DISTANCE LEARNING CENTRE

AHMADU BELLO UNIVERSITY

ZARIA, NIGERIA

COURSE MATERIAL

FOR

Course Code &Title: COMM 837/ BEHAVIOURAL SCIENCE

Programme Title: MASTERS IN PUBLIC HEALTH (MPH)

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 ACKNOWLEDGEMENT
We acknowledge the use of the Courseware of the National Open University of
Nigeria (NOUN) as the primary resource. Internal reviewers in the Ahmadu Bello
University who extensively reviewed and enhanced the material have been duly
listed as members of the Courseware development team.

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 COPYRIGHT PAGE
© 2018Ahmadu Bello University (ABU) Zaria, Nigeria

All rights reserved. No part of this publication may be reproduced in any form or
by any means, electronic, mechanical, photocopying, recording or otherwise
without the prior permission of the Ahmadu Bello University, Zaria, Nigeria.

First published 2018 in Nigeria.

ISBN:

Ahmadu Bello University Press,

Ahmadu Bello University
Zaria, Nigeria.

Tel: +234

E-mail:

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COURSE WRITERS/DEVELOPMENT TEAM
Editor
Prof. M.I Sule
Course Materials Development Overseer
Dr. Usman Abubakar Zaria
Subject Matter Expert
Dr Saleh N Garba
Subject Matter Reviewer
Rahamatu Shamsiyyah Iliya
Language Reviewer
Mohammed Yau
Instructional Designers/Graphics
Rahamatu Shamsiyyah Iliya
Proposed Course Coordinator
Rahamatu Shamsiyyah Iliya
ODL Expert
Prof. Adamu Z. Hassan

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 TABLE OF CONTENTS
Title Page…………………………………………………………….……?
Acknowledgement Page……………………………………………..……?
Copyright Page………………………………………………………..……?
Course Writers/Development Team……………………………………….?
Table of Content………………………………..……………………………?

COURSE STUDY GUIDE ?

i. Course Information ?
ii. Course Introduction and Description ?
iii. Course Prerequisites ?
iv. Course Learning Resources ?
v. Course Objectives and Outcomes ?
vi. Activities to Meet Course Objectives ?
vii. Time (To complete Syllabus/Course) ?
viii. Grading Criteria and Scale ?
ix. OER Resources ?
x. ABU DLC Academic Calendar ?
xi. Course Structure and Outline ?
xii. STUDY MODULES ?
Module 1: Defining Concepts; Conceptualising Health/Illness
Dichotomies and Determinants, and Conceptualising Health
Behaviour and Models ?
Study Session 1: Behaviour: Basic Concepts and Conceptualising
Health and Disease………………………………………………………….?
Study Session 2: Conceptualising Illness, Health, Illness and the mind
– Body Relationship……………………………………………………….?
Study Session 3: Acute Illness versus Chronic Illness, Culture and Socio-Demographic
Determinants of Health and Illness……………………..……………………?
Study Session 4: What is Health Behaviour and Changing Patterns of Health
and Illness……………………………………………………………………?

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Study Session 5 Theoretical Approaches to Health and Illness Behaviour…?

Module 2: Attitude Change and Specific Health Behaviour Problems and

Conceptualising illness Behaviour……………………………………….?
Study Session 1: Preventive Health Behaviour…………..…………………..……….?
Study Session 2: Attitude Change and Health Promotion………..………..………….?
Study Session 3: Addressing Specific Health Behaviour Problems……….…….……?
Study Session 4: Defining Illness Behaviour………………………….………………?
Study Session 5: Symptom Experience and the Sick Role………….………………...?

Module 3: Dependent Patient Role/ Recovery and Rehabilitation…………………….?

Study Session 1: Healing Options ………………..………….………………..……….?
Study Session 2: Doctor/Patient Interaction………….………………………..……….?
Study Session 3: Delay or Overuse of Medical Care…………..…….………..……….?
Study Session 4: Recovery – Rehabilitation…………....……………………..……….?

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 COURSE STUDY GUIDE
i. COURSE INFORMATION
Course Code: COMM 305
Course Title: Behavioural Science
Credit Units: 2 Credit Units
Year of Study: 2020
Semester: First

ii. COURSE INTRODUCTION AND DESCRIPTION

Introduction:
Welcome to COMM 305 (Behavioural Science). For a better appreciation of this
course, we shall start from the most basic term, human behaviour‘. Some may
argue why bother defining behaviour since it appears very obvious and simple.
However, this assumption may be wrong, especially in trying to assess the
underlying factors influencing behaviour. This unit therefore hopes to
systematically analyze the term behaviour and specifically, human behaviour‘

iii. COURSE PREREQUISITES

You should note that there are no pre-requisite in this course, however you are
expected to have:
1. Satisfactory level of English proficiency
2. Basic Computer Operations proficiency
3. Online interaction proficiency
4. Social media interactive skills

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 iv. COURSE LEARNING RESOURCES
i. Course Textbooks and Journals
Bishop, G. D. (1994). Health Psychology: Integrating mind and body. Boston:
Allyn and Bacon
Black, J.G. (1996). Microbiology. Principles and Applications, 392-412. Third
Edition. New Jersey: Prentice Hall. Upper Saddle River
Brown L, (1993). The new shorter English dictionary. Oxford: Clarendon Press.
Cockerham, W. C. (2003). Medical Sociology. 9th Edition. NY: Prentice Hall.
Cole, R. M. (1970), Sociology of Medicine. New York: McGraw-Hill Book Co.
Kendell, R. E. (1975), The role of diagnosis in Psychiatry. Oxford: Blackwell
Scientific Pub:
Marinker M. Why make people patients? Journal of Medical Ethics 1975:I:81–4.
Szasz, T. S. (1987). Insanity – The idea and its Consequences. New York: John
Wiley and Sons:
Taylor, S. E. (2006). Health Psychology (6th Edition). Los Angeles: McGraw Hill.
The British Journal of Psychiatry (2001) 178: 490-49 © 2001 The Royal College
of Psychiatrists
United Nations. (1995) Basic Facts. Geneva: United Nations.
WHO. (1994a) Basic Documents. Geneva: WHO.

ii. Others
1. http://www.freebookcentre.net. Freebookcentre.net contains links to
thousands of free online technical books. The books collection are either
downloadable or can be viewed online. These collections include core
Computer Science, Electronics, Science, Medical and many more. You are
welcome to follow the links for the free books tour.

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 v. COURSE OUTCOMES
After studying this course, you should be able to:
1. Define behavior in a more general term
2. Discuss principles of behavior.
3. Define human behavior
4. Identify features of human behavior
5. Identify distinctions between human and animal behaviour

vi. ACTIVITIES TO MEET COURSE OBJECTIVES

Specifically, this course shall comprise of the following activities:
1. Studying courseware
2. Listening to course audios
3. Watching relevant course videos
4. Field activities, industrial attachment or internship, laboratory or
studio work (whichever is applicable)
5. Course assignments (individual and group)
6. Forum discussion participation
7. Tutorials (optional)
8. Semester examinations (CBT and essay based).

vii. TIME (TO COMPLETE SYLABUS/COURSE)

To cope with this course, you would be expected to commit a minimum of 3hours
weekly for the Course.

viii. GRADING CRITERIA AND SCALE

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Grading Criteria
A. Formative assessment
Grades will be based on the following:
Individual assignments/test (CA 1,2 etc) 20
Group assignments (GCA 1, 2 etc) 10
Discussions/Quizzes/Out of class engagements etc 10

B. Summative assessment (Semester examination)

CBT based 30
Essay based 30
TOTAL 100%

C. Grading Scale:
A = 70-100
B = 60 – 69
C = 50 - 59
D = 45-49
F = 0-44

D. Feedback
Courseware based:
1. In-text questions and answers (answers preceding references)
2. Self-assessment questions and answers (answers preceding references)

Tutor based:
1. Discussion Forum tutor input

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 2. Graded Continuous assessments

Student based:
1. Online programme assessment (administration, learning resource,
deployment, and assessment).

IX LINKS TO OPEN EDUCATION RESOURCES

OSS Watch provides tips for selecting open source, or for procuring free or open
software.
SchoolForge and SourceForge are good places to find, create, and publish open
software. SourceForge, for one, has millions of downloads each day.
Open Source Education Foundation and Open Source Initiative, and other
organisation like these, help disseminate knowledge.
Creative Commons has a number of open projects from Khan
Academy to Curriki where teachers and parents can find educational materials for
children or learn about Creative Commons licenses. Also, they recently launched
the School of Open that offers courses on the meaning, application, and impact of
"openness."
Numerous open or open educational resource databases and search engines
exist. Some examples include:
• OEDb: over 10,000 free courses from universities as well as reviews of
colleges and rankings of college degree programmes
• Open Tapestry: over 100,000 open licensed online learning resources for an
academic and general audience

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• OER Commons: over 40,000 open educational resources from elementary
school through to higher education; many of the elementary, middle, and high
school resources are aligned to the Common Core State Standards
• Open Content: a blog, definition, and game of open source as well as a
friendly search engine for open educational resources from MIT, Stanford, and
other universities with subject and description listings
• Academic Earth: over 1,500 video lectures from MIT, Stanford, Berkeley,
Harvard, Princeton, and Yale
• JISC: Joint Information Systems Committee works on behalf of UK higher
education and is involved in many open resources and open projects including
digitising British newspapers from 1620-1900!

Other sources for open education resources

Universities
• The University of Cambridge's guide on Open Educational Resources for
Teacher Education (ORBIT)
• OpenLearn from Open University in the UK
Global
• Unesco's searchable open database is a portal to worldwide courses and
research initiatives
• African Virtual University (http://oer.avu.org/) has numerous modules on
subjects in English, French, and Portuguese
• https://code.google.com/p/course-builder/ is Google's open source software
that is designed to let anyone create online education courses

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• Global Voices (http://globalvoicesonline.org/) is an international community
of bloggers who report on blogs and citizen media from around the world,
including on open source and open educational resources

Individuals (which include OERs)

• Librarian Chick: everything from books to quizzes and videos here, includes
directories on open source and open educational resources
• K-12 Tech Tools: OERs, from art to special education
• Web 2.0: Cool Tools for Schools: audio and video tools
• Web 2.0 Guru: animation and various collections of free open source
software
• Livebinders: search, create, or organise digital information binders by age,
grade, or subject (why re-invent the wheel?)

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 X. ABU DLC ACADEMIC CALENDAR/PLANNER

PERIOD
Semester Semester 1 Semester 2 Semester 3
Activity JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC
Registration
Resumption
Late Registn.
Facilitation
Revision/
Consolidation
Semester
Examination

N.B: - All Sessions commence in January

- 1 Week break between Semesters and 6 Weeks vocation at end of session.
- Semester 3 is OPTIONAL (Fast-tracking, making up carry-overs & deferments)

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 XI. COURSE STRUCTURE AND OUTLINE
Course Structure
WEEK MODULE STUDY ACTIVITY
SESSION
1. Read Courseware for the corresponding Study Session.
Study Session 1: 2. View the Video(s) on this Study Session
Behaviour: Basic 3. Listen to the Audio on this Study Session
Week1 Concepts and 4. Read Chapter/page of Standard/relevant text.
Conceptualising 5. Any additional study material
Health and Disease 6. Any out of Class Activity
Pp???
STUDY
MODULE 1 1. Read Courseware for the corresponding Study Session.
Defining Concepts: Study Session 2 2. View the Video(s) on this Study Session
Week 2 Human Behaviour, Conceptualising 3. Listen to the Audio on this Study Session
Disease and illness. Illness, Health, 4. Read Chapter/page of Standard/relevant text.
Conceptualising Illness and the 5. Any additional study material
Health/Illness mind – Body 6. Any out of Class Activity
Dichotomies and Relationship.
Determinants, and Pp???
Conceptualising 1. Read Courseware for the corresponding Study Session.
Health Behaviour Study Session 3 2. View the Video(s) on this Study Session
Week3 and Models, Acute Illness 3. Listen to the Audio on this Study Session
versus Chronic 4. Read Chapter/page of Standard/relevant text.
Illness, Culture and 5. Any additional study material
Socio- 6. Any out of Class Activity
Demographic
Determinants of
Health and Illness.
Pp???
1. Read Courseware for the corresponding Study Session.
2. View the Video(s) on this Study Session

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Week4 Study Session 4 I 3. Listen to the Audio on this Study Session
What is Health 4. Read Chapter/page of Standard/relevant text.
Behaviour and 5. Any additional study material
Changing 6. Any out of Class Activity
Patterns of Health
and Illness. II
Theoretical
Approaches to
Health and Illness
BehaviourPp???
1. Read Courseware for the corresponding Study Session.
Study Session1 2. View the Video(s) on this Study Session
Week 5 Preventive Health 3. Listen to the Audio on this Study Session
Behaviour Pp??? 4. Read Chapter/page of Standard/relevant text.
5. Any additional study material
6. Any out of Class Activity

STUDY 1. Read Courseware for the corresponding Study Session.

MODULE 2 Study Session2 2. View the Video(s) on this Study Session
Week 6 Attitude Change and Attitude Change 3. Listen to the Audio on this Study Session
Specific Health and Health 4. Read Chapter/page of Standard/relevant text.
Behaviour Problems Promotion 5. Any additional study material
and Conceptualising Pp??? 6. Any out of Class Activity
illness Behaviour
1. Read Courseware for the corresponding Study Session.
2. View the Video(s) on this Study Session
Study Session3 3. Listen to the Audio on this Study Session
Week7 Addressing 4. Read Chapter/page of Standard/relevant text.
Specific Health 5. Any additional study material
Behaviour 6. Any out of Class Activity
Problems. Pp???

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 1. Read Courseware for the corresponding Study Session.
Study Session4 2. View the Video(s) on this Study Session
Week8 Defining Illness 3. Listen to the Audio on this Study Session
Behaviour. Pp??? 4. Read Chapter/page of Standard/relevant text.
5. Any additional study material
Study session 5: 6. Any out of Class Activity
Symptom
Experience and the
Sick Role
1. Read Courseware for the corresponding Study Session.
Study Session1 2. View the Video(s) on this Study Session
Week 9 Healing Options 3. Listen to the Audio on this Study Session
Pp??? 4. Read Chapter/page of Standard/relevant text.
5. Any additional study material
6. Any out of Class Activity
STUDY
MODULE 3 1. Read Courseware for the corresponding Study Session.
Dependent Patient Study Session2 2. View the Video(s) on this Study Session
Week 10 Role/ Recovery and Doctor/Patient 3. Listen to the Audio on this Study Session
Rehabilitation Interaction 4. Read Chapter/page of Standard/relevant text.
Pp??? 5. Any additional study material
6. Any out of Class Activity

1. Read Courseware for the corresponding Study Session.

Study Session3 2. View the Video(s) on this Study Session
Week 11 Delay or Overuse 3. Listen to the Audio on this Study Session
of Medical Care 4. Read Chapter/page of Standard/relevant text.
Pp??? 5. Any additional study material
6. Any out of Class Activity

1. Read Courseware for the corresponding Study Session.

Study Session4 2. View the Video(s) on this Study Session
Week 12 Recovery – 3. Listen to the Audio on this Study Session
Rehabilitation 4. Read Chapter/page of Standard/relevant text.
Pp??? 5. Any additional study material

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 6. Any out of Class Activity

1. Read Courseware for the corresponding Study Session.

2. View the Video(s) on this Study Session
3. Listen to the Audio on this Study Session
4. Read Chapter/page of Standard/relevant text.
5. Any additional study material
6. Any out of Class Activity

Week 13 REVISION/TUTORIALS (On Campus or Online)& CONSOLIDATION

WEEK

Week 14& SEMESTER EXAMINATION

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Course Outline
Module 1: Ia Defining Concepts: Human Behaviour, Disease and illness?
Ib Conceptualising Health/Illness Dichotomies and
Determinants, and Conceptualising Health Behaviour and
Models?
Study Session 1: Behaviour: Basic Concepts and Conceptualising Health and
Disease
Study Session 2: Conceptualising Illness, Health, Illness and the mind – Body
Relationship
Study Session 3: Acute Illness versus Chronic Illness, Culture and Socio-
Demographic Determinants of Health and Illness
Study Session 4 I What is Health Behaviour and Changing Patterns of Health
and Illness

Module 2: Attitude Change and Specific Health Behaviour Problems and

Conceptualising illness Behaviour
Study Session 1: Preventive Health Behaviour
Study Session 2: Attitude Change and Health Promotion
Study Session 3: Addressing Specific Health Behaviour Problems
Study Session 4: Defining Illness Behaviour
Study Session 5: Symptom Experience and the Sick Role

Module 3 Dependent Patient Role/ Recovery and Rehabilitation

Study Session 1: Healing Options
Study Session 2: Doctor/Patient Interaction
Study Session 3: Delay or Overuse of Medical Care
Study Session 4: Recovery – Rehabilitation

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 XII STUDY MODULES
Module 1: Ia Defining Concepts: Human Behaviour, Disease and illness?
Ib Conceptualising Health/Illness Dichotomies and
Determinants, and Conceptualising Health Behaviour and
Models?
Content
Study Session 1: Behaviour: Basic Concepts and Conceptualising Health and
Disease
Study Session 2: Conceptualising Illness, Health, Illness and the mind – Body
Relationship
Study Session 3: Acute Illness versus Chronic Illness, Culture and Socio-
Demographic Determinants of Health and Illness
Study Session 4 I What is Health Behaviour and Changing Patterns of Health
and Illness

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 STUDY SESSION 1
Ia Behaviour: Basic Concepts
Section and Subsection Headings:
Introduction
1.0 Learning Outcomes
2.0 Main Content
2.1 - Defining Behaviour
2.2 - Principles of Behaviour
2.2.1- Stimulus and Response
2.2.2- Innate and learned Behaviour
2.2.3- Reflex Behaviour
2.3- Defining Human Behaviour
2.4- Features of Human Behaviour
3.0 Tutor Marked Assignments (Individual or Group assignments)
4.0Study Session Summary and Conclusion
5.0Self-Assessment Questions
6.0Additional Activities (Videos, Animations & Out of Class activities)
7.0 References/Further Readings

Introduction:
Welcome to COMM 305 (Human Behaviour in Health and Illness). For a better
appreciation of this course, we shall start from the most basic term, ‗human
behaviour‘. Some may argue why bother defining behaviour since it appears
very obvious and simple. However, this assumption may be wrong, especially in
trying to assess the underlying factors influencing behaviour. This unit therefore
hopes to systematically analyze the term ‗behaviour‘ and specifically, ‗human
behaviour

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1.0 Study Session Learning Outcomes
After studying this session, I expect you to be able to:
1. Describe “behavior” in a more general term
2. Define human behaviour
3. Explain principles of behaviour
4. Analyse features of human behaviour
5. Compare/contrast distinctions between human and animal behaviour

2.0 Main Content

2.1 Defining Behaviour
• The term behaviour generally refers to the actions or reactions of a person
or animal or plant in response to external or internal stimuli.
• Behaviour is also viewed as an external change or activity exhibited by an
organism.
• It is also a manner in which something functions or operates.
• Behaviour can also be viewed as the way a person, animal, a plant or
chemical behaves or functions in a particular situation. (Wikipedia - The
Free Encyclopedia, 2007)
The above definitions are pointers that plants as well as animals (including
humans), display behaviour patterns which can also be observed and measured.

2.2 Principles of Behaviour

The following are therefore basic principles guiding behaviour.

2.2.1 Stimulus and response

A stimulus is any phenomenon that directly influences the activity or growth of
a living organism. Phenomenon, meaning any observable fact or event, is a
broad term and appropriately so, since stimuli can be of so many varieties.
Chemicals, heat, light, pressure, and gravity can all serve as stimuli, as indeed
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can any environmental change. In some cases an internal environment can act as
a stimulus. A good example is when an animal reaches the age of courtship and
mating and responds automatically to changes in its body.
All creatures, even humans, are capable of automatic responses to stimuli.
When a person inhales dust, pepper, or something to which he or she is allergic,
a sneeze follows. The person may suppress the sneeze (which is not a good
practice, since it puts a strain on blood vessels in the head), but this does not
stop the body from responding automatically to the irritating stimulus by
initiating a sneeze (Nebraska Behavioural Biology Group, 2007)

2.2.2 Innate and learned behaviour

In general, behaviour can be categorized as either innate (inborn) or learned, but
the distinction is frequently unclear. In many cases it is safe to say that
behaviour present at birth is innate, but this does not mean that behaviour that
manifests later in life is learned.
Behaviour is considered innate when it is present and complete without any
experience. At the age of about four weeks, human babies, even blind ones,
smile spontaneously at a pleasing stimulus. Like all innate behaviour, babies‘
smiling is stereotyped, or always the same, and therefore quite predictable.
Lower animals that lack a well-developed nervous system rely on innate
behaviour. Higher animals, on the other hand, use both innate and learned
behaviour. A fish is born knowing how to swim, whereas a human or a giraffe
must learn how to walk (Black, 1996).

2.2.3 Reflex behaviour

An excellent example of an innate animal behaviour, and one in which humans
also take part, is the reflex. A reflex is a simple, inborn, automatic response to a
stimulus by a part of an organism‘s body. The simplest model of reflex action
involves a receptor and sensory neuron and an effector organ. Such a

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mechanism is at work, for instance, when certain varieties of coelenterate (a
phylum that includes jellyfish) withdraw their tentacles.
More complex reflexes require processing inter-neurons between the sensory
and motor neurons as well as specialized receptors. These neurons send signals
across the body, or to various parts of the body, as, for example, when food in
the mouth stimulates the salivary glands to produce saliva or when a hand is
pulled away rapidly from a hot object.
Reflexes help animals respond quickly to a stimulus, thus protecting them from
harm. By contrast, learned behaviour results from experience and enables
animals to adjust to new situations. If an animal exhibits a behaviour at birth, it
is a near certainty that it is innate and not learned. Sometimes later in life,
however, a behaviour may appear to be learned when, in fact, it is a form of
innate behaviour that has undergone improvement as the organism matures.
For example, chickens become more adept at pecking as they get older, but this
does not mean that pecking is a learned behaviour; on the contrary, it is innate.
The improvement in pecking aim is not the result of learning and correction of
errors but rather is due to a natural maturing of muscles and eyes and the
coordination between them (Nebraska Behavioural Biology Group, 2007)

In-text Question 1 Define a Reflex

Answer A reflex is a simple, inborn, automatic response to a stimulus by a part of an

organism‘s body.

2.3 Defining Human Behaviour

Now, let us attempt to provide more specific definition of behaviour, i.e.,
human behaviour. Remember, this course is about human behaviour in health
and illness. However, the dimensions of behaviour provided earlier are also
very useful for a proper grasp of the term human behaviour.
• Human Behaviour could therefore be broadly defined as manner of acting
or controlling oneself
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 • It could be viewed as an observable demonstration of capability, skill, or
characteristics.
• Human behaviour could also be viewed as an especially definitive
expression of capability, in that it is a set of actions that presumably, can
be observed, taught, learned and measured (Wikipedia- The free
Encyclopedia, 2007).

These definitions therefore portray human behaviour as observable

demonstration of skills and characteristics as well as definitive expression of
such characteristics. This then indicates that human behaviour is not
mechanistic but rather definitive, controlled and flexible. What then are the
features of human behaviour.

2.4 Features of Human Behaviour

Let us now briefly discuss the features of human behaviour. Human behaviour
could therefore present the following features:
Verbal – this means that human behaviour requires a language to express
feelings and emotions. Lower animal also use a form of language to express
feelings and emotions but human language appears to be more conscious and
definitive. Verbal expression also stimulates good doctor/patient relationship
and helps in better diagnosis of illnesses.
Nonverbal – this means human behaviour which is independent of a formal
language. This type of behaviour can sometimes be observed through body
languages and facial gesture.
Conscious – this refers to a state of being aware of a stimulus or event. For
example, a hungry or sick person is very likely to be aware of the state, which in
turn triggers behaviours necessary for that particular stimulus. It is thus
expected that an individual eats when hungry or visits the health professional
when sick.
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Unconscious – this is an opposite of consciousness. Here a person is unaware of
a stimulus or event. Interestingly, certain body languages that people exhibit
could be categorized here. For example, an anxious person may be unaware to
the fact that he or she is exhibiting certain behaviours like: tapping the foot,
biting the fingers, sweating, etc. Also, a complete state of unconsciousness is
best described while sleeping, if not rudely woken by a loud sound.
Overt – this form of human behaviour is open, observable and possibly
measured. Good examples are a; child crying when in need or a sick person
engaging in certain health habits (eating healthy, exercising), to feel better.
Covert – here, behaviour is closed, hidden and not readily observable. Certain
cultural practices could trigger this type of behavioural pattern. A very
interesting example is the belief that men are generally not supposed to cry
because they are the stronger sex. They are expected to be brave and bear grief
like men‘, though they may cry in the safety of their homes. Here, behaviour is
covert because such emotions are not readily observed.
Voluntary – here, behaviour is performed willingly and controlled, and not
forced. The adage that you can take a horse to the stream but you cannot force it
to drink‘ also applies to human behaviour. For example, a student must be
willing to learn, and when forced could lead to school drop-out or exam
malpractices.
Involuntary – this refers to actions or behaviour, performed suddenly without
an ability to be controlled. For example, a sudden sharp pain could trigger a
corresponding uncontrollable response like jerking or screaming.
Normal – normal behaviour refers to typical, expected or ordinary activities
that generally conform to a given norm and dictate of a society. For example, it
is normal for a child to wet the bed or generally behave like a child but such
behaviour could be frowned at when they are exhibited by an adult.
Abnormal – abnormal behaviour refers to those activities that are different
from the usual or expected. Thus, they are seen to be a deviation from the norm.

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3.0 Tutor Marked Assignment
1. Define human behaviour
2. Identify and Discus the features of human behaviour

4.0 Conclusion/Summary
Now, you all will agree with me that the concept Behaviour‘ is not as easy as it
sounds. Perhaps, we have come to appreciate other technical aspects of
behaviour and human behaviour, which appear simple and complex at the same
time. I hope that the concepts introduced in this unit, such as stimulus and
response, innate and learned behaviour etc. are not very difficult to assimilate.
Try applying them to everyday activities and you will realize that they are much
simpler than they appear.

In this unit, you have learnt the definitions as well as the characteristics of
behaviour. We also attempted specific conceptualization of human behaviour as
well as its associated features. The information provided in this unit should
therefore aid an in-depth understanding of the distinction between human and
animal behaviours (Lower animals). We hope you enjoyed this unit. Now, let us
attempt the questions below.

5.0 Self-Assessment Questions

Self-Assessment Questions (Should correspond to the No of Session Learning
Outcomes & each should relate to the corresponding Learning Outcome)
1) Define Behaviour
2) Identify the principles of Behaviour

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 6.0 References/Further Readings
Behavior Resources on the Internet. Nebraska Behavioral Biology Group
(Website). <http://cricket.unl.edu/Internet.html>. Site visited on 10th April,
2007
Black, J.G. (1996). Microbiology. Principles and Applications. Third Edition.
Prentice Hall. Upper Saddle River, New Jersey. pp. 392-412
Dugatkin, Lee Alan. (1999). Cheating Monkeys and Citizen Bees: The Nature
of Cooperation in animals and human. New York: Free Press.
Hauser, M. D. (2000). Wild Minds: What Animals Really Think. New
York: Henry Holt
Pavlov, I. P. (1927). Conditions Reflex. Translated by G. V. Anrap. London:
Oxford.
Skinner, B. F. (1938). The behaviour of organisms. NY: Appleton Century
Crofts.
The Oxford Advanced Learner’s Dictionary, (2000). 6th Edition. Wehmeier, S.
& Ashby, M. (Eds). Oxford: Oxford Univ. Press.
Thorndike, E. L. (1898). Animal intelligence: An experimental study of the
associative process in animals. Psychological Monographs, 2:8.
Behaviour – Wikipedia, the free Encyclopedia. Retrieved from
http://en.wikipedia.org/wiki/behaviour. Page last modified on 14th
March 2007. Site visited on 17th March 2007

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 STUDY SESSION 1
1b: Conceptualising Health and Disease
Section and Subsection Headings:
Introduction
1.0 Learning Outcomes
2.0 Main Content
2.1 What is Health
2.2 Components of health
2.2.1- Holistic Dimension
2.2.2- Positive Dimension
2.2.3- Negative Dimension
2.3- Defining Disease
2.4- Syndromes and Disease
2.5- Transmission of Disease
2.6- Social Significance of Disease
3.0 Tutor Marked Assignments (Individual or Group assignments)
4.0Study Session Summary and Conclusion
5.0Self-Assessment Questions
6.0Additional Activities (Videos, Animations & Out of Class activities)
7.0 References/Further Readings

Introduction:
Granted that we are all well, we are likely to assume we do not need to take any
special actions to keep healthy. We are unlikely to think of ourselves as ill when
we have minor discomfort caused by colds or headaches, or when we feel tired
or depressed. However, we all, knowingly or unknowingly, have different
concepts of health that guide our behaviours. This unit, therefore, seeks to
review the WHO definition of health as well as different concepts of health and
disease

29
1.0 Study Session Learning Outcomes
After studying this session, I expect you to be able to:
1. Describe the WHO perspective of health
2. Define Disease
3. Explain transmission of Disease
4. Analyse between holistic, positive and negative concepts of health
5. Critique Syndrome and Disease
6. Assemble social significance of Disease

2.0 Main Content

2.1 Major Topic
What is health?
The Constitution of WHO, in conformity with the Charter of the United Nations
declares that the following principles are basic to the happiness, harmonious
relations and security of all people:
Health is a state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity.
The enjoyment of the highest attainable standard of health is one of the
fundamental rights of every human being without distinction of race, religion,
and political belief, economic and social isolation.
The health of all people is fundamental to the attainment of peace and security
and is dependent upon the fullest cooperation of individual states.
The achievement of any State in the protection of health is of value to all.
Unequal development in different countries in promotion of health, control of
disease, especially communicable disease, is a common danger.
Healthy development of the child is of basic importance; the ability to live
harmoniously in a changing total environment is essential to such development.
The extension to all people of the benefits of medical, psychological and related
knowledge is essential to the fullest attainment of health. Informed opinion and

30
active cooperation on the part of the public are of the utmost importance in the
improvement of the health of the people.
Governments have a responsibility for the health of their people which can be
fulfilled only by the provision of adequate health and social measures.

