HEALTH SEEKING BEHAVIOUR

Kuliah Perilaku Manusia

Semester II-2013
Umi Athiyah
 Illness Behaviour
• Illness is a social state.
• It is not just a disturbance of body and has social
meanings and impact
– i.e. it is partially the result of disease but is also
determined by social and cultural factors
• Sometimes a distinction is made between disease
(medical definition) and illness (lay person’s
perception)
– Can be sick but no symptoms
– Can feel ill but no disease/condition

10
 Disease Vs Illness
• Disease = pathological changes within the
body which find expression in physical signs
and symptoms.
• Illness = subjective experience of illness.
Includes the interpretation and response to
these signs & symptoms.
 Defining Health

• Williams (1983) found that lay definitions of health

consisted of:
– Absence of disease
– Functional fitness
– Health as dimension of strength, weakness & exhaustion
• Definitions of health vary between social,
geographical & cultural contexts.
• Lay epidemiology is important to perception of
disease prevention and health promotion
 HEALTH
• Blaxter (1983): Whilst people consider diet, exercise and
rest might contribute to health, they may not see such
activities as preventing disease/illness. Blaxter found that
the working class women she interviewed considered
that the most common causes of disease to be infection,
hereditary factors and agents of the environment.
• Lay epidemiology: people collect won knowledge. It
recognises luck. E.g. view that ‘lazy slob’ who gorges on
fatty food, smokes, drinks and doesn’t exercise is at
greater risk of heart attack. Yet some people have a
relative who’s that but outlives everyone
 Health beliefs & Lifestyles

• Sociology of lay health beliefs is of value to public

health:
1. Can contribute to an understanding of professional-
patient interactions
2. Can provide insight into lay conceptualisation which
affect compliance and health seeking behaviours
3. Understanding people’s ideas about health maintenance
and disease prevention is crucial to the effectiveness of
health promotion
4. Can contribute to our knowledge of informal healthcare
(i.e. carers)
 KEBUTUHAN

PERILAKU
PASIEN PERILAKU
SISTEM RUJUKAN PRAKTISI
PROFESIONAL
• Pengenalan kebutuhan
• Memutuskan u/ mencari yankes • Proses Diagnosa
• Proses mencari yankes • Dokter • Proses Terapi
• Dasar/pijakan: “Perilaku Sakit” • Perawat
• Apoteker

Pelayanan yang digunakan

• Periksa ke dokter
• Masuk ke RS
Hasil (Pasien) • Terapi obat
• Hilangnya gejala
• Sembuh
• Tidak ada efek samping

PROSES PELAYANAN KESEHATAN

 Sick Role
Talcott Parsons (1951):
• Illness is disruptive for society as sick people are not
able to fulfill their normal roles. It is a form of
deviance.
• Society instituted a special role for sick people that
functions to control amount of illness in society and
to return sick people back to state of health as
quickly as possible
 Sick Role
• Two Rights
– Sick people are exempt from performing their normal
social roles
– Sick people are exempt from responsibility for their own
state
• Two Obligations
– To get better as soon as possible
– To consult and co-operate with medical experts whenever
severity of condition warrants it
 Illness Behaviour

• Only small numbers of people with symptoms

decide to consult GPs (many self-medicate)
• People often discuss symptoms with others
before the discuss them with their doctor (‘lay
referral’)
• Lay referral network (Friedson, 1960)
– Patient experiencing symptoms would receive advice
from a close relative before being referred to
progressively more remote and expert people
Health Disease

Determinants

Host Etiologic agent

Time

Environment
Healthy behaviour Unhealthy
behaviour

Context Cognitions

Health
state

Behaviour
 Behaviour and illness
• Direct psychophysiological effects, e.g., anxiety
causing physical changes
• Health-impairing behaviours
• Reaction to illness
• Reaction/adherence to treatment
 Health belief model
• Prevention or change is a function of:
– Perceived threat: severity, susceptibility
– Cost/benefit analysis of the new behaviour

These remain a part of all following models

 Cultural

Social/
Structural
environmental

Health behaviour

Personal Health state

 Effectiveness goals
• Actions are effective if they strengthen the capacity
to exert control over the determinants of health.
• Change cognitions about
– Health behaviours
– Use of health services
• Change the context
– Social, economic, environmental conditions
– Provision of health services
 Challenges
• Development of reliable and valid indicators of
success
– Health outcomes: long-term or intermediate
– Healthy behaviours
– Healthy environments
– Theoretical indicators of potential change
• Beliefs, attitudes, perceptions, intentions
 In response to illness
• Cognitive representations of the illness:
– Symptoms, information, past experience
– Cultural representations; what others think
• Development and implementation of an
action plan/coping strategy
• Appraisal of the outcome
 Cognitive representations of disease
• Identification
• Causality
• Consequences
• Time-line
• Potential for cure
 Delay in health care
Patients
• Appraisal delay: Am I ill?
• Illness delay: Do I need medical care?
• Utilisation delay: Should I use the treatment?
Health care
• Diagnosis delay
• Delivery delay
 Delay in health care
• Appraisal delay: longer if read about
symptoms; shorter if pain or bleeding
• Illness delay: longer for females, longer if
passively respond to symptoms, longer if hold
negative image of the condition or its
treatment; shorter if symptoms are new or
unknown.
• Utilisation delay: longer if worried about cost,
shorter if pain or perceived curability
 LEVEL OF
ADHERENCE

Treatment
& health care Beliefs
characteristics Information
Transfer
Patient
•Access •wants treatment
•Fits patient needs •Understanding •feels treatment most
•Costs appropriate choice
of treatment:
•can monitor progress
Why, when, how

PAST EXPERIENCE