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1: Intro

What is health psycho­logy?
the aggregate of the specific educat­ional, scientific and profes­sional contri­butions of the discipline of psychology to unders­tanding the socio-­env­iro­nme­ntal, behavi­oural , cognitive and emotional factors that influence: - Mainte­nance of optimal health - Develo­pment and course of illness and disease - Response to illness and disease – by patient, family, community, health care providers
What is health?
Not being ill, an absence of symptoms, but also (1) physical fitness and vitality (2) health enhancing behaviour (3) psycho­social well-being (4) function (5) having a positive resource
WHO definition of health: A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (World Health Organi­sation, 1948)
Biopsy­cho­social model
the intera­ction between biolog­ical, psycho­logical and social factors is a prime determ­inant of an indivi­dual’s health status
bio = genetic predis­pos­ition + physio­logical functi­oning
psycho = cognition + motivation + emotion + person­ality
social = culture +legis­lation + community + access­ibility
(1) health is a continuum (2) patient centred (3) coping is the best possible outcome if there is no cure
Common measures of health status
life expectancy = # of years of life, on average, remaining to an individual at a particular age if death rates do not change. Most commonly used measure is life expectancy at birth.
mortality = # of deaths in a population at a given period
morbidity = # cases of a disease that exist at some point of time --> measured by incidence (new cases) and prevalence (total # of existing cases)
burden of disease = the impact of a disease or injury on an individual or a population --> quantifies gap between a popula­tion's actual health and ideal level of health --> measures burden of living with ill health + dying premat­urely using DALY
Disabi­lit­y-A­djusted Life Years (DALY) = # of years of healthy life lost due to (1) premature death: cancer, cardio­vas­cular disease, injuries or (2) living with ill health: mental and substance abuse, muscul­osk­eletal disorders
Health status of austra­lians
Average life expectancy was 80.4 years for males, 84.6 for females. Death rates continue to fall, despite increases in absolute # of deaths
2013 premature deaths (<75 years) = (1) coronary heart disease (2) lung cancer (3) suicide
Leading causes of death are most valuable when making compar­isons over time or between population groups
5 risk factos for potent­ially avoidable deaths (1) tobacco use (2) high body mass (3) high alcohol use (4) physical inactivity (5) high blood pressure
potent­ially avoidable deaths = deaths that could have been avoided given timely and effective health care -> represents underlying population health and access­ibility / effect­iveness of health syste
Health inequa­lities: Aboriginal and Torres Strait Islander people; Low SES; Rural and remote popula­tions; People with disabi­lity; LGBT and intersex people; Veterans; Prisoners
Chronic diseases AKA non-co­mmu­nicable diseases
are long lasting, persistent and need LT management --> respon­sible for greatest amount of illness, death and DALY.
Eight major chronic diseases (1) arthritis (2) asthma (3) back pain and problems (4) cancer (5) cardio­vas­cular disease (6) chronic obstru­ctive pulmonary disease (7) diabetes (8) mental health conditions
dementia charac­terised by the gradual impairment of brain function + affects memory, cognition and person­ality + irreve­rsible and progre­ssive -> not caused by age, primarily affects older people >65
diabetes (1) autoim­mune, childhood onset inability to produce insulin, (2) genetic + enviro­nment, not being able to use insulin effect­ively -> increases rapidly with age
Levels of prevention
primary = preventing the occurence of the disease, e.g. childhood obesity
secondary = preventing / slowing progress of a disease before it causes signif­icant negative health conseq­uences, e.g. smoking
tertiary = treating / managing a disease to reduce its impact, e.g. diabetes
health psychology in practice
clinical health psycho­logists = illness assess­ment, treatment and rehabi­lit­ation, mainly secondary and tertiary
population health psycho­logists = health promotion, illness preven­tion, primary

