Social determinants of health/Placebos
What is the “nocebo” effect? Give an example.
Definition: Patients can experience adverse side effects from a treatment even if it is a placebo
Example: when lactose was prescribed, some patients reported GI symptoms even though they were not lactose intolerant
What group represents a major priority for the future of healthcare?
Older adults
What does the Theory of Planned Behavior predict?
Intentions to change a behavior
What is true about weight bias (aka weight stigma)?
Weight bias can have a detrimental impact on an individual’s ability to maintain weight loss
What are the factors that contribute to food access?
Understanding of healthy food choices, whether grocery stores are available in one’s neighborhood, free time for grocery shopping and cooking, etc.
What is one main difference between public (Medicare) and private (insurance) healthcare?
The prices insurancers pay for hospital treatments are much higher
Marcel is committed to quitting smoking, and he is poised to start using Nicorette and the patch within the week. According to the Transtheoretical/Stages of Change model, Marcel is in which stage of change?
Preparation - intent upon taking action
What does research on the impacts of sedentary time and physical activity on mortality risk suggest?
Individuals can still have a low risk of mortality if they sit a long time, but they have to work in a large amount of physical activity
What type of placebos are there? Can a placebo have an effect if patients know it is a placebo? What characteristics of a placebo influence how effective it is?
Types: Sugar pills, sham interventions (fake surgeries, shots, etc.)
yes!
Characteristics: Setting (placebos are more effective in a medical setting than a non-medical setting); Instructions (complicated instructions are associated with a stronger placebo effect than more simple instructions); Cost of medication (more effective if it is more expensive compared to less expensive); Route of administration (injections have a stronger placebo effect than pills); Color (blue/green pills = more sedating effects; red/orange/yellow pills = more stimulating effects); Culture (schemas); Healthcare provider’s behavior and interactions with the patient
What is medicine’s “dirty little secret?”
Patients’ medication adherence is very low, even when there are severe consequences
What stage of change is best reflected in this case example? “Chris has realized that he may spend too much time using pot. He acknowledges that his drug use has been negatively impacting his grades at school and that it causes some problems with his parents. However, he also likes that it helps him to feel more relaxed. He feels ambivalent about reducing his pot use.”
Contemplation - aware a problem exists, no commitment to action
A person has a BMI in the "healthy" range. What inferences can we make about this person's health status? Why?
A BMI in the “healthy” range does not guarantee metabolic health - It doesn’t distinguish between excess fat, muscle, or bone mass and doesn’t measure body fat directly
According to Dr. Khullar’s article, what is true about discrimination and health?
Experiencing chronic discrimination may result in larger physiological stress responses
Injected patients with a chemical similar to adrenaline - Black patients had a larger temporary increase in blood pressure than white patients
Do healthcare providers share accurate information with their patients?
No, providers withhold information because they fear negative emotional reactions - less than half received accurate survival rates
The more you believe you are capable of quitting smoking, the more likely you are to intend to do it. What is this an example of? Define each answer choice.
Perceived behavioral control
Perceived intentional control
Norms
Attitudes
Perceived behavioral control - do you think performing the behavior is up to you or not?
Perceived intentional control - are you likely or unlikely to perform the behavior?
Norms - do you think most people approve or disapprove of the behavior?
Attitudes - do you see the behavior as good, neutral, or bad?
What are the facilitators and barriers to physical activity?
Facilitators: convenient and easily accessible settings for activity, “chunking” activity, social support, etc.
Barriers: stress, lack of time, fatigue, interference with daily activities, etc.
What are social determinants of health? What are the five main categories and what do they entail?
Definition: Conditions in which we are born, live, learn, work, play, worship, and age; Factors influence the health of individuals and communities
Categories:
Economic stability - lower incomes and an income drop increase the prevalence of heart disease and the more likely people are likely to engage in behaviors that increase their risk for CVD
Education - the more education a person has, the longer they will live and the lower their risk of CVD
neighborhood and built environment - more green spaces lower your mortality risk and food deserts are connected to obesity and diet-related diseases (diabetes and CVD)
social and community context - discrimination has been linked to Mental health symptoms and disorders, poor general physical health, chronic disease conditions, and early indicators of chronic disease risk
health & healthcare - health literacy can lead to poor treatment regimen adherence and greater emergency department usage
In the Gawande article, what was true about healthcare spending?
There was more variability in the hospital prices paid by private insurers than by Medicare
Define the health belief model, the theory of planned behavior, and the transtheoretical model (stages of change). What are the pros and cons for each?
Health Belief Model: aims to explain what encourages or discourages people from engaging in a health behavior
Pros: includes useful constructs (i.e. ideas/concepts) and focuses on people’s beliefs - it is a subjective model
Cons: assumes behavior is rational, assumes people have the skills to alter behavior, ignores the social or economic context of many health behaviors, most relevant for preventative behaviors
Theory of Planned Behavior: predicts intentions to perform a behavior
Pros: incorporates social aspect of health behaviors (in norms), doesn’t assume people want to be healthy (in attitudes), and includes person’s beliefs about their ability to change (in control)
Cons: Doesn’t take into account environmental or economic factors that may influence intentions, predicts intentions, not actual behaviors, and people don’t always do what they intend to do
Transtheoretical Model (stages of change): behaviors change is a process, not an event; there is more to behavior change than beliefs and perceptions
Pros: realistic (acknowledges that people can be at different stages) and practical (doesn’t force techniques into one theory)
Cons: ignores social context, people may be in the same stage for different reasons and doesn’t explain how people can move from one stage to the next
When researchers at Duke University followed up participants who completed an exercise intervention or remained inactive as controls about 10 years earlier:
Even if participants didn’t currently exercise, some showed better blood pressure if they walked in the earlier intervention