Seeking Health Care IISeeking Health Care II

Seeking Medical AttentionSeeking Medical Attention

What Influences Seeking Medical What Influences Seeking Medical AttentionAttention

Seeking medical attention is a special Seeking medical attention is a special case of engaging in health related case of engaging in health related behaviorbehavior

The same models discussed previously The same models discussed previously applyapply

Research using these models has found a Research using these models has found a number of factors related to seeking health number of factors related to seeking health carecare

Illness BehaviorIllness Behavior

Activities undertaken by people Activities undertaken by people experiencing symptoms in order to:experiencing symptoms in order to: Define the illnessDefine the illness Seek reliefSeek relief

Seeking health care is one of many illness Seeking health care is one of many illness behaviorsbehaviors

Factors Influencing Illness Factors Influencing Illness BehaviorBehavior

Personal ReluctancePersonal Reluctance Personal View of IllnessPersonal View of Illness

Attitudes about illness/health careAttitudes about illness/health care

Social and Demographic FactorsSocial and Demographic Factors

AgeAge GenderGender Cultural Cultural EconomicEconomic

Symptom CharacteristicsSymptom Characteristics

Visibility of symptomsVisibility of symptoms Perceived SeverityPerceived Severity InterferenceInterference Frequency and persistenceFrequency and persistence

Sick-Role BehaviorSick-Role Behavior

Behavior after diagnosisBehavior after diagnosis Same goal as illness behavior, different Same goal as illness behavior, different

dynamicsdynamics Not the person’s faultNot the person’s fault Relief from responsibilityRelief from responsibility Take steps to get wellTake steps to get well The right to make health-related decisionsThe right to make health-related decisions The right to become dependent on othersThe right to become dependent on others

Being in the hospital is a special caseBeing in the hospital is a special case

Being in the HospitalBeing in the Hospital

First “hospitals” were temples in ancient GreeceFirst “hospitals” were temples in ancient Greece Throughout history hospitals have been run by Throughout history hospitals have been run by

religious groupsreligious groups Catered to poor, who usually died of diseases Catered to poor, who usually died of diseases

they didn’t have when they enteredthey didn’t have when they entered People with resources were treated at homePeople with resources were treated at home

All this changed as medical technology All this changed as medical technology advancedadvanced

Currently hospitals = medical centers. Provide Currently hospitals = medical centers. Provide numerous servicesnumerous services

9

Length of Hospital StayLength of Hospital Stay

6

6.5

7

7.5

8

1970 1975 1980 1985 1990

Ave

rag

e S

tay

(in

day

s)

10

Use of Hospitals Use of Hospitals (Class Session #7)(Class Session #7)

110

120

130

140

150

160

170

1970 1975 1980 1985 1990

Dis

char

ges

per

1,0

00 P

op

ula

tio

n

Being in the Hospital: ProblemsBeing in the Hospital: Problems

DepersonalizationDepersonalization Treating as if the Treating as if the

person were not thereperson were not there Lack of InformationLack of Information

Information overloadInformation overload Sometimes the Sometimes the

medical staff just medical staff just doesn’t knowdoesn’t know

Loss of controlLoss of control

““Good” patient versus “bad” Good” patient versus “bad” patientpatient

““Good” patient refers Good” patient refers to one whoto one who conforms and conforms and

complies. complies. assumes non-person assumes non-person

rolerole does not complaindoes not complain appears cheerfulappears cheerful conforms to routineconforms to routine

Learned Learned HelplessnessHelplessness

““Bad” patientBad” patient asks questionsasks questions demands answersdemands answers complainscomplains attempt to restore attempt to restore

control control fails to conformfails to conform DisobedientDisobedient

ReactanceReactance

Preparing for ProceduresPreparing for Procedures

Preparation is fundamentally about increasing Preparation is fundamentally about increasing perceived controlperceived control Information ControlInformation Control

Providing InformationProviding Information Anderson (1987)Anderson (1987)

Modeling ProceduresModeling Procedures ChildrenChildren

Cognitive ControlCognitive Control Focus on the benefitsFocus on the benefits

Behavioral ControlBehavioral Control Anderson (1987)Anderson (1987)

14

InfInformation and Behavioral Control: ormation and Behavioral Control: Anderson Anderson (1987) Study(1987) Study

HypothesisHypothesis: Does : Does information and coping information and coping preparationpreparation improve recovery? improve recovery?

Practical purposePractical purpose: How to : How to improve hospital careimprove hospital care to to help patients cope with surgery?help patients cope with surgery?

DesignDesign: 60 male open-heart surgery patients : 60 male open-heart surgery patients randomly assigned to 1 of 3 treatment groups:randomly assigned to 1 of 3 treatment groups: Standard Care (control group)Standard Care (control group) Information OnlyInformation Only Information plus Coping Information plus Coping

15

Standard Care (Control Group)Standard Care (Control Group) PamphletsPamphlets Nurse ContactsNurse Contacts

Information OnlyInformation Only Standard careStandard care Videotape: Videotape: subjectivesubjective and and objectiveobjective

informationinformation

Information plus CopingInformation plus Coping Standard careStandard care Information Only treatmentInformation Only treatment Exercise trainingExercise training: coughing, breathing, : coughing, breathing,

movement movement

16

RResults: Anxietyesults: Anxiety

30

32

34

36

38

40

42

44

Admission Before Surgery After Surgery

An

xiet

y S

core

Standard CareStandard Care

Information OnlyInformation Only

Info + CopingInfo + Coping

17

ResultsResults In addIn addition, cition, compared to Standard Care, ompared to Standard Care,

bothboth psychological treatments psychological treatments equallyequally . . . . . .

improved improved physical recoveryphysical recovery

reduced reduced complicationscomplications

Information Plus Coping provided Information Plus Coping provided no no

added benefitadded benefit beyond Information Only beyond Information Only

Modeling ProceduresModeling Procedures

Modeling is often used with childrenModeling is often used with children Puppet showsPuppet shows

Preschoolers and young school childrenPreschoolers and young school children Videos/demonstrationsVideos/demonstrations

Older childrenOlder children