Illness behavior (sick role) Dr. safeyya Adeeb Alchalabi Illness behavior (sick role)

Illness behavior Illness behavior refers to those behaviors that individuals engage in once they believe that they are ill.

Illness behavior “It is not the symptoms themselves that are significant in comprehending illness behavior, but the way in which they are defined.”

Sick role is a term used in medical sociology regarding sickness and the rights and obligations of the affected. It is a concept created by American sociologist Talcott Parsons in 1951.

Sick role In sociology, the “sick role” is a term used to describe the social behaviors exhibited both by people who are sick and the people around them.

Benefits of sick role Ability to gain exemption from normal roles e.g. employment, domestic work Societal relinquishment of perspective that individuals concerned are responsible for their illness and predicament.

obligations under the sick role theory People who are sick are expected to get better, work on getting better by going to the doctor, complying with medication regimens, and cooperating with treatment plans.

Being sick can come with loaded social responsibilities and burdens. Sick role Being sick can come with loaded social responsibilities and burdens. The sick role can also be involved in social perceptions of disability and disabled persons, for example, many people believe that people with mental illness should adhere to prescribed medications in order to be functional members of society or to be entitled to receive benefits.

Sick role Illness perception might reflect cultural beliefs, psychological needs, or something else that may have little to do with measurable disease.

Factors influencing individual response to illness Symptom visibility & perceived importance of this Assessment of symptom’s significance Potential for symptoms to disrupt community Symptom denial for fear of confirmation of serious illness Deferring response to symptoms because of competing social demands Assessment of social & economic costs of responding to symptoms versus potential health-related benefits Available information knowledge & cultural assumptions & understandings Symptom frequency & persistence Competing interpretations of symptoms

Sick role An understanding of a patient’s illness perception is necessary to help in a diagnosis. This can be difficult because perception is highly subjective and there's no absolute method of measuring it either from individual to individual, or even within one person’s perspective through time. Researchers have determined that reducing illness perception to its most basic elements can help patients describe what it is they are feeling. By organizing these components into a structure. patients can reconstruct the architecture of their beliefs about their illnesses

Sick role The first area of focus is identity. This component contains what the patient believes is true of the disease, including cause and symptoms. A patient who lists a number of experiences such as confusion, nausea, and anxiety as symptomatic of a particular disease may be more likely to experience those symptoms while simultaneously failing to recognize others that are just as likely to be part of the cluster.

Sick role The patient’s sense of timeline describes the third component. This area is concerned with the perceived illness’s initial appearance, its trajectory, and its conclusion. Patients with the illness perception that a sickness is or will become chronic are less likely to recover from it quickly than those who believe it is temporary.

Those scoring highest on Optimism Scale tend to be: More successful Healthier Improve under pressure Endure stress better Live longer Importance of habitual patterns of subjective beliefs about the causes of events (“explanatory style”)

Sick role The fourth area of concern is consequences. Patients whose illness perception leads them to believe that it will have a profound and negative effect on the quality of life are more likely to become discouraged or depressed than those who don’t have this particular perception. Patients who, in fact, do have a serious disorder but lack a strong sense of consequences might be better able to fight it or less equipped to handle the effects.

Sick role The fourth area of concern is consequences. Patients whose illness perception leads them to believe that it will have a profound and negative effect on the quality of life are more likely to become discouraged or depressed than those who don’t have this particular perception. Patients who, in fact, do have a serious disorder but lack a strong sense of consequences might be better able to fight it or less equipped to handle the effects.

Sick role The general idea is that the individual who has fallen ill is not only physically sick, but now adheres to the specifically patterned social role of being sick. ‘ Being Sick’ is not simply a 'state of fact’ or ‘condition’, it contains within itself customary rights and obligations based on the social norms that surround it. The theory outlined two rights of a sick person and two obligations:

Sick role Rights: Obligations: The sick person is exempt from normal social roles The sick person is not responsible for their condition Obligations: The sick person should try to get well The sick person should seek technically competent help and cooperate with the medical professional

Rejecting the sick role. This model assumes that the individual voluntarily accepts the sick role. Individual may not comply with expectations of the sick role, may not give up social obligations, may resist dependency, may avoid public sick role if their illness is stigmatized. Individual may not accept ‘passive patient’ role.

Doctor Patient relationship Going to see doctor may be the end of a process of help seeking behavior ,importance of 'lay referral system'- lay person consults significant lay groups first. This model assumes 'ideal' patient and 'ideal'doctor roles). Differential treatment of patient, and differential doctor patient relationship- variations depend on social class, gender and ethnicity.

Blaming the sick. ‘Rights’ do not always apply. Sometimes individuals are held responsible for their illness, i.e. illness associated with sufferers lifestyle. (alcoholism). In stigmatized illness sufferer is often not accepted as legitimately sick.

Chronic Illness. Model fits acute illness (measles, appendicitis, relatively short term conditions). Does not fit Chronic/ long-term/permanent illness as easily, getting well not an expectation with chronic conditions such as blindness, diabetes. In chronic illness acting the sick role is less appropriate and less functional for both individual and social system. Chronically ill patients are often encouraged to be independent.

factors that determine the type of illness behavior expressed in the individual. age and gender in illness behavior, far greater in women . variation to ethnicity education, family structure, and social networks health care coverage and insurance. socioeconomic status. lower-class individuals (lower in socioeconomic status) most likely to delay seeking professional health care even when presented with severe symptoms.

Treatment & Management Beliefs Do less Avoid exercise Rest Avoid academic work Exercise more & do more “The exploration of a patient’s biography is an important strategy in establishing a successful working relationship.”

variations in interpretation of sickness can be summarized in ten general categories: (1) the visibility, recognizability, or perceptual salience of deviant signs and symptoms; (2) the extent to which the person perceives the symptoms as serious (that is, the person’s estimate of the present and future probabilities of danger; (3) the extent to which symptoms disrupt family, work, and other social activities; (4) the frequency of the appearance of deviant signs and symptoms, or their persistence, or their frequency of recurrence; (5) the tolerance threshold of those who are exposed to and evaluate the deviance signs of symptoms;

variations in interpretation of sickness can be summarized in ten general categories: (6) the information available to, the knowledge of, and the cultural assumptions and understanding of the evaluator; (7) the degree to which autistic psychological processes (perceptual processes that distort reality) are present; (8) the presence of needs that conflict with the recognition of illness or the assumptions of the sick role; (9) the possibility that competing interpretations can be assigned to the symptoms once they are recognized; and (10) the availability of treatment resources, their physical proximity, and the psychological and monetary costs of taking action (including not only physical distance and costs of time, money, and effort, but also stigmatization, resulting social distance, and feelings of humiliation resulting from a particular illness decision)

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