POME 1
Family Medicine and PHC
Mirriam Mogotsi MSc (Psych)
Bio -psychosocial approach
Biomedical versus Biopsycosocial
Biopsychosocial model
Context: Relationships, perceptions, personality, level of education; previous experiences; beliefs and expectations are determinants of health behaviour.
Health behaviour includes: The understanding and development of disease and illness; health maintenance; sick-role behaviour; risk behaviour; help-seeking behaviour; doctor-patient relationship and responses to treatment (adherence).
See Pretorius et al, 2010
How is it possible?
Physiological and neurological response to
personality and environmental factors.
• Circuit of Papez
• Stress response
Define health
• Absence of disease…
• State of complete physical, social and mental well-being (WHO)
• Context specific
• Age and development dependent
• Education and lifestyle dependent
• Meaning of health and illness (Jung)
Define disease
• DISEASE: Medical term – genetics; pathogens; environmental causes (pollutants & allergens); system-organ-molecular level
• DISEASE: cultural perspectives (humoral theory and balance – laxatives etc); lifestyle choice versus disease - homosexualism and alcoholism; medical advancement (heart attack not cause of death until this century)
• Signs and symptoms as defined by science (label)
Emotional reactions to disease (Kubler-Ross)
• Denial
• Anger / frustration
– Anxiety
– Resentment / blame
– Confusion / overwhelmed
• Negotiation / bargaining
• Sadness /depression
• Acceptance
Define illness
• This is the subjective experience of the
disease and is defined and responded to
differently by different people
• Determinants:
– Own understanding
– Previous experiences
– Culture and belief system
– Medical literacy
Define health, illness and disease (Alder et al, 2009:39 and Pretorius et al, 2010)
Public account
of illness
(lay perceptions)
Normal illness
due to disease
e.g. otitis media
Real illness
e.g. Major life
threatening disease
e.g. MI
Health problems
that are not illness
e.g. Conditions
associated
with age
Psychological e.g.
Stress related and/or
Psychiatric conditions
Define illness behaviour
Health /illness
behaviour
Sick role behaviour Health behaviour Risk behaviour Adherence
behaviour
Sick role behaviour
Risk behaviour
Three stage assessment Clinical Label
Illness, disease and health
Primary / presenting complaint
Secondary complaint (related or non-
related)
Chronic condition / underlying complaint
Management
Individual RICEFF Management
Contextual Family; Relationships; Support; Lifestyle
(smoking, alcohol use, drugs, diet, exercise); Income;
Stressors, and other social detrminants of
health - Rural vs urban; Socio-economic
factors; Pollution; Water resources;
Housing; Sanitation; Work place; Socio-
political; Ideology; Infrastructure; Food
security and hunger; War ; Displacement;
Environment; Culture etc.
Management
Clinical
• Label
• Illness, disease and health
• Primary / presenting complaint
• Secondary complaint (related or non-
related)
• Chronic condition / underlying complaint
Diabetes, TB lung, Smokers lung and HIV
Individual
• R - Reason for consultation
• I - Ideas
• C - Concerns
• E - Expectations
• F - Feelings
• F - Fears
Reason for the consultation/
encounter /presenting at health
care
• Limit of tolerance
• Limit of anxiety
• Problems of living presenting as
symptoms
• Administrative reasons
• Preventative
INDIVIDUAL
Ideas /Beliefs
Ideas /Beliefs
Ideas /Beliefs
Ideas /Beliefs
Ideas /Beliefs
Ideas /Beliefs
Contextual
• Behaviour is contextual
• Defined by systems – informal and formal
• Defined by culture and sub-culture
• Dynamic
• Social determinants of health
Ideology
• Political ideology: form of government
(e.g. democracy, theocracy etc.) Political
ideologies are concerned with many different aspects of a society,
some of which are: the economy, education, health care, labor law,
criminal law, the justice system, the provision of social security and
social welfare, trade, the environment, minors, immigration, race,
use of the military, patriotism, and established religion.
• economic system (e.g. capitalism,
socialism, etc.)
• Rights based (feminism, etc)
Family
Families
• Nuclear Family (have a husband, wife and
one or more biological or adopted
children.)
• Single Parent Family
• Extended Family
• Childless Family
• ??Gay family- people of the same sex
having a marriage
On the basis of marriage: Family has been classified into three major types:
• Polygamous or polygynous family- the
practice of having more than one wife at the same time
• Polyandrous family - having more than one
husband at a time
• Monogamous family - having one mate
Western Kinship
• Mother: a female
parent
• Father: a male parent
• Son: a male child of
the parent(s)
• Daughter: a female
child of the parent(s)
• Brother: a male child
of the same parent(s)
• Sister: a female child
of the same parent(s)
• Grandfather: father of
a father or mother
• Grandmother: mother
of a mother or father
• Cousins: two people
that share the same
grandparent(s)
For collateral relatives within the nuclear
family:
• Grandfather: a
parent's father
• Grandmother: a
parent's mother
• Grandson: a child's
son
• Granddaughter: a
child's daughter
• Uncle: father's brother, mother's
brother, father's sister's husband,
mother's sister's husband
• Aunt: father's sister, mother's sister,
father's brother's wife, mother's
brother's wife
• Nephew: sister's son, brother's son,
wife's brother's son, wife's sister's son,
husband's brother's son, husband's
sister's son
• Niece: sister's daughter, brother's
daughter, wife's brother's daughter,
wife's sister's daughter, husband's
brother's daughter, husband's sister's
daughter
• Cousin: the most classificatory term;
the children of aunts or uncles
Relationships
Context
Rural versus urban
Pollution
Work place
Infrastructure
Access to Water
Food and food storage
Hunger
Natural resources Arum lily- The leaves are also traditionally used as a poultice for aching
inflamed wounds and a treatment for headaches
Fever tree: grow in swampy areas and the early settlers realised that they get fever in those areas (later we knew it was malaria due to mosquitoes in swampy areas)
Willow tree: Hippocrates referred to their use of salicylic tea to reduce fevers around 400 BCE (acetylsalicylic acid – aspirin)
Jackal Berry - The fruit, leaves, bark and roots contain tannin - an astringent substance that helps stop bleeding. The tree also contains substances with antibiotic properties. Bark extracts and crushed young shoots are applied to wounds and bruises to promote healing. A decoction of the roots is ingested to fight internal parasites such as ringworm and to help people recover from dysentery and fever. Sometimes pieces of bark are placed on a grid above burning coals and people who suffer from coughing fits or sinus problems inhale the steam coming from it
Two alkoloids in the leaves of the plant have been found beneficial in the treatment of some types of cancer (Leukemia, Lymphoma). This led to the
development of Vincristine and Vinblastine
Madagascar Periwinkle
Services
War
Tools to document contextual
factors
• Genogram
• Ecomap
Thank you