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HSCI 130 (11)
Chapter 9

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Simon Fraser University
Health Sciences
HSCI 130
Rochelle Tucker

Chapter 9 Iceberg of Health Care: Iceberg metaphor Iceberg mordibility: actions people undertake to deal with everyday illness episodes common symptoms -bottom to top = More serious health problems and intensive problems - People engage in variety of self-care practices Ex. Get support and advice from family and friends, restrict daily activates, take non prescript medication Iceberg Effect and treating injures are just the tip of the Ice berg & Injuries - Minor injuries are often under-reported - Detecting Iceberg of Disabilities - We don’t understand impact of physical, mental, and social disabilities on peoples daily lives HIDDEN COMPONET OF THE HELATH CARE SYSTEM Iceberg Morbidity - Consists of distance layers with permeable boundaries - Daily symptoms are at the bottom, then symptoms treated by oneself, then problems which cause short term restricted activating, conditions which cause long term limitations, visits to health professional, hospital episodes, then death at the top - Layers above water involve contact with health professionals and formal part of healthcare and are routinely measures - Layers below water are hidden, informal component of health care - Qualities methods help gain information on informal health care contrition to health and wellness 1. Base of Iceberg - Lay believe about health and illness - We have personal beliefs of mean of good health and idea of what keeps us healthy - Lay beliefs help define health and select wellness-oriented behaviors practices to help protect our health - Lay beliefs are vital importance b/c they guide out pursuit of health and wellness - They provide an frame work for making sense of prevalent conditions such as sickness - Gave meaning of how we experience changes in health status and guided health actions Limits to lay beliefs - Cannot be directly observed - Difficult to measure 2. Next layer- Self-care behaviors practices - Routines people engage in to try and maintain good health and manage illness episodes 3. Next layer- Supportive social networks - Social support is good for health - Informal caregivers play critical part in pursuit of health and wellness 4. Below waterline-organized helping network or special purpose self-help groups - Ex. Alcoholics Anonymous - Brings people together who have a common health problem to support with health problems - Ie. Abuse, body image, weight management, addictions - Gap Between Informal Self –care and Informal Medical care LAY EXPLINATORY BELIEFES ABOUT HELATH MAINTENACE AND ILLNESS MANAGEMENT - All people account for health and illness using belief or shared ideas about the nature of the world - Lay concepts are important to peoples determination of population health - Lay beliefs about the nature and cause of inequities in health play a critical part in shaping person health care practices - -meaning could provide invaluable insisting into dynamic relationship between human agency and wider social structure - Lay beliefs are difficult to study - -focus on health related behaviors b/c they are directly observed and measured and operation on behaviors practices rely beliefs - If you listen you can learn a great deal about conceptions of health and illness - Ex. Smoking- people know that smoking is bad for your lungs and respiratory system which decreases health but it also relieves stress which helps your health - Lay Beliefs about good health: Meaning of Wellness - Research concentrating on ill health rather than good health - Focus attention on chronic illness - Learned that people’s ideas regarding the cause and consequences of sickness - Didn’t learn about lay beliefs regarding sources of good health and meaning of wellness - Social analysis concentrate on lay beliefs about ill ness management - Lay beliefs reflect general view that health is a multi-dimensional concepts: Physical, Psychological and social Lay Concepts of good Health include 1. Symptom Orientation: good health means absence of symptoms of illness (ie. Physical component) 2. Performance Orientation: good health means being able to carry out ones usual daily actives (ie. Social component) 3. Feeling-State Orientation: good health mean a sense of wellbeing( ie. psychological component) - Individuals interprestation fo personal meaning of good health determeins which compeonet is most important - “absence of illness and disease is not the same as being well” Symptom Orientation – Absense of illness (Lack) - Negative approach - “health-in-a-vacuum- - absence from individuals life(illness) - not having any serious disese - not having anything more than serious cold - freedom from symptoms of ill health (aches pains) - Health and whole derived from the same word – Hoelth – - Presence of disease is not incompatible with conception of good