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Health Psychology Notes Ch.9 Becoming Ill and Getting Medical Treatment

Terms in this set (20)

Perceiving symptoms is more complicated than it sounds as we do not assess our internal states well and our judgments about heart rate, BP, breathing and congestion do not correlate well with physiological measures.

A number of factors affect our perception of symptoms:

Individual Differences:

Almost all people begin to experience heat as pain when it gets to around 44-46 degress C. This suggests that individual standards of pain do not vary as greatly as is often thought.

Many internally focused people believe they can sense negative changes in their internal states but they have been shown to overestimate the importance of these changes and underestimate the speed of their recovery.

Competing Environmental Stimuli:

When the environment is supplying a great deal of competing input people are less likely to notice pain. (that explains why some athletes continue to play hard after experiencing serious injuries).

People who live alone and hold boring jobs tend to report more symptoms and take more aspirin and sleeping pills.

Psychological Influences

Perceptions of wellness and illness and recovery are greatly influenced by cognitive processes.

Placebos are the best known example of this. Sometimes these are accompanied by nocebo side effects like fatigue and dizziness.

In a study of people in a neighborhood about to be sprayed with insecticide it was found that people who were itentified in self reports as having more concerns about health reported three times the number of symptoms after the spraying.

Medical student's disease appears in med students as they imagine they suffer from the diseases they are studying, two thirds at some point self diagnosis with a condition they are studying.

Mass psychogenic illness involves widespread symptom perception across individuals when no medical basis exists any illness. Usually this is preceded by an unusual odor or someone fainting that triggers the expectation of illness.

Why do these things happen?

1. those involved already have high stress or negative emotions

2. the symptoms involve common events like headaches or dizziness that care real but vague

3. expectations and other cognitive factors support the illusion

4. modelling of the symptoms occurs

Gender and Cultural Differences

Women report feeling pain at lower levels of intensity than men do and ask for relief sooner. This may be explained by several factors including hormones and social roles.

Cultural norms about displaying pain vary.

1. people from Asian cultures report more physical symptoms that have psychological bases than people from other cultures

2. in studies of patients in six countries with similar back problems Americans were found to complain the most followed by Italians and New Zealanders and then the Japanese, Colombians and Mexicans

3. in the US Blacks will delay treatment seeking longer than Whites
Ideas, Beliefs and Using Health Services

Medical mistakes account for 100,000 deaths in the US yearly. Sometimes treatment makes people worse. These are called iatrogenic conditions and are part of the reason people avoid help seeking.

Some people are concerned about confidentiality. Many adolescents have health concerns they do not want repeated to their parents. LGBT folk may avoid doctors for the same reason.

Some minority groups may belief they will suffer from discriminatory practices like the Tuskegee study.

The Health Belief Model and Seeking Medical Care

According to the health belief model symptoms initiate a decision making process about seeking medical care. How much threat people perceive depends on three factors:

1. cues to action: this can include the symptoms themselves, advice from lay people, mass media health information

2. perceived susceptibility:

3: perceived seriousness:

The threat people feel grows the greater numbers two and three are.

Then people will weigh the perceived benefits against the perceived barriers to getting treatment. If the benefits outweigh people are likely to seek attention.

People report that transportation costs and medical bills influence their treatment seeking. So does their perceived medical knowledge. People who think cancer cannot be treated successfully will delay treatment.

But some studies have found only weak correlations between help seeking and this model.

Social and Emotional Factors and Seeking Medical Care

The role of emotions when symptoms appear can vary. If people are already depressed they will have trouble mobilizing the energy to seek treatment.

But people who are frightened by symptoms may seek treatment very quickly. However if they expect pain from the disease and its treatment the fear of that pain may cause them to delay treatment.

Fear plays a large role in dental treatment about 5 % of Americans avoid it altogether.

Sometimes embarrassment plays a role. People may fear making an issue out of nothing or discussing a medical problem like bladder control.

Urging from others can tip the balance toward seeking help.

Stages in Delaying Medical Care

Treatment delay refers to the time that elapses between the first awareness of a symptom and the seeking of medical care. In many cases of heart attacj this can be only a few minutes.

Delay occurs in three stages:

1. appraisal delay - the time a person takes to interpret a symptom as a sign of illness, here the sensory experience has the greatest impact on taking action, the more severe the pain or bleeding the sooner it is recognized as illness

2. illness delay - the time taken between recognizing one is ill and deciding to see attention, people will seek attention more quickly if the symptom is new rather than familiar

3. utilization delay - the time after deciding to seek medical care until actually going to use that health service, delay will be less for people not worried about cost, who are sure it can be treated and who have experienced sever pain

Many people delay treatment when the pain is minimal but pain not a major symptom of many major diseases like hypertension or cancer.

Heart attacks do involve pain and some drugs must be administered within three hours to prevent myocardial damage.
Medical Regimens and Illness Characteristics

Some regimens require people to change long standing habits. Patients are less liking to change habits than they are to take medication.

Some regimens are complicated and difficult to follow.

Compliance tends to fall over time if the regimens make large time demands, are in force for extended periods, have side effects or are expensive.

Part of the problem is that some conditions like hypertension manifest not symptoms. Patients who rate their illnesses as serious are more likely to adhere to their regimes.

Age, Gender and Sociocultural Factors

Generally each of these factors exerts a very small influence on adherence and compliance. But together, say an elderly, male on social assistance will have noticable differences in their level of compliance

Age can be seen as an influence in these cases:

a) childhood cancer patients had more difficulty adhering to drug regimens even though they were helped by their parents

b) adolescents were less adherent to special diabetic diets than children were

c) among adult arthritis patients middle aged patients made more errors than elderly sufferers

In some cultures, like First Nations the idea of cure is inherent in the healing process so long term medicatice regimens seem ineffective. Special efforts are also needed to help communities with low literacy rates.

Psychological Aspects of the Patient

The health belief model as helps explain why people do and do not follow treatment regimens.

Sometimes non-compliance appears rational. If

a) it appears the medication isn't helping
b) the side effects are unpleasant
c) are confused about dosages
d) can't afford refills
e) interrupt their regimens to test if the illness is still there

But most non adherence is a result of simple forgetting.

Adherence is often affected by cognitive and emotional factors that impact a patient's memory of their instructions and even if the instructions are in writing, if the level is above the fifth grade it can cause problems for some patients.

Negative affect has been linked to low levels of adherence.

In general higher self-efficacy and social support promote following a regimen but in some cases where there are dietary and alcohol free aspects to the regimen social support increase the level of temptation.