Medical sociology
Lijodi Brenda

Health behaviour

Health behaviour
• Health behaviour refers to the activities people do that either
maintain or improve their health or potentially harm their health.
• The full set of health behaviours, then, consists of activities that
promote good health (promotive, positive, protective, or preventive
behaviours) and of activities that may harm their health (risky,
negative, or dangerous behaviours).
• It also the periodic activities we do to screen for various health
problems
• We learn many behaviors, including health behaviors (positive and
risky behaviors alike) from our parents, friends, and other people

Types of health behaviour
 Health-directed behavior
◦ Observable acts that are undertaken with a specific health
outcome in mind
 Health-related behavior
◦ Those actions that a person does that may have health
implications, but are not undertaken with a specific health
objective in mind

Types of health beahaviour
 Preventive Health Behaviour
◦ action taken when a person wants to avoid being ill or having a
problem e.g. a mother takes her child for immunisation
 Illness Behaviour
◦ action taken when a person recognizes signs or symptoms that
suggest a pending illness e.g. a mother gives her child cough
medicine after hearing her wheeze

 Sick-role Behavior
◦ action taken once an individual has been diagnosed (either self or
medical diagnosis) e.g. an employee takes a vacation because he is
ill, he takes treatment and obeys his doctor’s advice

Models of behaviour change

COGNITIVE DISSONANCE MODEL
 The model holds that inconsistency is a painful or uncomfortable
state
 Since dissonance is psychologically uncomfortable, it will
motivate an individual to reduce dissonance to achieve
consonance
 In addition, the individual will actively avoid situations and
information that are likely to increase the dissonance

 For example, if a respected role model with whom an individual
identifies makes a statement or declaration with which the individual
disagrees, consonance is achieved by either:
◦ (a) changing the belief, or
◦ (b) changing attitudes to the respected person.

Maslow hierarchy of needs
 Behaviour is motivated by a hierarchy of human needs
 Explains why not everybody responds to the obviously beneficial
and well-meaning interventions
 Health needs may be compromised for the sake of satisfaction of
low- order needs

Safety needs - to feel secure and safe, out of
danger
Basic physiological needs - hunger, thirst and related needs
Belongingness
and love needs -
to affiliate
(follow) with
others, be
accepted
Esteem needs - to
achieve, be competent,
and gain approval and
recognition
MASLOW’S HIERARCHY OF NEEDS
Self-actualization needs - to
find self-fulfilment and realise
one’s own potential

Health belief model
• Two major factors influence the likelihood that a person will adopt a
recommended preventive health action
• First they must feel personally threatened by disease i.e. they must
feel personally susceptible to a disease with serious or severe
consequences
• Second they must believe that the benefits of taking the preventive
action outweigh the perceived barriers to (and/or cost of) preventive
action”

HEALTH BELIEF MODEL
Demographic variable
[age, sex, race
ethnicity, etc.]
Socio-psychological
variables
Perceived Threat of
Disease “X”
Perceived
Susceptibility to
Disease “X”
Perceived Severity
of Disease “X”
Perceived benefits
of preventive
action
minus
Perceived barriers
to preventive
action
Likelihood of Taking
Recommended
Preventive Health
Action
Cues To Action
Mass Media Campaigns
Advice from others
Reminder postcard from physicilan or dentist
Illness of familiy member or friend
Newspaper or magazine article
I N D I V I D U A L
P E R C E P T IO N S
M O DIFYI N G
FA C T O R S
L IK E L IH O O D
O F A C T I O N

HBM
Concept Definition
Perceived Susceptibility One’s opinion of chances of getting a condition
Perceived Severity One’s opinion of how serious a condition and its
sequelae are
Perceived Benefits One’s opinion of the efficacy of the advised
action to reduce risk or seriousness of impact
Perceived Barriers One’s opinion of the tangible and psychological
costs of the advised action
Cues to Action Strategies to activate “readiness”