2.2 Components of Health

A researcher once asked a sample of participants, ‗Is your health good, average
or poor?‘ When a respondent gave the answer ‘good‘, the researcher asked,
‗When you say your health is good, what do you mean?‘ The answers could be
extracted from these three dimensions of health. They are:
• A holistic dimension
• A positive dimension
• A negative dimension

You might also be wondering whether there is any advantage or disadvantage in

holding one or other of these views. Below are explanations to the three
perceptual dimensions of health as well as the advantages and disadvantages

2.2.1 A holistic dimension of health

A Holistic Concept of health is the belief that being healthy means being
without any physical disorders or diseases and being emotionally comfortable.
For example, a person who feels anxious or who has low self-esteem would,
according to this concept, may not be well. Likewise, a person with malaria or
chickenpox is likely to label himself/herself ill. Generally, People with this view
are likely to label themselves as ill when they experience a wide range of
unpleasant feelings, not just physical discomfort or pain.

31
Advantage of holistic dimension of health
• One advantage of having the holistic concept is that it tends to make
people sensitive about their health. This can be an advantage because it
can help them to notice symptoms more quickly than other people. They
notice when something does not feel right and pay more attention to their
bodies.
• It can spur people to eat healthy and live healthy.

Disadvantage of holistic dimension of health

• It can lead to oversensitivity to signs and symptoms of illness. Thus,
oversensitivity can lead people to believe that they are ill when they are
not.
• It can lead to unnecessary worry and result in people wasting their
Doctor‘s time

2.2.2 A positive dimension of health

A positive dimension of health is the belief that being healthy is a state
achieved only by continuous effort. People with this belief take active steps to
maintain their health for example, through their choice of food, by taking
exercise and other activities they believe will keep them well. Such people are
likely to feel responsible for their own health. They will take credit for the
continued absence of disease and blame themselves if they develop symptoms.
According to this view, people who do not take action to maintain their own
health (for example, by ‗healthy eating‘) cannot be healthy — even if, at any
one time, there is nothing wrong with them (Cockerham, 2003).

32
Advantages of positive dimension of health
• One result of having a positive concept of health is that people tend to
take plenty of exercise, avoid smoking and excessive intake of alcohol,
and eat a balanced diet. This is likely to be advantageous to them.
• Another advantage is that if such people become ill, they are likely to
adopt attitudes and behaviour that contribute to getting better. There is
some evidence that the chances of surviving cancer are influenced by the
attitude of the patient. People who believe they can recover and avoid
feeling defeated by their illness tend to do better than those who believe
that they are doomed to die.
• People with positive dimensions to health tend to be active rather than
passive in relation to their own health.

Disadvantage of positive dimensions of health

• One disadvantage of this concept is that, by taking responsibility for their
own health, people might blame themselves for their illnesses and feel
guilty when they become ill.

2.2.3 A negative dimension of health

A negative dimension of health is the view that being healthy is the absence of
illness — for example, not having any symptoms of disease, pain or distress.
People with this view are likely to believe that good health is normal and to take
it for granted.

Advantage of negative dimension of health

• A person with this perspective may be less anxious about his/health.

33
Disadvantage of negative dimension of health
• A person with negative health concept believes that being healthy is by
chance, while those with positive concepts take active steps to stay well.
• He/she may think less of healthy habits as well as measures to live
healthy.
• He/she may engage in self medication because good health is taken for
granted.

2.3 Defining Disease

When we think of physical infirmities that we have had, we most often think in
terms of what is wrong with our bodies biologically; for instance, a virus
producing disease such as chicken pox or the flu, or a failure of the body to
produce needed substances such as insulin in diabetes, or an abnormal growth
as in cancer. In other words, we usually think in terms of some type of disease.
Pathology is the study of diseases. The subject of systematic classification of
diseases is referred to as nosology. The broader body of knowledge about
human diseases and their treatments is medicine. Many similar (and a few of the
same) conditions or processes can affect animals (wild or domestic). The study
of diseases affecting animals is veterinary medicine.

Definition 1 A disease is a change away from a normal state of health to an

abnormal state in which health is diminished

Definition 2 Disease is also a medical condition. It is an abnormality of the

body or mind that causes discomfort, dysfunction, distress, or death to the
person afflicted or those in contact with the person. Sometimes the term is used
broadly to include injuries, disabilities, disorders, syndromes, infections,
symptoms, deviant behaviours, and atypical variations of structure and function,
while in other contexts these may be considered distinguishable categories.
34
Definition 3 Cole (1970), defined disease as specific kinds of biological
reactions to some kind of injury or change affecting the internal environment of
the body Disease thus alters the normal functioning of the body and creates a lot
of anxiety for the sick person. It is also a universal phenomenon, constitutes a
threat to survival and disrupts socio-economic life of people.

Definition 4 In biology, disease refers to any abnormal condition of an

organism that impairs function.
The term disease is also, often used metaphorically for disordered,
dysfunctional, or distressing conditions of other things, as in disease of society.

In-text Question 1 (A short question requiring a single sentence answer for quick reflection
over the read topic) Define Disease?

Answer It is an abnormality of the body or mind that causes discomfort, dysfunction, distress,
or death to the person afflicted or those in contact with the person.

2.4 Syndromes and Disease

Medical usage sometimes distinguishes a disease, which has a known specific
cause or causes (called its etiology), from a syndrome, which is a collection of
signs or symptoms that occur together. However, many conditions have been
identified, yet continue to be referred to as ―syndromes. Furthermore,
numerous conditions of unknown etiology are referred to as ―diseases in many
contexts (Taylor, 2006).

2.5 Transmission of Disease

Some diseases, such as influenza, are contagious or infectious, and can be
transmitted by any of a variety of mechanisms, including aerosols produced by
coughs and sneezes, by bites of insects or other carriers of the disease, from
contaminated water or food, etc.

35
Other diseases, such as cancer and heart disease are not considered to be due to
infection, although micro-organisms may play a role, and cannot be spread from
person to person.

2.6 Social Significance of Disease

The identification of a condition as a disease, rather than as simply a variation
of human structure or function, can have significant social or economic
implications. The controversial recognitions of diseases of post-traumatic stress
disorder, also known as ―Soldier‘s heart, ―shell shock, and ―combat
fatigue‖; repetitive motion injury or repetitive stress injury (RSI); and Gulf War
syndrome has had a number of positive and negative effects on the financial and
other responsibilities of governments, corporations and institutions towards
individuals, as well as on the individuals themselves. The social implication of
viewing aging as a disease could be profound, though this classification is not
yet widespread (Taylor. 2006).
A condition may be considered to be a disease in some cultures or eras but not
in others. Oppositional-defiant disorder, attention-deficit hyperactivity disorder,
and, increasingly, obesity are conditions considered to be diseases in the United
States and Canada today, but were not so-considered decades ago and are not
so-considered in some other countries. Also, malaria, HIV/AIDS, childhood
diseases like polio etc, seem to be top priority in the sub Saharan African
countries. Lepers are also a group of afflicted individuals who were historically
shunned and the term ―leper‖ still evokes social stigma. Fear of disease can
still be a widespread social phenomenon, though not all diseases evoke extreme
social stigma

3.0 Tutor Marked Assignments (Individual or Group)

1. Define Disease
2. Identify and briefly describe the 3 components of health. Identify the

36
advantages and disadvantages of each component

4.0Conclusion/Summary
When thinking about your own health, you might have realized that you use
more than one of the three concepts of health, or perhaps you use all three. Do
not be surprised by this. The fact that there are different perceptual dimensions
of health does not mean that your attitude to health necessarily belongs to just
one of them. You will probably find that you apply one concept in some
situations and others on different occasions.
We have been able to define health as well as identify different components of
health. We have also learnt different definitions of disease, as well as
syndromes, transmission and social significance of disease. I hope you find
them quite interesting and insightful.

5.0Self-Assessment Questions
1. Give a summary of the WHO perspective of Health.

Exercise 2
Read the following replies from different people on the question ‗Are you
healthy‘? And decide which dimension of health best fits each answer.
Answer A: There‘s nothing wrong with me, as far as I know.‘
Answer B: I look after myself, stay fit and that sort of thing.‘
Answer C: I feel well balanced. My body and my mind are working well
together.
Now try to decide which concept of health is closest to the way you think
about your health.
Answer to Exercise
A Negative dimension of health

37
B Positive dimension of health
C Holistic dimension

6.0 References/Further Readings

Bishop, G. D. (1994). Health Psychology: Integrating mind and body. Boston:
Allyn and Bacon
Black, J.G. (1996). Microbiology. Principles and Applications, 392-412. Third
Edition. New Jersey: Prentice Hall. Upper Saddle River
Brown L, (1993). The new shorter English dictionary. Oxford: Clarendon Press.
Cockerham, W. C. (2003). Medical Sociology. 9th Edition. NY: Prentice Hall.
Cole, R. M. (1970), Sociology of Medicine. New York: McGraw-Hill Book Co.
Kendell, R. E. (1975), The role of diagnosis in Psychiatry. Oxford: Blackwell
Scientific Pub:
Marinker M. Why make people patients? Journal of Medical Ethics 1975:I:81–
4.
Szasz, T. S. (1987). Insanity – The idea and its Consequences. New York: John
Wiley and Sons:
Taylor, S. E. (2006). Health Psychology (6th Edition). Los Angeles: McGraw
Hill.
The British Journal of Psychiatry (2001) 178: 490-49 © 2001 The Royal
College of Psychiatrists
United Nations. (1995) Basic Facts. Geneva: United Nations.
WHO. (1994a) Basic Documents. Geneva: WHO.

38
 STUDY SESSION 2
2a. Conceptualising Illness
Section and Subsection Headings:
Introduction
1.0 Learning Outcomes
2.0 Main Content
2.1 Defining Illness
2.2 Perspectives of Illness
2.2.1- Illness as subjective sensation of illness
2.2.2- Illness as observable symptom of disease
2.2.3- Illness as disorder or malfunction
2.3 How concepts of Illness overlap
2.4 How concepts of illness do not overlap
2.5 Distinction between disease and illness
2.6 Illness Dynamics
2.6.1 Major Components of Illness Dynamics
3.0Tutor Marked Assignments (Individual or Group assignments)
4.0Study Session Summary and Conclusion
5.0Self-Assessment Questions
6.0Additional Activities (Videos, Animations & Out of Class activities)
7.0 References/Further Readings

Introduction:
All of us have had experiences of getting sick and feelings of discomfort
associated with it. It may be something as mild as cold, headache, fainting spell,
or as serious and long lasting as chronic life-threatening disease such as cancer,
diabetes, HIV/AIDS, etc. Illness is certainly a universal human experience,
irrespective of age, gender, religious belief or socio-cultural differences. What
then is illness?

39
This unit tries to introduce the definition and different dimensions of illness.
First we will try to provide several definitions of illness.

1.0 Study Session Learning Outcomes

After studying this session, I expect you to be able to:
1. Construct an in-dept definition of illness.
2. Explain perspectives of illness
3. Analyse how concepts of illness overlap
4. Analyse how concepts of illness do not overlap
5. Compare/contrast between disease and illness
6. Assemble components of illness dynamics

2.0 Main Content

2.1 Definition of Illness
Illness has several definitions. Two of them are of the way the word was used
up to the 18th century—to mean either "wickedness, depravity, immorality", or
"unpleasantness, disagreeableness, hurtfulness". These older meanings reflect
the fact that the word "ill" is a contracted form of "evil".
Another meaning, dating from the 19th century, is the modern one: "Illness; the
state of being ill". The dictionary defines "ill" in this third sense as "a disease, a
sickness". Looking up "sickness" we find "The condition of being sick or ill;
illness, ill health"; and under "sick" (a Germanic word whose ultimate origin is
unknown) we find "affected by illness, unwell, ailing ... not in a healthy state",
and, of course, "having an inclination to vomit".
There is a rather unhelpful circularity about these dictionary definitions. But
dictionaries of the English language usually only aim to tell us the origins of
words and how they have been used historically. They do not aim at the much
more contestable goal of conceptual clarity. For that we have to look elsewhere.
In this case, let us look at how disease, illness and sickness have been elucidated

40
first by a medical practitioner, who ought to know something about the subject;
and then, after noting some popular and literary definitions, by a philosopher,
who ought to know something about conceptual clarity.
It might be thought that so fundamental a concept in medical science, illness‘
would have been the subject of broad agreement and succinct definition, but this
appears to be very far from the truth indeed (Szasz, 1987). Definitions of illness
have changed regularly throughout the history of medicine in response to
fashion and a variety of other factors. The present situation is in part
complicated because many of these historical definitions co-exist with their
more recent counterparts (Cockerham, 2003; Taylor, 2006).
For example, the definition of illness as a syndrome, or coherent cluster of
symptoms is credited to the seventeenth-century physician Sydenham. His
definition, which does not rely on the notion of pathogens or pathological
process, is still current, being used alongside the more modern, but logically
quite different definition of illness, as that of bacterial infection. There are, of
course, still more recent definitions; all are useful and all more or less
appropriate according to circumstances.
Definition 1: Bishop (1994) defined Illness as the experience of suffering and
discomfort, which may or may not be related to objective physical pathology.

Definition 2: Barondness (1979); Jennings, (1986), defined illness as an

experience of discomfort and suffering.
Advances in science and technology have greatly improved our ability to detect
disease and, more than any other factor, have influenced the views of both lay
people and professionals in their understanding of illness (Kendel, 1975). For
this reason, definitions of illness, with the exception of mental illness which is
sometimes defined ambiguously, are biased towards a structural or
physiological view, making the assumption that the core of illness consists of
organic dysfunction or ‗disease‘.

41
Definition 3: Illness is also defined as a state or condition of suffering as the
result of a disease or sickness.
This definition is thus based on the modern scientific view that an illness is an
abnormal biological affliction or mental disorder with a cause, a characteristic
train of symptoms, and a method of treatment (Cockerham, 2003).

Definition 4: Illness is also the individual‘s perception and labeling of a set of

physical and emotional experiences.
This definition, therefore, highlights the role of cognition on illness perception
(Cockerham, 2003).

Definition 5: Illness, although often used to mean disease, can also refer to a
person‘s perception of their health, regardless of whether they in fact have a
disease (Weiss and Lonnquist, 2005)
As you will rightly agree the above perspectives to illness leave one in little
doubt about the concept. Now let us try our hands on this simple exercise.

2.2 Perspectives of Illness

Now let us introduce another aspect of illness experience that could further aid
our understanding of the concept. We can call them perspectives of illness.
They are:
• Illness as subjective sensation
• Illness as a set of symptoms or disease
• Illness as a disorder or a malfunction of a body tissue, organ or system

2.2.1 Illness as the subjective sensation

A subjective sensation of illness means feeling ill. People might feel ill when
they have some disease symptoms; they might also feel ill when no symptoms
are present. By this definition, illness exists when people decide that they feel ill
42
or describe themselves as being ill. People who are very anxious about, or
sensitive towards, their health are likely to think of themselves as ill even when
symptoms are very mild or absent. Other people may also refuse to think of
themselves as ill even when there are obvious signs that something is wrong
(Taylor, 2006).

2.2.2 Illness as observable symptoms of disease

Disease refers to a diagnosable problem, which might be physiological (a
physical disorder) or psychiatric (a mental disorder). This view of illness is
objective, i.e. illness is something for which there is likely to be publicly
available evidence — for example, two people with medical knowledge
agreeing that a patient has a disease. Also, when people become ill they usually
develop symptoms. A symptom is something that is noticeable to the affected
person (e.g. itching or pain). It might be noticeable to other people too (e.g. a
rash or a lump). Soon after developing symptoms, people begin to think of
themselves as ill anddecide to take some action. This might be to buy some
medication or to visit their doctor. The physician might then confirm that the
person is ill and diagnose the disease. However, there are sometimes situations
in which this pattern is not followed. For example, people might think of
themselves as ill but a doctor or a hospital consultant might be unable to detect
any disorder. Sometimes, people might have a disease but not notice any
symptoms, or might notice symptoms but not think of themselves as ill. For
example, a person might catch a cold, but ignore it and carry on as normal. It
might surprise you that there are several different opinions about what is meant
by being healthy and also a range of views about what is meant by being ill
(Bishop, 1994).

43
2.2.3 Illness as a disorder or malfunction
The term disorder‘ refers to some malfunction of a body tissue, organ or
system. This concept is based on the idea that body systems can go wrong. This
definition is the one that the writer of a medical textbook is likely to have in
mind (Cockerham, 2003).

2.3. How Concepts of Illness Overlap

Students can have difficulty in telling the difference between the three concepts
of illness. This is partly because they sometimes overlap.
For example, ‗illness as subjective sensation‘ can overlap with ‗illness as
having symptoms of disease‘. This is because some of the symptoms of illness
(e.g. pain and tiredness) are themselves subjective sensations. This overlap is
most noticeable with mental disorders. Unlike physical illnesses, mental
disorders often have no symptoms that are detectable through observation,
blood tests, scans, and so on. For example, a person suffering from depression is
likely to have no observable symptoms apart from complaining of
overwhelming feelings of misery and helplessness. In this case, ‗illness as a
subjective sensation‘ is the same as ‗illness as disease symptoms‘.
In other situations it is easier to tell the difference. For example, a person with a
skin rash (observable disease symptom) might not think of himself or herself as
ill (subjective sensation), particularly if the rash is not accompanied by pain.
The concept of ‗illness as disease symptoms‘ can also overlap with ‗illness as a
disorder or malfunction‘. This is usually the case when the symptoms
correspond very closely to the malfunction. For example, a person with a lung
disorder such as pneumonia will experience difficulty in breathing.

2.4 When Concepts of Illness Do Not Overlap

However, in other situations these concepts of illness can be distinct. For
example, a person could experience symptoms, such as sneezing and a runny

44
nose that are not caused by malfunction of any body tissue, organ or system.
Rather, those symptoms are the result of ineffective functioning of the immune
system to overcome a cold virus. In this case, ‗illness as disease symptoms is
distinct from ‗illness as disorder or malfunction‘. A contrasting example is that
a person can have a serious malfunction of body tissue (such as a tumour
growing on the spleen) but not feel ill. Some symptoms like tumours in some
parts of the body, including the abdomen and brain, can grow for many months
before they are noticed. This is because there are few sense organs in these parts
of the body. Symptoms are unlikely to be felt until the tumour is pressing on
surrounding tissue that has more sense organs. So the sufferer might remain
healthy with no sign of illness until it gets critical.
Another situation in which ‗illness as symptoms of disease‘ and ‗illness as
malfunction‘ do not overlap is when the symptoms could be the result of a range
of malfunctions. For example, a person feels constantly tired and out of breath.
A blood test reveals that the person is anaemic (has too few red blood cells).
The symptoms of tiredness, shortness of breath and anaemia do not arise from
any particular disorder or malfunction. The anaemia could be caused in several
ways — for example, by a disorder of the bone marrow, by internal bleeding or
by a dietary deficiency. Only by further tests and investigations could a specific
disorder or malfunction be detected.
However, in most people who are seriously ill, these three aspects of illness
occur together. People will think of themselves as ill, they will notice symptoms
(e.g. partial paralysis) and they will have an organ malfunction (e.g. a stroke or
bleed into the brain).

2.5 Distinction between Illness and Disease

Professor Marshall Marinker, a general practitioner, suggested over twenty
years ago a helpful way of distinguishing between disease and illness. He
characterizes these "two modes of unhealth as follows.

45
"Disease ... is a pathological process, most often physical as in throat infection,
or cancer of the bronchus, sometimes undetermined in origin, as in some mental
illnesses. Thus, disease can be thought of as the presence of pathology, which
can occur with or without subjective feelings of being unwell or social
recognition of that state. The quality which identifies disease is some deviation
from a biological norm. There is an objectivity about disease which doctors are
able to see, touch, measure, and smell. Diseases are valued as the central facts
in the medical view.

"Illness ... is a feeling, an experience of un-wellness which is entirely personal,

interior to the person or the patient. Thus, it is a subjective state of un-wellness,
with certain individual differences in coping mechanisms. Often it accompanies
disease, but the disease may be undeclared, as in the early stages of cancer or
tuberculosis or diabetes. Sometimes illness exists where no disease can be
found. A person without any disease may feel unhealthy and believe he/she has
an illness. Another person may feel healthy and believe he/she does not have an
illness even though he/she may have a disease such as dangerously high blood
pressure which may lead to a fatal heart attack or categorized as subjective, with
certain individual differences in coping mechanisms. Alternatively, a person
may have a disease and not feel ill. For example, Hypertension is called the
silent killer because it can exist for a long time without being detected. Many
cancers can also exist and develop for weeks, months or even years without
being detected (Weiss and Lonnquist, 2005).

2.6 Illness Dynamics

The relationship among one‘s biological status (e.g., genetic constitution and
physical pathology), emotional makeup, and the supports and stresses of a
social matrix (confluence of biologic, psychologic, and social aspects),
represents the patient‘s understanding of a specific disease during a particular

46
period of life. Illness dynamics incline one to assess all illness-related
information in light of singular values, wishes, needs, and fears, ultimately
causing the patient to perceive, assess, and defend against the loss of health in a
highly subjective manner. This may significantly affect the patient‘s ability to
cope with the disease.

2.6.1 Major components of illness dynamics

Biological
• Nature, severity, and time course of disease
• Affected organ, system, body part, or body function
• Baseline physiological functioning and physical resilience
• Genetic endowment

Psychological
• Maturity of ego functioning and object relationships
• Personality type
• Stage in the lifecycle
• Interpersonal aspects of the therapeutic relationship (e.g., counter
transferance of healthcare providers)
• Previous psychiatric history
• Effect of past history on attitudes toward treatment (e.g., postoperative
complications)

Social
• Dynamics of family relationships
• Family attitudes toward illness
• Level of interpersonal functioning (e.g., educational and occupational
achievements; ability to form and maintain friendships)

47
 • Cultural attitudes

In-text Question 1 List the major components of illness dynamics.

Answer
1. Social
2. Psychological
3. Biological

3.0 Tutor Marked Assignments (Individual or Group)

1. Distinguish between illness and disease
2. Identify the major components of illness dynamics.

4.0 Conclusion/Summary
Illness definition is indeed not as easy as it appears because of its dynamic
nature. As a subjective experience, illness is influenced not only by the
person‘s biological state but also by cultural and social factors, situational
variables, stress, personality, and concepts held by the person about the
nature of disease. Thus illness represents a true interaction between the
physical, social and the psychological.
We have systematically defined illness. We also went further to analyze the
three perspectives of illness as well as the distinction between illness and
disease. Lastly, we looked at the dynamics of illness. I hope you found this
unit helpful. Now let us try this exercise.

5.0 Self-Assessment Questions

1 i. Define Illness
ii. Can the 18th century conception of illness be applicable in contemporary
time?
Have you enjoyed your readings? Now let us attempt this.

48
A researcher asked a sample of people the question, What does ―illness mean
to you?‘ Read the following replies from different people and decide which
concept of illness best fits each answer. The three concepts of illness you
should use are:
• Illness as a subjective sensation of illness
• Illness as disease symptoms
• Illness as disorder or malfunction

6.0 References/Further Readings

Barrondness, J. A. (1979). Disease and illness: A crucial distinction. American
Journal of Medicine, 66, 375-376.
Bishop, G. D. (1994). Health Psychology: Integrating mind and body. Boston:
Allyn and Bacon.
Brown L, ed. (1993). The new shorter English dictionary. Oxford: Clarendon
Press.
Cockerham, W. C. (2003). Medical Sociology. (9th edition). NY: Prentice Hall.
Jennings, D. (1986). The confusion between disease and illness in clinical
medicine. Canadian Medical Association Journal, 135, 865-870.
Kendell, R. E. (1975), The role of diagnosis in Psychiatry. Oxford: Blackwell
Scientific Pub:
Marinker, M. (1975). Why make people patients? Journal of Medical Ethics,
1:81-84.
Szasz, T. S. (1987). Insanity – The idea and its Consequences. New York: John
Wiley and Sons.
Taylor, S. (2006). Health Psychology (6th edition). Los Angeles: McGraw Hill.
Weiss, L. G. and Lonnquist, L. E. (2005). The Sociology of Health, Healing and
Illness, (5th edition). Safari book online. Retrieved from
http//www.safari.com/0131928406/ch07iev1sec3. Site visited on 17th
March 2007.
49
 STUDY SESSION 2 CONTD
2b: Health and Illness and the Mind – Body Relationship?
Section and Subsection Headings:
Introduction
1.0 Learning Outcomes
2.0 Main Content
2.1 - Illness and the Mind-Body Relationship: A Brief History
2.1.1 Illness and the Mind-Body Relationship: The Middle Ages
2.1.2 Illness and the Mind-Body Relationship: The Modern Era
3.0Tutor Marked Assignments (Individual or Group assignments)
4.0Study Session Summary and Conclusion
5.0Self-Assessment Questions
6.0Additional Activities (Videos, Animations & Out of Class activities)
7.0 References/Further Readings

Introduction:
The relationship between the mind and the body has long been a controversial
topic. Are experiences, such as illness experiences purely mental, physical, or
an interaction between the mental and physical? This unit therefore seeks to
provide answers to these.

1.0 Study Session Learning Outcomes

After studying this session, I expect you to be able to:
1. Describe historical perspective of illness and the mind – body relationship.
2. Explain the conception of illness and the mind-body relationship in the
modern era.
3. Assemble Identify the perspectives of illness and the mind-body relationship
in the middle ages.

50
2.0 Main Content
2.1 Illness and the Mind and Body Relationship: A Brief History
As Gentry and Matarazzo (1981) pointed out, the view that there are delicate
interrelationships, such as the dry mouth and racing heart associated with fear
and anger, or the headache triggered by emotional stress, can be found in
ancient literature documents from Babylonia and Greece.
The Greeks were among the earliest civilizations to identify the role of bodily
functioning in health and illness. Rather than ascribing illness to evil spirit, they
developed a humoral theory of illness that was first proposed by Hippocrates in
377 B.C., and later expanded by Galen (A.D. 129). According to this view,
disease arises when the four circulating fluids of the body – blood, black bile,
yellow bile and phlegm – are out of balance. An excess of yellow bile was
linked to a choleric temperament. It was assumed that this yellow bile prompted
an individual to become chronically angry and irritable, hence the word choleric
(angry), which literally means bile. An excess of black bile was considered to
cause a person to be chronically sad or melancholic, hence the term melancholy,
which literally means black bile. The sanguine or optimistic temperament,
characterized by calm, listless personality attributes, was seen as being due to an
excess of bodily humor phlegm (Gatchel, et al, 1997).
Of course, this humoral view of personality and illness was long ago
abandoned, along with a number of other pre-scientific notions. On a historical
level, however, it points out how physical or biological factors have been seen
through the ages as significantly interacting with and affecting the personality
or psychological characteristics of an individual (Gatchel, et al, 1997).
The function of treatment is to restore the balance among the humors. Specific
personality types were thus believed to be associated with bodily temperaments
in which one of the four humors predominated. In essence, then, the Greeks
ascribed disease states to bodily factors, but also believed that these factors
could also have an impact on the mind (Taylor, 2006).

51
2.1.1 Illness and the mind-body relationship - the middle ages
Mysticism and demonology dominated concepts of illness in the middle-ages,
while afflicted persons were seen as receivers of God‘s punishment for evil
doing. Cure often consisted of driving out evil by tutoring the body. Later, this
―therapy was replaced by penance through prayers and good works.
Throughout this time, the church was seen as the guardian of medical
knowledge; as a result medical practices took on religious overtones, including
religiously based but unscientific generalizations about the body-mind illness
relationship.

2.1.2 Illness and the mind-body relationship – the modern era

Beginning in the Renaissance and continuing up to the present day, great strides
have been made in the technological basis of medical practices. Most notable
among these were Anton Vaan Leeuwenhoek‘s (1632-1723) work in
microscopy and Gionanni Morgagni‘s (1682-1771) contributions to autopsy,
both of which laid the groundwork for the rejection of the humoral theory of
illness. The humoral approach was finally put to rest by the theory of cellular
pathology, which maintains that all disease is disease of the cell rather than a
matter of fluid imbalance (Kaplan, 1975).As a result of such advances, medicine
looked more and more to the medical laboratory and bodily factors, rather than
to the mind, as a basis for medical progress.
This view however began to change with the rise of modern psychology,
particularly with Sigmund Freud‘s (1856-1936) early work on conversion
hysteria. According to Freud, specific unconscious conflicts can produce
particular physical disturbances that symbolize the repressed psychological
conflicts. In conversion hysteria, the patient converts the conflict into a
symptom via the voluntary nervous system; he or she becomes relative free of
the anxiety the conflict would otherwise produce.

