Before health promotion strategies can be implemented it is important to look at an individual (such as Maureen in the case study) and analyse their health beliefs and health behaviour. Matarazzo (1984) illustrates in his work on health behaviours that actions associated with health can be broken down into two main categories, one which is positive and one which is negative. Positive health protection behaviours he labelled as “behavioural immunogens” and health impairing habits he labelled as “behavioural pathogens”. Maureen’s action of smoking is a health impairing habit that might lead to further illness and disease; also she is significantly overweight caused by overeating, which can be classed as negative health behaviour.
Negative health behaviours now have a bigger impact on disease and death than ever before, previous serious health conditions such as Tuberculosis were primarily infectious diseases spread through poor living conditions and lack of medical interventions. However, McKeown (1979) as cited by Ogden (2004) illustrates that it is not necessarily improvement in medical interventions that has led to the reduction of traditional killers such as whooping cough, pneumonia and cholera, but improvements in sanitation and overall living conditions. It could be argued that negative health behaviours are currently the biggest predictors of serious health complaints, such as heart disease, cancer and circulatory illnesses.
As illustrated in the case study Maureen believes that smoking lowers her stress levels and without cigarettes her stress levels would increase. This could be an indicator that Maureen is adhering to a lay theory of health. Health psychologists have explored lay theories by using in depth interviews, this method of interviewing allows the interviewee to be more descriptive leading to qualatitive research. When developing health interventions an understanding of lay theories is important, if Mauureen’s health beliefs are contradictory to those of the health professionals, interventions may be not effective. (Ogden, 2004).
Graham (1987) reported that women saw it necessary to maintain smoking, even though the women studied were aware of all the health risks. These women saw smoking as a necessary way of coping with stress and this was seen to outweigh their fears about their overall health. Whether or not Maureen is compliant with the recommendations of health professionals will have a large impact on her health behaviours. Haynes et al, cited in Ogden define compliance as: “the extent to which the patient’s behaviour (in terms of taking medications, following diets or other lifestyle changes) coincides with medical or health advice. (Ogden, 2004, p. 77) For Maureen to manage her diabetes effectively she needs to cease smoking and loose weight; effective health interventions will help Maureen to change her negative health behaviours. However, studies have illustrated that about half of patients with chronic illnesses such as diabetes are non-compliant with health professional’s recommendations. (Dekker et al. 1992).
The psychological approach to health beliefs, as indicated by Marks et al, puts the emphasis on “discourse” and the context in which the communication takes place. Within health psychology the word “discourse” encompasses the way that information is delivered to all parties and is embedded within social interaction. Through the use of effective discourse people’s health beliefs can be modified through the development of an understanding of health and illness. This is illustrated in a study by Blaxter (1993) on working class women in Scotland. “Simple cognitive representations” were changeable through the use of effective communication and understanding of health and illness was developed within the study sample.
If this approach was applied to Maureen a change in her health beliefs may be apparent. The emphasis on the client participating in active discourse may lead to a deeper understanding of her individual situation and this could lead to more tailored health strategies that Maureen may be compliant with.
Overall smoking is in the decrease, with some countries such as the Republic of Ireland using a total ban on smoking in public as a way of discouraging smoking overall. The United Kingdom is in the process of following the Irish and Scottish lead and is meeting with some opposition from the smoking lobby. The smoking lobby puts forward the argument that smoking is the choice of the individual.
Statistics cited by Ogden (2004) show that smoking is on the decline and the decline is greater in men than women, although, overall fewer women take up smoking behaviour. Also Ogden (2004) indicates that smoking is more prevalent in the unskilled manual labour group.
The fact that people in the unskilled manual group are more likely to smoke is indicative of Maureen’s health behaviour. Statistics show that working class females are the least likely to give up smoking (Ogden, 2004), however two-thirds of the smoking population indicate that they would like to cease smoking with the majority also reporting that to give up would be very difficult. Maureen has also indicated that she would like to give up but maintains that smoking is a stress management aid.
Maureen’s use of smoking, as an aid to coping with stress, could be described as a “maladaptive coping strategy”. Rogers (1983) developed the “protection motivation theory”, this theory puts forward that there are five main components of health related behaviours. These range from self-efficacy i.e. confidence in own ability to undertake positive health behaviours; to fear i.e. an emotional response and active avoidance of undertaking positive health behaviour. The component of the model that Maureen adheres will inform as to whether or not she will develop adaptive or maladaptive coping responses to what is being recommended by health professionals.
Maureen may be classed as overweight, depending on her body mass index (B.M.I.), if her B.M.I. is above thirty she will be classed as clinically obese and this may lead to elements of stigmatisation within society. It has been illustrated by the media that some health authorities are taking the unusual step of withdrawing certain treatments if a person is classed by the medical profession as being clinically obese. Not only does this show clinical professions as making assumptions on the person’s lifestyle but it also shows society’s non-acceptance of obesity. This is also an illustration of the power that physicians have by being the gatekeepers of services and decreeing whether an individual fits the criteria that the health authority may put forward. (BBC online, 2005)
It could also be argued that Maureen may be in denial of her overall health issues; this could be because Maureen does not want entry into the sick role. Labelling an individual can lead to feelings of inadequacy and have serious physical and psychological side effects, the physical side effects can stem from prescribed medication and the psychological side effects can lead to feelings of helplessness and stigmatisation. Once an individual such as Maureen has entered into the sick role her overall life chances may diminish.
