The health belief model from the patient’s point of view.
Health and Illness ■ 73
Perceived Susceptibility. How susceptible to a certain condition do people consider themselves to be? For example, a woman whose family does not have a history of breast cancer is unlikely to consider herself susceptible to that disease. A woman whose mother and maternal aunt both died of breast cancer may well consider herself highly susceptible, however. In this case, the provider may concur with this perception of susceptibility on the basis of known risk factors.
Perceived Seriousness. The perception of the degree of a problem’s seriousness varies from one person to another. It is in some measure related to the amount of difficulty the patient believes the condition will cause. From a background in pathophysiology, the provider knows—within a certain range—how serious a problem is and may withhold information from the patient. The provider may resort to euphemisms in explaining a problem. The patient may experience fear and dread by just hearing the name of a problem, such as cancer.
Perceived Benefits: Taking Action. What kinds of actions do people take when they feel susceptible, and what are the barriers that prevent them from taking action? If the condition is seen as serious, they may seek help from a doctor or some other significant person, or they may vacillate and delay seeking and using help. Many factors enter into the decision-making process. Several factors that may act as barriers to care are cost, availability, and the time that will be missed from work.
From the provider’s viewpoint, there is a protocol governing who should be consulted when a problem occurs, when during that problem’s course help should be sought, and what therapy should be prescribed.
Modifying Factors. The modifying factors shown in Figures 4–5A and 4–5B indicate the areas of conflict between patient and provider.
The variables of race and ethnicity are cited most often as complex prob- lem areas when the provider is White and middle-class (or from one socio- cultural economic class and the patient is from another) and the patient is a member of the emerging majority. The issues are complex and include over- tones of personal and institutional racism. Such perceptions vary not only among groups but also among individuals.
Social class, peer group, and reference group pressures also vary between the provider and patient and among different ethnic groups. For example, if the patient’s belief about the causes of illness is “traditional” and the provid- er’s is “modern,” an inevitable conflict arises between the 2 viewpoints. This conflict is even more evident when the provider either is unaware of the pa- tient’s traditional beliefs or is aware of the manifestation of traditional beliefs and practices and devalues them. Quite often, class differences exist between the patient and the provider. The reference group of the provider may well be that of the “technological health system,” whereas the reference group of the patient may well be that of the “traditional system” of health care and health care deliverers.
74 ■ Chapter 4
Structural variables also differ when the provider and the patient see the problem from different angles. Often, each is seeing the same thing but is using different terms (or jargon) to explain it. Consequently, neither understands the other. Reference group problems also are manifested in this area, and the news and broadcast media are an important structural variable.
In summary, this section has attempted to deal solely with the concept of health. The multiple denotations and connotations of the word have been explored. A method for helping you tune in to your health has been presented, a transitional discussion illustrating the plethora of issues to be raised later in the text has been included, and an overview of Healthy People 2020 has set the tone for the remainder of the text, and the Health Belief Model serves to pro- vide a context for the discussion.
■ Illness It is a paradox that the world of illness is the one that is most familiar to the providers of health care. It is in this world that the provider feels most comfort- able and useful. Many questions about illness need to be answered:
■ What determines illness? ■ How do you know when you are ill? ■ What prompts you to seek help from the health care system? ■ At what point does self-treatment seem no longer possible? ■ Where do you go for help? And to whom?
We tend to regard illness as the absence of health, yet we demonstrated in the preceding discussion that health is at best an elusive term that defies a specific definition. Let us look at the present issue more closely. Is illness the opposite of health? Is it a permanent condition or a transient condition? How do you know if you are ill?
When you google illness, the response on the World Wide Web is well over 37,500,000 results in 0.19 seconds (February 29, 2012). One basic dictionary definition for this term is an unhealthy condition of body or mind: SICKNESS (© 2005 by Merriam-Webster Incorporated). Another definition is found in Mosby’s Medical Dictionary: unhealthy condition, an abnormal process in which aspects of the social, physical, emotional, or intellectual condition and function of a person are diminished or impaired compared with that person’s previous condition” (Mosby’s Medical Dictionary, 2009).
What is illness? A generalized response, such as “abnormal functioning of a body’s system or systems,” evolves into more specific assessments of what we observe and believe to be wrong. Illness is a sore throat, a headache, or a fever—the last one determined not necessarily by the measurement on a ther- mometer but by a flushed face; a warm-to-hot feeling of the forehead, back, and abdomen; and overall malaise. The diagnosis of intestinal obstruction is described as pain in the stomach (abdomen), a greater pain than that caused by
Health and Illness ■ 75
“gas,” accompanied by severely upset stomach, nausea, vomiting, and marked constipation.
Essentially, we are being pulled back in the popular direction and encouraged to use lay terms. We initially resist this because we want to employ professional jargon. (Why use lay terms when our knowledge is so much greater?) It is crucial that we be called to task for using jargon. We must learn to be con- stantly conscious of the way in which the laity perceive illness and health care.