52
The conversion hysteria literature is full of intriguing but biologically
impossible disturbances, such as glove anaesthesia (in which the hand, but not
the other parts of the arm, loses sensation) in response to highly stressful events.
Other problems include sudden loss of speech, hearing or sight; tremors;
muscular paralysis, etc, have also been interpreted as forms of conversion
hysteria. True conversion hysterias are now less frequent than they were in
Freud‘s time (Taylor, 2006)
Nonetheless, the idea that specific illnesses are produced by individual‘s
internal conflicts was perpetuated by the works of Flanders Dunbar (Dunbar,
1943), and Franz Alexander (Alexander, 1950). Unlike Freud, these researchers
linked patterns of personality rather than single specific conflict to specific
illnesses. For example, Alexander developed a profile of the ulcer prone
personality as someone whose disorder was caused primarily by excessive
needs for dependency and love. A more important departure from Freud
concerned the physiological mechanism postulated to account for the link
between conflict and disorder. Whereas, Freud believed that conversion
reactions occurred via the voluntary nervous system with no necessary
physiological changes, Dunbar and Alexander argued that conflicts produce
anxiety that becomes unconscious and takes a physiological toll on the body via
the autonomic nervous system. The continuous physiological changes
eventually produce an actual organic disturbance. In the case of ulcer patient,
for example, repressed emotions resulting from frustration dependency and
love-seeking needs were said to increase the secretion of acid in the stomach,
eventually eroding the stomach lining and producing ulcer (Alexanader, 1950).
Dunbar and Alexander‘s work however helped shape the emerging field of
psychosomatic medicine (Taylor, 2006)

53
In-text Question 1 State the developmental strides in modern era that laid the groundwork
for the rejection of the humoral theory of illness.

Answer
Most notable among these were Anton Vaan Leeuwenhoek‘s (1632-1723) work in microscopy
and Gionanni Morgagni‘s (1682-1771) contributions to autopsy.

3.0 Tutor Marked Assignments (Individual or Group)

Identify the pre and post historic views of illness and the mind body
relationship.

4.0 Conclusion/Summary
There indeed exist a delicate relationship between mind and body on illness
experiences. Observations have shown the delicate relationship between
stress, personality and physical complaints like headache or even cancer. The
Greeks were therefore one of the first civilization to identify the role of
bodily functioning to illness. Thus, rather than ascribing illness to evil spirit,
as previously thought, or even as currently thought sometimes, illness was
ascribed to imbalance in bodily fluids. Also, a further assessment of mind-
body relationship gave rise to the psychosomatic movement, which was of
course, without its criticism.
Wow, I‘m sure you find this unit very insightful, like the previous ones. In
this unit, we have been able to trace the historical perspective of mind-body
relationship as well as different perceptions of illness, pre and post the
modern era. Now let us attempt the following exercise.

5.0 Self-Assessment Questions

1. Explain the conception of illness and the mind-body relationship in the
modern era.
2. Assemble Identify the perspectives of illness and the mind-body
relationship in the middle ages.

54
6.0 References/Further Readings
American Psychiatric Association (1994) Diagnostic and Statistical Manual of
Mental Disorders (4th Ed) (DSM-IV). Washington, DC: APA.
Alexander, F. (1950). Psychosomatic Medicine. New York: Norton.
Cockerham, W. C. (2003). Medical Sociology. (9th edition). NY: Prentice Hall
Dunbar, F. (1943). Psychosomatic diagnosis. New York: Hoeber
Engel, B. T. (1986). Psychosomatic medicine, behavioural medicine, just plain
medicine. Psychosomatic medicine, 48, 466-47.
Gatchel, R. J., Baum, A. and Krantz, D. S. (1997). An Introduction to Health
Psychology (3rd edition). NY: McGraw Hill.
Gentry, W. D. and Matarazzo, J. D. (1981). Medical Psychology: Three decades
of growth and development. In L. A. Bradely and C. K. Prokop (Eds).
Medical Psychology: Contributions to behavioural medicine. New York:
Academic Press.
Kaplan, H. I. (1975). Current psychodynamic concepts in psychosomatic
medicine. In R.O. Pasnau (Ed.), Consultation-Liaison Psychiatry. New
York: Grune & Stratton
Taylor, S. E. (2006). Health Psychology (6th edition). Los Angeles: McGraw
Hill.
World Health Organization (1992) International Statistical Classification of
Diseases and Related Health Problems. Geneva: WHO.

55
 STUDY SESSION 3
3a Acute Versus Chronic Illness
Section and Subsection Headings:
Introduction
1.0 Learning Outcomes
2.0 Main Content
2.1 Defining Acute Illness
2.1.1 Types of Acute Illness
2.2 Defining Chronic Illness
2.2.1 Types of Chronic Illness
2.3- Distinction between Chronic and Acute Illnesses
2.4- Chronic Illness and Hospitalization
3.0 Tutor Marked Assignments (Individual or Group assignments)
4.0 Study Session Summary and Conclusion
5.0 Self-Assessment Questions
6.0 Additional Activities (Videos, Animations & Out of Class activities)
7.0 References/Further Readings

Introduction:
As you must have noted, we provided information on illness and the mind-body
relationship in the previous unit. Of course, these are very necessary
information as they help for better appreciation of this course. However, in this
unit, we will analyze acute versus chronic illness. Observations indicate that we
cannot understand human behaviour in health and illness without looking at
these basic terms. So, we are going to look at acute versus chronic illness as
well as the diseases categorized under each. Happy reading!

56
1.0 Study Session Learning Outcomes
After studying this session, I expect you to be able to:
1. Define acute illness
2. Explain types of acute illness
3. Define chronic illness
4. Analyse types of chronic illness
5. Describethe influence of chronic illness on hospitalization
6. Assembledifferences between acute and chronic illness

2.0 Main Content

2.1 Defining Acute Illness
Acute illness is by definition a self-limiting disease which is mostly
characterized by the symptoms having a rapid onset. These symptoms are fairly
intense and resolve in short period of time as either cure or death in the patient.

2.1.1 Types of Acute Illness

We commonly know these acute diseases as:
• Most headaches
• Some infectious diseases, etc.

2.2 Defining Chronic Illness

Chronic diseases are those that occur across the whole spectrum of illnesses,
mental health problems and injuries. Chronic diseases tend to be complex
conditions in how they are caused, are often long-lasting and persistent in their
effects and can produce a range of complications.
Chronic conditions are those which are long-term (lasting more than 6 months)
and can have a significant effect on a person‘s life. Management to reduce the
severity of both the symptoms and the impact is possible in many conditions.
Management includes medication and/or lifestyle changes such as diet and
57
exercise, and stress management. At the same time, it should be noted that
chronic diseases may get worse, lead to death, be cured, remain dormant or
require continual monitoring.

2.2.1 Types of chronic illness

The following are various types of chronic illness
• Epilepsy – Neurological Disease
The condition arises when there is a brief interruption in the normal electrical
function of the brain. Epileptic attacks can vary between momentary withdrawal
without loss of consciousness (petit mal) and muscular spasms and convulsions
(grand mal) (Wikipedia – The free Encyclopedia, 2007)

• Heart Disease
This is an umbrella term for a number of different diseases which affect the
heart. The most common heart diseases are:
Coronary Heart Disease: a disease of the heart itself caused by the
accumulation of atheromatous plaques within the walls of the arteries that
supply the myocardium.
Ischaemic Heart Disease: another disease of the heart itself, characterized by
reduced blood supply to the organ.
Cardiovascular Disease: a sub-umbrella term for a number of diseases that
affect the heart itself and/or the blood vessel system, especially the veins and
arteries leading to and from the heart. Research on disease dimorphism suggests
that women who suffer with cardiovascular disease usually suffer from forms
that affect the blood vessels while men usually suffer from forms that affect the
heart muscle itself. Known or associated causes of cardiovascular disease
include diabetes mellitus, hypertension, hyperhomocysteinemia and
hypercholesterolemia.
Cor pulmonale: a failure of the right side of the heart.
58
Hereditary Heart Disease: heart disease caused by unavoidable genetic factors
since birth.
Hypertensive Heart Disease: heart disease caused by high blood pressure,
especially localized high blood pressure.
Inflammatory Heart Disease: heart disease that involves inflammation of the
heart muscle and/or the tissue surrounding it.
Valvular Heart Disease: heart disease that affects the valves of the heart.
(Retrieved from "http://en.wikipedia.org/wiki/Heart_disease")

• Asthma – Respiratory Disease

Asthma is characterized by attacks of breathlessness, coughing and wheezing.
Attacks vary in severity and duration. Attacks can be triggered by a variety of
factors: exposure to allergens, dust, humidity and infection, emotional factors
etc.

• Mental Illness
A mental illness as defined in psychiatry and other mental health professions is
abnormal mental condition or disorder expressing symptoms that cause
significant distress and/or dysfunction. This can involve cognitive, emotional,
behavioural and interpersonal impairments.
Similar but sometimes alternative concepts include: mental disorder,
psychological or psychiatric disorder or syndrome, emotional problems,
emotional or psychosocial disability. The term insanity, sometimes used
colloquially as a synonym for expressing symptoms of a mental health
condition or irrationality, is used technically as a legal term.
Specific disorders often described as mental illnesses include clinical
depression, generalized anxiety disorder, bipolar disorder, and schizophrenia.
Diagnosis is performed by a mental health professional. Mental health
conditions have been linked to both biological (e.g. genetics, neurochemistry,
59
brain structure), disease (viruses, bacteria, toxins), drugs (both illegal and over-
the-counter medication) and psychosocial (e.g. cognitive biases, emotional
problems, trauma, socioeconomic disadvantage) causes. Different schools of
thought offer different explanations, although current research employing the
term 'mental illness' would most probably originate in a biopsychiatry point of
view (Wikipedia – The free Encyclopedia, 2007).

• Diabetes – Metabolic Disease

Diabetes is one of the leading causes of death in Africa and the world, and
contributes to significant illness disability, and poor quality of life. It shares
several of the risk factors with cardiovascular disease and is itself a risk factor.
There is a marked difference in the age profile of people with different types of
diabetes. There are two types:
- Type 1: Insulin-dependent diabetes – IDD (common among children);
- Type 2: Non-insulin-dependent diabetes – NID (adults over 40).

Type 1 diabetes is the most common form among children and young adults. In
these children, the pancreas does not produce sufficient insulin. Type 2 diabetes
is predominant among middle- aged and elderly due to its rapid increase in
prevalence after age 45. Here, blood sugar is increased and sugar in the urine is
increased also (Wikipedia – The free Encyclopedia, 2007).

Cancer
Cancer develops when cells in a part of the body begin to grow out of control.
Although there are many kinds of cancer, they all start because of out-of-control
growth of abnormal cells. Normal body cells grow, divide, and die in an orderly
fashion. During the early years of a person's life, normal cells divide more
rapidly until the person becomes an adult. After that, cells in most parts of the
body divide only to replace worn-out or dying cells and to repair injuries.
60
Because cancer cells continue to grow and divide, they are different from
normal cells. Instead of dying, they outlive normal cells and continue to form
new abnormal cells.
Cancer usually forms as tumour. Some cancers, like leukemia, do not form
tumours, instead, these cancer cells involve the blood and blood-forming organs
and circulate through other tissues where they grow. Often, cancer cells travel to
other parts of the body where they begin to grow and replace normal tissue.
This process is called metastasis. Regardless of where a cancer may spread,
however, it is always named for the place it began. For instance, breast cancer
that spreads to the liver is still called breast cancer, not liver cancer. Not all
tumours are cancerous. Benign (noncancerous) tumours do not spread
(metastasize) to other parts of the body and, with very rare exceptions, are not
life threatening. Different types of cancer can behave very differently. For
example, lung cancer and breast cancer are very different diseases. They grow
at different rates and respond to different treatments. That is why people with
cancer need treatment that is aimed at their particular kind of cancer.
The overall incidence for cancer is lowest in late childhood. In adult life it
increases with age. Death rates from cancer increase with age, from age 15. The
older population makes up a higher proportion of those dying from cancer, and
this proportion is increasing (wikipedia – The free Encyclopedia, 2007).

• HIV/AIDS
HIV/AIDS was to enter the world‘s consciousness and become part of the
vocabulary of the human soul as a result of the dawning awareness of the advent
of the strange new disease first reported in California in 1981. With time, the
HIV/AIDS pandemic is unfolding and revealing its secrets. (Pratt, 2003). AIDS
is therefore a new disease and its full name is Acquired Immune Deficiency
Syndrome. As the name implies, it is a disease caused by a deficiency in the
body‘s immune system. It is a syndrome because there is a range of different
61
symptoms which are always found in each case. It is acquired because
HIV/AIDS is an infectious disease caused by a virus which spread from person
to person through a variety of routes. This makes it different from immune
deficiency from other causes such as treatment with anti-cancer drugs or
immune system suppressing drugs given to persons receiving transplant
operations. (Hubley, 1995). Thus, with Africa, inclusive Nigeria, bearing about
70%, of HIV infections, there is no gainsaying that the epidemic is one of the
new factors responsible for the continued underdevelopment of the continent
(Human Development Report, Nigeria, 2004).

2.3. Distinction between Acute and Chronic Illness

We have looked at various definitions of acute and chronic illness as well as
some various types obtainable, now let us look at the basic distinctions between
them.
• Acute diseases have a limited duration, while chronic diseases can remain
in the individual for decades.
• Suffice to note that these diseases do not necessarily result in the death of
the individual and they may not die directly from the symptoms of this
disease. However, the chronic nature of the escalating symptomatology
associated with chronic diseases, brings about great hardship to the
individual in one way or another and severely undermines the quality of
life through a continuum of ongoing fixed symptoms as well as the
addition of ancillary sufferings. All this eventually leads to a terminal
situation due to a weakening of the vital force.
• A person with chronic illness is more likely to depend longer on
healthcare services than those suffering from acute illness. He or she is
more likely to be dependent more on family and friends for normal
everyday activities, than those with acute symptoms.

62
 • Psychological, social and family stress could be more visible in the case
of chronic illness than acute illness. For example, a HIV positive
individual grapples daily with the depression, fear, anger, stigma and
discrimination associated with the disease and may feel traumatized by
such medical state.
• Chronic diseases bring about gradual deterioration of the mental,
physical and emotional spheres of a person, while this may not be so for
acute disease. Thus, the deterioration observed for acute disease is most
times sudden and reduces when the person gets medical attention. For
example, a person suffering from terminal cancer, long before it has been
diagnosed, may show mental and emotional symptoms years before the
overt symptoms manifest. Some people may suggest that this person
used to be friendly and out going until a particular tragedy occurred some
years earlier. The patient may also complain how their mental clarity
used to be clearer before the said event. The patient will be able to relate
their loss of mental clarity by stating that they now have a horrible
memory for peoples‘ names, or that now, unlike before, they can‘t
remember anything and always have to make lists of everything.
However, this almost imperceptible decline is recognized by the vital
force‘s attempt to call for help, by producing symptoms. It is the accurate
reporting and faithful recording of these injured cries that allow the
healer to clearly prescribe a therapeutic protocol for the alleviation of the
suffering.

2.4 Chronic Illness and Hospitalization

When individuals have a chronic disease, whether from birth or contracted in
later life, they are likely to engage with the health system to a greater extent
than anyone else. This may begin with visits to a general practitioner, followed
by diagnostic tests, pharmaceutical prescriptions, consultations with specialists,
63
visits to hospitals and possibly surgery. This may also take place in the context
of a reduced earning capacity.
Put differently, people with chronic diseases require maximum health services
and they are least able to afford them. Those within the 60+ population with a
sustained chronic disease are likely to have been on welfare benefits, if there is
any, before the usual retirement age of 60 to 65 years. People with chronic
disease may have also continued to work, though this may have been part time
or casually.
An important aspect of living with a chronic disease is that as people become
older they may develop other illnesses. Co-morbidities have a number of
impacts; these people have even more expenses, they suffer the effects of
polypharmacy, and suffer increased effects of the illnesses.

In-text Question 1: State Eight (8) most common heart diseases

Answer
1. Coronary Heart Disease
2. Ischaemic Heart Disease
3. Cardiovascular Disease
4. Cor pulmonale
5. Valvular Heart Disease
6. Hypertensive Heart Disease
7. Inflammatory Heart Disease
8. Hereditary Heart Disease

3.0 Tutor Marked Assignments (Individual or Group)

1. Distinguish between acute and chronic illness
2. Identify the influence of chronic illness on hospitalization

4.0 Conclusion/Summary
Advances in research and the delivery of health care have reduced mortality
from disease and extended life expectancy in developed countries. We are living
longer, but are we necessarily living better? Those who would have died from

64
their condition may now survive but there is the emotional cost of long-term
treatment and medical surveillance to consider (for example, the patient who
has had a liver transplant must then continue immuno suppression treatment).
Such patients must cope with a chronic condition and yet the emotional
dimensions of these conditions are frequently overlooked when medical care is
considered.
In this unit, we have briefly defined acute and chronic illnesses. We also
enumerated the various types of acute and chronic illnesses. This unit also
provided a detailed distinction between acute and chronic illness and also went
further to look at chronic illness and hospitalization. Let us now answer the
questions stated below.

5.0 Self-Assessment Questions

1. Analyse types of chronic illness
2. Describe the influence of chronic illness on hospitalization
3. Assemble differences between acute and chronic illness

6.0 References/Further Readings

Cockerham, W. C. (2003). Medical Sociology. (9th edition). NY: Prentice Hall
Human Development Report, Nigeria, (2004). HIV and AIDS: A challenge to
sustainable development. UNDP
Hubley, A. (1995). The AIDS Handbook: A guide to the understanding of AIDS
and HIV. Second Edition, Oxford: Macmillan Education Ltd.
Pratt, R. J. (2003). HIV and AIDS: A foundation for nursing and healthcare
practice. Fifth Edition. London: Book Power.
Taylor, S. E. (2006). Health Psychology (6th edition). Los Angeles: McGraw
Hill.
Weiss, L. G. and Lonnquist, L. E. (2005). The Sociology of Health, Healing and
Illness, (5th edition). Safari book online. Retrieved from

65
 http//www.safari.com/0131928406/ch07iev1sec3. Site visited on 17th
March 2007.
Wikipedia – The free Encyclopedia. ‗Heart Diseases‘ Retrieved from
"http://en.wikipedia.org/wiki/Heart_disease") Site visited on 4th April
2007
Wikipedia – The free Encyclopedia. ‗Mental Illness‘ Site last modified 03:41,4
April 2007. Site visited on 4th April 2007.

66
 STUDY SESSION 3 CONTD
3b Culture and Socio-Demographic Determinants of Health and Illness
Section and Subsection Headings:
Introduction
1.0 Learning Outcomes
2.0 Main Content
2.1 Cultural factors of Health and Illness
2.2 Social and Demographic factors of Health and Illness
2.2.1 Age, Health and Illness
2.2.2 Gender, Health and Illness
2.2.3 Marital status, Health and Illness
2.2.4 Living Condition, Health and Illness
1.2.1 Socioeconomic status, Health and Illness
3.0 Tutor Marked Assignments (Individual or Group assignments)
4.0 Study Session Summary and Conclusion
5.0 Self-Assessment Questions
6.0 Additional Activities (Videos, Animations & Out of Class activities)
7.0 References/Further Readings

Introduction:
We have looked at several conceptions of illness, disease and health, illness and
the mind-body relationship. We also looked at certain dichotomies of illness,
such as acute versus chronic illnesses. We presented other contributory factors
that accounted for changing patterns of illness. This unit therefore hopes to
further identify contributory variables of illness and health. Specifically, this
unit looks at cultural, social, demographic and situational perspectives of illness
and health. Thus, illness does not occur in isolation, it is such contributory
variables that predict various human behaviours in illness and health.

67
1.0 Study Session Learning Outcomes
After studying this session, I expect you to be able to:
1. Describe cultural factors influencing health and illness behaviour
2. Assemble the socio-demographic factors of health and illness behaviour

2.0 Main Content

2.1 Cultural Factors of Health and Illness
Understanding the nature of health and illness and how people engage in several
health behaviour, in a bid to keep healthy or respond to physical distress when
ill, as the case may be, requires a consideration of the cultural context in which
health and illness behaviours takes place. Although, the biological processes
involved in disease are the same across cultural boundaries, but how people
understand, experience and respond to illness is often radically different.
Anthropological studies of different illness and health seeking behaviours
across culture have shown that health and illness conceptions do not occur in
isolation, but are part of the larger cultural belief system. Western technological
societies tend to think of illness in terms of germs or specific dysfunctions
within the body, while others may have a mystical interpretation to it. In
Fabrega (1974) study of illness belief and medical care among the Spanish
speaking people, the author described two contrasting approaches to illness.
Indians of Mayan descent, regard illness as either a sign of sin or an indication
that one‘s enemies have plotted with devils and witches to cause harm. A return
to health requires that the sick person and his family make certain social, moral
and religious reparations.
Individuals of direct Spanish descent, however, have different and more
individualistic views of illness. They regard the occurrence as evidence that the
person‘s strength has been overcome and depleted. For these individuals, illness
can be caused by biological, social and psychological factors, with the principal
causes found in the person‘s emotions and social relationships. Thus, a return to

68
health means a return of a person‘s strength, positive emotions and good social
relationships. These beliefs, in turn, reflect the more differentiated world view
that conceives of the individual as a separate person but with strong ties to the
social group.
Even within Western technological society, cultural groups differ in their
responses to illness. For example, Zola (1964), found a classical difference
between Irish American and Italian American. Whereas, patients of Irish
descendants tended to describe a relatively small number of localized symptoms
and downplay the pain, patients of Italian descent reported more symptoms
relating to more areas of the body and were vocal about the pain.
Also, in a comparison of reaction to pain among the Jewish, Italians, Iris and
Americans, Zborowski (1952) observed that Italian and Jewish patients tended
to be emotional about the pain, often exaggerating their illness experience. Irish
tended to deny the pain while the Americans tended to be more stoical and
―objective‖ about their discomfort. Thewriter observed that, even though the
Jews and Italians tended to be more expressive about their illness experience,
they apparently did so for different reasons. He noted that Italians were
primarily concerned with pain sensation and were satisfied simply to find relief.
Jews, however, were more concerned with the meaning of the pain and with
potential consequences. In these studies therefore, the different responses to
discomfort reflect overall cultural differences between groups and they also
provide basic orientations and categories for interpreting somatic experiences.

2.2 Social and Demographic Factors of Health and Illness

Although culture provides basic orientations to interpreting health and illness
experiences, the experience of such, however, is further shaped by various
demographic factors. Such factors therefore include: age, gender, marital status,
living arrangement and socioeconomic status.

69
2.2.1 Age, health and illness
Observations indicate that childhood and youthfulness signifies good health and
vigour while illness and thus, decline in health increases as one gets older. Thus,
older people are likely to report more activity restriction, physician visit and
health complications due to chronic diseases and frail immune systems than the
younger ones.
Younger people are also more likely to engage in risky health behaviours like
unprotected sexual habits, drug abuse or even engage in dangerous physical
activities than the older ones because of the assumption that they are younger
and full of energy. They are also more likely to be careless with illness
experience and might interpret symptoms differently than the older ones.
Whereas the older people might view symptom experience seriously and work
towards getting well, the younger ones are likely to ignore those symptoms until
its late to get medical attention.

2.2.2 Gender, health and illness

Studies have shown that women report more illnesses than do men. Also,
because of their physical make-up and experiences like child birth and
motherhood, women are more likely to engage in health seeking behaviour than
men. Although there are some questions as to whether women actually
experience more symptoms, one study has found evidence that women have
more ―diffuse‖ view of illness, often reporting symptoms that ―radiate‖
throughout the body. In addition, men often appear unaware of serious health
problems when reporting symptoms to a doctor (Verbrugge, 1980). It is also
known that breast cancer is more common in women than men and only men
have prostrate cancer.

70
2.2.3 Marital status, health and illness
Marital status also seems to have significant effect on illness behaviour. Studies
have shown that compared with those who are married, unmarried individuals
are likely to report more symptoms and think themselves to be in poorer health
than the married ones. This may be due to the poor feeding habit and other
associated health risks likely to be observed among the unmarried individuals.
For the unmarried females, boredom and an urge for a husband may predispose
them to stress, depression and poor immunity to diseases.
Also, child bearing and motherhood may predispose the married ladies to
several forms of health complications, stress and loss of energy may sometimes
arise when they had to combine motherhood with a formal job. Thus, they are
more likely to engage in health seeking behaviours in a bid to function
adequately in the home.
Likewise, married men are more likely to engage less in risky health and
physical behaviours than the unmarried one, especially when there are children
involved.

2.2.4 Living conditions, health and illness

Overall, individuals living with one to three others may report fewest symptoms
than those living with four or more others. Also, those living in a crowded and
poorly ventilated environment are more vulnerable to diseases than those living
in neat and spacious environment. Overall, poor living condition predisposes
one to frequent hospital visits and self medications.

2.2.5 Socioeconomic status, health and illness

Social class or socioeconomic status plays an important role in health and
illness behaviour. A poor person is more like to have less purchasing power,
poor feeding habit, and poor health service, live in poor and indecent
environment and die younger due to complications of diseases. In their

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comparison between the white and blue collar jobs, Rosenblatt and Suchman
(1964) observed that the blue-collar workers are less informed about health and
illness, more skeptical about medical care, more dependent when ill than their
white-collar counterparts.

In-text Question 1 Enumerate the various demographic factors that affect health and illness

Answer Such factors therefore include: age, gender, marital status, living arrangement and
socioeconomic status.

3.0 Tutor Marked Assignments (Individual or Group)

Identify and discuss the Socio-demographic factors of Health and Illness
behaviour

4.0 Conclusion/Summary
We have seen that the cultural and socio-demographic factors of illness
experience are indeed part of the very many facets of health and illness.
Observations indicate that though biological processes involved in illnesses
are globally similar, but the perceptions, experiences and responses to illness
are often radically dissimilar. Culture described as the way people live, plays
a huge role in the understanding and studying of illness behaviour. Also, the
influence of certain socio-demographic factors of illness experience cannot
be over-emphasized. We have seen that age, gender, marital status, living
conditions and socio-economic status exert significant influence on health
and illness behaviour.
I hope you enjoyed your studies. In this unit, we looked at the roles of
culture as well as socio-demographic variables on health and illness
experience. Now let us tackle the question stated below.

72
5.0 Self-Assessment Questions
1. Describe cultural factors influencing health and illness behaviour

6.0 References/Further Readings

Bishop, G. D. (1994). Health Psychology: Integrating mind and body. Boston:
Allyn and Bacon.
Cockerham, W. C. (2003). Medical Sociology. (9th edition). NY: Prentice Hall
Fabrega, H. (1974). Disease and social behaviour: An interdisciplinary
perspective. Cambridge, MA: MIT Press.
Rosenblatt, D. and Suchman, E. A. (1964). Blue-collar attitudes and information
about health and illness. In A. B. Shostak and W. Gomberg (Eds.), Studies
of American worker. Englewood Cliff, NJ: Prentice Hall.
Taylor, S. E. (2006). Health Psychology (6th edition). Los Angeles: McGraw
Hill.
Verbrugge, L. M. (1980). Sex differences in complaints and diagnosis. Journal
of Behavioural Medicine, 3, 327-355.
Weiss, L. G. and Lonnquist, L. E. (2005). The Sociology of Health, Healing and
Illness, (5th edition). Safari book online. Retrieved from
http//www.safari.com/0131928406/ch07iev1sec3. Site visited on 17th
March 2007.
Zborowski, M. (1952). Cultural components in responses to pain. Journal of
Social Issues, 8, 16-30.
Zola, I. K. (1964). Illness behaviour of the working class: Implications and
recommendations. In. S. Shostak and W. Gomgerg (Eds.), Blue-collar
world: Study of American worker. Englewood Cliffs, NJ: Prentice Hall.

73
 STUDY SESSION 4
What is Health Behaviour
Section and Subsection Headings:
Introduction
1.0 Learning Outcomes
2.0 Main Content
2.1 Defining Health Behaviour
2.2 Health Promotion: An Overview
2.3 Dimensions of Health Behaviour
2.4 What are Health Habits
2.5 Complexities of Health Behaviour
3.0 Tutor Marked Assignments (Individual or Group assignments)
4.0 Study Session Summary and Conclusion
5.0 Self-Assessment Questions
6.0 Additional Activities (Videos, Animations & Out of Class activities)
7.0 References/Further Readings

Introduction:
At the beginning of this course, we started by defining behaviour, and human
behaviour. We also looked at diseases, health and illness. We further discussed
other health and illness related variables like illness and the mind-body
relationship, acute versus chronic illness, and also scrutinized cultural and
socio-demographic factors of health and illness.
The fact that social and cultural factors provide the context for the experience of
health and illness is well established, but how then do we notice symptoms and
perceive ourselves to be ill or healthy. An obvious beginning is providing a
clear and in-depth definition of health behaviour as well as illness behaviour.
This is because we cannot conceptualize illness behaviour without first looking
at health behaviour. It is not an understatement to state that a deviation in health

74
behaviour could lead to illness and thus, illness behaviour. We purposely left
this topic till now, to form the beginning of module 3, unit 1 while all the topics
discussed in previous units and modules served as basic introductions to health
and illness behaviours.
Remember that the term ‗health‘ is defined as a state of complete physical,
mental and social well-being and not merely the absence of disease or/and
infirmity. However, health is a broad term that includes both health and illness
behaviours.

