CM2.1-5 | Social and Behavioural Determinants of Health — Practice Quiz

Correct. The Modified Kuppuswamy scale has three domains: education (scored 0–7), occupation (1–10), and per-capita monthly income (1–12), giving a total range of 3–29, classifying into five socio-economic classes.

The Modified Kuppuswamy scale is the standard urban SES classification tool. Its three domains — education, occupation, income — yield a 3–29 score. The income component must be updated annually using the CPI-IW. Rural settings use the Pareek scale.

Incorrect. The Kuppuswamy scale specifically scores education, occupation, and per-capita monthly income of the head of household. Land ownership and social participation are components of the rural Pareek scale, not Kuppuswamy.

Correct. The income component of the Kuppuswamy scale is anchored to the 1982 CPI-IW base and must be updated every year to reflect current rupee values. Using outdated thresholds leads to systematic misclassification of SES.

Only the income component of the Kuppuswamy scale requires annual CPI-IW updating. Education and occupation scores remain unchanged. This is a frequent source of error in community assessments and examinations.

Incorrect. A common and critical error is using textbook income cut-offs from prior years. The CPI-IW must be used to recalculate income brackets annually, regardless of the study setting.

Correct. Enabling factors include income, insurance coverage, transport availability, and health facility proximity — the structural conditions that make seeking care possible or impossible regardless of the patient's health beliefs or disease severity.

The Andersen Behavioural Model organises barriers to health care into predisposing factors (who you are and what you believe), enabling factors (what resources and access you have), and need factors (how sick you perceive yourself to be). Transport and facility proximity are canonical enabling factors.

Incorrect. In the Andersen Model, the three factor categories are: predisposing (beliefs, socio-demographics — e.g., supernatural beliefs, age, education), enabling (income, transport, facility access), and need (perceived/evaluated illness severity).

Correct. Social capital refers to the network of relationships, mutual trust, shared norms, and reciprocity within a community. Communities with high social capital show better collective action, higher vaccination uptake, lower maternal mortality, and better chronic disease management.

Social capital has three components: structural (networks and associations), cognitive (trust, shared norms), and relational (reciprocity). High social capital enables communities to mobilise around health programmes and support sick members, independent of their economic SES.

Incorrect. Social capital is not a competitive resource; rather, it functions as a collective good. It is relevant in both urban and rural settings and is distinct from income-based SES measures.

Correct. Daily-wage casual labour scores 2 (unskilled) for occupation; Class 5 education scores 2; low per-capita income from irregular wages would score 1–2. Total score is likely 5–6, corresponding to Class V (Lower).

Incorrect. Combine the three Kuppuswamy domains: occupation (unskilled daily wage = 2), education (Class 5 = 2), and estimated per-capita income (low = 1–2). Total ≈5–6 places this family in Class V.

Correct. Transport cost is an enabling factor — an economic barrier that makes physically accessing the health facility impossible even when the patient recognises the need for care. This is a classic enabling-factor barrier distinct from her health beliefs or perceived severity.

Incorrect. Transport cost impedes access regardless of health beliefs or perceived severity. It is an enabling factor in the Andersen Model — specifically an economic-logistic barrier.

Correct. The assertion correctly states the bidirectional nature of the poverty-disease relationship. The reason accurately identifies the two reinforcing mechanisms: illness depletes household income (catastrophic health expenditure, lost wages) while poverty raises disease risk through undernutrition, poor housing, and unsafe water.

The poverty-disease spiral is a fundamental concept in social medicine. Catastrophic health expenditure (defined as out-of-pocket costs exceeding 10–25% of household income) is a major driver of downward social mobility and a key target of PM-JAY and other social security schemes.

Incorrect. Both the assertion and the reason are factually correct, and the reason provides the mechanistic explanation for why the bidirectional relationship exists — illness reduces earnings (income shock + opportunity cost) while poverty increases exposure (structural risk factors).

Correct. The Pareek scale is specifically designed for rural populations. It uses eight multidimensional domains including land holding, housing, farm power, food self-sufficiency, social participation, material possessions, education, and occupation — capturing rural economic realities that income-only scales miss.

Scale selection depends on setting: urban → Modified Kuppuswamy; rural → Pareek (multidimensional) or B.G. Prasad (income-only, both settings). For NMC examination purposes, Kuppuswamy = urban, Pareek = rural.

Incorrect. The Modified Kuppuswamy scale is for urban populations. B.G. Prasad classification uses only per-capita income and applies in both settings, but the Pareek scale is the validated rural-specific multidimensional tool most appropriate for a rural village.

Correct. A descriptive norm reflects what most people in a group actually do — a perceived typical behaviour. The mothers are conforming to what they observe others doing, not to an explicitly stated community approval or legal rule.

Descriptive norms ('what most people do') and injunctive norms ('what is approved or expected') operate simultaneously. Health behaviour change programmes must identify which norm is dominant and target it specifically — descriptive norm interventions often use social proof ('8 out of 10 mothers in this area breastfeed for 6 months').

Incorrect. When behaviour is driven by 'everyone does this,' it is a descriptive norm — a pattern perceived as typical. An injunctive norm would involve explicit approval or disapproval from the community (e.g., 'we must breastfeed for six months'). Cognitive dissonance involves awareness of a conflict, not mere conformity.

Correct. PM-JAY provides up to Rs 5 lakh per year per family for secondary and tertiary hospitalisation, targeting the bottom 40% of the Indian population including BPL households. RSBY was its precursor (Rs 30,000 cover), targeting BPL households for hospitalisation. Both directly address hospitalisation costs for this patient.

Social security schemes for health in India operate at different target populations: PM-JAY = BPL and lower-middle hospitalisation; ESI = formal sector; ICDS = under-6 children and pregnant mothers; MGNREGA = rural employment income. Matching the scheme to the patient's eligibility is a core community medicine skill.

Incorrect. MGNREGA provides employment income support but not hospitalisation coverage. ICDS addresses child and maternal nutrition — not adult hospitalisation. ESI applies to formal organised-sector employees, not agricultural labourers. Only PM-JAY and RSBY (its precursor) are hospitalisation-focused schemes for BPL households.

Correct. A systematic Andersen-model barrier assessment proceeds from predisposing factors (beliefs, stigma, socio-demographics) → enabling factors (income, transport, facility access, working hours) → need factors (perceived severity, symptom attribution). This order mirrors the causal logic of the model and ensures no category is missed.

In a structured simulated barrier assessment, explicitly name all three Andersen categories in your written notes: (1) Predisposing: health beliefs, stigma, gender roles, education; (2) Enabling: income, transport, facility distance, insurance; (3) Need: perceived symptom severity, attribution. Multi-barrier delays are the rule, not the exception.

Incorrect. While any order can gather information, the Andersen model's logical structure — predisposing → enabling → need — provides the most systematic framework. Starting from enabling factors alone (Option A) or a single income question (Option C) risks missing attitudinal barriers. Deferring social assessment (Option D) undermines integrated CBME care.