List the five phases of the Behavioural epidemiology Framework:
- 1. Establish links between behaviours
- 2. develop methods for measuring the behaviour
- 3. identify factors that influence the behaviour
- 4. evaluate interventions to change it
- 5. translate research into practice
Wha is the Behavioural Epidemiological Framework?
- It is a framework which studies the distribution and aetiology of health related behaviours in populations.
- It is used to guide progession of research to ensure its application to public policy and practice.
Describe what is a DALY and what its made up of?
- Disability Adjusted life years:
- YLL (Years life lost due - gap in age of death and the standard) + YLD (Years lived with disability)
One DALY = one healthy life lost.
In what year was tobacco linked with lung cancer and what is meant by "lag in movement"
- 1950's - studies showed people who smoked longer in their lives died quicker than those that didnt.
- If stopped before 44 you lived longer than those you continued to smoke after 44 Doll et al 2004.
Lag in movement as links are made then years later guidelines are introduced and years later a slight change can be seen.
Describe the levels of evidence from strongest to weakest:
- 1. Systematic reviews and meta-analysis of RCTs
- 2. Randomised Control Double Blind Trials
- 3. Quasi randomised controlled trials
- 4. Cohort/ Longitudinal Studies - follow ups = gets idea of temporality
- 5. Cross sectional studies - only measure one point in time
- 6. Case Series
- 7. Case Study
Explain the evidence that is available on alcohol consumption in Australia
- - many risks associated with heavy drinking = guidelines put in place
- - both physical and mental health outcomes
- - drinking heaps is on the decrease
Explain the evidence on Physical Activity
- 3x per week at least 20min
- - has high benefits, low injury risk
- - moderate to vigorous exercise
- - decreases cardiovascular disease and diabetes type 2 AND obesity
- - weight bearing avtivities = diff activitys = diff gain
Explain the evidence on Oral Health Behaviours:
- -brushing, flossing, low refined sugar intake, no inbetween snacks decrease, no smoking
- - Outcomes: PD, caries, systemic health issues - diabetes managment and pregnancy issues, atheroscleorosis
What is so bad with blaming the victim?
- simplifies the situation
- ignores the extent of the problem
- not helpful blaming
Explain the evidence on sedentary behaviour:
time have changes so that there are more domestics where we are sitting for prolonged periods f time - work, transport, leisure activities.
Outcomes: mortality, CVD, metabolic syndrome, cancer, diabetes
- *The more sitting you do increases your chance of dying 15 years later
- - breaks in sedentary behaviours is important as it reactivates proteins in your muscles - decreasing the outcomes
Give examples of Measurements at a National Level:
- the assignment of numerals to aspects or objects or events according to rules
- - it evaluates interventions
- - is important for finding links between health and behaviours
- - whole range of people measure - doctors, govt officials, oral health therapists, psychologists
National health survey, National nutrition survery, National Survey of Adult Oral Health
What does monitoring and surviellance methods do?
- they work at tracking process and looking at the associations between health and behaviours on a population level.
- looks at impacts cultural or political change has
Is a concept that describes and includes a number of characteristics and attributes about a person or environment
Whats the difference between an objective and a subjective measure?
- Objective - based on external factos outside of the person performing the behaviour
- Subjective - internal factors - self reports = personal judgement.
What is the difference between qualitative and quantitative measures?
- Qualitative: analysing aspects of behaviours i.e. personal beliefs
- Quantitative: assigning numbers to a particular behaviour
List the problems with Measuring:
- - Recall Bias = errors in ones ability to accurately recall what they did in the past
- - Social Desirability Bias = tendency for people to reply in a way that would be favourably viewed by others
- - Reactivity = change you behaviour due to the measurement itself
List some Types of Measures:
- - Self Reports:
- = diaries: record on real time, quite burdensome, social desirability bias
- = questionaires: can be usual or unusual behaviour, cheap but overreporting/ under estimating is a problem
- = recall : can miss behaviours outside of timeframe (snapshot effect), more accurate then general recall but takes long time to complete
- Observation = time consuming and expensive, used on little kids, reliabilti of observers need to be trained so looking for the same things
- Acitivity monitors: no recall bias just reactivity and assesses the behaviour directly, costly
- biobehavioural measures: invasive as blood tests and saliva and urine, can be affected by external facotrs e.g. nerves or caffeine
Describe the Levels of Measurement:
- Nominal: number used for simple classification, no heirarchy
- Ordinal: theres a heirarchy, they are inrelation to each other
- Interval: distance between any 2 numbers on the scale are of a known and consistant size - temp
- Ratio: interval characteristics with the addition of a true zero point (zero value means none) - weight, height
6 Criteria to measuring the quality of a measure:
- Applicability: how well the measure fits the particular sample of interest
- Acceptability: the willingness and ability of the sample to complete the behavioural measure
- Sensitivity: ability of the measure to detect differences between individuals or change within an individual or group
- Specificity: extent of the measure to identify the individuals with a specific attribute and not mis-identify individuals that do not have that attribute
- Reliability: dependability or consistency of a measure = made up of test-retest reliability, internal consistency (extent to which indiv. give similar responses to all items within a measure) and inter-rater reliability (observers rate participants behaviour and their ratings are assessed and compared)
- Validity: Made up of Internal validity and External Validity
Interval Validity: degree to which the results are correct for the group being studied = three types: criterion validity (how is compares to the gold standard), concurrent validity (how the results compare with similar studies results) and content validity (panal of experts evaluate it - does it cover all important aspects of the construct)
External Validity: degree to which the results of a study aply to people not the study - broader pop group
Define Prevalence and Trends:
Give some examples
- prevalence: number of people engaging in a behaviour at a specific point in time
- trends: changes in the prevalence of a behaviour within a specified period of time - need prevalence to determine trends in behaviours and can show changes over time and between subgroups
- *guideline compliance measured by self-administered questions and telephone administered questions
- * gives information for intervetions plans - what groups need to be focused on?
