Health Psychology An Introduction to Behavior and Health 8th Edition by Linda Brannon – Test Bank
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CHAPTER 3
Seeking and Receiving Health Care
Lecture Outline
1. Seeking
Medical Attention
How people determine their health status when they don’t feel
well depends on their social and cultural background, their interpretation of
symptoms, and their concept of what constitutes illness. Illness behavior consists
of those activities taken by people who feel sick and are directed toward
determining health status before an official diagnosis. Sick role behavior consists
of those activities exhibited by people after they
have been diagnosed and are aimed at trying to get well.
1. Illness
Behavior
Many people experience symptoms that may signal illness; some
seek help for these symptoms and others do not. Six possibilities explain how
people respond to symptoms.
1. Personal
factors include people’s way of viewing their own body, their
level of stress, and their personality traits. Stress affects people’s
readiness to seek care—that is, people who experience a great deal of stress
are more likely to seek health care than those under less stress, even with
equal symptoms.
2. Gender also
plays a role in seeking health care, with women more likely than men to seek
treatment. Women tend to be more sensitive to their bodies than men and also to
report more non-life threatening symptoms. In addition, women’s gender role
allows them to seek assistance more readily than men’s gender role permits.
3. Age is
another factor in seeking treatment, with young and middle-age people being
most reluctant to check out symptoms. Older adults must decide if their
symptoms are the result of aging or disease. In many situations, this
attribution is difficult to make, and their uncertainty make delay seeking
health care.
4. Socioeconomic,
ethnic, and cultural factors also relate to seeking
medical care. People in high socioeconomic levels are less likely than other to
have symptoms, but when they do experience pain and discomfort, they are more
likely to go to a health care professional. Knowledge of the implications of
symptoms is similar in all groups, but access to care varies with socioeconomic
status.
5. Symptom
characteristics often influence how people respond to illness.
People are most likely to seek medical care when: (1) their symptoms are quite
visible to themselves and to others, (2) they view the symptoms as severe, (3)
their symptoms interfere with usual lifestyle, and (4) their symptoms recur or
persist.
6. Conceptualization
of disease is a sixth factor that may help explain why some people
seek health care, whereas others with the same symptoms do not. Howard
Leventhal and his colleagues identified five components in the
conceptualization of illness. (1) People need to label their
symptoms, and a non-threatening label seems to alleviate symptom anxieties. (2)
When people receive a diagnosis, they think about the time line of
both the disease and the treatment. (3) Most people feel less anxious when they
can attribute some cause to their symptoms. (4) People think of the consequences of
their disease, and some overestimate or underestimate the mortality rates of
certain diseases. (5) People who believe that they can control their own
disease process (for example, through diet or exercise) are less likely than
others to seek health care.
7.
The Sick Role
After people become convinced that they are ill, they adopt the
sick role, which allows them both privileges and responsibilities. Their
privileges include: (1) the right to make decisions concerning health-related
issues, (2) the right to be exempt from normal duties, and (3) the right to
become dependent on others for assistance. Their three responsibilities are (1)
the duty to maintain health as well as get well, (2) the duty to perform
routine health care management and, (3) the duty to use a range of health care
resources.
1. Seeking
Medical Information from Nonmedical Sources
Once an individual notes symptoms they must decide if and how
they are going to seek help. Individuals often turn to family and friends
(e.g., lay referral network) and the internet before seeking health information
from a doctor.
1. Lay
Referral Network
Many people seek help from their lay referral network,
a network of friends and family who offer information and advice. This is often
a person’s first source of information, and while it may be beneficial, it can
also provide people with false or faulty healthy information.
1. The
Internet
The Internet has become a popular source of health information.
The majority of Internet users in the US have used the Internet to seek health
information. Women and those with higher education are more likely to seek
health information on the Internet. However, like the lay referral network, the
Internet can be a source of health misinformation.
III. Receiving Health Care
By the time most people in the United States have reached their
21st birthday, they have had multiple experiences of receiving health care.
Those experiences vary according to economic factors, which may limit access to
health care.
1. Limited
Access to Health Care
Hospitalization and other complex medical treatments are so
expensive that most people cannot afford these services. People who can afford
health insurance do so. In an attempt to rectify this condition, the U.S.
Congress created two programs in 1965 to provide health care—Medicare, which
pays hospital expenses for most Americans over the age of 65 and Medicaid,
which provides health care based on low income and physical problems, such as
disability or pregnancy.
1. Choosing
a Practitioner
Sick people have a wide choice of health care providers,
including midwives, nurses, physical therapists, psychologists, osteopaths,
chiropractors, dentists, nutritionists, and herbal healers. The recent growth
of alternative medicine has come mainly from well-educated people who are
dissatisfied with traditional medical care. For many poor people, their most
common experience of receiving health care is going to a hospital emergency room,
giving them very little choice of practitioner.
1. Practitioner-Patient
Interaction
The interaction between the practitioner and patient is
important, as satisfied patients are more likely to follow medical advice and
obtain checkups.
