Review for Exam 1 (part 2—Chapter 3 Seeking and Receiving Health Care & Chapter 4 Adhering to Medical Advice

Chapter 3, Seeking Health Care

Illness Behavior—behavior oriented toward determining health status when faced with

symptoms

Know certain factors that may lead to different responses to symptoms:

Personal factors: Examples--a person’s way of viewing their own body, stress

levels, and personality traits. According to research findings, people who

experience a great deal of stress are more likely to seek health care than

those under less stress, even with equal symptoms. People who score high

on neuroticism generally had high self-reports of illness whether or not

objective evidence confirmed their reports

Social and demographic factors:

Gender differences: generally, women seek out more medical care than

men

Socioeconomic Status: those with higher social economic status

experience fewer symptoms and report a higher level of health than those

at lower SES. However, when high SES individuals are sick, they are

more likely to seek medical likely due to greater access to appropriate and

affordable resources

Stigma: higher levels of perceived stigma may deter a person from

seeking care

Race: European Americans are more likely than other racial groups to

obtain medical care. Various explanations offered include lack of

resources/insurance coverage and access to care, discrimination, cultural

insensitivities

Symptom characteristics: heighten visibility, perceived severity, degree to which

the symptom interferes with a person’s life, and persistence and recurrence can

lead to a higher likelihood of the person seeking medical care

Conceptualization of the disease: how a person makes sense of the disease

can influence when they might seek health care

The Sick Role—behavior after the person is diagnosed

Segall proposed that the sick role consists of 3 rights/privileges (right to make

decisions concerning health issues, right to be exempt from normal duties, right to

become dependent on others) and 3 duties/responsibilities (duty to maintain health and

get well, duty to perform routine health management, and duty to use a range of health

resources). This is an ideal, but not necessarily realistic—know what are some of the

limitations of Segall’s conceptualization of the sick role.

Receiving Health Care

Choosing a Practitioner—remember the 3Cs: Caring, Communicative, and

Competent practitioners are highly desirable and lead to greater patient satisfaction

with health care.

Strategies for helping young children cope with medical procedures. Be able

to describe some effective strategies for helping children including:

• providing parent/child understandable and age-appropriate information,

• the use of toys/books and other fun tools to discuss health procedures,

• the use of distraction (for short-term procedures),

• modeling (use an effective and relatable model who models the ability to

successfully go through the procedure),

• cognitive-behavioral intervention (e.g., teaching positive self-talk to reduce

stress).

A multicomponent approach—using more than one strategy is most effective.

Chapter 4, Adhering to Healthy Behavior

Adherence--a person’s ability and willingness to follow recommended health practices;

or the extent to which a person’s behavior coincides with medical or health advice.

Estimates of the problem of noncompliance/nonadherence can range from

15%-93%, but overall, it can be a problem

Be familiar with strategies to measure adherence including:

1) asking the practitioner (the least valid because practitioners generally

overestimate adherence rates)

2) asking the patient (problematic because patients tend to present themselves

as being more compliant than they are and/or they are not very accurate at rating their

adherence)

3) asking other people such as other hospital staff or family members

4) measuring adherence through objective measures such as pill counts, number

of prescriptions or refills

5) examining biochemical evidence

All strategies for measuring adherence have limitations, but using a combination

of these methods may be the most accurate although costly.

From your reading, there are several barriers to adherence mentioned. Note

optimistic bias, the tendency to believe that you will not encounter the negative effects

of nonadherence, can be commonly displayed in relation to a number of different health

behaviors.

Factors that predict adherence: The test will focus on the strongest factors.

Please review reading sections on the following:

--Patient’s perception of disease severity

--Complexity of treatment

--Depression, especially problematic in adhering to treatments for chronic

illnesses

--Income

--Social support

--Patient’s beliefs and cultural norms

--Practitioner-patient interaction (discussed in class)

Quality of verbal communication

Practitioner’s personal characteristics (3Cs)

Theories of health-related behavior

Test will emphasize the older more researched continuum theories: the Health

Belief Model, Self-Efficacy Theory, and Theory of Planned Behavior). Know the major

tenets of these theories as outlined below:

Health Belief Model (Becker & Rosenstock): Major tenet—beliefs are important

contributors to health behaviors. HBM looks at 4 different beliefs that combine to predict

health behaviors:

1) perceived susceptibility to disease

2) perceived severity of the disease

3) perceived benefits of doing the health behavior

4) perceived barriers of doing the health behavior

Overall, the HBM is fairly good at predicting simple and infrequent health behavior (e.g.,

vaccinations, screenings), it’s not as good at predicting more complex, ongoing, lifestyle

behaviors (e.g., smoking cessation, exercising). The HBM does not consider personal

control, one’s belief about their ability to have some control over themselves and their

environment (also known as, self-efficacy).

Self-efficacy Model (Bandura): Major tenet—health outcomes result from

reciprocal/mutual interactions of three factors: environment, person, behavior =

“reciprocal determinism”. In particular, the person factor of self-efficacy can better

predict patient adherence in specific situations if efficacy is developed and enhanced,

and the health behavior is expected to produce valuable outcomes.

Theory of Planned Behavior (Ajzen): Major tenet—the most immediate

determinant of behavior is intention (one’s plan to take action or not take action).

Intentions are shaped by three factors:

1) one’s attitude toward the behavior

2) one’s perception of how much control they have over their own behavior

3) social norms/pressure to perform the behavior

Research on the TPB has been mixed. Overall, the model can demonstrate

some predictiveness about certain ongoing and planned health behaviors (e.g.,

engaging in a diet plan or an exercise program). It’s less predictive about risky,

spontaneous behavior.

Behavioral Model: suggests that reinforcement (to strengthen behaviors) may

be helpful in improving adherence: positive reinforcement—a positively valued

stimulus will likely increase a behavior (e.g., receiving $20 contingent on appearing for

your doctor’s appointment on time); negative reinforcement—the removal/reduction of

a negative stimulus by engaging in a behavior will strengthen that behavior (e.g., a

reduction in pain by taking a prescribed medicine will likely strengthen the patient’s

adherence to the prescription).

Note: While the specifics of the stage theories of health behavior (e.g.,

Transtheoretical Model and The Health Action Process Approach) will not be

emphasized on the test, please know that stage theories are helpful in highlighting the

importance of recognizing where the patient is at in terms of their readiness to make

specific changes in their health behavior.

--Be familiar with strategies for improving adherence. Note: the most effective

strategies focus on changing people’s behavior rather than simply educating them or

inducing fear about the consequences of nonadherence:

--Clearly written instructions,

--Simple prescriptions

--Follow-up calls for missed appointments

--Rewards for compliant behavior

--Cues to assist in following medical regimen

--Involvement of significant others in support of regimen

--Contingency contracting

Note: combination of techniques is the most effective