Health Psychology, 5th edition Shelley E' Taylor

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Health Psychology, 5th editionShelley E. Taylor

• Chapter Eight
• Using Health Services

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Recognition and Interpretation of Symptoms
Recognition

• Individual Differences in Personality
• Those who use the defense mechanism repression,
  when compared to those who dont
• Are less likely to experience symptoms
• Are less like to experience treatment side
  effects
• Monitors visit physicians with symptoms that
  are less severe than do blunters
• Neurotics recognize and report symptoms more
  quickly than those who are not neurotic

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Recognition and Interpretation of Symptoms
Recognition

• Cultural Differences
• Anglos tend to report more infrequent symptoms
• Mexicans tend to report frequently-occurring
  symptoms
• Attentional Differences
• Those who focus on themselves notice symptoms
  quicker than those who focus on their environment
  and activities

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Recognition and Interpretation of Symptoms
Recognition

• Situational Factors
• Boring situations make people more attentive to
  symptoms than do interesting situations
• Symptoms are noticed on days when a person is at
  home rather than days full of activity
• Medical Students Disease as students study each
  illness, many members of the class imagine that
  they have it

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Recognition and Interpretation of Symptoms
Recognition

• Stress can precipitate or aggravate the
  experience of symptoms
• Closer attention to ones body when a vulnerable
  to illness is perceived
• Stress-related physiological changes may be
  interpreted as symptoms of illness.

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Recognition and Interpretation of Symptoms
Recognition

• Mood
• Those in a positive mood
• Rate themselves as more healthy
• Report fewer illness-related memories
• Report fewer symptoms
• Those in a negative mood
• Report more symptoms
• Are pessimistic about relieving their symptoms
• Perceive themselves as more vulnerable to future
  illness

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Recognition and Interpretation of Symptoms
Interpretation

• Example A man in his 20s arriving at the
  Emergency Room with a number of relatives
• His only symptom A sore throat
• Cultural interpretation Staff joked about
  Italian families panicking over illness
• Actual significance of symptom The mans brother
  had died of Hodgkins disease and the first
  symptom, a sore throat, had not been treated.

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Recognition and Interpretation of Symptoms
Interpretation

• Prior Experience
• Personal History Those with a history of a
  medical condition tend to regard the condition as
  less serious than those people without a history
  of the condition
• How Common? Common symptoms that are not
  distinctive are regarded as less serious

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Recognition and Interpretation of Symptoms
Interpretation

• Expectations
• People may ignore symptoms that they are not
  expecting
• People may amplify symptoms that they do expect
• Example Premenstrual Symptoms
• Women close to menstruation interpret vague
  discomfort as premenstrual
• The same symptoms are ignored at different times
  in the menstrual cycle

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Recognition and Interpretation of Symptoms
Interpretation

• Seriousness of the Symptoms
• Symptoms that affect highly valued parts of the
  body are interpreted as more serious
• Symptoms that affect highly valued parts of the
  body are interpreted as requiring attention
• Symptoms that limit mobility or cause pain are
  perceived as serious

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Recognition and Interpretation of Symptoms
Cognitive Representations of Illness

• Illness Schemas (Illness Representations)
• Organized concepts of illness
• Acquired through the media, personal experience,
  family and friends.
• Illness Schemas influence
• Preventive health behaviors
• Reaction to symptoms
• Adherence to treatment
• Expectations for future health

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Recognition and Interpretation of Symptoms
Cognitive Representations of Illness

• Most people have three models of illness
• Acute illness
• Short in duration, no long term consequences
• Chronic illness
• Long in duration, consequences can be severe
• Cyclic illness
• Alternating periods with no symptoms, then many
  symptoms

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Recognition and Interpretation of Symptoms
Cognitive Representations of Illness

• Disease Prototypes organized conceptions of a
  particular disease
• Help people organize information about physical
  sensations
• Help people evaluate sensations
• Example Heart Disease
• Might include concepts of poor exercise as a
  cause, chest pain as a consequence, long duration
  and possibly fatal

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Recognition and Interpretation of Symptoms
Treatment Begins

• Diagnosis begins before formal medical treatment
  is sought
• Lay referral network, an informal network of
  family and friends, offers interpretation of
  symptoms
• Home remedies may be recommended
• One in three American adults may use
  unconventional therapy (chiropractic, massage,
  etc) in the course of a year

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Who uses health services?Age

• Young children develop a number of infectious
  childhood diseases
• Declines in the use of health services in
  adolescence and early adulthood
• Use of health services increases in later
  adulthood
• Chronic conditions
• Disorders related to the aging process

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Who uses health services?Gender

• Women use health services more frequently than
  men
• Pregnancy/childbirth account for much of the
  difference but not all
• Women may be more sensitive to bodily disruptions
• Women may not be subject to social norms to
  ignore pain and be tough
• Women may be part-time workers and not need to
  take time off work as often
• Womens health care is fragmented and more visits
  are needed

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Who uses health services?Social Class and Culture

• Lower social classes use medical services less
  than do upper classes
• Services for the lower classes are often
  inadequate and understaffed
• Biggest gap between rich and poor
• in preventive health services
• Inoculations against disease
• Screening for treatable disorders

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Who uses health services?Social Psychological
Factors

• These factors involve an individual's attitudes
  and beliefs about symptoms and health services
• Health Belief Model
• Explains peoples use of health services
• Treatment-seeking of those who have money and
  access to health care
• Socialization
• Parental use of health care services

