Symptom experience and health action

Labeling of Health Risk in Industrial Settings

In January 1974 a Louisville, Kentucky chemical company announced that a link had been found between angiosarcoma and exposure to vinyl chloride. A program of medical screening identified "at risk" workers, some of whom were reassigned to an alternative work setting, a wood pallet plant. Twenty-four "high risk" pallet plant workers (PP) were matched with an equal number of workers with some abnormal test results (TP) and normal results (TN). Illness behavior in the form of medical visits for reasons of illness and injury was documented from the dispensary medical records. Frequency of dispensary use was compared across groups for each PP worker's first year in the pallet plant and for one year prior to furlough or reassignment.

Findings in relation to illness and injury for the three groups and the two time periods were not significant. Although the results were unexpected and negative, they demonstrate that high-risk workers can be perceived in a derogatory way. Such workers are faced with stigmatization as well as difficulties associated with their uncertain state of health.

Specific Health Conditions and Work-Retirement Status Among the Elderly

A thorough understanding of the relationship between ill health and retirement requires the investigation of specific illnesses and mediating mechanisms. We examined the relationship between specific major and minor health conditions and work status (retired-health, RH; retired-other, RO; or working, W) in a population- based (N = 3097) study of rural elderly persons. Lifetime history rates of major conditions were typically highest among RHpersons, and differed little between RO and Wpersons. Mean number of major conditions was typically highest among RH persons. RH was associated with poorer self-perceived health, physical functional status, mood, and recall than were RO and W, which did not differfrom each other. RH was also associated with increased prevalence and number of minor conditions among women but not men. Thus RH is preferentially associated with specified major medical conditions, increased number of major and minor health conditions, and quantitative functional and psychological decrements.

Symptoms and Self-Care in Old Age

Self-care has recently come to be recognized as the predominant form of response to illness among the general population, but little is known regarding beliefs and practices of the aged. In this study, beliefs regarding the appropriate response to 53 common symptoms were investigated and contrasted to actual responses. Various forms of self-care were seen as appropriate responses to symptoms ranging from minor to potentially serious. Preference for self-care responses appears to be related to perceived severity of symptoms and the perceived effectiveness of available self-care responses.

Strategies adopted by late middle-age and older adults with HIV/AIDS to explain their physical symptoms

Although the attributions individuals make about what causes their physical symptoms are known to influence their care seeking and self-care behaviours, much less is known about the strategies they use to arrive at these attributions. The strategies employed to understand the causes of their symptoms were investigated using in-depth interviews with 100 late middle-age and older adults with HIV/AIDS in New York City. The data revealed that most participants actively sought to explain their symptoms. The explanatory strategies identified included: relying upon illness or medication representations, lay beliefs about the body and ageing, invoking pre-existing vulnerabilities, engaging in lay experimentation, social comparison processes, considering temporal ordering and consulting authoritative sources. While most of them offered a single cause for their symptoms, some offered more complex multi-causal explanations. These findings provide understanding into the reasons why some older adults with HIV/AIDS misattribute symptoms resulting in delay in care or care over-utilisation, suggesting the need for patient education.

Health beliefs and over-the-counter product use

BACKGROUND

Pharmacists are often consulted as medical advisors. Given this case, customers and pharmacists should interact in a trustful way (eg, in terms of responding to customer's needs or recommending a different drug). Consideration of the health beliefs of the customer could improve the interaction between pharmacists and their clients and have a positive impact on medical adherence.

OBJECTIVE

To examine the health beliefs of pharmacy customers in Germany, the impact of those beliefs on over-the-counter (OTC) medication use, and associations with sociodemographic variables.

METHODS

By means of literature review and methodical surveys, a standardized questionnaire was designed that contained 68 items concerning health beliefs, habits of OTC product use, decision criteria that customers used when purchasing drugs, and information about the sociodemographic background of the participants. Main outcome measures were reliability (Cronbach's alpha) and correlations. A random sample of 58 pharmacies in Saxony, Germany (10 questionnaires per pharmacy), invited their customers to take part in our study.

RESULTS

One hundred twenty-three questionnaires (response rate 53.48%) were completed and returned to us. The outcome suggests that there is a strong association between health beliefs and frequency of use or the type of OTC drug (eg, illness attributions: p < 0.05; preventive lifestyle: p < 0.05). There were no significant associations between sociodemographic variables and chosen drugs.

