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Illness Behavior
SOCI 1050
Chapter 6
Illness Behavior
• Kasl and Cobb define it as any activity
undertaken by a person who feels ill for
the purpose of defining that illness and
seeking relief from it
• David Mechanic – varying ways individuals
respond to bodily indications, how they
monitor internal states, define and
interpret symptoms, make attributions,
take remedial actions and utilize
various sources of formal and
informal care
Seeking Care
• Responding to symptoms that are
disruptive, painful and visible
• More likely when discomfort is severe
• Sometimes determined by criteria
outside the disease process
• Social factors can encourage or
discourage pursuit of care
Self-Care
• Most common response to symptoms
• Includes taking preventive measures,
self-treatment of symptoms,
• Managing chronic conditions
• May involve consultation with health
care providers and use of their
services
• Includes both health and illness
behavior
Factors Promoting Interest in
Self-Care
• Shift in emphasis from cure to care
• Public dissatisfaction with depersonalized
care
• Recognition of limits to modern medicine
• Increased visibility of alternative healing
• Consciousness of the effects of lifestyle
• Desire to exercise personal
responsibility
• Access to information on the Internet
Bottom line on self-care …
• “When laypersons lack knowledge,
competence or experience to
proceed, or are simply more
comfortable in allowing professionals
to handle matters, they turn to
doctors” (p. 121-2)
Sociodynamic Variables in
Help-Seeking Behavior
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Age
Sex
Ethnicity
Socioeconomic status
Age and Sex
• Use of health services is greater for
females than males
• Greatest for the elderly
• Women generally know more about
health issues and take better care of
themselves
• The more females in a household,
the greater the demand for
physician care
• People older than 65 are in poorer health
hospitalized more than younger
counterparts
• More likely to visit a doctor (probably
because they have public insurance –
Medicare)
• Reproductive issues account for
fewer than 20% of female visits to
doctors
• Higher number of visits by females seems
to be associated with a higher
number of ailments
Suchman categorized ethnic groups as
either cosmopolitan or parochial
• Parochial groups
– Close relationships with family, friends and
members of their ethnic group, had limited
medical knowledge and tended not to trust
medical care
– Reliance on lay-referral system (family,
friends, neighbors who assist in interpretation
of symptoms
– Highest resistance to using medical
services was among the poorest groups
– Quite dependent when ill
• Cosmopolitan groups
– Low ethnic exclusivity, less limited friendship
systems, and fewer authoritarian family
relationships than the parochial groups
– More likely to know something about disease
and to trust health-care professionals
– Less dependent on others when they were
sick
Social Networks
• Close and ethnically exclusive social
relationships tend to channel helpseeking behavior toward the group
rather than professionals
• On the other hand, some research
suggests that family is more critical
than ethnic group in determining
help-seeking behavior
• The role of the social network and its
specific values, opinions, attitudes
and cultural background act to
suggest, advise or coerce an
individual into taking or not taking
particular courses of action
• See Table 6-1 page 125
• Economic realities may dictate
use of alternatives to medical
practitioners
• Ethnicity provides a cultural context
for decision making within the social
networks
• See Table 6-2 page 126 for health
insurance coverage by ethnic group
• Some specific patterns are noted for
African American and Hispanic
American populations
Socioeconomic Status
• Culture of poverty – poverty, over
time, influences the development of
certain social and psychological traits
among those trapped in it
• These traits include: dependence,
fatalism, inability to delay gratification,
and lower value placed on
health
• Medicare and Medicaid have changed the
patterns of physician utilization such that
those at the lowest income levels (along
with those at the highest income levels)
tend to utilize health care services the
most
• Poor tend not to use the same sources as
the upper classes who have more use of
private
physicians
• Middle class persons have become
the underutilizers
Need for Care
• However, if need for services is taken
into account, lower income persons
tend to use fewer services relative to
their needs.
• Poor persons may be more likely to
ignore symptoms and not define them
as illness
• Tend to continue to function to
meet the needs for survival
• Having a regular source of care has
been identified as an important
variable in help-seeking behavior
• Poor people seeking care in the
public sector are likely to have more
fragmented pathways to health care
Future Patterns of Physician
Utilization by Social Class
• There may be more of a consumer
orientation toward health among
socially advantaged persons
• In a free-market situation, health
consumers typically havae more
freedom to choose their source and
mode of health
Locus of Control
• Whose responsibility is health or
illness?
• Lower class persons may tend to
have a more passive orientation
toward life in general and less
willingness to take responsibility for
problems
– More fatalistic and more accepting of
belief that external forces are controlling
their lives
Culture of Medicine
• Does not promote equality among
lay-persons when direct physicianpatient interaction is required
• Physicians are portrayed as powerful
individuals with training and intellect
to make life or death judgments and
patients are portrayed as
dependent on these judgments
Mechanic: Determinants for
seeking medical care:
• Visibility and recognition of symptoms
• Extent to which symptoms are perceived
as dangerous
• Extent to which symptoms disrupt family,
work or social activities
• Frequency and persistence of
symptoms
• Amount of tolerance for the
symptoms
• Available information, knowledge, and
cultural assumptions
• Basic needs that lead to denial
• Other needs competing with illness
responses
• Competing interpretations that can be
given to the symptoms once recognized
• Availability of treatment resources,
physical proximity, and psychological
and financial costs of taking action
Illness Experience
• Begins with symptom stage (decision
about whether something is wrong)
• Assumption of sick role (relinquishing
normal social obligations)
• Seeking medical assistance
• Taking on the dependentpatient role
• Recovery and rehabilitation
• See figure 6.1 on page 140