Biopsychosocial Model Of Health Research Articles

Narrative Review of the Theoretical-Methodological Foundations of the TREINI Program.

Scientific knowledge has advanced in the implementation of safe and beneficial interventions for children and adolescents with cerebral palsy (CP). Although the importance of interdisciplinary interventions that integrate all components of the International Classification of Functioning, Disability and Health (ICF) into family-centered practices is widely recognized, this approach is not yet widely adopted. Instead, many programs remain focused on isolated domains. This study presents the theoretical and methodological foundation of TREINI, an interdisciplinary and family-centered program developed for children and youth with CP and other neurodevelopmental disorders. TREINI incorporates intervention strategies that address all ICF domains. It is grounded in the biopsychosocial model of health and utilizes principles based on the best evidence in pediatric rehabilitation, including intensive training, task-oriented training, and a naturalistic learning environment. Unlike traditional rehabilitation approaches, the care provided by the TREINI program is delivered through an intensive and interdisciplinary approach, by a team working collaboratively in a single location. In addition to including evidence-based interventions, the TREINI program features two innovative components: the "City of Tomorrow", a naturalistic learning environment, and the "TREINI Exoflex" therapeutic suit, specifically designed to address deficiencies in the body functions and structures of children with CP and other neurodevelopmental disorders. This program has been carefully designed to support the process of neurological re-education and rehabilitation for children and adolescents with neuropsychomotor developmental delays.

Healthcare workers’ perspectives on a prescription phone program to meet the health equity needs of patients in the emergency department: a qualitative study

ObjectivesPeople experiencing homelessness and marginalization face considerable barriers to accessing healthcare services. Increased reliance on technology within healthcare has exacerbated these inequities. We evaluated a hospital-based prescription phone program aimed to reduce digital health inequities and improve access to services among marginalized patients in Emergency Departments. We examined the perceived outcomes of the program and the contextual barriers and facilitators affecting outcomes.MethodsWe conducted a constructivist qualitative program evaluation at two urban, academic hospitals in Toronto, Ontario. We interviewed 12 healthcare workers about their perspectives on program implementation and outcomes and analyzed the interview data using reflexive thematic analysis.ResultsOur analyses generated five interrelated program outcomes: building trust with patients, facilitating independence in healthcare, bridging sectors of care, enabling equitable care for marginalized populations, and mitigating moral distress among healthcare workers. Participants expressed that phone provision is critical for adequately serving patients who face barriers to accessing health and social services, and for supporting healthcare workers who often lack resources to adequately serve these patients. We identified key contextual enablers and challenges that may influence program outcomes and future implementation efforts.ConclusionsOur findings suggest that providing phones to marginalized patient populations may address digital and social health inequities; however, building trusting relationships with patients, understanding the unique needs of these populations, and operating within a biopsychosocial model of health are key to program success.

The Role of Art Therapy in Enhancing Rehabilitation Outcomes for Athletes with Sports Injuries

Purpose: This study sought to analyze the role of art therapy in enhancing rehabilitation outcomes for athletes with sports injuries. Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library. Findings: The findings reveal that there exists a contextual and methodological gap relating to the role of art therapy in enhancing rehabilitation outcomes for athletes with sports injuries. Preliminary empirical review revealed that art therapy offers significant benefits for athletes recovering from sports injuries. Through a review of empirical studies, it was found that art therapy facilitated emotional expression, coping skills development, and social support, leading to improved psychological well-being and holistic healing. The study emphasized the importance of addressing the biopsychosocial aspects of rehabilitation and highlighted the need for further research to understand the mechanisms underlying the therapeutic effects of art therapy. Overall, the findings underscored the transformative potential of art therapy in optimizing rehabilitation outcomes for athletes with sports injuries. Unique Contribution to Theory, Practice and Policy: Biopsychosocial Model of Health, Self- Determination theory (SDT) and Transactional Model of Stress and Coping may be used to anchor future studies on rehabilitation for athletes with sports injuries. The study provided several recommendations contributing to theory, practice, and policy in sports injury rehabilitation. It suggested further exploration of theoretical frameworks to understand art therapy's therapeutic mechanisms and its integration into existing models. In practice, it recommended incorporating art therapy into multidisciplinary rehabilitation programs, along with developing evidence-based guidelines for its implementation. Additionally, the study advocated for policy initiatives to increase access to art therapy services for athletes, emphasizing collaboration among stakeholders and interdisciplinary knowledge sharing. These recommendations aimed to promote holistic approaches to rehabilitation, improve outcomes, and enhance the overall well-being of injured athletes.

