CH. 9 Illness Cognitions, Adherence, and PatientPractitioner Interactions Flashcards
Illness Cognitions, Adherence, and PatientPractitioner Interactions
Illness Cognitions, Adherence, and PatientPractitioner Interactions:
- Different cultures have different ways of coping and reacting to symptoms of illness.
Culture and Illness Behaviors
CULTURE AND ILLNESS BEHAVIORS – Many factors surround illness, and culture influences every one of them.
- Before we are treated, we have to recognize that we have a problem. We then seek treatment. Once we get a diagnosis, we have to adhere to the course of treatment prescribed for us.
ILLNESS BEHAVIORS – Recognition, seeking treatment, and adhering to treatment—collectively referred to as illness behaviors.
- Three main stages influenced by our cultural backgrounds.
ILLNESS BEHAVIORS – Varying ways individuals respond to physiological symptoms, monitor internal states, define and interpret symptoms, make attributions, take remedial actions, and use various forms of informal and formal care.
- African Americans’ mistrust of the health-care system is often cited as a cause of racial disparities in health.
- Marked underuse of mental health resources by many non-European American groups, suggesting an increased focus on the availability of and preference for alternative medicine.
- Chinese Americans had the highest prevalence of any CAM use.
- Ayurvedic medicine, an ancient Indian tradition especially popular among Indians.
Role of Acculturation
ROLE OF ACCULTURATION – Acculturation is sometimes linked to more negative health behaviors. This perception suggests that it is important to look at the ethnic identity and acculturation of doctors and, more importantly, at their beliefs and preferences, since these factors may influence their referrals and their prescriptions
- African Americans who strongly identified with their ethnicity reported a lower probability of health-care use in comparison with those with weaker ethnic identities.
- Spanish-speaking Latinos differed from both English-speaking Latinos and Caucasians on most measures of health-care use.
ILLNESS REPRESENTATIONS – Health psychologists lump together all thoughts or cognitions about the subjective experience of an illness under the umbrella term illness representations.
- Your illness representation will influence your behaviors and experiences whether it is a common cold or inflammatory bowel disease.
- When your illness representation is activated, specifics behaviors may follow.
- In one study, participants made to think of the common cold actually walked more slowly, fitting their mental schema of how you behave with a cold (
The Commonsense Model of Illness Behavior
The Commonsense Model of Illness Behavior – The CSM identifies variables, and behaviors that reflect how people in different settings perceive, and managing threats to health.
- Includes studies of folk medicine by medical anthropologists such as Kleinman (1980), which makes this model perfect for a cultural approach to health psychology.
- It is always easy to say “I told you so” once you see the results of a study, but a lot harder to successfully predict an outcome in advance.
FEAR COMMUNICATIONS – Those attempts to change behavior that used gruesome statistics or pictures to get a person to change their behavior.
TWO FUNDAMENTAL ELEMENTS:
- First, individuals are seen as active problem solvers trying to make sense of their physical states while acting to avoid and control signs of illness.
- When we notice symptoms that suggest we are ill, we have to make decisions based on our understanding of the potential threat (an illness representation), our options to manage that threat, and our sense of the costs and benefits of the procedures.
- Reminiscent of the Health Belief Model.
- The second element is that individuals’ decisions will be based on their beliefs, perceptions, and skills.
- Perception is key. It does not matter what the objective physiological issues are or what the optimal medical procedures are; people’s illness representations are a function of their past experiences, cultural backgrounds, and sense of themselves.
- CSM assumes that illness representations are shaped by their sociocultural environments, family, friends, doctors, traditional healers, and the media.
Illness Perception Questionnaire–Revised (IPQ-R) – Tackles symptoms, components of illness, causes.
Brief Illness Perception Questionnaire (Brief IPQ) – Includes a single item for each of nine components of illness.
- Coping strategies were a mediator.
Key steps in the process of seeking health care.
