Transcript Health_L6_handout

Health Psychology
Lecture 6
Receiving Health Care
Lecture 6 - Outline
• Part 1
– Receiving Health Care
• Patient-practitioner relationships
• Hospitalization and noxious procedures
Receiving Health Care
Receiving health care is a multifaceted process…
1. Notice the symptoms
2. Interpret the symptoms
3. React to the symptoms
4. Satisfaction with health care
5. Comply with medical recommendations
Receiving Health Care
1. Noticing the symptoms
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Individual differences
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Competing environmental stimuli
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Emotional, cognitive, and situational variables
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Sociocultural issues
Receiving Health Care
2. Interpreting the symptoms
• Am I ill?
Receiving Health Care
3. Reacting to the symptoms
• Majority of symptoms are not reported to a health
professional
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What factors influence whether people seek
medical care?
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Personal reluctance to seek care
Social and demographic factors
Symptom characteristics
Personality
Beliefs about illness (illness schemata)
Delay in seeking medical care
Three stages of delay in seeking medical help for symptoms
Receiving Health Care
4. Satisfaction with health services
• Commonly, people express a high level of
satisfaction with their consultation
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Patient satisfaction is affected by
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Average = 88% (ranges from 43 to 99%)
Type of health issues
Quality of patient-practitioner interactions
Outcomes of patient satisfaction
What are your major complaints?
Sources of dissatisfaction with medical consultations
• The doctor does not listen to them
• The doctor is not sympathetic
• They do not understand what the doctors tell them
Patient-Practitioner Relationships
Satisfaction with medical care = satisfaction with
practitioner
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Factors that lead to dissatisfaction include
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Personal style
Interrupting
Terminology
Differing aims and expectations
Patient characteristics
Receiving Health Care
5. Adherence to treatment regimes
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Nonadherence occurs when people do not adopt
the behaviors or treatments prescribed by their
doctors
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Average nonadherence = 50% (ranges from 15 to 93%)
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Nonadherence with medication - low (25%)
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Nonadherence with lifestyle changes - high (75%)
Receiving Health Care
5. Adherence to treatment regimes
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Measuring nonadherence
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Clinician’s report, Self-report, Other-report
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Objective count of pills, biochemical markers
Consequences of nonadherence - does it matter?
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Often no deleterious effects but…
Over 10% of hospital admissions can be attributed to
nonadherence
Receiving Health Care
5. Adherence to treatment regimes
• Causes of nonadherence - possible solutions
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Understanding and remembering the treatment regimen
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Satisfaction with patient-practitioner relationship
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Features of the treatment regimen
Features of the disorder
Contingencies - operant conditioning
‘Rational’ nonadherence
Reactance and self-labeling
Receiving Health Care
5. Adherence to treatment regimes
• Causes of nonadherence - possible solutions
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Simple regimens + written information
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Teach approachability, warmth, communication skills
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Promoting participation in decision making
Highlight benefits of adherence, costs of nonadherence
Cues, self-monitoring and reinforcement
Request a verbal (or written) commitment
Encourage patient to ask questions
Hospitalization and Noxious Procedures
Hospitalization
Relevance of psychology to hospitalization
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Determination of psychological effects, and their
causes and consequences**
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Determination of effective interventions to
prevent/reduce adverse psychological effects**
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Dissemination of information to relevant care
providers
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Delivery of interventions
Hospitalization
Satisfaction with hospital care
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Tends to be high (Cleary et al., 1991; Delbanco, 1992)
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Charles et al (1994) - Canada, 5 000 patients
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Communication
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Did not understand answers to questions
Did not understand explanation of test results
Practitioners talked as if patient not there
8%
15%
12%
Pain
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Was not told about how much pain to expect
Had pain which could have been eliminated
26%
16%
Hospitalization
Consequences of hospitalization
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Loss of Control (Taylor, 1979)
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Loss of control over one’s body
Loss of control over typical activities
Loss of ability to predict what will happen
Explanations for problems
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Familiarity, time, effort, depersonalization, pain
Hospitalization
Emotional Reactions to hospitalization
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Anxiety
Learned helplessness
Reactance
Depression
Hospitalization
Individual differences in reaction to hospitalization
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Coping Skills
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Problem-focused (information seeking)
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Emotion-focused (cognitive restructuring, wish-fulfilling
fantasy, threat minimization)
Painful or Stressful Procedures
Intervention aim - reduce anxiety to  recovery
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Reassurance
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Information
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Sensory information (sensations likely to experience)
Procedural information (mechanics of what will happen)
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Review of empirical evidence
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Suls and Wan (1989)
Anderson (1987)
Auerbach (1989)
Painful or Stressful Procedures
Intervention aim - reduce anxiety to  recovery
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Cognitive-Behavioral Strategies
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Aim: Alter appraisal and enhance control or distraction
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Review of empirical evidence
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Shipley et al. (1978)