10. Dementia

What is dementia?
not the name of a specific disease; rather, it describes a syndrome charac­terised by the gradual impairment of brain function. affects memory, cognition and person­ality
What does the current service system look like
(1) assessment service and referral pathway (2) community services (3) royal comission
My Aged Care
inbound referral > assessment > referral > service planning and delivery
Royal Commission into Aged Care Quality and Safety
Government funded aged care before death
Government programs
(1) respite care (2) national dementia support program (3) dementia education and training for carers (4) dementia training program
Aged Care Quality Standards
(1) Personal and clinical care (2) services and supports for daily living (3) organi­sat­ion's service enviro­nment (4) feedback and complaints (5) human resources (6) organi­sat­ional governance (7) ongoing assessment and planning with consumers (9) MOST IMPORTANT consumer dignity and choice
Approaches / models for care
(1) butterfly model (2) eden altern­ative (3) greenhouse model (4) household model of care
butterfly model
the belief that for people experi­encing dementia, feelings matter most, that emotional intell­igence is the core competency and that “people living with a dementia can thrive well in a nurturing enviro­nment where those living and working together know how to “be” person centred together
eden altern­ative
focuses on partnering with nursing homes to help them change their culture, enviro­nment and approach to care to “create a habitat for human beings rather than facilities for the frail and elderly”
greenhouse model
focuses on helping companies and indivi­duals build or convert reside­ntial homes that can provide high levels of care for indivi­duals who do not wish to be in a nursing home setting
household model
residents have a signif­icant say in their daily lives, their care, and their living enviro­nment.
What is person­-ce­ntred care?
views the person with dementia as a whole: unique, complex, enabled, person­hood, value of others, empowe­rment
Essential elements of person centred care
establ­ishing a therap­eutic relati­onship > shared power and respon­sib­ility > getting to know the person > empowering the person > trust and respect
Overcoming stiga (Ageism)
bias towards older indivi­duals, fear of dependency > us vs them > myths and stereo­types > denial of ageing
Language should be
accurate, respec­tful, inclusive, empowering and non-st­igm­atising

2: Theory in Practice

What is a theory?
a systematic way of unders­tanding events or situations (1) a set of concepts that explain or predict events by illust­rating the r/s between variables (2) applicable to a broad variety of situations (3) abstract, until filled with practi­cality
Types of theories and examples
(1) explan­atory, describes the reasons a problem exists. e.g. health belief model + theory of planned behaviour (2) change: guides develo­pment of health interv­ent­ions. e.g. Diffusion of innova­tions + implem­ent­ation theory not mutually exclusive
Role of theory
Foundation for program planning, implem­ent­ation of eviden­ce-­based interv­entions --> use a planning model, e.g. preced­e-p­roceed + theore­tical domains framework
9 criteria to assess theory quality
(1) clarity of constructs (2) clarity of r/s between constructs (3) measur­ability / method­ology (4) testab­ility (5) being explan­atory, statis­tical or observ­atory (6) describing causality (7) parsim­onious (8) genera­lis­ability across behavi­ours, popula­tions and contexts (9) eviden­ce-­based
Ecological approach
emphasises the intera­ction between and across all levels of a health problem. levels of influence (1) indivi­dual, intrap­ers­onal, cognitive behavi­oural (2) interp­ersonal (3) community, insitu­tional
individual key concepts
most basic level: what we know and think affects our actions, e.g health belief model + stages of change (trans­the­ore­tical) + theory of planned behaviour + precaution adoption process
interp­ersonal key concepts
assumes indivi­duals exist within and are influenced by a social enviro­nment, e.g. social cognitive theory + theory of reasoned action + theory of planned behaviour
community key concepts
how social systems function and change, e.g. diffusion of innova­tions theory + commun­ication theory + community organi­sation
What is a self-r­eport?
cheap, easy and common, especially useful for measuring sexual behavi­ours, attitudes, opinions and beliefs BUT consis­tently undere­sti­mates the proportion of indivi­duals at risk
Conseq­uences of inaccuracy
(1) under/over estimation of risk and inappr­opriate interv­entions and resource allocation (2) miscla­ssi­fic­ation of risk status by the individual (3) obscuring possible causal relati­onships between risk and disease (4) erroneous conclu­sions about effect­iveness of interv­ention strategies
Assessing accuracy of self-r­eport
(1) true positive / negative: screening = diagnosis (2) false positive: screened but no actual disease (3) false negative: not screened but has disease
proportion of people with diagnosis who score positive on screening instrument = people who are at risk for a health behaviour who accurately report that they are a smoke (a/(a+c))
proportion of people without the diagnosis who score negative on the screening instrument = proportion of people who are not smokers who accurately report that they are not smokers (d/(b+d))
What factors impact accuracy?
(1) recall difficulty (2) lack of knowledge (3) poor survey design (4) lack of motivation to answer (5) demand charac­ter­istics, e.g. social desira­bility (6) differ­ences between instru­ments, measures and modes of data collection (7) imperfect gold standard
How can we optimise accuracy?
(1) reduce response cost, minimise response biases (2) maximize rewards for responding optimally. using recall­-aiding strategies and clear, exhaus­tive, mutually exclusive questions (3) bogus pipeline techniques (4) level and signif­icance of measur­ement error, triang­ula­tion, validation sub-st­udies