Recognizing Symptoms
RECOGNIZING SYMPTOMS – Patients often ignore symptoms. Why is this the case?
The Confirmation Bias
THE CONFIRMATION BIAS – If there is any ambiguity in a person’s behavior, people are likely to interpret what they see in a way that is consistent with their bias.
- Once we believe something is true, we often change the way we interpret new information and the way we look at the world because of it. We tend to try to confirm our belief and have a bias in how we process information.
- If we believe that a change in our bodies is not a symptom of illness, we will probably look for information to support that belief and find it.
ILLUSORY CORRELATION – The belief that our expectations have been correct more often than they actually have been is referred to as an illusory correlation.
- Confirmation biases occur because we ignore disconfirmations of our biases and selectively remember information to support our biases.
Attributions and Misattributions
AMBITIONS AND MISATTRIBUTIONS:
- Another social psychological process that can influence the recognition of symptoms is related to how we determine the cause of events.
ATTRIBUTIONS – Process of assigning meaning to a symptom or behavior.
- EX. If your stomach hurts, you may attribute the pain to what you just ate. If you have not eaten anything different recently, you are more likely to worry about a stomach pain than if you have just tried something that is very different.
- The cause to which you attribute your symptoms can influence whether you seek treatment for them or not.
MISATTRIBUTE – Sometimes, we mistakenly label our physiological experiences based on external factors.
- If you feel tired and there are several people at work with colds, you are likely to misattribute your tiredness to your developing a cold, when it could be due to you not getting enough sleep.
- This misattribution can increase your anxiety and, in combination with a confirmation bias (that you have caught a cold), you may soon find yourself accumulating more evidence to support your theory.
- Your belief that you are getting sick will, in fact, make you sick (a SElf-fulfilling prophecy).
- Such self-fulfilling prophecies can contribute to the continual use of folk medicines and treatments.
- If you are biased against Western biomedicine, you will probably not try to get better after a visit to a doctor. If you are biased toward shamanism, you are probably going to feel a lot better after a shamanistic ritual is performed over you
PERSONALITY
PERSONALITY – The most common individual factor that influences the recognition of symptoms and the seeking of treatment is personality.
- People who are relatively high in anxiety tend to report more symptoms of illness.
- High in neuroticism experience higher levels of anxiety. This characteristic often translates into oversensitivity to symptoms and to more complaining about ill health. People with chronic negative affect show a disease-prone personality.
People who monitor their symptoms to an extreme may be HYPOCHONDRIACS – psychological disorder characterized by excessive preoccupation with one’s health and constant worry about developing physical illnesses.
- Hypochondriacs believe that any minor change in their condition could be a sign of a major problem.
- Other personality traits such as optimism and self-esteem delay us from seeking treatment.
BEHAVIORAL INVOLVEMENT – The patient’s attitude toward self-care, specifically an active involvement in treatment.
INFORMATIONAL INVOLVEMENT – Measures how much the patient wants to know about his or her illness and specific details of its treatment.need for information may vary with social norms as well.
- The more conservative the social norms, the less people are involved in their medical decision making.
PRIVATE BODY CONSCIOUSNESS – Some individuals are more sensitive to their health states than others.
- This increased vigilance over the body may also cause the patient to feel more discomfort than the patient with low vigilance. Differences in vigilance may underlie a major sex difference in symptom reporting. Women both perceive and report more physical symptoms than men do which could be due to women being higher in private body consciousness.
Seeking Treatment
SEEKING TREATMENT – Once you recognize you have a problem, you have to decide whether to seek treatment.
Arthur Kleinman EXPLORATORY MODEL. – Explicitly applied across cultures. Kleinman (1980) showed that complex systems have three overlapping health-care systems.
POPULAR or LAY SECTOR – Involves culturally based personal and familial beliefs and practices.
FOLK SECTOR – Involves cultural traditions and specialists.
PROFESSIONAL SECTOR – Involves legally sanctioned professionals and the Western medical system.
