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