Gold standard

7: HIV

What is HIV?
a virus that attacks the body's immune system, transm­itted by bodily fluids including blood and semen. currently no cure or vaccine, untreated can lead to AIDs. People don't die from HIV, but other serious illnesses they are vulnerable to.
What is AIDS?
Acquired Immune Deficiency Syndrome, when a person's immune system has been severely damaged by the HIV virus. Person will be vulnerable to infections and illnesses that their immune system would normally be able to fight of.
4Es pre-re­qui­sites for transm­ission
(1) exist (2) exit (3) enter (4) enough (viral load)
4 main ways of transm­ission
blood, semen, vaginal fluids and breast milk
What are the current trends in HIV infection?
decreasing incidence of HIV but increasing preval­ence: more people are surviving with HIV related illnesses.
Stigma and discri­min­ation
Stigma, discri­min­ation, and social exclusion from employment and education can increase the risk of HIV
Preventing transm­ission through sexual activity
test often, treat early, stay safe (1) condoms (2) Pre-ex­posure prophy­laxis (anti-­viral drug, like the birth control pill) (3) Undete­ctable viral load (undet­ectable = untran­smi­ssable)
At risk groups
(1) ATSI, (2) Culturally and lingui­sti­cally diverse MSM, (3) Trans and gender diverse people

11. Trauma and Aboriginal Health

What is trauma?
involves threats to life or bodily integrity, or a close personal encounter with violence or death
What is interg­ene­rat­ional trauma?
transm­ission of experi­enc­es:­Mem­ories, emotions and lived experi­ences are passed on uncons­ciously to subsequent genera­tions within families. especially when parents have been abused or neglected as children
What is collective trauma?
Blow to the basic tissues of social life that damages the bonds attaching people together and impairs the prevailing sense of community. also includes interg­ene­rat­ional trauma
How does it cause individual to feel and behave?
feeling powerless, helpless and paralysed > tends to be sudden and overwh­elming, potent­ially life-t­hre­atening
What kinds of trauma related behaviours might we see?
(1) mental health behavi­ours, e.g. PTSD, survivors guilt (2) homele­ssness psycho­somatic illness (3) A&OD misuse (4) poverty (5) lack of self-r­egu­lation (6) distorted body image (7) cutting and self harm (8) fractured relati­onships (9) disregard for safety (10) hoarding (11) poor educat­ional achiev­ements
Toxic stress
when a child experi­ences strong, frequent, and/or prolonged advers­ity­—such as physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumu­lated burdens of family economic hardsh­ip—­without adequate adult support.
Assimi­lation policy
Stolen generation
Recovery from trauma
public acknow­led­gement and community action


