2. Health, Illness and quality of life By A. Prof: Mohamed Adel El-Hadidy Psychiatry department, Mansoura Faculty of Medicine 1

3. DEFINITION HEALTH  Medical model of illness defined as Health as absence of disease and efforts rarely go beyond the elimination of disease  In biopsychosocial model of illness :Is a multi-dimensional concept that is usually and measured in term : 1)Absence of physical illness 2)Absence of physical pain, physical disability, or a condition that is likely to cause death 3)Emotional and mental well-being 4)Satisfactory social functioning

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5. Models of Health and Illness There are two main models to explain what is illness, each of them has its roots, history, characteristics and justifications: A)The medical model (MM). B)The biopsychosocial model (BSP). 4

6. The medical Model: Its roots are related to Rene Descartes (1596-1650), This model has characteristics: 1.Disease Oriented: Health is defined as absence of disease and efforts rarely go beyond the elimination of disease. 2.Dualistic: Physical and psychosocial processes are separate and disease is not influenced by the latter. 3.Reductionistic: the disease condition of the patient is of major importance. Social, psychological, and other “external” factors, which may influence patient’s behavior, may be ignored or de-emphasized. 5

7. Important Aspects of the Medical Model: Adherence to the MM has a number of other consequences for the patient and society as a whole, both positive and negative. For example: 1) Development of medications that destroy pathogens. 2) Development of vaccines to protect against viral diseases as polio- and small pox.... etc. 3) Medical technology to diagnose disease (X-rays, and new imaging devices). 4) New surgical procedures (and anesthetics) to reduce complications and save lives. 6

8. The Rise of the Biopsychosocial Model (George L. Engel, 1977): The biopsychosocial model (BPS) is a general model or approach that posits that – biological, – psychological (which entails thoughts, emotions, and behaviors) – social factors, all play a significant role in human functioning in the context of disease or illness. This model actually is return to holism existed at the time Hippocrates 460-370 BC. In it health and illness are states of being that result from multiple factors and have multiple effects. 7

9. Effects Social Physiological Psychological Biopsychosocial Model

10. Definition To understand how the cause of the illness stems from the functioning of the individual's body Biological Component Looks for potential psychological causes for a health problem such lack of self-control, emotional turmoil, and negative thinking Psychological Component Investigates how different social factors such as socioeconomic status, culture, poverty, technology, and religion can influence health Social Component

11. 10 medical ModelBiopsychosocial Model Reason for visit: Patient complains of chest pain. Presentation: The focus is on physical causes of disease. The physician will ask few questions on recent diet, pain history, and familial incidence The aim to ascertain psychosocial and physical processes that may cause the chief complaint, chest pain. The physician may ask for a history of recent life stressors and behaviors. Diagnosis: The clinician will order objective lab tests and monitor vital signs (i.e. temperature, pulse, and blood pressure) that would form the sole basis of any finding. Based on a combination of psychological factors and standard lab tests, the clinician will form a diagnosis. Therapy: The doctor will prescribe a medicinal plan for the patient based on biological etiology and pathogenesis. The physician discusses the available interventions with special attention to behaviors and lifestyles that could influence her pain and adherence to the treatment plan. The patient is involved in formulating and implementing the plan, and maintains a supportive relationship with the clinician.

12. HEALTH FIELD MODEL

13. MEASUREMENT OF HEALTH INDIVIDUAL HEALTH STATUS  1- MEASURED BY PHYSICIAN By performing examination and evaluate the individual in several aspects, including:- -presence or absence of life threatening diseases -severity of disease -overall health

14.  2- ASKING A PERSON may be assessed by asking persons to report for his and her health perceptions in domain of interest using scales or questioners

15. DEFINITION of quality of life -In general, quality of life is the perceived quality of an individual’s daily life, that is, an assessment of their well being. This includes all emotional, social and physical aspects of the individual’s life.

