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Which factor is most likely to increase a person's attention to bodily symptoms?
What characteristic is likely to reduce an individual's perception of internal states?
Which of the following is NOT likely to influence symptom perception?
How does experiencing pain or disruption affect symptom perception?
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What role does the novelty of a symptom play in its perception?
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What is the primary difference between illness and disease?
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Which of the following factors is least likely to influence symptom perception?
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How does increased knowledge of symptoms influence symptom perception?
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Which scenario is likely to lead to a higher perception of symptoms?
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What role do stereotypical notions about disease vulnerability play in symptom perception?
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What does the term 'mass psychogenic illness' refer to in the context of symptom perception?
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How do pre-existing chronic diseases influence symptom perception?
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Which factor is likely to reduce symptom perception in individuals?
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What stereotype about vulnerability to heart disease may affect symptom perception in females?
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How does increased knowledge of symptoms correlate with symptom perception?
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What contributes to men's tendency to ignore bodily symptoms according to gender socialization?
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Which coping style tends to minimize awareness of bodily sensations?
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What is a common characteristic of individuals with Type A personality traits in terms of symptom perception?
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What primary stage follows the perception of symptoms in response to illness?
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Which of the following is NOT a component of the Illness Representations according to Leventhal et al.?
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What is a key characteristic of disease prototypes?
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Which aspect of illness representation includes beliefs about what causes an illness?
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What is the perceived timeline for an illness that is described as short term with no long term consequences?
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What leads to the formation of personal illness representations?
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How do cognitive representations of illness influence behavior?
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Which of the following factors is NOT typically considered a cause of illness?
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In the context of the common sense model of illness, what is the role of a stimulus?
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What is one factor that can influence how individuals interpret their symptoms?
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Which of the following outcomes is NOT reportedly influenced by illness representations?
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What is the sequence of responses individuals typically follow after recognizing symptoms?
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What is the first stage in the delay behavior model where an individual infers they are ill based on their symptoms?
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During which delay do individuals consider whether they need medical attention?
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What factor is least likely to influence an individual's utilitation delay?
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Which of the following is NOT a factor that can influence delay behavior?
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What is the primary reason individuals may delay seeking health care?
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What factor influences how individuals interpret their symptoms as illness?
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Which of the following has been shown to have a direct effect on illness-related outcomes?
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How does self-identity influence individuals' symptom interpretation?
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Cultural influences on symptom interpretation may include which of the following?
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Which of the following best describes how previous illness experiences impact symptom interpretation?
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Study Notes
Illness vs Disease
- Disease: A physical disorder or underlying pathology affecting organs, cells, or tissues
- Illness: The subjective experience of feeling unwell; "what the patient feels when they go to the doctor" (Cassell, 1976)
Stages of Illness Response
- Perceiving symptoms
- Interpreting symptoms as illness
- Planning and taking action
Factors Influencing Symptom Perception
- Painful or disruptive: Symptoms with consequences for the individual are more likely to be perceived
- Novel: Unique symptoms are more likely to be seen as serious or rare
- Persistent: Symptoms lasting longer than usual or despite self-medication increase perception
- Pre-existing chronic disease: Past or current illness experience increases symptom perception
Attentional States and Symptom Perception
- Individual differences exist in attention given to internal and external states
- Well-publicized illnesses: Increased attention and symptom perception ("mass psychogenic illness")
- Increased knowledge of symptoms: Increased perception of them ("medical student's disease")
- Distractions: Reduce symptom perception (e.g. athlete winning a race despite injury)
Social Influences on Symptom Perception
- Perceptions of Vulnerability: Stereotypes about who gets specific illnesses influence perception (e.g., men with heart disease)
- Social Situations: The context influences motivation to attend to symptoms (e.g., playing a sport vs. watching TV)
Individual Differences and Symptom Perception
- Gender: Gender socialization may make women more likely to perceive symptoms and men more likely to ignore them
- Life Stage: Limited evidence suggests older adults pay less or more attention to internal states. Research on children is sparse
- Emotions and Personality Traits: Anxiety, depression, and neuroticism/negative affectivity increase attention to bodily signs
- Cognitions and Coping Style: Type A personalities may reduce attention to internal states; Repressors are less likely to experience symptoms; Monitoring vs. blunting coping styles influence symptom perception
Symptom Interpretation
- Cultural Influences: Shape readiness to respond to and express bodily signs as symptoms
- Individual Differences: such as gender, life stage, personality, self-identity, illness experience
- Disease Prototypes: Cognitive schemata and common-sense models of illness
Common-Sense Model of Illness
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Illness Representations (IRs):
- Identity: Variables identifying the presence or absence of illness
- Consequences: Perceived short and/or long-term effects of illness
- Cause: Perceived cause(s) of illness
- Timeline: Perceived time frame for illness development and duration
Symptom Interpretation
- Individuals interpret symptoms differently based on cultural influences, personal experiences, and individual differences.
