doctors may give less information be less supportive and demonstrate less proficient clinical performance with Blacks or Hispanics Many doctors have negative opinions of the elderly Describe the hospital setting and describe the interventions targeted towards specific groups ie children Setting Administration at the top with doctors and nurses and technicians as employees Interventions to increase medication and treatment compliance Children showing modeling videos parental preparation and support relaxation training coping techniques making hospitals less frightening places Opportunities for play and contact with a caregiver Explaining procedures is key both preparationexplanation and distraction from the procedure at hand have their place Define adherence Identify causes of nonadherence to treatment regimens Adherence following treatment regimens in the context of health behaviors Nonadherence can be brought on by bad communication a non friendly doctor 0 Long treatment regimens that require many doses are less likely to be adhered to Complex directions Interfere with other desirable behaviors in a person s life Creative nonadherence involves modifying and supplementing a prescribed treatment regimen when patients change the dosage levels What types of interventions are targeted at reducing patient nonadherence Health care institution interventions o postcard reminders of appointments 0 reducing the time before an appointment Treatment presentation interventions 0 write down the regimen 0 test the patient for understanding Skills training training providers how to communicate nonverbal communication keeping prescriptions simple reminder containers call patient emphasize adherence involve family instruct use short words and sentences repeat things be friendly don t use medical jargon and spend time conversing Identifying barriers Good communication fosters adherence satisfaction with provider predicts adherence patient needs to actively make decision to be adherent Making adult literacy a priority How do models of behavior change ie theory of planned behavior relate to adherence How do individual difference dimensions and intelligence relate to adherence Patients may believe they need to supplement their treatment because they think that the doctor may not have understood Lower intelligence has a lower rate of adherence because the patient may not understand Some people ask more questions and are more outgoing so they may get better results if they don t understand something and ask about it Theory of planned behavior attitudes subjective norms perceived behavioral control gt intentions gt actions 0 perceived control over behavior is more important than motivation How does literacy relate to patient adherence over A of Englishspeaking patients have low health literacy communication barriers alternative presentation of information may interfere with proper treatment of patients outside the medical facility 0 Le If a patient is given a prescription that they must take on their own illiteracy may impede the proper usage of that prescription May not be able to read the directions or interpret the correct dosage Chapter 10 What is the significance of pain It is critical for survival Causes disruption and is frightening Most likely leads to seek treatment Can be the source of a misunderstanding between a patient and the provider Significant of an underlying disorder What are some ofthe measures and methods used to assess pain verbal reportsdescription on pain pain questionnaires 0 patients with chronic pain show loss of gray matter in regions associated with processing pain in future may use structural markers like this to assess paintreatment efficacy pain behavior ex hunching over due to chronic back pain physiology of pain 0 gate control theory of pain a theory detailing how the experience of pain is reflected in sensory psychological and behavioral responses negative emotions exacerbate pain and vice versa 0 3 types of pain perception o mechanical nociception 0 thermal damage 0 polymodal nociception pain that triggers chemical reactions from tissue damage Compare and contrast acute and chronic pain Define the different kinds of chronic pain ie chronic benign pain recurrent acute pain and chronic progressive pain 0 Acute Pain 0 results from a specific injury 0 disappears when the damaged tissue is repaired 0 last for six months or less 0 Chronic pain 0 typically begins with an acute episode I pain does not decrease with treatment I pain does not decrease as time passes 0 types of chronic pain I chronic benign pain persists for 6 months or longer and is relatively unresponsive to treatment chronic back pain recurrent acute pain series of intermittent episodes of pain that are acute in character but chronic because it persists for more than 6 months migraine headaches I chronic progressive pain persists longer than 6 months and increases in severity over time rheumatoid arthritis What is the relationship between mental health and chronic pain Chronic pain often carries an overlay of psychological distress When people realize that they are unable to carry on desired activities and have little control it results in psychological distress 0 Depression anxiety and anger are typically associated with chronic pain What is the relationship between personality and pain 0 PainProne personality 0 constellation of personality traits that predispose a person to experience chronic pain Neuroticism introversion and the use of passive coping strategies Neurotic triad hypochondriasis depression hysteria O 0 Describe and provide examples of different types of pain management techniques ie biofeedback surgical pharmacological counterirritation Pharmacologica is treating pain with medicine Influence neural transmission Antidepressants combat pain in the higher brain regions Not long lasting addiction Surgica cutting pain fibers so pain sensation can no longer be conducted Short lived and more risks and can worsen pain because there is damage to the nervous system Counterirritationinhibiting pain in one part of the body by stimulation another Spinal cord stimulation using electrodes Short lived Biofeedbackachieving control over a bodily process Learn which thoughts and behaviors modify their bodily functions Treats headaches Raynaud s disease Relaxationshift body into low state of arousal by progressively relaxing different parts of the body Modestly successful Hypnosis relies on pain reduction techniques relaxation the patient is told the pain will go away then told to think about pain differently then given pain killers Acupuncture it appears to have an analgesic effect May work like counterirritation and also relaxation Short term pain relief Distraction focus attention on something else or do a high level activity May be useful in conjunction with other techniques Coping techniques cognitive coping skills includes distraction and focusing on sensory aspects of pain instead of the pain Guided imagery patient is told to conjure up a picture that they hold in their mind during a painful experience Aids in relaxation Acute pain What are some of the cognitive behavioral techniques used to manage and control pain conceptualize the problem from overwhelming to manageable enhance expectation that this training will be successful client s role is to be active resourceful and competent clients monitor maladaptive cognitions and stop negative selftalk specific behaviors are taught that are adaptive responses to pain success is due to the client s efforts relapse prevention is part of pain control How do emotions influence the experience of pain stressemotions create physical symptoms anxiety can produce diarrhea upset stomach shortness of breath sleep problems depression can produce fatigue loss of appetite listlessness What is the placebo effect and how is it used as a methodological tool Placebo effect any medical procedure that produces an effect in a patient because of its therapeutic intent and not its chemical nature Used as a methodological tool 0 doubleblind experiment 0 They may also work by stimulating the release of opioids natural painkiller Why is the placebo effect significant in clinical trials


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