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Summary - Class notes - Health Psychology
1446418800 Hoofdstuk 1: Health Psychology Introduction
What is health psychology?Psychology can be defined as the scientific study of mental and behavioural functioning. Health psychology: integrates many cognitive, developmental and social theories, but it applies them soley to HEALTH, ILLNESS, and HEALTH CARE. Health Psychology can addresss questions such as why some people behave in a healthy way and others do not.
Clinical psychologyMental Disorders - Psychology. Clinical psychologists are typically practitioners working within the health care setting.
PsychiatryMental disorders - medicine. Biomedical approach (medication, medical treatment)
Behavioral Medicine / Medical PsychologyPhysical disorders - medicine. Behavioural medicine: Interdisciplinary field (psychology, sociology and health education) in relation to medicine. Integration of behavioural and biomedical knowledge. Medical Psychology: Clinical health psychologist (psychologist (psychologists working in medical setting-hospitals).
Health psychologyPsysical disorders - psychology. Psychological theories (theoretical models and interventions from clinical psychology influenced and shaped health psychology!) and methods are applied in order to examine how to ensure that people stay healthy or achieve better adaptation to or recovery from illness.
First element of health psychology by MatarazzoPromotion and maintenance of health. Primary prevention. To reduce chance that a health problem will develop. Usually based on behavioral model rather than a disease model. Typically considered the most cost-effective form of health care.
Second element of health psychology by MatarazzoThe prevention and treatment of illness. Secondary prevention. Reduce the risk of disease onset or progression. Asymptomatic persons who have already developed risk factors or preclinical disease. Early case finding (screening e.g. mammogram)! Tertiary prevention. Care of established disease (minimize negative effects). Both secondary and tertiary prevention is provided by biomedical, behavioral (adherence to treatment) and psychologial interventions (example paper Duijts).
Behavioral techniques improve outcomesResults are relevant for practitioners: better inform patients of psychosocial effects of breast cancer and its treatment. Develop strategies to minimize adverse effects (behavioral therapy, cognitive therapy, education, relaxation, counseling. Reduce fatigue, depression, anxiety and stress).
Third element of health psychology by MatarazzoThe identification of etiologic correlates of health, illness, and related dysfunction. The role of psychological factors in the etiological process. Etiology = study of causation (in medicine, etiology refers to the many factors coming together to cause an illness).
Fourth element of health psychology by MatarazzoHealth care system & health policy. Lack of health insurance is associated with delay in seeking emergency care for acute myocardial infarction. There are interesting studies which have examined the impact of different types of health care environment on patient well being and recovery.
1446505200 Hoofdstuk 2: The Role of Behaviour in Health
Understanding the determinants of health behaviour and identifying more effective methods of promoting behaviour change and healthier lifestyles are two of the central issues in health psychology.
Socioeconomic status and health(SES), measurement is complicated: (1) occupation, (2) income, (3) education (problematic in the elderly!).
Kankerpatient met hoge opleiding wordt beter behandeld: ze gaan zelf op onderzoek uit en stellen dingen voor aan de dokters. (Hoog opgeleide mensen wonen vaker rond de stad, niet in de stad). SES has an impact on social inequalities (e.g. smoking etc.).
What causes most deaths?Cardiovascular diseases and cancer are by far the most common causes of death, together accounting for 64 per cent of male and 71 per cent of female deaths. Other leading causes are accidents and unintentional injury.
SES and health behaviourHealth behaviours make a wide spread contribution to social inequalities in health. (smoking, diet, physical activity, alcohol consumption). Behavioural factors are estimated to account for half of the premature death. Healthier lifestyles are key to reducing the incidence of these conditions, while early detection through screening and other medical assessments can improve outcomes.
Doll & HillFound out that smoking causes lung cancer.
Health Behaviour ConceptHealth behaviours cluster and have a range of effects (veel roken, veel drinken, weinig beweging etc). Different behaviours may have common determinants.
Health risk behaviourAny activity undertaken by people with a frequency or intensity that increases risk of disease or injury. Smoking, being physically inactive; drinking a lot, and eating less than five servings of fruit and vegetables per day are negative health behaviours. The more of these negatives behaviours that are performed, the greater the risk of deaths from 'all causes', cardiovascular disease and cancer.
Positive health behaviourActivities that may help to prevent disease, detect disease and disability at an early stage, promote and enhance health, or protect from risk injury. Regardless whether the individual carries out this activity for health reasons. (there is evidence that moderate alcohol consumption is associated with more favourable health outcomes than either heavy drinking or complete abstinence).