The Impact of Positive Mental State on Physical Health

Mental and physical aspects of health in humans have long shared a symbiotic relationship, with various studies in Psychology acknowledging the same. Modern studies have increasingly focused on the impact of positive mental status on an individual’s physical well-being. Jerome E. Baum and Tasha E. Posluszny in 1999 published an article "Mapping Biobehavioural Contributions to Health and Illness" that probes into numerous aspects of health psychology, such as the effects of stress, coping mechanisms, health behaviour change, and the biopsychosocial model of health. Hippocrates, regarded as the father of Western medicine, proposed a theory of involving various body resources including blood, bile etc., which could influence a person's physical and mental health. He was one of the earliest to recognise the impact that psychological factors held on physical health and acknowledged the role that emotions such as anger, fear, and sadness held in influencing both physical and mental well-being. Psychotherapists and practicing physicians too have recognized the co-existence of psychological and physical disorders. What is missing though, is the specific link that connects emotional status with physical complaints in an individual, although the simultaneous existence of depressed mood and increased complaints of physical complaints is well documented. This research paper strives to delve into the existing literature to decode the multi-faceted connections that exist between positive mental states, like optimism, flexibility, persistence and happiness, and how they impact physical health outcomes. Using theoretical groundworks and empirical evidence, this paper aims to provide a far-reaching understanding of how physical health and overall well-being can be inculcated with a positive mental state.

Evaluation of the effectiveness of complex medical rehabilitation of patients with polyposis rhinosinusitis associated with atopic dermatitis using ICF

BACKGROUND: In medical rehabilitation of patients with polyposis rhinosinusitis, aimed at solving the urgent strategic task of public health care to achieve and maintain an optimal level of functioning of persons suffering from partial disability through the development of effective methods of restoration of impaired functions and prevention of complications, there is a need to adequately assess the effectiveness of the measures taken. In this regard, it should be noted that the International Classification of Functioning, Disability and Health (ICF) serves as the gold standard for assessing the patient's quality of life and the effectiveness of rehabilitation measures. The category of human functioning acts as a system-forming basis and starting point of the patient's rehabilitation process in the ICF. In practice, the ICF is based on the biopsychosocial model of health (disease) assessment, which considers psychological and social factors of health (disease) and biological disorders in close interrelated unity. AIM: To evaluate the effectiveness of complex medical rehabilitation of patients with polyposis rhinosinusitis associated with atopic dermatitis using dynamic changes in the main domains of the ICF. MATERIALS AND METHODS: The study was performed with 89 patients with polyposis rhinosinusitis associated with atopic dermatitis. All patients were divided into 4 groups by simple fixed randomisation. The first group (control, n=22) received only basic therapy, including endonasal application of nasonex 2 doses 2 times a day, daily twice daily washing of the nasal mucosa, as well as the use of desensitising (antihistamines, topical glucocorticoids and moisturising and emollient agents) and detoxifying agents. Patients in the second group (comparison group 1, n=22) were additionally subcutaneously administered dupilumab at a dose of 300 mcg once a fortnight. In the third group (comparison group 2, n=23) against the background of dupilumab administration the combined effect of alternating magnetic field and low-intensity laser radiation of red spectrum was performed. Patients of the fourth group (the main group, n=22) received a course of phototherapy in addition to the scope of treatment of patients of the third group. The results of medical rehabilitation of patients with polyposis rhinosinusitis associated with atopic dermatitis were evaluated according to the dynamics of specialised categories of ICF, which most accurately characterise the patient's condition from the perspective of the biopsychosocial model of the disease. RESULTS: Changes in the estimated parameters of ICF at comparable initial values had different character and were determined by the scheme of medical rehabilitation. Minimal changes were recorded in the control group. The use of dupilumab was accompanied by positive dynamics of the parameters after 1 month with a significant increase in the shifts after 6 months, indicating the recovery of a number of mental and physical functions, as well as the ICF categories characterising the organism structures, activity and participation of the patient. Supplementation of biological therapy with course magnetolaser influence was accompanied by an increase in positive changes, which were confirmed in 6 months after rehabilitation. The maximum dynamics of the considered ICF categories was noted in the 4th group, where dupilumab administration was supplemented with complex use of therapeutic physical factors. CONCLUSION: The obtained results prove the high informativeness of the system approach realised with the help of ICF in assessing the effectiveness of medical rehabilitation measures. The comparative evaluation of rehabilitation results convincingly showed the advantages of the complex programme including dupilumab target therapy in combination with physiotherapeutic effects.