- E.g. guidelines for PA = 30 min mod-vig exercige 5 days a week OR 20 min vig exercice 3 days a week, children should do 60 min of mod-vig every day
- older you get the more likely you are to consume inadequate levels of fruit and veg
Factors that affect population prevalence estimates:
- behavioural measure (whether its objective or subjective)
- timing of measure ( active aus and olympics)
- purpose/ motivation of measure ( government research or? )
- Sampling techniques (specific groups or random)
factors that affect population trend estimates
- levels of influence (policy, environment, seasonal change)
- methodological change (wording of questions, administration technique, type of measure)
What are the Four assumptions of the Ecological Approach to Understanding health Behaviours
- There are five layers
- 1. multiple layers of influence
- 2. there are interactions between these layers
- 3. the model should be behaviour specific
- 4. an intervention that targets all 5 levels will be most successful
What are the five layers of the ecological approach to understanding health behaviour?
- intrapersonal - those inner thoughts psychological
- interpersonal - related to the interactions between peers e.g. social support, marital status
- organisation - group of people with a common goal e.g. workplace, uni, school
- community/ environment - environemtn around us, the setting/ context e.g. natural built or commercial environment
- policy - legislative, regulatory or policy making actions e.g. no smoking in clubs, alcopops
- things that are associated with a behaviour
- an association does not necessarily mean that a change in event a causes a change in event b
- helps develop hypothesises
- have a causal relationship (caused/ influence)
- one determines another
- are identified by experimental or quasi experimental studies
There are three types of other factors that affect the influence and behaviour. What are they are give examples?
- Confounder: related to both the influence and the behaviour
- e.g. outdoor play area --> childrens activity (confounder is the preschool curiculum)
mediator: is necessary to make the link between the two e.g. tv viewing -> snacking (advertisements need to be present)
moderator: changes the strength or direction of the behaviour e.g. oral health campaign --> teeth brushing frequency (goor or poor access to tooth brush and tooth paste changes the strength of the amount of times poeple will brush - frequency)
what is self-efficacy?
confidence in their ability to perform a behaviour
Explain in more detail the first level of the Ecological Approach:
intrapersonal influences: first came from psychologists in the 1950s = based on theories 4 types of explanatory theories, Health belief model, the theory of reasoned action/ planned behaviour, transtheoretical model and social cognitive theory
What is the Health Belief Model?
- Is used to explain the lack of use of free public health programs
- health actions are predicted by a balance between degree of fear (perceived threat - perceived susceptibility and severity) AND fear reduction potential of action (how much threat is taken away by getting the disease?)
- cues to action and selfefficacy are also addressed
What is the theory of reasoned action/ planned behaviour?
behaviour is affected by behaviour intention (perceived likelihood of performing the behaviour) which is affected by 1. a persons attitude to do it and 2. whether or not their peers think the behaviour is importnant
What is the trans-theoretical model?
- behaviour change is a PROCESS not an event
- move through five stages:
- 1. precontemplation - not even thought about it
- 2. contemplation - intend to take action in next 6 months
- 3. preparation - intend to take action in next 30 days - gradual goals
- 4. action - has changed behaviour for less than 6 months
- 5. maintenance - has changed it for more than 6 months
*good when assessing fruit and veg intake OR PA but it can be too broad and hard to actually test
What is the social cognitive theory?
- put in the idea of social pressure
- 3 main factors: self efficacy, goals and outcome expentations
- *reciprocal determination = dynamic interaction of the person, behaviour and the environemnt
- *observational learning = social influence, learn from watching -influential people
- * reinforcements = rewards