MODIFYING FACTORS

Factors that modify a person’s perceptions include the following:

• Demographic variables. Demographic variables include age, sex, race, and ethnicity. An infant, for
example, does not perceive the importance of a healthy diet; an adolescent may perceive peer approval
as more important than family approval and as a consequence may participate in hazardous activities or
adopt unhealthy eating and sleeping patterns.

• Sociopsychological variables. Social pressure or influence from peers or other reference groups (e.g.,
self-help or vocational groups) may encourage preventive health behaviors even when individual
motivation is low. Expectations of others may motivate people, for example, not to drive an automobile
after drinking alcohol.

• Structural variables. Knowledge about the target disease and prior contact with it are structural
variables that are presumed to influence preventive behavior.

• Cues to action. Cues can be either internal or external. Internal cues include feelings of fatigue,
uncomfortable symptoms, or thoughts about the condition of an ill person who is close

 Health status. State of health of an individual at a given time. A report of health status may
include anxiety, depression, or acute illness and thus describe the individual’s problem in
general. Health status can also describe such specifics as pulse rate and body temperature.

 Health beliefs. Concepts about health that an individual believes are true. Such beliefs may or
may not be founded on fact. Some of these are influenced by culture, such as the “hot–cold”
system of some Hispanic Americans.

 Health behaviors. The actions people take to understand their health state, maintain an optimal
state of health, prevent illness and injury, and reach their maximum physical and mental
potential. Behaviors such as eating wisely, exercising, paying attention to signs of illness,
following treatment advice, avoiding known health hazards such as smoking, taking time for rest
and relaxation, and managing one’s time effectively. Health behavior is intended to prevent
illness or disease or to provide for early detection of disease. Nurses preparing a plan of care
with an individual need to consider the person’s health beliefs before they suggest a change in
health behaviors.

Internal Variables

Internal variables include biologic, psychological, and cognitive dimensions. They are often described as
nonmodifiable variables because, for the most part, they cannot be changed.

1. BIOLOGIC DIMENSION
Genetic makeup, sex, age, and developmental level all significantly influence a person’s health.
 2. PSYCHOLOGICAL DIMENSION
Psychological (emotional) factors influencing health include mind– body interactions and self-
concept. Mind–body interactions can affect health status positively or negatively. Emotional
responses to stress affect body function
3. COGNITIVE DIMENSION Cognitive or intellectual factors influencing health include lifestyle
choices and spiritual and religious beliefs.

External Variables

External variables affecting health include the physical environment, standards of living, family and
cultural beliefs, and social support networks.

1. ENVIRONMENT
People are becoming increasingly aware of their environment and how it affects their health and
level of wellness. Geographic location determines climate, and climate affects health. Pollution
of the water, air, and soil affects the health of cells.
2. STANDARDS OF LIVING
An individual’s standard of living (reflecting occupation, income, and education) is related to
health, morbidity, and mortality. Hygiene, food habits, and the ability to seek health care advice
and follow health regimens vary among high-income and low-income groups.
3. FAMILY AND CULTURAL BELIEFS
The family passes on patterns of daily living and lifestyles to offspring.
4. SOCIAL SUPPORT NETWORKS
Having a support network (family, friends, or a confidant) and job satisfaction helps people
avoid illness. Support persons also help the individual confirm that illness exists

Illness-
 Acute illness- symptoms with relatively short duration; appear abruptly and goes; even
without going to the doctor, they go away
 Chronic illness- lasts for extended period; 6 months or longer; exacerbates after a while;
appear slowly

Illness behavior- coping mechanism

According to Parson:

Rights:

1. Clients are not held responsible for their condition. Even if the illness was partially
caused by an individual’s behavior (e.g., lung cancer from smoking), the individual is not
capable of reversing the condition on his or her own.
2. 2. Clients are excused from certain social roles and tasks. For example, an ill parent
would not be expected to prepare meals for the family.
 Obligations:

3. Clients are obliged to try to get well as quickly as possible. The ill person should follow
legitimate advice regarding a specialized diet or activity restrictions that could help with
recovery.

4. Clients or their families are obliged to seek competent help. For example, the ill person
should contact the primary care provider rather than relying solely on his or her own ideas
of how to recover.