CHILDHOOD FAMILY ENVIRONMENT, GENETIC RISK FOR ALZHEIMER’S DISEASE, AND LATE-LIFE COGNITIVE DECLINE

Abstract How genetic risks for Alzheimer’s disease (AD) interact with environmental factors to shape individuals’ cognitive trajectories across the lifespan is a burgeoning area of research. However, relatively little is known about the role childhood family environment plays in the relationship between genetic risk factors for AD and cognitive decline in later life. This study examined whether and how early-life family environments may modify cognitive decline associated with genetic AD risks. Using longitudinal data from the Health and Retirement Study (HRS; 1998-2018), we followed over 9,000 individuals aged 51 and older during the observation period spanning nearly two decades. Cognitive functioning was assessed with the full cognitive battery from the HRS. Childhood family environment was evaluated separately with the relationship quality with one’s mother and the number of household adults before the age of 16. We estimated a series of multilevel models to assess the association between polygenic risk score for AD (PGS-AD) and changes in cognitive functioning, and whether the association was moderated by the two measures of childhood social capital. Findings indicated that childhood maternal relationship quality, but not the number of household adults, protected against cognitive decline accelerated by PGS-AD. That is, the associations between higher PGS-AD and accelerated cognitive decline were attenuated for individuals who reported a better childhood maternal relationship. Findings are in line with the biopsychosocial model of health and suggest that a better quality of maternal relationships in childhood may have a protective effect on cognitive functioning across the lifespan.

Health and Well-Being in Higher Education: Student Perception of an Australian University

The health and well-being of university students is a priority agenda, given the need to advance health in the university system and the United Nations Sustainability Development Goal regarding quality and inclusive education. However, current literature lacks adequate insights regarding health and well-being considerations. This study investigated students’ perceptions concerning how university students experience health and well-being. The study is underpinned using the biopsychosocial model of health and was conducted via a cross-sectional student survey with quantitative and open-ended questions at an Australian university in 2021. A hierarchical regression model with 625 respondents indicated health and well-being are significantly influenced by mental (t-value = 15.7, p < 0.001), physical (t-value = 9.48, p < 0.001), university learning (t-value = 5.16, p < 0.001), and economic (t-value = 4.78, p < 0.001) domains regardless of the demographic and study characteristics of students. Students’ perception of their health and well-being varied according to student age, the college of study, and whether they were an international student. Both the quantitative and qualitative findings supported that the mental, physical, university learning, and economic domains of students’ health and well-being are interdependent. There is a case for a proactive, continuous, inclusive, and holistic health and well-being approach to support student success in higher education.

