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54 Cards in this Set
- Front
- Back
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What are the steps to increasing self-efficacy? |
1) setting a goal: must be specific, moderately difficult, divisible, and allows for feedback
2) self efficacy enhancement: performance experience, vicarious experience, verbal persuasion, emotional arousal |
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Which type of prevention combats a disease/illness (including its risk factors) before it develops? |
primary prevention
(e.g. promote exercise) |
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Which type of prevention identifies and treats a disease early, with the aim of stopping or reversing the problem? |
secondary prevention
(e.g. taking blood pressure medication) |
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Which type of prevention contains damage once a disease has progressed beyond its early stages (expensive!)? |
tertiary prevention |
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What is the term that describes the extent to which a person's behavior corresponds with medical advice? |
adherence |
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What is the term that describes the occurrence of the actual treatment that the patient receives being different from the intended treatment? |
nonadherence |
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What is the term that describes the extent to which a person's behavior (in terms of taking medications, following diets, or executing lifestyle changes) coincides with medical or health advice? |
compliance:
- patient in a passive role - having to follow medical advice as a standard - emphasizing patient obedience to instructions |
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What model is adherence consistent with and how? |
biopsychosocial model:
implies active and collaborative involvement of the patient and clinician
adherence assumes the patient's agreement with the recommendations
working together in planning and implementing the treatment regimen
greater emphasis on the patient's role in carrying out a particular treatment
empowering the patient to make decisions among available choices |
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What is HAART? |
highly active antiretroviral therapy to treat HIV
secondary prevention
suppresses HIV viral load to undetectable levels
increases indicators of immune system functioning such as CD4 lymphocytes
improves clinical health
decreases AIDS-related mortality |
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What were the results of single drug therapy in the 1980s-early 90s? |
interfered with the ability of HIV to produce DNA needed for cell replication
temporarily slowed viral replication, but clinical benefits were often transient (short term) |
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Those who reported more frequent missed doses of HAART over time were most likely to have detectable _______________. |
viral loads |
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What is the ABC model of adherence? |
A = antecedents (triggers or cues) B = behavior C = consequences (reinforcements or punishments)
ABC model emphasizes the importance of developing regular habits |
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What are the psychological features of adherents? |
lower in depression
lower perceived medication side-effect severity
greater adherence self-efficacy ("I think I can!")
greater levels of perceived emotional support |
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What are the recommendations of adherence? |
patient understanding of HAART
integration of regimens into daily activities
enhanced patient-provider communication
problem solving skills targeting adherence barriers |
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What are the stages of dying according to Kubler-Ross' Stage Model? |
denial (shock): patient rejects reality of his/her impending death
anger (emotion): patient resents interruption of personal hopes and plans
bargaining: trying to enter an agreement with God, the physician, family
preparatory depression: mourning for loss
acceptance: patient calmer, more realistic |
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What two factors are positively correlated with desire for hasty death? |
depression (r = 0.49) and hopelessness (r = 0.54) |
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What factor is negatively correlated with desire for hasty death? |
spirituality (r = 0.42) |
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What is the median length of hospice service? |
26 days |
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What is a MET? |
one MET represents the approximate rate of oxygen consumption of a seated adult at rest |
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What intensity of METS is performed during moderate physical activity? |
3-6 METS --the equivalent of a brisk walking at 3 to 4 mph for most health adults |
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What are the stages in the transtheoretical model? |
precontemplation
contemplation
preparation
action
maintenance |
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Which stage of the transtheoretical model can be described as when people are not seriously thinking about changing their behavior and may even refuse to acknowledge that their behavior needs changing? |
precontemplation |
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Which stage of the transtheoretical model can be described as when people acknowledge the existence of a problem and they are seriously considering changing their behavior in the near future? |
contemplation |
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Which stage of the transtheoretical model can be described as people intending to change their behavior but may not have begun to do so, or may have modified the target behavior somewhat? |
preparation |
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Which stage of the transtheoretical model can be described as people actually have changed their behavior and are trying to sustain their efforts? |
action |
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Which stage of the transtheoretical model can be described as people who continue to be successful in their efforts to reach their final goal? |
maintenance
length is often set arbitrarily at 6 months, though it can last indefinitely |
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What describes the "recycle" through stages many times before reaching success? |
relapse
a "slip" should not be considered an utter failure, but, rather a step back |
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What are the steps to motivating behavior change? |
no advice you can give will be new to the patient
to promote behavior change, listening is far more important and effective than giving advice