- Most people first turn to their popular sectors.
Kleinman (1980) developed an interview to measure cross-cultural exploratory models:
- What do you think caused your problem?
- Why do you think it started when it did?
- What do you think your sickness does to you?
- How severe is your sickness? Will it have a long or short course?
- What kind of treatment do you think you should receive?
- What are the most important results you hope to receive from this treatment?
- What are the chief problems your sickness has caused for you?
- What do you fear the most about your sickness?
* Useful for tapping into the full details of a person’s illness representations.
Role of Culture
ROLE OF CULTURE:
- The cultural norms and the values of collectivistic families mean that care of all immediate and extended family members is provided by the family at home.
- In collectivist cultures, it is absolutely imperative to include the family, and sometimes the community, for effective counseling; otherwise, the treatment plan will not be followed.
- For many indigenous populations (e.g., American Indian people), the fact that one member of the tribe or clan is ill means that the tribe or clan is sick.
- The greater the cultural stigma and the more the culture values spiritual or religious healers, the more likely there will be a delay in seeking health care and counseling, resulting in the condition being more severe at the time of treatment.
Health psychologists have tried to understand the main reasons why people do not seek treatment.
- DiMatteo (1991) suggests that:
- (1) people often misinterpret and underestimate the significance of their symptoms.
- (2) they worry about how they will look if the symptoms turn out to be nothing
- (3) they are concerned about troubling their physicians
- (4) they do not want to change their social plans by having to see a doctor
- (5) they tend to waste time on unimportant things, such as gathering and packing personal belongings before going to the hospital.
Understanding Delays
UNDERSTANDING DELAYS:
Why People Delay Seeking Treatment
Three Main Components of Delay:
APPRAISAL DELAY– People sometimes take a lot of time to recognize they have symptoms.
ILLNESS DELAY – The time between the recognition that one is ill and the decision to seek care.
USE DELAY – Between the decision to seek care and the actual behaviors to obtain medical health care.
- Sometimes the delay in seeking treatment results from the symptoms of a problem being misattributed.
- Other times a delay is due to concern over not having health insurance.
TRIGGERS – Some factors increase the likelihood that a person will seek treatment.
Five triggers that will increase the likelihood that a person will seek treatment :
- First, the degree to which you are frightened by symptoms.
- The second trigger is the nature and quality of symptoms. The more symptoms you have and the worse they are, the more likely you are to go to a doctor.
- Third trigger– This interference with life, personal relationships, job, plans that you have made.
- Social interference —when your occupation or vacation is threatened by symptoms—is the fourth trigger.
- SOCIAL SANCTIONING – Even if you do not want to seek treatment, your employer could pressure you to get treatment or return to work. Such as this can also trigger a visit to the doctor (the fifth trigger).
Factors influencing treatment seeking, a number of explicit cultural variables play a role:
- Age and sex differences.
- Women and elderly persons use health services at a significantly higher rate than do men and younger individuals.
- Part of this difference is because these two groups have specific issues that need care such as pregnancy and childbirth for women, and chronic and terminal illnesses among elderly persons.
- In addition, women have been shown to be more sensitive to changes in their bodies than men are.
- And may find it more socially acceptable to report symptoms than men.
- Men may not report symptoms or pains as much so as not to appear weak (“boys don’t cry”).
Treatment seeking varies by ethnicity as well
Treatment seeking varies by ethnicity as well:
- Non-European Americans tended to form close, exclusive relationships with friends, family, and members of their ethnic group and to show skepticism of medical care. These groups were more likely to rely on a lay-referral system.
LAY-REFERRAL SYSTEM – Nonprofessionals such as family, friends, and neighbors—in coping with illness symptoms instead of seeking biomedical treatment.
- Some ethnic groups relying on folk medicine.