Experiences of Veteran and Civilian Patients in Exploratory Yoga Sessions for Chronic Pain: A Qualitative Study

ABSTRACT Background Yoga integrates all aspects of self, with biological, mental, intellectual, and spiritual elements. The practice of yoga aligns with the biopsychosocial model of health and, as such, it can be instrumental in pain treatment. Aims The purpose of this qualitative study was to explore perceptions regarding the yoga sessions for chronic pain through thematic content analysis with comparison of gender, veteran or civilian status, and delivery methods. Methods Patients with chronic pain attended a 5-week intensive interdisciplinary chronic pain management program at the Michael G. DeGroote Pain Clinic. Participants were asked to complete six open-ended questions following four weekly 1-h yoga classes, through in-person or virtual delivery. Survey responses were thematically and separately analyzed by reviewers. Results Forty-one (N = 41) participants (56% males, 71% veterans) with an average age of 50.87 (SD 10.10) years provided comments. Nine themes emerged: (1) mind and body are one through yoga practices; (2) meaningful practice of yoga basics is productive for range of motion/movement, tension in joints, and chronic pain; (3) yoga classes provide an enjoyable process of learning; (4) yoga reminds patients of their physical capabilities; (5) routine practices lead to improvements; (6) yoga improved on strategies for chronic pain; (7) yoga can be adapted for each patient; (8) mindset improves to include positive thinking, better focus, and willingness to try new things; and (9) improvements exist for the current yoga programming. Conclusion Findings of the current study were nine qualitative themes that present the experience of patients with chronic pain in the yoga sessions.

“Winging It”: An Exploration of the Self-Perceived Professional Identity of Social Prescribing Link Workers

The practice of social prescribing (SP) has been rapidly expanding throughout the UK in recent years. The role of SP link workers (SPLWs) currently has no nationally prescribed requirements in terms of qualifications, background, or experience. This qualitative study of 13 SPLWs using semi-structured interviews is believed to be the first exploration of perceptions of their professional identity and the agency and structure within their roles. SPLWs reported feeling caught between biomedical and biopsychosocial models of health. Some identified with clinical healthcare teams, whilst others preferred non-medical and community-based identities. SPLWs valued professional flexibility and freedom, though were concerned this was becoming increasingly restricted. They reported filling gaps in the health system and absorbing more risk and complexity than they believed was reflected in their training or pay. Despite this, SPLWs demonstrated consistent core values of person-centredness, holistic practice, and a strength-based approach. A more consistent approach to professional identity is recommended as a way forward for SP.

Quality of Japanese Online Information on Causes of Neck Pain: A Biopsychosocial Analysis.

Background While a considerable amount of information on neck pain is available online, the quality and comprehensiveness of this information can vary greatly. Particularly, the representation of the biopsychosocial model - which recognizes neck pain as an interplay of biological, psychological, and social factors - in online information remains unclear. Given the prevalence and accessibility of online health information, it is important to understand its quality and how it may shape individuals' understanding and management of neck pain. Therefore, the objective of this study was to analyze the quality of online Japanese information on the causes of neck pain from a biopsychosocial perspective. Methodology A descriptive cross-sectional study was conducted. The search term "neck pain" was utilized on Google's search engine in June 2023, and the websites from the first two pages of the search results were included in the study. Ten advertisement websites were excluded, resulting in 19 websites being analyzed. Each website was evaluated based on the presence of the Health-on-the-Net (HON) code. Biomedical and psychosocial factors present in each website were identified using the biopsychosocial analysis tool. Websites were then categorized as biomedical, limited biopsychosocial, or biopsychosocial based on the number of psychosocial factors they mentioned. Results Among the 19 evaluated websites, only one possessed the HON certification, indicating a potential lack of credibility for the remaining sites. Of these websites, a large majority (63.2%) were classified as biomedical, while the remaining (36.8%) were classified as limited biopsychosocial. All the websites included some form of biomedical information on the causes of neck pain, while only seven websites mentioned psychological factors and one website mentioned social factors. The most common biomedical causes of neck pain discussed were cervical muscle strain and radicular pain due to cervical disc prolapse. On the other hand, the limited biopsychosocial websites highlighted perceived stress, depressed mood, and job-related mental stress as psychosocial factors contributing to neck pain. Conclusions This analysis revealed that freely accessible Japanese online information on the causes of neck pain, as found through Google, predominantly focuses on the biomedical causes, often neglecting or insufficiently addressing the psychosocial aspects. This finding underscores a gap between the available online resources and the comprehensive understanding promoted by the biopsychosocial model of health. Healthcare professionals need to be proactive in guiding their patients toward reliable, well-rounded resources that acknowledge the crucial role of psychosocial factors in neck pain. Furthermore, developers of online health information must aim to improve the depth and breadth of psychosocial factors discussed, promoting a more holistic understanding of neck pain for the Japanese public.

