18 - Illness and Coping Behaviours Flashcards
How do ‘we’ make sense of the world?
- Searching: extract information using senses, e.g. see, hear, attend.
- Inferring: process information based on experience/ capacity, e.g. judge, store, recode, transform, retrieve and transmit
We create mental representations of health and illness. What does this representation guide?
Guides our actions to continue or treat.
What does it mean to be ‘healthy’ according to WHO 1947?
“A state of complete physical, mental and social well being”
What does it mean to be ill?
- Having symptoms - bodily signs or physical sensations (pain, tired, nausea / blood pressure, rash, etc).
- Sensations are novel and/or non-attributable (attention).
- Having symptoms… for some time (timeline).
- Not feeling normal (perception).
- Not being able to do what normally do (behaviour).
What is symptom perception?
- Difference in physiological or emotional state labelled as unusual and/or harmful.
- Sign of the onset of illness and/or progression.
What did Broadbent and Petrie find in their 2007 study about symptoms?
Extremely common, 2-3 symptoms a week, e.g. 38% headache
What did Campbell and Rowland find in their 1996 study about acting upon symptoms?
Usually not acted upon, <5% go to doctor with symptoms
What is symptom perception affected by?
- Persistence: severity, worsening and/or more symptoms.
- Attention: Focus/ Distraction/ Context, e.g. medical student-itis.
- Societal mores: stereotypes (e.g. 28% of death in men cardiovascular disease; in women – 6% 16% 26% 36% 46%?); culture/ socialisation (e.g. acceptable to be ill/ not be ill)
- Individuals differences: life stage, sex, personality styles
- Mood: sad, anxious, relaxed, e.g. negative moods more symptoms.
- Experience: illness experience, knowledge
What was Parsons study ‘The Sick Role’?
Society ‘gives’ people a sick role when it identifies and accepts them as ill
What are examples of societal expectations of ‘sick people’?
Exemption from normal social roles – must be legitimised by an authority (e.g. mum/ ASD/ GP)
Exemption from responsibility for illness (e.g. sick must be looked after/ not your fault)
Illness is undesirable (e.g. want to get well)
Seek appropriate help (e.g. see a doctor, stay in)
Time limited (e.g. acute/ length illness)
What are illness behaviours?
Illness behaviours are the actions a person undertakes when they feel ill to:
- Relieve the experience
- Seek more information (Kasl and Cobb. 1966; Mechanic, 1995).
- Solve ‘the problem’ of illness and return to status-quo.
What was Leventhal’s illness model?
Self-regulation/illness representation theory – person’s mental model of their illness
Framework linking illness representations with coping, and actions
- Person’s mental model of his/her illness.
- Person’s mental model of someone else’s illness ‘inaccurate’.
What is stage 1 of Leventhal’s model - Cognitive Representation?
Cognitive Representation - Belief Scheme
- Identity – beliefs about the illness label and symptoms
- Cause – beliefs about causes illness
- Timeline – beliefs about length illness (acute/ chronic)
- Consequences – beliefs about illness impact on physical, social and psychological well-being
- Control/ Cure – beliefs about the how well illness can be controlled or cured
What is stage 1 of Leventhal’s model - Emotional Representation?
Feelings/mood
Symptom/diagnosis: clam, relief, shock, fear, depression, anxiety, distress
What is stage 2 of Leventhal’s model - Coping?
Types of coping strategies people use to return to health status quo:
• Appraisal-focused – to make sense of illness (logical analysis, preparation)
• Problem-focused (approach) – to ‘fix’ illness (go to doctor, take remedy, plan goals or action).
• Emotion-focused (avoidance) – to ‘fix’ feelings (ignore, denial, anger, comfort).
What is stage 3 of Leventhal’s model - Appraisal?
- Evaluate coping strategy with illness problem.
- Worked / not worked.
- Choose another strategy and/or reappraise symptoms
What is the Period of Dysphoria?
< 2 weeks: short-term coping; change perceptions and behaviour.
What are the dynamic adjustment to illness?
- Initial response and coping strategies, e.g. calm/ do nothing, denial/ over compensate (Period of Dysphoria)
- Revised response and coping strategies, e.g. anxiety/ seek help (adaptation, coping strategies)
What did Geoff’s study find regarding ovarian cancer?
Found 90% of women with ovarian cancer experienced symptoms prior to diagnosis
- 70% for 3 months
- 15% for 1 year
Why are people reluctant to go to the doctors?
- Symptoms very typical of other things e.g. indigestion, nausea, wind, bloating, full feeling, inc waist size, pain in lower abdomen, change in bowel or bladder habits, lower back pain
- Women thought it would be embarrassing to go to the doctor
What is MEASURE?
Illness Perception Questionnaire (Moss-Morris et al, 2002)
What was Horne’s beliefs about medicine?
- Specific – necessity: beliefs that this medication improves health status (e.g. efficacy)
- Specific – concerns: beliefs that this medication harmful (e.g. dependence, side-effects)
- General – harms: beliefs about harms of all medications (e.g. all some form of poison)
- General – overuse: beliefs professionals over-reliant on medication (e.g. over-prescription)
What % of medication is not taken as prescribed?
Between 30-40%
What are reasons for non-adherence to medication?
Information / instructions unclear
Memory
Beliefs and cognitions patients (active non-adherence)
What was found about jab behaviour influences?
Jab behaviour predicted by beliefs about vaccine, not ‘flu’
What did Petrie find in his 2011 study regarding asthma?
124 asthma patients, not adhering inhaler use, completed IPQ & BMQ.
Findings:
- increased adherence by 10%
- changed people’s understanding illness
- changed peoples beliefs about necessity of inhaler.
Compared the effect of sending text messages reminding asthma patients to take their medicines compared to normal practice – improved adherence
What does the Common Sense Model help to understand?
how beliefs, coping and behaviours linked to illness behaviour.
What are beliefs about treatment associated with?
Adherence
What was Horne’s theory about beliefs about medicines?
Doctors have a stronger belief about medicines than patients