- Cultural influences on symptom interpretation include differences in health behaviors, disease prevalence, and cultural expectations about expressing bodily signs.
- Individual differences in symptom interpretation include gender, life stage, and personality, where personality traits like negative affectivity can influence how readily individuals interpret symptoms as an illness.
- Self-identity can also impact symptom interpretation, as symptoms that threaten a salient social identity are often viewed as more severe.
- Illness experiences, including past experiences with illness or exposure to others' experiences, can influence how individuals interpret symptoms.
- Disease prototypes are cognitive representations of illnesses, based on learned knowledge, and can influence how individuals perceive symptoms.
Common Sense Model of Illness
- The common sense model of illness is a widely-studied model that emphasizes the importance of cognitive representations of illness in influencing health outcomes.
- It suggests that individuals have belief-based constructs about illness that impact coping responses and actions taken in response to perceived illness.
- These illness representations include:
- Identity: Identifying the presence or absence of illness based on symptoms.
- Consequences: Perceived short and long-term effects of illness on life domains like physical, emotional, and economic well-being.
- Cause: Perceived causes of illness, including biological, emotional, psychological, genetic, environmental, or behavioral factors.
- Timeline: Perceived timeframe for the development and duration of illness, including acute (short-term), chronic (long-term), and episodic (cyclical) illness.
- Curability or Controllability: Perceived ability to control, treat, or limit the progression of illness.
Influences on Symptom Interpretation
- Illness experiences play a significant role in shaping symptom interpretation, as demonstrated by differences in breast cancer perceptions between healthy women and those with breast cancer diagnoses.
- Causal attributions, determining the cause of symptoms, can influence interpretation by considering internal vs. external, stable vs. unstable, and global vs. specific causes.
- Cultural factors, such as beliefs in supernatural causes and controllability, can influence how individuals interpret and respond to symptoms.
Delay Behavior
- Delay behavior refers to individuals delaying seeking health advice despite experiencing illness symptoms.
- The delay behavior model identifies three stages of delay:
- Appraisal Delay: The time taken to recognize that symptoms indicate an illness.
- Illness Delay: The time taken to decide whether or not medical attention is needed.
- Utilization Delay: The time taken between deciding to seek medical attention and actually making an appointment or presenting to a healthcare professional.
Influences on Delay Behavior
- Several factors can influence delay behavior, including:
- Symptom type, location, and perceived prevalence: The nature, location, and perceived commonality of symptoms.
- Financial concerns: Financial barriers to seeking medical care.
- Culture: Cultural beliefs about illness and healthcare seeking.
- Age and Gender: Age and gender can influence how individuals interpret symptoms and seek healthcare.
- Influence of others: Advice and opinions from family, friends, or other social contacts.
- Treatment beliefs: Beliefs about the effectiveness of treatments, which can influence the decision to seek care.
- Emotions and traits: Personality traits and emotional factors that might influence the willingness or reluctance to seek care.