5 stages of illness:

STAGE 1: SYMPTOM EXPERIENCES At this stage the person comes to believe something is
wrong. Either someone significant mentions that the person looks unwell, or the person
experiences some symptoms such as pain, rash, cough, fever, or bleeding.

 May try home remedies

Stage 1 has three aspects: • The physical experience of symptoms • The cognitive aspect
(the interpretation of the symptoms in terms that have some meaning to the person) • The
emotional response (e.g., fear or anxiety).

STAGE 2: ASSUMPTION OF THE SICK ROLE The individual now accepts the sick role and
seeks confirmation from family and friends. During this stage people may be excused from
normal duties and role expectations. Emotional responses such as withdrawal, anxiety, fear,
and depression are not uncommon depending on the severity of the illness, perceived
degree of disability, and anticipated duration of the illness.

STAGE 3: MEDICAL CARE CONTACT Sick people seek the advice of a health professional
either on their own initiative or at the urging of significant others. When people seek
professional advice, they are really asking for three types of information: • Validation of
real illness • Explanation of the symptoms in understandable terms • Reassurance that they
will be all right or prediction of what the outcome will be

STAGE 4: DEPENDENT CLIENT ROLE After accepting the illness and seeking treatment, the
client becomes dependent on the professional for help. . People vary greatly in the degree
of ease with which they can give up their independence, particularly in relation to life and
death. Role obligations—such as those of wage earner, parent, student, sports team
member, or choir member—complicate the decision to give up independence.

STAGE 5: RECOVERY OR REHABILITATION During this stage the client is expected to

relinquish the dependent role and resume former roles and responsibilities.

Disease- Alteration of body function

Etiology- cause of disease or condition

 Health care delivery system
 Primary healthcare-improved health outcome primary health care education, family
planning, immunization
 Secondary prevention- health promotion and illness prevention; diagnostics and
treatments; annual physical exam, pap smear
 Tertiary prevention- rehabilitation and palliative care; self monitoring of blood
glucose, self-management education for diabetes

TYPES OF HEALTH CARE AGENCIES AND SERVICES

1. Hospital- emergency services

2. Hospice care- n the hospital, in the home, or in another agency within the community
3. Public health-Government (official) agencies are established at the local, state, and
federal levels to provide public health services. Health agencies at the state, county, or
city level vary according to the needs of the area. RH1082- Rural health act;1953; rural
health unit personnel
4. Ambulatory care centers-diagnostic and treatment facilities; clinics, Medicus
5. Occupational health clinics- setting for employee healthcare; The industrial
(occupational) clinic is gaining importance as a setting for employee health care
6. Extended long term care facilities- nursing homes
7. Retirement and assisted living centers- separate houses, condominiums, community;
8. Rehabilitation centers- play role in assisting clients with their health; therapy and
rehabilitation
9. Daycare centers- for infants and children while parents are at work
10. Rural care- provided emergency care to clients in rural areas
11. Crisis centers- emergency help to clients with life crisis

Providers of healthcare

1. Nurse-roles varies with need of client; assists and identifies health status
2. A licensed vocational nurse (LVN), in some states known as a licensed practical nurse
(LPN), provides direct client care under the direction of an RN, physician, or other
licensed practitioner
3. Alternative (Complementary) Care Provider- chirapractors
4. Case managers- desk setting
5. Dentists- treat mouth jaw and dental problems
6. Dieticians or nutritionists- diets required to treat disease
7. Medical health personnel- ambulance or fire departments
8. Occupational therapists
9. Paramedical technologists- connection with medicine
10. Medical technologists-
11. Radiologic technologists- x-rays
 12. Nuclear medicine technologists- radioactive substances
13. Pharmacists- prepare medicines; monitor and evaluate medications to clients
14. Physical therapists- treat clients musculoskeletal problems
15. Physicians- medical diagnosis; treatment of disease
16. Podiatrists- doctors that treat foot and ankle disease
17. Respiratory therapists – respiratory problems
18. Social workers- council clients and give advices
19. Spiritual support personnel- pastors, priests, etc in hospitals; help spiritual needs of
clients
20. Unlicensed assisted personnel- assist in feeding, collecting feces, etc.

FACTORS AFFECTING HEALTH CARE DELIVERY

Increasing number of older adults

Advances in technology

Economics

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