If Maureen was to adopt the sick role it may be used as a way of reflecting certain responsibilities from Maureen on to certain health care professionals. These responsibilities may include adopting a healthier lifestyle by making significant changes to her diet also by striving to limit or cease smoking and also adopting a manageable exercise programme. If she allows herself to adopt the sick role she may adopt the attitude that it is up to practitioners to cure her rather than her take responsibility for her overall health and well being.
Crandall (1994) wrote about the comparison between racism and “fatism”. He identified that within the obesity culture feelings of stigmatisation may be felt by those who are labelled as obese. The feeling of stigmatisation can also lead to feelings of isolation, but most of all stigmatisation can lead to feelings of inadequacy because the person in question may feel marginalised and rejected by society. These are all elements that may be visible within other social groups such as ethnic minorities and gay and lesbian people. The reasons that these feelings are identified by these groups may be because society does not understand these social groups, and also in some way they are seen as deviating from societal expectations and societal norms.
Ogden (2004) identifies the role of the media in building social norms. An example of this is that although a significant percentage of the population of the U.K. is overweight this is not reflected in media imagery. Images of slim people are seen to be attractive and it has become the social and societal norm to expect people to emulate, sometimes unattainable role models and imagery.
3. A suggestion on how your profession and others in an interprofessional team could assist with the condition.
Whelan (2002) identifies that the World Health Organisation (W.H.O.) estimates that without successful patient management systems, the largest contributory factor to disability will be chronic illness. The W.H.O. suggests that by 2020 the most expensive problem facing health care organisations, including the National Health Service (N.H.S.), will be the management of chronic disease and illness. Therefore it is important that interprofessional teams put in place relevant management systems. Psychoeducational interventions have shown effectiveness in promoting patient self management of chronic disease and illness and Barlow et al (2004) have identified a number of American studies that have shown the effectiveness of chronic disease self management courses (CDSMC).
CDSMC’s are generally delivered within community settings, and participants on these courses can be referred by a number of public or private professionals or organisations, such as G.P.s, specialist support organisations or other health professionals. The attendants on these courses participate interactively through group discussions, role-play and problem solving scenarios. This type of intervention delivery can sometimes lead to a foundation dialogue between participants which may increase social networks. (Barlow et al, 2004)
The case study indicates that Maureen has two main health impairing habits which are going to impact on her overall health status, these are smoking and over-eating. A reluctance to combat these habits could be overcome by the introduction of positive health strategies such as CDSMC. Trials on CDSMC have shown positive outcomes such as improved cognitive symptom management, better communication with relevant professionals, lessening of depressive symptoms and also a widening of social networks.
It is important that professionals communicate effectively with each other and also with the service users, such as Maureen. When dealing with the service users it is important to use non-jargonistic language as this may lead to feelings of fear and nervousness if the patient is unsure what is being communicated. When working in an inter-professional environment it is also important to remember that each professional will bring a different perspective to the case. For example the occupational therapist may apply the psycho-social model of health perspective and the surgeon is applying a medical perspective with the surgeon’s aim being ‘let’s fix the problem’. (Sutton et al 2005)
Cooper and Roter in Sutton et al (2002) recommend that communication skills training programmes need to be more broadly based to train health care practitioners to communicate in a culturally more sensitive way, and that strategies are needed to empower patients across ethnic and social groups to participate more in their care.
Whether Maureen is entitled to Disability Living Allowance (DLA) depends on the severity of her diabetes. If her diabetes is causing her to lose her sight or any other related complication it would be up to benefit specialists to look at their guidance. If Maureen’s diabetes is being controlled by insulin injections and no other part of her daily life is affected she may not be entitled to any form of benefit. A Social Worker may be assigned to Maureen to help her explore the avenue of benefits; also other diabetes professionals may be able to offer financial advice. One thing Maureen would be entitled to would be free prescriptions and her G.P may be able to give her information about this.
It is important to remember when assessing a client such as Maureen that unified assessment principles should be applied. Unified assessment means that all professionals are working to common goals and objectives and putting the client at the forefront of this process. This means of assessment should limit the number of professionals that undertake this process as multi-disciplinary teams should have access to this document. (W.A.G. online, 2005.) It is also important (in multi-disciplinary teams) to make sure that communication channels with the client and other key professionals are maintained and encouraged. To facilitate this process it is always a good principle to make sure that the client is consulted at all levels of the decision making process.
One of the barriers to multi-disciplinary working could be the lack of supportive infra structures, such as the I.T. systems that each profession uses not being based on a common operating system that can be accessed and understood within different professions. The Government have a goal that all patients within health and social care settings should have a digitised version of their notes available to all practitioners that may come in contact with them. Also these formatted notes should be available on pocket personal computer format to enable professionals to collaborate at the bedside. The developments being made in I.T. will help with collaboration and partnership working and overall this will lead to an improvement in patient care, which should always be at the forefront of any health and social care professionals mind.
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Student Number. St03000605.
Year. 3rd year.
Module. Behavioural Studies
Assignment Title. Report on the case study of “Maureen”
Module Lecturer. Dr Caroline Limbert
Word Count. 2, 838.