Delay Behaviour Model
- Represents the time taken between recognizing the need for medical attention and seeking help
- Appraisal delay: Time taken to interpret symptoms as an indication of illness
- Illness delay: Time taken to decide to seek medical attention after recognizing illness
- Utilization delay: Time taken between deciding to seek help and actually receiving it
Reasons for Seeking Healthcare
- Belief that symptoms are serious
- Life disruption caused by symptoms
- Desire for information about symptoms and cause
- Need for reassurance about symptoms
- Legitimization of concerns
- Belief in potential treatment for symptoms
- Encouragement from others (lay referral system)
- Desire to avoid symptom progression
Reasons for Delaying Healthcare
- Lack of time
- Unwillingness to take sick leave
- Dislike of clinics or hospitals
- Lack of trust in medical professionals
- Concern about costs
- Belief that symptoms are transient or not serious
- Unawareness of symptom meaning
- Reassurance from others
- Non-medical views of illness
- Fear of appearing weak
- Belief that illness is not curable
- Fear of diagnosis or tests
- Fear of judgment from healthcare professionals
Influences on Delay Behaviour
- Symptom type, location and perceived prevalence: Visible, painful, disruptive and frequent symptoms lead to action
- Financial concerns: Costs of healthcare and lost work time
- Cultural influences: Language barriers, responsibility for illness management
- Age: Younger and older groups use more healthcare
- Gender: Women seek healthcare more than men
- Influence of other people: Lay referral system
- Treatment beliefs: Belief in the necessity and benefit of treatment
- Emotions and traits: Fear, anxiety and denial increase delay
Phases of Medical Consultation (Byrne & Long, 1976)
- Phase 1: Establishing a doctor-patient relationship
- Phase 2: Identifying the reason for patient's attendance
- Phase 3: Conducting a verbal or physical examination
- Phase 4: Considering the condition (Doctor, Doctor & Patient, Patient - in order of probability)
- Phase 5: Considering further treatment or investigation (Doctor, occasionally Patient)
Factors for a 'Good' Medical Consultation
- Doctor having good knowledge and communication skills
- Building a good relationship with the patient
- Understanding the patient's medical problem
- Understanding the patient's understanding of their problem
- Engaging the patient in decision-making
- Managing time to avoid a rushed consultation
Approaches to Medical Consultation
- Professional-centred approach: Doctor controls the interaction, asks direct questions, makes decisions, patient passively accepts
- Patient-centred approach: Doctor identifies and works with patient's agenda, actively listens, encourages patient engagement
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Shared decision-making approach (Elwyn et al., 2012):
- Choice: Doctor conveys the existence of treatment options
- Option: Doctor provides detailed information about options
- Decision: Patient determines their choice based on their knowledge and preferences
Power Differentials in Medical Consultation
- Health professional has more relevant knowledge than the patient
- Many patients resist being empowered in decision-making
- Patients may become distressed if the doctor admits to uncertainty about the best treatment
Preferred Consultation Styles
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Lee et al. (2002):
- Shared decision-making: 42%
- Physician decision-making: 10%
- Physician decision after discussion: 21%
- Patient decision after discussion: 22%
- Patient decision: 5%
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Murray et al. (2007):
- Shared decision-making: 75%
- Paternalism: 14%
- Consumerism: 11%
Gaps in Preferred Consultation Styles
- Doctors state a preference for shared decision-making, but many patients do not report experiencing it.
- Keating et al. (2002) found that only 33% of women with breast cancer reported experiencing collaborative decision-making.
Influencing the Consultation: Health Professional Factors
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Health professional behaviour:
- Patient ratings are influenced by the doctor's understanding of their feelings, quality of communication and confidence in handling their illness.
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Type of health professional:
- Nurses are perceived as more nurturing, easier to talk to and better listeners than doctors.
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Gender of health professional:
- Patients may disclose more medical and personal information to female physicians.
Patient-Centered Consultations
- Patients rate a doctor’s understanding of their feelings and the quality of their contact with the doctor as being as important as their confidence in the doctor’s ability to cope with their illness and their distress.
- Nurses are generally seen as more nurturing, easier to talk to, and better listeners than doctors.
- Patients may tend to speak to female physicians more than male physicians, and report more medical and personal information.
- Patients are more likely to report being treated disrespectfully by doctors of the opposite gender.
- Critical processes for patient-centered consultations: information giving and response to emotions/concerns.
- Information giving should maximize understanding and memory.
- Strategies to maximize understanding: using appropriate language, prompting patients to ask questions, and preparing patients to ask questions before giving them information.
- Strategies to maximize memory: giving important information early or late in the flow of information, emphasizing important details, using repetition, making specific statements, and providing patients with records.
- Quality of doctor’s interactions is vital to respond effectively to patients' emotions and concerns.