Health Belief model
theorizes that people’s beliefs about whether or not they are at risk for a disease or health problem, and their percep­tions of the benefits of taking action to avoid it, influence their readiness to take action --> most-often applied for health concerns that are preven­tio­n-r­elated and asympt­omatic, such as early cancer detection and hypert­ension screening – where beliefs are at least as important as overt symptoms.
(1) perceived suscep­tib­ility (2) perceived severity (3) perceived benefits (4) perceived barriers (5) cues to action (6) self-e­ffi­acacy
States of change (trans­the­ore­tical) model
(1) precon­tem­plation (2) contem­plation (3) prepar­ation (4) action (5) mainte­nance
Two other models - theory of planned behaviour & precaution adoption process model

Change Strategies

Change Strategies


3: Eviden­ce-­based Practice

What is evidence based practice?
an approach to health care that promotes the collec­tion, interp­ret­ation and integr­ation of best research evidence in making decisions about patient care (Straub, 201)
Levels of evidence
levels reflect how confident we can be about the findings (1) most confident: systematic reviews / meta-a­nal­ysis, e.g. (2) randomised controlled trials, control group (3) other types of empirical studies, e.g. e.g. pre-post trial + interr­upted time series + multiple baseline design (4) no planned data collec­tion, e.g. expert opinions
What consti­tutes high quality evidence?
What sets a systematic review apart from others?
Systematic reviews have pre-de­ter­mined criteria with explicit methods of appraisal and synthesis. It is replic­able, resolves contro­versy between confli­cting trials, reduces biases and identifies opport­unities for research
What is bias?
introd­uction of systematic error into sampling, encour­aging an outcome over another
How to minimise bias?
(1) objective measures (2) blinding / random allocation of partic­ipants and invest­igators (3) process measures
What causes bias in effect­iveness trials?
(1) social approval bias (2) knowing group allocation (3) treatment diffusion / contam­ination (4) non-st­and­ardised interv­ention delivery (5) non-ra­ndo­mised recrui­tment (6) funding bias
Consort statement
an eviden­ce-­based, minimum set of recomm­end­ations for reporting randomized trials.
Cochrane collab­oration
Intern­ational non-profit that maintains and dissem­inates systematic reviews of health care interv­entions to assist profes­sionals in making informed decisions about health care by preparing and regularly mainta­ining systematic reviews. i.e. peer reviewed gold standards focusing on interv­ention effect­iveness updated < 22 years

5. Substance use

How are substances charac­ter­ised?
Based on their chemical compos­ition, legality and effect in intoxi­cation: stimulant, depressant or halluc­inogen
increase neuroc­hemical activity, energy, heart rate. e.g. coffee, nicotine, amphet­amine, ecstasy, cocaine
depress brain function, alertness and lowers inhibi­tions. e.g. alcohol, opioids, benzod­iaz­epines, GHB, inhalants, marijuana
distort percep­tion, may be stimulants or depres­sant. (1) psyche­delics, e.g. LSD, mescaline, DMT, magic mushrooms (2) dissoc­iat­ives, e.g. ketamine, PCP, nitrous oxide (3) deliri­ents, e.g. datura, atropine
What are the most commonly used substances in Australia?
tobacco - alcohol - cannabis - ecstasy - metham­phe­tamine - cocaine - heroine
Models / approaches to treatment
(1) motiva­tional interv­iewing (2) stress vulner­ability model
(MI) Fundam­ental processes
engaging, focusing, evoking and planning
(SV) strategies
talking therapy, meaningful activities and supportive relati­ons­hips, healthy lifestyles
What underpins our approaches to treatment?
demand reduction, supply reduction, harm reduction. National Drug Strategy, 2017
(1) drug use is universal, almost everyone uses drugs (3) use of mind altering drugs is normal (4) illicit drugs do not inherently differ from other drugs
Substance use disorder (DSM-5) >2
(1) failure to fulfil major role obliga­tions (2) physically hazardous (3) recurrent social or interp­ersonal problems (4) tolerance (5) withdrawal (6) using more or over a longer period than intended (7) persistent desire / unsucc­essful efforts to control substance abuse (8) excessive time spent obtaining, using and recovering (9) reduced social, occupa­tional or recrea­tional activities (10) continued use despite physical or psycho­logical problems (11) cravings