1.0 Study Session Learning Outcomes

After studying this session, I expect you to be able to:
1. Define health behaviour
2. Develop an overview of health promotion
3. Assemble dimensions of health behaviour
4. Explain and identify health habits
5. Describe the complexities of health behaviour

2.0 Main Content

2.1 Defining Health Behaviour
Health behaviour is a broad term that includes:
• Health Behaviour
• Illness behaviour

Definition 1: Health behaviours are behaviours considered to be related to

primary prevention of disease.
Definition 2: Health behaviour is defined as: any activity undertaken by an
individual, regardless of actual or perceived health status, for the purpose of
promoting, protecting or maintaining health, whether or not such behaviour is
objectively effective towards that end.
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Definition 3: The combination of knowledge, practices, and attitudes that
together contribute to motivate the actions we take regarding health.
Definition 4: Health behaviours are behaviours undertaken by people to
enhance or maintain their health (Stone, 1979). Poor health behaviours are thus
important not only because they are implicated in illness but also because they
may easily become poor health habits.
Definition 5: Health behaviours are behaviours that a person engages in, while
still healthy for the purpose of preventing disease (Kasl and Cobb, 1966). These
include a wide range of behaviour from stopping smoking, losing weight,
exercising regularly and eating right.
Definition 6: Health behaviour is an activity undertaken by a person believing
himself/herself to be healthy, for the purpose of preventing disease or detecting
it in an asymptomatic stage (for example, following a healthy diet). This is
regarded as primary prevention of disease.
Secondary prevention of disease is more closely related to the control of a
disease that an individual has or that is incipient in the individual. This type of
prevention is most closely tied to illness behavior. Illness behaviour – Any
activity undertaken by a person, who feels ill to define the state of his or her
health and to discover a suitable remedy (for example, going to the doctor).
Tertiary prevention is generally seen as directed towards reducing the impact
and progression of symptomatic disease in the individual. This type of
prevention is highly related to the concept of sick-role behaviour. Sick role
behaviour – Any activity undertaken for the purpose of getting well, by those
who consider themselves ill (for example, taking prescribed medication or
resting). It generally includes receiving treatment from appropriate therapists,
involves a whole range of dependent behaviours, and leads to some degree of
neglect of the person‘s usual duties.

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2.2 Health Promotion: An Overview
Health promotion is a general philosophy that has at its core the idea that good
health, or wellness, is a personal and collective achievement.
• For the individual, it involves developing a programme of good health
habits early in life and carrying them through adulthood and old age.
• For the medical practitioner, health promotion involves teaching people
how best to achieve this healthy lifestyle and helping people at risk for
particular health problems learn behaviours to offset or monitor those
risks (Maddux, et al, 1988).
• For the psychologist, health promotion involves the development of
interventions to help people practice good health habits and change poor
ones.
• For the community and the nation, health promotion involves a general
emphasis on good health, the availability of information to help people
develop and maintain healthy life styles, and the availability of resources
and facilities that can help people change poor health habits.
• The mass media can contribute to health promotion by educating people
about health risks posed by certain behaviours such as smoking,
excessive alcohol consumption, unprotected sexual habits and sharing of
sharp objects.

The legislation can also contribute to health promotion by mandating certain

activities that may reduce risk, such as the use of seat belts when driving,
prohibition of drunk driving, mandatory immunization of children etc (Taylor,
2006)

2.3 Dimensions of Health Behaviour

However, there is no consensus about the traits that constitute a genuinely
healthy body and researchers operationalize the concept of health behaviour in
77
many ways. Ware (1986), in his review of literature identified the following 6
primary dimensions of health behaviours used by many researchers:
Physical Functioning: focuses on physical limitations regarding ability to take
care of self, being mobile and participating in physical activities, ability to
perform everyday activity; and number of days confined in bed.
Mental Health: focuses on feelings of anxiety and depression, psychological
well-being and control of emotions and behaviour.
Social Well being: focuses on visiting with or speaking on the telephone with
friends and family and the number of close friends and acquaintances.
Role Functioning: focuses on freedom and limitations in discharging usual role
activities such as work or school
General Health Perception: focuses on self-assessment of current health status
and amount of pain being experienced.
Symptoms: focuses on reports of physical and psychophysiological symptoms.
(Weiss and Lonnquist, 2005).
Now, we know that we cannot talk about illness behaviour without first
touching on the concept of health behaviour. This is a broad concept that deals
with illness, health and sick role behaviour. Let us now, attempt this interesting
exercise.

2.4 What Are Health Habits?

Health habits are health-related behaviour that are firmly established and often
performed automatically, without awareness. These habits usually develop in
childhood and begin to stabilize around age 11 or 12 (Cohen, Brownell and
Felix, 1990). Wearing a seat belt, brushing one‘s teeth, and eating a healthy diet
are examples of these kinds of behaviours. Although, a health habit may have
developed initially because it was reinforced by positive outcomes, such as
parental approval, it eventually becomes independent of the reinforced process
and is maintained by the environmental factors with which it is customarily

78
associated. As such, it can be highly resistance to change. Consequently, it is
important to establish good health habits and eliminate poor ones (Taylor,
2006).
A dramatic illustration of the importance of good health habits in maintaining
good health is provided by a classic study of people living in California,
conducted by Belloc and Beslow (1972). These scientists began by defining
seven important good health habit: sleeping 7 to 8 hours at night, not smoking,
eating breakfast each day, having not more that one to two alcohol drinks each
day, getting regular exercise, not eating between meals, and being not more that
10% overweight. They then asked each of nearly 7,000 country residents to
indicate which of these behaviours they practiced. Residents were also asked to
indicate how many illnesses they had had, which illnesses they had, how much
energy they had and how disabled they had been (for example, how many days
of work they had missed on the previous six to twelve months period). The
researchers found that the more good health habit people practiced, the fewer
illnesses they had, the better they felt, and the less disabled they had been. A
follow-up of these individuals nine and half years later found that mortality rate
were dramatically lower for both men and women practising the seven health
habits. Specifically, men following these health habits had a mortality rate only
28%, than that of men following zero to three of the health habits (78%), and
women following the seven health habits had a mortality rate of 43% than that
of women following zero to three of the health habits, (57%) (Breslow and
Enstrom, 1980)

In-text Question 1 Define Health Behaviour

Answer
Health Behaviour is defined as any activity undertaken by an individual, regardless of actual
or perceived health status, for the purpose of promoting, protecting or maintaining health
whether or not such behaviour is effectively towards that end.

79
2.5 Complexities of Health Behaviour
Although, healthy and unhealthy lifestyles are commonly discussed as if a
person either does or does not practice good health behaviour, research on
health behaviours has shown that the practice of one health behaviour is often
only weakly related to the practice of others (Kirscht, 1983, Mechanic, 1979).
Why is this?
The major reasons seem to be that health behaviours differ on a number of
dimensions and may be influenced by different factors. For one thing, some
health habits require that a person actively engage in positive activities, whereas
others require the avoidance of harmful ones. Thus, a person may initiate good
habits like exercising and eating right, the same person may have difficulty in
avoiding the temptation involved in smoking and excessive use of alcohol.
In addition, some health habits such as brushing ones teeth, eating right and
exercising, can be performed by the individual without professional assistance,
whereas others, such as receiving regular check-ups or immunization, require
medical supervision.
Health behaviours also differ considerably in their complexity. Some, like
immunization or check-ups, are relatively simple and are performed only
occasionally, many health behaviours, however, are repeated and are embedded
in important habit patterns. For example, obtaining health benefits from exercise
requires that the person exercise on a regular basis. Positive habits like brushing
one‘s teeth, and negative habits such as smoking and overeating, are closely
related to the person‘s daily routines and general habits patterns. Beyond this,
complex, long- term habits may become integrated together as a part of the
person‘s overall life-style (Kirscht, 1983).

3.0 Tutor Marked Assignments (Individual or Group)

1. Explain and identify health habits
2. Describe the complexities of health behaviour

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4.0 Conclusion/Summary
This unit provided an in-depth definition of health behaviour, of which most
tended to perceive health behaviour as any activity undertaken by an individual,
regardless of actual or perceived health status, for the purpose of promoting,
protecting or maintaining health. This unit also presented an overview of health
promotion as well as complexities of health behaviours. It further analyzed
dimensions of health behaviour and identified several health habits that could
aid healthy living.
I hope you enjoyed reading through this unit. In this unit, we define health
behaviour in an unambiguous manner to aid proper assimilation. It is very
important to have a firm grasp of what health behaviour is all about as these
also influences conception of illness behaviour. Now let us attempt the
following questions.

5.0 Self-Assessment Questions

1) Define health behaviour
2) Identify the 6 primary dimensions of health behaviour
Have you done that?

6.0 References/Further Readings

Belloc, N. D. and Breslow, L. (1972). Relationship of physical health status and
family practices. Preventive Medicine, 1, 409-421.
Bishop, G. D. (1994). Health Psychology: Integrating mind and body. Boston:
Allyn and Bacon.
Breslow, L. and Enstrom, J. E. (1980). Persistence of health habits and their
relationship to mortality. Preventive Medicine, 9, 469-483.
Cockerham, W. C. (2003). Medical Sociology. (9th edition). NY: Prentice Hall
Kasl, S. V. and Cobb, S. (1966). Health behaviour, illness behaviour and sick
role behaviour. Archives of Environmental Health, 12, 246-266.

81
Kirscht, J. P. (1983). Preventive health behaviour: A review of research issues.
Health psychology, 2, 277-301.
Maddux, J. E., Rogers, R. W., Sledden, E. A. and Wright, L. (1986).
Developmental issues in child health psychology. American Psychologist,
41, 25-34.
Stone, G. C. (1979). Patient compliance and the role of expert. Journal of Social
Issues, 35, 34-59.
Taylor, S. E. (2006). Health Psychology (6th edition). Los Angeles: McGraw
Hill.
Ware, J. E. (1986). Dimensions of Health Behaviour. In L. G. Weiss and L.
E.Lonnquist. (Eds). The Sociology of Health, Healing and
Illness,(5thedition).Safaribookonline.Retrievedfromhttp//www.safari.com/
0131928 406/ch07iev1sec3. Site visited on 17th March 2007.
Weiss, L. G. and Lonnquist, L. E. (2005). The Sociology of Health, Healing and
Illness, (5th edition). Safari book online. Retrieved from
http//www.safari.com/0131928406/ch07iev1sec3. Site visited on 17th
March 2007.

82
 STUDY SESSION 4 CONTD
4b Changing Patterns of Health and Illness
Section and Subsection Headings:
Introduction
1.0 Learning Outcomes
2.0 Main Content
2.1 Changing Patterns of illness and Disease Metamorphosis
2.2 Environment, Health and Diseases
2.3 Lifestyle, Health and Diseases
2.4 Health/Illness and the Advent of New Technology
2.5 Health/Illness and Health Research
2.6 Changing patterns of Health/Illness and Epidemiology
3.0 Tutor Marked Assignments (Individual or Group assignments)
4.0 Study Session Summary and Conclusion
5.0 Self-Assessment Questions
6.0 Additional Activities (Videos, Animations & Out of Class activities)
7.0 References/Further Readings

Introduction:
One may ask, why bother with changing patterns of illness since illness and
health experience seems obvious and also cuts across age, social, race, etc.
However, by focusing our lenses on the changing pattern of health/illness, we
are able to appreciate the great metamorphosis that has been experienced in
illness causation and origins, as well as in different health seeking habits. Do
not forget that before now, the human race reported less complicated illnesses,
which are also mainly acute in nature and thus less complicated treatment
regimes. But now, the table is turning the other way. Most illnesses reported
now are chronic and oftentimes very complicated. One is thus wont to ask, what
triggered these changes in illness patterns. Thus, changes in technology and

83
lifestyle reflect directly to these observations. This unit seeks to further shed
more light on the aforementioned topic.

1.0 Study Session Learning Outcomes

After studying this session, I expect you to be able to:
1. Describe the changing patterns of illness and metamorphosis of disease
2. Define the influence of lifestyle on the changing patterns of health/illness
3. Explain environmental influences on health/illness
4. Analyse the role of technological advancement on disease detection
5. Explain changing patterns of illness and health research
6. Assemble the role of epidemiology on changing patterns of health/illness

2.0 Main Content

2.1 Changing Patterns of Illness and Disease Metamorphosis
In the past 100 years of so, it was observed that patterns of disease have
changed substantially. Observations have shown that until the 20th Century, the
major causes of illness and death were acute disorders, especially tuberculosis,
influenza, pneumonia, cholera, etc. Presently, it could be observed that chronic
diseases like cancer, diabetes, HIV/AIDS, heart diseases, etc. are major causes
of illness. Simultaneously, there has been an increase in what have been called
the ‗preventable‘ disorders, including the lung cancer, cardiovascular diseases,
alcohol, drug abuse and vehicular accidents (Matarazzo, 1985).
Also, since 1900, life expectancy for both men and women has greatly
improved in the western world and more recently in the developing world. This
change is made possible by, in part, breakthroughs in treating and preventing
infectious diseases such as polio, influenza, smallpox, rubella (Matarazzo,
1985). With the elimination of these diseases through vaccination, ‗new‘
diseases become more prominent and now account for more deaths. Cancer
deaths, for example, have tripled, even among children, presently, heart

84
diseases, cancer and HIV/AIDS have become major killers. Thus, because
people may live with such chronic diseases, presently obtainable across the
globe for so many years, such illness behaviours such as health seeking habits
and decisions for treatment are thus on the rise in connection to these.

2.2 Environment, Health and Disease

Added to the effect of individual behaviour on health are the effects of our
collective actions as a society. Health hazards in the environment, such as
polluted water, air, toxic chemicals, refuse dumps, etc. have the potential to kill,
injure and sicken individuals, and significantly influence the entire
communities. Air pollution contributes substantially to respiratory ailments;
toxic compounds have been shown to lead to cancer, chronic degenerative
diseases, reproductory and developmental impairment, neurological problems
and diseases of immune system (Bishop, 1994).

2.3 Lifestyle, Health and Disease

Suffice to note that such chronic diseases like cancer, diabetes, HIV/AIDS, etc.
that formed major causes of death and illness nowadays, have no ‗magic bullet‘
cure or vaccine but are, in some respect, diseases caused by lifestyle and
behaviour. Diet, smoking, stress, substance use and abuse are all behavioural
factors that are associated with development of today‘s feared illnesses.
Califona (1989), for example, observed that at the turn of the century, 580
deaths out of every 100,000 U.S. citizens were due to influenza, pneumonia,
diptheria, tuberculosis, and gastro-intestinal infections. Today, these diseases
account for only 30 deaths per 100,000 citizens. This rapid decline in deaths
from infectious agents, he argues, has been accompanied by increased numbers
of deaths from diseases caused or facilitated by preventable behavioural factors
such as smoking.

85
2.4 Health/Illness and Advent of New Technology
Worthy of note is the fact that new technologies now make it possible to detect,
prevent, and even identify genes that contribute to, many disorders. Just in the
past years, genes contributing to many disorders including breast cancer,
diabetes, etc. have been uncovered. Equipment for proper diagnosis of diseases
like HIV/AIDS have improved the life-span of individuals. Such complex and
innovative technologies have also aided the production of drugs needed to
tackle several debilitating diseases. Thus, we could assert that the advent of new
technologies have really paved way for more informed health seeking
behaviour.

2.5 Changing Patterns of Health/Illness and Epidemiology

Changing pattern of illness could also be analyzed from the point of view of
epidemiology. Epidemiology is the study of frequency, distribution and causes
of infectious and noninfectious diseases in a population, based on an
investigation of the physical and social environment. For example,
epidemiologists not only study who has what kind of cancer, but address
questions such as why some cancers are more prevalent in certain areas than
others, likewise HIV/AIDS and other communicable and non-communicable
diseases. Thus, such findings help form certain illness and health seeking
behaviour, like safe sex and sex education in areas where HIV/AIDS prevalence
is seen to be very high.

In-text Question 1 List the Health hazards in the environment that have the potential to kill,
injure and causes illness.

Answer Polluted water, air, toxic chemicals, refuse dumps, etc., and significantly influence
the entire communities.

3.0 Tutor Marked Assignments (Individual or Group)

Identify the roles of lifestyle, health research and advent of new technology on

86
changing patterns of health and illness.

4.0 Conclusion/Summary
It is indeed very obvious that there are many variables associated with changing
patterns of health and illness. Suffice to note that variables such as lifestyle,
health researches, new technology, disease metamorphosis, epidemiological
variables all combine to form coherent understanding in this regard. Please note
that the variables presented here are just few of the many factors that influence
such observable changing patterns of health and illness. Please, feel free to
come up with more.
In this unit, we look at certain variables associated with changing patterns of
health and illness. Such variables include: lifestyles changes, the advent of new
technology, disease metamorphosis, epidemiological issues and health research
that sought to provide empirical findings to these variables.

5.0 Self-Assessment Questions

1. Explain environmental influences on health/illness
2. Analyse the role of technological advancement on disease detection
3. Explain changing patterns of illness and health research
4. Assemble the role of epidemiology on changing patterns of
health/illness

7.0 References/Further Readings

Bishop, G. D. (1994). Health Psychology: Integrating mind and body. Boston:
Allyn and Bacon.
Califona, A. (1989). Lifestyle and changing patterns of illness. In Gatchel, R.
B., Baum, A. and Krantz, D. S. (Eds). An introduction to health
psychology (second edition). NY: Random House.
Cockerham, W. C. (2003). Medical Sociology. (9th edition). NY: Prentice Hall

87
Mattarazzo, J. D. (1985). Behavioural health and behavioural medicine:
Frontiers for anew health psychology. American Psychologist, 35, 807-
817.
Pratt, R. J. (2003). HIV and AIDS: A foundation for nursing and healthcare
practice. Fifth Edition. London: BookPower.
Taylor, S. E. (2006). Health Psychology (6th edition). Los Angeles: McGraw
Hill.
Weiss, L. G. and Lonnquist, L. E. (2005). The Sociology of Health, Healing and
Illness, (5th edition). Safari book online. Retrieved from
http//www.safari.com/0131928406/ch07iev1sec3. Site visited on 17th
March 2007.

88
 STUDY SESSION 4 CONTD.
4C Theoretical Approaches to Health and Illness Behaviour
Section and Subsection Headings:
Introduction
1.0 Learning Outcomes
2.0 Main Content
2.1 Expectancy-Value Model
2.1.1 Social Learning Model
2.1.2 Fishbein‘s Theory of Reasoned Action
2.1.3 The Health Belief Model
2.2 Attribution Model
2.3 The Health Perception Approach
2.4 Social Network/Social Support Theories
2.5 Naturalistic Viewpoint
3.0 Tutor Marked Assignments (Individual or Group assignments)
4.0 Study Session Summary and Conclusion
5.0 Self-Assessment Questions
6.0 Additional Activities (Videos, Animations & Out of Class activities)
7.0 References/Further Readings

Introduction:
All theories of health and illness serve to create a context of meaning within
which the patient can make sense of his or her bodily experience. A meaningful
context for illness usually reflects core perceptual, social, and expectancy
values, and allows the patient to bring order to the chaotic world of serious
illness and to regain some sense of control in a frightening situation. The
following are models that would broaden our conception of health and illness
behaviour.

89
1.0 Study Session Learning Outcomes
After studying this session, I expect you to be able to:
1. DescribeExpectancy-Value Model as well as its 3 main approaches
2. Explain the role of Attribution Model of health and illness perception
3. Construct/deconstruct the influence of Health Perception Model on illness and
health seeking behaviours.
4. Analyse the social network/social support theory
5. Assemble the views of Naturalistic Model of illness perception and causation.

2.0 Main Content

2.1 Expectancy-Value Model
Many models of health and illness behaviour are based upon an expectance-
value approach to motivation. This asserts that individuals are motivated to
maximize gains and minimize losses. Behavioural choice and persistence are a
function of the expected success of the behaviour in attaining a goal and the
value of the goal. Below are three models based on this approach:

2.2.1 Social Learning theory

Rotters‘s Social Learning Theory posits that: ‗the potential for behaviour to
occur in any specific situation is a function of the expectancy that the behaviour
will lead to a particular reinforcement in that situation and the value of that
outcome‘ (Rotter, 1954). Thus, a sick person is likely to take a day or two off
from work if he or she expects to be pampered by worried relatives and vice
versa. One generalized expectancy in particular – locus of control – has been the
focus of much work. Locus of control is the generalized expectancy that
whether one‘s own behaviour or forces external to oneself controls
reinforcement. Starting with Rotter‘s Scale, measuring generalized expectancies
on one dimension (Rotter, 1966), locus of control has been expanded to include
three orthogonal dimensions (internal; powerful and chance: (Levenson, 1973).

90
Locus of control can be measured as a general expectancy or an expectancy
specific to a particular situation. Strickland (1978) therefore suggests that in a
novel or ambiguous situation an individual‘s behaviour is predictable from
generalized expectancies.
Also, the concept of health as a value has been neglected in health research. It is
frequently assumed that the value placed on health is uniformly high. The most
common method of measuring health is based on Rockeach‘s terminal value
ranking test (1973), for which respondents are asked to assess the value of
health relative to such items as: a comfortable life, world peace, happiness and
health.

2.1.2 Fishbein’s theory of Reasoned Action

This theory is based on the assumption that most human behaviour is under
voluntary control and hence is largely guided by intention. Intention is
determined by both the individual‘s attitude towards performing the behaviour
and their subjective norms, i.e. their perception of the degree to which
significant others think performing the behaviour is important (Fishbein and
Ajzen, 1975).
The attitude component is the product of the beliefs (expectations) that
performing a specific behaviour will lead to a certain consequence, and the
individual‘s valuation of that consequence (i.e., how good or bad such an
outcome would be). The subjective normative component of the model also
incorporates an expectancy and value component. It is the product of the
expectation that important others will consider the performance of the behaviour
important and the value of that person‘s approval. This theory thus considers
both the individual‘s attitude towards a behaviour as well as the influence of
social environment as important predictors of behavioural intention. The
relative contribution of the two components of the model will in part depend on
the behaviour in question. For example, a pregnant woman is likely to go

91
through the pain and rigors of pregnancy because of the value and the joy that a
new baby brings.

2.1.3 The Health Belief model

The Health Belief Model (HBM), unlike the previous theories was developed to
explain and predict behaviour in health context (Becker, 1974). While originally
developed to predict preventive health behaviours, the model has also been used
to predict behaviour of both acute and chronically ill patients. The likelihood of
an individual undertaking a particular action is seen as a function of the
individual‘s perception of:
• Their susceptibility to the illness
• The seriousness of the illness
• The potential benefit and costs involved in undertaking the particular
action.

Cues to action, which may be internal (such as the perception of a symptom) or

external (such as health education message) will determine whether behaviour is
performed. However, the precise way in which the variable combine to predict
behaviour is unclear. Stone (1990) suggests that the HBM makes relative rather
than quantitative predictions.

2.2. Attribution Model

Attribution Model is concerned with the way people explain events (Kelly and
Michela, 1980). It deals with causes that individuals infer from outcomes that
have occurred in the past. By contrast, Social Learning Theory deals with
expectancies about the future. However, the distinction between attribution of
causes of past events and perceived control over a future situation has been
made by Brickman et al. (1983). They treat judgement about the cause of a
problem as separate from judgement about solutions to the problem. Hence in a
92
health-related context, attributions concerning the origin of an illness will not
necessarily be the same as attributions concerning its treatment or course.

2.3. The Health Perception Approach

This view is based on the notion that illness related to behaviours result from a
series of decisions based on how patients view their current health situations
(Garrity and Lawson, 1989). Therefore, a patient‘s understanding of his or her
clinical status is seen as equally important as actual physical status in
determining behavioural health outcomes such as return to work and resumption
of activities. Patient‘s mood and behaviour concerning their illness are seen as
resulting from what they believe about how severe their disorder is, and, within
the limits of the patient‘s actual physical disability, recovery is bound to health
perceptions.

2.4 Social Networks/Social Support Theories

Most health educators today recognize the critical importance of the social
environment and advocate changes in the social ecology which is supportive of
individual change leading to better health and a higher quality of life. However,
within the community, long-term behavior change depends on the level of
participation and ownership felt by those being served. In order to see how
Social Networks and Social Support Theories might impact on health needs, it
is thus necessary to define what is meant by certain concepts.
Social networks can be kin (extended family) or non-kin (church or work
groups, friends or neighbours who regularly socialize in clubs and sporting
teams). Social networks have certain types of characteristics:
(1) Structural, such as size (number of people) and density (extent to which
members really know one another);

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(2) Interactional, which include reciprocity (mutual sharing), durability (length
of time in relationship), intensity (frequency of interactions between members),
and dispersion (ease with which members can contact each other); and
(3) Functional, such as providing social support, connections to social contacts
and resources, and maintenance of social identity.
Social support refers to the varying types of aid that are given to members of a
social network. Research indicates that there are four kinds of supportive
behaviors or acts:
(1) Emotional support - listening, showing trust and concern;
(2) Instrumental support - offering real aid in the form of labor, money, time;
(3) Informational support - providing advice, suggestions, directives, referrals;
and
(4) Appraisal support -affirming each other and giving feedback. This social
support is given and received through the individual's social network. However,
it is important to remember that "some or all network ties may or may not be
supportive."

2.5 Naturalistic Model

In naturalistic causation, illness is explained in impersonal terms. When the
body is in balance with the natural environment, a state of health prevails.
However, when that balance is disturbed, illness results. Often, people invoke
both types of causation in explaining an episode of illness, and treatment may
entail two corresponding types of therapy.
Naturalistic theories of disease causation tend to view health as a state of
harmony between a human being and his or her environment; when this balance
is upset, illness will result.

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In-text Question 1 Identify the three models categorized under the expectancy value
principles.

Answer The Social Learning theory, Fishbein‘s Theory of Reasoned Action and The Health
Belief Model

3.0 Tutor Marked Assignments (Individual or Group)

Identify the views of the following models of health/illness
• The Naturalistic model of Illness
• The Health Perception model
• Attribution model
• The Social support theory

4.0 Conclusion/Summary
As we have seen, theories about health and illness deal with ideas people use
to maintain a healthy state.
Such ideas spanned from perceptual, social and expectancy values.
Expectancy-Value Approach looked at motivation and health/illness
behaviour. Thus, the Social Learning perspective is of the notion that the
potential for an illness or health beahviour is a function of expectancy that
the behaviour will lead to a particular reinforcement. The Feinbein‘s Theory
of Reason Action is also based on the assumption that most human
behaviour – health/illness behaviour is under voluntary control and hence
largely guided by intentions. For the Health Belief Model, its approaches and
principles are based on how individuals predict and behave in health context.
Also, attribution theory is concerned with how individuals explain events. To
Health Perception Approach, health/illness related behaviour results from a
series of decisions based on how patients view their current health status,
while the naturalistic model saw illness as resulting from imbalance between
the nature and the body. Lastly, the social support view, looked at the
varying types of aid that are given to members of a social network.
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 This unit highlighted different theoretical perspectives to health/illness and
thus provided insights and understanding of health/illness behaviour. It first
looked at the Expectancy-Value Models of illness; secondly, it looked at the
role of attribution and health perception on illness perceptions. Finally, it
analyzed the naturalistic viewpoints to illness causation. I hope you found
this unit interesting. Now let us do some exercises.

5.0 Self-Assessment Questions

1. Identify the three models categorized under the expectancy value
principles.
2. Give a brief description of each.

6.0 References/Further Readings

Becker, M. H. (1974). The Health Belief Model and personal health behaviour.
Health Education Monographs, 2, 324-508.
Brickman, P., Kidder, L. M., Coates, D., Rabinowitz, V., Colin, E. and Karuza,
J. (1983). The dilemma of helping: making aid fair and effective. In J.
Fisher, A.Nedler and P. Depaulo (Eds). Directions in elping (Vol 1, pp.
17-49). NY: Academic press.
Cockerham, W. C. (2003). Medical Sociology. (9th edition). NY: Prentice Hall:
Encyclopedia of Public Health, (2002). The Gale Group Inc.
Fishbein, M., & Ajzen, I. (1975). Belief, attitude, intention, and behaviour : An
introduction to theory and research. Reading Mass, Don Mills, Ontario:
Addison-Wesley Pub. Co.
Garrity, T. F. and Lawson, E. J. (1989). Patient-physician communication as a
determinat of medication misuse in older minority women. Journal of
Drug Issues, 19, 245-259.
Kelly, H. H. and Michela, J. L. (1980). Attribution Theory and Research.
Annual Review of Psychology, Vol 31: 457-501.

96
Levenson, A. H. (1973). Multidimensional locus of control in psychiatric
patients.Journal of Consulting and Clinical Psychology, 41, 347-404.
Rockeach, M. (1973). The nature of human values. NY: Free Press.
Rotter, J. B. (1954). Social learning and clinical psychology. NY: Prentice Hall.
Rotter, J. B. (1966). Generalized expectancies for internal versus external
control of reinforcement. Psychological Monographs, 80, (whole number
609).
Stone, G. C. (1990). An international review of the emergence and development
of health psychology. Psychology and Health, 4, 3-17.
Strickland, B. R. (1978). Internal-external expectancies and health related
behaviours. Journal of Consulting and Clinical Psychology, 46, 1192-
1211.
Taylor, S. (2006). Health Psychology (6th edition). Los Angeles: McGraw Hill.
Weiss, L. G. and Lonnquist, L. E. (2005). The Sociology of Health, Healing and
Illness, (5th edition). Safari book online. Retrieved from
http//www.safari.com/0131928406/ch07iev1sec3. Site visited on 17th
March 2007.

