Breast cancer: Varied perceptions of social support in the illness experience

Social support has been identified as an important factor in cancer. However, the stigma associated with cancer often leads to avoidance behavior and withdrawal of support. This investigation examines percieved social support in a population of 100 breast cancer patients, and anticipated social support among 100 disease-free individuals. Results demonstrate that healthy individuals report assignment of stigma and avoidance behavior directed towards cancer patients, yet they believe they themselves would have a dense network of support to call upon if stricken with cancer. Patients report nonmaterialization of expected support networks, and decreased adjustment due to this subjective experience. In addition, patients assert that the support extended to them is often inappropriate in nature, due to the mistaken assumption on the part of healthy individuals that the most salient concern of a mastectomized woman is the loss of her breast, rather than the fact that she has cancer.     

From sick role to practices of health and illness

Context Health care research generally, and medical education research specifically, make increasingly sophisticated use of social science methods, but these methods are often detached from the theories that are the substantive core of the social sciences. Enhanced understanding of theory is especially valuable for gaining a broader perspective on how issues in medical education reflect the social processes that contextualise them. Methods This article reviews five social science theories, emphasising their relevance to medical education, beginning with the emergence of the sociology of health and illness in the 1950s, with Talcott Parsons’ concept of the ‘sick role’. Four turning points since Parsons are then discussed with reference to the theory developed by, respectively, Harold Garfinkel, Michel Foucault and Pierre Bourdieu, and what is called the ‘narrative or dialogical turn’. In considering these, the author argues for a theory‐grounded research that relates specific problems to what Max Weber called the ‘fate of our times’. Conclusions The conclusion considers how medical education research can critique the reproduction of a discourse of scarcity in health care, rather than participating in this discourse and legitimating the disciplinary techniques that it renders self‐evident.     

African American women's preventative care usage: the role of social support and racial experiences and attitudes

Research suggests that African Americans are less likely to utilise preventative care services than Americans of European descent, and that these patterns may contribute to racial health disparities in the United States. Despite the persistence of inequalities in preventative care utilisation, culturally relevant factors influencing the use of these gateway health services have been understudied among marginalised groups. Using a stratified sample of 205 low‐income African American women, this research examines the predictors of receiving a physical exam, with a particular emphasis on how differing levels of social support from friend and family networks and experiences of racial discrimination and cultural mistrust shape utilisation. The findings underscore the importance of traditional predictors of utilisation, including insurance status and having a usual physician. However, they also indicate that supportive ties to friendship networks are associated with higher predicted rates of having an annual physical exam, while social support from family and sentiments of cultural mistrust are associated with lower rates of utilisation. Broadly, the findings indicate that even as traditional predictors of help‐seeking become less relevant, it will be critical to explore how variations in discrimination experiences and social relationships across marginalised groups drive patterns of preventative care utilisation.     

Nutrition communication: consumer perceptions and predicting intentions

Health claims on food products, which aim at informing the public about the health benefits of the product, represent one type of nutrition communication; the use of these is regulated by the European Union. This paper provides an overview of the research on health claims, including consumers' perceptions of such claims and their intention to buy products that carry health-related claims. This is followed by a discussion on the results from some recent studies investigating public perceptions and willingness to use products with health claims. In these studies, claims are presented in the form of messages of different lengths, types, framing, with and without qualifying words and symbols. They also investigate how perceptions and intentions are affected by individual needs and product characteristics. Results show that adding health claims to products does increase their perceived healthiness. Claim structure was found to make a difference to perceptions, but its influence depended on the level of relevance, familiarity and individuals' need for information. Further, the type of health benefit proposed and the base product used also affected perceptions of healthiness. The paper concludes that while healthiness perceptions relating to products with health claims may vary between men and women, old and young and between countries, the main factor influencing perceived healthiness and intention to buy a product with health claim is personal relevance.     

In spite of good intentions: patients' perspectives on problematic social support interactions

Background  

In the setting of an acute coronary syndrome, the natural inclination of friends and family members is to provide social support. However, their efforts may be perceived as being problematic or unhelpful. The objective of this study was to identify the characteristics of problematic social support interactions from the perspectives of patients.     

Observations of shipboard illness behavior: work discipline and the sick role in a residential work setting

In this article, the author reports on a small-scale ethnographic study of illness behavior in a residential work setting, a large merchant cargo ship with a multinational crew. Although parallels with previous observational work on illness behavior in residential settings (where illnesses result in treatment only if there is a break in accommodation to symptoms) exist, it is clear that type of setting is pivotal in shaping illness careers. Here, accommodation to symptoms was overlain by the economic imperative to keep the ship functioning: Management feared that the right to the sick role would allow "malingering," whereas workers feared adoption of the sick role would exclude them from employment. In the latter case, the worker might experience illness or disability in a manner parallel to a Marxist analysis of the product of workers'labor: as an alien object of control and oppression, grounds for his or her removal from the workforce.     

