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PSYC 328
Blaine Ditto

Using Health Services  Psychological, social, and cultural factors are involved in whether one chooses to seek medical care How Do We Recognize and Interpret Symptoms?  People’s awareness of their body is limited, allowing for many psychological and social factors to influence the recognition of symptoms and interpretation of illness Recognition of a Symptom  In the face of seemingly severe symptoms, some people continue normal activities , while others go back to bed when they have to tiniest sniffle Individual Differences and Personality  Some people are consistently more likely to notice a symptom than others  Hypochondriacs (4-5% of population) worry that normal bodily functions are signs of illness  Most frequent symptoms among patients converting distress to physical pain are: back pain, joint pain, headache, abdominal symptoms, food “allergies”, cardiovascular symptoms  Women are not more likely than men to report symptoms, but older people are  Neuroticism (personality dimension marked by negative emotions, self-consciousness, and concerns with bodily processes) affects perception of symptoms  Symptom perception hypothesis: people high in neuroticism or negative affectivity trait recognize and/or report symptoms more quickly  Neurotic people may exaggerate their symptoms or simply be more attentive to real ones  Depression linked to increased physical symptoms but only when recalled retrospectively  Anxiety increased reports only for current physical symptoms  Encoding and retrieval process is distinct for anxious and depressed people Cultural Differences  Reliable cultural differences in how quickly and what kind of symptoms are recognized  Reasons for these differences not fully understood  Cultural differences in emotional responses may be at the root of observed differences  Even symptoms from the same problem can be experienced differently  Japanese women less likely than American women to report menopause symptoms – differences may be due to socio-cultural differences in language/meaning and biological variations in experiencing symptoms Situational Factors  Boring situations make people more attention to symptoms  Medical student’s disease: students imagine they have the illnesses they study, but as they learn more about different diseases, their distress (not perception) decreases – likely a normal process, not hypochondriasis Stress  Stress can precipitate or aggravate experience of symptoms  Stress-related physiological symptoms can include accelerated heartbeat or breathing  stress can trigger symptoms or flare-ups of existing health problems Interpretation of Symptoms  interpretation of symptoms is heavily a psychological process  contextual factors of symptom can provide information about how it may be interpreted  individual, historical; cultural; and social factors all conspire to produce interpretations of symptom experience Prior Experience  interpretation of symptoms heavily influenced by prior experience  people with experience of medical condition estimate the prevalence of symptoms to be greater, and regard condition as less serious  symptom’s meaning influenced by how common it is in culture or among acquaintances  high prevalent risk factors and disorders are generally seen as less serious than rare ones Expectations  expectations play a role in experience and interpretation of symptoms  simply expecting symptoms activates brain areas associated with the experience of them, and distracting yourself reduces activation Seriousness of the Symptoms  symptoms affecting valued body parts are seen as more serious and requiring more attention  believing a symptom has a profound impact on one’s life can prompt seeking medical and/or taking medication  if a symptom causes pain, a person will seek treatment faster Cognitive Representations of Illness Illness Schemas  Illness representation s (schemas): organized conceptions of illness influencing how people react to symptoms  Illness schemas are acquired through the media, personal experience, and family/friends  These schemes can range from sketchy and inaccurate to extensive, technical and complete  Schemas lend importance to a person’s comprehension of their illness  Schemas influence preventative health behaviours, reactions to diagnoses and experience of symptoms, adherence to treatment, and expectations for future health  Five distinct components: identity (name of illness), consequences (symptoms, treatment, extent person believes illness will affect life), causes (factors believed to give rise to the illness), duration (expected length of illness), cure (belief of whether illness can be cured)  Characteristics of illness cognitions guide decisions about actions needed to cope with illness  3 models of illness: acute, chronic, cyclic  Acute illness: caused by specific viral/bacterial agents, short duration; no long-term consequences (ex. Flu)  Chronic Ilness: caused by several factors, long duration; severe consequences (ex. Heart disease)  Cyclic illness: alternating periods of many symptoms/no symptoms (ex. Herpes)  Disease model a person has can greatly influence behavior related to disease (ex. Diabetes can be seen acute or chronic depending on the person) The La Referral Network  Lay referral network (LFN): informal network of family/friends who offer their own interpretations of symptoms well before medical treatment is sought  LFN preferred mode of treatment in many communities  70% of people talk with people in LFN about whether to seek treatment for symptoms  LFNs often recommend home remedies and alternative forms of treatments  Alternative medication is so on the rise, the World Health Organization has taken steps to evaluate their efficacy  Natural health products (NPH): include vitamins, herbal remedies and teas, minerals, plants  71% of Canadians have tried NPH and 31% use them daily  Only a fifth of Canadians consult alternative therapy providers (ex. chiropractor) in a year  Therapies mainly used to complement rather than replace traditional medicine, but health care providers are usually unaware of the supplemental treatments and this can cause risk of conflicting treatments The Internet  Internet could be a LFN on its own  4million Canadians seek health information online per day  6/10 internet users have used the net to seek health information  Women 2x more likely than men use internet for health info, and households with children are much more likely to. Men 15-24 are least likely nd  Most common info searched is for specific diseases/conditions - Lifestyle information is 2  96% of surveyed physicians say internet will positively affect health What Predicts the Use of Health Services?  Wait times main reason for not getting care when needed in Canada, and cost in main barrier in USA  Presence of atypical or numerous symptoms, serious illness, or disability are common reasons people seek help, but individual and social factors also play a role Age  Age influences use of healthcare serves- very young, and elderly most frequent users  Young children develop many infectious diseases and more likely to experience unintentional injuries such as falls- children under 5 accounted for more ER visits than any other group  In late adulthood, chronic conditions and diseases start to develop  Advancing age (as isolated factor) associated with increased physician consultations Gender  Women use healthcare system more than men  Pregnancy and childbirth account for much of gender difference but not all  Women have better homeostatic mechanisms- report pain earlier, experience temperature changes more rapidly, and detect new smells faster  As women age, use becomes closer to men  It is more socially acceptable for women to express feelings of pain  Economic factors- more women work PT/not at all so don’t have to skip work for treatment- however less work also means more money woes which can lead to poorer health  Medical care for women is also more fragmented- physician, gynecologist, breast cancer specialist, etc- medical care not well structured to meet their needs Socio-economic Status  Income, education; and culture associated with how and when health services are used  Lowest-income households and people without high school education are less likely to have visited family doctor in a year, but those in the same group that do consult a physician are more likely to make 4x visits to physicians than higher SES people, and more ER visits/hospital admissions  People in rural areas have less access to healthcare, especially specialists Culture  Cultural factors influence types of medical and health services people use  Use of health services vary considerably by ethnicity in Canada  Ethnic minorities (except Aboriginals and
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