2. Verbal
Communication
Verbal communication is important in practitioner-patient
interactions. Reasons for unsatisfied communications include physician’s not
listening to the patients concerns or physicians speaking a “different”
language than the patient,
3. The
Practitioner’s Personal Characteristics
Patients are more likely to follow the advice of physicians they
see as worm, caring, friendly, and interested in the welfare of patients, and
these may be more likely to be female doctors. Female doctors spend 10% more time
with patients, are more positive in their communications, and were evaluates
more highly by their patients than male doctors.
1. Being
in the Hospital
2. The
Hospital Patient Role
The experience of being in the hospital has changed during the
past 25 years. Hospitalization has become less common for many types of surgery
and diagnostic tests, and hospital stays have become shorter, but those who are
hospitalized tend to be sicker. An array of technology for diagnosis and
treatment adds to the depersonalization and stress of hospitalization.
Part of the sick role is to be a patient, and being a patient
means conforming to the rules of the health care institution, complying with
medical advice, and being a good patient, that is, a “nonperson” who tolerates
lack of information and loss of control.
Hospitalized patients become part of hospital routine, which
allows them limited information concerning their illness and little control
over their situation. This situation adds to the stress of being ill, but
hospitals have become more technology-oriented and more impersonal, so this
situation is not likely to improve.
2. Children
and Hospitalization
Children are especially vulnerable to persistent fears as a
result of receiving medical treatment. Reassuring children that they have
nothing to fear is not effective, but allowing children to tour the premises to
become familiar with the treatment they will receive can decrease fears.
Observing a model deal with a similar procedure is another approach to
preparing children to cope with hospitalization. Unfortunately, costs, not
effectiveness, are the main problem with children’s interventions to reduce
children’s stress.
Exploring Health on the Web
The Internet is now a vast resource for information about
various conditions and treatment options. Several websites offer good,
objective information and links related to the health care system and choosing
a practitioner.
http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareservice.html
MedlinePlus is a U.S. government-sponsored website that contains
a vast amount of health-related information, including access to the National
Library of Medicine. In addition to a listing of physicians and hospitals, one
of the features presents guidelines to choosing a doctor or health care
services. The site contains no advertising (as many sites about choosing a
practitioner do) and no endorsements. MedlinePlus screens the information
carefully and updates it frequently.
http://dmoz.org/Society/Issues/Health/Health_Policy/
This website is part of a project to provide organization for
the information available on the Internet. This section deals with health care
policy and provides dozens of links to papers and research about health care
and health care reform.
Suggested Activities
Personal Health Profile — Assessing Personal Preferences in
Health Care
Some people prefer to be involved, active participants in their
own health care whereas others prefer to rely on the opinions of professionals.
The 16-item Krantz Health Opinion Survey (Krantz, Baum, & Wideman, 1980)
measures preferences for different treatment approaches. The questionnaire asks
respondents to agree or disagree with statements about their preferences in
health care situations. Krantz and his colleagues divided the survey into two
scales; one measures the desire for information and the other measures the
extent of behavioral involvement in health care. Your students can complete
this survey in a few minutes, and the results will give them information about
their own preferences as a patient, which they can add to their personal health
profiles.
That scale appears in an article that can be found in:
Krantz, D. S., Baum, A., & Wideman, M. V. (1980). Assessment
of preferences for
self-treatment and information in healthcare. Journal of Personality
and Social Psychology, 39, 977-990.
Culture and Medical Care
Direct your students to explore the impact of culture on giving
and receiving medical care. They can gather this information from Internet
sources, research articles, and even by interviewing people. They should look
for information concerning the cultural differences in types of acceptable and
desirable medical care, the impact of culture and ethnicity on receiving health
care, and the impact of those factors on providers.
Instruct your students to find examples of instances in which
health care has been culturally aware and sensitive and examples in which
patients have received less than optimal care because their culture is not
compatible with the health care they sought.
A further point of discussion could be to ask students how the
US healthcare system could change to decrease confusion that may arise. Also,
the textbook mentions studies that show that perceived discrimination decreases
the likelihood of utilizing the healthcare system. What could practitioners or
hospitals change about their current practices that may help increase minority
ethnic groups seeking of health care?
What Makes a Practitioner Good?
Conduct a class discussion concerning the important decision of
choosing a practitioner. Although most people would say that competence
is the main criterion in this decision, research indicates that people tend to
choose a medical practitioner on the basis of many other factors. What other
factors have your students used to decide what physician, dentist,
chiropractor, or other practitioner to visit?
Do your students believe that their practitioners are competent?
On what do they base their opinions? Do some students believe that their
practitioner is competent because she or he is friendly and appears to be
caring? How can people without medical training know the competence level of
health care professionals?
For another viewpoint of practitioners, have students read the
following news article
http://www.nbcnews.com/id/7317399/ns/health-health_care/t/look-questions-doctors-dread/#.URPmrKVV58E .
What are the responsibilities of patients when visiting the practitioner? In
what ways might the practitioners’ behavior influence the patient and vice
versa?
Of course, physicians’ personal beliefs influence their
interactions with patients as well. For example, a recent study from Johns
Hopkins University suggests that physicians’ beliefs about the causes of
obesity influence the advice they give to their patients. In what other ways
might the beliefs of a physician influence the type and quality of care they
provide?