9. Psycho­-on­cology

What is psycho­-on­cology?
concerned with the effects of cancer on a person's psycho­logical health, as well as the social and behavi­oural factors that may affect the disease experi­ence.
What factors influence the develo­pment of cancer?
(1) genetic predis­pos­ition (2) compro­mised immune systems (3) other social determ­inants of health, e.g. allostatic load, racism (4) enviro­nmental exposure to carcin­ogens. e.g. radiation, sun, smoking
What are the aims of treatment?
(1) managing / treating mental illness (2) fostering post traumatic growth (3) increasing patient's ability to complete cancer treatment (4) managing transition to surviv­orship
What approaches are used?
CBT, Acceptance and commitment therapy (ACT), exercise, medica­tion,
Take note of burnout in clinicians - if caregivers are distress, patients find it harder to adjust, caregi­ver's QoL decreases, patient is more likely to have poor treatment outcomes
What are some ways clinicians in this field can look after themse­lves?
vary workload; set bounda­ries; collab­orate with treating physic­ians; manage expect­ations
How surgery impacts people psycho­log­ically
threat to personal security and control; distress from separa­tion; anxiety regarding death
Common psycho­social challenges
(1) loss of personal security and control (2) poor physical health, fatigue, disfig­urement (3) cognitive impact (4) strained relati­ons­hips, differ­ences in coping styles (5) spirit­uality and existe­ntial issues (6) changes in world view
Greater risk of distress if
pre-ex­isting mental illness, homele­ssness or financial stress; bad prognosis at time of diagnosis; poor overall quality of health through treatment


Social cognitive theory BANDURA
Health behavi­oural change is the result of reciprocal relati­onships among the enviro­nment, personal factors and attributes of the behaviour itself.
(1) Self efficacy is the confidence in one's abilities to take action and overcome barriers
(2) Reciprocal determ­inism = dynamic intera­ction of person, behaviour and enviro­nment in promoting behavi­oural change
(3) behavi­oural capability = knowledge and skill to perform a given behaviour
(4) expect­ations = antici­pated outcomes of a behaviour
(5) observ­ational learning = imitating

4. Obesity prevention

How do we measure obesity?
Definition not a judgement. BMI = kg/m2 > 29.9
Trends in obesity
Greater prevalence of obesity, especially in regional Australia
Problems associated with obesity
(1) sleep apnea (2) cardio­vas­cular disease (3) Type 2 diabetes (4) renal dysfun­ction (5) cognitive impairment and depression (6) cancer (7) non-al­coholic fatty liver disease (8) osteoa­rth­ritis (9) discri­min­ation (10) academic perfor­mance due to absences
What are some contri­buting factors to obesity?
multi-­fac­torial (1) intern­ational develo­pment, advert­ising (2) national urbani­zation, education, transport, media, F&N (3) community / individual lifestyle
Lifestyle factors contri­buting to obesity
(1) low-cost, high calorie foods (2) larger portion sizes (3) greater purchasing power (4) misleading nutrit­ional labels (5) health marketing (6) sedentary work (7) smoking cessation (8) reward eating / feeding (9) perceived conseq­uences
Obesogenic enviro­nment
(1) advert­ising (2) infras­tru­cture - indoors, easily accessible (3) technology = labour saving devices
Biological factors contri­buting to obesity
(1) leptin deficiency (2) genetics (3) maternal obesity and gestat­ional imprinting (4) undera­ctive thyroid (5) post menopause and increasing age
Why is childhood obesity a concern?
childhood obesity often leads to adult obesity
Good for Kids, Good for Life programme targeted behaviours
(1) sweet drink consum­ption (2) less energy dense food, more fruits and veg (3) more physical activity (4) less small screen recreation
Good for Kids, Good for Life programme key charac­ter­istics
empirical, whole of popula­tion, sustai­nable
Good for Kids, Good for Life programme trials
(1) canteen picnic (2) physical activity scheduling (3) good sports junior trial
proces­s-s­ettings based change
(1) review current practice (2) identify barriers and facili­tators (3) develop a contex­t-s­pecific interv­ention (4) Identify approp­riate implem­ent­ation strategies > repeat
theore­tical domains framework:
• Knowledge –
• Skills
• Social­/pr­ofe­ssional role and identity
• Beliefs about capabi­lities
• Optimism
• Beliefs about conseq­uences
• Reinfo­rcement
• Intentions
• Goals
• Memory, attention and decision processes
• Enviro­nmental context and resources
• Social influences
• Emotion
• Behavi­oural regulation

