Session 4: Lay Beliefs and Health Promotion Flashcards
1
Q
What is meant by people with lay beliefs?
A
- How people with no specialised knowledge, understand and make sense of health and illness
- Lay beliefs are not simply a watered-down version of medical knowledge
- Socially embdedded - drawn from personal experiences, what they’ve observed from the people around them etc
- Complex - drawn from many different sources
- Definitions of health and illness vary e.g. cultures, subcultures, communities, generations.
- Potential gaps between lay and medical concepts
- Language - lay beliefs (can seem patronising) or lay knowledge (can be quite problematic as the term can give them an inappropriate status - some people’s beliefs are scientifically wrong).
- Exploring what health means to people
- Beliefs can impact on behaviour (to what extent are you willing to be healthy?)
- Beliefs can impact on compliance/non-compliance (adherence) on treatment - can help explain why patient is not following doctor’s advice etc.
2
Q
What is meant by sociological theory and lay perceptions?
A
- How much control do you think you can assert over your health?
- How much control do you think you can assert in everyday life?
- How does this relate to your wider social and cultural perceptions of health? To what extent do you feel you can make choices about /influence your future?
3
Q
Describe the different perceptions of health
A
- Negative definition: health equates to the absence of illness
- Functional definition: health is the ability to do certain things - tend to be found in older generations (a certain level of illness is acceptable if they can still do the things they need to/want to do) or lower socioeconomic statuses (can they look after their kids/work etc?)
- Positive definition: health is a state of wellbeing and fitness (long term perspective, more commonly assoicated with upper socioeconomic statuses)
4
Q
Describe lay theories about health and illness
A
- Complex and sophisticated
- Draw on cultural, social and personal knowledge and experience and own biography (‘what they see going around them’)
- Medical information may be rejected if it is incompatible with competing ideas for which people consider there is good evidence.
- E.g. lay understandings of inheritance and vulnerability to disease may not match your medical knowledge.
- Lay constructions of a ‘family history’ of heart disease.
- Language/concepts used included: genes, genetics hereditary, inheritance, make-up, family line, blood line (terms can be quite colloquial)
- Implications for the medical encounter?
5
Q
What are the issues in Lay epidemiology?
A
- Understand why and how illness happens
- Why it happened to a particular person at a particular time
- Many of us observe and generate hypotheses from experiences of those around us
- Why this illness at this point? a combination of personal, familial and social sources of knowledge => develop idea of coronary candidate - identify many risk factors (fat people, smokerss, unfit; “heart attack waiting to happen”)
- Why it should never have happened to them: system is fallible. Fat smoker always with a pint in hand (Uncle Norman) who lives to a ripe old age compared to ‘the last person you would expect to have a heart attack. Randomness and fat have implications for health promotion messages -people are less likely to engage in good behaviour if they believe it is due to randomness and fate
- In the COPD example, there was resistance to accept the link between smoking and COPD. Blaming it on workplace exposure to pollution takes responsibility away from the individual. If it is the individual’s fault, it can be potentially quite stigmatising.
6
Q
Describe the interplay between lay and medical beliefs. What are the types of influence of lay beliefs on behaviour?
A
- Public surrounded by professional concepts so difficult for lay understandings to develop independently.
- But professional concepts interpreted and made sense of in light of everyday life experience.
Influence of lay beliefs on behaviour
- Health behaviour: activity undertaken for purpose of maintaining health and preventing illness
- Illness behaviour: activity of ill person to define illness and seek solution
- Sick role behaviour: formal response to symptoms including seeking formal help and action of person as patient
7
Q
Describe Health Behaviour in more detail
A
- Smoking is more prevalent among manual workers and this difference has persisted overtime. This might be because:
- Higher social class more likely to have a positive definition of health (more likely to do something now that will be beneficial in the future)
- Incentives of giving up smoking are more evident for groups who could expect to remain healthy - more able to focus on long term investments => quitting is a rational choice.
- Incentives to quit less clear for disadvantaged groups - focus on improving immediate environment, smoking a coping mechanism, may be normalised behaviour => smoking is a rational choice
8
Q
Describe Lay beliefs and illness behaviour
A
Over a 2 week period about 75% of the population will experience one or more symptoms of ill health.
- For almost half (~2/3rds of all symptoms, respondents did nothing)
- 35% of symptoms, resulted in the use of lay-care, usually OTC medicine.
- 12% of symptoms led to a consultation with a primary care health professional, usually the GP.
- Most symptoms never get to a doctor - known as symptom or illness iceberg.
9
Q
What influences illness behaviour?
A
- Culture e.g. ‘stoical attitude’
- Visibility or salience of symptoms
- Extent to which symptoms disrupt life (think functional definition e.g. can you still look after your kids?)
