Illness and sick-role behaviour

1. Illness and sick-role behaviour Presented by Assist .Prof Dr Sirwan K Ali 2012-2013

2. Disease • What is Disease? The biological process that doctors use to explain and understand illness

3. Illness and Disease • The process of diagnosing disease is central to medical education. This becomes the doctor’s agenda • However in at least 25% of GP consultations, no disease specific diagnosis is available • We must understand then what the illness means to the patient – the patient’s agenda

4. Illness • What is Illness? Definitions vary and patients and doctors will disagree! The patients experience of a physical or psychological disturbance

5. Illness Behaviour • Symptoms of Illness may be differently perceived, evaluated and acted upon by different kinds of people. • This is sometimes called “Illness Behaviour”

6. Illness Behavior • Illness behavior is described as the state when the individual feels ill and behaves in a particular way • Illness is a psychological concept: • It has different meanings for different people • It’s based upon an individual’s personal evaluation of his/her bodily state and ability to function

7. Illness behaviour • The concept of illness behaviour was defined and • adopted during the second half of the twentieth • century. • It is any behaviour undertaken by an individual • who feels ill to relieve that experience. • Illness behaviour is usually mediated by strong • subjective interpretations of the meaning of • symptoms. • Many social and psychological factors intervene • and determine the type of illness behaviour • expressed in the individual.

8. Disease versus ill/illness behaviour: • Disease is physical malfunctioning of the body. • Illness is subjective perception of whether one is sick or not. Possible to have a disease and not feel ill, e.g., undetected diabetes. Also possible to feel ill without any detectable disease, e.g., hypochondriasis.

9. How do people determine when they’re ill? • Illness is a condition of pronounced deviation from the normal healthy state • Illness is a subjective experience • When do patients report illness? • When they’re unable to engage in day-to-day activities • When they have decreased energy • When they feel pain, nausea, fatigue • When they just don’t feel well (DiMattteo & Martin, 2002)

10. Illness • Often it is difficult to decide objectively whether someone is ill or not • Some suggest using scales that define illness based on a total score of symptoms • However, illness is a relative concept, and is often functionally based

11. Symptoms • Illness is recognized because of the presence of symptoms, either physical or mental • People respond to symptoms in a variety of ways including dismissing, ignoring, denying, and/or maximizing their symptoms • If we experience unusual symptoms, which are severe enough, we may feel that we are ill and then behave in certain ways

12. Why symptoms lead to medical visits • Intensity • Duration • Change in presentation • Family history • Previous experience • Unfamiliarity • Perceived threat • Loss of control

13. Illness behavior involves • Much of it is a result or associated with the recognized disease . • Some are generated by the fear of disease or the positive rewards and support provided for a person in the sick role . • Some times a person may adopt the sick role and illness behavior without having illness or may show illness behavior which is out of proportion to the degree of illness. • Behaving normally in the presence of undiagnosed illness .

14. Physical and mental experience of illness • David Mechanic (1995): • Biological predispositions. • The nature of symptomatology. • Learned patterns of response. • Attributional predispositions. • Situational influences, and the organization and incentives • characteristics of the health care system that affect access. • Responsiveness and availability of secondary benefit.

15. Is disease real or is it in the mind?

16. Types of illness behaviour • Individuals who experience physical or mental symptoms turn to the medical care system for help. • Others may turn to self-help strategies. • Some individuals may decide to dismiss the symptoms. • In every day life, illness behaviour may be a mixture of behavioural decisions.

17. Factors influence illness behaviour • Age and gender in illness behaviour; is far • greater in women. • Ethnicity, education • Family structure and social network • Healthcare coverage and insurance • Socioeconomic status; with lower-class • individuals most likely to delay seeking health • care even with sever symptoms

18. The Sick Role • The sick role – any activity undertaken for the purpose of getting well by those who consider themselves ill • This is a social role • A patient who enters the sick role has both rights and obligations • There are positives and negatives to the sick role

19. Advantages Exempt from many daily activities Able to rest and be taken care of Social support Workers compensation, disability Disadvantages Behaviors are scrutinized Others may view behaviors as illegitimate attempt to gain advantages Confusion, discomfort, decreased functioning, and distress The Sick Role

20. The Sick Role • People are not expected to let themselves better by effort, and the illness is not considered to be their fault • However, the symptoms must be recognized by others • Sick people are expected to want to get better • They are also expected to seek professional help if needed and to comply with health recommendations

21. The Sick Role • The (societal) obligations: • The person’s symptoms must correspond with a diagnosis recognized by society • There must be overt symptoms before others will recognize the illness • The patient must accept the sick role, and is expected to take steps to get well

22. The Sick Role—more (societal) obligations • Sick people are expected to remain optimistic and cheerful and not display distress • Not everyone is willing to act sick and some people may conceal their symptoms to avoid becoming dependent

23. The Sick Role • Most believe being ill is temporary and in most cases, this is true • Chronic diseases bring about different responsibilities and the person cannot stay in the sick role forever • Most people have symptoms of one sort or another at any one time, but whether or not they enter the sick role may be only loosely related to the severity or persistence of symptoms

24. Chief characteristics • Parsons defined the sick-role as having four • characteristics • First; the sick person is freed or exempt from • carrying out normal social roles. The more sever • the illness, the more one is freed from social • roles. • Second; people in the sick-role are not directly • responsible for their plight.

25. Chief characteristics • Third; the sick person needs to try to get well, • the sick role is regarded as a temporary stage • of deviance that should not be prolonged if at • all possible. • Fourth; the sick person or patient must seek • competent help and cooperate with medical • care to get well

26. Thank you