PT 751 Final Exam
Health literacy
The ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions and follow instructions for treatment We assume if we educate our patient then they understand you — we are the sender and they are the receiver and sometimes that message doesn't go through
Stages of change in the transtheoretical model
precontemplation, contemplation, preparation, action, maintenance
Americans with Disabilities Act
prohibits discrimination against the disabled Modeled off of the civil right acts World's first comprehensive civil rights law for people with disabilities
Compassion
put yourself in their shoes
Individual health promotion for behavioral change
Knowledge, attitudes, belief, personality (internal vs external LOC)
Locus of control model
Very powerful model on how they will respond Perception that health outcomes are either under our control or out of our control
Health
"A state of complete physical, psychological and social well-being and not simply the absence of disease or infirmity" — WHO 1948
Who is responsible to smoking, ETOH abuse, obesity, venereal diseases
#1 is patient
If a conditional job offer is withdrawn, it must show
- related to essential functions - reason for job-related and consistent with business necessity - no reasonable accommodations available "Because they could not get task done in ______ time frame" CANNOT say it's because of their disability that you cannot hire them
Ajzen's Theory of planned behavior
1. Behavioral intentions-individuals attitude about the behaviors 2. Perceptions of the subjective Norms (attitudes of important others such as family, friends, and society about the performance of a behavior ) - "may mom things I should..." 3. Perceptions of difficult control over performance of the behavior
5 titles for ADA
1. Employment 2. Public services and transportation 3. Public accommodations 4. Telecommunications 5. Other provisions
A pipe welder kept his job with the assistance of an ADA center
10 years as a pipe welder who is deaf has successfully worked with his team by communicating via ASL, reading lips, exchanging notes, and using gestures. The company he worked for has a contract with a larger gas and electricity company which tests all employees. Process recently changes to include oral questions, he asked for interpreter and was denied. He contacted his ADA for help
What year did the disabilities law get amended?
2008
Undergrad vs. Georgia-Pacific Corporation
2009 Examined the issue of whether a physical capacity evaluation of employees returning to work from medical leave is lawful physical fitness test, or a prohibited medical examination under the ADA Inter grad later filed suit in federal court claiming that the PCE constituted a prohibited medical examination under the ADA. The court disagreed, finding that the PCE was a lawful fitness exam Employers concerns must be reasonable and supported by objective evidence
What percentage of Canadians over 16 y/o have low literacy?
60%
What percentage of Canadian seniors have low health literacy
88%
Motivational interviewing
A cognitive-behavioral approach that uses the stages of change and challenging habitual thought patterns to encourage and support alternative behaviors
Health behavior
A series of actions we take to maintain, pro motor, or improve our well-being Behavior is key factor in determining health -immunizations, dental check-ups, annual medical visits, eating well, exercise on, avoiding excessive ETOH, regular hand washing, wearing a helmet, wearing a mask/social distancing
Financial assistance
ADA provides financial assistance to employers to cover the costs of accommodations Special tax breaks available to small employers
Preparation
Actively planning to change in next 30 days but not actively doing it - they are serious about changing Seek commitment to risk behavior change and starting date. Support decision to take action with discussion of resources and coping skills
Community level models
Analyze social systems functions Mobilize communities, organizations, and policy makers (forcing the individuals to do something) 3 models (community mobilization, organizational change, diffusion of innovations theory)
ADA special requirements
Assembly and auditorium areas for WC seating, check out counters, elevators, knee clearance height, curb cuts, doors and doorways, grab bars/handrails, parking spaces, drinking fountains
functional capacity evaluations
Assist in determining disability status Not typically performed pre-employment
Progress monitoring
Brain does a good job at this if its positive but not when it's negative Trying to get someone's attention you should highlight the progress and not the declines
Transtheoretical model
Changes one's behavior is a process, not an event (not quick, its a process) Individuals present at different levels of change (meet them where they are) Gear intervention to level of change (where they are at)
Title 1
Employment Prohibits discrimination of "otherwise qualified individuals" due to disability in all areas of employment. Applies to businesses with 15 or more employees -employer does not have to provide accommodations if it imposes a possible "undue hardship" - ADA prohibits medical inquires or examinations before making a conditional job offer to an applicant - when put in place medical inquires must be as a second step after other requirements are met and non-discriminatory is applied to all applicants
In most instances policy makers (state and federal) should help
Encourage physical activities
Evocation
Evoke the solution
ADA 25th anniversary video