This article can be found in:
Bleich, S. N., Gudzune, K. A., Bennett, W. L., & Cooper, L.
A. (2013). Do physician beliefs about causes of obesity translate into
actionable issues on which physicians counsel their patients?” Preventive Medicine.
How Children Are Prepared for Hospitalization
Many hospitals in the United States offer programs that prepare
children for hospitalization and stressful medical procedures. If you are able
to locate a hospital that offers such a program, you can invite the person who
administers it (often called a child life specialist) to speak with your
class. Request that information be included about the size of the
program, types of children served, costs and benefits, and the types of
activities included in the program. If the hospital has no analogous program
for adults, ask the guest to consider why these preparations are considered
worthwhile services for children but not for adults.
If you cannot get a person from your community to speak to your
class, the Internet offers a wide variety of options to learn about programs
from various hospitals. A search engine such as Google will allow you to access
dozens of hospitals’ child preparation programs by entering preparing children for
hospitalization as the search term. Many of these websites are oriented
toward instructing parents about how to help their children cope with a
hospital stay and the frightening and painful procedures they may undergo. The
Kids Health website offers an article with tips for parents, which appears at http://kidshealth.org/parent/system/surgery/hosp_surgery.html
Seeking Medical Attention
Have students think about the last time they sought (and did not
seek) medical care for a condition, by asking the following questions- “What
was the symptom? How did you interpret the symptom? Think about the last time
you decided not to get care for a condition… what was the
symptom? How did you interpret the symptom? Did you seek help from any other
sources besides a doctor or nurse?”
Students may be reluctant to discuss their own personal behavior
in a face-to-face classroom setting but are willing to talk about their parents
or family members. Depending on the responses of your students, you also may
also be able to relate seeking medical care back to topics of gender (males
less likely to seek care than females) and age (parents should seek medical
care more than their children or their parents).
Video Recommendations
From Films for the Humanities & Sciences:
The Hospital Experience (2003) explores why
hospitalization is such a distressing experience by following a patient through
the process.
Killed by Care: Making Medicine Safe (2004)
presents the problem of medical errors, including commentary by two of the most
prominent proponents of patient safety, Donald Berwick and Lucien Leape.
The Chronically Ill: Pain, Profit, and Managed Care (2000)
focuses on the problems of providing medical care to people with chronic
illness in a system oriented toward acute care. The video also highlights the
issues of cost and the profit-oriented health care system in the United States.
From Fanlight Productions:
To highlight the role of culture in receiving medical
care, Worlds Apart: A Four-Part Series on Cross-Cultural Healthcare (2003)
follows four patients with serious medical problems as they negotiate the
health care system and make important medical decisions.
Videos from the Web:
http://youtu.be/XF8yZRgcSkg –
“Cultural Diversity Health Care” is a short video that examines the importance
of practitioners being aware of cultural factors that may impact healthcare
(1:16).
Multiple Choice Questions
1. Which
of these statements expresses a healthy attitude toward seeking medical care?
1. “I
believe that if I feel well, I’m healthy.”
2. “Only
severe symptoms of a disease are worth worrying about.”
3. “When
I don’t understand my doctor’s explanations or instructions, I’ll ask questions
until I do understand.”
4. “When
facing a stressful medical procedure, I try not to think about it.”
ANS: c REF: Seeking Medical
Attention
2. Although
the terms “disease” and “illness” are often used interchangeably, they have
somewhat different meanings. Technically, disease refers to
1. psychological
disorders.
2. the
experience of being sick.
3. the
process of physical damage.
4. an
existing, official diagnosis.
ANS: c REF: Seeking Medical
Attention
3. In the
United States, people are considered to be ill
1. after
they have been officially diagnosed by a health care provider.
2. if
they have an elevated temperature for at least 24 hours.
3. when
a disease process first begins.
4. whenever
they feel sick.
ANS: a REF: Seeking Medical
Attention
4. Maud
has not been feeling well due to a sore throat. She has taken aspirin and spent
most of the day in bed. Her actions would be defined as
1. sick
role behavior.
2. illness
behavior.
3. both
a and b.
4. neither
a nor b.
ANS: a REF: Seeking Medical
Attention
5. Edna
waited almost 2 weeks after her sinuses started bothering her before she made
the appointment to see her doctor. Making the appointment would be considered
1. sick
role behavior.
2. illness
behavior.
3. psychotic
behavior.
4. health-seeking
behavior.
ANS: b REF: Seeking Medical
Attention
6. Joshua
has been told by friends that he does not look well. He feels flushed and
decides to take his temperature to determine if he has a fever. His actions
would be defined as
1. self-defeating
behavior.
2. disease
behavior.
3. illness
behavior.
4. socialized
behavior.
ANS: c REF: Seeking Medical
Attention
7. The
function of illness behavior is to
1. determine
health status.
2. alleviate
symptoms.
3. seek
a cure.
4. increase
compliance.
ANS: a REF: Seeking Medical
Attention
8. People
experiencing high levels of stress are _____ likely to report symptoms and
______ likely to have their symptoms acknowledged as indicating a disease.
1. more
. . .more
2. more
. . .less
3. less
. . .less
4. less
. . .more
ANS: b REF: Seeking Medical
Attention
9. Women
are more likely than men to seek health care, possibly because
1. they
feel less stress than men.