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Misusing Health ServicesEmotional Disturbances

• About 2/3 of physicians time is spent with
  non-medical complaints
• Why do people seek physicians time when the
  complaints are psychological?
• Stress/emotions create physical symptoms
• Anxiety can produce diarrhea, upset stomach,
  shortness of breath, sleep problems
• Depression can produce fatigue, loss of appetite,
  listlessness

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Misusing Health ServicesEmotional Disturbances

• The Worried Well
• Concerned about physical and mental health
• Inclined to perceive minor symptoms as serious
• Believe that they should take care of their own
  health
• Actually use health services more than other
  individuals

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Misusing Health ServicesEmotional Disturbances

• Somaticizers
• Experience distress and conflict through bodily
  symptoms
• When self-esteem is threatened they are
  especially likely to somaticize convince
  themselves that they are physically ill.
• Medical disorders are perceived as more
  legitimate than psychological ones

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Misusing Health ServicesEmotional Disturbances

• Secondary gains
• Benefits that an illness brings
• Ability to rest
• Freedom from unpleasant tasks
• Care of ones needs by others
• Time off from work
• Secondary gains can be reinforcing, and can
  interfere with returning to good health

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Misusing Health ServicesDelay Behavior

• An individual seek treatment for a symptom but
  puts off doing so
• Delay the time between recognition of a symptom
  and obtaining treatment
• Example Monica finds a small lump in her breast
  when taking a shower but this month is just too
  busy to have it checked out.

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Misusing Health ServicesTime Periods of Delay
Behavior

• Appraisal Delay the time it takes a person to
  decide that a symptom is serious
• Illness Delay the time between the recognition
  that a symptom implies an illness and the
  decision to seek treatment
• Behavioral Delay the time between actually
  decided to seek treatment and actually doing so
• Medical Delay the time between making an
  appointment and receiving appropriate care

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Misusing Health ServicesDelay Behavior

• A major factor in delay is perceived expense of
  the treatment
• Delay is more common in people with no regular
  contact with a physician
• Delay is more common when symptoms are ones that
  are similar to past symptoms that have proven to
  be minor

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Patients in the Hospital SettingStructure of
the Hospital

• Structure depends on the health program under
  which care is delivered
• Health Maintenance Organizations (HMOs) have
  their own hospitals with a hierarchical organized
  structure
• Private Hospitals have two lines of authority
  medical line, administrative line
• Nurses are part of both lines of authority and
  conflicting requirements sometimes occur

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Patients in the Hospital SettingFunctioning of
the Hospital

• Conditions change rapidly in a hospital
• Fluctuating demands require flexibility in
  responding to particular situations
• Lack of communication across professional
  boundaries can create problems
• Example hand washing
• Nurses feel free to correct other nurses
• Nurses do not feel free to correct physicians
• Yet, physicians are more likely to break this
  rule

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Patients in the Hospital SettingRecent Changes
in Hospitalization

• Walk-in Clinics
• Can handle smaller emergencies
• Less serious complaints can be addressed
• Home-help services
• Can provide care for the chronically ill
• Hospice
• Can provide services for terminally ill
• Provides palliative care rather than active
  intervention

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Patients in the Hospital SettingImpact of
Hospitalization

• Patients enter a large organization
• Adjusting to a time schedule and pattern of
  activity beyond the patients control
• Giving up customary identity, and even clothing,
  for a new role as patient
• Complaints about fragmented care and lack of
  communication about treatments have led hospitals
  to try to reduce these concerns.

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Interventions to Increase Control Coping with
Surgery

• Irving Janiss Study Work of Worrying
• Patients must work through some of their fears
  about surgery before adjusting to it
• Contemporary View
• Patients who are carefully prepared for surgery
  and its aftereffects will show good postoperative
  adjustment
• Control-enhancing interventions with patients
  awaiting surgery has a marked effect on
  postoperative adjustment

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Interventions to Increase Control Coping with
Procedures

• Anticipating an invasive procedure is often a
  crisis situation for anxious patients
• Successful interventions to help people cope with
  these procedures include
• Providing information
• Relaxation techniques
• Cognitive-behavioral interventions

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The Hospitalized Child Anxiety

• Anxiety is the most common adverse reaction to
  hospitalization
• Young children (under age 6 years)
• may be anxious because they want to be with their
  family or they feel rejected by their family
• May develop new fears (of the dark, of staff)
• May convert anxiety into bodily symptoms
• Older children (ages 6 to 10 years) may have more
  free floating anxiety that is not tied to any
  particular issue

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The Hospitalized Child Anxiety

• Children just entering puberty
• May be embarrassed
• May be ashamed about exposing themselves to
  strangers
• Spontaneous coping methods of children often
• Are not well chosen
• Are not effective

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The Hospitalized Child Preparing Children for
Interventions

• Children about to undergo surgery benefit from
  films portraying children who are hospitalized
  for surgery
• Older children benefit when the film is viewed
  several days in advance
• Younger children need exposure immediately before
  the relevant event
• Even very young children should be told something
  about their treatment and be given a chance to
  express emotions

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The Hospitalized Child Preparing Children for
Interventions

• Parental support is important
• Most hospitals now provide 24 hour parental
  visitation rights
• Some hospitals allow parents to room in
• When parents cannot stay with the child
• Hospitals should provide continuity in staff who
  interact with the child
• Children can develop relationships with
  particular adults at the hospital