Integrated first‐level psychosocial response to disasters in low‐ and middle‐income countries

AbstractThe widespread occurrence of disasters in recent times has largely been attributed to climate change, with its long‐term consequences on the welfare and mental well‐being of individuals and communities. Increasingly, studies indicate that victims of disasters may experience a range of mental health issues, with post‐traumatic stress disorder (PTSD) and major depressive disorder ranking as the most common. Low‐ and middle‐income countries (LMICs) face unique challenges in providing proper rehabilitation and adequate mental health services after a disaster, due to poverty, lack of educational opportunities, lack of awareness and knowledge of disaster, and lack of resources and infrastructure. Despite these challenges, some LMICs have made efforts to address mental health needs in the aftermath of disasters. However, they are faced with the challenge of implementing formalised mental health support programmes. Moreover, immediate mental health support should be provided to victims of disasters to ameliorate the psychopathologies that may develop afterwards. The current approach of providing mostly physical and social relief neglects the psychosocial implications of disasters on victims. The biopsychosocial model of health, which is being advocated for, suggests that treatment should encompass all aspects of an individual's life, and thus, a team of mental health workers can provide holistic interventions to aid victims in their recovery process by making efforts to involve them in the emergency response teams usually employed during disasters.

The Integration of Patient-Centered Care and the Biopsychosocial Model by Athletic Trainers in the Secondary School Setting.

Our purpose was to explore the degree to which secondary school athletic trainers (SSATs) perceive they are integrating the principles of patient-centered care (PCC) and the biopsychosocial (BPS) model in their practice. We used a cross-sectional design to explore the primary research question. We used the Global Perceptions of Athletic Trainer Patient-Centered Care (GPATPCC) tool and the Biopsychosocial Model of Health (BPSMH) tool, both measured on a 4-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree, with an unscored "unsure" option). We sent the survey to 5665 SSATs through the National Athletic Trainers' Association. Results indicate participants expressed strong agreement (mode = 4) with 7 of the 14 statements and agreement (mode = 3) with the remaining 7 statements of the GPATPCC tool (grand mean = 3.4 ± 0.8). Overall, participants rated their level of agreement on the BPSMH as agreeing (mode = 3) for each item (grand mean = 3.0 ± 1.0). SSATs perceive they are integrating the principles of PCC and the BPS model in clinical practice. These findings align with two previous studies concluding that patients, parents, and providers believe athletic trainers provide care that is focused on whole-person healthcare.

Precision and personalized medicine: What their current definition says and silences about the model of health they promote. Implication for the development of personalized health.

The US National Human Genome Research Institute defines precision medicine as follows: "Precision medicine (generally considered analogous to personalized medicine or individualized medicine) is an innovative approach that uses information about an individual's genomic, environmental, and lifestyle information to guide decisions related to their medical management. The goal of precision medicine is to provide a more precise approach for the prevention, diagnosis, and treatment of disease." In this perspective article, we question this definition of precision medicine and the risks linked to its current practice and development. We highlight that in practice, precision medicine is based on the use of large volumes of biological data for individual purposes mostly in line with the biomedical model of health, which carries the risk of the biological reductionism of the person. A more comprehensive, precise, and even "personal" approach to health would require taking into account environmental, socio-economic, psychological, and biological determinants, an approach more in line with the biopsychosocial model of health. The role of environmental exposures, in a broad sense, is highlighted more and more, notably in the field of exposome research. Not considering the conceptual framework in which precision medicine is deployed leads to the concealment of the different responsibilities that can be mobilized within the health system. Anchoring precision medicine in a model that does not limit its definition to its biological and technical components makes it possible to envisage a personalized and more precise medicine, integrating a greater share of interventions centered on the skills and life contexts of individuals.