Health behaviour1. Activities can change as medical knowledge develops
2. Behaviours vary in influence across time and populations
3. Strength of evidence relating behaviours with health outcome is variable (a basic principle of research is that association is not the same as cause)
4. Health motivations and cognitions must be viewed in a broad context
A number of other important health behaviours, including sunscreen use, sleep pattern, drug use, dental health behaviour and breast self-examination are not discussed in the interests of space.
Diet- Epidemic of overconsumption of fat, sugar and salt. Underconsumption of high-fibre, nutrient-rich, plant-based foods such as vegetables and fruits.
- Women eat more lower fat food than men
- Women eat more fruit and vegetables
- High SES groups eat more fruit and vegetables
Fat is the most energy-dense of the macronutrients, and so fat intake is strongly linked to weight gain.
Fruit and vegetable consumption has been linked with low rates of the development of heart disease and many cancers in a number of large-scale studies (households with children eat less vegetables and fruits, low SES groups tend to buy strikingly less fruit and vegetables than high SES groups)
Physical activity- Inactivity is related to premature mortality (especially coronary heart disease, higher risk cancer, elderly have higher falling risk, more disturbed mood)
- Mechanism (blood pressure, obesity, cholesterol, diabetes, inflammation)
Men tend to be more physically active than women. People of higher SES are also more physically active.
Nederlandse norm gezond bewegen- Jongeren: dagelijks 1 uur ten minste matig intensieve lichamelijke activiteit.
- Volwassenen: een half uur ten minste matig intensieve lichamelijke activiteit op minimaal vijf, maar bij voorkeur alle dagen van de week.
- 55-plussers: Een half uur ten minste matig intensieve lichamelijke activiteit op minimaal vijf, maar bij voorkeur alle dagen van de week; voor niet-actieven, zonder of met beperkingen, is elke extra hoeveelheid lichaamsbeweging zinvol, ongeacht duur, intensiteit frequentie of type.
Smoking- Burden of disease attributable to smoking in developed countries is greater than for any other health behaviour. The incresed risk associated with smoking dissapears after a short period, although cancer risks merely stop increasing.
- Preventing people to start and encourage to stop = targets for health psychology
- In developed countries: smoking increases with decreasing SES
- Sex difference is also narrowing. People who start smoking when they are young are more likely to smoke heavily and become more nicotine-dependent.
Sexual behaviour- Sexually transmitted infections (such as gonorrhoea and genital herpes) are more common in teenagers, young adults and MSM (men who have sex with men)
- Risk increasing behaviours: early age first intercourse, multiple sexual partners, no condoms, anal intercourse
Global rates of infection with HIV/AIDS have stabilised in recent years, but remain high. Sexual behaviour can also spread viruses linked with cancer risk: hepatitis B is linked with liver cancer and types of human papillomavirus (HPV) are responsible for cervical cancer. The occurrence of risky sexual behaviour is particularly high among intravenous drug users, homeless people and others at the margins of society.
SOA cijfers in NL- In 2011 lieten 113.000 mensen in NL zich op een SOA testen, 14% was positief
- Chlamydia meest voorkomende SOA (13.000 komt vooral voor bij heteroseksuelen <25 jaar)
- Meeste SOA bij MSM
- In 2009: 1252 nieuwe gevallen HIV infectie, 16.500 in totaal in NL geregistreerd, 8.000 AIDS.
Alcohol use (1)Health risks of alcohol: alcohol dependece, foetal alcohol syndrome and alcoholic liver cirrhosis, and illnesses in which alcohol is one of a number of important causal factors. Also road traffic accidents and domestic violence and sexually transmitted disease.
Binge drinking is worse than drinking the same amount only spread accross the week.
- U-shaped relation between alcohol use and mortallity (boodschap: drink met mate)
- However, association between alcohol use and disease differs per disease studied! (moderate alcohol consumption increases breast cancer risk; moderate alcohol consumption decreases risk of ischemic stroke)
Alcohol use (2)- Heavy alcohol consumption is more common in lower SES
- Less of a social gradient in moderate users
- Consumption more common in men than women, but small gap in developed countries
- In NL werd in 2005 gemiddeld 9,5L gedronken, in 2009 9,2L. Highest capita consumption is in France and the lowest in the USA.
- The age at which pepole start drinking predicts the likelihood of later problems.
