1. Illness Behaviour

2. Illness Behaviour
Illness behaviour refers to those behaviours that individuals engage in once they believe that they are ill.
Illness Behaviour Research Group
Illness behaviour is an active rather than passive process that involves interpreting symptoms, evaluating possible responses and, finally, deciding on whether to try to alleviate those symptoms or simply to ignore them.
Harding & Taylor, 2002

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

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

5. The Sick Role
A form of behaviour deemed appropriate to those perceived as being encumbered by illness
Comprises regulatory features that control the “deviant behaviour” of illness thereby preventing disruption of societal stability & cohesiveness (i.e. “The Social Order”).
The social community determines whether we can legitimately consider ourselves as ill.
We influence the social community’s decision by how we present and behave.

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

7. Obligations of The Sick Role
Individual should be seen as wishing to leave this temporary role and become well
Individuals must cooperate with competent health professionals

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

9. The Social Context Behaviour is socially determined Zborowski,1952
Cultural differences in pain perception & responses to pain
Daryanani et al, 2001
Pathways into, & accessibility of, Child & Adolescent Mental Health Services are highly ethnically, culturally & socially determined

10. Race, Ethnicity & Culture
A person’s biological inheritance
Ethnicity
The way a person thinks about that biological inheritance
Culture
The social network within which converstions about race & ethnicity evolve

11. Daryanani et al, 2001
1,117 children referred to local Child & Adolescent Mental Health Service over a period of one year
113 (10%) did not attend any appointments
348 (31%) remained open
423 (38%) were seen and subsequently closed
Non recording of ethnic origin data significantly greater for families who failed to attend

12. Statistically Significant Referral Tendencies
Over referral of White children by General Practitioners
Over referral of Black & South Asian children by Specialist Doctors
Over referral of Black children by Education Services
Over referral of Mixed Race children by Social Services
No relationship between problem type & referral tendencies

13. Implications
Significant biases operating in referral route according to ethnic background of child.
Problem of overlooking within-group cultural diversity
Nonetheless, even in ostensibly liberally-minded, educated, caring & professional groups, skin colour remained the most influential immediate factor in assessing ethnic identity.
In 1994 “Black-Caribbean” pupils accounted for only 1.1% of the school population but formed 7.3% of those permanently excluded.

14. The Psychological Context
Cognitions as well as behaviours have a situational basis influenced by time, location & company.
“It is not things themselves which disturb us but the view we take of them.” - Epictetus
Atrributional Style – Seligman
Internal-external dimension (“locus of control”)
Global-specific dimension (situationality)
Stable-unstable dimension (time)
Optimism scale

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

16. Richards et al, 2005, 2006
21 young people with Chronic Fatigue Syndrome & their parents
Opinion regarding likely causes & appropriate responses/treatments sought
Effort to expand understanding of young peoples’ and family’s beliefs & responses rather than extrapolating simplistically from adult research data

17. Causality Beliefs