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 MODULE 2
Attitude Change and Specific Health Behaviour Problems and
Conceptualising illness Behaviour
Contents
Study Session 1: Preventive Health Behaviour
Study Session 2: Attitude Change and Health Promotion Addressing Specific
Health Behaviour Problems
Study Session 3: Defining Illness Behaviour
Study Session 4: Symptom Experience and the Sick Role

STUDY SESSION 1
Preventive Health Behaviour
Section and Subsection Headings:
Introduction
1.0 Learning Outcomes
2.0 Main Content
2.1 Understanding Preventive Health Behaviour
2.2 Determinants of Preventive Health Behaviour
1.2 Major Trends in Preventive Health Behaviour
3.0 Tutor Marked Assignments (Individual or Group assignments)
4.0 Study Session Summary and Conclusion
5.0 Self-Assessment Questions
6.0 Additional Activities (Videos, Animations & Out of Class activities)
7.0 References/Further Readings

Introduction:
In the developed and other developing countries, premature death and disability
results mainly from chronic diseases such as heart disease, stroke, cancer,

98
injury, chronic obstructive pulmonary disease, arthritis, e.t.c. Many of these
illnesses have been characterized as resulting largely from "accumulated,
multiple indiscretions" (Westberg and Jason 1996, p. 145) and linked to
habitual, and sometimes harmful, ways of living. It follows that considerable
morbidity and premature mortality could be reduced if individuals practiced
certain preventive health behaviors. Such preventive health behaviours will be
discussed in this unit

1.0 Study Session Learning Outcomes

After studying this session, I expect you to be able to:
1. Describe preventive health behaviour
2. Construct/deconstruct the determinants of preventive health
3. Explain the major trends in preventive health behaviours behaviour

2.0 Main Content

2.1 Understanding Preventive Health Behaviour
There is no one theory or concept that explains why people perform certain
behaviors. Many theories have been developed to describe, understand, explain,
and influence health-related behavior. Although these theories contribute
substantially to our understanding of individual behavior, they are often limited
because the broader social and environmental context in which an individual
lives is not taken into account. It is becoming increasingly recognized that
individual unhealthful behaviors reflect the social, cultural, and environmental
contexts within which they occur.
Theories, that assist our understanding of preventive health behaviors, can be
divided into three categories:
1. Theories that describe the health behavior and behavior change of
individuals. Commonly used theories include the health belief model; the theory
of reasoned action; the trans-theoretical (or stages of change) model; and social

99
cognitive theory (Pronchaska and DiClemente, 1984; Strecher and Rosenstock,
1997; Rogers, 1983; Bandura, 1986).
2. Theories that describe the behavior of communities and environmental
changes, such as the diffusion of innovation theory and the communication-
behavior change model (McGuire, 1989).
3. Theories that help people understand different approaches to societal change,
such as community organization theories (Ajzen and Fishbein, 1980).
These and other theories help to explain "why we do what we do when we do
it." Their common thread is the belief that if a person performs a health-related
behavior, the chances of acquiring a disease or an illness will decrease.
Preventive health behavior generally follows from a belief that such behavior
will benefit health. An obvious example is quitting smoking to reduce the
chances of early morbidity and mortality. It does not follow, of course, that all
beliefs on which preventive behaviors are based are well founded, nor that the
resulting behaviors will have the desired outcomes. Many preventive behaviors
have never been demonstrated to be effective, such as megadoses of vitamin C
to prevent the common cold.
Preventive actions can reduce, but not eliminate, the chances of acquiring a
disease or illness. The strength of the cause and effect relationship between a
certain behavior and the health problem one is trying to prevent will determine
the impact performing the behavior will have on reducing the risk. This impact
is measured in terms of attributable risk. Attributable risk is a measure of the
chance of acquiring a disease if the risk factors for it are eliminated or
preventive health behavior is engaged in. The chances are influenced by the
relationship of the preventive behavior to the etiology of the disease. Most
people are aware that if you smoke you have an increased risk of getting lung
cancer. Data indicate that almost 90 percent of lung cancer cases in males and
79 percent in females can be attributed to smoking, according to the Office on
Smoking and Health. Some people who do not smoke get lung cancer, of

100
course, but the numbers are small. Similarly, wearing a seat belt reduces the
chance of dying in an automobile crash, yet it does not guarantee that the
individual involved will not be seriously hurt.

2.2. Determinants of Preventive Health Behaviour

Although individual actions contribute to a person's health behavior, preventive
health behavior is not totally volitional. Socio-cultural and environmental
aspects of a person's life influence preventive health behavior, and these factors
can have minimal to great effect in determining whether a preventive health
behavior is performed.
Some preventive health-related behaviors occur for reasons unrelated to
health. Cultural traditions, attitudes, and beliefs can play an important role in
the ways in which people behave. In Mediterranean countries, the traditional
diet has been found to be an important preventive diet. The traditional meal
is often cooked in olive oil, which may help in preventing heart disease.
• Social, economic, and cultural determinants of behaviors are closely
linked. For many years it was unfashionable for women to smoke
cigarettes. In the decades since this taboo was removed, there have been
substantial gender-related changes in the overall burden of smoking-
related diseases. Between 1981 and 1996 the per-person mortality burden
of smoking-related diseases such as lung cancer and chronic obstructive
pulmonary disease decreased by 15 percent and 16 percent, respectively,
for males, but increased by 62 percent and 70 percent for females.
Currently, 24.2 percent of adult men and 20.9 percent of adult women
smoke cigarettes, according to the Centers for Disease Control and
Prevention (CDC).
• Preventive health-related behaviors are also undertaken specifically to
improve or enhance health. These types of behavior include both primary
prevention and early detection. Primary prevention behaviors aim to
101
 prevent the incidence of disease (the number of new cases occurring
within a given time frame). Exercise to improve aerobic fitness and
prevent cardiovascular disease is an example of a primary preventive
behavior. People who increase their levels of physical activity have been
found to have reduced levels of risk factors such as high blood pressure,
high blood cholesterol, and excess body fat. Early detection (or
secondary prevention) behaviors aim to prevent early forms of disease
from progressing. This involves people who have already developed
preclinical disease or risk factors for disease but in whom the disease has
not yet become clinically apparent. Behaviors such as having a breast
screen (mammogram) or a pap test for cervical cancer are intended to
detect disease early so it can be treated promptly (Westbeng and Janson,
1996).
• Some preventive health-related behaviors may, or may not, improve
health outcomes. It is becoming increasingly common for people to use a
range of complementary and alternative medicines to improve their
health. The 1995 Australian National Health Survey estimated that
almost 26 percent of the population used vitamin or mineral
supplements, and over 9 percent used herbal or natural medications.
Females used these therapies more than males. These behaviors are
undertaken with the hope of improving health without clear evidence that
the practice has beneficial effects for individuals or populations

2.3. Major Trends in Preventive Health Behaviour

Despite the general good health of people in developed and developing
countries, there is still considerable scope for improvement in preventive health
behaviors. Unfortunately, the last years of the twentieth century and early
twenty first century saw only modest improvements in this area.

102
The number of people using seat belts has improved due to several sensitization
programmes. This period also saw a reduction in the number of people reporting
driving while over the blood alcohol limit and a reduction in alcohol-related
motor vehicle deaths. Also, economic hardship in some countries may have
stopped many from drinking excessively.
In African countries, society frowns at women that smokes so cases of lung
cancer is not very common among this group, though, the younger generation
appears to be smoking more than the older ones.
Although there is a strong association between dietary behavior and many
chronic illnesses, there has been little change in terms of people following
dietary guidelines or eating fresh fruits and vegetables. Obesity has
continued to increase, with no real change in physical activity.

In-text Question 1 What do you understands by preventive Health behaviour?

Answer Preventive health related behaviour are also undertaken specifically to improve or
enhance health. These types of behaviour include both primary prevention and early
detection.

3.0 Tutor Marked Assignments (Individual or Group)

Describe the determinants of preventive health behaviour

4.0 Conclusion/Summary
It is clear that individual preventive behaviors such as eating healthy,
exercising regularly, moderation in the use of alcohol and the avoidance of
tobacco and tobacco products can contribute greatly to a person's health.
However, preventive health behavior is but one element within a complex
range of influences on health. Biological, social, environmental, and
economic factors also play a role. Together these influence the health
outcomes for individuals as well as for populations.
I hope you enjoyed reading through this unit. In this unit, we looked at

103
 the concept of preventive health behaviour, its determinants as well as major
trends in preventive health behaviours. Now let us attempt the following
questions presented below.

5.0 Self-Assessment Questions

1. What do you understand by preventive health behaviour?

6.0 References/Further Readings

Ajzen, I., and Fishbein, M. (1980). Understanding Attitudes and Predicting
SocialBehavior. Englewood Cliffs, NJ: Prentice Hall.
Bandura, A. (1986). Social Foundations of Thought and Action: A Social
Cognitive Theory. Englewood Cliffs, NJ: Prentice Hall.
Glanz, K.; Lewis, F.; and Rimer, B. (1997). Health Behavior and Health
Education: Theory, Research and Practice. San Francisco: Jossey Bass.
McGuire, W. J. (1989). "Theoretical Foundations of Campaigns." In Public
Communication Campaigns, eds. R. E. Rice and C. Atkin. Thousand
Oaks, CA: Sage.
Office on Smoking and Health (1989). Reducing the Health Consequences of
Smoking: A Report of the Surgeon General. Washington, DC: U.S.
Department of Health and Human Services.
Prochaska, J. O., and DiClimente, C. C. (1984). The Transtheoretical
Approach: Crossing Traditional Boundaries of Therapy. Homewood, IL:
Dow Jones Irwin.
Rogers, E. M. (1983). Diffusion of Innovations, 3rd edition. New York: Free
Press.
Strecher, V. J., and Rosenstock, I. M. (1997). "The Health Belief Model." In
Health Behavior and Health Education: Theory, Research and Practice,
ed. K. Glanz et al. San Francisco: Jossey- Bass.

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U.S. Department of Health and Human Services (1995). Healthy People 2000
Review: 1994. USDHHS publication no. PHS 95–12561. Washington,
DC: U.S. Government Printing Office.
Westberg, J., and Jason, H. (1996). "Influencing Health Behavior." In Health
Promotion and Disease Prevention in Clinical Practice, eds. S. H.
Woolfe, S. Jonas, and R. Lawrence. Baltimore, MD: Williams and
Wilkins.

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 STUDY SESSION 2
2A. Attitude Change and Health Promotion
Section and Subsection Headings:
Introduction
1.0 Learning Outcomes
2.0 Main Content
2.1 Principles used to promote attitude change and positive health
behaviour
2.1.1 Information Appeals
2.1.2 Persuasion
2.1.2.1 Key factors in Persuasion
2.1.3 Fear Appeal
2.1.4 Mass Media Appeal
2.1.5 Self help Groups
2.2 Health Promotion in the schools
2.3 Health Promotion in the work place
1.3 Health Promotion in the communities
3.0 Tutor Marked Assignments (Individual or Group assignments)
4.0 Study Session Summary and Conclusion
5.0 Self-Assessment Questions
6.0 Additional Activities (Videos, Animations & Out of Class activities)
7.0 References/Further Readings

Introduction:
How can we encourage healthy living? One way is through changing people‘s
attitudes and beliefs. As noted earlier, two of the major Theoretical approaches
to healthy behaviour: the health belief model and the theory of reasoned action
emphasize belief and attitude as determinants of people‘s health practices. Both
theories also argued for changes in attitude and belief as prerequisites for

106
changes in health behaviour. Thus, according to HBM, promoting positive
health behaviours requires that we persuade people that they are susceptible to
given diseases such as AIDS, Cancer or heart disease and there are effective
ways of preventing these illnesses. Alternatively, the TRA argues that attempts
to change health behaviours need to produce change in people‘s attitudes
towards behaviours such as smoking cessation and exercise, as well as convince
people that such behavioural changes will be viewed positively by others.

1.0 Study Session Learning Outcomes

After studying this session, I expect you to be able to
1. Explain the principles used to promote attitude change and positive health
behaviour.
2. Construct/deconstruct the goals of health promotion in schools, workplaces
and communities.

2.0 Main Content

2.1 Principles Used to Promote Attitude Change and Positive Health
Behaviour
How can we go about promoting these attitude changes? This question has been
the focus of great deal of research among health professionals. Beginning in the
1950‘s, many studies have examined in great detail how people respond to
persuation attempts and the process involved. From these researches have come
principles that can be used to promote attitudes and beliefs conducive to good
health behaviour (Bishop, 1994). The following are some of the principles
identified:
2.1.1 Information appeals
Promoting good health behaviour requires that people be aware of the
connections between behaviour and health and know what is involved in
healthy behaviour. For example, motivating people to eat a balanced and

107
healthy diet or engage in more physical exercise demands that they be aware of
the role of diet and exercise in health and realize their importance. So, a
necessary step in changing health behaviour is providing people with
information to guide their actions.
This is a simple enough proposition, but there is more to information appeal
than simply providing the information. Bringing about changes in behaviour
through information appeals involves at least five different processes.
(McGiure, 1969). They are:
We need to get the audience attention: This is no mean feat, considering the
amount of information that people are constantly bombarded with. Once a
message is received, the next step is comprehension. For a message to be
comprehensive, it must be presented in terms that are understandable to the
audience and that fit their conceptions of health and illness. Assuming the
message is understood by the audience, the third step in persuasion is yielding,
that is, accepting the position advocated by the message. For information to
have a long-term effect there must also be message retention, and finally, action
in which the person‘s behaviour changes to become healthier.

2.1.2 Persuasion
How can we facilitate these processes and increase the likelihood that health
information will be effective in changing health behaviour? Studies of
persuasion have identified key factors in persuasion. They are:
2.1.2.1 Key factors in persuasion
• First, the effectiveness of a message often depends on who presents it. It
is clearly advantageous for a message to be delivered by a communicator
who is perceived as an expert or trustworthy. For health messages,
physicians and other health professionals are ideal communicators,
especially when they are well known and prestigious. Also, traditional
rulers, religious heads, non-governmental organizations, parents, etc.
108
 could also act as communicators of health messages, especially in the
area of HIV/AIDS and safe sex.
• Secondly, messages are more likely to be accepted when they are
presented by communicators who are attractive (Chaiken, 1979),
confident in their delivery and perceived as similar to the audience. For
example, information on female genital mutilation or Vesico Vaginal
Fistula is more likely to be accepted when presented by a female health
worker or the head of an NGO working in that area than the opposite.

2.1.3 Fear appeal

One of the more common approaches to attitude change is to try to motivate
change in behaviour through the use of fear. The idea is that people will be
more likely to accept a message and change their behaviours if their fears and
apprehension are appealed to. Such an approach is particularly relevant to health
behaviour since the objective of changing health behaviour is to avoid future
disease and disability. Thus the message often has a built-in component of fear
(Bishop, 1994). For example, recent efforts aimed at encouraging ‗safe sex‘ are
designed to convince people to change their sexual behaviour so as to avoid the
threat of AIDS. Given the fear of AIDS, such messages are implicitly, if not
explicitly, designed to motivate behaviour change through arousing fear.
Similarly, efforts to persuade people to stop smoking are often based on
appealing to their fear of cancer and heart diseases.

2.1.4 Mass media appeal

Another means of influencing people‘s attitudes and health behaviour that
would seem promising is through the mass media. In modern technological
societies, there are few people who are not touched in one way or another by
television, radio, newspaper and other mass media. Overall, the primary value
of mass media appeals lies in their cumulative effects. Although, individual
109
media messages and campaigns may have relatively weak effects, the
summation of multiple messages over time can be quite impressive. A good
example is the daily and consistent campaign against HIV/AIDS infection, thus
reducing the statistics of HIV/AIDS in most countries.

2.1.5 Self-help groups

The discussion above considers programmes that rely on professionals to assist
in bringing about behaviour change. What about programmes in which people
with problem health behaviours help themselves and others with similar
problems. Interest in self-help groups for a variety of problems, including
chronic ailments like HIV/AIDS, Cancer, Alcoholism, weight problems,
physical deformities, etc, have dramatically increased in recent years. All these
groups are based on the idea that no one is better able to help another with a
problem than someone who has experienced or is experiencing the problem first
hand. Further, by helping others, the helper is also helped. This is what Alan
Gartner and Frank Riessman (1984), called the ‗helper therapy principle‘.
Groups play a critical role of providing its members with support,
reinforcement, sanction and feedback. Thus, it enhances the power of the
individual members to deal with the problem.

2.2 Health promotion in the schools

By their nature, schools provide an ideal setting for promoting positive health
behaviour. Childhood is the time when many lifelong behaviour patterns are
being formed, and the amount of time children spend in the classroom makes
school settings attractive as an intervention site. Thus many have called for
comprehensive health education in schools because it is believed that such
programmes would help children understand personal and societal health issues.
It will also increase their competency to make informed decisions about health
behaviours that effect health.

110
2.3 Health promotion in the work place
Whereas schools provide a seemingly ideal location for promoting health in
children, the work place has considerable potentials for encouraging good
health habits in adults. Working adults spend a great deal of time at their places
of work. Thus, the work place has a large captive audience that can potentially
be influenced to adopt positive health habits. From an employee‘s point of view,
there are some economic and humanitarian reasons for promoting healthy
living. It is evident that the annual cost of treating preventable diseases runs into
millions of Naira or Dollars, including the direct cost of disease treatment and
indirect costs from lost productivity, absenteeism, and employee turnover.
Recent years have witnessed a veritable explosion of health promotion
programmes in the work place. Programmes range in size from few lectures on
health topics such as stress management, nutrition, exercise, to extensive
programmes involving large, well-staffed exercise and health facilities.

2.4 Health promotion in the communities

Several of the approaches already described have been aimed at specific
segments of the population such as school children and adult employees, what
about health promotion programmes that target entire communities? Might there
be advantages to developing programmes that can be applied across the board to
everyone living in a particular area? The answer is clearly yes. Stephen Weiss
(1984) points out several advantages for community-based prevention
programmes.
Such programmes use prevention methods that apply to the environments in
which people live. One problem with programmes limited to the clinic, schools
or work place is that person‘s behaviour might be effectively changed in that
setting, but the change may not generalize to other environments. Because
members of the target population all live in the same community, community-
based programmes enhance opportunities for information exchange and social

111
support among programme participants. Further, because of their scale,
community-based programmes can minimize the per capital cost.
By their nature, community based interventions are complex undertakings. To
be comprehensive and effective, such programme typically involves multi
channels such as mass media campaigns, work place programmes, health
education programmes in the schools, physician appeals and face-to-face
counseling (Puska, 1984)

In-text Question 1 Identify the principles used to promote attitude change and positive health
behaviour

Answer
Fear appeal
Persuasion
Information appeal
The Mass media
Self help group

3.0 Tutor Marked Assignments (Individual or Group)

1. Discuss the principles used to promote attitude change and positive health
behaviour
2. Briefly discuss health promotions in school, workplace and communities.

4.0 Conclusion/Summary
Does changing attitudes change health behaviour? Studies of persuasion
demonstrate convincingly that people‘s attitudes can be changed through
information and fear appeals. Although this is encouraging and provides us with
an important first step, it is only a first step. For attitude change to promote
good health, the changes must not be only in attitude, but in behaviour also.
Thus, our interest in attitude change is predicated on the assumption that
changes in attitudes will be reflected in people‘s behaviour.

112
In this unit, we looked at basic principles employed to promote attitude change
and positive health behaviour. We further discussed issues of health promotion
in schools, work place and the communities. We hope you enjoyed this unit.
Now let us attempt the questions below.

5.0 Self-Assessment Questions

Identify the principles used to promote attitude change and positive health
behavior.

6.0 References/Further Readings

Bishop, G. D. (1994). Health Psychology: Integrating mind and body. Boston:
Allyn and Bacon.
Chaiken, S. (1979). Communicator physical attractiveness and persuasion.
Journal of Personality and Social Psychology, 37, 1387-1397.
Cockerham, W. C. (2003). Medical Sociology. (9th edition). NY: Prentice
Hall:Encyclopedia of Public Health, (2002). The Gale Group Inc.
Gartner, A. and Reissman, E. (Eds). (1984). The self-help revolution. New
York: Human Science Press.
McGuire, W. J. (1969). Taylor, S. (2006). Health Psychology (6th edition). Los
Angeles: McGraw Hill.
Puska, P. (1984). Community based prevention of cardiovascular disease: The
North Karelia Project. In J. D. Matarazzo, S. M. Weiss, J. A. Herd, N. E.
Miller and S. M. Weiss (Eds). Behavioural Health: A handbook of health
enhancement and disease prevention. New York: Wiley.
Weiss, L. G. and Lonnquist, L. E. (2005). The Sociology of Health, Healing and
Illness, (5th edition). Safari book online. Retrieved from
http//www.safari.com/0131928406/ch07iev1sec3. Site visited on 17th
March 2007.

113
 STUDY SESSION 2 CONTD.
2B: Addressing Specific Health Behaviour Problems
Section and Subsection Headings:
Introduction
1.0 Learning Outcomes
2.0 Main Content
2.1 Alcohol Abuse
2.1.1 Causes of Alcohol Abuse
2.2 Obesity
2.2.1 Causes of Obesity
2.3 HIV/AIDS
2.3.1 Causes of HIV/AIDS
2.3.1.1 Sexual Contact
2.3.1.2 Exposure to Infected Body Fluid
2.3.1.3 Mother-to-child Transmission
3.0 Tutor Marked Assignments (Individual or Group assignments)
4.0 Study Session Summary and Conclusion
5.0 Self-Assessment Questions
6.0 Additional Activities (Videos, Animations & Out of Class activities)
7.0 References/Further Readings

Introduction:
So far, we have considered the processes that determine people‘s health
behaviour and some of the basic techniques available for influencing those
behaviours. We are now ready to take up applications of these principles to
specific health problems. The unit thus considers alcohol abuse, obesity, and
HIV/AIDS which forms one of the main products of risky sexual behaviours.
These 3 specific health problems form just a small sample of the very many
health behaviour problems.

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1.0 Study Session Learning Outcomes
After studying this session, I expect you to be able to:
1. Describe alcohol abuse and its health implications
2. Explain causes of alcohol abuse
3. Analyse obesity and its causes
4. Developin detail, the symptoms and causes of HIV/AIDS

2.0 Main Content

2.1 Alcohol Abuse
Data on consumption of alcoholic beverages indicate that the use and abuse of
alcohol is widespread throughout the world. Alcohol consumption differs
significantly between countries, but all countries have at least some individuals
who drink to excess. Along with tobacco, alcohol consumption is a major
source of disease and death. Although some evidence indicates that the
consumption of moderate amounts of alcohol may, in fact, be beneficial to one‘s
health, the extended heavy drinking of alcohol and the consumption of alcohol
under certain circumstances can produce serious health effects, including
cirrhosis of the liver, gastrointestinal problems, lung disease, and neurological
problems. Among the latter is the Wermick-Korsakoff Syndrome, a psychotic
condition characterized by severe memory deficits and confusion, as well as
visual and movement difficulties. One of the most heart wrenching effects of
alcohol use is the Fetal Alcohol Symdrome (FAS), in which the consumption of
alcohol by a woman during pregnancy can lead to serious health problems of
the child, including growth deficiencies, central nervous system difficulties,
facial abnormalities and mental retardation (Benzer, 1987).
In addition to the direct medical complications of alcohol use, the consumption
of alcohol also has many indirect effects. For example, a good number of traffic
accidents, suicides and homicides could be attributed to alcohol related habits.

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Also, the abuse of alcohol could cost a country a huge amount of money, as
indirect cost of treatment, crime and vehicular accidents.

2.1.1 What causes alcoholism?

Alcoholism generally refers to alcohol consumption that is compulsive,
addictive or habitual and results in serious threat to a person‘s health and well-
being.
What is it that leads to alcoholism and why are some people able to consume
alcohol in moderate quantities while others become alcoholics?
The causes of alcoholism have been widely debated for a long time. Probably
the most popular theory is that alcoholism is a disease (Gitlow, 1973, Jellinek,
1960). According to this model, the alcoholic sometimes differ from others who
consume alcohol. Although most people can control their drinking, the alcoholic
cannot. After a drink or two, an alcoholic experiences a physiological addictive
response triggered by the alcohol consumed, which leads to an irresistible
craving for more alcohol. The person is then unable to stop drinking until
intoxication occurs or the person runs out of alcohol drinks. Despite its
popularity, the disease model was seriously criticized by several alcoholism
researchers (Marlatt, 1979, Peele, 1984). Among the criticisms are that the
disease model does not address why people drink or adequately describe the
process by which a person becomes an alcoholic. Further, it does not explain
how it is that many problem drinkers cease their problem drinking without
treatment or account for alcoholics who learn to drink in a controlled manner
(Peele, 1984).
Whereas the disease model seeks the causes of alcoholism in the biological
makeup of the person, the social learning model looks to the social
environment. According to this model, alcoholism is a learned addictive
behaviour that can be unlearned. Several studies have also provided evidence
that drinking patterns are related to the person‘s social environment. For

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example, parent drinking and drinking by peers are significantly related to onset
of drinking habit in adolescents (Monti, Abrams, Kadden and Cooney, 1989). In
addition, the amount that a person drinks in a particular situation can be
significantly influenced by the drinking behaviour of a model (parents, friends).
Beyond this, there is also evidence that the likelihood of becoming an alcoholic
is increased if the person has a history of deviant behaviour and lacks the social
skills for dealing with distressed situation (Zucker and Golberg, 1986).

2.2 Obesity
Obesity is a condition in which the natural energy reserve, stored in the fatty
tissue of humans and other mammals, is increased to a point where it is
associated with certain health conditions or increased mortality. Obesity is both
an individual and clinical condition and is increasingly viewed as a serious
public health problem. Excessive body weight has been shown to predispose to
various diseases, particularly cardiovascular diseases, diabetes mellitus type 2,
sleep apnea, and osteoarthritis
Obesity, especially central obesity (male-type or waist-predominant obesity), is
an important risk factor for the "metabolic syndrome" ("syndrome X"), the
clustering of a number of diseases and risk factors that heavily predispose for
cardiovascular disease. These are diabetes mellitus type 2, high blood pressure,
high blood cholesterol, and triglyceride levels (combined hyperlipidemia). An
inflammatory state is present, which — together with the above — has been
implicated in the high prevalence of atherosclerosis (fatty lumps in the arterial
wall), and a prothrombotic state may further worsen cardiovascular risk
(Powdemaker, 1997).
Apart from the metabolic syndrome, obesity is also correlated (in population
studies) with a variety of other complications. For many of these complaints, it
has not been clearly established to what extent they are caused directly by
obesity itself, or have some other cause (such as limited exercise) that causes

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obesity as well. Most confidence in a direct cause is given to the mechanical
complications in the following list:
• Cardiovascular: congestive heart failure, enlarged heart and its associated
arrhythmias and dizziness, cor pulmonale, varicose veins, and pulmonary
embolism.
• Endocrine: polycystic ovarian syndrome (PCOS), menstrual disorders,
and infertility.
• Gastrointestinal: gastroesophageal reflux disease (GERD), fatty liver
disease, cholelithiasis (gallstones), hernia, and colorectal cancer.
• Renal and genitourinary: erectile dysfunction, (Esposito et al, 2004),
urinary incontinence, chronic renal failure, (Ejerblad, et al, 2006),
hypogonadism (male), breast cancer (female), uterine cancer (female),
stillbirth.
• Integument (skin and appendages): stretch marks, acanthosis nigricans,
lymphedema, cellulitis, carbuncles, intertrigo
• Musculoskeletal: hyperuricemia (which predisposes to gout), immobility,
osteoarthritis, low back pain
• Neurologic: stroke, meralgia paresthetica, headache, carpal tunnel
syndrome, dementia (Whitmer et al, 2005).
• Respiratory: dyspnea, obstructive sleep apnea, hypoventilation syndrome,
pickwickian syndrome, asthma
• Psychological: Depression, low self esteem, body dysmorphic disorder,
social stigmatization
While being severely obese has many health ramifications, those who are
somewhat overweight face little increased mortality or morbidity. Some studies
suggest that the somewhat "overweight" tend to live longer than those at their
"ideal" weight (Giugliano, Di Palo, Giugliano, Marfella, D‘Andrea, D‘Armiento
and Giugliano, 2004). This may in part be attributable to lower mortality rates

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in diseases where death is either caused or contributed to by significant weight
loss due to the greater risk of being underweight experienced by those in the
ideal category. Another factor which may confound mortality data is smoking,
since obese individuals are less likely to smoke (Giugliano, Di Palo, Giugliano,
Marfella, D‘Andrea, D‘Armiento and Giugliano, 2004).

2.2.1 Causes of obesity

Overeating
In its simplest conception, obesity is only made possible when the lifetime
energy intake exceeds lifetime energy expenditure by more than it does for
individuals of "normal weight". When food energy intake exceeds energy
expenditure, fat cells (and to a lesser extent muscle and liver cells) throughout
the body take in the energy and store it as fat.

