Reasons for difference in PA
- Increased car ownership
- Better public transport
- Energy saving devices - dishwasher
- Work and leisure activities more sedentary
- Cultural attitudes and children may make PA difficult to do
- Children who do less PA in school are less likely to continue this as adults
Health benefits of PA
Physical health • Manage physical conditions e.g. T2D • Maintains organ health • Healthier bones Mental health • Improved mood (endorphins) • Less cortisol • Reduced risk of anxiety and depression • Increased self esteem • Social benefits = make friends in class, less stigma and discrimination • Improved sleep
Determinants of undertaking PA
1) Socioeconomic status: people will higher SES have more money and better access to resources/gyms, likely to live in a safe area where they can run
2) Gender: sports culture centred around males, campaigns like This Girl Can aim at girls
3) Social support: motivation and encouragement
4) Barriers: time, cost, money, carer, low self-efficacy and confidence, lack of motivation, health issues, lack of social support
5) Age: younger people have the time, energy and strength
6) Active childhood: children are more likely to continue sports into adulthood if they’ve had a positive experience with it
7) BMI: people with low BMI are likely to feel less self conscious about PA, whereas people with high BMI are likely to have low self esteem and stigma/discrimination putting them off PA
Psychological determinants of PA
1) Social support: resources provided to us via our interactions with others, creates and sustains motivation
- Instrumental = person makes it easier for you to do activity
- Informative = person tells you about activity
- Emotional = support and encouragement to do activity
2) Self-efficacy: confidence in your abilities to overcome obstacles and do activity; strongest predictor
- Low SE = hopeless, give up
- High SE = come up with solutions
3) Beliefs: Health Belief Model:
- Perceived threat (composed of perceived susceptibility and severity)
- Perceived benefits vs risks
- Self-efficacy
- External and internal cues
4) Motivation: health, appearance, enjoyment, social interactions, stress relief, satisfaction
Theory of planned behaviour
• Intention determines behaviour
• Intention is determined by three aspects:
- Attitude = how do we feel about the activity?
- Subjective norm = is the activity accepted by those we associate with?
- Perceived behavioural control
:( Intention-behaviour gap –> rectified by implementation intention
COM-B model
• Behaviour is determined by:
- Capability = physical, psychological
- Opportunity = physical, social
- Motivations = automatic, reflective
Social determinants of health
1) Individual characteristics: age, sex, constitutional factors, social class
2) Individual lifestyle: alcohol, drugs, exercise
3) Social and community networks: how well supported people are
4) General socioeconomic, cultural and environmental conditions
- Agriculture and food production = quality of food we are eating
- Educational attainment = affects work prospects = income = living standards, children’s early development (cycle repeats with them)
- Employment
- Living standards
- Income = may affect child’s early development and later opportunities, which can affect their employment, opportunities and income)
- Healthcare services provision
- Housing
Causes of obesity
1) Genetic
- Parental obesity = increasing risk of obesity with each parent that is obese
- Twin studies: identical twins reared apart had similar obesity compared to non-identical twins reared together
- Adoption studies = children showed similar obesity levels to biological parents than adopted parents
- Metabolic theory = low resting metabolic rate is heritable
- Fat cell theory = number of fat cells we have is genetically determined, obese people have more and bigger cells
- Appetite theory = leptin deficiency
2) Economic
- High energy foods are cheaper and easily available
- Less time to prepare meals
3) Behavioural
- Obese people eat more fatty foods and foods with high glycaemic index
- Externality theory = people eat in response to external cues (e.g. sight of food) rather than internal cues (e.g. actually being hungry)
- Society is becoming more sedentary = work, leisure activities, energy-saving devices
- Lack of sleep = affects leptin and ghrelin
4) Psychological
- Homeostatic theory = people with high BMI tend to have high body dissatisfaction, result in depression/anxiety, overeat as coping mechanism, cycle repeats
- Ghrelin = increases with stress
- Negative emotions (emotionality theory) = binge-eating is associated with chronic negative emotions
- Restraint theory = restrictive dieting is associated with episodes of binge eating – people set strict boundaries and lapse leading to a what the hell effect
- Self-perception = some people don’t see themselves or their children as obese, media portrays extreme images of obesity
- Partners = married people are more likely to be overweight if their partner is, potential for partner-based interventions
- Social = if you are close to someone that is obese, you are likely to become obese
- Cultural = thinness with attractiveness
- Gender differences = men are more satisfied with their weight than women and lose weight using healthy eating/exercise, whereas women opt for diet and pills
- Obesogenic environment = role of external environment (type of food available, access to gym) interacting with genes to determine if person will become obese
Perception:
recognition, interpretation and integration of sensory stimuli to develop knowledge and understanding of the world
- Depends on who you are, who you are with, what you expect/value/want
- Balance of bottom up theory (realist) and top down theory (fantasy)
Factors altering perception
PEMPPAD
- Personality = introverts have more sensitive visual perception
- Emotion = depressed people see negative information more, anxious people see threatening information more
- Motivation = people perceive information more that is relating to their needs e.g. overestimating benefit of treatment
- Perceptual set = context, expectations, past experiences
- Physiological = brain injury/disease e.g. agnosia so can see properly but can’t make sense of visual information
- Attention = have to pay attention to something to get the information to perceive it; Simon and Levin scenarios where people didn’t notice change in people they were talking to but may have subconsciously reacted
- Demographic = age (old people can’t ignore irrelevant information), gender (males have better visual acuity in the day whereas females at night), culture
Biopsychosocial theory
• Biological factors: genetics, physiology and tissue health
• Psychological factors: self-efficacy, perceived control, depression, anxiety, anger
- Contributes to pain once sensitised
• Social factors: SE status, social support
Ways to distribute resources
1) Libertarianism = a complete free market, state shouldn’t play a role in healthcare, more down to individual people, lots of private spending, ensure no redistribution
:( Discrimination (to race, lifestyle, genetics), excludes poor, inefficient
2) Lottery = like pulling names out of a hat, everyone is treated equally, no discrimination
:( Doesn’t consider individual needs or cost effectiveness
3) Needs = who needs it most?