to promote behavior change, asking questions is far more important and effective than giving advice |
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What are the steps to motivating behavior change? |
Establish Rapport
Elicit Agenda
Assess Readiness
Avoid Resistance |
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What may contribute to treatment failures in medical interventions? |
poor adherence |
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Estimates of nonadherence range widely but the adherence rate is about ______% in developed countries according to the World Health Organization. |
50%
"Drugs don't work in patients who don't take them." |
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What did the studies regarding adherence of drugs reveal? |
1) individuals were gradually less adherent to taking medications over time
2) individuals with two diseases/illnesses were less adherent than those with just one, but both groups were gradually less adherent with time
3) individuals with greater frequencies of doses (4) were less adherent than those with just 1 dose |
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What is the proper way to assess adherence and non adherence? |
a comparison of the number of doses taken properly with the number of doses prescribed |
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After the results of single drug therapy in the 1980s-90s, what was the difference once HAART was introduced in mid 1996? |
combination drug therapy
usually individual takes 3 different antiretroviral drugs
HAART reduced AIDS-related deaths indicated by a SIGNIFICANT reduction on a line graph, beginning at year 1996 |
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The lesser number of T-cells an individual has, the greater cost of _______________ care. |
inpatient |
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What is the projected life expectancy of a person entering HIV care (according to 2006 estimates)? |
24.2 years |
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What is the monthly cost of HIV care (according to 2006 estimates)? |
$2100
73% is antiretroviral medications 13% inpatient care 9% outpatient care 5% other HIV related medications and lab costs |
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Why may there be difficulty in HIV drug adherence? |
many different medications taken daily
different dosage interval schedules
some drugs require refrigeration, others do not
some drugs taken on an empty stomach, others after certain types of meals
some are preceded or followed by other drugs to control side effects |
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What were the results of the HAART study in Milwaukee? |
those who reported more frequent missed doses over time were most likely to have detectable vital loads
77% had detectable viral loads if missed at least once a week in the past 3 months |
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What are the endorsed reasons for HAART non adherence? |
treatment reminds me that I am HIV+ (89%)
I do not want others to know I am HIV+ (71%)
When I have clinic appointments, I forget to ask some of my questions about treatment (63%)
I have trouble remembering names of medicines and what they are for (57%) |
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What are the barriers mentioned by non-adherents versus adherents? |
I get confused about how many pills of each kind to take (31% vs. 5%)
I get confused when different kinds of pills look alike (69% vs. 25%)
The instructions for how to take my medications are too complicated to understand (23% vs. 3%)
I do not think treatments will help anyway (23% vs. 0%) |
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What are the strategies to promote adherence? |
asked a doctor, nurse, or pharmacist a question about medication when you saw them (94% endorsed this strategy)
ate meals at regular times (92%)
used mealtimes as a reminder to take medications (82%)
used bedtime as a reminder to take medications (74%) |
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What did the Reduced HIV Concern study reveal? |
Both HIV- and HIV+ individuals had a number of partners that was above the median. Those HIV+ individuals had a greater number of partners than those HIV-
people who engage in high-risk behaviors (sexual or otherwise) may underestimate their own risk for harm
HAART may be used to justify involvement in unsafe sexual behavior |
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What is the life expectancy for the average American born in 1900? |
47 years old |
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What generally occurs after a relapse? |
individuals often regress to an earlier stage and then begin progressing through the stages again |
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behavior change = __________________ |
adult learning |
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Describe adult learning through motivational interviewing. |
self-initiated and self-directed
practical, useful, applicable (problem-solving)
incorporates feedback
therapist is: partner, not expert coach, not parent mirror, not magic pill |
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What is the goal of counseling through motivational interviewing?
What are the three questions that should be answered to promote adult behavior change through motivational interviewing? |
help patient move ahead in readiness |
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What are the three questions that should be answered to promote adult behavior change through motivational interviewing? |
What to do?
Why to do it? (="Imporatance")
How to do it? (="Confidence") |
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What are the tasks of motivational interviewing? |
1) establish rapport
2) elicit agenda
3) assess readiness (i.e. importance and confidence), then build on that base
4) avoid or reduce resistance |
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What are the tasks of motivational interviewing? |
open-ended questions
non-judgmental attitude
appropriate feedback (i.e. reflection, not evaluation) |
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What occurs when rapport is established? |
patient sees you as an ally and not as a boss to be pleased
patient works with you to consider an issue
patient feels comfortable and listened to
therapist's self-esteem is not dependent on patient's change |
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Describe the listening method. |
listen carefully
generate hypothesis about content, meaning, emotion
put your hypothesis in form of a statement
keep voice inflection neutral/down at end
listen to patient's reaction/clarification
restate hypothesis about clarified content |
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What is the purpose of assessing readiness? |
elicit self-motivating statements (positive reasons for change) by patient
self-motivating statement = what they want to do and why |