6: Smoking Cessation

Smoking related morbidity and mortality
21,000 people die each year due to smoking related disease, generates high health care costs > tobacco smoking is the leading preven­table cause of morbidity and premature mortality
At risk groups
substance abusers, juvenile delinq­uents, homeless people, people with psycho­sis­,ATSI,
Why is quitting harder for some?
addiction : physically and psycho­log­ically dependance on the substance.
Two main approaches
(1) Public health / legisl­ative (2) Clinical
Public health and legisl­ative approaches
(1) smoke free policies (2) tobacco tax (3) advert­ising (4) providing quitline services (5) advert­ising
Clinical prevention
(1) profes­sional advice, CBT (2) Nicotine Replac­ement Therapies (3) Vareni­cline (4) anti-d­epr­essants
(Clinical) Behavi­oural therapies
self-m­ana­gement therapies, motiva­tional interv­iewing, reduction vs cold turkey, relapse prevention strategies
What works best?
(1) combine interv­entions - let the smoker decide (2) be consistent (3) better funding (4) longer interv­entions

8: Alcohol Related Harm

How does alcohol cause harm?
(1) intoxi­cation: acute harm through CNS impairment (2) toxicity: chronic harm due to LT consum­ption (3) addiction: chronic harm through neuro-­ada­ptation of the brain's reward mechanism
Alcohol is
carcin­ogenic (esoph­ageal, liver and breast cancers), terato­genic (fetal malfor­mat­ion), hepato­toxic (liver cirhosis) and poison
Acute vs chronic harm
increased quantity of alcohol consumed = increased risk of alcohol related harm over the short term (acute) and long term (chronic)
Australian guidelines
<2 standard drinks / day; <4 standard drinks / single occassion; 0 drinks for youths <18 and pregnant women
Approaches to prevention (Barbor, 2010)
(1) taxation and pricing (2) supply regulation (3) modifying the drinking enviro­nment (4) drink driving counte­r-m­easures (5) education and persuasion (6) treatment and early interv­ention
Most effective
alcohol taxes, ban on sales, blood alcohol concen­tration testing, early interv­ention
Least effective
education campaigns, social marketing, warning labels
Underp­innings of the current national policy approach
(1) demand reduction: delay onset (2) supply reduction: regulate availa­bility of alcohol (3) harm reduction: social, economic and health conseq­uences to individual / others
1 standard drink = 10g of alcohol


Diffusion of Innova­tions Theory Rogers
Important to consider program reach, adoption, implem­ent­ation and mainte­nance – innovative programs are worthless unless dissem­inated widely
Addresses how ideas, products, and social practices that are perceived as ‘new’ spread throughout a society or community (or from one to another)
By consid­ering the benefits of an innova­tion, it can be positioned effect­ively, thereby maximising its appeal and affecting the speed and extent of its diffusion
Key attributes affecting speed and extent of an innova­tion's diffusion
(1) relative advantage = is the innovation better than what it will replace?
(2) compat­ibility = does the innovation fit with the intended audience?
(3) complexity = is the innovation easy to use
(4) triala­bility = can the innovation be tried before making a decision to adopt?
(5) observ­ability = are the results easily observable and measur­able?


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