Session 3 - Lay Beliefs and approaches to long term conditions

Question 1

Outline the 3 perceptions of health

Answer 1

1. Negative perception (common perspective in lower SES)
   - Health means an absence of illness
   e. g. someone believes that if they haven’t got any conditions, then they are healthy
2. Functional perception (common perspective in older people)
   - Health enables you to do certain things
   e. g. being able to function in a way that’s important to you, such as going to the shops
3. Positive perception (common perspective in higher SES)
   - Health is a state of wellbeing and fitness
   e. g. something that you can achieve in the long term with short term changes (can be worked towards)

Question 2

Outline the 3 ways which lay beliefs can influence our behaviour

Answer 2

1. Health behaviour - activity undertaken for the purpose of maintaining health (and preventing disease)
2. Illness behaviour - activity of an ILL person to define disease and seek a solution
3. Sick role behaviour - a formal response to symptoms such as seeking formal help

Question 3

Explain why smoking is more prevalent amongst lower SES groups

Answer 3

• Lower SES are more likely to have a negative definition of health (whereas higher SES more likely to have a positive definition of health)
• Incentives of smoking are less clear to lower SES who focus on the immediate environment and smoking is a more normalised behaviour = smoking is a rational choice
• Incentives of giving up are more evident for higher SES who expect to remain healthy (able to focus on longer term investments) = quitting is a rational choice

Question 4

What things influence illness behaviour? (seeking solution and definition of disease i.e. going to GP)

Answer 4

• Culture
• Visibility of symptoms
• Frequency of symptoms
• Disruption caused by the symptoms / tolerance threshold
• Availability of resources
• Information and understanding

Question 5

Explain what ‘lay referral’ means

Answer 5

Lay referral is the chain of seeking advice which an ill person makes i.e. talking to peers, family, either prior to or instead of seeking help from healthcare professionals
e.g. should I go to the GP for this do you think??

Question 6

A group of people have asthma medication, some take their medication, some don’t and some take it in the event of episodes and not regularly. What 3 broad groups could you put these people in?

Answer 6

1. Deniers
   - deny that they have asthma so don’t adhere to the medication
2. Accepters
   - accept that they have asthma and adhere to the medication
3. Pragmatists
   - accept that they have asthma, but only treat it as a series of acute exacerbation rather than a long term conditions (e.g. only using reliever inhaler)

Question 7

Explain the meaning of illness narratives

Answer 7

Illness narratives are the story telling and accounting practices that occur in the face of illness

Question 8

List and explain the 5 types of work done by people with long term conditions

Answer 8

1. Illness work - symptoms management and treatment
   - Getting a diagnosis
   - Managing the symptoms (physical impact but also social impact)
   - Self management
2. Everyday like work - managing daily living
   - Coping and strategic management
   - Normalisation (2 ways)
3. Emotional work - managing own emotions and those of others
   - Protect the emotional well being of others around you
   - ‘Cheery self’
   - Downplaying pain or symptoms
   - Can impact perspective on their ‘role’
4. Biographical work - reconstructing the way their life is going to plan out now
   - Loss of self
   - Change between identity and body
   - Newly aware of the fragility of life, can change outlook on life (grief for a former life)
5. Identity work - work done to maintain an acceptable identity
   - Condition affects how people see them and how they see themselves
   - Illness can be a defining part of someone’s identity
   - ‘Stigma’

Question 9

Define the different types of stigma: discreditable and discrediting stigma and felt versus enacted stigma

Answer 9

Discreditable stigma:

• Where no disease characteristics can be seen, but if found out, then could think differently about you
  e. g. anxiety or HIV

Discrediting stigma:

• Where visible characteristics (or well known stigma) can set you apart
  e. g. physical disability or suicide attempt

Felt stigma (a thought):
- Fear of stigma, includes feelings of shame associated with having a condition

Enacted stigma (real):
- Experienced stigma, of discrimination, prejudice or disadvantage due to the condition