CONCLUSIONS

Health beliefs, in terms of the general attitude toward health and illness, illness attribution, prevention, and the attitude toward treatment strategies, influence the kind of remedy (conventional vs complementary medication) that consumers seek. These results may have implications for consultations in pharmacies or for product marketing.

Causal attributions for fatigue among late middle-aged and older adults with HIV infection

Fatigue, a symptom with many possible causes, is highly prevalent among persons with HIV/AIDS. The causal attributions HIV+ individuals make for their fatigue are important because they largely guide the coping responses they use to manage it. In a study to better understand the symptom appraisal process among 100 HIV+ older adults (50+), 49 participants discussed in depth their experience with fatigue. Many participants felt confused, at least initially, about the source of their fatigue, although most offered their HIV disease as a possible cause. However, many who did so also believed it was caused in part by other, generally less threatening causes, such as age, overexertion, or excess weight. HIV medications and other symptoms or comorbidities were also frequently cited as causes of fatigue. Health care professionals and HIV+ peers often helped to shape or reinforce participants' attributions for their fatigue.

The evaluation of medical symptoms by patients and doctors

This study investigates discrepancy and congruence between doctors and patients in their beliefs about the need for medical treatment. One hundred seventy-six outpatients and 337 university students rated each of a set of 35 symptoms on the urgency with which they would seek medical advice were they experiencing that symptom. Sixty-six general practitioners rated the urgency with which a person experiencing that symptom should seek medical advice. These symptoms were classified as relatively serious or nonserious on the basis of ratings by a separate set of doctors. General practitioners perceived a greater overall need for treatment than did patients, but this difference was greater for nonserious than for serious symptoms. In fact patients perceived treatment to be more urgent for three serious symptoms, each potentially indicative of cancer. The observed pattern of doctor-patient discrepancies can be explained in terms of the availability heuristic. The role of this heuristic in the cognitive dynamics of doctor-patient relationships merits future attention.

Perception of health and use of health care services in a Swedish primary care district. A ten year's perspective

In a study that covered ten years a questionnaire about perceived health and use of health care services was mailed each autumn to 1/60 representative samples of the population in Sollentuna, a Swedish primary care district. The majority of respondents thought that their health was good, and only a small minority reported themselves as quite, or very sick. Those assessments were stable during the ten year period. The tendency to visit the health services increased with the degree of severity of the illness. This increase was most marked in the case of visits to emergency departments and visits by appointment at hospitals, and least in the case of visits to private doctors and company/school physicians, while visits to doctors at health centres and to district nurses occupied an intermediate position. Thus, by including a simple question about perceived health in a questionnaire designed to measure use of health care services, important information about the relations between use of health services and health conditions could be obtained.

Urgency in seeking medical care for specific symptoms: perceptions of physicians and patients

A patient's appraisal of symptom significance is important to the timeliness with which care is sought. Little is known, however, about the variations in patients' responses to symptoms and the factors determining variations. To assess lay individuals' perception of the importance of symptoms, 75 private and 75 clinic outpatients and 73 inpatients were surveyed on 13 sets of hypothetical symptoms to determine whether they would seek care immediately, call for an appointment, or wait and see. All sets of symptoms were adjudged to be clinically significant by a panel of three physicians. Twenty-one other physicians were surveyed using the same questionnaire. Weighted mean responses of patients and physicians differed on seven symptoms. Physicians recommended more immediate care for symptoms suggestive of impending heart attack and stroke than did patients, and patients indicated that they would seek care earlier than physicians for less serious symptoms. Clinic patients would seek immediate care for symptoms more often than other patient groups. Nonwhites and those with less formal education reported greater urgency in seeking care for six symptoms. The results indicate that patients may not agree with physicians in the way they interpret symptoms of disease and that symptom appraisal may differ depending on patients' sociodemographic characteristics.