FIGHT FOR YOUR CIVIL RIGHTS - demanding respect and the right to not be left out and do whatever they want. Broad civil right bill to protect those with disabilities President George H.W. Bush signed the bill W/C accessible buildings and busses Play sports and work like everyone else
T/F Showing how the change will impact them and finding that hook (hobby) is much less effective
False It's more effective
T/F PT's mostly deal with the community
False Patients (indivuals) and their families (interpersonal)
Interpersonal health promotion behavioral change
Family, friends, peers
Spiritual healthcare Video
Gaining greater ground "Silent revolution" — not just the physical aspect of the person but getting to know who they are Front line is hospital chaplains A lot of data shows that when one is sick they have spiritual struggles. Chaplains can help them find or offer them meaning. Those that met with the chaplain said they had a higher satisfaction rate Better treatment rates and coping when addressing spirituality
Factors that contribute to health literacy
General literacy - ability to read, write and understand written text and numbers Amount of experiences in the health care system Complexity of information being presented Cultural factors - language How material is communicated
Action
Has initiated change within the past 6 months but there isn't much change yet Support behavioral changes and adaptive replacement of risk behaviors with new lifestyle practices. Provide information about social and medical resources that facilitate change. Teach self-management strategies to prevent relapse
Maintenance
Has successfully modified behavior for more then 6 months Prevent relapse and encourage long-term change. Review skills for managing situations that can trigger relapse to previous behaviors. Reinforce new lifestyle habits and achievement of goals
To be classified as an individual with a disability you must
Have a mental/physical impairment that substantially limits a major life activity Have a record of that impairment Perceived by others as having that impairment
To file a complain through ADA
Have to have a record of mental or physical impairment that keeps you from doing something
What is the best model
Health promotion model - biopsychosocial model - Pender's model
External cues
Heart healthy symbols
In most instances health care workers could
Help education and point patient in the right direction
"Bucket" from medicare
Higher satisfaction rates increases funds given my Medicare
Pender's model (basic)
Relatively comprehensive (most comprehensive of all models) Takes into account almost all other models
Internal cues
I feel better
Comtemplation
Intends to change within 6 months - kinda thinking about it but there is no plan and they haven't done anything about it yet Provide motivational messages of pros and cons of risk behaviors and tie those into goals. Support their decisions
Loam Linda University
Job applicant case of 2010 Hospital subjected application to nerve conduction studies to screen out repetitive motion injuries Hospital rescinded employment offer to applicants with "failing" test results, even though no evidence that essential functions could not be performed Hospital ruled to pay claimants
When did original ADA law get signed
July 6th 1990
Accessible lawn bowling made possible thanks to the ADA
Lawn bowling club was denied the opportunity to bowl from a manual w/c she uses. The club believed her w/c would damage the lawn where the bowling happens. At first, she asked them to put a mat down so she could bowl too. Club said no. She contacted ADA could help. The ADA said since bowling club falls under title 3, she could request a reasonable modification.
Essential functions
Limited number of employees to perform the function Function is highly specialized and person hired is for expertise or ability
Public policy for health promoto
Local policies related to healthy practices by law, rules, and regulations
7 things to indicate health literacy
Look for clues (missed app., not taking meds, incomplete forms, there are also verbal clues) Use audio visual cues Use demonstrations Highlight/circle main take home points Uses laymen terms and say most important things FIRST Encourage relationships with healthcare Encourage support networks
10 leading risk factors for PREVENTABLE diseases
Maternal and child underweight Unsafe sex High BP Tobacco use Alcohol Unsafe H20, poor sanitation and hygiene high cholesterol indoor smoke from solid fuels, Iron deficiency High BMI or obesity
Safe harbor
Means you DO NOT have to make modifications to elements in a building that comply with the 1991 ADA standards even if the 2010 standards have different requirements It is was installed before march 15, 2012 (the date 2010 ADA standards went into effect) is does not need to be changed
Qualified individuals
Meets the skill, experience, education, and other job related requirements of a position held or desires and who with out without reasonable accommodation can perform essential functions of a job
In most instance health care systems should help
Mitigate health risks
Pender's model (more in depth)
Modifying factors (demographics, biological characteristics, interpersonal influences, situational and behavioral factors) may influence perception of self-efficacy, health status, perceived benefits and barriers. Incorporates internal and external cures to action increase the likelihood of engaging in health promotion behaviors
Individual-oriented models
Most basic unit of health promotion 6 models
Does warnings, scare tactics, and shaming (by themselves) work?
