Health Screening

Health screening to detect illness may help a person seek early treatment, engage in
health-promoting behaviors, reduce uncertainty, and increase vigilance for symptoms
of the disease. Most important, screening may enable the individual’s life to be
prolonged or enhanced. However, screening may cause psychological and/or physical
harm and not truly eliminate uncertainty or increase life expectancy.
People vary considerably in their screening behavior. People with high levels of
education are more likely to follow recommended screening guidelines, whereas
those who lack health insurance are less likely to have regular screenings. Individual
difference factors, such as self-efficacy, attitudes, personality, and family history, all
influence screening behavior, as do practitioners’ beliefs about its value.
Various strategies can increase screening behavior. These include providing
education about its benefits, providing reminders, and removing potential costs of
screening.

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 Health Care Utilization

Researchers distinguish between illness behavior, meaning behavior that is directed

toward determining one’s health status after experiencing symptoms, and sick-role
behavior, meaning behavior that is directed at helping people who are ill return to
good health. In many cases, people delay seeking health care. Delay can be caused
by not noticing a symptom, situational and social factors, and people’s expectations.
People’s commonsense illness representations about their symptoms, and what they
indicate, also impact how they choose to manage their illness.
The stages of delay model describes the steps people go through when deciding to
get help, including appraisal delay, illness delay, utilization or behavioral delay,
scheduling delay, and treatment delay. Delay is influenced by the nature of the
symptoms, including whether they clearly indicate a problem, are painful, and involve
blood or a vital organ. People’s concern about the impact of the symptom and the
nature of the treatment may also influence delay. People often rely on a lay referral
network of friends and family to provide insight about health care symptoms and
suggested treatment.
Demographic factors, including income, culture and religion, gender, and
race/ethnicity, all influence how likely people are to utilize medical services. They may
also impact the type of medical care they receive.
Many people use some form of complementary or alternative medicine (CAM),
meaning a product or practice that falls outside traditional medicine. CAM approaches
include dietary supplements and diets, physical stimulation methods, and cognitive-
behavioral strategies emphasizing relaxation. However, most CAM drugs and
treatments have not undergone rigorous testing to demonstrate that they improve
health. Although the specific mechanisms explaining the beneficial effects of some
types of CAM approaches are not entirely clear, such treatments can at times help
people reduce pain and improve health.

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 The Experience of Hospitalization

The experience of hospitalization can be very difficult. Patients stay in unfamiliar

environments with low levels of control and privacy, feel dependent on other people,
and often experience anxiety-provoking procedures. Some people may become
passive in such situations, whereas many experience anger and arousal in such
circumstances.
Patients who are given information about what to expect, as well as how to manage
these experiences, demonstrate improved outcomes, including lower levels of anxiety
and faster recovery. Patients also benefit from learning both cognitive and behavioral
control strategies. Interestingly, patients with a view of nature also experience better
outcomes.

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 Health Care Interactions

Problems in patient–practitioner communication include patients’ reluctance to share

information and acknowledge pain, physicians’ failure to allow patients to provide
information and to give patients adequate information, and practitioners’
overestimation of the amount of information they provide (and that the patient
understands and remembers). Both physician and patient characteristics influence the
amount of information given. Patients may also forget, misunderstand, or misinterpret
the information they are given.
Many of these problems in patient–practitioner interaction are caused by old-
fashioned models of these relationships. The doctor-centered model describes
relationships in which the doctor is in control and the patient is passive. In a second
model, the patient’s thoughts and feelings are voiced, but the doctor still makes the
major decisions. The patient-centered model describes a mutual interaction, in which
both the patient and the practitioner share information and they make decisions
together. People vary in the type of model they prefer.
First, health care providers must pay attention not just to people’s physical complaints
but also to their psychological concerns. Second, health care providers must give
straightforward explanations about the problem and its treatment in terms that are at
the appropriate level. Third, physicians must show good nonverbal behavior, such as
maintaining eye contact, leaning toward the patient, and nodding their head. Having a
good physician–patient relationship leads to greater satisfaction with medical care.
Doctors experience very high levels of stress, which can lead to burnout. Factors that
contribute to burnout include dealing with patients and their family members and a
relative lack of control over their work environment. Doctors may respond by
depersonalizing their patients and are at greater risk of developing psychological and
physical problems. Giving people the opportunity to express their feelings is one way
to help ameliorate the effects of this environment.

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 Adherence

Many patients fail to show adherence to recommended medical regimens, which is

associated with substantial costs to individuals and to society. Methods of measuring
adherence include asking the patient whether he or she has taken the required
amount of medicine; measuring pill or bottle counts, electronic monitors, and/or
pharmacy refills; assessing therapeutic outcomes; and conducting direct tests of
levels of a drug in the body. All of these methods have both strengths and
weaknesses.
Intentional nonadherence may be caused by aspects of the treatment, the patient’s
beliefs about the overall costs and benefits of adherence, and individual difference
factors (personality, age, education, income). Social support from family and friends
and the quality of the relationship between the doctor and patient both impact
adherence. In the case of unintentional nonadherence, people intend to comply, and
may even believe they are complying, but for some reason they are not following
instructions. Patients may lack information about how to adhere to recommendations
or may forget or misunderstand the instructions they are given.
Strategies for decreasing unintentional nonadherence focus on giving the patient
clear and correct information, including easy-to-understand written materials,
illustrations, or an audio recording of the instructions, and reminding people to engage
in a particular behavior. The strategies for decreasing intentional nonadherence
include creating fear warnings to motivate behavior change, giving information about
the consequences of nonadherence, providing some type of incentive or reward for
following medical recommendations, increasing the ease and convenience of
adhering, enlisting the support of family members and friends, reducing depression,
and creating high-quality patient–practitioner relationships.

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