Quick test question:

What are the main psychological componentsof the biopsychosocial model?

Medical Psychology10. 02. 2011.

Patients’ Representations and Beliefs about Illness

High Prevalence of Somatic Symptoms

► 80-90% general population: > 1 symptom per week

► Typical adult: 1 symptom every 5-7 days

► 81% college students report > 1 symptom within 3 days

► 20% adults: “substantial,” “prolonged” fatigue

► 15%-30% back pain, joint pain, muscle pain within 2 weeks

► Only small minority seeks medical help!

Common symptoms in primary care (Mayou and Farmer, 2002)

► Precontemplation: not intending to make any changes

► Contemplation considering a change

► Preparation making small changes

► Action: actively engaging in a new behaviour

► Maintenance sustaining change over time

The transtheoretical model of behaviour change (Prochaska & DiClemente, 1982)

World Health Organization’s Definition of Health

• A state of complete physical, mental, and social well-being, not merely the absence of disease

Cultural Concepts of Health

► South Africa:

• Harmony with nature

• Harmony of mind, body, and spirit

► Asia:

• Physical and spiritual harmony with nature

• Balance of yin and yang

► Middle East:

• Spiritual Causes

• Cleanliness

► Western countries:

• Personal responsibility

with diet, rest, exercise,

and prevention

Protective Objects:

• Amulets

• Bangles

• Talismans

Protective Substances:

• Garlic

• Onions

• 1000 year old eggs

• Kosher foods

Health care professionals must change to accommodate other cultural beliefs and behaviors towards health and illness

Lay Definitions for Health

A sample of 9000 British adults defined health as:

► not-ill: the absence of physical symptoms.► despite disease.► reserve: the presence of personal resources.► behaviour: the extent of healthy behaviour   ► physical fitness► social relationships► vitality► function

(Blaxter, 1990)

Knowledge systems and health behaviour

Health-behaviour is related to the way in which people interpret their symptoms

Is behaviour that rational?

We have to take in consideration:

► Role of emotional factors such as fear and denial. ► The person’s belief in their ability to carry out behaviour ► How attitudes might change

► The measurement of each component

Illness Representations

► Illness representations will determine how someone responds to potential health threats

► Illness representations include:

Informations and beliefs about the illness

Illness Cognitions (Leventhal & Nerenz, 1985)

1. Identity• Diagnosis (a cold) and symptoms (runny nose, fever)2. Perceived cause of illness• Stress, a virus, unhealthy lifestyle3. Time line• Acute or chronic4. Consequences• Physical (pain, mobility problems) and emotional (lack of

social contact, anxiety)5. Cure & control• E.g. by taking medication or getting plenty of rest

Breast-cancer patients’illness attributions(Taylor, 1985)

► Illness representations

- interpret symptoms

- and give them meaning

►The course of action taken will be determined by the representation

Typical illness metaphors

► Challenge

► Enemy

► Loss

► Gain (primary / secondary)

► Punishment

The course of action taken

will be determined by the representation

Illness behaviour:is influenced by the individual’s interpretations of an

appropriate response to symptoms

pre-existing belief systems determined culturally &

experientially

dialogue with others & societal norms & values

May be initiated by one person on behalf of another – the

“lay referral system”

((Harding & Taylor, 2002Harding & Taylor, 2002))

Motivation PhaseMotivation Phase Volition PhaseVolition Phase

BehaviorBehaviorIntentionIntentionss

Self-EfficacySelf-Efficacy

Outcome Outcome expectanciesexpectancies

Risk Risk AwarenessAwareness

Self-EfficacySelf-Efficacy

Action Action PlanningPlanning

Health Action Process Approach: A 2-Layer Model (Schwarzer, 1992)

pre-intentionalpre-intentionalintentionalintentional actionalactional

Health Action Process Approach (Schwarzer, 1992)

Illness Perception Questionnaire(Moss& Morris, 2002)

Timeline: acute/chronic• – My illness is likely to be permanent rather than temporaryTimeline: cyclical• – My symptoms come and go in cyclesConsequences• – My illness has major consequences on my lifePersonal control• – What I do can determine whether my illness gets better• or worseTreatment control• – My treatment can control my illnessIllness coherence• – I have a clear picture or understanding of my conditionEmotional representations• – When I think about my illness I get upset