Most of us will experience chronic disorders.
Most of us will experience chronic disorders. 50% of the population at any one
time have a Chronic disorder. Some are mild, e.g. partial hearing loss, others
are life threatening e.g. renal disease.
No strong evidence. Taylor and Aspinwall (1990) - weak associations between negative affective styles and coronary heart disease, asthma, headaches, ulcers and arthritis. Link with Type A behaviour pattern and proneness to disease.
Good health weakly associated with positive emotional states (e.g. optimism and perceived control). Fewer symptoms or speedy recovery.
Problem, cancer can take a long time to develop before it is reported to health worker, so health problem could cause a person to adopt a behaviour style, rather than the other way around.
An example of where a positive style could cause hypertension is that of 'John Henryism'. This is where, for example, oppressed black people work hard to overcome deprivation, leading to hypertension. (See p122, in culture chapter).
High levels of anxiety produced by
Taylor and Aspinwall, 1990
Depression reported by just under a third of hospital admissions.
Difficult to see the pure effects of depression, as symptoms of depression
could also be symptoms of the disease
Patients can deal with uncertainty by
Patients experience some sense of control over their illness by these means.
Consider the uncertainty generated by AIDS (p172-4)
Other common problems include Mastectomy, Sexual problems (to be discussed
later with regard to Renal disease.
If you are not sure of what AIDS is read box 12.1.
Rotter (1966) external locus of control and internal locus of control.
Wallston et al (1978) expanded Rotter's scale.
Internality, belief in the power to make oneself well again
Chance, little control over becoming ill
Powerful others, belief that following doctor's orders will make one well.
Relationship between scale and outcome is not strong. Patients might be able to
control diet, for example, but not alcohol consumption. More specific scales
have been produced to look at control of pain, for example.
Murray, M. and McMillan, C. (1993) Health beliefs, locus of control, and women's cancer screening behaviour. British Journal of Clinical Psychology, 32, 87-100.
Questionnaire study of 400 women in Northern Ireland found that the dimension of powerful others was a predictor of breast self examination (BSE). This means that women who believed that doctors could deal with breast cancer tended not to do anything about detecting breast cancer themselves, whereas if they felt doctors could do little, then they took matters into their own hands and practised BSE.
In the same study, however, no relationship was found between attending a clinic for a cervical smear (to detect cervical cancer) and locus of control. This might suggest that locus of control is a predictor for a narrow range of health behaviours. A better explanation is the women's belief in their own ability to carry out a behaviour; this is known as self-efficacy. There was found a relationship between self-efficacy and BSE. Women would feel more confident in being able to turn up at a clinic, but might feel less sure about how to perform BSE.
Bandura (1977) what we believe we are capable of. If we believe that we can
do something we are more likely to do it.
Judgements of self-efficacy are based on our past performance. Other sources
are:
Wulfert and Wan (1993) study of college students. Well informed about AIDS but
condom use was best predicted by self-efficacy. If the student felt they could
use condoms without diminishing the sexual experience, then they used condoms.
Psychological responses to dialysis
High resistance.
Avoid discussion about treatment, as non-compliance could be revealed. this
would be perceived as lessening their chances of receiving a transplant.
Interviews often take place whilst dialysis is taking place.
Interventions include
I Use material from previous chapters.
Improving the communication between patient and health worker (Chapter 9).
Changing smoking habits (Chapter 7)
Adjusting lifestyles (Chapter 6)
Developing coping skills (Chapter 3)
groups for cancer, hypertension, epilepsy etc. Successful, but not known why they work. Supported by health professionals as self-help groups are cheap.
Tend to attract white professional women who are in contact with health services, so many people are not helped by this means. (Taylor and Aspinwall 1990).
Denial can be useful. If patient denies that his illness is life threatening then they would be positive towards it. Unfortunately the effects are short lived. Levine et al (1988) heart attack victims who had higher levels of denial had fewer days in intensive care and fewer signs of cardiac dysfunction. A year later many of these patients had not adapted their lifestyles to the demands of the disease and were less likely to adhere to the treatment programme. They required more days back in hospital.
Langer and Rodin (1976) compared patients living in a nursing home living on two different floors. Experimental group told:
They were offered a plant, and given option of watching a movie on Thursday,
Friday or not at all.
Control group given a similar talk, but personal responsibility and control
were not emphasised.
Given a plant, told to see the movie on one particular night, told how the
staff would make their rooms nice, etc.
Questionnaires given one week before and three weeks after.
93% of the experimental group improved their locus of control, compared with
21% of the control group. (Can you put forward possible explanations of the
improvement in the control group?). Study table 12.1, labels are around the
wrong way on figure 12.1.
Follow up study 18 months later (Rodin and Langer 1977). Experimental group were still improved. They were in better health and fewer had died.
Difficult to assess quality of life, because it is a subjective measure. For example, Jachuck et al, 1982) hypertension patients rated by doctors - 100% had an improved quality of life. 49% of patients thought that their quality of life had improved. 96% of relatives had seen no change or a slight deterioration.
Collins (cited by Taylor and Aspinwall, 1990) 90% of cancer patients reported positive consequences of their illness. Appreciated each day, didn't put things off, more effort into personal relationships, acquired a greater understanding and sympathy for the needs of others. They felt stronger and more self-assured. Similar results have been found for other life-threatening disorders.