- Doctors should use effective interpersonal and communication skills, such as reflection and mirroring.
Factors influencing consultations
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Culture and language affect consultations.
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South Asians in the UK fluent in English have shorter consultations than those not fluent in English.
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Immigrant patients in the Netherlands tend to have briefer consultations.
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The way information is given impacts how patients engage.
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Positive framing may encourage patients to engage in risky health care options.
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High anxiety or distress in the consultation and lack of familiarity with discussed information may minimize patient engagement.
Breaking Bad News
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Many senior doctors receive no formal training on delivering bad news.
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It’s stressful for both the patient and the doctor.
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The SPIKES model, a six-stage model, can be used for breaking bad news: setting up the interview, assessing the patient’s perception, obtaining the patient’s invitation, giving knowledge and information, addressing the patient’s emotions, strategy and summary.
Medical Decision Making
- Three approaches to diagnosing patients: hypothesis testing, pattern recognition, and opinion revision (heuristics and biases).
- Hypothesis testing is considered the “gold star” level due to its logical approach.
- Pattern recognition is useful for easy diagnoses but may not be as reliable for more complex decisions.
- Opinion revision relies on rules of thumb or heuristics, making it potentially the least reliable approach.
- Diagnosis heuristics often lead to biases such as: availability, representativeness, and potential payoff.
Adherence to treatment
- Social, psychological, and treatment factors contribute to poor medication adherence.
- Social factors: low levels of education, unemployment, concomitant drug use, low social support.
- Psychological factors: high levels of anxiety and depression, use of emotion-focused coping strategies, beliefs that continued use of a drug will reduce its effectiveness.
- Treatment factors: misunderstandings regarding treatment, complex treatment regimens, high numbers of side effects, lack of obvious benefit from treatment, poor communication between patient and health care provider.
- Concordance, maximizing understanding, and maximizing memory enhance adherence.
- Effective interventions for adherence in chronic disease are complex and involve combinations of: convenient timing of drug taking, relevant information, reminders to take medication, self-monitoring, reinforcement of appropriate use of medication, and family therapy.
Reasons for Non-Adherence to Behavioural Programs
- Factors influencing adherence: confidence in the ability to exercise, intentions to exercise, perceived control over exercise, belief in the benefits of previous physical activity, perceived barriers to exercise, and action planning.
Improving Adherence to Treatment
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Concordance - Patient and prescriber discuss treatment options and agree on a regimen. This process involves shared decision-making and good communication.
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Maximizing Understanding - Consultations should be patient-led, allowing them to ask questions and get their information needs met. This helps avoid problems that can arise from a doctor-driven approach.
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Maximizing Memory - Important information should be delivered early or late in the consultation, taking advantage of recency effects. Emphasize details such as frequency of medication intake and potential interactions.
Interventions for Adherence in Chronic Diseases
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Interventions to improve adherence are often complex and involve multiple strategies.
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Convenient Timing - Facilitates adherence by reducing barriers and promoting habit formation.
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Reminders and Self-Monitoring - Provide cues to action and allow for tracking of medication intake.
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Reinforcement and Family Therapy - Positive reinforcement encourages proper medication use. Family support provides an additional layer of adherence assistance.
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Pill Organizers - Can be helpful for self-monitoring, reducing errors, and acting as cues to action.
Reasons for Non-Adherence to Behavioral Programs
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Adherence to behavioral programs, particularly those related to exercise, can be far from optimal.
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Key factors related to exercise adherence include:
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Confidence in Ability to Exercise - This encompasses perceived behavioral control, self-efficacy, and intentions to exercise.
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Perceived Control over Exercise - Individuals who feel they have control over their exercise routine are more likely to adhere.
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Belief in Benefits of Exercise - Positive past experiences with exercise increase the likelihood of adherence.
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Perceived Barriers to Exercise - Lower perceived barriers correlate with greater adherence.
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Action Planning - Translating intentions into actions is crucial for bridging the intention-behavior gap, leading to higher adherence.
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Description
This quiz explores various factors affecting symptom perception and the distinctions between illness and disease. Delve into how knowledge, novelty, and chronic conditions impact one's attention to bodily symptoms. Test your understanding of the characteristics that influence our perception of health and wellness.