Broad context of health behaviourSociocultural and national factors (e.g. japanese diet and stomach cancer)
Legislation (e.g. Smoking rates in Finland are the lowest in Europe)
Economic factors (buoyancy of the economy and availability of disposable income, together with taxes on tobacco and alcohol)
Goods and services (e.g. not everyone has a bike)
Health service provision (not everyone can afford it)
Social and family factors (e.g. everyone in the family smokes)
Person (sociodemographic; health status; psychological; biological)
Cancer screeningThe purpose of screening is to detect abnormalities before the disease process is clinically manifest. For some cancers (e.g. breast and prostate cancer), techniques are not yet available to detect a pre-malignant stage, so screening aims to identify the area of cell proliferation before the cells have mutated to their metastasising form. In these cases, surgical treatment is likely to be required whenever any abnormality is detected.
The value of screening to public health depends on two related factors. Firstly, the benefits of screening for reducing mortality must outweigh treatment costs. In this respect, evidence supports the value of screening in reducing cervical cancer mortality, colorectal cancer mortality and breast cancer mortality. Secondly, high screening uptake rates among the at-risk population are needed to achieve the most benefits.
By reputation, men are less willing than women to involve themselves with medical care. Lower SES are less likely to participate in screening.
Hazardous driving behaviourRoad traffic injuries are the second-leading cause of death for children and young adults worldwide (drinking and driving, no seatbelt on and driving too fast increases the risk). For more common among men than women.
Latest added flashcards
- such a collaborative approach between oncology and palliative care differs from the traditional view of palliative care services being used only at the very end of life, and is increasingly endorsed in oncology guidelines
- also called 'living will': make advance decision to refuse certain treatment before you lose capacity to do so
- discussion impact on:
* values/personal goals of care
* understanding illness and prognosis
* preferences for type of care
- not only important for patient choice
- also for open dialogue between care providers and patients and family
- NB: timing of discussion of advance care planning is important (niet direct bij diagnose of tijdens actieve behandeling)
- 'fighting spirit' was thought to improve outcomes, but does not
- avoidance and denial are thought of as maladaptive, ut can also be adaptive!
- avoidance can reduce stress
- denial can allow people to enjoy the times when they are relativley well
- caregiving can be very demanding
* sense of imminent loss
* demands of caring for a patient with unpredictable and high dependency needs
- many carers regard caregiving as normal part of reciprocal relationships (do not identify with label 'carer')
- relatively few RCTs to provide evidence
- challenges for research in this field
* attrition (uitval)
* follow-up assesment
* confounding variables (many symptoms)
* operationalisatie uitkomsten (zie ook RCT dignity)
* terminal prognosis with a life expectancy of six months or less
* if they were receiving palliative care services through an affiliated recruitment site
* if they were 18 years of age or greater
* if they were willing to commit to 3 to 4 contacts over approximately 7 to 10 days
- all participants were randomly assigned to ne of three study arms
1. dignity therapy
2. client centred care
3 standard palliative care and
* asked to complete base-line psychosocial questionnaires
- patients who received dignity therapy were significantly more likely to
- report benefits (compared to ther 2 arms):
* finding it helpful
* improving their QOL
* their sense of dignity
* changing how their family might see or appreciate them
* deeming it helpful to their family, compared to the other study arms
- no impact on distress!!
- invites patients to discuss issues that matter most or that they would most want remembered
- sessions are transcribed and edited, with a returned final version that they can bequeath (=nalaten) to a friend or family member
1. Illness related concerns
- level of independence (cognitive acuity, functional capacity)
- symptom distress (physical and psychological)
2. dignity-conserving repertoire(continuity of self, role preservation, hopefulness, autonomy, acceptance etc)
3. social aspects of illness - privacy boundaries
- social support
- aftermath concerns
- care tenor
- burden to others
- high prioriyt in health and social care strategy documents in EU
- overarching goal of palliative care
- for some, 'dying with dignity' = right to assisted suicide and euthanasia
- gemiddelde leeftijd 66 jaar
- gem 32 maanden na diagnose vragenlijst
- laag opgeleid (t.o.v. gemiddelde NLe populatie)
- 86% heeft Katholieke achtergrond/opvoeding (onderzoek vond plaats in NB/Limburg)
- 70% voelt zich verwant met christendom
Beschouwt zich als
- religieus: 46%
- spiritueel: 12%
- paranormaal: 5%
- steun van anderen
- positieve herwaardering (relaties en omgeving)
- aanvaarding en humor
- ... religie en spiritualiteit minder van belang
1. 'nauwelijks coping' (10%)- lang na diagnose, weinig klachten
2. 'ongeloof en berusting' (30%)- veel symptomen, laag welbevinden, slechte prognose
3. 'aanvaarding en humor' (47%)- gemiddeld lichamelik en psychisch welbevinden, relatief hoog opgeleid
4. 'religie en spiritualiteit' (13%)- slecht lichamelijk welbevinden, hoog exitentieel welbevinden, laag opgeleid