Flashcards in L19 – Illness Cognition and Behaviour Deck (65):
What is Illness cognition?
= patient’s own common sense beliefs about their illness
What does illness cognition serve as a frame work for?
Coping with and understanding their illness;
Telling them what to look out for if they are becoming ill
What are the five cognitive dimensions of illness beliefs?
Perceived cause of the illness
Time line (duration)
Consequences (expected outcomes)
Curability and Controllability
What is identity (one of five cognitive dimension of illness beliefs) mean?
a) Label given to the illness (medical diagnosis, e.g. cold)
b) The symptom experienced (e.g. runny nose)
What is a social impact of identity/medical diagnosis on an individual? Give one example where renaming a condition can alleviate such social impact?
Schizophrenia 精神分裂 now referred to as psychosis 思覺失調: less stigmatizing
more willing to accept diagnosis and seek help
What are the two main perceived causes of illness?
What are some examples of biological perceived cause of illness?
What are some examples of psycho-social perceived cause of illness?
Are the two main causes of perceived causes of illness always exclusive?
e.g. “My cold was caused by a virus, as well as the result of being run down”
What does time line mean? (one of five cognitive dimensions of illness beliefs)
patients’ beliefs about how long the illness / symptoms will last:
a) Acute (short term)
b) Chronic (long term)
How can a patient's personal belief contradict with the time line of illness? Give one example.
Breast cancer survivors: recovered for 10 years but still think they are at risk for another cancer
What does CONSEQUENCES (expected outcomes) mean? (one of five dimensions of cognitive dimensions of illness beliefs)
patient’s perceptions of the possible effects of the illness on their life
What types of effects could a patient perceive an illness has on his life?
a) Physical (e.g. pain, lack of mobility)
b) Emotional (e.g. loss of social contact (stigmatization), loneliness)
c) A combination of factors, e.g.:The anti-hypertensive medication makes me tired and thus affects my work performance
What is the inference of CONSEQUENCES (expected outcome) on patient care? What should doctors do to manage expected outcomes?
help them make the optimal choice
What is Curability and controllability? (one of five dimensions of illness beliefs)
patients’ beliefs about whether the illness can be treated and cured
What are the types of perceived sense of control over the outcome of illness?
Internal and External
a) Internal, e.g. “If I rest, my cold will go away”
b) External, e.g. “If I get medicine from my doctor, my cold will go away”
What can doctors do to manage curability and controllability in chronic disease patients?
Chronic illness: need to improve their confidence for better sense of control
What follows illness cognition?
What is Illness behavior?
actions taken in response to perceived illness
What is illness behavior strongly determined by?
strongly determined by symptom interpretation
What 4 actions are taken in response to perceived illness?
Responses to bodily signs, symptoms
Seek opinions, advice
Wait for symptoms to subside
What is the assumption stated in Leventhal’s self-regulatory model of illness behavior?
Given a problem / change in status quo, the individual will be motivated to solve the problem and re-establish their state of normality
What are the three stages of problem solving proposed by Leventhal's self-regulating model of illness behavior?
1. Interpretation of problem (making sense)
2. Coping (dealing with problem aiming to regain state of equilibrium)
3. Appraisal (assess the success of coping)
How can symptom perception, a stimuli of the first stage of Leventhal's self-regulating illness behavior model, be influenced?
Which 2 situational stimuli are necessary for an individual to realize his deviation from norm?
How can mood influence symptom perception? (e.g. Anxiety, stress, negative emotions)?
Anxiety, stress increases self-report symptoms (e.g. intensity, frequency of pain)
Negative emotions increases negative meanings and worries about the symptom
How can cognitive state be influenced by internal state- focused?
Boredom / absence of environmental stimuli > tend to focus internally >
more likely to notice if any physiological changes > increase self-report symptoms
How can cognitive state be influenced by external state-focus?
Distraction / attention diversion (e.g. busy > pay less attention to physiological changes) > under-reporting
What are the two attention states that can influence the cognitive state of an individual and influence symptom perception? What additional cognitive state can influence symptom perception?
internal states-focused vs. external states-focused
Anticipated symptom experience
Name one social environment what can influence symptom perception.
What are the three sources of social messages necessary for situational stimuli in Leventhal's self regulating model of illness behavior?
“lay referral system”
How can health professionals give an individual a social message about his deviation from norm?
via routine health check / screening
What does the "lay referral system encompass"?
strong influence on help-seeking behaviour
Social networks before seeking professional advice (e.g. colleagues / friends / family)
Seek info and advice from multiple sources
Give one example of media having a positive influence on social message, a stimuli of Leventhal's model in stage 1.
celebrities admit depression > break stigmatization
What are some typical emotional responses to health threat?
Does the representation of health threat equal the five cognitive dimensions of illness beliefs?
What does the transition from situational stimuli to coping involve?
Representation of health threat and/or emotional response to health threat
Define COPING, stage 2 of Leventhal's model.
person’s response to a threatening situation
process of managing external / internal demands that are perceived as taxing or
resources of the person
What are coping strategies?
specific way of how an individual manage a particular event
What are the three ways of coping?
Problem-focus / approach coping
Explain Problem-focus / approach coping.
manage / altering the problem with the environment causing distress
Deal with problem
What is important if problem-focused coping is limited?
Emotion-focus coping: to regulate the emotional response to the stressful event
What stage follows coping?
Appraisal-To assess how successful the coping stage has been
What does Sociological approach to illness behavior identify?
factors that influence help-seeking behaviours
What is help-seeking behavior driven by?
How can illness recognition and illness danger affect level of concern? (think about acute symptoms for an advanced cancer)
Increasing perception of illness danger
Increasing level of concern
Illness recognition is determined by?
occurrence of the illness is in a given population
familiarity with symptoms
Illness danger is determined by?
The relative predictability of the outcome of the illness (e.g. mortality rate)
The amount of threat / loss that is likely to result
Explain Visibility and recognition of symptoms on affecting help-seeking behavior?
other people can spot > more likely to seek help earlier
What determinant of illness behavior can lead to stigmatization?
Information, knowledge, and cultural assumptions
What determinant of health behavior can affect curability and controllability? (think public health sector overflowing)
Accessibility of health utilization (e.g. breast cancer: did not know could see GP > waited until had to
go to A&E)
What is a most common determinant of health behavior that is also 'social message'? (think lay-referral system)
Sanctioning (pressure from friends / relatives to visit the doctor)
What two determinants vary the most between individuals internally? (how they feel)
Perceived seriousness (e.g. minor = little notice)
Tolerance threshold (different between people)
What are the 3 common outcomes that follow decision to seek help/take action?
What events occur in help-seeking process?
Perception of symptoms > Accommodation to symptoms > Breakdown of symptoms > Decision to seek help/ take action
What are the 5 different response stages of illness ?
Assumption of the sick role
Medical care contact
Dependent- patient role
Recovery and rehabilitation
What are some outcomes of symptom experience, first stage of illness experience?
What is decided and done in stage 2 of illness experience, assumption of the sick role?
Give up normal roles
Lay-referral or continue lay remedies (e.g. folk medicine, self medication)
In which stage of illness experience is professional advice seeked and treatment procedures negotiated?
Medical care contact
What are some outcomes of medical care contact (stage 3)?
Denial, doctor shopping, confirmation
In what stage does secondary gain (e.g., disability benefits, or release from unpleasant responsibilities) exist within?
Stage 4: Dependent - patient role
What is decided by one in stage 4 of illness experience?
Accept professional treatment
procedures for illness
What is the last stage of illness experience?
What happens to the patient in stage 5 of illness experience?
Give up sick role
Resume normal role