2. they
tend to be more introverted.
3. they
have more diseases than men.
4. they
may be more sensitive to their internal body status.
ANS: d REF: Seeking Medical
Attention
10.
Who is most likely to seek health care?
1. a
55-year-old women with a rapid heart beat
2. a
26-year-old man with a sprained ankle
3. a
70-year-old women who attributes her symptoms to age
4. an
unemployed 30-year-old mother with four children
ANS: a REF: Seeking Medical
Attention
11.
Jane and Betty are both experiencing fever and nausea. Jane’s
friend Myrna asks her if she is sick and tells her that she looks terrible, but
when she sees Betty, Myrna says nothing about Betty’s appearance. Research
suggests that Jane
1. is
likely to seek health care but to advise Betty not to.
2. is
more likely than Betty to seek health care.
3. will
seek alternative health care rather than go to a physician.
4. and
Betty will both make appointments with a physician.
ANS: b REF: Seeking Medical
Attention
12.
Which of these people is most likely to seek health care?
1. A
19-year-old college man with a knot on his leg
2. A
19-year old college woman who misinterprets HIV symptoms for the flu
3. A
9-year-old boy knocked unconscious from a fall off his bicycle
4. A
40-year-old women worried about a lump in her breast
ANS: d REF: Seeking Medical
Attention
13.
Which of these people is most likely to seek health care?
1. Mildred
is 72 years old and simply does not feel well. She refers to her symptoms as
“the crud.”
2. Melvin
is a 63-year-old owner of his own profitable business. He began to feel chest
pains yesterday and is concerned.
3. Elmer
is 68 years old, never married, and lives alone. For the past 2 years, Elmer
has experienced “shortness of breath.”
4. Ida
is 92 years old and feels fine. However, she is lonely and would “like to talk
to someone about her health.”
ANS: b REF: Seeking Medical
Attention
14.
With equal symptoms, who is most likely to seek health care?
1. A
45-year-old man who runs his own business
2. A
45-year-old unemployed man
3. A
55-year-old woman with a very low level of stress
4. A
55-year-old woman with a very high level of stress
ANS: d REF: Seeking Medical
Attention
15.
According to David Mechanic, which of these symptom
characteristics is LEAST likely to determine people’s response to illness?
1. cost
of treatment and hospitalization
2. perceived
severity of the illness
3. visibility
of the symptoms
4. the extent
to which the symptoms interfere with normal daily functioning
ANS: a REF: Seeking Medical
Attention
16.
Several symptom characteristics predict a person’s readiness to
seek health care. Which of these is NOT one of these characteristics listed by
David Mechanic?
1. severity
of the symptom as seen by medical authorities
2. visibility
of the symptom
3. frequency
and persistence of the symptom
4. extent
to which symptoms interfere with daily life
ANS: a REF: Seeking Medical
Attention
17.
Finding a label for symptoms
1. tends
to catastrophize the problem.
2. tends
to make women believe that the problem is more serious but tends to make men
believe that the problem is less serious.
3. is an
important component of personal understanding of illness.
4. is
less important than receiving support from family and professionals.
ANS: c REF: Seeking Medical
Attention
18.
Gail has not been feeling well lately. According to the model of
illness conceptualization described by Howard Leventhal and his colleagues, Gail
is likely to
1. deny
her symptoms.
2. try
to label her symptoms in a non-threatening way.
3. repress
her symptoms and get to the point where she believes she does not experience
them.
4. exaggerate
her symptoms and attempt to get all the sympathy she can.
ANS: b REF: Seeking Medical
Attention
19.
Which of these factors was NOT among the factors identified by
Howard Leventhal as a component in the conceptualization of illness?
1. identification
of the disease
2. monetary
cost of the illness and treatment
3. cause
of the disease
4. consequences
of the disease
ANS: b REF: Seeking Medical
Attention
20.
Alexander Segall proposed that the sick role includes three
rights and privileges and three responsibilities. Which of these factors is a
responsibility of people who have adopted the sick role?
1. making
decisions about one’s health-related issues
2. making
an attempt to get better
3. the
duty to perform everyday chores
4. the
duty to depend on other people for assistance
ANS: b REF: Seeking Medical
Attention
1. A
_______ is the event that separates illness behavior from sick role behavior.
1. heart
attack
2. diagnosis
3. hospitalization
4. death
ANS: b REF: Seeking Medical
Attention
1. Poor
people, in comparison to wealthy people, utilize health care _______, and when
they do their illnesses are _________.
1. less
often; severe
2. less
often; not severe
3. more
often; severe
4. more
often; not severe
ANS: a REF: Seeking Medical
Attention
1. Of
all ethnic groups, _____ are the most likely to report a visit to a physician.
1. Asian
Americans
2. European
American
3. African
Americans
4. Mexican
Americans
ANS: b REF: Seeking Medical
Attention
1. When
diabetes patients viewed their illness as acute, rather than chronic, their
illness management was
1. better.
2. worse.
3. unchanged.