- Frequency and persistence of symptoms
- Tolerance threshold
- Information and understanding
- Availability of resources - patient may have to take day of work, pay for childcare to visit GP
- Lay referral.
- NB: not all people with all symptoms should consult. Department of Health supports self-care. Powerful social sanctioning of “hypochondriac” behaviour. It’s about the right symptoms getting to the doctor at the right time.
10
Q
What is meant by Lay referral? Why is it important?
A
- Relatively rare for someone to decide to visit a doctor without first discussing their symptoms with others.
- Up to 3/4s of those visiting a doctor have divscussed their symptoms with another person
- Lay referral system: the chain of advice-seeking contacts which the sick make with other lay people prior to - or instead of - seeking help from health care professionals. These contacts can steer people to or away from the doctor.
Lay referral is important because it helps you to understand:
- Why people might have delayed in seeking help
- How, why and when people should consult a doctor
- Your role as a doctor in their health (need to be aware that you may not be th only one advising them in their health)
- Use of health services and medication
- Use of alternative medicines
11
Q
Describe how lay beliefs influence illness behaviour using Rheumatoid Arthritis as an example
A
Good disease control requires early intervention, but many delay seeking advice. 4 main themes influenced decision
- Symptom experience
- Symptom evaluation
- Knowledge of RA and treatments
- Experience of, and attitudes towards, health professionals
- Early presenters: experience significant and rapid impact on functional ability “pain was horrendous…etc”
- Delayers: often developed explanation for symptoms that related to preceding activities “I just thought it was part and parcel of being on my feet all day” etc)
- Recognition that this explanation was inadeuqate to explain symptom progression frequently prompted consultation “it did not get any better for a week and a half…etc”
- Symptom evaluation: key factor influencing how quickly medical advice is sought
12
Q
Give an example demonstrating how symptom evulation is a key factor influencing how quickly medical advice is sought
A
- Women and first MI
- Haf trouble interpreting, understanding and linking symptoms “I could not associate this tiredness, SOB and the pain with an MI….I thought that only elderly people would have an MI…etc”
- Tried to self-manage discomfort and even chest pain
- Had difficulty making final decision to seek medical help
Why do people delay?
- Perceptions of MI - typical victim/candidate is obese, smoking, drinking, older, male. Typical heart attack is sudden => death
- Own heart attacks not like this - still able to do things, an evolving event
- Don’t recognise variation and mildness of some symptoms (just hadn’t made the connection)
13
Q
Describe lay beliefs and adherence to treatment, using the example of asthma
A
- Many patients don’t take their asthma medication as prescribed
Three broad groups:
- “Deniers and Distancers”: was up to half of the sample study population. Denied either having asthma at all (deniers) or denied having “proper” asthma (distancers). Claimed symptoms did not interfere with everyday life. Used complex or drastic strategies to hide it. Taking medication relies on accepting asthmatic identity - didn’t take drugs or attend asthma clinics.
- “Accepters”: accepted diagnosis and doctors’ advice completely. Normal life involved having control over symptoms through medication (including both preventive and relieving). Asthma was not a stigmatised identity - happy to use inhalers in public. Proactive.
- “Pragmatists”: did not use preventive medication but only when asthma was bad. Accepted they had asthma but saw it as a mild acute illness (that kept recurring rather than as a long term illness that required active managing).
Implications for medical professionals:
- Medication behaviour is tied to people’s beliefs about condition, social circumstances and threat to identity.
- “Irrational” use of medication is deeply embedded in complex social identities that have to be managed.
- Meanings of symptoms for patients may be different from those for professionals.
14
Q
What are the determinants of health?
A
A range of factors that have a powerful and cumulative effect on the health of populations, communities and individuals.
- The physical evironment
- The social and economic environment
- Out individual genetics, characteristics and behaviours
- The ‘health career’ - complex map of many determinants
- “The context of people’s lives determine their health, and so blaming individuals for having poor health or crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control many of the determinants of health” (WHO)
15
Q
Define Health Promotion
A
- “The process of enabling people to increase control over and to improve their health…Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just under the responsibility of the health sector, but goes beyond healthy lifestyles to well-being.” Ottawa Charter for Health Promotion (1986)
- Focus on social and well-being as well as physical health
26
Q
Describe the Prevention Paradox in more detail
A
Link with lay beliefs:
- If people don’t see themselves as a ‘candidate’ for a disease, they may not take on board the health promotion messages.
- Awareness of anomalies and randomness of a disease (e.g. heart attacks) will also impact on views about candidacy
Importance of health promoters engaging with lay beliefs