The role of attitudes and self-efficacy in predicting condom use and purchase intentions

This study examines the condom purchasing and use habits of 256 college students in Norway and English-speaking Canada, and develops a structural equation model to explain condom purchase and use. In the model, intention to purchase condoms is influenced by self-efficacy in condom purchasing, as well as by intention to use condoms. Intention to use condoms is influenced by having a positive attitude toward condom usage and by self-efficacy in persuading a partner to use condoms. The implications for health promotion and social marketing campaigns are discussed.     

Factitious illness in children: the social worker's role in identification and management

Factitious illness in children is a phenomenon that results in adverse consequences for the child. Munchausen by proxy is a factitious disorder, first described by Meadow (1977), in which a parent induces or creates the appearance of illness in the child. This article highlights the importance of social work skills in the identification and management of this syndrome, and proposes a format for decision making at various points in the process.     

Gender role attitudes and other determinants of breast feeding intentions in Brazilian women

This study of 230 Brazilian mothers examined the associations of several sociodemographic variables, maternal attitudes and perceptions with intended breast feeding duration. The usual relationships of sociodemographic variables such as mother's age, education, smoking, parity and infant birth weight with intended breast feeding duration were not found. However, mother's intentions were related to gender role attitudes with both the least and the most traditional women intending to breast feed longer than women with moderately traditional gender role attitudes. Mother's attitude toward breast feeding, help with household tasks, and the attitudes of friends and relatives toward breast feeding were also very significantly related to intended breast feeding duration. Women who did not work outside the home intended to breast feed significantly longer than those who were employed.     

HPV vaccine information in the blogosphere: how positive and negative blogs influence vaccine-related risk perceptions, attitudes, and behavioral intentions

This research examines the impact of exposure to online blogs about the human papillomavirus (HPV) vaccine on vaccine-related risk perceptions, attitudes, and behavioral intentions. In a controlled experiment (N = 341), college students were exposed to either a negative blog post about the HPV vaccine or a positive one. Compared to the control group, participants who had viewed the negative blog perceived the vaccine as less safe, held more negative attitudes toward the vaccine, and had reduced intentions to receive the vaccine. In contrast, exposure to the positive blog did not alter any vaccine-related risk perceptions, attitudes, or intentions. Implications of the findings for online vaccine risk communication are discussed.     

The role of illness perceptions in labor participation of the chronically ill

OBJECTIVE: We aimed to investigate associations between work disability and illness perceptions, over and above medical assessment and self-reported health. METHODS: A representative sample of people aged 15-64 years with various chronic physical diseases was derived from the Panel of Patients with Chronic Diseases in the Netherlands. In this group, 189 patients were fully work-disabled and 363 were employed. In this cross-sectional study, associations between medical health status stated by the general practitioner, self-reported health, and illness perceptions about the consequences of the illness, the timeline (cyclical vs. chronical), control (treatment and personal), coherence and three causal dimensions (psychological, risk factors and immunity) and work disability were investigated. These associations were investigated in three separate steps using multivariate logistic regression analyses, with the employed patients as a reference group. All models were corrected for age, sex, and level of education. RESULTS: In the second multivariate model containing medical health status and self-perceived health, complete work disability was significantly associated with more fatigue (OR 2.42), more self-perceived functional limitations (OR 11.94), higher age, female sex, and lower education. Medical health status was not significantly associated with work disability. After adding illness perceptions to this model, the percentage of explained variance for work disability increased from 65 to 77%. In this final model, work disability was significantly associated with the patient's perception that the consequences of the disease were more severe (OR 5.34), and also with more self-perceived functional limitations (OR 14.27), lower education, being female, and a higher age. Illness perceptions and self-reported health status were significantly associated with work disability. CONCLUSION: We conclude that illness perceptions are significantly associated with work disability in the chronically ill. Self-reported health is more strongly associated with work disability than the assessment of health status by the physician.     