No
Precontemplation
No knowledge or thought to it Help the patient identify personal priorities and lifestyle goals. Establish trust and rapport to eventually provide insight into negative risk behaviors
High risk behaviors
Often translate to disease, disabilities, and death — often referred to ask the "burden of disease" It is often more cost effective to address risky behaviors rather than to treat the disease (smoking and COPD, obesity and type 2 diabetes, venereal diseases and unprotected sex)
External locus of control
On the provider May be the compliant when the health care provider is providing the care. Show up for medical appointments where the provider is using passive treatments
Internal locus of control
On themselves Better health outcomes, tend to seek health information Less healthcare dollars spent
Title 2
Public transportation Covers buses, public rail transit May not discriminate against people with disabilities in the provision of their services Must comply with requirements for accessibility in new vehicles Purchase or lease accessible used buses Remanufacture buses in an accessible manner Unless is would results in undue burden, provide paratransit where they operate fixed route bus or rail systems
Social incentives
Other people can see what you're doing we care and we want to do it better. Signal from an emotion center in the brain
Title 5
Other provisions Contains a variety of provisions related to the ADA as a whole, including its relationship to other laws, state immunity, its impact on insurance providers and benefits, prohibition again retaliation and coercion, illegal use of drugs and attorney's fees Legal counsel
Principles of motivational interviewing
Partnership, acceptance, compassion, evocation Still ultimately up to the patient to do it but you are there to help
Compensatory model
Patient not responsible for causing but it responsible to solution Provider has sympathy for patient's problems. Patient education highly valued. Provider highly motivated to provide it
Medical model
Patient not responsible for causing problem or responsible for solution Patient education of less value. Provider has sympathy for patient. Provider will be responsible for solution, which minimizes need for patient education
Moral model
Patient responsible for causing and patient responsible to solution Patient admonished for causing problem. Patient education of high value but probably less likely to happen
Enlightenment model
Patient responsible for causing problem but not responsible for solution Patient education of less value. Patient likely to be admonished for causing problem. Provider will be responsible solution which minimizes need to patient education
Bioethics and Physiotherapy article
Physical therapy is providing services to people and populations to develop maintain and restore max movement and functional ability throughout the lifespan. Goes into detail about achieving successful physiotherapy Success and failure is shared by the PT and the patient EBP is based on 3 sources: patient values, clinician expertise, and knowledge of best research evidence PT's need to protect themselves against malpractice and must have answers for all ethical conflicts that they encounter
Title 3
Public accommodations Prohibits discrimination on the basis of disability in the activities of places of public accommodations such as restaurants, movie theaters, schools, day care facilities, recreation facilities, doctors offices Transportation services provided by private entities are also covered under this title Must comply with architectural standards for new and altered buildings; reasonable modification to policies, practices, and procedures; effective communication for hearing/vision/speech disabilities Must remove barriers in existing building where it is easy to do so
Health literacy basics for health professionals video
Research shows that patients that are health literate are able to make healthier lifestyle choices, better communication with their healthcare providers, access information and services, manage chronic diseases, and engage with health education and promotion Goes with having a health literate partners as well. Having high health care literacy can reduce health care dollars spent
Institutional health behavioral changes
Rules, policies, informal structures
How to motivate yourself for change video (tali sharot)
Scare yourself and others to change behaviors except science shows it has limited impact of behavior (on average) Why? Inducing fear it induces us to shut down and eliminate negative feelings (i.e my grandpa smoked and lived to be 90 — making you feel resilient) boomerang effect. 'Shit hitting the fan" - you could potentially change the outcome but that take energy and you don't "see the point" until its too late Change our beliefs towards the desirable news (ability to learn from good news stays stable and learning from bad news is related to age - kids and teenagers were the worst for learning from bad news and better as they age but around midlife (40 y/o) it starts deteriorating again)