health - Managing conditions relative to ageing process may be good health to people. Performance Orientation- Health as Fitness – Carry out Usual Tasks (physical) - Positive approach - Both physically and mentally fit - Being physically active - Having healthy body with psychological energy and vitality Vitality: being able to meet demands, being lively or “full of life” - Sense of healthiness or well-being and social capacity to perform well roles Feeling-State Orientation - (Psychological) - Based on psychological and social components of health - Feeling of happiness and healthiness - Being relaxed, contented and confident - Social dimension – having close ties to family moments and friends and meaningful interpersonal relationships - Balance in everyday life ( ie. Mind body, spirit in harmony) HEALTH AS FUNCTIONAL ABILITY - Functional conceptions – ability to carry out daily tasks and cope with demands of everyday life and social roles - Capacity to achieve preferred goals - Perform certain functions - Being able to do things - (Performance Orientations) - Doing things by yourself without restrictions Health as “resource of Living” - Combines social, psychological, and physical dimension - “Reserve of health” – resource of living - Person’s constrictions and temperament (eg. Energetic and having strength and vitality) - Capital asset to be managed - Savings reserves can increase and offer future financial security - Take care of yourself and you add more good years to your life - Reserve affected by personal as well as societal conditions Determinates of health - Heredity - Early childhood experiences - Self-Neglect - Harmful personal practice Lay Illness Belief Dimension: The meaning of sickness - Beliefs are developed over time as people attempt to make sense of sicknesses they experience - Chronic lay explanations are likely more developed than acute illness episodes of lay beliefs Illness belief dimensions most examined: 1. Causality 2. Controllability 3. Susceptibility 4. Seriousness 1. Causality: What caused it? - Origin of disease reflects influence of bio med model - Assumption: every identified disease has a cause or combination for causal factors - Helps them make sense of diagnoses and effect help-seeking behaviors Categories of Cause: 1. Heredity(modified) 2. Family susceptibility 3. Infection 4. Environmental (ex. Working in unpleasant setting) Modified (unhealthy health choices) VS. Non-Modifiable (heredity) Factors of causality -causes that were within vs. outside individuals control -people feel their health is more affected by outside sources -causes more on external (not my fault) VS. Internal (my fault) Age differences and attributes of casual - Older people attributed to internal physical process (aging in) rather than environmental external attributes Natural Factors: - Aging, social factors, supernatural factors 2. Controllability: - Extent to which individuals believe that illness is controllable Can be managed be either the sick person or another’s - associated with self-rated health - - Self-initiated preventive care - Use of physician services and complies with medical treatment Types of control: - Internal: Personal self-control belief (sense of mastery of health and illness) - External: Provider powerful other control beliefs (faith in health care professionals) - Chance health outcome beliefs( factors affecting health are beyond everyone’s control) - Personal control reflects peoples sense of master of environment and their belief about how effective they are at bring about positive event in their lives ( health and well0being) - Internal personal control belief – supported by ones associable with mortality and morbidity - More likely to adopts healthy behavior practices BOTH CASUALITY AND CONTROLLABLITY INTERRELATED: - Concentrate on notion of personal responsibility - Assume responsibility for the factors that cause the health problem 3. Susceptibility - Perceived vulnerability to illness - Perceived Vulnerability: degree to which person believe that she is susceptible to or might experience health problems - Notions of illness danger and threat - Risk vs. resistance and weakness vs. strength - related to all our ideas about the nature of illness - related to Beliefs about how our bodies functions 4. Seriousness: - condition that is long lasting - difficult to cure - requires medical attention - conditions that do not respond properly to intervention may be serious - conditions that become chronic in nature may become normalized and thus less serious - illness is familiar or recognizable - symptoms of illness are temp or permanent (i.e. stable over time) - beliefs about illness are predicable vs. random Origin of lay beliefs - misleading since ideas and know about health and illness come from internalizing medical or professional construction of the work - -shaped by medical rationality and bio med model - Do n
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