Health Psychology

Lecture 6

Receiving Health Care

Lecture 6 - Outline

• Part 1– Receiving Health Care

• Patient-practitioner relationships

• Hospitalization and noxious procedures

Receiving Health Care

Receiving health care is a multifaceted process…

1. Notice the symptoms

2. Interpret the symptoms

3. React to the symptoms

4. Satisfaction with health care

5. Comply with medical recommendations

Receiving Health Care

1. Noticing the symptoms

– Individual differences

– Competing environmental stimuli

– Emotional, cognitive, and situational variables

– Sociocultural issues

Receiving Health Care

2. Interpreting the symptoms• Am I ill?

Receiving Health Care

3. Reacting to the symptoms• Majority of symptoms are not reported to a health

professional

• What factors influence whether people seek medical care?

– Personal reluctance to seek care– Social and demographic factors– Symptom characteristics– Personality– Beliefs about illness (illness schemata)

Delay in seeking medical care

Three stages of delay in seeking medical help for symptoms

Receiving Health Care

4. Satisfaction with health services

• Commonly, people express a high level of satisfaction with their consultation

– Average = 88% (ranges from 43 to 99%)

• Patient satisfaction is affected by– Type of health issues

– Quality of patient-practitioner interactions

• Outcomes of patient satisfaction

What are your major complaints?

Sources of dissatisfaction with medical consultations

• The doctor does not listen to them• The doctor is not sympathetic• They do not understand what the doctors tell them

Patient-Practitioner Relationships

Satisfaction with medical care = satisfaction with practitioner

• Factors that lead to dissatisfaction include– Personal style

– Interrupting

– Terminology

– Differing aims and expectations

– Patient characteristics

Receiving Health Care

5. Adherence to treatment regimes

• Nonadherence occurs when people do not adopt the behaviors or treatments prescribed by their doctors

– Average nonadherence = 50% (ranges from 15 to 93%)

– Nonadherence with medication - low (25%)

– Nonadherence with lifestyle changes - high (75%)

Receiving Health Care

5. Adherence to treatment regimes

• Measuring nonadherence

– Clinician’s report, Self-report, Other-report

– Objective count of pills, biochemical markers

• Consequences of nonadherence - does it matter?– Often no deleterious effects but…– Over 10% of hospital admissions can be attributed to

nonadherence

Receiving Health Care

5. Adherence to treatment regimes

• Causes of nonadherence - possible solutions

– Understanding and remembering the treatment regimen

– Satisfaction with patient-practitioner relationship

– Features of the treatment regimen– Features of the disorder– Contingencies - operant conditioning– ‘Rational’ nonadherence– Reactance and self-labeling

Receiving Health Care

5. Adherence to treatment regimes

• Causes of nonadherence - possible solutions

– Simple regimens + written information

– Teach approachability, warmth, communication skills

– Promoting participation in decision making– Highlight benefits of adherence, costs of nonadherence– Cues, self-monitoring and reinforcement– Request a verbal (or written) commitment– Encourage patient to ask questions

Hospitalization and Noxious Procedures

Hospitalization

Relevance of psychology to hospitalization

• Determination of psychological effects, and their causes and consequences**

• Determination of effective interventions to prevent/reduce adverse psychological effects**

• Dissemination of information to relevant care providers

• Delivery of interventions

Hospitalization

Satisfaction with hospital care

• Tends to be high (Cleary et al., 1991; Delbanco, 1992)

• Charles et al (1994) - Canada, 5 000 patients– Communication

• Did not understand answers to questions 8%

• Did not understand explanation of test results 15%

• Practitioners talked as if patient not there 12%

– Pain• Was not told about how much pain to expect26%

• Had pain which could have been eliminated 16%

Hospitalization

Consequences of hospitalization

• Loss of Control (Taylor, 1979)

– Loss of control over one’s body

– Loss of control over typical activities

– Loss of ability to predict what will happen

• Explanations for problems

– Familiarity, time, effort, depersonalization, pain

Hospitalization

Emotional Reactions to hospitalization

• Anxiety• Learned helplessness• Reactance• Depression

Hospitalization

Individual differences in reaction to hospitalization

• Coping Skills

– Problem-focused (information seeking)

– Emotion-focused (cognitive restructuring, wish-fulfilling fantasy, threat minimization)

Painful or Stressful Procedures

Intervention aim - reduce anxiety to recovery• Reassurance

• Information

– Sensory information (sensations likely to experience)

– Procedural information (mechanics of what will happen)

– Review of empirical evidence• Suls and Wan (1989)

• Anderson (1987)

• Auerbach (1989)

Painful or Stressful Procedures

Intervention aim - reduce anxiety to recovery

• Cognitive-Behavioral Strategies

– Aim: Alter appraisal and enhance control or distraction

– Review of empirical evidence• Shipley et al. (1978)