biopsychosocial perspective

define illness

anything that means physical, mental and social wellbeing is harmed

define health

 a state of complete physical, mental and social well being and not merely the absence of disease

what does the biomedical apprach look at

• Focuses on physical process of disease

• Pathology, biochem, physiology

limitations of biomedical approach

• Prevention can only occur if we know what the stimulus is and what can be used to prevent it from progressing

• Only focuses on physical state of body, not reflective of definition of health

• Reflects a 'treatment paradigm' focused on disease

• Disease prevention is often overlooked

• Doesn’t recognise psychology or society in cause and treatment

• Doesn’t recognise psychosocial benefits of some preventative activities

• Doesn’t consider social influences on access to prevention

• Hard to treat conditions which are caused by multiple pathways such as neurological diseases- these are also usually discovered too late to prevent

biomedical approach

how does biopsychosocial model differ from biomedical

• How psychological and social factors are involved in physical disease processes

  • Society affects what we think but also environment which both affect our biological health

• Places responsibility for health on individuals and society

psychological factors can be split into two categories, name and explain

• Behavioural:

  • Health protective behaviours such as exercise, diet, sleep

  • Self management such as vaccinations or BSE (breast self examination)

  • Screening such as hypertension, blood cholesterol, cancer, dental

  • Health risk behaviours such as smoking, alcohol, unsafe sex and risky driving

• Cognitive

  • What we think

  • Stress - affects levels of cortisol

explain the importnace of palcebo and nacebo effects

• The placebo effect is measurable, observable, or felt improvement in health not attributable to treatment - observed in half of all people, if you get a choice of treatment then placebo effect is greater

• Nocebo effect occurs when inert substance produces symptoms of harm

• Effects are due to a combination of psychological and physiological mechanisms

strengths of biopsychosocial

• Treats whole person

• Acknowledges biographical and psychological factors

• Recognises influence of social context

limitations of biopsychosocial

• Macro-level factors such as legislation, infrastructure, service provision are often ignored

• Focus on individuals behaviour may distract from social responsibility

• Little acknowledgement of cultural factors

 

effect of Psychoneuroimmunology (PNI) … psychoneuroendocrinology (PNE)

• Loneliness/ depression/ stress impair immune function

• Positive moods enhance immune function

• Perception of situation is affected by social support

examples of social influence

 social support, social policy and provision of resources

protective effects of social support

• Lower physiological reactivity to stressful experiences

• Lower risk of premature death

• Lower risk of dementia

2 mechanisms of psychosocial influences on health

• Direct effects: positive emotions influence endocrine (hormonal system) and immune function

• Indirect effects: better social support encourages healthier behaviour and use of services

psychosocial factors - lifestyle (5)

• Decreased use of tobacco/ drugs

• Regular physical activity

• Balanced nutritional intake

• Positive mental health

• Safe sexual activity

psychosocial factors - health services (3)

• Provision of preventive services

• Culturally appropriate services

• Public involvement in planning and delivery

psychosocial factors (5)

• Participation in civic activities

• Control over life decisions

• Supportive family

• Self esteem

• Social networks

psychosocial factors - environments (6)

• Safe physically

• Meaningful job

• Affordable house

• Good food and water

• Healthy public policy

• Supportive conditions

ways to promote health + explanations (4)

• Promotion and evaluation of healthy lifestyle programmes

  • Health protective behaviours

  • Health risk behaviours

• Early identification of people at higher risk

  • Screening

  • Self examination

• Legislative action/ government initiatives may be required

  • Smoke-free public space

  • Product labelling

  • Taxation

• Importance of central and local government

what is the theory of planned behaviour

• On the basis that our behaviour is based on what we intend to do, our motivations

• Implementation intention is deciding how you will make sure that you will do a certain behaviour

• Behavioural control is whether or not we think we can change this behaviour

what is the COM-B model

• Very focused on individuals taking responsibility for their behaviour

• Includes opportunity for behaviour change

• Components may be multifaceted

• E.g. adding cycle lanes gives opportunity to cycle safely so more people do it

what is the dual process model

• Components may be multifaceted

• Recognises that we are not robots that always pick best option for us, it takes into account impulsive processes which are likely to be caused by emotions and other senses

• Boundary conditions is to what extent we are influenced by these processes

what is the transtheoretical/ stages of change model

• Transtheoretical model emphasises that behaviour change is a process that requires information, skills development and motivation at different stages

• Thinks about how people carry on with a behaviour after the initial decision to make the change

• Precontemplation is when they are unaware of the issue, they do not see a need to change

• Contemplation is just debating whether or not changing is worth it

• Preparation is getting ready to make the change, like throwing away all the junk food and buying healthy food now

what are the limitations of these behaviourial changing models (5)

• Probabilistic

  • Cannot explain variation in behaviour

  • Cannot deal well with ambivalence

• Individualistic

  • Other people can affect our actions

• Assume planning

  • Some actions do not have a large thought process behind them

• They are best for:

  • Explaining one off behaviours like vaccines

  • Explaining initial changes but not maintenance

3 main things to change unhealthy behaviour

• Identify important cognitive and motivational factors

• Develop required skills for initiation and maintenance

• Identify contextual factors and not only individual factors

what are the 3 levels at which there are interventions to chnage behaviours

• individual level

• multi-component - has individual and population components

• population/ cultural level

how can individual level interventions take place

• Motivational interviewing is semi-directive, client-centred counselling style involving:

  • Resolving ambivalence

  • Goal setting and monitoring

  • Skills development

  • Enhancing motivation to initiate and maintain change

how can multi-component interventions take place

• One-to-one interventions

• Group interventions

• Provides info, motivation, skills development and peer support

• e.g. stopober, nhs smokefree

how can population/ cultural interventions take place

• Opportunity to conduct behavioural experiments

• Opportunity to experience benefits of behaviour changes

• Develop skills

• Opportunity to enhance motivation

• Raises topics in society to be talked about more

• e.g. dry January raises alcohol awareness