1. Health Beliefs By Joshua Bower Peer Support 2013/14 - SocPop Night J.Bower@warwick.ac.uk

2. Learning Objectives Meaning of the terms ‘structure’ and ‘agency’ and relevance for health What are lay beliefs/knowledge Where lay beliefs/knowledge come from Why lay beliefs/knowledge are important to doctors Lay referral and triggers to seeking medical help What is meant by the term ‘symptom iceberg’ Definition of Health Behaviours Determinants of health - emotional dispositions (personality traits using the OCEAN framework) Generalised expectancies – locus of control, self-efficacy

3. Question 1 Stem Jennifer, a 20yo female came to her GP after noticing a recent weight loss of 5kg. Her current BMI was 17. She reported suffering with diarrhoea on occasion. She was feeling increasingly tired and occasionally bloated. O/E she was pale and had cool peripheries.

4. JLaw is concerned she has stomach cancer, because she read a report on the internet recently about a celebrity who suffered these symptoms. What is this an example of? [1] Lay belief

5. Give THREE other sources of this type of health belief [3] Personal knowledge Previous medical encounters Folk knowledge Spiritual beliefs Alternative/complementary medicine Media

6. Give FOUR reasons it is important to take these beliefs into account [4] Help to understand illness-related behaviours Increase patient satisfaction Increase doctor satisfaction Understand patient needs Understand patient expectations

7. During your consultation, you find out Jennifer only presented because her mother made her come. List FOUR other reasons a patient may access healthcare services [4] Temporalising of symptomatology (not better by the time Mockingjay Part 1 comes out…) Interfering with vocational activity (can’t fight in the Hunger Games) Interfering with social activity (can’t make out with Peeta and/or Gale) Interpersonal crisis (survived THG so should probably look after herself) Sanctioning is not acceptable – this was in the Q

8. Pick the most likely underlying diagnosis from the below: A – anorexia nervosa B – bulimia nervosa C – oesophageal carcinoma D – coeliac disease E – hiatus hernia F – Addison’s disease

9. Answer: D – coeliac disease What is Coeliac disease? [2] Disease of proximal small intestine caused by intolerance to proteins in cereal crops Inflammation and damage to duodenum and jejunum mucosa leads to blunting/loss of villi Clinical features related to malabsorption caused by loss of surface area

10. (i) What secondary diagnosis would explain your physical examination findings? [1] (ii) How does this relate to your first diagnosis? [2] (iii) What investigation would confirm this, and what would the results show? [1] (i)(Iron deficiency) anaemia (ii)Coeliac’s leads to malabsorption; iron being poorly absorbed (iii) Hb <120g/L Haematocrit <37% Iron <35mmol/L

12. QUESTION 1 – PASSED!

13. Question 2 Stem Leonardo is a 59 year old bus driver who reports to A+E after sustaining a fractured femur after a fall at home. You note he has a previous diagnosis of DeFonghi syndrome. You believe his condition led to postural hypotension, causing his fall.

14. Only when questioned further do you uncover Leo has been suffering from recurrent headaches, dizziness and weakness. He has been managing at home and did not wish to complain about it. What phenomenon is being described here? Symptom iceberg – not all symptoms get reported as they can manage without professional help. So not as many people present as there actually are.

15. You decide to enquire into Leo’s health behaviours. (i) Define health behaviour (ii) Define illness behaviour (i)Behaviours related to the health status of an individual (e.g. smoking, exercise) (ii)Behaviours a patient engages in once they believe they are ill (e.g. seeking help, changing habits)

16. What are the FOUR determinants of health behaviour? [4] Background factors (e.g. ethnicity, culture) Stable factors (personality type) Social factors (e.g. social cues, support) Situational factors (e.g. if bored you notice more, if publicly visible more distressed)

17. What are the THREE classes of stable factors? [3] Emotional dispositions (present) – psychological processes involved in both the experience and expression Generalised expectancies (future) – psychological processes involved in formulating expectations in relation to future outcomes Explanatory styles (past) – psychological proceses involved in explaining the causes of negative events

18. What are the FIVE personality traits affecting an individual’s emotional disposition? [5] Openness to new experiences (interest in culture) Conscientiousness (will to achieve) Extroversion (outgoing) Agreeableness (loving, friendly, compliant) Neuroticism (experience more negative emotions)

19. Leo believes that future outcomes are determined by himself and his actions. (i) What generalised expectancy does he have? [1] (ii) What THREE things do people with (i) believe? [3] (i)Internal locus of control (ii)Responsible for own health Illness can be avoided by good health behaviours Ill health is due to poor health behaviours

20. Self-efficacy is also an example of a generalised expectancy. What does self-efficacy mean? [2] Belief in one’s own ability to organise and execute a course of action, and the expectation that the action with result in/lead to a desired outcome

21. Breaking down Health Behaviours Background factors Stable factors – Emotional disposition OCEAN – Generalised expectancy Locus of control, self-efficacy – Explanatory style Optimistic/pessimistic Attributional style (self, time, situation) Situational factors Social factors – Cues, support

22. You are concerned about Leo’s fractured femur. An x-ray reveals the fracture is through the neck of his femur. (i) What complication is he at risk of? [1] (ii) Suggest another bone which is at risk of this complication [1] (i)Avascular necrosis (ii)Scaphoid, talus

23. DeFonghi syndrome leads to a loss of bone mass, similar to osteoporosis. Pick from the list below the most likely pharmacological intervention you would start the patient on. A – propranolol B – furosemide C – alendronate D – amitriptylline E – calcium manganese F - warfarin

24. Answer C - alendronate Alendronate is a bisphosphonate

25. What is DeFonghi syndrome? [2] It doesn’t exist Just to say – don’t panic if the stem throws you as you don’t know anything about the condition You can still pick up all the marks depending on what questions they ask (e.g. it could be entirely pink, or they may give you details in further questions!)

26. What is the relationship between individuals (agency) and society (structure)? Debate regarding the role of agency and structure in shaping human action Agency; focuses on the capacity of individuals to act independently and to make their own free choices Structure; focuses on the way in which society is constituted which influences or limits the choices and opportunities available Underpinned by certain philosophical assumptions; ontological, epistemological and methodological

27. QUESTION 2 – PASSED!

28. QUESTIONS? J.Bower@warwick.ac.uk