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17. MEASUREMENT OF QOL Physical Health Psychological Health Level of independence Social relationships Environment Spiritually

18. Physical Health Energy and fatigue Pain and discomfort Sleep and rest Psychological Health Bodily image and appearance Negative feelings Positive feelings Self-esteem Thinking, learning, memory and concentration Level of independence Dependence on medicinal substances and medical aids Work capacity Physical Health Energy and fatigue Pain and discomfort Sleep and rest Psychological Health Bodily image and appearance Negative feelings Positive feelings Self-esteem Thinking, learning, memory and concentration Level of independence Dependence on medicinal substances and medical aids Work capacity Environment Financial resources Freedom, physical safety, and security Health and social care Quality Spiritually Religion Principles Personal beliefs Social relationships Personal relationships Social support Sexual activity Environment Financial resources Freedom, physical safety, and security Health and social care Quality Spiritually Religion Principles Personal beliefs Social relationships Personal relationships Social support Sexual activity

19. Measurement of QOL using SF-36 SF-36 is the gold standard scale for measurement QOL. This is a valid / reliable sensitive but not specific measure (it is a generic measure) based on a biopsychosocial model, it measures (8 items) including physical limitation, social functioning and psychological variables (mood and energy levels). It is used to evaluate interventions and is predictive of a range of health outcomes 18

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24. Scoring SF-36 All questions are scored on a scale from 0 to 100, with 100 representing the highest level of functioning possible. Aggregate scores are compiled as a percentage of the total points possible, using the. The scores from those questions that address each specific area of functional health status are then averaged together, for a final score within each of the 8 dimensions measured. (eg pain, physical functioning etc.) For example, to measure the patients energy/fatigue level, add the scores from questions 23, 27, 29, and 31. If a patient circled 4 on 23, 3 on 27, 3 on 29 and left 31 blank, use table 1 to score them. 23

25. How to MAINTAIN HEALTH Health is something that is easy to take for granted. When we start losing it, it’s hard to believe we spent so long not valuing it. Maintaining a healthy lifestyle is the first step in preventing disability. 1)Quit smoking 2)Get regular checkups 3)Get regular cancer screenings 4)Watch your weight 5)Get regular exercise 6)Avoid excessive drinking 7)Become safety minded 8)promote your mental and emotional health, too

26. 25 Health Belief Model and Theory of Reasoned Action The Health Belief Model (HBM) is a psychological model that attempts to explain and predict health related behaviors (i.e., use condoms; stop smoking, practice exercises) to keep healthy. The HBM was first developed in the 1950s by social psychologists Hochbaum, Rosenstock and Kegels.

27. Core Assumptions and Statements A person will take a health-related action if person: 1.feels that a negative health condition (i.e., HIV) can be avoided, 2.has a positive expectation that by taking a recommended action, he/she will avoid a negative health condition (i.e., avoid illegal sexual relation and using condoms if his partner is ill will be effective at preventing HIV) 3.believes that he/she can successfully take a recommended health action (i.e., he/she can use condoms comfortably and with confidence and this will not impair my sexual performance). 26

28. The HBM include six constructs considered in the table 27

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30. Theory of reasoned action The theory of reasoned action (TRA) (Martin Fishbein and Icek Ajzen in 1975, 1980) is a model for the prediction of behavioral intention, across predictions of attitude toward behavior and Subjective Norm. 29

31. 1) Attitudes: the sum of beliefs about a particular behavior weighted by evaluations of these beliefs. You might have the beliefs that exercise 1. is good for your health, 2.that exercise makes you look good, 3. that exercise takes too much time, 4.that exercise is uncomfortable. Each of these beliefs can be weighted (e.g., health issues might be more important to you than issues of time and comfort). 30

32. 2) Subjective norms راي الناس المحيطة بك : looks at the influence of people in one's social environment on his/her behavioral intentions; the beliefs of people, weighted by the importance one attributes to each of their opinions, will influence one's behavioral intention. 1.You might have some friends who are avid شرة exercisers and constantly encourage you to join them. 2.However, your spouse might prefer a more sedentary lifestyle and scoff يسخر و يهزاء at those who work out. The beliefs of these people, weighted by the importance you (friend >< spouse) attribute to each of their opinions, will influence your behavioral intention to exercise, which will lead to your behavior to exercise or not exercise. 31

