What is illness behaviour?
Behaviours that patients engage in once they believe that they are ill. The belief can be objective or subjective, confirmed or suspected, self reported or notified Illness behaviour is an active process - can result in seeking help, behaviour change
What are illness beliefs?
A patient's implicit understanding of their health status based on common-sense beliefs about their illness e.g. beliefs about the cause, course and consequence of illness
What are Illness representations?
Gathering related beliefs into a framework which helps provide the patient with an understanding or picture of illness. This directs their coping responses and illness behaviour
What factors influence whether people notice symptoms and response to perceptions of symptoms?
Background Stable factors
How do background influences affect reporting of illness?
Social knowledge and beliefs about illness and seeking help. Health status also a factor, people with chronic conditions over report symptoms related to their condition and under report symptoms they believe are unrelated
How do stable factors influence symptom perception and reporting?
Emotional disposition: patients with negative disposition more likely to notice symptoms and report symptoms more quickly (high false positive). Patients with low emotional expression block emotionally arousing stimuli and tend to report fewer symptoms (high false-negative)
Generalised expectancies: Patients with favourable outcome expectancies (High self efficacy and internal locus of control) report fewer symptoms
Explanatory styles: Pessimistic style of explanation perceive more symptoms and more severe symptoms but delay seeking help
How do social factors influence symptom perception and reporting?
Illness information comes from social cues, which can act as confirmation for evidence and act as a lay referral network for advice, diagnosis and treatment
Perceived social support. Those with high social support rate themselves as more healthy, recall fewer illness-related memories and report fewer symptoms. Reverse for those with low social support.
What situational factors influence perception and reporting?
Competition for cues: patients more attentive to symptoms in isolation, when situation they are in is boring
Stress: often aggravates perception and reporting of physical symptoms and increases perceived vulnerability to illness. Can result in wrong attribution of physiological reaction to stress as symptoms of illness
Symptom characteristics: speed of onset, public visibility, complication of chronic illness. A high emotional response to recognition of a symptom can speed seeking help however they can also delay seeking help if too high as patients then suppress their emotions
What are the five belief dimensions that form a patient's response to their understanding of illness (illness representation)?
Identity: diagnostic label patients give to their illness based on beliefs about the symptoms, can bias interpretation and assimilation of information related to illness.
Cause: ideas patients develop about the cause of their illness
Time: how long will it last?
Consequence: perceived impact on the patient's life
Control-cure: beliefs on how illnes can be treated, controlled or managed
How does the belief dimension of identity affect illness representation?
Identity refers to the diagnositic label that patient's give to their illness based on the beliefs about the symptoms of the illness.
This can bias the interpretation and assimilation of illness-related information
e.g. patients will give more attention/increased importance to information they believe is more relevant to the illness they are labelled with, assimilate new information consistent with current beliefs and reject contradictory information, and interpret new symptoms in light of the illness representation.
How does the cause belief dimension affect illness representation?
Patients develop ideas about the cause of their illness (genetic, lifestyle, environment, chance) which influences their expectations of treatment. Adherence to treatment and advice is influenced by the degree of consistency with their expectations.
Causal beliefs also influence the emotional response to illness e.g. cancer - self blame, genetic - helplessness
How does the belief dimension of time affect illness representation?
The three main timelines for illness are acute, chronic and cyclical.
A mismatch in perceived time and the natural course of illness can affect compliance with medication
e.g. hypertension is believed to arise only when stressed, therefore negates the need to take medication
How can beliefs about consequences affect illness representation?
Perceived effects of an illness on the patient's life (identity, social relationships, finance)
The perceived severity of the consequences
Perceived severity of consequences can be prognostic, patients who perceive consequences as mroe severe tend to have longer hospital stays, longer recovery, greater disability and psychological morbidity.
How do beliefs about the treatment of an illness affect illness representation?
Control-cure: beliefs about treatment for an illness and the effectiveness of treatment.
Patients who believe it is possible to control an illness are more likely to adapt to the consequences of the illness, attend rehab and adhere to treatment.
Explain how the self-regulatory model can influnce a patient's illness behaviour
When a symptom arises, the patient interprets the symptom based on their perception of the symptom and social cues. This influences illness representations (identity of illness (diagnostic label), cause, timeline, consequences, cure or control)
The illness representations formed by the patient initiate a coping response to deal with the situation and then appraisal to decide whether or not the coping response was effective.
The emotional response to illness influences all four components.