ILLNESS BEHAVIOUR AND PERCEPTIONS

OF ILLNESS
Illness behavior, lay health beliefs, sick role
ILLNESS BEHAVIOR
ILLNESS BEHAVIOUR
It is the study of behaviour in social context, rather than in
relation to a physiological or pathological condition
Illness behaviour, then, is a sociological concept which
attempts to describe how people respond to their symptoms.
There are two perspective on illness behaviour which have
been identified by Morgan et al., in 1985 and termed as

•Individualistic
•Collectivist
Individualistic approaches stress the characteristic of
the individual.
Collectivist approaches emphasis the shared social
norms and values that influence the actions of people.
Ten variables have been identified which may influence
and individuals response to illness.
•Visibility, recognisability or perceived importance of
deviant signs and symptoms.
•The extent to which a person’s symptoms are perceived as
serious that is, the person’s estimate of the present and
future probabilities of danger indicated by these
symptoms.
•The extent to which symptoms disrupt family life, work
and other social activities.
•The frequency of the appearance of the deviant signs and symptom,
their persistence, or the frequency of their recurrence.
•The tolerance threshold of those who are exposed to and evaluate the
deviant sign and symptoms.
•Available information, knowledge and cultural assumptions and
understandings of the evaluator.
•Psychological factors that lead to denial of symptoms- for example,
fear of confirmation of disease, such as cancer.
•More pressing or immediate needs may complete with illness
responses – for example, work commitments may be regarded as more
important than dealing with illness
•Competing possible interpretations that can be assigned to the
symptoms once they recognised.
•Availability of treatment resources, physical proximity, and
psychological monetary costs of taking action. Included are not only
physical distance and costs of time, money and effort, but also costs
such as social stigma, social distance and feelings of humiliation.
•
The symptom iceberg
We realise that the majority of symptoms
experienced by people are not presented to a
health professional. Most people either fail to
perceive their symptoms, or ignore, tolerate or self
treat them.
Great britain ( british Market Research Bureau,
1997). This study found that 91 percent of the
individuals interviewed reported experiencing at
least one ailment during the previous two weeks
with an average of 5.2 ailment in a two – week
period. These ailment included some which were
recurrent in nature.
In response to these ailment 46 percent of those interviewed took
no action at all. 34 percent used an over the country home remedy,
whilst only 10 percent saw a doctor and one percent sought the
advice of a therapist.

Illness Adults reporting illness in previous two weeks(%)