Community health promotion behavioral change
Social networks, standards, norms
Pre-employment testing: human performance evaluations
Tailored to the essential functions of the job at hand Given to ALL candidates Typically a pass/fail basis
Title 4
Telecommunications relay services Requires communication carriers to establish interstate and intrastate telecommunications relay services 24 hours a day 7 days a week Also requires closed captioning of federally funded public service announcements
Specific requirements for ramps
The least possible slope shall be used for any ramp The max slop of a ramp in new construction shall be 1:12 (one foot of ramp for each inch of rise) The max rise for any run shall be 30 inches (ramp sections may be up to 30 feet long) The minimum clear width of a ramp shall be 36 inches 48 inches is the minimum width needed for an ambulatory person to pass a non-ambulatory or semi-ambulatory person (to allow someone to walk past a person in a w/c, ramps should be 4 feet wide) Shall have level landings at bottom and top of each ramp and each run (5 feet in length) If a ramp has a rise greater than 6 inches then it shall have handrails (34-38 inches in height)
Health belief model
The likelihood of an individual doing something to protect themselves from disease or injury is related to 4 main concepts 1. Perceives susceptibility 2. Severity of health threat 3. Benefits associated with behavioral change 4. Barriers or cost of the behavioral change
Self-efficacy
The measure of belief in one's own ability to complete tasks and reach goals. Often relates to past experiences. This can lead to learned helplessness. Breaking the task down into small, more manageable sessions may work well for those with poorer self-efficacy Will do better if they know it's in their control to get better
Acceptance
Their condition and where they are at in their process
Relapse
Thinking about changing their plan or they gave up
Others covered by ADA
Those who have relationships or associations with people with disabilities Ex: you cannot fire the spouse of a person with a disability due to a concern of time away from work
American with Disabilities Act turns 30 video
To this day it has not been fully impliminted Allows disabilities to have a life like everyone else Equal access to the same right as someone without a disability
T/F ADA requires an employer to focus on the essential functions of a hob to determine qualifications
True
T/F Low literacy increases with advances age
True
T/F We focus more on physical disabilities than mental disabilites
True
T/F We are all responsible for health but ultimately the patient is #1
True
T/F Is the providers believe the patients are not responsible for causing their problems, they are more willing to help (medical and compensatory model)
True Ex. Breast cancer, multiple sclerosis, ALS
T/F If providers see the patient as responsible for the solutions their problems, they are likely to involve the patient in solving the problem and then hold the pt responsible (compensatory and moral models)
True Ex: type 2 diabetes due to obesity (teach them to fix the problem themselves and not as lenient to helping out)
T/F If patient sees themselves as not responsible for their problem and providers see them as responsible, conflict may result. Patients may be resentful and angry of the provider and assigns blame
True Patient AND provider need to look at it from ALL aspects
T/F If providers see patients as not responsible for the solutions to their problems (I.e. treatment), they are likely to take most of the responsibility for patients and therefore do less patient education (medical and enlightenment models)
True ex: breast cancer - more likely to say "you know you're not responsible, so we are going to give you..... chemo, surgery, radiation, etc."
T/F If providers believe that patients are responsible for causing their problems, they are less willing to help (enlightenment and moral models)
True Obesity, smoking/lung cancer, drug abuse
Partnership
Trust, no judgement, willing to help them
Local w/c sports team wins a policy change on the court thanks to ADA
W/c sports team had been using a nearby college's basketball court for their w/c rugby and w/c lacrosse activities. After installing a new floor, the college told the group they could no longer use it because it had established a "no wheels on floor policy". The w/c sports team contacted regional ADA center to get help navigating the situation. ADA consulted the department of justice who agreed the policy was problematic under the ADA
Ask me 3
What is my main problem? What do I need to do? Why is it important for me to do this?
What 2 things sparked the ADA
World war 2 and industrial accidents
Immediate rewards
You can get an immediate result that you know could happen in advance so you're more likely to do it versus if you get rewards in the future because its "so far away" Studies shows it lasts for at least 6 months and more people are more likely to do it if it's immediate