How do patients evaluate cancer related symptoms and signs? A study from general practice

Descriptions of twenty different clinical situations, most of which included cancer related symptoms and signs, were assessed by 329 patients. The patients showed a satisfactory level of alertness in response to the clinical situations. Lumps and bumps and visible bleeding gave the quickest response. An inverse relationship was found between how frequent a situation was experienced among the patients and how serious it was interpreted to be. A comparison between the patients' assessment and the advice given by a random sample of 90 general practitioners revealed a quicker response rate recommended by the doctors than found among the patients for most of the symptoms and signs. The gap between doctors' and patients' understanding and interpretation of symptoms and signs is at least partly due to different levels of medical knowledge. This gap should be narrowed by public information and health education. In planning this education, knowledge of patients' evaluation of symptoms, as shown in this study, is of importance.

Correlates of mothers' use of medications for their children

This study examines the extent, determinants and quality of mothers' independent use of medications for treating their children's symptoms. Data on mother-initiated medication behavior (MIMB) were obtained from a stratified systematic random sample of 500 mothers of children presenting for a well child visit at two pediatric ambulatory care sites. Six expert pediatric judges each rated every reported medication use (N = 3908) along three dimensions (usefulness, correctness and harmfulness or helpfulness) and also evaluated the overall appropriateness of each mother's MIMB. Results indicate that: (1) mothers keep available and use for children a considerable variety of different medications and medical applicances; (2) a positive linear relationship exists between mothers' socioeconomic status (SES) and degree of MIMB; (3) mothers' attitudes toward medications and toward their children's health are associated with the number of categories of medications and applicances they possess and use; (4) the combination of SES and attitudinal characteristics accounts for substantial portions of the variance in MIMB; and (5) judges' ratings show only minimal-level support of MIMB (extending to mothers in all SES groups) and are linearly related to SES (P less than 0.001). These findings emphasize the need for health care providers to review MIMB, and to provide advice concerning use and misuse of mother-initiated treatments.

How mothers treat their children's physical symptoms

An important area of concern in community health is the widespread practice of individuals undertaking courses of treatment in the absence of medical advice or direction. This is especially a problem when it involves the administration of medicines to children. This study examines the extent, determinants, and quality of the independent use by mothers of medications for treating their children's symptoms. Data on mother-initiated medication behavior (MIMB) were obtained from a random sample of 500 mothers of children at two pediatric ambulatory care sites. Six expert pediatric judges rated every reported medication use (N = 3,908) along three dimensions (usefulness, correctness, and harmfulness/helpfulness) and also evaluated the overall appropriateness of each mother's MIMB. Results indicate that: 1) mothers keep available and use for their children a considerable number of different medications; 2) clear relationships exist between mothers' socioeconomic status and the different categories of medications they employ; 3) mothers' perceptions of their children's vulnerability to specific illnesses, and of the efficacy of over-the-counter medications for treating those illnesses, were related to the possession and use of relevant medications; and 4) judges' ratings indicated little enthusiasm for the mothers' therapeutic actions. These findings suggest the need for pediatricians to become aware of the medications their patients may be ingesting as a result of MIMB, and to educate mothers concerning use and misuse of over-the-counter (and other) treatments.

The impact of patients perceptions of high blood pressure on attendance at screening, An extension of the Health Belief Model

This study is concerned with a neglected area: the synthesis of two approaches relevant to health-related behaviour-the Health Belief Model and Attribution Theory. A prospective design was used to test the combination of health beliefs and causal attributions that predispose patients to attend a screening for raised blood pressure. It was proposed that causal attributions concerning high blood pressure (HBP) would (i) affect other health beliefs, (iii) would act in conjunction with health beliefs in relation to actual behaviour and (iii) might show, in some cases, a more direct influence on behaviour and behavioural intention. One hundred and three adults responded to the questionnaire. Multivariate analyses were used to discriminate between the characteristics of attenders and non-attenders. The general prediction was confirmed: overall, eight factors comparing both HBM and attributional items produced a highly significant discrimination. A correlational analysis revealed a variety of linear relationships between HBM-items and causal attributions. Much of the variance in attendance was accounted for by the intention variable, and multiple regression analysis was performed to examine the determinants or intention, as a significant intervening factor between beliefs and behaviour. Participation bias limits the generalisability of these findings. The potential significance of causal attribution as predictors of both health beliefs and behaviour is nevertheless apparent. The implications of such a synthesis of approaches are discussed in terms of psychological theory and health education.