COMING INTO BEING AN EMPATHIC DOCTOR: MODERN VIEWS AND CHALLENGES

Medical reformation process based on a human-centered approach requires universities to train healthcare professionals who are able to update knowledge and skills quickly, to adapt to new conditions, and be highly qualified and competitive specialists. The development of qualities that ensure communication with patients such as empathy is still of great importance.
 Empathy is an essential component in the professional activity of doctors of all specialties, therefore the fostering of empathy in students must be considered as inseparable component of future doctors’ training, a precondition for the successful independent practice.
 The article describes the concept of empathy, its types and components, considers the methods of forming empathy and analyzes some of them. Special attention is focused on the importance of developing empathy in the professional activity of doctors of all specialties.
 Empathy in a clinical context is the doctor's ability to understand the emotions of patients that can contribute to more thorough history taking and making more accurate diagnosis and as a consequence an effective personalized treatment plan. Clinical empathy includes the following components: 1 – the ability to understand the patients’ condition, their feelings (emotions); 2 – the ability to make a rapport with patients in order to understand their mental state, emotions, and check the accuracy of this understanding; 3 – the ability to act in a certain therapeutic way (taking into account the understanding of the patient's mental state).
 According to many researchers, empathy is a genetically determined property, strengthened or weakened by an individual's life experience that depends on certain individual personality traits, but scientists have proven that empathy can be fostered.
 According to the literature, a decline in the level of empathy is usually observed in the third year of medical training, when students begin clinical classes that require contact with patients. The researchers associate this decline with the deflation of the ideal image of a doctor and his / her professional role, which young people had when beginning their medical studies. The decrease in empathy after passing their first clinical classes can also be understood as a kind of protection mechanism in case of getting into various difficult and serious life-threatening situations. Other authors claim that there is no noticeable change in the level of empathy. Such ambiguous results arise can be explained by the fact that researchers use various evaluation methods and once again emphasize the relevance of these processes in modern clinical practice.
 Involvement of students in coming in contact with patients, and namely, during survey, examination and treatment; discussion of clinical cases with analysis of applied examination methods, treatment plan and prognosis helps to form and develop empathy, teaches communication with patients, which are quite important qualities of a doctor.
 When fostering empathy in students, one should not forget that during work the doctor encounters some stressful situations that are associated with the suffering of patients, and therefore, along with empathy, the doctor must possess stress resistance in order not to succumb to psychological deformation, emotional exhaustion and professional burnout, which in turn can negatively affect the quality of diagnosis and the effectiveness of patient treatment. It is worth noting that the achievements of modern medicine in the field of anesthesiological support, surgical intervention technologies, and patient care enable to harmonize this border between empathy and psychological deformation.
 Thus, during the professional training of doctors, educators and clinicians should pay special attention not only to the students’ acquisition of practical skills, but also to the development of empathy, the formation of stress resistance, the improvement of interpersonal communication both with colleagues and patients, and the development of skills, related to empathy in a broad sense as these aspects are one of the paramount tasks of medical education programs based on the biopsychosocial model of health.