4. better
for a few months, then worse.
ANS: b REF: Seeking Medical
Attention
1. Margaret
finds a lump in her breast but delays seeking medical attention because she is
worried it might be breast cancer. According to Leventhal, Margaret is worried
about the
1. consequences
of her disease
2. timeline
of her disease
3. determination
of her disease
4. identity
of her disease
ANS: a REF: Seeking Medical
Attention
1. Women
and those with higher education are more likely to seek health information from
1. their
friends and family.
2. the
Internet.
3. newspapers
and magazines.
4. television.
ANS: b REF: Seeking Medical
Information from Nonmedical Sources
1. Alex
found some information about a new treatment for asthma on the Internet and
shares this information with her doctor. Since Alex’s information is accurate
and relevant, her relationship with her doctor will most likely
1. deteriorate,
as her doctor feels challenged.
2. benefit,
as Alex and her doctor can discuss this new information.
3. end,
as Alex no longer trusts her doctor to provide her with new information.
4. Both
a and c.
ANS: b REF: Seeking Medical
Information from Nonmedical Sources
1. Patients’
_________ with their practitioner can lead to patients following medical advice
and continual use of medical services, like obtaining checkups.
1. payment
plan
2. satisfaction
3. differences
4. all
of the above
ANS: b REF: Seeking Medical
Information from Nonmedical Sources
29.
To help people 65 years old and older, the United States
Congress established
1. the
Health Maintenance Act.
2.
3.
4. the
Dole/Clinton Act of 2001.
ANS: c REF: Receiving Medical Care
30.
Which of these industrialized nations has the greatest
restrictions on access to health care?
1. France
2. China
3. Germany
4. the
United States
ANS: d REF: Receiving Medical Care
31.
In the United States,
1. most
people with health insurance are either employed or have a family member who is
employed.
2. all
citizens must possess health insurance.
3. every
person 65 or older receives free prescription drugs.
4. private
health insurance is not available to people with Medicare.
ANS: a REF: Receiving Medical Care
32.
When people without health insurance are in serious need of
medical attention, they are most likely to go to
1. an
emergency room.
2. an
alternative health provider.
3. a pharmacist.
4. another
country.
ANS: a REF: Receiving Medical Care
33.
Which of these factors reflects a significant trend in the
health care system during the past 30 years?
1. Hospital
stays are much longer.
2. Medical
schools are graduating fewer physicians.
3. The
percentage of general practitioners has increased dramatically.
4. Hospitalized
patients are more severely ill than they were 30 years ago.
ANS: d REF: Receiving Medical Care
34.
The “nonperson” treatment that hospital patients experience
arises from
1. the
requirement that patients follow hospital routine.
2. intentional
efforts by hospitals to transfer control from patients to staff.
3. physicians
who do not care about their patients’ well-being.
4. all
of these.
ANS: a REF: Receiving Medical Care
35.
Malone has been in the hospital for two weeks due to injuries
from an automobile crash. Because he is hospitalized, he does not have to work;
he receives three healthy meals a day; and most of his normal, everyday
decisions are made for him. In such circumstances, Malone will probably
1. enjoy
his hospital stay.
2. become
addicted to pain medication.
3. experience
less stress than usual.
4. experience
more stress than usual.
ANS: d REF: Receiving Medical Care
36.
Medical errors cause some deaths in the United States. Research
suggests that the number of such deaths per year is at least
1. 2,000.
2. 6,000.
3. 21,000.
4. 44,000.
ANS: d REF: Receiving Medical Care
37.
Parents who reassure children who are about to undergo stressful
medical procedures, telling them that “There’s nothing to be afraid of,”
1. provide
effective models.
2. decrease
the anxiety level in their children, but raise it in themselves.
3. are
more effective than filmed models in helping a child cope with the stressful
medical procedure.
4. tend
to increase rather than decrease their children’s fears.
ANS: d REF: Receiving Medical Care
38.
Using modeling to help children in the hospital prepare for
stressful medical procedures
1. is
not successful in helping children prepare for surgery but can help with less
serious procedures.
2. is
successful with children but not with adolescents or adults.
3. can
be as successful as drugs when modeling is combined with a cognitive behavioral
intervention.
4. can
be effective if the parents of the young patient are not allowed to
participate.
ANS: c REF: Receiving Medical Care
39.
Most adults would profit from the techniques that hospitals use
to prepare children for hospitalization. The main barrier to preparing all
patients who undergo stressful medical procedures is that
1. adults
do not have the time for these procedures.
2. these
procedures add to medical costs.
3. patients
find the preparation as stressful as the procedures, so preparation adds to the
overall stress of hospitalization.
4. these
procedures are not effective.
ANS: b REF: Receiving Medical Care
True/False Questions
1. People
with a disease are also ill.
ANS: F
1. Those
actions people undertake to learn whether or not they are ill are called
illness behaviors.
ANS: T
1. Sick
role behaviors occur before a person has seen a health care provider and prior
to receiving a diagnosis from that health care provider.
ANS: F
1. Women
are more likely than men to seek health care, even when pregnancy and
childbirth are not considered.
ANS: T
1. African
Americans are more likely than European Americans to visit a physician.