P e r c e i v e d
s u s c e p t i b i l i t y
Y o u n g m a n h a s
b e e n e n g a g i n g i n
s e x w i t h m u l t i p l e
p a r t n e r s .
P e r c e i v e d
S e v e r i t y
Y o u n g m a n
b e l i e v e s t h a t
A I D S i s a d e a t h
s e n t e n c e s i n c e
t h e r e i s n o c u r e .
P e r c e i v e d
T h r e a t
Y o u n g m a n
b e l i e v e s t h a t h e
i s a t r i s k b e c a u s e
f r i e n d i s ill.
C u e s t o A c t i o n
R a d i o m e s s a g e s
e x p l a i n i n g t h e
n e e d f o r s a f e s e x .
P e e r e d u c a t i o n o n
s a f e s e x a n d H I V.
B e n e f i t s / b a r r i e r s
 C o n d o m s a r e
e a s y t o u s e , o n e
c a n f e e l s a f e
 C o n d o m s n o t
r e a d i l y a v a i l a b l e ,
c o s t l y
D e s i r e d
B e h a v i o u r
Y o u n g m a n b u y s
a n d u s e s c o n d o m s
r e g u l a r l y.
S e l f - e f f i c a c y
Y o u n g m a n h a s
h a d p r a c t i c e u s i n g
c o n d o m s a n d f e e l s
c o n f i d e n t t o u s e
t h e m .

Illness behaviour and illness
experience

ILLNESS
• “Illness is a condition characterized by a
deviation from a normal health state which is
manifested by physical & psychological
symptoms.” – Kozier.

VARIABLES AFFECTING ILLNESS
BEHAVIOUR
1. Internal Variables.
2. External Variables.

INTERNAL VARIABLES
• 1. Perception of symptoms.
• 2. Nature of illness.
• 3. Characteristics of person.

1. Perception of symptoms
• It is the way of perceiving the symptoms of
illness that influence illness

If a person takes the symptoms not too seriously
& takes adequate treatment, recovery will be
quick, but if a person takes it very seriously , it
may become life threatening or fatal for the
person.

Nature of illness
• Nature of illness also affects
illness behaviour.
• As in the case of an acute illness
when the person is taking
treatment that will be

Characteristics of a person
• How a person responds to illness
depends upon the adjusting,
coping abilities.
• He may become well adjusted to
illness or may get mentally
disturbed.

EXTERNAL VARIABLES
• 1.Visibility of symptoms.
• 2.Social group.
• 3.Culture & values.
• 4.Economic variable.
• 5.Accesibility of health care
system.

1.VISIBILITY OF SYMPTOMS
• The visibility of symptoms
affects body image as well as
behaviour. The clients with
visible symptoms are more likely
to seek more assistance than
clients without symptoms.

• E.g. A person with lip ulcer will
seek medical help sooner than a
person with sore throat because
the lip sore has changed the
physical look.

SOCIAL GROUP

2.SOCIAL GROUP
• Social group may assist the client
in recognizing the threat of
illness or support the denial of
potential illness.
• The clients responds positively to
social support.

3.CULTURE & VALUES
• The culture & values teach
the client how to remain
healthy & also how to
recognize the illness.

ECONOMIC VARIABLES

4.ECONOMIC VARIABLE
• The economic constraints may
delay the treatment or may allow
the client to carry out daily
activities.
• Studies have shown that persons
of low economic status have
chronic illness.

5.ACCESIBILITY OF HEALTH
SERVICES.
• The proximity of health services
has great influence on
individuals in utilizing the same.

STAGES OF ILLNESS
BEHAVIOUR

• The experience of illness of
complex. The person generally
passes through five stages of
illness behaviour.
• This pattern involves how a
person seeks, finds & completes
the health care.

• 1.Stage I
• 2.Stage II
• 3.Stage III :
• 4.Stage IV :
• 5.Stage V :
: Symptom experience.
: Assumption of sick role.
Medical care contact.
Dependent client care.
Recovery &
rehabilitation.

STAGE I – SYMPTOM EXPERIENCE
• In the first stage, person feels
that something is wrong but
he is not able to diagnose the
problem.

• Perception of symptoms includes
awareness of physical change
like pain, rashes, lump. At the
end of this stage , he is able to
make the decision that it is a
symptom of an illness.

STAGE II –ASSUMPTION OF
SICK ROLE
• If the symptoms persist, then the
client will assume sick role &
seek confirmation from family &
others that they are indeed sick.
Then he gets excuse from normal
duties & role expectations.

• Assumption of sick role results
in emotional changes such as
withdrawal, depression, physical
changes. The person may deny &
delay the contact with health
care system.

STAGE III –MEDICAL CARE
CONTACT
• At this stage, the client
acknowledges the illness & seeks
explanation of causes, duration
of illness & it’s complications.
Health professional may
determine whether the client is
ill or not.

• After knowing about illness
some client seek medical
treatment , but sometimes, they
start denying the symptoms.

STAGE IV – DEPENDENT STAGE
• After accepting the diagnosis, client becomes dependent upon
health care professionals to get treatment.

• Here, the client accepts the
care, sympathy, protection
from the demands & stress of
life.

