Psychological & Social Factors Influencing Patient Behavior Version 3

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Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environmental

Text of Psychological & Social Factors Influencing Patient Behavior Version 3

  • Psychological & Social factors influencing

    patient behaviorin family medicine & Primary care perspective

    Krid Thongbunjob M.D. , M.P.H

  • ?

  • Holistic Medicine

    Person

    Who, Life cycle Development Family of Origin

    Illness

    Disease

    Family

    Family SystemFamily Life cycleFamily StressFamily CopingFamily ResourceImpact on Health

    Community

    Pt.& Fam RoleResourceHSSWorkSchoolCultureReligion

  • Like a Family,

    a Community is more than sum of its parts.

    McClaran J. In Working with the Family in Primary Care

  • Community & Family context

    Family

    Community

  • Community & Health

    A source of Health

    A source of Sickness

    A resource for clinician

  • ?

  • THEORIES OF DISEASE CAUSATION

    The germ theory of disease

    Multicausal models of disease

    The theory of general susceptibility

    The socioenvironmental approach

  • , DrPH

  • New Public Health : Health Field Model

    Marc Lalonde,

    Minister of National Health and Welfare in 1972

    , DrPH

  • The germ theory of disease

    Disease is caused by transmissible agents

    A specific agent is responsible for one disease only

    Medical practice consists of identifying and neutralizing these agents

  • Epidemiological triangle

    Exposure to an agent does not necessarily lead to disease

    Disease is the result of an interaction between agent, host and environment

    Disease can be prevented by modifying factors which influence exposure and susceptibility

  • Web of Causation

    Multicausal models of disease

  • Theory of susceptibility

  • Theories of disease causation and the concept of a general susceptibility

    Poverty, social exclusion, poor housing and poor health systems are among the main social causes of ill health.

    Najman JM. Theories of disease causation and the concept of a general susceptibility: A review. Social Science & Medicine Part A: Medical Psychology & Medical Sociology. 1980;14(3):231-7.

  • Socioenvironmental approach

    Health is powerfully influenced by the social and physical environments in which we live

    Risk conditions integral to those environments damage health directly and through the physiological, behavioral and psychosocial risk factors they engender

    Improving health requires political action to modify these environments

  • Social-Ecological Model

  • Determinants of Health center for disease control(1996)

    50%

    20%

    20%

    10%

    Life Style

    Biology

    Environment

    Health System

    , DrPH

  • Social and Environmental Determinants of health

    Social status and Income

    Social support networks

    Education

    Employment and working conditions

    Physical environments

    Personal health practices and coping skills

    Healthy child development

    Health services

    Source: Federal, Provincial and Territorial Committee Advisory Committee on Population Health (1994).

  • /

    //

    /

    //

    /

    26 November 2010 Humanized Rehabilitation for Chronic illness 23

  • Interaction Effect

    B=f{PxE}

    , DrPH

  • Bio-Psycho-Social Approach

  • SOCIAL AND PSYCHOLOGICAL FACTORS Related HEALTH

    Social and cultural change

    Social support

    Life events

    Occupational hierarchies and the organization of work

    Unemployment

    Health behaviors

    Sense of coherence

  • Type of Medical Care

    Primary Care

    1. First Contact

    2. Continuing Care

    3. Comprehensive Care

    4. Coordinating Care

    Secondary Care

    1. Short stay in hospital

    2. MD consulting

    Tertiary Care

    1. Uncommon Disease

    2. Need intensive & close monitoring

    3. Disease Specialists

  • Ecology of Medical Care

    1000

    750

    250

    951

    Adult population

    Age 16+ yrs

    Illness or injury

    a month

    Consulting MD in PC

    a month

    Admitted a month

    Referred TC a month

    Referred medical center a month

    White KL. NEJM 1961;265(18):885-892

  • A 2 x Perinatal dealth

    3 x Teenage preg.

    8 x TB infection

    20 x STD infection

    26 x Alcoholics

    5 x Crime rate

    6 x Suicidal rate

    7 x Sexual assault

    50% : Age < 25 yrs

    60% Adult : Smoking

    40% : Elementary education

    40% : Unemployed

  • White Canadian HC Providers

  • Inuit (quallunaat).

    . Quallunaat

  • Inuit

    ...( )...... ?

    ...

  • White clinician

    .

    Inuit .

  • White

  • Inuit

    .

