Chapter 3 Seeking Health care theories of health protective behaviors - should (1) generate research, (2) organize and explain observations, and (3) guide the practitioner in predicting behavior. Four theories related to "health behaviors" have been developed.
1. the Health Belief Model - is a "common sense" approach which focuses on beliefs in four areas: (1) susceptibility to illness, (2) severity of illness, (3) benefits of health enhancing behaviors, and (4) barriers to health enhancing behaviors.
For example, young people tend to have an "optimistic bias, seeing their symptoms as minor whereas older people attribute their symptoms to age. This model's predictive ability is increased when assessments of "self-efficacy" are added. the IHBS scale - Christensen et. al. have developed the Irrational Health Belief
Scale (IHBS) to investigate WHY people often don't act in common sense ways regarding their health. At present, more research is needed. self- efficacy - This concept was introduced, and extensively researched by
Albert Bandura (a social learning theorist). It relates to one's belief that a behavior will lead to a desirable outcome. As related to health behaviors selfefficacy appears to be "situation specific" rather than being a global (affecting all behaviors) factor.
2. the Theory of Reasoned Action - Assumes that people are reasonable and make systematic use of information in making decisions. The enactment of a behavior (e.g., going on a diet) is determined by "intention." Intention is, in turn, determined by (1) the person's attitude toward the behavior, and (2) social pressure regarding the behavior (social norms). It is comparable to the health belief model in terms of predictive ability. (see fig. 3.1)
3. the Theory of Planned Behavior - Ajzen's extension of the Theory of
Reasoned Action, adds the "person's perception of how much control he or she has over the behavior." (see fig. 3.2)
4. the Precaution Adoption Process Model - Weinstein's Precaution Adoption
Process model holds that people move through seven stages in arriving at a

health behavior decision. Notable is stage "2" in which an "optimistic bias" is held. optimistic bias - The unrealistic belief that one is less likely than other people to develop a disease, have an accident, or experience other negative events. conclusions on the "Models" - The Health Belief model and the Theory of
Reasoned Action (combined with the self-efficacy concept) have generated more research and interest than the Theory of Planned Behavior and Precaution
Adoption Process Model. While better than chance, all of these models "leave much to be desired" in terms of predicting health behaviors. disease vs. illness and the physician's role - Technically the terms differ.
Disease refers to damage within the body and can exist in the absence of a label or diagnosis. Illness requires that one has been "diagnosed" as being sick. This makes physicians the "gatekeepers" to further health care. They both determine the presence of the disease AND "sanction" it via their "diagnoses." illness behaviors - are those undertaken by people who feel ill. The goal is discovering what is wrong and what can be done about it. Illness behaviors occur
"pre-diagnosis." sick role behaviors - are those undertaken by people after being diagnosed (by physician OR self). The goal is getting well. Sick role behaviors occur "postdiagnosis." gender differences - Women are more likely to utilize health care. Men are more likely to interpret minor problems as serious illness. "Gender roles," may make it easier for women to seek more kinds of help whereas they may allow men to be riskier in their behaviors including not seeking out health care. age differences - Young and middle aged people are less likely to seek out care, perhaps because they see themselves as more "invulnerable." cultural and ethnic differences - Wealthier (high SES) people report better health and are more likely to seek out health care when ill than poorer (low SES) people. However poorer people are hospitalized more, suggesting that they experience more serious illnesses.

symptom characteristics - David Mechanic has defined four symptom characteristics associated with increased health seeking behaviors: (1) greater visibility of the symptom, (2) perceived severity (more important than actual severity), (3) degree of interference with life, and (4) symptom frequency and persistence. the sick role - According to Alexander Segall, the sick role brings three privileges: (1) making health-related decisions, (2) being exempt from normal activities, and (3) being dependent on others. The three responsibilities are: (1) maintaining health and getting well, (2) engaging in routine health care, and (3) utilizing a range of health resources. access to health care - The U.S. does NOT have national health care or insurance as do some other countries. "Employment" is very important in terms of access to health care as most jobs include "health benefit" programs. About
"17%" of people in the U.S. are uninsured. Individual insurance is much more expensive.
Medicare and Medicaid - Created by the U.S. government in 1965, Medicare provides basic health care for those over age 65. Medicaid was designed to provide health care to those of any age who can't afford it. However, only about
"40%" of the poor qualify.
"alternative" care - About 1/3 of middle class Americans seek out alternative care (chiropractors, nutritionists, herbal healers, etc.) in addition to a physician. female physicians - when compared with male physicians, are more "patient centered," spend, on average, 10% more time with patients, communicate more positively, and ask more questions. health maintenance organizations (HMOs) and PPOs - promote prevention and try to contain costs (sometimes by limiting access to treatment). Physicians are paid a set salary so are not motivated to order extra services and may be pressured to limit referrals. Preferred provider organizations "PPOs" allow patients more choices than do HMOs.

hospitalization - has changed in many ways in recent years. (1) Many surgeries are now done "outpatient." (2) Stays are shorter. (3) Complexity and understaffing have let to more medical "mistakes."
The hospital role - Today's hospitals are big, impersonal, and patients are often treated as "non-persons." They lose control of daily activities, are not given much information, and their comments or concerns are not given high priority. dangers of health care - In 1999, it was estimated that the number of people who die each year as a result of hospital errors was between 44,000 and 98,000.
The number of deaths attributed to prescription drugs was between 76,000 and
137,000. A 2005 Journal of the American Medical Assoc. report stated that the profession has made "only limited progress toward solving the problem of medical errors." distraction, not reassurance - A study which had parents either "reassure" or
"distract" their children while getting immunization shots showed that distraction was much more effective in calming the children.