Chapter 8: Health Psychology

Recognition of Symptoms

Some people maintain normal activities in the face of debilitating symptoms, whereas others hit the bed the moment they detect any minor bodily disturbance

• Individual Differences

• Attentional Differences

• Situational Factors

• Stress

• Mood and Emotions

Individual Differences

• People with illness anxiety disorders are convinced that normal bodily symptoms are indicators of illness

  • They make extensive use of medical services

• Hypochondriacs believe normal bodily symptoms are indicators or illness

• Neurotic people either exaggerate symptoms or are more attentive to real symptoms

• Men, older people are more likely to report symptoms

• People with low SES resources are more likely to have anxiety disorders

Attentional Differences

• People more focused on themselves are quicker to notice symptoms

• People with more distractions and who attend less to themselves experience fewer symptoms

• People who are socially isolated report more physical symptoms

Situational Factors

• A boring situation makes people more attentive to symptoms than an interesting situation

  • Ex: Feel an itch at a boring part of a movie

• Intense PA takes attention away from symptoms

• Medical Students Disease: As they study each illness, they imagine they have it

Stress

Can precipitate or aggravate the experience of symptoms

• People under stress may believe they are more vulnerable to illness, so they attend more closely to their bodies

• Stress related physiological changes are interpreted as symptoms of illness

Mood

People in a good mood or who have positive expectations rate themselves as more healthy, report fewer illness related memories and report fewer symptoms

• Affects perceptions about symptoms and perceived vulnerability to illness

Interpretation of symptoms

Ex: Headache because of dad

• Prior Experience

• Seriousness of Symptoms

• Common Sense Model of Illness

• Lay Referral Network

Expectations

People may ignore symptoms they aren’t expecting and amplify symptoms they are expecting

Seriousness of Symptoms

Symptoms that affect highly valued parts of the body are usually interpreted as more serious

• Symptoms that limit mobility or cause pain are perceived as serious

Common Sense Model of Illness

Argues that people hold implicit common sense beliefs about their symptoms and illnesses that result in organized illness representations or schemas

• These conceptions are acquired through media, personal experience, and family and friends

• They can vary from person to person

Lay Referral Network

An informal network of family and friends who offer their own interpretations of symptoms, often well before any medical treatment is sought

Who Uses Health Services

• Very young and elderly use it most frequently

• Women more than men

  • Pregnancy and birth are a huge reason for this difference

  • They may be more sensitive to bodily disruptions

  • Men are expected to project a tough, macho image

  • Women also have Pap tests, mammograms, etc

• People with low SES use these services less

  • Medicare and Medicaid from Affordable Care Act has narrowed the gap some

  • The biggest gap between rich and poor is the use of preventive health services

• Social Psychological Factors: An individual attitudes toward life and their beliefs about symptoms and health services

  • Influenced by socialization- chiefly by the actions of ones parents

  • Socially isolated people are motivated to seek care by a need for social contact

Delay Behavior

A person may live with one or more of these potentially serious symptoms for months without seeking care

Delay

Time between when a person recognizes a symptom and when a person obtains treatment

Appraisal Delay

Time it takes an individual to decide that a symptom is serious

Behavioral Delay

Time between deciding to seek treatment and actually doing so

Medical Delay

Time that elapses between the persons calling for an appointment and their receiving appropriate medical care

Community Health Workers

Are frontline public health workers who are trusted members of and/or have an unusually close understanding of the community served

• This trusting relationship enables them to serve as a liaison between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery

• They build individual and community capacity by increasing health knowledge and sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy

Roles of CHWs

1. Cultural meditation among individuals, communities, and health and social service systems

2. Providing culturally appropriate health education and information

3. Care coordination, case management, and system navigation

4. Providing coaching and social support

5. Advocating for individuals and communities

6. Building individual and community capacity

7. Providing direct service

8. Implementing individual and community assessment

9. Conducting outreach

10. Participating in evaluation and research

Effectiveness of CHWs

• Among hard to reach populations, CHWs can contribute to

  • Reducing the disease burden of hypertension

  • Reducing CV risk factors

  • Diabetes Control

  • Management of HIV

  • Cancer Screening

• Economic Benefits of CHWs

  • ROI 2.28:1.00

  • Social return on investment=$2.30

  • Average savings of $2,245 per patient

Guillermo Research

Empowering African American Men to Assist Peers in Improving Health

Background

• African American men are disproportionately impacted by adverse health conditions

• The use of preventative health services can help mitigate the impact of adverse health conditions

• African American men are less likely to use preventative health services than women and non-Hispanic white men

• When African American men do use these services, they present later than other me and with more advanced conditions

• One-size-fits-all efforts have produced limited results

• African Americans experience unique barriers to health care use

• Customized interventions to improve preventative health service utilization among African American men are needed

• Men of Color Health Awareness (MOCHA) project

• Men on the Move Project

Setting

• Columbia, SC 977.8 individuals per square mile

• Barnwell County, SC 41 individuals per square mile

  • Federally recognized qualified opportunity zone

Aim 1

To understand the unique factors associated with healthcare use among African American men in SC

Aim 1 Approach

• Recruitment of 10 African American men (i.e. “Leadership Team)

  • 5 from Barnwell and 5 from Columbia

• A training session will occur with the Leadership Team partners

• Each leadership team partner will recruit 3 African American men from their area and conduct 1-on-1 interviews

• Qualitative data will be collected from these 3 (n=30)

• Data will be transcribed and analyzed in NVIVO

Aim 2

To understand how male community health workers can best address these factors and promote healthcare use among African American men in SC

Aim 2 Approach

• Town hall-style meetings will be organized in Barnwell County and Columbia

• Each town hall will include members of the Leadership Team and 30 African American men from the area

• The goal of the meetings will be to:

  • Confirm the results found during Aim 1 of the study

  • Collectively develop strategies that can be implemented by male CHWs