:( Hard to define (subjective), doesn’t consider cost effectiveness or responsibility
4) Consequentialism = choose option that gives maximum benefit to society, gives numerical value of health (e.g. QALY) to assess benefit of treatments
:( Puts price on life, unethical as who decides numerical value of health, discrimination, ignores need
5) Personal responsibility = people are responsible for own health so allocate resources based on lifestyle, choice and responsibility (e.g. no liver transplant to alcoholics)
:( Doctors may become judgemental, not all choices are free choices
6) Democratic way = use voting system for allocation
:( Discrimination, not everyone votes, public lack specialist knowledge so may not know what exactly they’re voting for (#brexit)
7) Pluralism = takes aspects from democratic, personal responsibility, libertarianism
:( Incommensurability = difficulty weighing different values
Veil of ignorance
- This is a way to find out what a fair system would look like
- If we were to create a society without knowing our social status, ethnicity, ability, wealth etc. we are likely to choose a fairer society that benefits the disadvantaged in case we are the disadvantaged
Doctrine of double effect
• The action is permissible if:
1. Nature of act is not bad
2. There is at least one good consequence
3. There is at least one bad consequence
4. Sufficient and serious reason for allowing bad consequence to occur
5. Bad consequence is not a means to good consequence
6. Agent foresees bad consequence but intends good consequence
• Intentions matter but doesn’t change the consequence
• Law allows DDE to apply in some cases e.g. giving patient painkilling drugs knowing it’ll kill them faster
Acute grief response
- Intense emotion and distress
- Disbelief, shock, anger, loneliness, crying
- Disrupted sleep and weird dreams
- Aimless activity (e.g. pacing around the house) and inactivity (e.g. sitting down for long periods of time)
- Illusions/hallucinations = see/hear person around
- Preoccupation with images of lost person
- Typically 6 weeks
Longer term grief response
- Waves of heightened emotions (with unpredictable triggers)
- Loss of identity
- Social withdrawal
- Sleep disturbance, restlessness, changes in appetite
- Anxiety, reduced concentration, depressed mood
- Typically 3-12 months
5 stages of grief
DABDA
Denial, Anger, Bargaining, Depression, Acceptance
• Describes how terminally ill people come to terms with ending of their life
• Not linear so people can skip stages
Risk factors of complicated grief
- Circumstances surrounding loss = sudden/unexpected (e.g. accident), violent (e.g. murder), multiple losses, not being told person has died
- Individual circumstances = issues with coping, mental health issues, separation anxiety (Bowlby), unable to explain/understand loss
- Lack of social support = family rows over inheritance, having to move leaving friends from school behind
- Quality of lost relationship = harder for people to adjust if close to person lost, difficult relationships can bring back unresolved negative memories
- Disenfranchised grief = grief that cannot be expressed and publically acknowledged e.g. being someone’s secret partner or child; may lead to lack of social support
Health of people in bereavement
• Increased risk of mental and physical illness
• Affects immune system so bereavement is a chronic stressor and deregulates stress hormones (e.g. cortisol) so more vulnerable to illness
• Increases rates of disability, hospitalisation and medication use
• Earlier mortality (especially after death of partner or child)
- Potential causes = change in usual health practices, lack of self care, disrupted sleep, alcohol/drug abuse, ignore early signs of disease, poor management of pre-existing conditions, suicide
Key features of dual process model of grief
1) Important to maintain relationship with the deceased (e.g. still celebrate their birthday)
2) Avoid “separation” since it causes distress
3) Importance on cognition, meaning and emotions
4) Grieving is continual and incorporated into our growth
Attention bias
• Perceptual bias: people see things they’re primed to a lot quicker and move towards it
- Depressed people noticed negative things constantly because brain is expecting negative things
- Drug/alcohol dependent people notice drug-related stimuli quickly; may lead to increased risk of relapse
• Links to motivations and emotions
• May increase goal-directed behaviour e.g. looking for a cure, but may result in patient not fully attending to information from doctor
Bottom up
- Information is directly presented to sensory organs so nothing else happens
- Physical characteristics of the stimuli drive perception
- Brain doesn’t do anything
- Realist view of the world (what you see is what you get)
- Can be matched with stored knowledge to objectively identify things
Top down
- Combine simple sensory information with psychological constructs (previous experiences, expectations) which provides a context (what we see can be skewed)
- Implies perception is an active process
- Expectation effects: what we expect to see affects what we see temporarily
- Know what to expect via schema
Impact of caring
- ↓Financial cost to State – costs both considerable
- Impose financial, physical, psychological strain on carers
- Carers experience ↓independence & social participation
- Carers give-up careers since difficult to combine demands of paid employment with caring responsibilities + simultaneously unpaid care remains undervalued in society so loss of social status
- ↓Outside leisure & maintaining friendships interests to meet the needs of person with chronic illness so social isolation
- Physical labour to meet activities of daily living for immobile person + demanding for carers who could be elderly too
- Carers have loss of personal autonomy in relation to their increased dependence on others LA for support in their caring role
- Reciprocal caring relationships between partners + family members but relationship tensions arise from increasing dependency of recipient of care in relationship
- Individuals who are physically dependent on their partner feel frustration & anger with their physical condition which they cannot express to their carer – also with formal/professional carer
- Frequent, constant, unrelenting dependency on carer
- Health of carers more likely to deteriorate form detrimental changes directly attributable to caring role