Additional factors
Factors that have been suggested to contribute to the development of obesity
include:
✓ Genetic factors and some genetic disorders (e.g., Prader-Willi syndrome)
✓ Underlying illness (e.g., hypothyroidism)
✓ Eating disorders (e.g., binge eating disorder)
✓ Certain medications (e.g., atypical antipsychotics, some fertility
medication)
✓ Sedentary lifestyle
✓ A high glycemic diet (i.e., a diet that consists of meals that give high
postprandial blood sugar)
Weight cycling, caused by repeated attempts to lose weight by dieting.
As with many medical conditions, the caloric imbalance that results in obesity
often develops from a combination of genetic and environmental factors.
Various genetic abnormalities that predispose to obesity have been identified

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(such as Prader-willi syndrome and leptin receptor mutations), but known
single-locus mutations have been found in only about 5% of obese individuals.
While it is thought that a large proportion of the causative genes are still to be
identified, much obesity is likely the result of interactions between multiple
genes, and non-genetic factors are likely also important (Giugliano, et al, 2004).

2.3. HIV/AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency
syndrome (AIDS) is a collection of symptoms and infections resulting from the
specific damage to the immune system caused by the human immunodeficiency
virus (HIV) (Marx (1982). The late stage of the condition leaves individuals
prone to opportunistic infections and tumors. Although treatments for AIDS and
HIV exist to slow the virus's progression, there is no known cure. HIV is
transmitted through direct contact of a mucous membrane or the bloodstream
with a bodily fluid containing HIV, such as blood, semen, vaginal fluid,
preseminal fluid, and breast milk (Divisions of HIV/AIDS Prevention, 2003).
This transmission can come in the form of anal, vaginal or oral sex, blood
transfusion, contaminated hypodermic needles, exchange between mother and
baby during pregnancy, childbirth, or breastfeeding, or other exposure to one of
the above bodily fluids.
Most researchers believe that HIV originated in sub-Saharan Africa during the
twentieth century (Gao, Bailes, Robertson, Chen, Rodenburg, Michael,
Cummins, Arthur, Peeters, Shaw, Sharp, and Hahn, (1999). It is now a
pandemic, with an estimated 38.6 million people now living with the disease
worldwide (UNAIDS, 2006). As of January 2006, the Joint United Nations
Programme on HIV/AIDS (UNAIDS) and the World Health Organization
(WHO) estimate that AIDS has killed more than 25 million people since it was
first recognized on June 5, 1981, making it one of the most destructive
epidemics in recorded history. In 2005 alone, AIDS claimed an estimated 2.4 to

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3.3 million lives, of which more than 570,000 were children (UNAIDS, 2006).
A third of these deaths are occurring in sub-Saharan Africa, retarding economic
growth and destroying human capital. Antiretroviral treatment reduces both the
mortality and the morbidity of HIV infection, but routine access to antiretroviral
medication is not available in all countries (Palella, Delaney, Moorman,
Loveless, Fuhrer, Satten, Aschman and Holmberg, 1998). HIV/AIDS stigma is
more severe than that associated with other life-threatening conditions and
extends beyond the disease itself to providers and even volunteers involved with
the care of people living with HIV.

2.3.1 Causes of HIV/AIDS

The three main transmission routes of HIV are sexual contact, exposure to
infected body fluids or tissues, and from mother to fetus or child during
perinatal period. It is possible to find HIV in the saliva, tears, and urine of
infected individuals, but there are no recorded cases of infection by these
secretions, and the risk of infection is negligible.

2.3.1.1 Sexual contact

The majority of HIV infections are acquired through unprotected sexual
relations between partners, one of whom has HIV. Sexual transmission occurs
with the contact between sexual secretions of one partner with the rectal, genital
or oral mucous membranes of another. Oral sex is not without its risks as HIV is
transmissible through both insertive and receptive oral sex (Rothenberg,
Scarlett, del Rio, Reznik, and O'Daniels (1998). The risk of HIV transmission
from exposure to saliva is considerably smaller than the risk from exposure to
semen; contrary to popular belief, one would have to swallow gallons of saliva
from a carrier to run a significant risk of becoming infected (UNAIDS, 2001).
Sexually transmitted infections (STIs) increase the risk of HIV transmission and
infection because they cause the disruption of the normal epithelial barrier by

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genital ulceration and/or microulceration; and by accumulation of pools of HIV-
susceptible or HIV-infected cells (lymphocytes and macrophages) in semen and
vaginal secretions. Epidemiological studies from sub-Saharan Africa, Europe
and North America have suggested that there is approximately a four times
greater risk of becoming infected with HIV in the presence of a genital ulcer
such as those caused by syphilis and/or chancroid. There is also a significant
increased risk in the presence of STIs such as gonorrhea, Chlamydial infection
and trichomoniasis which cause local accumulations of lymphocytes and
macrophages (Mastro, de Vincenzi 1996).
During a sexual act, only male or female condoms can reduce the chances of
infection with HIV and other STDs and the chances of becoming pregnant. The
best evidence to date indicates that typical condom use reduces the risk of
heterosexual HIV transmission by approximately 80% over the long-term,
though the benefit is likely to be higher if condoms are used correctly on every
occasion (Mastro, de Vincenzi 1996). The effective use of condoms and
screening of blood transfusion in Africa and other countries, is credited with
contributing to the lower rates of AIDS in these regions. Promoting condom
use, however, has often proved controversial and difficult.
Many religious groups, most noticeably the Roman Catholic Church, have
opposed the use of condoms on religious grounds, and have sometimes seen
condom promotion as an affront to the promotion of marriage, monogamy and
sexual morality. Defenders of the Catholic Church's role in AIDS and general
STD prevention state that, while they may be against the use of contraception,
they are strong advocates of abstinence outside marriage. This attitude is also
found among some health care providers and policy makers in sub-Saharan
African nations, where HIV and AIDS prevalence is extremely high. They also
believe that the distribution and promotion of condoms is tantamount to
promoting sex amongst the youth and sending the wrong message to uninfected
individuals. However, no evidence has been produced that promotion of

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condom use increases sexual promiscuity, and abstinence-only programs have
been unsuccessful both in changing sexual behavior and in reducing HIV
transmission (UNAIDS, 2006).
The United States government and health organizations both endorse the ABC
Approach to lower the risk of acquiring AIDS during sex:
Abstinence or delay of sexual activity, especially for youth,
Being faithful, especially for those in committed relationships,
Condom use, for those who engage in risky behavior.
This approach has been very successful in Uganda, where HIV prevalence has
decreased from 15% to 5%. However, more has been done than just this. As
Edward Green, a Harvard medical anthropologist, put it:
"Uganda has pioneered approaches towards reducing stigma, bringing
discussion of sexual behavior out into the open, involving HIV-infected people
in public education, persuading individuals and couples to be tested and
counseled, improving the status of women, involving religious organizations,
enlisting traditional healers, and much more."
However, criticism of the ABC approach is widespread because a faithful
partner of an unfaithful partner is at risk of contracting HIV and that
discrimination against women and girls is so great that they are without voice in
almost every area of their lives. Other programs and initiatives promote condom
use more heavily. Condom use is an integral part of the CNN Approach. This is:
Condom use, for those who engage in risky behavior,
Needles, use clean ones,
Negotiating skills; negotiating safer sex with a partner and empowering
women to make smart choices.

2.3.1.2 Exposure to infected body fluids

This transmission route is particularly relevant to intravenous drug users,
hemophiliacs and recipients of blood transfusions and blood products. Sharing

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and reusing syringes contaminated with HIV-infected blood represents a major
risk for infection with not only HIV, but also hepatitis B and hepatitis C. Needle
sharing is the cause of one third of all new HIV-infections and 50% of hepatitis
C infections in North America, China, and Eastern Europe. The risk of being
infected with HIV from a single prick with a needle that has been used on an
HIV-infected person is thought to be about 1 in 150. Post-exposure prophylaxis
with anti-HIV drugs can further reduce that small risk (Gao, Bailes, Robertson,
Chen, Rodenburg, Michael, Cummins, Arthur, Peeters, Shaw, Sharp, and Hahn,
1999). Health care workers (nurses, laboratory workers, doctors etc) are also
concerned, although more rarely. This route can affect people who give and
receive tattoos and piercings. Universal precautions are frequently not followed
in both sub-Saharan Africa and much of Asia because of both a shortage of
supplies and inadequate training. The WHO estimates that approximately 2.5%
of all HIV infections in sub-Saharan Africa are transmitted through unsafe
healthcare injections. Because of this, the United Nations General Assembly,
supported by universal medical opinion on the matter, has urged the nations of
the world to implement universal precautions to prevent HIV transmission in
health care settings (UNAID, 2006)
The risk of transmitting HIV to blood transfusion recipients is extremely low in
developed countries where improved donor selection and HIV screening is
performed. However, according to the WHO, the overwhelming majority of the
world's population does not have access to safe blood and "between 5% and
10% of HIV infections worldwide are transmitted through the transfusion of
infected blood and blood products".
Medical workers who follow universal precautions or body-substance isolation,
such as wearing latex gloves when giving injections and washing the hands
frequently, can help prevent infection by HIV.
All AIDS-prevention organizations advise drug-users not to share needles and
other material required to prepare and take drugs (including syringes, cotton

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balls, the spoons, water for diluting the drug, straws, crack pipes, etc). It is
important that people use new or properly sterilized needles for each injection.
Information on cleaning needles using bleach is available from health care and
addiction professionals and from needle exchanges. In some developed
countries, clean needles are available free in some cities, at needle exchanges or
safe injection sites. Additionally, many nations have decriminalized needle
possession and made it possible to buy injection equipment from pharmacists
without a prescription.

2.3.1.3 Mother-to-child transmission (MTCT)

The transmission of the virus from the mother to the child can occur in utero
during the last weeks of pregnancy and at childbirth. In the absence of
treatment, the transmission rate between the mother to the child during
pregnancy, labor and delivery is 25%. However, when the mother has access to
antiretroviral therapy and gives birth by caesarean section, the rate of
transmission is just 1%. (Coovadia, 2004). A number of factors influence the
risk of infection, particularly the viral load of the mother at birth (the higher the
load, the higher the risk). Breastfeeding increases the risk of transmission by
10–15%. This risk depends on clinical factors and may vary according to the
pattern and duration of breast-feeding.
Studies have shown that antiretroviral drugs, caesarean delivery and formula
feeding reduce the chance of transmission of HIV from mother to child. Current
recommendations state that when replacement feeding is acceptable, feasible,
affordable, sustainable and safe, HIV-infected mothers should avoid breast-
feeding their infant. However, if this is not the case, exclusive breast-feeding is
recommended during the first months of life and discontinued as soon as
possible (UNAIDS, 2006). In 2005, around 700,000 children under 15
contracted HIV, mainly through MTCT, with 630,000 of these infections
occurring in Africa. Of the estimated 2.3 million [1.7–3.5 million] children

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currently living with HIV, 2 million (almost 90%) live in sub-Saharan Africa
(UNAIDS, 2006).
Prevention strategies are well known in developed countries, however, recent
epidemiological and behavioral studies in Europe and North America have
suggested that a substantial minority of young people continue to engage in
high-risk practices and that despite HIV/AIDS knowledge young people
underestimate their own risk of becoming infected with HIV. However,
transmission of HIV between intravenous drug users has clearly decreased, and
HIV transmission by blood transfusion has become quite rare in developed
countries.

In-text Question 1 What is Alcoholism?

Answer Alcoholism refers to alcohol consumption that is compulsive, addictive or habitual

and result in serious threat to a person’s health and well being

What causes alcoholism?

Alcoholism generally refers to alcohol consumption that is compulsive,
addictive or habitual and results in serious threat to a person‘s health and well-
being.

3.0 Tutor Marked Assignments (Individual or Group)

1. Briefly discuss HIV/AIDS and its origin

4.0 Conclusion/Summary
This unit looked at 3 specific health problems – Alcohol abuse, obesity and
HIV/AIDS. The health problems addressed here of course formed just a small
sample of the very many health behaviour problems. This unit highlighted the
meaning and causes of the alcohol abuse, obesity and HIV/AIDS as well its
effects on health and well-being. For example, Acquired immune deficiency
syndrome, (AIDS) was viewed as a collection of symptoms and infections
126
resulting from the specific damage to the immune system caused by the human
immunodeficiency virus (HIV). The late stage of the condition leaves
individuals prone to opportunistic infections and tumors. Obesity was also seen
as a condition in which the natural energy reserve, stored in the fatty tissue of
humans and other mammals, is increased to a point where it is associated with
certain health conditions or increased mortality. In this unit, alcoholism was
conceptualized as alcohol consumption that is compulsive, addictive or habitual
and results in serious threat to a person‘s health and well-being.
I hope you enjoyed reading through this unit and also found the self assessment
exercise very helpful. Now let us attempt the question below.

5.0 Self-Assessment Questions

1. Describe the modes of transmission of HIV/AIDS

6.0 References/Further Readings

Benzer, D. G. (1987). Medical complications of alcoholism. In. R. N.
Herrington, G. R. Jacobson and D. G. Benzer (Eds). Alcohol and drug
abuse handbook. St louis: Warren H. Green.
Coovadia, H. (2004). "Antiretroviral agents—how best to protect infants from
HIV and save their mothers from AIDS". N. Engl. J. Med. 351 (3): 289–
292. PubMed.
Divisions of HIV/AIDS Prevention (2003). HIV and Its Transmission. Centers
for Disease Control & Prevention. Retrieved on 2006-05-23.
Ejerblad E, Fored CM, Lindblad P, Fryzek J, McLaughlin JK, Nyrén O (2006).
"Obesity and riskfor chronic renal failure". J. Am. Soc. Nephrol. 17 (6): 1695-
702.
Esposito K, Giugliano F, Di Palo C, Giugliano G, Marfella R, D'Andrea F,
D'Armiento M, Giugliano D (2004). "Effect of lifestyle changes on erectile

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 dysfunction in obese men: a randomized controlled trial". JAMA 291 (24):
2978-84.
Gao, F., Bailes, E., Robertson, D. L., Chen, Y., Rodenburg, C. M., Michael, S.
F.,Cummins, L. B., Arthur, L. O., Peeters, M., Shaw, G. M., Sharp, P. M.
and Hahn, B. H. (1999). "Origin of HIV-1 in the Chimpanzee Pan
troglodytes troglodytes". Nature 397 (6718): 436–441.
Gitlow, L. G. (1973). Alcoholism: A disease. In P. G. Bourne and R. Fox (Eds).
Alcoholism progress in research and treatment. New York: Academic
Press.
Jellinek, E. M. (1960). The disease concept of alcoholism. New Heaven:
Hillhouse Press.
Marlatt, G. A. (1983). Relapse prevention: Theoretical rationale and overview
of the model. In G. A. Marlatt and J. R. Gordon (Eds). Relapse prevention:
Maintenance strategy in the treatment of addictive behaviours. New York:
Guillford Press.
Marx, J. L. (1982). "New disease baffles medical community". Science 217
(4560): 618–621.
Mastro TD, de Vincenzi I (1996). "Probabilities of sexual HIV-1 transmission".
AIDS 10 (Suppl): S75–S82.
Monti, P. M., Abrams, D. B., kadden, R. M. and Cooney, N. L. (1989). Treating
alcohol dependence: A coping skill training guide. New York: Guilford
Press.
Palella, F. J. Jr, Delaney, K. M., Moorman, A. C., Loveless, M. O., Fuhrer, J.,
Satten, G. A., Aschman and D. J., Holmberg, S. D. (1998). "Declining
morbidity and mortality among patients with advanced human
immunodeficiency virus infection. HIV Outpatient Study Investigators". N.
Engl. J. Med 338 (13): 853–860.
Peele, S. (1984). The cultural context of psychological approaches to
alcoholism: can we control the effects of alcohol? American Psychologist,

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 39, 1337-1351.
Zucker, R. A. and Gomberg, E. S. L. (1986). Etiology of alcoholism
reconsidered:The case for a biopsychosocial process. American
Psychologist, 41, 783-793.

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 STUDY SESSION 3
Defining Illness Behaviour
Section and Subsection Headings:
Introduction
1.0 Learning Outcomes
2.0 Main Content
2.1 Defining Illness Behaviour
2.2 Variations of Illness Behaviour
2.3 Stages of Illness Behaviour
3.0 Tutor Marked Assignments (Individual or Group assignments)
4.0 Study Session Summary and Conclusion
5.0 Self-Assessment Questions
6.0 Additional Activities (Videos, Animations & Out of Class activities)
7.0 References/Further Readings

Introduction:
So far, we have looked at health behaviours, its definitions, models, health
habits, as well as some specific health problems. Health behaviour is a broad
term that includes health behaviour and illness behaviour so we cannot
conceptualize illness behaviour without having a broad view of health
behaviour. By definition, health behaviour is viewed as any activity undertaken
by an individual, regardless of actual or perceived health status, for the purpose
of promoting, protecting or maintaining health, whether or not such behaviour is
objectively effective towards that end. Now, it is time to focus specifically on
the term ‗illness behaviour‘

1.0 Study Session Learning Outcomes

After studying this session, I expect you to be able to:
1. Defineillness behaviour

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2. Assemble variations of illness behaviour
3. Dissect stages of illness behaviour etc.

2.0 Main Content

2.1 Defining Illness Behaviour
The concept of illness behaviour was largely defined and adopted during the
second half of the twentieth century. The notion of ―illness behaviour‖ was
advanced in 1960 to explain the process by which patients seek medical help or
advice.
Definition 1: The concept ‗illness behaviour‘ refers to the way in which
symptoms are perceived, evaluated and acted upon by a person who recognizes
such pain, discomfort or other signs of organic malfunctioning. (Mechanic and
Volkart, 1961).
On the surface, it may seem that the nature and severity of illness would be the
sole determinant of an individual‘s response, and for very severe illnesses, this
often is true. But many people fail to see the physician or go very late in the
disease process despite the presence of serious symptoms, while many others
see the physician routinely for trivial or minor complaints. Thus, these patterns
suggest that illness behaviour is influenced by social and cultural factors in
addition to physiological conditions.
Definition 2: The concept of illness behaviour is also concerned with the
widely different ways that individuals behave in response to disease.
Definition 3: Broadly speaking, illness behaviour is any behaviour undertaken
by an individual who feels ill to relieve that experience or to define the meaning
of the illness experience.
Definition 4: The Sociologist, David Mechanic, also defined illness behaviour
as ‗the ways in which given symptoms may be differently perceived, evaluated
and acted (or not acted) upon by different kinds of persons (Mechanic, 1962).

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Definition 5: Illness behaviour includes all forms of reactions resulting from
signs and symptoms of a disease. Examples include conscious inactivity, self-
treatment, and seeking help from health professionals as well as from friends
and family (Cockerham, 2003)
However, it is important to note that the study of illness behaviour is therefore
the study of behaviour in its social context (which describes how people
respond to their symptoms), rather than in relation to a physiological or
pathological condition. Taking a Paracetamol, staying in bed, and visiting a
doctor are all examples of illness behaviours which may be associated with
malaria, and constitute the kinds of responses which show large variations from
individual to individual. The concept includes variations in the use of language
as well as in motor and non-verbal behaviour and thus encompasses individual
differences in the way people described and experience symptoms. We will look
at different variations of illness behaviour, after attempting the following self
assessment exercises

2.2. Variations of Illness Behaviour

Many studies (Cockerham, 2003; Weiss et al, 2005; Taylor, 2006; Suchman,
1965, etc.) have linked illness behaviour variation to:
✓ Ethnicity
✓ Education
✓ Family structure
✓ Social networks

Illness behaviour has also been shown to differ in terms of:

✓ Individual differences such as personality, age and sex
Illness behaviour is also shown to be linked with:
✓ Health care coverage and insurance.

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However, much of the early work on illness behaviour was seen in the context
of:
✓ Understanding patient help-seeking behaviour

Also other research literature on illness behaviour has gone well beyond this
more narrow medicalized view. Many studies have considered the different
perspectives of illness behaviour held by individuals and health care
practitioners.
✓ The differing worldviews of patients and practitioners are now seen as
highly relevant to illness behaviour. The medical practitioner and the
individual experiencing symptoms go through very different appraisals
of the meaning of the symptoms.

Increasingly in the literature there is the recognition of:

✓ The strong relationship between the physical and mental experience of
symptoms and the meaning of that experience for illness behaviour.

Similarly, it is also of the opinion that:

✓ Aspects of individual learning history have a marked influence on illness
behaviour. This is because, different style of modeling and reinforcing
illness behaviour such as avoiding work and chores produce differing
responses to illness both in individuals who are normally well, and in
those who are chronically ill.

From a review of the variations of illness behaviour provided above, you would
realize that the study of illness behaviour is thus multifaceted. Though, we seem
to have touched a good number of the variables identified earlier in previous
units, and they also served the very important function of precursors to the study

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of illness behaviour. Now we are going to focus on more specific variables of
illness behaviour. Let us look at the stages of illness behaviour.

2.3. Stages of Illness Behaviour

One approach that provides insight into the sequence of events that take place
when a person is not healthy is Suchman (1965) description of the stages of
illness experience. According to Suchman, when an individual perceives
himself/herself to be sick, he or she can pass through as many as five different
response stages, depending on their interpretation of the particular illness
experience. The precise starting and ending point of each stage, however, is not
always easy to determine since the different stages often overlap significantly.
Furthermore, although illness behaviour may not involve all of the stages
described by Suchman and can be terminated at any particular stage through
denial, the significance of this model is that each stage requires the sick person
to take different kinds of decisions and actions. In evaluating the experience of
illness, the sick person must therefore interpret not only his or her symptoms,
but also what is necessary in terms of available resources, alternative behaviours
and the probability of success.
In order to really have a very detailed overview of illness behaviour, Suchman
(1965) devised an orderly approach for studying illness behaviour with his five
key stages of illness experience. They are
1. Symptom Experience
2. Assumption of Sick Role
3. Medical Care Contact
4. Dependent Patient Role
5. Recovery and Rehabilitation Stage

Each stage involves major decisions that must be taken by the individual to
determine whether the sequence of stages continues or the process is

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discontinued. Below is a diagrammatic representation of Suchman‘s stages of
illness experience.

Note: These stages of illness behaviour/experience will be comprehensively

elaborated in the subsequent units and modules.

In-text Question 1 List five key stage of illness experience according to Suchman (1965)

Answer
1. Symptom Experience
2. Assumption of sick role
3. Medical care contact
4. Dependent patient role
5. Recovery and rehabilitation stage

3.0 Tutor Marked Assignments (Individual or Group)

1. Define illness behaviour

4.0 Conclusion/Summary
Suchman‘s stages of illness experience have indeed given us an orderly
approach to the study of illness behaviour. We will try to elaborate more on

135
 them.
In this unit, we looked at different perspectives of illness behaviour. Using
Suchman‘s stages of illness experience, we were able to articulate better the
pattern the study of illness behaviour should fall in. So in the subsequent
units, we will take a thorough look at each stage of illness experience

5.0 Self-Assessment Questions

1. Illustrate the stages of illness experience/behaviour.

6.0 References/Further Readings

Cockerham, W. C. (2003). Medical Sociology. (9th edition). NY: Prentice Hall
Mechanic, D. and Volkart, A. (1961). Illness Behaviour. In, G. L. Weiss and L.
E. Lonnquist. (Eds). The Sociology of Health, Healing and Illness, fifth
edition. NY: Prentice Hall
Mechanic, D. (1980). The experience and reporting of common physical
complaints. Journal of Health and Social Behaviour, 21, 146-55.
Pilowsky, I. (1969). Abnormal illness behaviour. British Journal of Medical
Psychology, 42, 347-351.
Pilowski, I. (1990). The concept of abnormal behaviour. Perspective, Vol 31,
no. 2.
Suchman, E. A. (1965). Stages of illness and medical care. Journal of Health
and Social Behaviour, 6, 114-128.
Taylor, S. E. (2006). Health Psychology (6th edition). Los Angeles: McGraw
Hill.
Ware, J. E. (1986) ‗Assessment of health status‘ pp204-228 in Application to
Social Science to clinical Medicine and Health
Policy, In L. A. Aiken and D.Mechanic (Eds). New Brunswick, NJ: Rutgers
Univ. Press.

136
Weiss, G. L. and Lonnquist, L. E. (2005). The Sociology of Health, Healing and
Illness, fifth edition. NY: Prentice Hall
World Health Organization (1986) ‗Ottawa Charter for Health Promotion‘,
Health Promotion, 1: iii-v

137
 STUDY SESSION 4
4A: Symptom Experience
Section and Subsection Headings:
Introduction
1.0 Learning Outcomes
2.0 Main Content
2.1 Defining Symptom
2.2 Importance of Symptoms
2.3 Symptom Interrogation
2.4 List of Symptoms
3.0 Tutor Marked Assignments (Individual or Group assignments)
4.0 Study Session Summary and Conclusion
5.0 Self-Assessment Questions
6.0 Additional Activities (Videos, Animations & Out of Class activities)
7.0 References/Further Readings

Introduction:
When we perceive ourselves to be ill, this assessment is often based on the
perception of certain symptoms. For example, a person feeling the onset of
malaria might note the occurrence of headache, feverish feelings and body ache.
Likewise, a person feeling the onset of cold might notice the occurrence of
cough, nasal congestion and body weakness. By perceiving such symptoms,
especially if one had previously experienced such similar occurrence, one may
be accurate in relating such symptoms to the health practitioner. Suffice to
observe that such assumptions may be accurate in many cases, but symptom
perception may represent far more than this. So this unit hopes to shed more
light on the aforementioned variable: symptom experience.
Due to the intricacy of symptoms, it is difficult to construct a simple definition.
Illness symptoms are ―differently labeled by individuals in dissimilar social

138
situations‖ (Browner 1983: 494). Certain aetiologies such as those found in
biomedicine maintain that disease occurs when an external pathogen enters the
body and disrupts physiological homeostasis. Therefore, symptoms are not
believed to be part of the ―patient‘s concept of his intact body‖ (Casell 1976:
145).

1.0 Study Session Learning Outcomes

After studying this session, I expect you to be able to:
1. Describe importance of Symptoms
2. Define Symptom
3. Describe symptom Interrogation
4. Develop a list of Symptoms

2.0 Main Content

2.1 Defining Symptoms
Definition 1
However, symptoms are viewed as the manifestation of bodily malfunction.
Definition 2
In non-traditional health care systems, symptoms are believed to be
manifestations of the intrusion of the supernatural. On the other hand, non-
western ideologies explain disease causation as an object intrusion, spirit
intrusion, an act of witchcraft, or the result of soul loss or
neglected/transgressed social taboos (Low 1985).
Although it may seem logical that different civilizations with diverse illness
ideologies would have different definitions for symptoms, certain
commonalities regarding the definition of symptoms exist among these
civilizations. For instance, some cultures do support the belief that symptoms
are the manifestation of illness, whether it is the cause of a pathogen or a spirit
invasion.

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Definition 3
Symptoms enable a person to report self-experiences of health on a day-to-day
basis. These self-reported experiences can be used to ―establish relationships
between physical symptoms, psychological factors, and health actions‖ (Brown
et al. 1994: 378).

2.2. Importance of Symptoms

Having a clear definition of the symptom is necessary, but just as vital is having
an understanding of why symptoms are important.
• Symptoms are used by the sick to gain legitimization of the sick role from
society.
• Just as culture is integrated in the beliefs and behaviours of every society,
symptoms are deeply embedded in the concept of sickness and healing.
• Symptoms add clarity to the complex ideas of sickness and healing in
such a way that it is difficult to discuss either process without touching
on these symbols.
• The symptom is regarded as a vital part of the illness experience because
it offers insight into the physiological and psychological aspects of the
patient‘s body. In this way, the symptom symbolizes the roots of a tree,
anchoring a societal understanding of medical knowledge and healing
aetiologies.
• The symptom is of great significance because ―everywhere, sickness
and healing are primal human concerns (Telles and Pollack 1981).
• The concept of feelings, in the form of symptoms, also becomes
important because they often act as threads that bind the aspect of health
to the personal concept of human emotion. In this rite, feelings are
important in the definition of health and illness. The way an individual

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 feels is a ―prime criterion of health, illness, and recovery (Telles and
Pollack 1981).
• The symptom is of great social significance in the way it ―reflects both
the individual‘s relations in the social system and represents cultural
participation; it is a help-seeking behaviour of individuals or families
attempting to re-establish a balanced sociocultural state‖ (Low
1985:190). These statements are important because they shed light on the
social and cultural component of the symptom.

