ILLNESS BEHAVIOR PARADIGM

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ILLNESS BEHAVIOR PARADIGM
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I. Situational adaption perspective

• A. Interactionism
• 1. Emergence and Change
• 2. Process of Labeling
• 3. Adjustment and Adaptation

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• B. Socially Defined Situation Social,
  Psychological, Cultural, Physical and Biophysical
  Factors Intersect in Situations
• C. Health and Illness Derive from Assessment of
  Situational Adaptation Across Situation Set

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• D. Health and Illness are not an Entity, but an
  Evaluation that Emerges from Relationships that
  we Create, Sustain and Negotiate across Situation
  Set
• E. Health and Illness are not an Entity, but an
  Evaluation that Emerges from Relationships that
  we Create, Sustain and Negotiate across Situation
  Set

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II. Types of Illness Behavior Everyday, Acute,
Chronic and Life Threatening Heroic or Terminal
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• A. Primary Process
• B. Role Relationship
• C. Lay Others
• D. MD Relationship

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EVERYDAY ILLNESS BEHAVIOR
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I. Everyday Illness Behavior

• Conceptual understanding of signs and symptoms
  that do not reach formal medical attention

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• A. HINKLE et al
• 1. Males, lower-middle class, 20-45 in 20
  years
• 2. 1 life endangering illness
• 3. 20 disabling illnesses
• 4. 200 non-disabling illnesses
• 5. 1,000 symptomatic episodes

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• 6. 1,221 episodes over 7,305 days or one new
  episode every 6 days
• 7. Only considers incidence, neglects illnesses
  where there is no awareness and not illness
  duration
• 8. Illness defined as presence of symptoms

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• B. White et al, Figure I Any symptom,
  disorder or affliction which persisted for one
  or more days or for which medical service
  was received or medicine purchased . . . and .
  . . includes the results of both disease and
  injury.

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• 1. 1000 adults population at risk
• 2. 750 adults reporting one or more illnesses
  or injuries per month
• 3. 250 adults consulting a physician one or
  more times per month
• 4. Are the 500 non-consulters healthier?

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• 5. 9 adult patients admitted to a hospital per
  month
• 6. 5 adult patients referred to another
  physician per month
• 7. 1 adult patient referred to a university
  medical center per month
• 8. What does this say about individuals seen in
  a tertiary medical center?

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• C. Epidemiology of Non- Consulting Behavior
• 1. Anderson, Buck, Kanaher and Fry
• a. Non-users did not have more complaints than
  users of medical services
• b. Non-users self-treat, users inclined not to
  self-treat

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• c. Reason for non- consultation Symptoms not
  sever enough previous consultation
  unsatisfactory self- treatment adequate fear
  of treatment

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• d. On the cost side Non-users view travel time,
  cost of travel, waiting time, loss of wages,
  leaving house or children, and appointment
  system, receptionists and physician as
  problematic

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• e. In general non-users view themselves as
  healthier than users users have more somatic
  anxiety and less self-sufficiency

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• 2. Kessel and Shepherd
• a. In one study 23 of ill people consult
  physician in given month in an other study
  less than 33 consult consistent with White
  et al

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• b. Kessel and Shepherd found that non-users are
  older, predominantly male, fewer children in
  household, equal number of illnesses as users, no
  serious illnesses, perceive self as healthy,
  manage illnesses without physician

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• c. Non-users did not like to bother physician
  unless seriously ill, could not afford to be
  ill, too busy to see physician, critical of
  physicians, did not like to wait

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• D. In EIB we want to study the lower part of
  the illness iceberg How majority of
  individuals handle signs and symptoms within
  their daily routines
• 1. Assumptions

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• a. Health Status Deviations emerge within
  socially defined situations against the total
  background of daily life and relations with
  others
• b. In socially defined situations individual,
  social structure, culture and biology intersect

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• c.Deviations from ones Bodily Background
  Expectancies
• d. Deviations will not be defined come to medical
  attention if individuals can contain them
  within daily situation

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• e. When signs and symptoms cannot be contained
  over a substantial portion of situation set
  medical consultation will be sought
• 2. Theoretical Context and Three Elements
• a. Biophysical Reality
• 1. Absolutists meaning resides in disease
  itself

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• 2. Ideational meanings of illness emerge from
  interaction of biophysical sensations and
  processes of social selection, interpretation and
  evaluation

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• 3. We are and Have a body they impose and
  dispose themselves to our action
• 4. Bodily Background Expectations

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• b. Socially Defined Situations
• 1. Necessary condition of human conduct
• 2. W.I.Thomas If we define situations as real,
  they are real in their consequences.

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• 3. Gonos potential worlds that answer all
  questions about...what is...real and how to
  be involved in this reality
• 4. Goffman little social systems, a little
  social reality that we sustain because they are
  subjectively meaningful and give social
  organization to our life

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• 5. Goffman Involvement rules
• a. individuals negotiate juggle situational
  claims rights and obligations
• b. dominant involvement give or withhold
  concerted attention to activity

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• c. side involvements
• 1. auto involvements signs of the
  animal creature releases
• 2. aways reverie, woolgathering
  daydreaming
• 3. insufficient situational presence

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• c. Containment Everyday signs and symptoms as
  bodily background expectancies, normal processes,
  chronic diseases or consequences of situational
  participation kept as a side involvement

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• 1. retain definition of situation
• 2. sustain situational participation
• 3. signs and symptoms not dominant focus
• 4. signs and symptoms contained physical,
  normal processes, psycho-social

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• 5. situation set and drift
• 6. cumulative and ongoing assessment
• 3. Cumulative and ongoing assessment
  situation types
• a. Health and illness from cumulative and ongoing
  assessment of situation set, bodily background
  expectancies and sensations and degree of
  achieved containability

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• b. Situation Types
• 1.Type One most daily situations
• 2. Type Two produce or potential to produce
  signs and symptoms
• 3. Type Three breaks, transitions, containment
  resources

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• 4. Type Four diagnostic, illness, health
  training or therapeutic situations bodily and
  psycho-social problems dominant situational
  attention
• 5. Situation set Health and illness definitions
  emerge from situation set assessment and capacity
  to contain

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• 4. Factors in Containment
• a. Engrossment in and Commitment to the
  situation attention and identity
• b. Role enactment and Status definers
• 1. tolerance quotient
• 2. idiosyncrasy credit
• 3. benefit of the doubt

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• c. Position and Power
• 1. alter idiosyncrasy credit
• d. Social Propriety and Deference
• 1. tight and loose situations
• 2. contagion, cost and danger

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• e. Situational Resources
• f. Meaning and Significance of Signs and
  Symptoms independent of situation
• 5. Summary

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