A unified qualitative-quantitative method to evaluate the impact of being a near-peer health educator

Abstract Grasping the complexity of public health interventions is of increasing interest. Program evaluation may involve previously known and unknown variables; the former are best explored with quantitative, the latter with qualitative methods. As part of the impact evaluation of the Balassagyarmat Health Education Program (BEP), a near-peer education intervention targeting adolescents from a disadvantaged region of Hungary, we aimed to understand the complex effects of being an educator on medical students’ knowledge about the biopsychosocial model of health. Thus, we developed a unified method that enables us to conduct an exploratory study on the effects of our intervention, then quantify and model that qualitative data. We started the method design with literature review and consultations with methodological and public health experts. We then refined the research questions based on a focus-group discussion held with 6 peer educators. After a set of pilot-interviews, we chose simulation interviewing as our knowledge elicitation procedure, then finalized the protocol with the help of additional piloting. In this unified method, simulation interviews are administered to peer educators and aligned controls, and cognitive task analysis is performed with the help of visual stimuli. Codes are developed inductively and, along with segmentation procedures, applied deductively to the entire dataset via the Reproducible Open Coding Kit. Resulting quantified narratives are further processed with Epistemic Network Analysis. The relative frequency of code co-occurrence in each segment is modelled with networks enabling the qualitative and statistical comparison of data between subsamples. Building on the benefits of qualitative and quantitative approaches, this method offers a complex evaluation of the impact of health education interventions. By strengthening the methods of program evaluation we aim to facilitate the development of more effective interventions. Key messages • Qualitative and quantitative methods can be unified in program evaluation to promote a deeper understanding of the complexity in public health interventions. • Cognitive task analysis as a knowledge elicitation procedure can be used for the impact evaluation of health education programs.

Silenced: Patients’ experiences of voicelessness in head and neck cancer

ObjectivesThe objective of this qualitative study was to explore patients’ experiences of communicating with health professionals following a diagnosis of head and neck cancer (HNC). MethodsA qualitative research approach based on social constructionist theory was used. A total of 21 in-depth semi-structured interviews were conducted with people diagnosed with HNC. Thematic analysis was used to identify themes. ResultsThe experience of losing the capacity for speech was experienced by survivors of HNC as distressing and traumatic. Voicelessness was not just a loss of physical speech, but a holistic experience of silencing. A number of tensions emerged including patients’ experiences of losing their voice and then finding different ways to verbally express themselves; in interactions with health professionals there was a tension between abrupt, hurried communication and a slower, more mindful communication style. Sub-themes around communication style emerged where disparities between levels of health literacy were unaddressed, and patients’ experienced a lack of empathy. Another tension experienced was between an old style medical model and the ideal of person-centred care and the biopsychosocial model of health. ConclusionWhether HNC patients lose their voice temporarily, have periods of voicelessness, or are able to speak, but feel unheard, the treatment experience is too often one of disempowerment and silencing of their perspectives. Practice ImplicationsHealth professionals are challenged to find creative communication methods, to practice mindful listening, source speech pathology and adaptive technologies, and to facilitate communication that supports patients in expressing their values, preferences and needs.

IMPLICATIONS OF ADOLESCENT AND PARENT PERCIEVED SKILL-BUILDING ON MISCARREID HELPING AND SELF-EFFICACY FOLLOWING A TRANSITION WORKSHOP FOR ADOLESCENTS WITH INFLAMMATORY BOWEL DISEASE

