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ILLNESS BEHAVIOR PARADIGM

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Conceptual understanding of signs and symptoms that do not reach formal medical attention ... 8. Illness defined as presence of symptoms ... – PowerPoint PPT presentation

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Title: ILLNESS BEHAVIOR PARADIGM


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(No Transcript)
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ILLNESS BEHAVIOR PARADIGM
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I. Situational adaption perspective
  • A. Interactionism
  • 1. Emergence and Change
  • 2. Process of Labeling
  • 3. Adjustment and Adaptation

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  • B. Socially Defined Situation Social,
    Psychological, Cultural, Physical and Biophysical
    Factors Intersect in Situations
  • C. Health and Illness Derive from Assessment of
    Situational Adaptation Across Situation Set

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  • D. Health and Illness are not an Entity, but an
    Evaluation that Emerges from Relationships that
    we Create, Sustain and Negotiate across Situation
    Set
  • E. Health and Illness are not an Entity, but an
    Evaluation that Emerges from Relationships that
    we Create, Sustain and Negotiate across Situation
    Set

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II. Types of Illness Behavior Everyday, Acute,
Chronic and Life Threatening Heroic or Terminal
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  • A. Primary Process
  • B. Role Relationship
  • C. Lay Others
  • D. MD Relationship

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EVERYDAY ILLNESS BEHAVIOR
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I. Everyday Illness Behavior
  • Conceptual understanding of signs and symptoms
    that do not reach formal medical attention

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  • A. HINKLE et al
  • 1. Males, lower-middle class, 20-45 in 20
    years
  • 2. 1 life endangering illness
  • 3. 20 disabling illnesses
  • 4. 200 non-disabling illnesses
  • 5. 1,000 symptomatic episodes

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  • 6. 1,221 episodes over 7,305 days or one new
    episode every 6 days
  • 7. Only considers incidence, neglects illnesses
    where there is no awareness and not illness
    duration
  • 8. Illness defined as presence of symptoms

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  • B. White et al, Figure I Any symptom,
    disorder or affliction which persisted for one
    or more days or for which medical service
    was received or medicine purchased . . . and .
    . . includes the results of both disease and
    injury.

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  • 1. 1000 adults population at risk
  • 2. 750 adults reporting one or more illnesses
    or injuries per month
  • 3. 250 adults consulting a physician one or
    more times per month
  • 4. Are the 500 non-consulters healthier?

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  • 5. 9 adult patients admitted to a hospital per
    month
  • 6. 5 adult patients referred to another
    physician per month
  • 7. 1 adult patient referred to a university
    medical center per month
  • 8. What does this say about individuals seen in
    a tertiary medical center?

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  • C. Epidemiology of Non- Consulting Behavior
  • 1. Anderson, Buck, Kanaher and Fry
  • a. Non-users did not have more complaints than
    users of medical services
  • b. Non-users self-treat, users inclined not to
    self-treat

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  • c. Reason for non- consultation Symptoms not
    sever enough previous consultation
    unsatisfactory self- treatment adequate fear
    of treatment

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  • d. On the cost side Non-users view travel time,
    cost of travel, waiting time, loss of wages,
    leaving house or children, and appointment
    system, receptionists and physician as
    problematic

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  • e. In general non-users view themselves as
    healthier than users users have more somatic
    anxiety and less self-sufficiency

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  • 2. Kessel and Shepherd
  • a. In one study 23 of ill people consult
    physician in given month in an other study
    less than 33 consult consistent with White
    et al

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  • b. Kessel and Shepherd found that non-users are
    older, predominantly male, fewer children in
    household, equal number of illnesses as users, no
    serious illnesses, perceive self as healthy,
    manage illnesses without physician

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  • c. Non-users did not like to bother physician
    unless seriously ill, could not afford to be
    ill, too busy to see physician, critical of
    physicians, did not like to wait

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  • D. In EIB we want to study the lower part of
    the illness iceberg How majority of
    individuals handle signs and symptoms within
    their daily routines
  • 1. Assumptions

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  • a. Health Status Deviations emerge within
    socially defined situations against the total
    background of daily life and relations with
    others
  • b. In socially defined situations individual,
    social structure, culture and biology intersect

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  • c.Deviations from ones Bodily Background
    Expectancies
  • d. Deviations will not be defined come to medical
    attention if individuals can contain them
    within daily situation

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  • e. When signs and symptoms cannot be contained
    over a substantial portion of situation set
    medical consultation will be sought
  • 2. Theoretical Context and Three Elements
  • a. Biophysical Reality
  • 1. Absolutists meaning resides in disease
    itself

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  • 2. Ideational meanings of illness emerge from
    interaction of biophysical sensations and
    processes of social selection, interpretation and
    evaluation

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  • 3. We are and Have a body they impose and
    dispose themselves to our action
  • 4. Bodily Background Expectations

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  • b. Socially Defined Situations
  • 1. Necessary condition of human conduct
  • 2. W.I.Thomas If we define situations as real,
    they are real in their consequences.

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  • 3. Gonos potential worlds that answer all
    questions about...what is...real and how to
    be involved in this reality
  • 4. Goffman little social systems, a little
    social reality that we sustain because they are
    subjectively meaningful and give social
    organization to our life

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  • 5. Goffman Involvement rules
  • a. individuals negotiate juggle situational
    claims rights and obligations
  • b. dominant involvement give or withhold
    concerted attention to activity

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  • c. side involvements
  • 1. auto involvements signs of the
    animal creature releases
  • 2. aways reverie, woolgathering
    daydreaming
  • 3. insufficient situational presence

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  • c. Containment Everyday signs and symptoms as
    bodily background expectancies, normal processes,
    chronic diseases or consequences of situational
    participation kept as a side involvement

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  • 1. retain definition of situation
  • 2. sustain situational participation
  • 3. signs and symptoms not dominant focus
  • 4. signs and symptoms contained physical,
    normal processes, psycho-social

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  • 5. situation set and drift
  • 6. cumulative and ongoing assessment
  • 3. Cumulative and ongoing assessment
    situation types
  • a. Health and illness from cumulative and ongoing
    assessment of situation set, bodily background
    expectancies and sensations and degree of
    achieved containability

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  • b. Situation Types
  • 1.Type One most daily situations
  • 2. Type Two produce or potential to produce
    signs and symptoms
  • 3. Type Three breaks, transitions, containment
    resources

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  • 4. Type Four diagnostic, illness, health
    training or therapeutic situations bodily and
    psycho-social problems dominant situational
    attention
  • 5. Situation set Health and illness definitions
    emerge from situation set assessment and capacity
    to contain

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  • 4. Factors in Containment
  • a. Engrossment in and Commitment to the
    situation attention and identity
  • b. Role enactment and Status definers
  • 1. tolerance quotient
  • 2. idiosyncrasy credit
  • 3. benefit of the doubt

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  • c. Position and Power
  • 1. alter idiosyncrasy credit
  • d. Social Propriety and Deference
  • 1. tight and loose situations
  • 2. contagion, cost and danger

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  • e. Situational Resources
  • f. Meaning and Significance of Signs and
    Symptoms independent of situation
  • 5. Summary

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