33. Behavioral intention: a function of both attitudes toward a behavior and subjective norms toward that behavior, which has been found to predict actual behavior. Your attitudes about exercise combined with the subjective norms about exercise, each with their own weight, will lead you to your intention to exercise (or not), which will then lead to your actual behavior. 32

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36. Definition of Disability: A condition or function judged to be significantly impaired relative to the usual standard of an individual or group. Refers to individual functioning, including: – Physical impairment – Sensory impairment – Cognitive impairment – Intellectual impairment – Mental illness – Various types of chronic disease MODEL OF DISABILITIES

37. Mobility and Physical Impairement: – Limits the physical function of limbs or fine or gross motor ability – Can be either an in-born or acquired with age problem or effect of a disease – e.g: Broken bones Spinal Cord Disability: – Spinal cord injury (SCI) Leads to lifelong disabilities Mostly due to severe accidents May be complete or incomplete Types of Disabilities Head Injuries - Brain Disability – Brain injury: Acquired Brain Injury (ABI) – Not a hereditary type defect – Degeneration that occurs after birth Traumatic Brain Injury (TBI) – Results in emotional dysfunctioning and behavioral disturbance Vision Disability – Injuries can result into blindness and ocular trauma – E.g: Scratched cornea, scratches on the sclera

38. Hearing Disability – Completely or partially deaf Partially deaf – Can often use hearing aids – Can be evident at birth or occur later in life from several biologic causes – E.g: Meningitis - can damage the auditory nerve or the cochlea Cognitive or Learning Disabilites – E.g: Dyslexia, speech disorders Types of Disabilities

39. Viewing disability as a problem of the person, directly caused by disease, trauma, or other health condition which therefore requires sustained medical care provided in the form of individual treatment by professionals Medical model of disability

40. Problem lies within society’s attitude towards disability and not within the individual with the disability. So, the society have to do best action to help disabled people to live easy and to participate in community, e.i. special place for disabled pepole in public transport, special books for blind pepole. Social model of disability

41. Medical modelSocial model A disability is a deficiency or abnormality. A disability is a difference. Being disabled is considered to be negative. Being disabled is considered neutral. The disability resides within the individual. The disability stems from an interaction between this individual and society. Cures that will allow for the normalization of the individual are used to remedy the disability. Altering the way society interacts with these individuals is used to remedy the problems associated with a disability. A professional acts as the agent of the remedy. The individual with the disability, an advocate or anyone that can affect the arrangements between society and the individual can act as an advocate of the remedy. Medical model vs social model for disability

42. TRIGGERS TO CONSULTATION 1. perceived interference with occupational or physical activity (my constant headaches mean I can’t concentrate at work…) 2. perceived interference with social or personal relations; (I can’t play football anymore because my knee hurts so much…) 3. occurrence of interpersonal crisis; (my brother’s just had a heart attack, so think I should do something about my chest pain…) 4. temporalising of symptoms; Setting time limits (if my leg hasn’t got better by next week I’ll go to the GP…) 5. sanctioning. Other people's suggestion: (my wife told me to come and see you…) 41

43. TRIGGERS TO CONSULTATION Lay consultations : refers here to discussions with or asking for advice from significant others. often resulted in advice to visit a doctor Self treatment : DIY assay – positive  doctor Incapability of doing works results in economic impact and less efficient work. If getting worse, maybe he get fired Crisis : People may experience a form of crisis such as a death in the family. Relationships : May feel they can't sleep or concentrate which affects their relationships with others. Sanctioning : Other people's suggestion: "Oooh, you don't look well," or " You look pale, have you seen a doctor?” Temporalising : Setting time limits - "I know, I'll leave my sore leg till Monday and if it isn't better i'll go to the doctor“ Activities : Interference with sporting or social activities. 42

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