STAGE V – RECOVERY &
REHABILITATION
• This is the stage when the
symptoms of illness get
subsiding. The person starts
regaining original health status.

• In case of chronic illness, final
stage involves an adjustment to
a prolonged reduction in health
& functioning.

EMOTIONAL
RESPONSE TO ILLNESS

• An emotion is a bodily state
which involves feelings that may
be consciously or unconsciously
motivated.

• How the emotions are expressed
or experienced depends upon
person's basic personality,
perception, situation & also
extent of support.

• By knowing the emotional
responses to illness, nurse can
anticipate different reactions &
can encourage the client &
family to express the feelings in
a constructive way.

EMOTIONAL
RESPONSES TO
ILLNESS

1. Fear.
2. Over dependence & feeling
of helplessness.
3. Anxiety.
4. Hope.
5. Anger & hostility.

1.FEAR
• Fear is an emotional response
characterized by expectation of
harm or unpleasantness.
• Normally, the body reacts by
attempting to avoid or withdraw
from threat.

• Patient with fear expresses it
freely but, few explanations
from the nurse can alleviate the
fear readily, on the other hand
some are reluctant to express
fears.

2.OVER DEPENDENCE
• During the period of illness, the
dependence & feelings of
helplessness usually increase up
to the point they may be harmful
for the client.

• Nurse can observe the over
dependency in patient & can
assist the client to decrease it in
a manner compatible with
patient’s capabilities.

3.ANXIETY
• Illness results in anxiety, & in
anxious patients, insight is
lacking. Anxiety leads to
insomnia, diarrhoea, shift in Bp,
fatigue & inadequate coping
with disease condition.

• The nurse should have proper
knowledge about anxiety level of
the clients & should know the
interventions to reduce anxiety.

4.HOPE
• Mostly people hope for the best
& expect a long & healthy life.
Physical & emotional equilibrium
gets disturbed & even death may
occur if a person gives up the
will to live.

5.ANGER & HOSTILITY
• Anger is an emotion
characteristically associated with
frustrations & struggling with an
unpleasant situation.

• It is commonly seen when the
goal is blocked or cannot be
achieved, or the respect for self
has lowered.

• Hostility is an unfriendliness that
is associated with a desire for
aggression. Sarcasm, abusive
remarks are the expression of
hostility.

• The over demanding,
unreasonable aggressive &
argumentative patients may
express their hostility through
their behaviour.

• Nurse should have complete
knowledge about all these
emotions, so that she can help
the client to adjust / adapt to
the situation

IMPACT OF
ILLNESS

1.Impact of illness on client.
2.Impact of illness on client &
family.

1.BEHAVIOURAL &
EMOTIONAL CHANGES
• Individual’s reaction towards illness
depends on his attitude, nature of
illness & reaction of others to it.
Short term illness causes few
behavioural changes in the
functioning of the client & the
family.

• Life threatening or severe illness
leads to more extensive
behavioural changes such as
anxiety, shock, denial, anger &
withdrawal.
• The nurse develops interventions
to assist the client & family in
coping with the stress.

2.IMPACT ON FAMILY ROLES
• During illness, role of the client
& the family members get
disturbed, may be for shorter or
for long period.

• An individual & a family adjust
easily to short term changes.
E.g., A mother of two children
with common cold continues to
go to the work.

• Long term changes require an
adjustment process. The client &
his family requires counseling &
guidance to assist them in coping
with role changes.

3.IMPACT ON BODY IMAGE
• The reaction of a client & family
members to illness & subsequent
change in body image depends
on the following :

• 1.The type of changes.
• 2.Their adaptive capacity.
• 3.The rate at which changes
take place.

• 4. Supportive services available.
• 5.The client responds to illness
as in the way of shock,
withdrawal, acceptance &
rehabilitation.

4.IMPACT ON SELF CONCEPT
• Self concept means individual
mental image of themselves, like
how they view their strengths &
weakness in all aspects of their
life.

• The impact of illness on self
concept is not easily observed,
but when the concept gets
affected, the person will no
longer meet the expectations of
family leading to anxiety,
frustration & conflict.

• While providing care, nurse must
be able to observe changes in
client's & family member’s self
concept & then help them to
adjust with the situation.

5.IMPACT ON FAMILY DYNAMICS
• Family dynamics is a process by
which a family functions, makes
decision, gives support to an
individual member & copes with
every day changes & challenges.

• Due to the illness impact on
client, it leads to changes in the
family dynamics. Nursing
interventions should be devoted
towards client as well as family
members.

THANK YOU