    Its just a symptom, not a cause

  • Inuit Inuktitut

    Inuit

  • Inuit

    .

  • Inuit

    .

    .

    .

  • Inuit

    Inuktitut ! .

    !

  • Holistic Medicine

    Person

    Who, Life cycle Development Family of Origin

    Illness

    Disease

    Family

    Family SystemFamily Life cycleFamily StressFamily CopingFamily ResourceImpact on Health

    Community

    Pt.& Fam RoleResourceHSSWorkSchoolCultureReligion

  • Social Determinant of Health

    Family Determinant of Health

  • --- Hardware--- Software

  • "

    .. , .

  • Culture & Gender : Inequality ? There is a difference in health care

    so that women receive lesser quality health care than men receive.

    Occupational

    Income

    Educational

  • hot-cold imbalance

  • Different types of Patient

    Person is unique patients are different

    Same words mean different things to different people

    What works for this one may not work for others

  • Satirs model : Cognitive-Behaviour Linkage

    Consciousness

    Unconsciousness

  • Health Belief ModelHow patients believe about health

    5 elements :

    1. Health motivation

    2. Perceived vulnerability

    3. Perceived seriousness

    4. Perceived costs & benefits

    5. Cues to action

  • Health Belief Model

    1.

    4.

    3.

    2.

    5. !

  • 2.

    3.

    4.

    5. !

    1.

  • Readiness to Change

    Locus of ControlSelf EsteemSelf Efficacy

  • Locus of Control

    1. Internal controller

    2. External controller

    3. Powerful other

  • 1. Internal Controller

  • 6 May 2011 Humanzied Holistic Rehabilitation Krid@SWU 75

  • 6 May 2011 Humanzied Holistic Rehabilitation Krid@SWU 76

  • 6 May 2011 Humanzied Holistic Rehabilitation Krid@SWU 77

  • C spine injury

    6 May 2011 Humanzied Holistic Rehabilitation Krid@SWU 78

  • C spine injury

    6 May 2011 Humanzied Holistic Rehabilitation Krid@SWU 79

  • 6 May 2011 Humanzied Holistic Rehabilitation Krid@SWU 80

  • 6 May 2011 Humanzied Holistic Rehabilitation Krid@SWU 81

  • 2. External Controller

  • 2 .. 2551

    MCA with Head injury S/P tracheostomy

    26 November 2010 Humanized Rehabilitation for Chronic illness 84

  • 9 .. 2551

    ( )

    26 November 2010 Humanized Rehabilitation for Chronic illness 85

  • 26 November 2010 Humanized Rehabilitation for Chronic illness 86

  • 31 .. 2551

    26 November 2010 Humanized Rehabilitation for Chronic illness 87

  • 14 .. 2552

    26 November 2010 Humanized Rehabilitation for Chronic illness 88

  • 26 November 2010 Humanized Rehabilitation for Chronic illness 89

  • 3. Powerful Others

  • Nature of Life Story

  • .

  • Influencing Locus of Control

    Humans are not consistent

    Everyone can be changed & influenced by skillful communicable Medical Professions

  • Personality

    fight or flight

  • Examples of questions

    Do you feel guilty if you use spare time to relax?

    Do you need to win in order to derive enjoyment from games and sports?

    Do you generally move, walk and eat rapidly?

    Do you often try to do more than one thing at a time?

    Type A behavior: Competitive

    Ambitious

    Impatient

    Aggressive

    Fast talking

    Type B behavior: relaxed

    non-competitive

    Rosenman, R. H., Brand, R. J., Sholtz, R. I., & Friedman, M. (1976). Multivariate prediction of coronary heart disease during 8.5 year follow-up in the Western Collaborative Group Study.

    The American journal of cardiology, 37(6), 903-910.

  • Personality & Disease

    The Type A personality types behavior makes them more prone to stress-related illnesses such as CHD, raised blood pressure etc.

    different coping strategies are just as important as personality.

    http://www.simplypsychology.org/personality-a.html

  • Stress-related illness

  • Stress Psychological variables ; life events & loneliness.

    immune responses (T cell activity) were weak feeling most lonely

    experiencing other stressful life events

    psychiatric symptoms ; depression ,anxiety

    Stress (of the exam) reduced the effectiveness of the immune system

    Kiecolt-Glaser, J. K., Garner, W., Speicher, C., Penn, G. M., Ho

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