2.3. Symptom Interrogation

Most health care practitioners are likely to follow the following history taking
steps in symptoms interrogation. They are:
Onset: When did it start?
Palliative: What relieves your symptom?
Provocative: What provokes your symptom?
Quality: How would you describe the symptom? Sharp? Stabbing? Sore?
Uncomfortable? Throbbing? Ripping?
Radiating: Do the symptom or pain radiate to another area of your body?
Note: These could be represented as OPPQR

2.4 List of Symptoms

Here are just a few things that will automatically pop into a doctor's head when
you give the following symptoms. The doctor will then perform various
orthopaedic, laboratory or imaging tests on you to confirm or deny his or her
suspicions:
Please keep in mind there are many other conditions, diseases, syndromes and
illnesses that your doctor may be thinking depending on what you stated in your
patient history. The following are list of symptoms and associated
manifestations:
141
• Abdominal Pain: - may be indicative of appendicitis, food allergies, food
poisoning, gastro-intestinal disorders, hernia or pre-menstrual syndrome.
• Abnormal vaginal discharge: - may be indicative of yeast infection
(candidaisis), genital herpes, gonorrhea or trichomoniasis.
• Backache: - may be indicative of back strain, DDD (degenerative disc
disease),lack of exercise, obesity, female disorders, spinal injury or
pancreatic disorders.
• Blood in the urine, stool, vomit, vagina or penis: - may be indicative of
haemorrhoids, infections, polyps, bowel tumours, ulcers, cancer of the
kidneys, colon or bladder.
• Difficulty in swallowing: - may be indicative of emotional stress, hernia,
cancer of the oesophagus.
• Excessive sweating: - may be indicative of thyroid disorder, menopause,
stress, food allergies, fever, infection or Hodgkin's disease.
• Frequent urination: - may be indicative of bladder infection, a diuretic
effect, excessively taking of liquid, not emptying the bladder in a timely
fashion or cancer.
• Indigestion: - may be indicative of poor diet, lack of enzymes such as
HCL (hydrochloric acid), gallbladder dysfunction, heart disease,
acidosis, alkalosis, allergies, stress, adrenal liver or pancreatic disorders.
• Persistent cough: - may be indicative of lung disorders, pneumonia,
emphysema, bronchitis, influenza, food allergies or cancer.
• Persistent fever: - may be indicative of influenza, mononucleosis,
rheumatic disorders, bronchitis, colds, meningitis, diabetes or chronic
infection.
• Persistent headache: - may be indicative of migraines, eyestrain, need
for glasses, allergies, asthma, drugs, glaucoma, high blood pressure,

142
 brain tumour, vitamin deficiencies, sinusitis or stress due to personal life
experiences.
• Rash with blisters: - may be indicative of Herpes Zoster or Shingles.
• Sudden weight gain: - may be indicative of over-eating, lack of exercise,
thyroid condition (under-activity) or oedema.
• Sudden weight loss (unexplained): - may be indicative of cancer,
diabetes, thyroid condition (overactive), hepatitis, parasites, infection or
mal-absorption syndrome.
• Swelling in the appendages or abdomen: - may be indicative of
oedema, heart condition, kidney dysfunction, medication, food allergies,
oral contraceptives or steroids.
• Swollen lymph nodes: - may be indicative of chronic infection,
lymphoma, various cancers, toxic metals, toxic build-up or Hodgkin's
disease.
• Thirsting excessively: - may be indicative of diabetes, infection,
excessive exercise or fever (Standley, 2007)
In-text Question 1 State history taking steps in symptoms interrogation
2. What do you understand by symptoms?

Answer 1.Represented by the acronym (OPPQR)

✓ Onset
✓ Palliative
✓ Provocative
✓ Quality
✓ Radiating
2. Symptoms are viewed as the manifestation of bodily malfunction.

3.0 Tutor Marked Assignments (Individual or Group)

1. Identify stages of symptom interrogation

143
2. Identify list of symptoms for: persistent headache, sudden weight loss,
frequent urination, abdominal pain and backache.

4.0 Conclusion/Summary
The symptom may initially seem to merely ―play a simple role, primary in
nature, (Foucault 1973:91) but without this vital actor, the cast of the healing
process would be incomplete. The presence of the symptom not only indicates
to the patient that illness is present, but it also initiates the process of healing
when presented to the practitioner. The healing process is thus considered
complete when the symptoms and the illness disappear. While some may argue
that symptoms are merely somatic complaints, these people are blind to the
intricate details that assemble the process of healing.
We have seen that symptoms are an integral part of the healing process in
numerous ways. I hope you enjoyed reading this unit. I‘m sure you will agree
with me that information encountered in this unit is quite novel and insightful.
Now let us try the assignment presented below.

5.0 Self-Assessment Questions

1. What do you understand by symptoms?
2. Identify the importance of symptom experience

6.0 References/Further Readings

Cockerham, W. C. (2003). Medical Sociology. (9th edition). NY: Prentice Hall
Foucault, M. (1973). Birth of the Clinic. London: Random House.
Low, S. M. (1985). Culturally interpreted symptoms or culture bound
syndromes: A cross-cultural review of nerves. Social Science and
Medicine 21(2):187-196.
Telles, J.L., and M.H. Pollack (1981). Feeling sick: The experience and
legitimization of Illness. Social Science and Medicine 15A:243-251.

144
Standley, L. J. (2007). List of Symptoms. Sourced from
www.drstandley.com/signsandsymptom_index.shtml#symptoms.Cite visited on
7th March 2007.
Suchman, E. A. (1965). Stages of illness and medical care. Journal of Health
and Social Behaviour, 6, 114-128.
Taylor, S. E. (2006). Health Psychology (6th edition). Los Angeles: McGraw
Hill.
Weiss, G. L. and Lonnquist, L. E. (2005). The Sociology of Health, Healing and
Illness, fifth edition. NY: Prentice Hall

145
 STUDY SESSION 4 CONTD.
4B: The Sick Role
Section and Subsection Headings:
Introduction
1.0 Learning Outcomes
2,0 Main Content
2.1 Background of the Sick Role Concept
2.2 Parsons Sick Role Theory
2.2.1 Rights and Obligations of the Sick Role
2.3 Underlying Values of the Sick Role
2.3.1 Vulnerability
2.3.2 Deviance
2.4 The Sick Role Theory: Ideas from Freud and Max Weber
2.5 Some Criticism of the Parsons Sick Role Theory
2.5.1 Rejecting the Sick Role
2.5.2 Doctor-Patient Relationship
2.5.3 Blaming the Sick
2.5.4 Sick Role and Chronic Illness
2.6 Strengths of Parsons Sick Role Theory
3.0 Tutor Marked Assignments (Individual or Group assignments)
4.0 Study Session Summary and Conclusion
5.0 Self-Assessment Questions
6.0 Additional Activities (Videos, Animations & Out of Class activities)
7.0 References/Further Readings

Introduction:
Suffice to note, just as we stated earlier, that if the individual accepts that the
symptoms are a sign of illness, and are sufficiently worrisome, then transition is

146
made to the sick role, at which time the individual begins to relinquish some or
all normal social roles.
The sick role is therefore a social role characterized by certain exemptions,
rights and obligations, and shaped by the society, groups and the cultural
tradition to which the sick person belongs.

1.0 Study Session Learning Outcomes

After studying this session, I expect you to be able to:
1. Describe background of Parsons sick role concept
2. Define Parsons sick role theory
3. Explain the rights and obligations of the sick role
4. Construct/deconstruct the underlying values of Parsons sick role theory
5. Analyse ideas from Sigmund Freud and Max Weber in the illustration of
Parsons sick role theory
6. Assemble the strengths and weaknesses of Parsons sick role theory

2.0 Main Content

2.1 Background of the Sick Role Concept
The sick-role is a concept arising from the work of an American Sociologist,
Talcott-Parsons (1902-1979). Parsons was a structural-functionalist who argued
that, social practices should be seen in terms of their function in maintaining
order to structure in society. Thus Parsons was concerned with understanding
how the sick person relates to the whole social system, and what the person‘s
function is in that system.
Specifically, the sick role concept was first introduced by Talcott Parsons in a
1948 journal article but was elaborated upon in his 1951 book titled ‗The Social
System‘. Parsons emphasized that illness is not simply a biological or
psychological condition, and it is not simply an unstructured state free of social
norms and regulations. When one is ill, one does not simply exit normal social

147
roles to enter a type of social vacuum; rather, one substitutes a new role – the
sick role – for the relinquished, normal roles.
Ultimately, the sick role and sick-role behaviour could be seen as the logical
extension of illness behaviour to complete integration into the medical care
system. Parsons‘ argument is that sick-role behaviour accepts the
symptomatology and diagnosis of the established medical care system, and thus
allows the individual to take on behaviours compliant with the expectations of
the medical system.

2.2. Parsons Sick Role Theory

One of the most widely-accepted attempts to define the place of the patient in
modern health care was that of Talcott Parsons, the prominent American scholar
who was a champion of the Structural Functionalist approach to social analysis.
For Parsons, individuals played set roles within particular institutional settings,
such as the family, the workplace, the legal apparatus, the medical system, and
so on. Parsons argued that the ill take on a sick role, which (like all roles)
provides them with a set of responsibilities and privileges. As he wrote, "illness
is not merely a state of the organism and/or personality, but comes to be an
institutionalized role". Illness represented a legitimate withdrawal into a
dependent relationship -- a sick role.
One of the prominent characteristics of Parsons' theory is an asymmetry
between the roles of patients and healers. Their rights and obligations are not
equal, with the more institutionalized and legitimized functions of doctors
taking precedence over the role of the patients. Indeed, from a
phenomenological standpoint, a doctor and a patient may define the illness in
different ways. For example, in a study of elderly patients who were recovering
from strokes, Becker and Kaufman (1995) noted that the experience of "living"
a disease means that one will construct a different idea of the illness trajectory
(the narrative, often quite personal, of the progress and development of a

148
disease) and the expected outcomes of that disease. The acceptance of the sick
role implies that the patient takes on some responsibility for getting well, and
some patients may be actively advised to take over even greater responsibility
(diabetics represent a prime example here). Indeed, much healthcare-related
intervention relies on the passive co-operation (usually referred to as
"compliance") of the patient. Patient compliance has been a standard feature of
medical journals in the last couple of decades. Trostle (1988), who interpreted
patient compliance as a euphemism for "physician control," claimed that it was
an ideology which reaffirmed and legitimized the unequal doctor/patient
relationship. The fascination with patient compliance indicates a particular
conception of the patient as an "opponent" of the doctor. This interest in patient
compliance was ascending in Parsons' time, and came to full bloom in the 1970s
and 1980s (based on the importance of the topic in the medical literature; see
Trostle, (1988). In some ways, the concern over patient compliance could also
be read as a reaction to the rise of self-help movements, the increasing
competition from non-traditional medicine, and the emergence of patient
activists of various sorts. These developments represent threats to the
established institutions of medicine.
Parsons thus, outlined four aspects related to this role, two rights and two
obligations (Parsons, 1951: 436-437; Parsons (1978). These are thus presented
below.

2.2.1 Rights and Obligations of the Sick Role

Sociologists conceptualize social roles as the expected behaviours (including
rights and obligations) of someone with a given position (status) in society.
Generally, people hold a status (position) and perform a role (behaviour).
Parsons (1951) utilized these concepts to construct a theoretical view of
individuals who are sick, hence the ―sick role. This theory outlines two rights

149
and two obligations of individuals who become sick in our society (Cockerham,
2001; 2003).
Rights
i. The sick person is exempt from “normal” social roles. An individual‘s
illness is grounds for his or her exemption from
normal role performance and social responsibilities. This exemption, however,
is relative to the nature and severity of the illness. The more severe the illness,
the greater the exemption. Exemption requires legitimation by the physician as
the authority on what constitutes sickness. Legitimation serves the social
function of protecting society against malingering (attempting to remain in the
sick role longer than social expectations allow – usually done to acquire
secondary gains or additional privileges afforded to ill persons).
ii. The sick person is not responsible for his or her condition. An
individual‘s illness is usually thought to be beyond his or her own control. A
morbid condition of the body needs to be changed and some curative process
apart from person will- power or motivation is needed to get well.
Obligations
(1) The sick person should try to get well. The first two aspects of the sick
role are conditional upon the third aspect, which is recognition by the sick
person that being sick is undesirable. Exemption from normal responsibilities is
temporary and conditional upon the desire to regain normal health. Thus, the
sick person has an obligation to get well.
(2) The sick person should seek technically competent help and cooperate
with the physician. The obligation to get well involves a further obligation on
the part of the sick person to seek technically competent help, usually from a
physician. The sick person is also expected to cooperate with the physician in
the process of trying to get well.

150
2.3. Underlying Values of Parsons Sick Role
It is important to note that these rights and obligations of Parsons sick role
depend upon each other. If the sick person does not fulfill their obligations or
duties their immunity from blame will be withheld and they may lose their other
‗rights‘. The following are two underlying values of Parsons sick role.

2.3.1 Vulnerability
• Because of threatening symptoms.
• Because they are passive, trusting and prepared to wait for medical help
they are vulnerable and open to exploitation by others.
• Patient must submit to bodily inspection, high potential for intimacy,
breaches social taboos.
• Patient/ doctor relationship are sometimes unequal and requires
higher levels of trust.

2.3.2 Deviance
• The sick can be viewed as a social threat. Because they are relieved of
social obligations.
• The more they feel sick the greater the threat to the social system.
• Sickness may be used to evade responsibility.
• Society may be exploited.
The medical profession acts as gate-keeper against this form of deviance. They
provide a form of social regulation to protect society.

2.4 The Sick Role Theory: Ideas from Freud and Max Weber’s Theories
Parsons used ideas from Freud’s psychoanalytic theories as well as from
functionalism and from Max Weber’s work on authority to create an ‘ideal type’

151
that could be used to shed light on the social forces involved in episodes of
sickness.

Freud’s concepts of transference and counter-transference led Parsons to see

the doctor/patient relationship as analogous to that of the parent and child. The
idea that a sick person has conflicting drives both to recover from the illness and
to continue to enjoy the ‘secondary gains’ of attention and exemption from
normal duties also stems from a Freudian model of the structure of the
personality. The functionalist perspective was used by Parsons to explain the
social role of sickness by examining the use of the sick role mechanism. In
order to be excused from their usual duties and to be considered not to be
responsible for their condition, the sick person is expected to seek professional
advice and to adhere to treatments in order to get well. Medical practitioners are
empowered to sanction their temporary absence from the workforce and family
duties as well as to absolve them of blame.

Weber identified three types of authority: charismatic; using the force of

personality, traditional; how it has always been, and rational/legal authority,
which relies on a framework of rules and specialist knowledge. While
individual doctors may have any or all of these types of authority in some
situations, it is assumed that their credibility as a profession is based on their
patients accepting their rational/legal authority in making diagnoses, prescribing
treatment and writing sick-notes. (Macguire, 2002).

2.5 Some Criticism of Parsons Sick Role Theory

2.5.1 Rejecting the sick role
• This model assumes that the individual voluntarily accepts the sick role.

152
 • 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.

2.5.2 Doctor-patient relationship.

• Going to see a doctor may be the end of a process of help-seeking
behaviour, (Cokerham, 2003) discusses importance of 'lay referral
system'- lay person consults significant lay groups first.
• This model assumes 'ideal' patient and 'ideal' doctor‘s roles.
• Differential treatment of patient, and differential doctor-patient
relationship- variations depend on social class, gender and ethnicity.

2.5.3 Blaming the sick

Rights‘ do not always apply.
• Sometimes individuals are held responsible for their illness, i.e. illness
associated with sufferer‘s lifestyle, e.g., alcoholic lifestyle.
• In stigmatized illness sufferer is often not accepted as legitimately sick.

2.5.4 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.

153
2.6 Strengths
In spite of its shortcomings the idea of the sick role has generated a lot of useful
far-reaching research. Arguably, it still has a role in the cross-cultural
comparison of ways in which ‘time-out’ from normal duties can be achieved or
in which deviant behaviour may be explained and excused.
The sick role theory is also a valuable contribution to understanding illness
behaviours and social perceptions of sickness. (It is perhaps best considered an
ideal type – a general statement about social phenomena that highlight patterns
of ―typical.) We discussed a number of criticisms of Sick Role theory,
including: a violation in the ―ability to get well for a number of conditions
(particularly chronic illnesses); but individuals or groups may sometimes not
possess the resources to ―seek technically competent help or to ―cooperate
with the physician based upon health insurance, income, role conflicts to
compliance, etc.; certain illnesses may reflect an element of personal ―blame
due to unhealthy lifestyle choices (i.e. smoking leads to lung cancer); the
potential inability to be ―exempt from normal social roles due to issues of
status (i.e. parent), income (need to work), gender, age, etc as exist.

In-text Question 1 Define Parsons sick role

Answer A state of understanding how the sick person relates to the whole social system, and
what the person‘s function is in that system

3.0 Tutor Marked Assignments (Individual or Group)

1. Identify and describe the rights and obligations of the sick role.
2. Identify the strengths and weaknesses of Parsons sick role theory.

4.0 Conclusion/Summary
The sick-role is thus perceived as a concept arising from the work of
American Sociologist, Talcott-Parsons (1902-1979). Parsons was a

154
 structural-functionalist who argued that social practices should be seen in
terms of their function in maintaining order to structure in society. In his
theory, Parsons argued that the ill take on a sick role, which (like all roles)
provides them with a set of responsibilities and privileges. Parsons thus
identified two rights and privileges of the sick role. Also, vulnerability and
deviance concepts were identified as two underlying values of the theory.
Further ideas from related theories, like Freud psychoanalytic theory and that
of Max Weber, were drawn to further buttress the efficacy of the Parsons
Sick Role theory. However, the assumption that the individual voluntarily
accepts the sick role was highlighted as one of the drawbacks of the theory.
In-spite of the numerous criticisms, the sick role theory is regarded as a
valuable contribution to understanding illness behaviours and social
perceptions of sickness.
In this unit, we looked at Parsons sick role theory, drawing insightful
concepts on the rights and obligations of the theory. We further drew ideas
from theories of Sigmund Freud and Max Weber, to further assess Parsons
sick role theory. The strengths and weaknesses of the theory were also
analyzed. Hope you had fun reading this unit. Let us now try the following
exercises.

5.0 Self-Assessment Questions

1. Describe Parsons Sick Role Theory

6.0 References/Further Readings

Becker, G. and Kaufman, S. (1995). Managing an Uncertain Illness Trajectory
in Old Age: Patients' and Physicians' Views of Stroke. Medical
Anthropology Quarterly 9(2): 165-187.
Cockerham, W. C. (2003). Medical Sociology (9th Edition). Univ. of Alabama:
Prentice hall.

155
Cockerham, W. C. (2001) Medical Sociology, (8th Edition) N.Y: Prentice Hall;
pp 156-178.)
Macguire, K. (2002). Sociologies of Health and Illness. E-Learning Data Bank.
Retrieved from www.medgraphics.com.ac.uk/shield/ on 17th March 2007.
Parsons, T. (1978). Action Theory and the Human Condition. NY: Free Press.
Parsons, T. (1972). 'Definitions of Health and Illness in the Light of American
Values and Social Structure'. In E. G. jaco (Ed). Patients, Physicians and
Illness: A Sourcebook in Behavioral Science and Health, Ed. 2. NY: Free
Press,.
Parsons, T. (1951). The Social System. NY: Free Press.
Taylor, S. E. (2006). Health Psychology (6th edition). Los Angeles: McGraw
Hill.
Trostle, J. (1988). 'Medical Compliance as an Ideology'. Social Sciences and
Medicine 27(12): 1299-1308.
Weiss, L. G. and Lonnquist, L. E. (2005). The Sociology of Health, Healing and
Illness, fifth edition, Safari book online. Retrived from
http//www.safarix.com/0131928406/ch07iev1sec3. Accessed on 10th April,
2007.

156
 MODULE 3
Dependent Patient Role/ Recovery and Rehabilitation
Contents
Study Session 1: Healing Options
Study Session 2 & 3: Doctor/Patient Interaction
Study Session 4: Delay or Overuse of Medical Care
Study Session 5: Recovery – Rehabilitation

STUDY SESSION 1
Healing Options
Section and Subsection Headings:
Introduction
1.0 Learning Outcomes
2.0 Main Content
2.1 The Modern health care
3.1.1 Primary Care Provider
3.1.2 Nursing care
3.1.3 Drug Therapy
3.1.4 Specialty Care
2.2 Complementary or Alternative Medicine
2.2.1 Faith Healing
2.2.2 Folk Healing
2.2.3 Aromatherapy
2.2.4 Homeopathy
2.2.5 Naturopathy
2.2.6 Aryuveda
2.2.7 Shiatsu
2.2.8 Crystal Healing

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 2.2.9 Biofeedback
2.2.10 use of Dietary Supplements
3.0 Tutor Marked Assignments (Individual or Group assignments)
4.0 Study Session Summary and Conclusion
5.0 Self-Assessment Questions
6.0 Additional Activities (Videos, Animations & Out of Class activities)
7.0 References/Further Readings

Introduction:
In the previous unit, we reviewed the sick role as well as choices patients need
to make to get well. For the patient to make such critical choices he or she needs
to identify the healing options available, therefore this unit seeks to identify
several options available for medical care/healing. Basically, such healing
options are usually categorized under two broad parts: The modern health care
and complementary or alternative health care. We will elaborate more on them.

1.0 Study Session Learning Outcomes

After studying this session, I expect you to be able to;
1. Describe the healing options available in the modern medical care
2. Explain the healing options available in the complementary or alternative
medicine

2.0 Main Content

2.1 The Modern Health Care
2.1.1 Primary care provider
A primary care provider (PCP) is the person a patient sees first for checkups and
health problems. The following is a review of practitioners that can serve as
PCP.

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 ✓ The term "generalist" often refers to medical doctors (MDs) and doctors
of osteopathic medicine (DOs) who specialize in internal medicine,
family practice, or pediatrics.
✓ OB/GYNs are doctors who specialise in obstetrics and gynaecology,
including women's health care, wellness, and prenatal care. Many women
use an OB/GYN as their primary care provider.
✓ Nurse practitioners (NPs) are nurses with graduate training. They can
serve as a primary care provider in family medicine (FNP), pediatrics
(PNP), adult care (ANP), or geriatrics (GNP). Others are trained to
address women's health care (common concerns and routine screenings)
and family planning. In some countries, NPs can prescribe medications.
✓ A physician assistant (PA) can provide a wide range of services in
collaboration with a Doctor of Medicine (MD) or Osteopathy (DO),
(Medical Encyclopedia).

2.1.2 Nursing care

✓ Registered nurses (RNs) have graduated from a nursing programme, have
passed a state board examination, and are licensed by the state.
✓ Advanced practice nurses have education and experience beyond the
basic training and licensing required of all RNs. This includes nurse
practitioners (NPs) and the following:
✓ Clinical nurse specialists (CNSs) have training in a field such as cardiac,
psychiatric, or community health.
✓ Certified nurse midwives (CNMs) have training in women's health care
needs, including prenatal care, labour and delivery, and care of a woman
who has given birth.
✓ Certified registered nurse anaesthetists (CRNAs) have training in the field
of anaesthesia. Anaesthesia is the process of putting a patient into a

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 painless sleep, and keeping the patient's body working, so surgeries or
special tests can be done (Medical Encyclopedia)

2.1.3 Drug therapy

Licensed pharmacists have graduate training from a College of Pharmacy.
Your pharmacist prepares and processes drug prescriptions that were written by
your primary or specialty care provider. Pharmacists provide information to
patients about medications, while also consulting with health care providers
about dosages, interactions, and side effects of medicines.
Your pharmacist may also follow your progress to check the safe and effective
use of your medication (Medical Encyclopedia).

2.1.4 Specialty care

Your primary care provider may refer you to professionals in various specialties
when necessary, such as:
• Allergy and asthma
• Anesthesiology -- general anaesthesia or spinal block for surgeries and
some forms of pain control
• Cardiology -- heart disorders
• Dermatology -- skin disorders
• Endocrinology -- hormonal and metabolic disorders, including diabetes
• Gastroenterology -- digestive system disorders
• General surgery -- common surgeries involving any part of the body
• Haematology -- blood disorders
• Immunology -- disorders of the immune system
• Infectious disease -- infections affecting the tissues of any part of the
body
• Nephrology -- kidney disorders

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 • Neurology -- nervous system disorders
• Obstetrics/gynaecology -- pregnancy and women's reproductive disorders
• Oncology – cancer treatment
• Ophthalmology -- eye disorders and surgery
• Orthopaedics -- bone and connective tissue disorders
• Otorhinolaryngology -- ear, nose, and throat (ENT) disorders
• Physical therapy and rehabilitative medicine -- for disorders such as low
back injury, spinal cord injuries, and stroke
• Psychiatry -- emotional or mental disorders
• Pulmonary (lung) -- respiratory tract disorders
• Radiology -- X-rays and related procedures (such as ultrasound, CT, and
MRI)
• Rheumatology -- pain and other symptoms related to joints and other
parts of the musculoskeletal system
• Urology -- disorders of the male reproductive and urinary tracts and the
female urinary tract (Medical Encyclopedia).

2.2 Complementary and Alternative Medicine

Complementary and Alternative Medicine (CAM) is the use of treatments that
are not commonly practiced by the medical profession. CAM includes visits to:

2.2.1 Faith healing

This is the use of suggestions, power and faith in God to achieve healing.
According to Denton (1978), two basic beliefs are prevalent in religious
healing. They are:
1. The idea that healing occurs through psychological processes and is effective
only with psychophysiological disorders.

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2. The other idea is that healing is accomplished only through the intervention
of God. This thus constitutes the present day miracle. Denton (1978) also offers
5 general categories of faith healing. They are:
• Self-treatment through prayer.
• Treatment by a lay person thought to be able to communicate with God.
• Treatment by an official church leader for whom healing is only one of
many tasks.
• Healing obtained from a person or group of persons who practice healing
fulltime without affiliation with a major religious organization.
• Healing obtained from religious leaders who practice full time and are
affiliated with a major religious group.

A common theme running through each of these categories is an appeal to God

to change a person‘s physical and mental conditions for the better (Denton,
1978).

2.2.2 Folk healing

Folk medicine is often regarded as a residue of health measures leftover from
pre-scientific historical periods (Bakx,1991). Yet, folk healing has persisted in
modern scientific society, and major reasons appear to be dissatisfaction with
professional medicine and a cultural gap between biomedical practitioners and
particular patients (Bear, 2001, Bakx, 1991, Madsen, 1973). These patients,
typically low income persons may view folk medicine as a resource because it
represents a body of knowledge about how to treat illness that has grown out of
historical experiences of the family and ethnic group (Thorogood, 1990).
Common ingredients in folk remedies are such substances as ginger tea, honey,
whisky, lemon juice, garlic, pepper, salt, etc.

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2.2.3 Aromatherapy
Aromatherapy is the use of aromatic oils for relaxation.

2.2.4 Acupuncture
Acupuncture is an ancient Chinese technique of inserting fine needles into
specific points in the body to ease pain and stimulate bodily functions.

2.2.5 Homeopathy
Homeopathy is the use of micro doses of natural substances to boost immunity.

2.2.6 Naturopathy
Naturopathy is based on the idea that diseases arise from blockages in a
person‘s life force in the body and treatments like acupuncture and homeopathy
are needed to restore the energy flow.

2.2.7 Aryuveda
This is an Indian technique of using oil and massage to treat sleeplessness,
hypertension and indigestion.

2.2.8 Shiatsu
Japanese therapeutic massage

2.2.9 Crystal healing

This is based on the idea that healing energy can be obtained from quartz and
other minerals.

2.2.10 Biofeedback
This is the use of machines to train people to control involuntary bodily
functions.

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2.2.11 Use of dietary supplements
Like garlic to prevent blood clot, ginger, fish oil capsules to reduce the threat of
heart attack.

In-text Question 1 Define the term Complementary and Alternative Medicine (CAM)

Answer
Complementary and Alternative Medicine (CAM) is the use of treatments that are not
commonly practiced by the medical profession

3.0 Tutor Marked Assignments (Individual or Group)

Identify and discuss at least 8 healing options obtainable in the complementary/
alternative medicine.

4.0 Conclusion/Summary
As you can see, there are quite a huge number of options available for medical
care/self care. The usage of one or more available options depends on one‘s
orientation, experience and socialization. The list of healing options provided in
this unit is of course not exhaustive.
In this unit, we looked at several healing options available in modern health care
and complementary or alternative health care. These observations also form part
of medical care/contact stage of illness behaviour. New let us attempt this
exercise.

5.0 Self-Assessment Questions

1. Identify some healing options and specializations available in the modern
health care.

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6.0 References/Further Readings
Bakx, K. (1991). The ‗eclipse‘ of folk medicine in western society. Sociology of
health and illness, 13: 20-38.
Bear, H. A. (2001). Biomedicine and alternative healing system in America:
Issues of class, race, ethnicity and gender. Madison, WI: Univ. of
Wisconsin.
Cockerham, W. C. (2003). Medical Sociology, 9th edition. NY: Prentice Hall.
Denton, J. A. (1978). Medical Sociology. Boston: Houghton Mifflin
Medical Encyclopedia – Types of Healthcare providers. Update on 10/24/2006
by Daniel R. Alexander. Retrieved from Medline Plus Online. Site visited
on 22 march 2007.
Medsen, W. (1973). The Mexican-American of South Texas. 2nd edition. NY:
Holt, Rinehart and Winston.
Taylor, S. E. (2006). Health Psychology (6th edition). Los Angeles: McGraw
Hill.
Thorogood, N. (1990). Caribbean home remedies and the importance for
black‘s health care in Britain, pp 140-152. In P. Abbott and G. Payne
(Eds). New Directions in the Sociology of Health. London: Taylor and
Francis.
Weiss, L. G. and Lonnquist, L. E. (2005). The Sociology of Health, Healing and
Illness, fifth edition, Safari book online. Retrived from
http//www.safarix.com/0131928406/ch07iev1sec3. Accessed on 10th
April, 2007.