ANS: F
1. In
the United States, medical errors are the second leading cause of death.
ANS: F
1. Men
tend to report only life-threatening situations, such as heart disease, whereas
women tend to report more body symptoms and distress.
ANS: T
1. Young
adults show the greatest reluctance to seek health care.
ANS: T
1. People
often seek medical information from their family and friends, also known as
their lay referral network.
ANS: T
1. Emily
is trying to decide between two doctors: one is female and one is male.
Research on how doctors interact with their patients, suggest that Emily may
want to consider choosing the female doctor, as this doctor is more likely to
spend more time with her and be more positive when communicating with her.
ANS: T
Essay Questions
1. Differentiate illness
behavior from sick role behavior and give examples of each.
2. Illness
behavior
3. Consists
of those activities undertaken by people who feel sick to determine if they are
ill.
4. Occurs
before a diagnosis.
5. Is
influenced by personal reluctance to seek medical care.
6. Is
exhibited more often by women than men and more readily by the middle- and
upper-class than the lower-class.
7. Is
prompted by diseases with visible and persistent symptoms and diseases that the
person believes to be serious.
8. Examples
are making an appointment with a physician, taking one’s temperature,
scheduling diagnostic tests, etc.
9. Sick
role behavior
10.
Is exhibited by people who are ill in order to get well.
11.
Occurs after a diagnosis and is oriented toward getting well.
12.
Mandates changes in normal activities and relief
from normal responsibilities—staying home from work or school, not doing
regular chores, resting, and also not engaging in recreational activities.
13.
Mandates behavior oriented toward getting well, such as getting
prescriptions filled, taking medication, and making any required changes in
behavior to comply with doctor’s orders.
2. What personal and
social factors influence seeking health care?
3. Personal
factors such as a person’s body concept and perceived levels of stress affect
the decision to seek health care.
4. Gender
is a factor in seeking care; women are more likely to do so than men.
5. Age
is also a factor in seeking health care; young and middle-aged people show more
reluctance than older individuals.
6. Economic
and cultural factors also play a role in seeking health care.
7. People
with more money receive more health care.
8. European
Americans are more likely to see a physician than those from other ethnic
groups, possibly because they tend to have better insurance coverage than other
ethnic groups.
3. How people understand
disease is critical for their behavior when they believe they are ill. Discuss
each of the five components that Leventhal and his associates have identified
as components of illness conceptualizations in terms of the implications for
illness behavior.
4. Identity
of the disease
5. Labeling
symptoms as a disease is a critical component in illness conceptualization;
labels provide a framework.
6. People
tend to try to identify their symptoms as less threatening diseases.
7. Timeline
8. The
time course of a disease is usually part of the label, but people can
misunderstand this aspect of disease.
9. People
tend to interpret diseases as acute rather than chronic, implying a short
timeline rather than a lifelong one.
10.
Determination of cause
11.
People attribute their illness to some event or circumstance,
but they may be inaccurate.
12.
People are more likely to seek care for conditions they perceive
as having a physical cause rather than mental or spiritual causes.
13.
Consequence of a disease
14.
People try to understand the implications of having a disease,
but misunderstanding is possible.
15.
People may avoid health care if they believe that the
consequences of a diagnosis are severe.
16.
Controllability
17.
People want to see their condition as controllable.
18.
If people believe that they can control their disease, they are
less likely to seek health care than if they believe they need help to control
their illness.
4. What circumstances
restrict people’s access to adequate health care?
5. Lack
of insurance coverage
6. Health
care is too expensive for most people to afford, and insurance allows access to
expensive procedures.
7. People
without insurance have limited access to regular health care and complex
medical technology.
5. In addition to being
ill, what makes hospitalization stressful? Why don’t hospitals make changes to
alleviate these circumstances?
6. Factors
that make hospitalization stressful include
7. Necessity
of conforming to hospital routine promotes impersonal treatment.
8. Increased
use of technology has promoted even greater depersonalization.
9. Lack
of information—patients often undergo tests and treatment but are not informed
of the purpose or outcome of these procedures.
10.
Lack of control—patients must relinquish control over many
aspects of their lives.
11.
Hospitals could make changes to make hospitalization less
stressful.
1 The emphasis on controlling costs makes these
changes very unlikely.
2. Children
are much more likely than adults to receive preparation for hospitalization;
decreasing children’s anxiety and fear makes hospital procedure smoother, which
can save money.
CHAPTER 5
Defining, Measuring, and Managing Stress
Lecture Outline
1. The
Nervous System and the Physiology of Stress
The nervous system is made-up of neurons (nerve
cells) that provide internal communication by releasing chemical neurotransmitters across
the synaptic
cleft (the space between neurons). The billions of
connections among neurons provide for complex actions. The nervous system is
divided into the central
nervous system and the peripheral nervous system.
The central nervous system consists of the brain and spinal cord, whereas all the
other nerves in the body are in the peripheral division (see Figure
5.1).
