1. 2017/2018

2. Public Health Phase 3a Revision Session Anna Kirkwood and Jess Hartley
09/10/17
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3. Contents Health belief models Communicable Disease Control
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4. Health belief model Perceived susceptibility to ill health
Perceived severity of ill health
Likelihood of engaging in health-promoting behaviour
Perceived benefits of behaviour change
HBM proposes individuals conduct internal assessments comprising four components when deciding whether or not to change their behaviour
Any suggestions as to the four components?
Perceived barriers to taking action
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5. Stages of change/trans-theoretical model
Pre-contemplation
Contemplation
Preparation
Roger, 74 years old- smoked 20/day since he was 16
Action
A widely applied behaviour change model. It suggests that the process of health behaviour change involves progression though six stages of change that represent the levels of motivational readiness
Does anyone know the stages?
If you apply this to a GP setting, where you are trying to get patients to change their health behaviours for the better.
Roger has smoked all his life, it’s a natural habit for him and he has never thought of quitting- where is he on the scale? (Pre-contemplation)
It would be a big ask if he came into a consultation to tell him to stop, prescribe champix and tell him when he gets home to throw all his cigarettes out.
Use the health belief model to bring up and discuss the prospect of quitting smoking (perceived susceptibility to ill health, severity of ill health, benefits of behaviour change, barriers to taking action). Roger will now leave in contemplation
When Roger returns, he is ready to quit smoking- DISCUSS setting a quit date, throwing out extra cigarettes, lighters and ashtrays, and stopping buying extra cigarettes. Prescribe champix (Preparation)
Roger quits smoking according to the plan (ACTION)
Roger returns, he has not smoked for 3 months (MAINTENANCE)- you remind him of the importance of avoiding triggers, back up the benefits he is starting to feel (health belief model)
Roger comes back in another month- he has had a family crisis and had a cigarette to calm his nerves (RELAPSE). Reassured that this is not failure- he is not back at the contemplation stage and will need to prepare to quit again.
Maintenance
Relapse
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6. Perceived behavioural control
Theory of planned behaviour
Attitudes
Subjective norm
Intention
Behaviour
The central factor is the individuals intention to perform a given behaviour
The stronger the intention to engage in a behaviour, the more likely the completion of behaviour change
Intentions are influenced by three things…..attitudes towards the behaviour, the subjective norm, the perceived behavioural control
Perceived behavioural control
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7. Communicable disease control
SURVEILLANCE,
PREVENTION,
CONTROL
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8. Which communicable diseases do public health care about?
High mortality
High morbidity
Highly contagious
Expensive to treat
Effective interventions
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9. WHO? Registered Medical Practitioners Laboratories Notifiable diseases
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10. WHEN? Notifiable diseases Individual cases of notifiable diseases
Other infection/ contamination which could be a significant risk to human health
On CLINICAL SUSPICION
DON’T wait for lab confirmation
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11. WHAT? Notifiable diseases
Index case details: name, NHS no., DOB, contact details
Disease/ contamination details: what, onset, diagnosis, samples, hospitalised?, died?
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12. HOW? Notifiable diseases
Contact your local health protection authority
Written notification or if urgent, telephone followed by written
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13. Notifiable diseases There’s a long list!
Worth going over, easy marks to be had
Acute encephalitis
Acute infectious hepatitis
Acute meningitis
Acute poliomyelitis
Anthrax
Botulism
Brucellosis
Cholera
Diphtheria
Enteric fever (typhoid or paratyphoid fever)
Food poisoning
Haemolytic uraemic syndrome (HUS)
Infectious bloody diarrhoea
Invasive group A streptococcal disease
Legionnaires’ disease
Leprosy
Malaria
Measles
Meningococcal septicaemia
Mumps
Plague
Rabies
Rubella
Severe Acute Respiratory Syndrome (SARS)
Scarlet fever
Smallpox
Tetanus
Tuberculosis
Typhus
Viral haemorrhagic fever (VHF)
Whooping cough
Yellow fever
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14. Other notifications
Other infection/ contamination which could be a significant risk to human health
Known chicken pox in a healthcare worker
Emerging infectious disease (something like SARS)
Radiological hazard
Other chemicals e.g. carbon monoxide
Voluntary notification of suspected outbreaks/ clusters
E.g. scabies in a care home
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15. An aggregation of cases which may or may not be linked
Outbreak control: definitions
CLUSTER
An aggregation of cases which may or may not be linked
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16. SUSPECTED OUTBREAK Definitions
Occurrence of more cases than normally expected within a specific place/ group over a given period of time
2+ cases linked through common exposure/ characteristic/ time/ location
SINGLE case of rare/ serious disease
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17. Link confirmed through epidemiological/ microbiological investigation
Definitions
CONFIRMED OUTBREAK
Link confirmed through epidemiological/ microbiological investigation
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18. Definitions
EPIDEMIC
Occurrence within an area in excess of what is expected for a given time period
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19. PANDEMIC Epidemic widespread over several countries Definitions
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20. ENDEMIC HYPER-ENDEMIC Definitions
Persistent level of disease occurrence
HYPER-ENDEMIC
Persistently high level of disease occurrence
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21. SBA
GP sees a patient with 2 day history of vomiting and diarrhoea following a meal at a local takeaway. This is the 3rd patient this week with a similar presentation
No need to notify
Written notification to arrive within 3 days
Call the communicable disease consultant
Call the laboratory
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22. SBA
20 year old medical student presents with unilateral swelling of the parotid gland, fever, headache and malaise.
No need to notify
Written notification to arrive within 3 days
Call the communicable disease consultant
Call the laboratory
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23. SBA
Patient presents with flu like illness, headache, muscle pains and cyclical shivering/fevers. Their temperature is 38oC and they are sweating profusely. They returned from holiday in Madagascar 5 days ago.
No need to notify
Written notification to arrive within 3 days
Call the communicable disease consultant
Call the laboratory
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24. SBA
22 year old man presents with purulent urethral discharge and dysuria
No need to notify
Written notification to arrive within 3 days
Call the communicable disease consultant
Call the laboratory
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25. Any Questions?
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