- Having close-knit networks or having strong religious beliefs does not always prevent someone from seeking treatment. Showed that members of the close-knit Mormon community in Salt Lake City were actually more likely to seek treatment than members of loosely knit communities.
- The biggest cultural factor predicting the seeking of treatment is socioeconomic status.
- In fact, many conditions that may at first appear to be a function of ethnicity may actually be due to poverty.
Culture of poverty in which poverty over time influences the development of psychological traits and behaviors including the use of health services:
- This lack of use is directly correlated with financial barriers to medical care.
- Only upper-middle-class families treated all illnesses with Western biomedicine.
- Only lower-class families treated all illnesses at home.
Hospital Setting
HOSPITAL SETTING
- Many millions of American citizens do not have health insurance of any form even after the Affordable Care Act passed, a factor that can prevent them from going to the hospital except for extreme situations.
- Most hospital visits begin with filling out forms and gathering information and are often accompanied by long waiting periods. For these reasons and a host of others, most people dread having to go to a hospital.
- Physician may only spend a very brief time with each patient, and this is often one of the major causes of dissatisfaction with the treatment-seeking process.
- Patient quotas are often set by the hospital as a result of the complex interplay of a health maintenance organization and insurance billing requirements.
- Stress was lowest when there was no television playing in the rooms and when videotapes of nature scenes were playing.
Adherence to Treatment
ADHERENCE TO TREATMENT** – The extent to which a patient’s behavior matches with his or her practitioner’s advice is referred to as **ADHERENCE.
- Nonadherence can cause morbidity and influence clinical diagnosis of treatment plans, the cost-effectiveness of health care, and the effectiveness of clinical trials.
- The failure of a patient to adhere satisfactorily to a treatment costs the country between $100 billion to $300 billion a year.
- Adherence in general ranges from 15% to 93%, prompting many to believe that finding ways to help patients follow medical treatments could have larger effects on health than any treatments specifically.
- Just having the physician pay closer attention to the patient after diagnosis can increase treatment adherence.
CONCERNS THAT INFLUENCE ADHERENCE:
- Adherence rates vary according to the type of treatment prescribed and to the disease or illness a patient has.
- Some treatments are easier to adhere to than others.
- Some treatments are long term and complex, severely interfere with life, and affect desirable behaviors.
- Patients’ intentions to adhere, their understanding of the treatment, and their satisfaction with their practitioners can also influence how likely they are to adhere.
CREATIVE NONADHERENCE – Patients sometimes modify and supplement their treatment plans.
- Intentional nonadherers, compared with adherers, have lower perceptions of the necessity of their new medication and higher levels of concern about taking it.
- Unintentional nonadherers are not significantly different from adherers in terms of perceptions of medication necessity.
- Social, political, and economic barriers can prevent minority group members from complying with their practitioner’s prescriptions.
Adherence to treatment involves dietary practices:
- Many treatments involve either food restrictions or prescriptions to eat certain foods.
- These prescriptions may not fit with some cultural beliefs.
The three main stages in the health–illness process (recognizing symptoms, seeking treatment, and adherence to treatment)** are all related to **patient–practitioner interactions.
Patient–Practitioner Interactions
Patient–Practitioner Interactions – When you do see a doctor, the quality of your interaction with him or her can play a big role in how you feel and in the extent to which you adhere to the prescribed treatment.
Three major models of patient–practitioner interaction. In the active-passive model – The doctor plays a pivotal role, making the majority of the decisions because the patient is unable to do so, often because of his or her medical condition. Here the patient has little to no say in what is done.
GUIDANCE COOPERATION MODEL – The doctor still takes the primary role in diagnosis and treatment, but the patient plays a part by answering questions, although he or she does not take part in decision-making regarding treatment.
MUTUAL COOPERATION MODEL – The doctor and patient work together at every stage, consulting each other on the planning of tests for diagnosis and in decisions regarding treatment.
- Good communication is perhaps one of the most critical ingredients in successful patient–practitioner interactions