1. The
Peripheral Nervous System
The peripheral nervous system is also divided into two
divisions, the somatic
nervous system, which consists of the nerves that activate voluntary
muscles in the body. The autonomic
nervous system (ANS) serves internal organs and glands and
works automatically. Although conscious control of autonomically controlled
reactions is possible, this control requires training. The ANS is also divided
into two parts, the sympathetic and parasympathetic divisions
(see Figure 5.2). These two divisions act reciprocally, the sympathetic
increasing its activity in emergency or stress situations and the
parasympathetic acting in normal situations. Neurotransmission in the ANS is
conducted mainly by two chemicals, acetylcholine and norepinephrine,
which exert complex effects.
1. The
Neuroendocrine System
The endocrine
system consists of ductless glands, and the neuroendocrine system consists
of endocrine glands controlled by the nervous system. These glands
release hormones that
travel through the blood and act on target organs (see Figure
5.3).
1. The
Pituitary Gland
The pituitary
gland is located in the brain and releases a number of
hormones that affect target organs in many parts of the body. One pituitary
hormone—adrenocorticotropic
hormone (ACTH)—acts on the adrenal glands.
2. The
Adrenal Glands
The adrenal
glands are located on top of the kidneys and contain two
structures that produce different hormones, the adrenal cortex (outer
covering) and the adrenal
medulla (inner structure). The adrenocortical response
occurs when ACTH stimulates the adrenal cortex to secrete glucocorticoids, the
most important of which is cortisol. The adrenomedullary response is
activated by the sympathetic nervous system and secretes catecholamines,
including epinephrine and
norepinephrine.
1. The
Physiology of the Stress Reaction
The stress reaction mobilizes body resources in emergency
situations. One route occurs through activation of the sympathetic nervous
system, which is called the adrenomedullary response. The other route is
through the hypothalamic-pituitary-adrenal
axis and involves all these structures. The response of
the hypothalamus prompts the pituitary to stimulate the adrenal cortex to
produce glucocorticoids, including cortisol. (See Figure
5.4 for these two routes of activation.)
Maintaining an appropriate level of activation calls for varied
levels of activation of the peripheral nervous system. This process is called allostasis, but
prolonged activation of the sympathetic nervous system creates allostatic load,
which may cause problems. Shelly Taylor and her colleagues have proposed that
this “fight or flight” model may be more appropriate for men; women may manage
stress through a “tend and befriend” strategy.
1. Theories
of Stress
Hans Selye and Richard Lazarus proposed influential theories of
stress.
1. Selye’s
View
Selye’s
theory defined stress as a nonspecific or generalized response to a variety of environmental
stressors. Whenever the body encounters a disruptive stimulus, it mobilizes
itself in a generalized attempt to adapt to that stimulus.
1. The
General Adaptation Syndrome
This
mobilization is called the General
Adaptation Syndrome (GAS). The GAS has three stages—alarm, resistance, and exhaustion. The
potential for trauma or illness exists at all three stages (see Figure
5.5).
2. Evaluation
of Selye’s View
Selye concentrated on the physiological aspects of stress,
downplaying the psychological ones and ignoring the perceptual and
interpretative processes that can moderate the human experience of stress.
1. Lazarus’s
View
Richard
Lazarus saw a person’s perception of an event as more important than the event
itself. His transactional view emphasizes psychological factors (such as
cognitive mediation), appraisal, vulnerability, and coping.
1. Psychological
Factors
Lazarus
held that people are harmed by negative life events only if they perceive those
events as being personally important, are in a vulnerable state, and believe
that they lack the ability to successfully cope with those events.
2. Appraisal
Lazarus
and his associates recognized three kinds of appraisal—primary, secondary, and reappraisal. Primary
appraisal is one’s initial judgment of an event, which may be seen as (1)
potentially harmful, (2) threatening or damaging to self-esteem, or (3)
personally challenging. Secondary appraisal is one’s perceived ability to cope
with harm, threat, or challenge. Reappraisal of an event occurs as an ongoing
process to reevaluate a changing situation.
3. Vulnerability
Stress
is most likely to be aroused when people are vulnerable; that is, when they
perceive a lack of resources to cope with a situation of some personal importance.
4. Coping
Coping
involves our constantly changing efforts to manage both internal and external
demands that are appraised as taxing or exceeding our resources. Coping is
enhanced by such resources as health, energy, high self-efficacy, problem-solving
skills, social skills, and social support.
III. Measurement of Stress
The usefulness of stress measures rests on their ability to
consistently predict some established criterion—for example, illness.
1. Methods
of Measurement
Stress
has been measured by several methods, but most fall under two groups: (1)
physiological measures and (2) self-reports, which may be either life events scales
or daily hassles scales.
1. Physiological
Measures
Blood
pressure, heart rate, galvanic skin response, respiration rate, and biochemical
measures such as cortical and catecholamine release are some of the
physiological indexes used to assess stress. A disadvantage of these procedures
is that the equipment and the setting may themselves produce stress.
2. Life
Events Scales
Most
life events scales are patterned after the Holmes and Rahe Social Readjustment
Rating Scale, an
instrument that emphasizes change in a person’s life. The scale lists
43 life events arranged in rank order from most to least stressful. Respondents
check the items they have experienced during a recent period, usually the
previous 6 to 24 months.