Understanding successful behaviour change: the role of intentions, attitudes to the target and motivations and the example of diet

Although many attempts to change health behaviour fail, some individuals do show successful behaviour change. This study assessed the role of behavioural intentions, motivations and attitudes to the target in explaining successful changes in diet with a particular focus on positive and negative intentions and positive and negative attitudes. Participants (n=282) completed a questionnaire describing a recent change in eating behaviour (becoming a vegetarian, cutting out a food group, eating fewer calories), their intentions, their attitudes to the food being avoided, a range of motivations and their degree of success. The results showed that the three behaviour change groups differed in terms of their cognitions with those trying to eat fewer calories reporting less success in changing their behaviour. Successful vegetarianism was associated with a lower positive attitude; successfully cutting out a food group was related to ethical motivations, a lower positive attitude and greater positive and negative intentions, and reducing calorie intake was associated with greater positive intentions and a lower positive attitude. Therefore, success was associated with different cognitions depending upon the type of change being made, although cognitions such as 'I will eat more vegetables' and 'I no longer find high fat foods palatable' were consistently most predictive of success. Suggestions for the development of more effective interventions to change health behaviours are made.     

Predicting intentions to purchase organic food: the role of affective and moral attitudes in the Theory of Planned Behaviour

This study examined the usefulness of integrating measures of affective and moral attitudes into the Theory of Planned Behaviour (TPB)-model in predicting purchase intentions of organic foods. Moral attitude was operationalised as positive self-rewarding feelings of doing the right thing. Questionnaire data were gathered in three countries: Italy (N=202), Finland (N=270) and UK (N=200) in March 2004. Questions focussed on intentions to purchase organic apples and organic ready-to-cook pizza instead of their conventional alternatives. Data were analysed using Structural Equation Modelling by simultaneous multi-group analysis of the three countries. Along with attitudes, moral attitude and subjective norms explained considerable shares of variances in intentions. The relative influences of these variables varied between the countries, such that in the UK and Italy moral attitude rather than subjective norms had stronger explanatory power. In Finland it was other way around. Inclusion of moral attitude improved the model fit and predictive ability of the model, although only marginally in Finland. Thus the results partially support the usefulness of incorporating moral measures as well as affective items for attitude into the framework of TPB.     

Increasing physician involvement In cholesterol-lowering practices: The role of knowledge,attitudes and perceptions

The study evaluated a multifaceted educational intervention systematically designed to increase physician involvement in cholesterol-lowering practices. We hypothesized that knowledge, perceptions and behaviours would be enhanced in participating physicians, compared with controls. Method: Fifty-one family physicians were assigned randomly to three groups; the two experimental groups attended a training workshop, received physician and patient education materials and ongoing consultant support. One experimental group also received a “cuing” intervention. The control group received no interventions. Outcome measures included knowledge and attitude scores, self-efficacy perceptions, and physician dietary counselling behaviour. Measures were taken at pretest, 6 weeks and 15 months later. Results: Intervention group physicians achieved significantly higher knowledge scores than the control group at the six-week test; the differences disappeared at 15 months. Attitudes, self-reported practices and overall self-efficacy scores were similar across groups. Within group variation was highly significant. Physician dietary counselling scores were significantly higher in the intervention groups (p = 0.0001). Some associations were seen among knowledge, attitude, self-efficacy and dietary counselling scores. Conclusion: Physician behaviour change in cholesterol reduction may not depend entirely upon knowledge, attitudes and perceptions. This revised version was published online in June 2006 with corrections to the Cover Date.     

Helping Holocaust survivors with the impact of illness and hospitalization: social work role.

Illness and hospitalization can trigger intense reactions for Holocaust survivors and their families which derive from the brutal and dehumanizing experiences they endured during World War II. Some characteristic problems and reactions to illness and hospital care they and their families experience are reviewed, as are indicated social work interventions based on crisis theory.     

Living with invisible illness: social support experiences of individuals with systemic lupus erythematosus

Purpose

Because symptoms are not immediately visible to others, systemic lupus erythematosus (SLE) is often considered an invisible illness. This invisibility can reduce the social support received from network members and adversely affect the quality of life. In the light of this, social support from formal support groups and from medical professionals can be particularly important; however, literature examining support from these sources is scarce. The purpose of this study was to explore the nature and impact of social support from medical professionals and from support groups for individuals with SLE.

Methods

Participants responded to open-ended questions on an online survey administered by Lupus UK and Lupus Group Ireland. Qualitative data from 133 participants (77 % of respondents) were analysed.

Results

Thematic analysis revealed three overarching themes: invisibility, inadequate care, and validation. Respondents felt that their SLE was invisible to social ties and to medical professionals. In addition, treatment and organisational factors in health care contributed to the sense of inadequate care. Finally, validation was derived from informational and emotional support from both support groups, and from some medical professionals.

Conclusions

The findings suggest that individuals with SLE have mixed experiences in terms of contact with medical professionals and involvement with support groups. Furthermore, low public awareness of lupus appears to contribute to feelings of invisibility for patients, leading to loneliness and isolation. Medical professionals might benefit from skills training in terms of managing the psychosocial consequences of lupus.