llness beliefs
What people believe about the nature of their illness and its presentation affects how they and their doctors cope and deal with it (Bates et al., 1997) and remains fundamental for a number of theoretical models of illness behaviour (Wade & Halligan, 2003), causation (Srinivasan & Thara, 2001) and medication compliance (Horne, 2006b). Knowing a patient’s beliefs regarding their condition (i.e. their illness representation) is clinically relevant for managing their condition and can also help predict subjective experience, capacity to cope, recovery (Diefenbach & Leventhal, 1996), treatment compliance and behaviour (Horne, 2006a; Weinman & Petrie, 1997).
A good example of this can be seen in the study by Mittenberg et al. (1992), who set out to see whether symptoms of mild brain damage could be related to what patients believed to be the likely symptoms that follow head injury. They asked 223 controls with no personal experience or knowledge of head injury to complete an affective, somatic and memory checklist as to their expectations of symptoms six months post head injury. A similar checklist was given to 100 head-injured patients for comparison. Predicted concussion symptoms in the naive controls reliably showed a coherent cluster of symptoms virtually identical to the post-concussion syndrome reported by patients with head trauma, suggesting a possible aetiological role for expectations in the experience and expression of symptoms – perhaps people have a reasonable idea of what it would be like to have a head injury, and these beliefs drive some post-injury symptoms. Patients, on the other hand, consistently underestimated the premorbid prevalence of the symptoms compared with controls – people who received a head injury underestimated what life was like before.
In a similar vein but larger-scale, Buchbinder (2006) showed the role that selectively targeted preventive public health initiatives on beliefs can play in successfully changing population beliefs and health-risk behaviours. This study provides compelling empirical findings to support the effectiveness of a groundbreaking mass media campaign in Victoria, Australia, which promoted positive beliefs about back pain and encouraged self-coping strategies among the general public. The campaign not only produced a dramatic reduction in disability from back pain and reliance on healthcare professionals but also changed physicians’ beliefs and attitudes towards low back pain and its traditional management.
The physician’s own beliefs can be influenced by patient expectations and other psychosocial factors. In reviewing the Australian epidemic of repetitive strain injury (RSI) in the early 1980s (where New South Wales saw an 11-fold increase in disability claims), Lucire argued that doctors played an important (if unknowing) part in the belief that RSI was the primary result of an occupational injury caused by inhumane working conditions (Lucire, 2003).
As a subjective state of being unwell, illness is culturally defined and socially sanctioned. As such, traditional biomedical models will always struggle to provide satisfactory explanations for the patient or clinician. It is equally important to recognise that illness beliefs crucially depend on the views of healthcare professionals and society, all of which dynamically contribute to the interpretations of symptoms, patient presentation and treatment outcomes (Cherkin et al., 1995).
Any adequate understanding of illness and associated disability needs to also consider the beliefs held by healthcare professionals, academics and those in wider society regarding the causes of illness, the extent of disability, recovery and the potential for treatment. Central to this account is the ‘view that [all] individuals construct models, internal representations or schema which reflect their pooled understanding of previous experiences and are used for interpreting new ones and planning behaviour’ (Weinman & Petrie, 1997).
As social organisations, healthcare systems depend on members of society adopting a congruent belief system (model) regarding the expectations and responsibilities associated with illness and the sick role. Wade and Halligan (2004) suggest that the adoption of a common psychosocial model might improve the delivery of better health more than any other change in healthcare organisation.
Professor Peter Halligan is in the School of Psychology, Cardiff University. E-mail: HalliganPW@cardiff.ac.uk. See also www.cardiff.ac.uk/psych/cpdr.
What people believe about the nature of their illness and its presentation affects how they and their doctors cope and deal with it (Bates et al., 1997) and remains fundamental for a number of theoretical models of illness behaviour (Wade & Halligan, 2003), causation (Srinivasan & Thara, 2001) and medication compliance (Horne, 2006b). Knowing a patient’s beliefs regarding their condition (i.e. their illness representation) is clinically relevant for managing their condition and can also help predict subjective experience, capacity to cope, recovery (Diefenbach & Leventhal, 1996), treatment compliance and behaviour (Horne, 2006a; Weinman & Petrie, 1997).
A good example of this can be seen in the study by Mittenberg et al. (1992), who set out to see whether symptoms of mild brain damage could be related to what patients believed to be the likely symptoms that follow head injury. They asked 223 controls with no personal experience or knowledge of head injury to complete an affective, somatic and memory checklist as to their expectations of symptoms six months post head injury. A similar checklist was given to 100 head-injured patients for comparison. Predicted concussion symptoms in the naive controls reliably showed a coherent cluster of symptoms virtually identical to the post-concussion syndrome reported by patients with head trauma, suggesting a possible aetiological role for expectations in the experience and expression of symptoms – perhaps people have a reasonable idea of what it would be like to have a head injury, and these beliefs drive some post-injury symptoms. Patients, on the other hand, consistently underestimated the premorbid prevalence of the symptoms compared with controls – people who received a head injury underestimated what life was like before.
In a similar vein but larger-scale, Buchbinder (2006) showed the role that selectively targeted preventive public health initiatives on beliefs can play in successfully changing population beliefs and health-risk behaviours. This study provides compelling empirical findings to support the effectiveness of a groundbreaking mass media campaign in Victoria, Australia, which promoted positive beliefs about back pain and encouraged self-coping strategies among the general public. The campaign not only produced a dramatic reduction in disability from back pain and reliance on healthcare professionals but also changed physicians’ beliefs and attitudes towards low back pain and its traditional management.
The physician’s own beliefs can be influenced by patient expectations and other psychosocial factors. In reviewing the Australian epidemic of repetitive strain injury (RSI) in the early 1980s (where New South Wales saw an 11-fold increase in disability claims), Lucire argued that doctors played an important (if unknowing) part in the belief that RSI was the primary result of an occupational injury caused by inhumane working conditions (Lucire, 2003).
As a subjective state of being unwell, illness is culturally defined and socially sanctioned. As such, traditional biomedical models will always struggle to provide satisfactory explanations for the patient or clinician. It is equally important to recognise that illness beliefs crucially depend on the views of healthcare professionals and society, all of which dynamically contribute to the interpretations of symptoms, patient presentation and treatment outcomes (Cherkin et al., 1995).
Any adequate understanding of illness and associated disability needs to also consider the beliefs held by healthcare professionals, academics and those in wider society regarding the causes of illness, the extent of disability, recovery and the potential for treatment. Central to this account is the ‘view that [all] individuals construct models, internal representations or schema which reflect their pooled understanding of previous experiences and are used for interpreting new ones and planning behaviour’ (Weinman & Petrie, 1997).
As social organisations, healthcare systems depend on members of society adopting a congruent belief system (model) regarding the expectations and responsibilities associated with illness and the sick role. Wade and Halligan (2004) suggest that the adoption of a common psychosocial model might improve the delivery of better health more than any other change in healthcare organisation.
Professor Peter Halligan is in the School of Psychology, Cardiff University. E-mail: HalliganPW@cardiff.ac.uk. See also www.cardiff.ac.uk/psych/cpdr.
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