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 STUDY SESSION 2 & 3
Doctor/Patient Interaction
Section and Subsection Headings:
Introduction
1.0 Learning Outcomes
2.0 Main Content
2.1 Models of Doctor/Patient Interaction
2.2 Determinants of Doctor-Patient Interaction
2.2.1 Communication
2.2.2 Cultural Differences in Communication
2.2.3 Women Physicians
2.2.4 Personality of Patient
2.2.4.1 Seductive Patients
2.2.4.2 Hateful Patients
2.2.5 Patients with 1000 Symptoms
2.2.6 Mentally Disturbed patients
2.2.7 The Dying Patient
3.0 Tutor Marked Assignments (Individual or Group assignments)
4.0 Study Session Summary and Conclusion
5.0 Self-Assessment Questions
6.0 Additional Activities (Videos, Animations & Out of Class activities)
7.0 References/Further Readings

Introduction:
Talcott Parsons (1951) concept of the sick role provided some basic guidelines
for understanding doctor-patient interaction. Parsons explains that the
relationship between a physician and his or her patient is one that is oriented
towards the doctor helping the patient to deal effectively with a health problem.
The physician has the dominant role because he or she is the one invested with

166
medical knowledge and expertise, while the patient holds a subordinate position
oriented towards accepting, rejecting or negotiating the recommendation for
treatment being offered. In the case of a medical emergency, however, the
option of rejection or negotiation on the part of the patient may be quickly
discarded as the patient‘s medical needs require prompt and decisive actions
from the doctor (Cockerham, 2003). This unit therefore hopes to elaborate more
of these observations.

1.0 Study Session Learning Outcomes

After studying this session, I expect you to be able to;
1. Explain models of doctor-patient interaction
2. Construct/deconstruct determinants of doctor-patient interaction

2.0 Main Content

2.1 Models of Doctor/Patient Interaction
Since Parsons formulated his concept of the sick role, two additional
perspectives of physician-patient interaction have added to our understanding of
the experience. These are the view of Szasz and Hollender of Hayes-Bautista.
Thomas Szasz and Marc Hollender (1956), both physicians, take the position
that the seriousness of the patient‘s symptoms is the determining factor in
doctor-patient interaction. Depending on the severity of the symptoms, Szasz
and Hollender argued that physician-patient interaction falls into one or three
possible models:
• Active-passivity: This applies when the patient is seriously ill or being
treated on an emergency basis in a state of relative helplessness because
of a severe injury or lack of consciousness. Typically, the situation is
desperate as the physician works in a state of high activity to stabilize the
patient‘s condition.

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 • Guidance-cooperation: This arises most often when the patient has an
acute, often more infectious illness like measles or flu. The patient
knows what is going on and can cooperate with the physician.

• Mutual participation: This applies when the physician and the patient
participate actively to achieve treatment. Strict adherence to medication
and related health activities could be obtainable here.

2.2. Determinants of Doctor-Patients Interaction

The following are some determinants of Doctor-patient interaction
2.2.1 Communication
The interaction that takes place between a physician and a patient is an exercise
in communication. Medical treatment usually begins with a dialogue. Thus, the
effectiveness of doctor-patient interaction depends on the ability of both to
understand each other. However, a major barrier to effective communication
usually lies in the difference between physicians and the patients with respect
to:
• Status
• Education
• Professional Training
• Authority

Several sources (Waitzkin, 2000; Clair, 1993), report that a failure to explain a
patient‘s condition to the patient in terms easily understood is a serious problem
in medical encounters. Physicians in turn state that an inability to understand or
the potentially negative effects of threatening information are the two most
common reasons for not communicating effectively with their patients (Davis,
1972).

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However, some doctors are very effective communicators, and as Eric 1985 in
(Cockerham, 2003) explains, information can be an important therapeutic tool
in medical situations if it meets three tests:
• Reduces uncertainty
• Provides a basis for action
• Strengthens the physician-patient relationship

2.2.2 Cultural differences in communication

Physician-patient interaction can also be influenced by cultural differences in
communication. A major study in this area is that of Zola (1966), comprising
Irish and Italian American patients in the presentation of symptoms of an eye,
ear, nose and throat clinic. Zola found that Irish patients tended to understate
their symptoms while Italian patients tended to overstate them. Zola observed
that the Irish made short concise statements like (I can‘t see across the street),
while Italians provided far greater details (my eyes seem very
burny….especially the right eye….Two or three months ago, I woke with my
eyes swollen, I bathed it and it did go away, but there was still the burny
sensation) – for the same eye problem. The doctors were required to sort the
differences in communication styles in order to help them arrive at the
appropriate diagnosis.

2.2.3 Women physicians

Sometimes for women doctors in a work situation, being a woman is a more
meaningful status than being a physician. West (1984), reports that some
patients may perceive women physicians as less an authority figure than the
male physician. In one instance, West (1984) noted that male hospital patients
were asked by a woman physician if he was having difficulty passing urine and
the patient replies ‘You know, the doctor asked me that’ In this case, indicates
West, it was difficult to tell who the doctor was because ‘the doctor’ was
169
evidently the female physician who was treating him. Hammond (1980) also
suggests that female medical students deliberately develop personal biographies
about themselves that show them as being no different from any other medical
student. They do so in order to gain acceptance as colleagues from male
students who question their motivation, skill and potential for medicine.

2.2.4 Personality of the patient

2.2.4.1 The seductive patient
• Patient idealizes the doctor, taking form in erotic or sexualized
transference
• Can be both flattering and disturbing to the physician
• Can evoke [sexual] feelings in the doctor
• Essentially, a doctor cannot stop these feelings. However, it‘s unethical to
act on them and thus, it‘s not the feelings themselves but what you do
with them that may or may not cause trouble

Example
An attractive woman, experiencing difficulty in her marriage, becomes
infatuated with her doctor or psychotherapist/counselor, and expresses a desire
to see him outside of the office.

2.2.4.2 The hateful patient

• This patient is demanding and dissatisfied with their treatment
• Tends to blame physician and others for their illness
• Have unrealistic expectations
• Dumps their inner turmoil into the world around them

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Example
Female on male in-patient is uncooperative, demanding and childlike. She
assigns staff to being either in the ―good‖ staff or the ―bad‖ staff. This causes
the staff to bicker among themselves.

2.2.5 Patient with 1000 symptoms

✓ These are somatizing patients
✓ Appear to be invested in remaining ill
✓ Doctors get frustrated and angry and often order unnecessary
procedures/tests.
• These patients show up frequently in general practice; account for 5-10%
of patients seen.
• The need to be ill is unconscious and patients believe the symptoms are
real.

Example
A female or male patient fears she may have a tumour. First, she thinks eye
pain=tumour, she is given referral to opthalmologist. Second, she thinks elbow
pain=tumour, given referral to orthopaedics. Even after seeing a therapist, and
making connections between and increase in frequency of symptoms with an
increase in stress, she still continue to develop new symptoms and have
recurrent fears related to health.

2.2.6 Mentally disturbed patient

• False assumption that psychotic individuals cannot deal rationally with
illness
• Doctors, as well as staff, may feel frightened of these patients

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Example
A 50 year old man with paranoid psychosis is diagnosed with colon cancer. He
is admitted to the ward and the staff becomes upset because they are fearful of
their safety and feel he should be on the psych floor. They end up avoiding the
patient all together. A psychiatrist was called in and found the patient able to
understand his illness and able to make decisions regarding his treatment.
Therefore, the patient was concerned about why no one was telling him what
was going on.

In-text Question 1 State the physician-patient interaction models according to Szasz and
Hollender:

Answer
Active-Passivity
Guidance-cooperation
Mutual Participation

3.0 Tutor Marked Assignments (Individual or Group)

Identify and describe determinants of Doctor-Patient Interaction

4.0 Conclusion/Summary
We have seen that the relationship between a physician and his or her patient is
one that is oriented towards the doctor helping the patient to deal effectively
with a health problem. While the doctor is perceived to have the dominant role,
the patient is expected to hold a subordinate position oriented towards
accepting, rejecting or negotiating the recommendation for treatment being
offered. Szasz and Hollender (1956) also argued that physician-patient
interaction falls into one or three possible models: Active-passivity, guidance-
cooperation, mutual participation. This unit also identified several determinants
of doctor-patient interaction which include: poor communication, personality of
patients, cultural differences in communication, the mentally retarded patient,

172
patient with 1000 symptoms etc. All these influence illness, and illness
behaviour.
In this unit, we looked at models of doctor-patient interaction as well as several
determinants of doctor-patient interaction. I hope you found the unit interesting.
Now let us attempt the following questions.

5.0 Self-Assessment Questions

1. Explain the models of doctor-patient interaction

6.0 References/Further Readings

Cockerham, W. C. (2003). Medical Sociology, 9th edition. NY: Prentice Hall.
Clair, J. M. (1993). The application of social science to medical practices, pp.
12-28. In J. Clair and R. Allman (Eds). Sociomedical perspectives on
patient care. Lexington: University of Kentucky Press.
Davis, F. (1972). Illness Interaction and the Self. Belmont Cliff: Wadworth.
Hommand J. (1980). Biography building to ensure the future: women
negotiation of gender relevancy in medical school. Symbolic Interaction,
3, 35-49.
Parsons, T. (1951). The Social System, Glencoe 1ll: The Free Press
Szasz, T. and Marc Hollender (1956). A contribution to the philosophy of
medicine: The basic model of the doctor-patient relationship. Journal of
the American Medical Association, 97: 585-588.
Taylor, S. E. (2006). Health Psychology (6th edition). Los Angeles: McGraw
Hill.
Waitzkin, H. (2000). Changing patient-physician relationship in the changing
health policy environment, pp. 271-283. In, C. Bird, P. Conrad and A.
Fremond (Eds). Handbook of Medical Sociology, 5th Edition. Upper
Saddle River, NJ: Prentice Hall.

173
Weiss, L. G. and Lonnquist, L. E. (2005). The Sociology of Health, Healing and
Illness, fifth edition, Safari book online. Retrived from
http//www.safarix.com/0131928406/ch07iev1sec3. Accessed on 10th
April, 2007.
West, C. (1984). ‗When the Doctor is a lady‘ Power, status and gender in
physician-patient encounters. Symbolic Interaction, 7, 87-106.
Zola, I. K. (1966). Culture and symptoms – An analysis of patient‘s presenting
complaints. American Sociological Review. 31: 615-630

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 STUDY SESSION 4
Delay or Overuse of Medical Care
Section and Subsection Headings:
Introduction
1.0 Learning Outcomes
2.0 Main Content
2.1 Delayed Medical Care
3.1.1 Appraisal Delay
3.1.2 Illness Delay
3.1.3 Utilization Delay
2.2 Overuse of Medical Care
3.2.1 Emotional Response
3.2.2 Learned Social Response
3.2.3 Self Handicapping Strategy
2.3 Self Medication
3.0 Tutor Marked Assignments (Individual or Group assignments)
4.0 Study Session Summary and Conclusion
5.0 Self-Assessment Questions
6.0 Additional Activities (Videos, Animations & Out of Class activities)
7.0 References/Further Readings

Introduction:
For certain illnesses, prompt medical attention is needed in order to survive. For
example, the case of sudden heart attack should be taken as an emergency
because getting immediate medical attention can literally make the difference
between life and death. However, despite the obvious need for prompt and
timely treatment, many still have the habit of delaying or overusing medical
care. The reason for such unhealthy illness beahviour will be the focus of this
unit.

175
1.0 Study Session Learning Outcomes
After studying this session, I expect you to be able to;
1. Describe factors influencing delayed medical care
2. Explain factors influencing overuse of medical care
3. Construct/deconstruct the effects of self medication

2.0 Main Content

2.1 Delayed Medical Care
What causes people to delay seeking medical attention for serious conditions?
Addressing this question is assisted by conceptualising the process of seeking
medical help in term of stages. In their analysis of the determinants of delay
behaviour, Safer, et al., (1979), outline three basic issues:
2.1.1 Appraisal delay
First, the person must decide if he or she is ill. However, the time involved in
this decision is termed appraisal delay. Put differently, appraisal delay is the
amount of time it takes a person after experiencing symptoms to decide that he
or she is actually ill. As discussed in the previous unit, certain needs, like the
need to go to work and earn a living, may trigger such appraisal delay. Thus, an
individual may wish away a symptom hoping that he or she would get better
with time, while continuing to carry out work activities.
What then determines the amount of delay at this stage? Interviews with
patients seeking care at the hospital reveals that, appraisal delay was related to
the sensory aspect of the person‘s symptoms, as well as whether the person had
read about the symptoms. It was observed that patients showed less appraisal
delay when they are in pain or bleeding, or have a sudden heart attack, but
showed more delay when they took time to read about their symptoms. In order
words, they are not in so much pain so the probability of taking time to read up
about symptoms of a particular illness is very likely.

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2.1.2 Illness delay
However, when a person finally recognizes that a particular symptom is actually
as a result of a certain illness or disease, it is then time for such a person to
decide whether medical help is needed. This can result in illness delay. Thus
illness delay is referred as the time required for a person to decide that
professional help is required after deciding that he or she is ill.
To ascertain what actually determines the amount of delay in illness delay,
Bishop (1994), observed that illness delay showed a somewhat different pattern.
The sensory aspects of the symptoms were still important, but other factors also
came into play. At this stage, longer delay was associated with having
symptoms that the person had had before. Apparently, because of the previous
experience with the symptoms, patients experiencing old symptom may not feel
the same urgency to seek help, as did those experiencing such for the first time.
Observations also indicate that certain negative images and thoughts associated
with medical care could also influence illness delay. Patients who imagine being
on the operating table or seeing plenty of blood may tend to delay longer than
others.

2.1.3 Utilization delay

Finally, a sick person must decide to actually be in need of help. Thus, the time
required to take this decision is referred to as utilization delay. This is described
as the time it takes a person to decide to seek professional help after deciding
that such help is needed.
What then triggers delay at this phase? It seems that, whereas appraisal and
illness delay depended on sensory aspects of the symptom, utilization delay was
mostly related to practical concerns. Bishop (1994) observed that the strongest
predictor of utilization delay was concern over the cost of treatment. Not
surprisingly, those very concerned about the cost of medical care delay longer
than other who, were less concerned. Here, socio-economic status of an

177
individual can greatly influence illness behaviour. In addition, patients with
painful symptoms, who felt that their symptoms could be cured, showed less
delay than others.

2.2. Overuse of Medical Care

The opposite of delay is the seeking of medical care without good reason.
Observations indicate that many patients seeking medical care from family
practitioners have no diagnosable disease. The ‗worried well‘, those who are
not sick but believe that they might be, are estimated to be responsible for about
50% of the cost of adult ambulatory health care. In addition, patients who seek
medical care needlessly may be subjected to unnecessary medical tests, given
unnecessary medications and put through needless surgeries. An example of
this, as described by Quill (1985), is a 74 year old woman, who over the course
of a single year had been evaluated by a cardiologist for chest pain,
gastroenterologist for abdominal pain, a pulmonologist for shortness of breath,
and was currently being referred for severe headache and weakness. Beginning
when she was 24, she had had over 30 operations for vague problems and was
currently taking six different prescription medicines. Yet physical examination
showed her to be in remarkably good health.
What leads to this overuse of medical services? Such overuse could be
attributed largely to the following factors:
2.2.1 Emotional reasons
Some of these patients suffer from psychiatric disorders, while others use
symptoms and help seeking as a way of getting attention or manipulating others.
Overuse of medical care could also be as a result of hypochondriasis - a false
belief in having a disease or exaggerated fear of contracting one, could persist
despite medical reassurance that nothing is in fact wrong (Kellner, 1987).

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2.2.2 Learned social response
Overuse of medical care may also be a learned response, in which a person
attempts to attract attention and manipulate others. Thus, the person complains
of symptoms so as to obtain sympathy or encouragement, and use sick role to
avoid responsibilities or challenges. Visiting the doctor is a way to gain
sympathy and to have one‘s entry into the sick role validated (Bishop, 1994).

2.2.3 Self-handicapping strategy

Physical complaints also seem to serve as a means by which people can protect
their self esteem. Along this line, individuals may use physical symptoms as a
self-handicapping strategy. Self handicapping strategy provides people with
ready excuses for failure by placing impediments in their own paths. Thus
should they perform poorly, they can save face and preserve their self esteem by
attributing their failure to the impediment, rather than their own lack of ability
(Bishop, 1994).

2.3. Self Medication

Another factor that could influence overuse of medical care is self-medication.
Self-medication can be defined as the use of drugs to treat self-diagnosed
disorders or symptoms, or the intermittent or continued use of a prescribed drug
for chronic or recurrent disease or symptoms. It is usually selected by
consumers for symptoms that they regard as troublesome to require drug
therapy but not to justify the consultation of a prescriber. In developing
countries, most illnesses are treated by self-medication. A major shortfall of
self-medication is the lack of clinical evaluation of the condition by a trained
medical professional, which could result in missed diagnosis and delays in
appropriate treatments. Self-medication may be a matter of concern for several
reasons:
✓ First, there is a lack of objectivity, and professional distance.

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 ✓ Self-medication can lead to delayed diagnosis and treatment and
worsening of the illness.
✓ Many diseases need follow-up apart from medication, particularly for
mental illness and chronic diseases and this is not usually achieved by
self treatment.

In-text Question 1. Define the following terms

i. Illness delay
ii. Utilization delay

Answer
i. Illness delay is referred as the time required for a person to decide that professional help
is required after deciding that he or she is ill.
ii. Utilization delay. This is described as the time it takes a person to decide to seek
professional help after deciding that such help is needed.

3.0 Tutor Marked Assignments (Individual or Group)

Examine the factors that trigger overuse of medical care.

4.0 Conclusion/Summary
In a bid to identify the determinants of delay and overuse of medical care, we
observed different illness behaviour. For delay of medical care, the sick person
first forms an appraisal of the illness, and if not objectively done could result in
illness delay. Thus illness delay is referred as the time required for a person to
decide that professional help is needed after deciding that he or she is ill.
Finally, a sick person must decide to actually be in need of help. Thus, the time
required to take this decision is referred to as utilization delay. This is described
as the time it takes a person to decide to seek professional help after deciding
that such help is needed.
Overuse of medical care could also be a response to emotional difficulties.
Some of these patients suffer from psychiatric disorders, while others use
symptoms and help seeking as a way of getting attention. Overuse of

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 medical care may also be a learned response, in which a person attempts to
attract attention and manipulate others. Along this line, individuals may use
physical symptoms as a self-handicapping strategy-a situation where illness
provides ready excuses for personal failures. The issues of self medication,
was briefly discussed to broaden our understanding of illness behaviours
obtainable in overuse or delay in medical care.
This unit looked at issues of delay and overuse of medical care. Several
determining factors were identified. I‘m sure you must have others in mind.
Well done for reading this far. Now let us attempt the following tutor marked
assignments.

5.0 Self-Assessment Questions

1. Examine the factors that trigger delay of medical care

6.0 References/Further Readings

Cockerham, W. C. (2003). Medical Sociology, 9th edtion. NY: Prentice Hall.
Bishop, G. D. (1994). Health Psychology: Integrating mind and body. Boston:
Allyn and Bacon.
Kellner, R. (1987). Hypochondriasis and somatization. Journal of the American
Medical Association, 258, 2717-2722.
Quill, T. E. (1985). Somatization Disorder: One of medical blind spots. Journal
of American Medical Association, 254, 3075-3079.
Safer, M. A., Tharps, Q., Jackson, T. and Leventhal, H. (1979). Determinants of
3 stages of delay in seeking care at a medical clinic. Medical care, 17, 11-29.
Taylor, S. E. (2006). Health Psychology (6th edition). Los Angeles: McGraw
Hill.
Weiss, L. G. and Lonnquist, L. E. (2005). The Sociology of Health, Healing and
Illness, fifth edition, Safari book online. Retrived from

181
http//www.safarix.com/0131928406/ch07iev1sec3. Accessed 10thApril,
2007.

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 STUDY SESSION 5
Recovery – Rehabilitation
Section and Subsection Headings:
Introduction
1.0 Learning Outcomes
2.0 Main Content
2.1 Physical Problems Associated with Chronic Illness
2.1.1 Physical Problems as a Result of the Illness
2.1.2 Physical Problems as a Result of Treatment
2.1.3 Goals of Physical Rehabilitation of the Chronically Ill
2.2 Vocational Issues in Chronic Illness
2.3 Social Interaction Problems in Chronic Illness
2.4 Personal Issues in Chronic Illness
3.0 Tutor Marked Assignments (Individual or Group assignments)
4.0 Study Session Summary and Conclusion
5.0 Self-Assessment Questions
6.0 Additional Activities (Videos, Animations & Out of Class activities)
7.0 References/Further Readings

Introduction:
The final stage of Suchman‘s stage of illness experience (Suchman, 1965), is
recovery and rehabilitation. At this stage, the acute patient is expected to
relinquish the sick role and move back to normal activities. For the chronic
patient, the extent to which prior role obligations may be resumed ranges from
those who forsake the sick role, to those who will never be able to leave it
(Weiss and Lonnquist, 2005).
Chronic illness raises a number of highly specific problem-solving tasks that a
patient encounters on the road to recovery. These tasks include physical
problem associated with illness, vocational problems, problems with social

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relationships, and personal issues concerned with chronic illness (Taylor, 2006).
This unit therefore seeks to elaborate more on the aforementioned issues.

1.0 Study Session Learning Outcomes

After studying this session, I expect you to be able to;
1. Analyse and discuss the physical problems associated with chronic illness.
2. Assemble goals of physical rehabilitation of the chronically ill.
3. Describe vocational issues of chronic illness.
4. Explain problems of social interaction associated with chronic illness.
5. Construct/deconstruct personal issues of chronic illness.

2.0 Main Content

2.1 Physical Problems Associated With Chronic Illness
Physical problems associated with chronic illness may be divided into those that
arise as a result of illness itself, and those that emerge as a consequence of the
treatment.
2.1.1 Physical problems as a result of the illness
Physical problems that are produced by the illness itself range widely. They
may include physical pain such as chest pain experienced by heart patients,
headaches which are a presenting discomfort for a wide range of illnesses, or
the chronic pain associated with Arthritis. Breathlessness associated with
respiratory disorders, and motor difficulties produced by spinal cord injuries
also represent important physical problems (Taylor, 2006). Cognitive
impairment may also occur, such as language, memory, and learning deficits
associated with stroke. In many cases, then, the physical consequences of
chronic illness place severe restrictions on the individual‘s life.

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2.1.2 Physical problems as a result of treatment
Treatment of primary symptoms and the underlying disease also produce
difficulties in physical functioning. Cancer patients receiving chemotherapy
sometimes face nausea, vomiting, hair loss, skin discoloration and other
unattractive and uncomfortable bodily changes. Those cancer patients who
receive radiation therapy must cope with the burning of the skin, gastrointestinal
problems and other temporary disturbances (Nail et al, 1986). Medication of
hypertension can produce a variety of side effects including drowsiness, weight
gain and impotence. Sexual dysfunction as a result of illness and/or treatment
may occur in patients with hypertension and cancer (Anderson, Anderson and
daProsse 1989a). Restrictions on the activities of patients, who have a heart
attack-including, elimination of smoking, dietary changes and exercise
requirements, etc, may pervade their entire way of life. In many cases, patients
may feel that, in terms of discomfort and restrictions they impose, the
treatments are as bad as the disease.

2.1.3 Goals of physical rehabilitation of the chronically ill patient

Physical rehabilitation is an important aspect of chronic illness. This is because,
chronic disability leads to higher levels of anxiety, distress and even suicide
ideations. Physical rehabilitation of the chronically ill patient therefore involves
several goals:
• To learn how to use one‘s body as much as possible
• To learn how to sense changes in the environment in order to make
appropriate physical accommodations
• To learn new physical management skills
• To learn a necessary treatment regime
• To learn how to control expenditure of energy (Gartner and Reissman,
1976).

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2.2. Vocational Issues in Chronic Illness
Many chronic illnesses create problems for patient‘s vocational activities and
work status. Thus, some patients may need to restrict or change their work
activities. For example, a salesman who previously conducted his work from his
car, motorcycle or simply by walking around door to door, but is now diagnosed
with stroke, may need to switch to a job in which he/she can do less walking
about and use the telephone instead. Also, patients with spinal cord injuries,
who previously held positions that require physical activities, will need to
acquire skill that will enable them work from a seated position.
Important to note that many chronically ill patients, especially the mentally ill
and HIV/AIDS patients face job discrimination. Such patients are likely to be
fired, more than other and if tolerated, may be moved to less demanding and
obscure positions. They may also be promoted less because the organization
believes that they have a poor prognosis and are not worth the investment of
time and resources required for training.
Because of these potential problems, any job difficulties that the patient may
encounter should be assessed early in the recovery process. Job counseling,
retraining programmes and advice on how to combat discrimination can then be
initiated promptly (Taylor, 2006).

2.3 Social Interaction Problems in Chronic Illness

The development of chronic illness can create problems of social interaction for
the patient. After diagnosis, patients may have problems re-establishing normal
social relations. They may complain of others pity or rejection, but
unconsciously behave in ways that inadvertently elicit these behaviours. They
may withdraw from other people altogether; shy away from social functions or
may thrust themselves into social activities before they are ready.
Patients could solely be responsible for whatever difficulties and awkwardness
that arise in interaction with others. Acquaintances, friends and relatives may

186
have problems of their own adjusting to patients altered conditions. Many
people hold pejorative stereotypes about certain chronically ill patients,
including those with AIDS, particularly when individuals are seen as having
brought on a disease or problem through their own negligence or seen as not
attempting to cope with the disorder. Thus, reactions experienced here may be
highly negative. (Schwarzer and Leppin, 1991).
There is however the need for patients to think through whether they want to
disclose the fact of their illness to those outside their immediate family. If they
decide to do so, they may need to consider the best approach, because certain
illnesses, particularly HIV/AIDS, mental illness, may elicit negative reactions
from people.
There is some evidence that chronically ill women may experience more
deficits in social support than do chronically ill men. One study found that
disabled women receive less social support because they are less likely to get
married, than disabled men (Kutner, 1987).

2.4 Personal Issues in Chronic Illness

It seems that throughout this unit, we focused more on the adverse changes that
chronic illness create and what can be done to ameliorate them. This focus tends
to obscure an important point namely, that chronic illness can confer positive
outcomes as well as negative ones. In one study of cancer patients, (Collins et
al, 1990), observed that more that 90% of the respondents at least reported some
beneficial changes in their lives, an a result of the cancer, including an increased
ability to appreciate each other and inspiration to do things new in life rather
than postponing them. The patients reported that they were putting more effort
into their relationships and believed that they had acquired more awareness of
others‘ feelings and more sympathy and compassion for people. They reported
feeling stronger, more self-assured and more compassionate toward the
unfortunate.

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How do patients suffering from chronic illness with its often severe
consequences and emotional trauma, nonetheless, manage to achieve such high
quality of survival? When people experience an adverse condition like a chronic
illness, they strive to minimize its negative impact (Taylor, 2006). When they
encounter damaging information and circumstances, they try to reduce the
negative implications for themselves or think of it in as much unthreatening a
manner as possible. When negative consequences are difficult to deny, a person
may attempt to offset them with perceived gains incurred from the event, such
as finding meaning through the experience or believing that the self is a better
person for having withstood the event.

In-text Question 1 (A short question requiring a single sentence answer for quick reflection
over the read topic) State four (4) goals of physical rehabilitation of the chronically ill
patient

Answer
1. To learn how to use one’s body as much as possible
2. To learn how to sense changes in the environment in order to make appropriate physical
accommodations
3. To learn new physical management skills
4. To learn a necessary treatment regime

3.0 Tutor Marked Assignments (Individual or Group)

Discuss the vocational, social interaction and personal issues associated with
chronic illness.

4.0 Conclusion/Summary
This unit highlighted dimensions of the final stage of Suchman‘s, stage of
illness experience: recovery and rehabilitation. Here, the acute patient is
expected to relinquish the sick role and move back to normal activities while the
chronically ill patient may need to grapple with highly specific problem-solving
tasks encountered on the road to recovery. These tasks include physical problem

188
associated with illness, vocational problems, problems with social relationships,
and personal issues concerned with chronic illness.
In this unit, we discussed the physical problems associated with chronic
illness, as well as related vocational, social interaction and personal issues. I
hope they were helpful. Now let us attempt the following questions.

5.0 Self-Assessment Questions

i. Identify the physical problems that occur as a result of illness
ii. Identify the goals of physical rehabilitation of the chronically ill

6.0 References/Further Readings

Anderson, B. L., Anderson, B. and deProsse, C. (1989a). Controlled perspective
longitudinal study of women with cancer: 1. sexual functioning outcomes.
Journal of Consulting and Clinical Psychology, 57, 683-691.
Cockerham, W. C. (2003). Medical Sociology, 9th edtion. NY: Prentice Hall.
Collins, R. L., Taylor, S. E. and Skokan, L. A. (1990). A better world or a
shattered vision? Changes in perspective following victimization. Social
Cognition, 8, 263-285.
Gartner, A. and Reissman, F. (1976). Health care in a technology age. In self
help and health: A report. NY: New Human Services Institute.
Kutner, N. G. (1987). Issues in the application of high cost medical technology:
The case of organ transplantation. Journal of Health and Social Behaviour,
28, 23-36.
Nail, L. M., King, K. B. and Johnson, J. E. (1986). Coping with radiation
treatment for gynecological cancer: Mood and disruption in usual function.
Journal of Psychosomatic Obstetrics and Gynaecology, 5, 271-281.
Schwarzer, R. and Leppin, A. (1991). Social support and health: a theoretical
and empirical overview. Journal of Social and Personal Relationship, 8,
99-127.

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Suchman, E. A. (1965). Social patterns of illness and medical care. Journal of
Health and Human Behaviour, 6, 2-16.
Taylor, S. (2006). Health Psychology, 6th edition. NY: McGraw Hill
Weiss, L. G. and Lonnquist, L. E. (2005). The Sociology of Health, Healing and
Illness, fifth edition, Safari book online. Retrived from
http//www.safarix.com/0131928406/ch07iev1sec3. Accessed 10th April,
2007.

190