•Tiredness 40
•Headache 33
•Muscle aches or pain 29
•Sleeping problems 23
•Stiffness in joints 22
•Back problems 20
•Stress or anxiety 17
•Feeling low or depressed 16
•Common cold 14
•Arthritis 14
•Acne 12
 LAY BELIEFS
We have been seen, people’s responses to symptoms are
many, varied and diverse. Ideas and beliefs about health
are derived from many sources and have also been the
subject of study by medical sociologists. The first
sociological studies of people’s views of health and illness
appeared in the early 1960s (Apple, 1960, Freidson, 1961).
The ideas of individuals with regard to health and illness
are referred to in the sociological literature as ‘ lay health
beliefs’. An understanding of lay health beliefs is useful
and important because it serves to:
•Enhance our understanding of the social impact and
meaning of health, disease and illness.
•Enhance the health professional – patient
relationship.
•Allow the development of realistic approaches and
strategies in health education and promotion.
•Allow the development of appropriate health services
based on the perceived needs of suffers rather than on
the perceptions of health care providers.
Multiplicity of ideas model
Chrisman (1977) in a review of the literature from different
cultures on lay ideas about the aetiology of disease,
identified four commonly used explanations to account for
the pathology of the body in the event of ill- health.
1. Invasion: the rationale that the body is susceptible to
intrusion of matter or substances that are able to make
the body ill, such as micro-organisms, toxic chemicals
or spoiled food.
2. degeneration: where by the body is perceived and
expected to get progressively worse with age.
3. mechanical: the structure or functioning of the body is
impeded as the result of blockages, fractures,
breakdowns, etc.
4. Balance: the imperative of maintaining an equilibrium
between elements within the body and between the
body and the environments.
People’s health beliefs are particularly relevant in relation
to so-called ‘ behavioral disease’ such as acquired
immune deficiency syndrome (AIDS). In a study titled ‘
constructing common sense – young peoples beliefs
about AIDS Warwick et al. (1988) stress three reasons
why young peoples views are important:
1. Lay beliefs may temper the effectiveness of the official
health education message which rely on professional
and bio-medical explanations to inform people about
the causes of AIDS.
2. Peoples ideas and beliefs are likely to influence their
perception of risks.
3. Lay beliefs have an impact on the way diseases is
understood and interpreted, and thus experienced.
Models of lay health beliefs
The health beliefs model (HBM) attempts to identify
motives which influence people’s health related actions
and tries to recognize those which are most vulnerable to
change. Factors such as age and sex would be immutable;
however, subjective factors in the form of peoples
perceptions would be alterable. The dimensions of the
HBM are:
•The level of interest an individual expresses in health
issues (health motivation)
•Their perceived vulnerability to illness (susceptibility)
•The perceived seriousness of certain illness (severity)
•The perceived value of taking health actions (benefits and
costs).
SICK ROLE
The work of an American sociologist, Talcott parsons (1902
_79), is prominent among these critiques. Parsons (1951)
defined illness not as a biological state but as a social role –
namely, the ‘sick role’. This role distinguishes those who are
healthy from those that society, and the medical profession
in particular, classifies as being ill. The purpose of this
distinction, parsons argues, is to ensure the cohesion and
stability of society. In playing out our everyday
conventional roles for example, as employs or employers, as
unemployed, as members of families, or as pensioners- the
social order is maintained. These roles, he argues, have a
positive and purposeful function maintaining the social
order. Taking on roles which are not conventional –for
example, that of a criminal or ‘drop out’ – undermines the
social order and is generally considered deviant behavior
because conventional roles are not being filled.
In western society only a medical practionier can legitimise
entry into sick role. Once admitted this role, the patient gains
two benefits:
1. Patients are temporarily excused their normal roles.
Gaining a sickness certificates from doctor is the obvious
way in which this exception is met. Merely visiting the
doctor, however, confers some legitimacy on the claim to
be sick. Whereas ‘ feeling unwell’ might be treated
sceptically by friends and colleagues, a visit to the doctor
may be sufficient to gain credibility.
2. Patients are not held responsible for their illness. Not
being held responsible for the illness relieves the patient of
a considerable burden in our society. In some other
socities the patient may be held responsible in that, for
example the illness may be believed to be a punishment for
some past crime, din or transgression.
However, in return for these benefits, patients are in turn
excepted to fulfil two obligations:
1. Patient must want to get well and should recognise that the
sick role is only a temporary state which they must want to
leave behind. If they apparently do not want to get well then
instead of the sick role being conferred by the doctor, they
may be categorized as malingerers or hypochondriacs.
2. Patients must co-operate with technically competent help.
The fact that it is only medical practioners who can
legitimately confer the sick role in our society ensures that
the technically competent help tends to be confined to the
official medical services. Patients who choose to defer to a
lay person with claims to medical knowledge, in preference
to a medical practioner, are judged as not fulfilling one of
the basic obligations of the sick role.
The patient’s ‘sick role’ along with the professional role of
the doctor in this relationship as suggested by Parsons, is
summarized:
Patient sick role Doctor: professional
Obligations are privileges role Excepted to:
1. Must want to get well as 1. Apply a high degree
Quickly as possible. Of knowledge to the
problem of illness.
2. Should seek professional 2. Act for the welfare
Medical advice and cooperate of the patient and
With the doctor community rather
for their own self
interest, desire for
money, advancement.
3. Allowed ( and may be 3. Be objective and
Excepted) to shed some emotionally detached
Normal activities and (e.g. should not judge
Responsibilities( e.g. Patients, behaviour in
Employment, household terms of personal
tasks.). Value system or
become emotionally
involved with them).
4. Regarded as being in 4. Be guided by rules of
Need of care and unable to professional practice
Get better by his or her
Own decision and will.