Abstract BACKGROUND The rising prevalence of Inflammatory Bowel Disease (IBD) in children and subsequent need for continued care into adulthood, begets the call for patient education on the transition to adult healthcare. To address this need, we designed a virtual, transition program for adolescents with IBD and their parents. The objective of this study was to assess program efficacy by examining changes in transition readiness skills, self-efficacy, and miscarried helping. METHODS Sixteen adolescent-parent dyads participated in the transition workshop. The program was structured around the biopsychosocial model of health and a multidisciplinary group of professionals contributed. The impact of the workshop was measured by validated self- and parent-report measures of transition readiness (transition readiness assessment questionnaire; TRAQ), self-efficacy (IBD-self efficacy scale; IBD-SES), and miscarried helping (Helping for Health Inventory; HHI) at pre-workshop and 1-year post-workshop. Median values were used to perform Wilcoxon rank sum tests and Spearman correlations for statistical analysis. RESULTS Adolescents gained tangible transition readiness skills as demonstrated by improvement in self- and parent-reported TRAQ scores at 12 months (median increase of 14 points and 19 points respectively, p<0.05). Parents reported less miscarried helping as demonstrated by improved HHI scores, however, adolescents did not (median decrease of 2 points). Adolescent IBD-SES scores improved at 12 months (median increase of 1 point). There was weak correlation between: 1) Adolescent IBD-SES and TRAQ scores (r=0.42), and 2) Parent TRAQ and HHI scores (r=0.49). DISCUSSION/CONCLUSIONS Improvements in adolescent TRAQ scores indicate that following the workshop, participants more frequently performed tasks necessary to manage their disease. Improvement in parent-reported TRAQ scores suggest parents also witnessed their child taking on more responsibility and developing autonomy. Correlation between improved parent-reported TRAQ scores and improved HHI scores suggests that as adolescents gain more autonomy over the day-to-day tasks of managing their IBD, their parents more readily allow them to take the lead, but the weak correlation observed could be from the small sample size given the attrition in survey response rate at 12 months. The correlation between increased adolescent TRAQ scores and IBD-SES scores suggest that as adolescents engage in disease management tasks they develop increased self-efficacy in relation to their disease as a delayed measure of program success. Future directions include implementing more frequent topic-based workshops to allow for peer-to-peer learning and increasing our sample size to increase the power of our analysis.

The impact of gastrointestinal conditions on psychosocial factors associated with the biopsychosocial model of health: A scoping review.

The increase in the prevalence of gastrointestinal (GI) conditions is an emerging global health concern. Studies of the impact on the lives of individuals living with GI conditions such as irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) typically focus on biological elements, such as symptomology and treatment efficacy. Comparatively fewer studies have explored the psychological and social aspects of GI conditions, which could provide key information needed to better understand the impact of GI conditions on people and their lived experiences. In this review, existing literature concerning the psychosocial factors and well-being outcomes associated with GI conditions was reviewed using a scoping methodology. Sixty-eight studies were selected for inclusion. Of these studies, the well-being outcomes most frequently addressed, for both IBS and IBD, were quality of life and health-related quality of life, and the most frequently addressed psychosocial factors were social support and coping. These outcomes are largely consistent with those identified for other medical conditions explored using the biopsychosocial model of health, with some exploration of the lived experiences of those with a GI condition.

CRITICAL OBSERVATION OF PSYCHOSOCIAL MEDIATORS OF HEALTH HABITS AND PATTERNS OF HEALTH RELATED BEHAVIOR

Human health in present day’s lifestyle due to technological advancement, stress to compete with world, urbanization, changing lifestyle and changing cultural beliefs of people has given rise to many diseases, particularly life style diseases. The studies have proved that Indians are genetically prone to heart diseases. The top ten causes of illness and death are accidents, suicide and diseases like, cancer, diabetes, blood-pressure and other diseases affected by quality and style of life. These are largely the result of psychological factors, including behavioural pathogens, lack of behavioural immunogens, psychosocial stress and poor coping strategies. The bio-psychosocial model of health and illness refute that biological, social and psychological factors interact in an interdependent or systemic way of maintaining health or causing illness. The emphasis of the article is only on the psychosocial mediators in health and illness. Mediators shape a person's responses to stress. They are the internal and external resources the person can bring to assess and interpret the magnitude stress, to assess his or her own capacities for addressing the stress, and to formulate a coping strategy to overcome the stress.

The Biopsychosocial Model of Health and Disease

I respond to the 4 commentaries by Awais Aftab & Kristopher Nielsen (A&N), Hane Htut Maung (HHM), Diane O’Leary (DO’L) and Kathryn Tabb (KT) under 3 main headings: “What is the BPSM really?” & Why update it?; “Is our approach foundationally compromised?”, and finally, “Antagonists or fellow travellers?”.