1. Quick test question: What are the main psychological components of the biopsychosocial model?

2. Medical Psychology 10. 02. 2011. Patients’ Representations and Beliefs about Illness

3. High Prevalence of Somatic Symptoms ► 80-90% general population: > 1 symptom per week ► Typical adult: 1 symptom every 5-7 days ► 81% college students report > 1 symptom within 3 days ► 20% adults: “substantial,” “prolonged” fatigue ► 15%-30% back pain, joint pain, muscle pain within 2 weeks ► Only small minority seeks medical help!

4. Common symptoms in primary care (Mayou and Farmer, 2002)

5. ► Precontemplation: not intending to make any changes ► Contemplation considering a change ► Preparation making small changes ► Action: actively engaging in a new behaviour ► Maintenance sustaining change over time The transtheoretical model of behaviour change (Prochaska & DiClemente, 1982)

6. World Health Organization’s Definition of Health A state of complete physical, mental, and social well-being, not merely the absence of disease

7. Cultural Concepts of Health ► South Africa: Harmony with nature Harmony of mind, body, and spirit ► Asia: Physical and spiritual harmony with nature Balance of yin and yang

8. ► Middle East: Spiritual Causes Cleanliness ► Western countries: Personal responsibility with diet, rest, exercise, and prevention

9. Protective Objects: Amulets Bangles Talismans Protective Substances: Garlic Onions 1000 year old eggs Kosher foods

10. Health care professionals must change to accommodate other cultural beliefs and behaviors towards health and illness

11. Lay Definitions for Health A sample of 9000 British adults defined health as: ► not-ill: the absence of physical symptoms. ► despite disease. ► reserve: the presence of personal resources. ► behaviour: the extent of healthy behaviour ► physical fitness ► social relationships ► vitality ► function (Blaxter, 1990)

12. Knowledge systems and health behaviour

13. Health-behaviour is related to the way in which people interpret their symptoms Is behaviour that rational? We have to take in consideration: ► Role of emotional factors such as fear and denial. ► The person’s belief in their ability to carry out behaviour ► How attitudes might change ► The measurement of each component

14. Illness Representations ► Illness representations will determine how someone responds to potential health threats ► Illness representations include: Informations and beliefs about the illness

15. I llness Cognitions (Leventhal & Nerenz, 1985) 1. Identity Diagnosis ( a cold ) and symptoms ( runny nose, fever ) 2. Perceived cause of illness Stress, a virus, unhealthy lifestyle 3. Time line Acute or chronic 4. Consequences Physical (pain, mobility problems) and emotional (lack of social contact, anxiety) 5. Cure & control E.g. by taking medication or getting plenty of rest

16. Breast-cancer patients’ illness attributions (Taylor, 1985)

17. ► Illness representations - interpret symptoms - and give them meaning ► The course of action taken will be determined by the representation

18. Typical illness metaphors ► Challenge ► Enemy ► Loss ► Gain (primary / secondary) ► Punishment

19. The course of action taken will be determined by the representation

20. Illness behaviour: is influenced by the individual’s interpretations of an appropriate response to symptoms  pre-existing belief systems determined culturally & experientially  dialogue with others & societal norms & values May be initiated by one person on behalf of another – the “lay referral system” (Harding & Taylor, 2002)

21. Motivation Phase Volition Phase Behavior Intentions Self-Efficacy Outcomeexpectancies RiskAwareness Self-Efficacy ActionPlanning H ealth A ction P rocess A pproach: A 2-Layer Model (Schwarzer, 1992) pre-intentional intentionalactional

22. Health Action Process Approach (Schwarzer, 1992)

23. Illness Perception Questionnaire (Moss& Morris, 2002) Timeline: acute/chronic – My illness is likely to be permanent rather than temporary Timeline: cyclical – My symptoms come and go in cycles Consequences – My illness has major consequences on my life Personal control – What I do can determine whether my illness gets better or worse Treatment control – My treatment can control my illness Illness coherence – I have a clear picture or understanding of my condition Emotional representations – When I think about my illness I get upset