Other stress inventors include the Undergraduate Stress
Questionnaire (USQ). The USQ is a self-report similar to the SRRS in that it provides
a list of sources of stress and asks college students to check the ones that
have happened to them during the past two weeks. Most items are hassles rather
than major life events.
The Perceived Stress Scale, which emphasizes perception of
events, is a 14-item scale that attempts to measure the degree to which
situations in people’s lives are appraised as unpredictable, uncontrollable, or
overloading. The scale assesses three components of stress: (1) daily hassles,
(2) major events, and (3) changes in coping resources.
3. Everyday
Hassles Scales
Lazarus
pioneered scales that measure daily hassles rather than major life events. The
original Daily Hassles Scale assumes that only unpleasant events (hassles) can
be stressful; pleasant events (uplifts) may help reduce stress and even promote
health. A companion measure was the Uplifts Scale, made up of items that might
make a person feel good. Both scales emphasized the person’s view of
the event. Later, Lazarus and his colleagues published the revised Hassles and
Uplifts Scale, a shorter scale that allows participants to see an event as
either a hassle or uplift. Specialized versions of hassles scales have also
been developed.
1. Reliability
and Validity of Stress Measures
The
reliability of self-report inventories of stress is most often
determined by having people fill out the instrument a second time at a later
occasion or by having a close associate—such as a spouse—fill out the inventory
as if answering for the person. Although most self-reports inventories have
acceptable reliability, their validity to predict illness is more difficult to
determine. The SRRS shows some ability to predict stress-related symptoms.
1. Sources
of Stress
Many
sources of stress exist and can be organized into cataclysmic events, life
events, and daily hassles.
1. Cataclysmic
Events
Certain unique and powerful events require major adaptive
responses. These events affect large numbers of people and may be unintentional
events such as natural disasters or intentional events such as terrorist
attacks. Cataclysmic events are more stressful when they are intentional acts
and when people are in close proximity to the events. People who experience
cataclysmic events may develop posttraumatic
stress disorder (PTSD).
1. Life
Events
Cataclysmic events occur to some people, but everyone
experiences life events that require change. These events affect individuals
rather than groups and tend to take place across time rather than suddenly.
Divorce and job loss are examples of such life events, but so is crime
victimization, which is a life event that produces stress.
1. Daily
Hassles
Daily hassles are events that occur as part of everyday life
that may arise from the physical or psychological environment.
1. Daily
Hassles and the Physical Environment
Sources of stress such as noise, pollution, crowding, and fear
of crime are associated with urban living; Eric Graig gave this combination the
name urban press.
Each of these events may occur individually. Noise, or
noxious, unwanted auditory stimulation that intrudes into a person’s
environment, can be stressful. Population
density is a physical situation, but crowding is a
psychological condition that arises from the perception of a high-density
environment. Both noise and crowding are more stressful when people believe
they have little control over the situation. The “environment of poverty”
describes a situation that often adds fear of crime to the other hassles common
in urban life. People in ethnic minorities are more likely to live in such an
environment, and these individuals are often subject to hassles from the
psychosocial environment as well as from the physical environment.
2. Daily
Hassles and the Psychosocial Environment
Discrimination is a common experience for African Americans in
the United States, creating daily hassles in the community and at work. Other
ethnic groups and women also experience stress due to discrimination, which may
affect cardiovascular health. Other situations that produce stress at work include
jobs with high demands and low control, such as food servers and middle-level
managers. Workplace stress may also affect personal relationships, producing
conflict between work and family. Finding a balance between work and family is
a challenge for both women and men. Family relationships are important because
they are both sources of stress and sources of support.
1. Coping
with Stress
2. Coping is
the term applied to strategies people use to manage distressing problems and
emotions in their lives.
3. Personal
Resources that Influence Coping
Folkman and Lazarus listed resources that affect coping, which
included health and energy, positive beliefs about the ability to cope,
problem-solving skills, material resources, social skills, and social support.
Social support refers to a variety of
material and emotional supports that people receive from others. Social support
differs from social
contacts and social
networks in that it is a measure of the quality of
one’s social contacts. Social
isolation refers to the absence of meaningful personal
relationships. The Alameda County Study established a link between social
support and good health and decreased mortality. Social support may help
people’s health by providing encouragement to adopt healthy habits or seek medical
care, by helping people cope with stress, by altering the physiological
responses to stress, or by buffering against stress.
A feeling of personal
control may also help people cope with stress, either by
having an internal locus of control or by exerting control over one’s
environment. A study of nursing home residents by Ellen Langer and Judith Rodin
suggested that when people are allowed to assume even small amounts of personal
control and responsibility, they live longer and healthier lives.
1. Personal
Coping Strategies
Coping strategies may be classified in many ways, but one
approach divides them into problem-focused coping and emotion-focused
coping. Problem-focused
coping is aimed at changing the source of the stress,
whereas emotion-focused
coping is oriented toward managing the emotions that
accompany stress. Both types of strategies can be effective, but
problem-focused coping is generally a better choice than emotion-focused
strategies.. The relationship between coping strategy and health is complex,
involving an interaction between the type of coping strategy and whether the
outcome is measured in terms of physical or mental health.
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