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Culture and Symptoms--An Analysis of Patient's Presenting Complaints
Abstract
Physical disorder is often thought to be a fairly objective and relatively infrequent phenomenon. An examination of the literature reveals, however, that the empirical reality may be that illness, defined as the presence of clinically serious signs, is the statistical norm. Given that the prevalence of abnormalities is so high, the rate of acknowledgement so low, and the decision to seek aid unrelated to objective seriousness and discomfort, it is suggested that a socially conditioned selective process may be operating in what is brought in for medical treatment. Two such processes are delineated and the idea is postulated that it might be such selective processes and not etiological ones which account for many of the previously unexplained epidemiological differences between societies and even between subgroups within a society. A study is reported which illustrates the existence of such a selective process in the differing complaints of a group of Italian and Irish patients--a pattern of differences which is maintained even when the diagnosed disorder for which they sought aid is held constant.
... 36 Among whites, one third see practitioners of unconventional treatments (e.g., homeopathy, high colonic enemas, crystal healing) at a frequency that exceeds the number of primary care visits, and most do not inform their physicians of these treatments. 37 Conversely, physicians may judge the appropriateness of patient behaviors on the basis of their own cultural biases and make efforts to show them the right way without fi rst understanding the patient ' s illness schema. Considering the hot-cold theory of illness practiced by some Puerto Ricans, if a clinician prescribes a hot medicine (not related to temperature) for a hot illness, the patient might not take that medicine. ...
... 29 In China, communicating psychological distress is stigmatizing, 31 so when a person is in distress, reporting physical symptoms (somatization) is more acceptable. 37 However, in Southern Europe, emotional expression is not only assumed but is also a reinforcer of family support. 35 U.S. health care providers in the rural South need to be familiar with "root working," a form of voodoo magic practiced by some rural African Americans. ...
... In some nonliterate societies, individuals freely describe hallucinations that are fully accepted by others in the community. 37 In fact, the meaning of the hallucinations, not their presence, is the focus of interest, particularly when reported by those in a position of power. Conversely, in Western societies, the emphasis is on rationality and control, and hallucinations produce fear and may be viewed as a manifestation of psychosis until proved otherwise. ...
... This seems most likely to occur and would have especially important implications in people's evaluations of negative conditions like health disorders. Because of the effect of prevalence information on evaluation, individuals who have a particular health disorder may be less likely to seek information about it or treatment for it if they believe many people have it than if they think very few have it (Zola, 1966). ...
... However, subjects in the negative conditions sought more information about TAA presence when they believed the condition was relatively rare than when they believed it was relatively common. This finding supports anecdotal evidence provided by Zola (1966) suggesting that cultural and ethnic differences in symptom reporting might be due in part to differences in the symptom's prevalence rate within the different populations. ...
Experiments showed a scarcity principle in evaluative judgments such that the identical characteristic is evaluated more extremely the lower its perceived prevalence. In Study 1, Ss evaluated a fictitious medical condition that was described as either beneficial or detrimental to health and as occurring in either 30% or in one half of 1% of a test population. The condition was evaluated more extremely—as a more positive health asset or a more negative health liability—in the low-prevalence than in the high-prevalence conditions. Study 2 demonstrated the same effect in self-evaluations and with a different manipulation of perceived prevalence. Ss were told that they actually had the fictitious medical condition, that it was either beneficial or detrimental to their health, and either that they were the only 1 of 5 Ss who had it or that 4 of the 5 did. Low-prevalence Ss exhibited more extreme evaluative, affective, and behavioral reactions to the medical condition than did high-prevalence Ss. The origins and validity of the scarcity principle are discussed, as are its implications for uniqueness theory, reactance theory, and social evaluation theories.
... For example, there appear to be relatively persistent cultural differences in patterns of alcohol use that are independent of socioeconomic factors (Snyder, 1978;Glassener and Berg, 1980;King, 1961;Chafetz and Demone, 1962;Roberts and Myers, 1967;Room, 1968;Lowenthal, Walt, and Klein, 1975;Schmidt and Papham, 1976). The degree to which symptoms are perceived, labeled and acted upon has been shown to be significantly related to gender, ethnicity, and social class (Zborowski, 1952;Saunders, 1954;Koos, 1954;Zola, 1966;Zborowski, 1969;Angel and Cleary, 1984;Sternbach and Tursky, 1965;Hochschild, 1981;Barnett, Biener, Baruch, 1987;Cleary and Mechanic, 1983;Kessler, Brown, and Broman, 1981;Mechanic, 1972;Koopman, Eisenthal and Stoeckel, 1984;Pennebaker, 1982;Lipton and Marbach, 1984;Cleary, Mechanic, and Greenley, 1982). For example, in a classic study conducted at the Massachusetts General Hospital in Boston, Zola (1966) examined the effect of culture on patients' presentation of symptoms. ...
... The degree to which symptoms are perceived, labeled and acted upon has been shown to be significantly related to gender, ethnicity, and social class (Zborowski, 1952;Saunders, 1954;Koos, 1954;Zola, 1966;Zborowski, 1969;Angel and Cleary, 1984;Sternbach and Tursky, 1965;Hochschild, 1981;Barnett, Biener, Baruch, 1987;Cleary and Mechanic, 1983;Kessler, Brown, and Broman, 1981;Mechanic, 1972;Koopman, Eisenthal and Stoeckel, 1984;Pennebaker, 1982;Lipton and Marbach, 1984;Cleary, Mechanic, and Greenley, 1982). For example, in a classic study conducted at the Massachusetts General Hospital in Boston, Zola (1966) examined the effect of culture on patients' presentation of symptoms. He examined 29 patients at one of the clinics who had no apparent medical disease. ...
... For example, there appear to be relatively persistent cultural differences in patterns of alcohol use that are independent of socioeconomic factors (Snyder, 1978;Glassener and Berg, 1980;King, 1961;Chafetz and Demone, 1962;Roberts and Myers, 1967;Room, 1968;Lowenthal, Walt, and Klein, 1975;Schmidt and Papham, 1976). The degree to which symptoms are perceived, labeled and acted upon has been shown to be significantly related to gender, ethnicity, and social class (Zborowski, 1952;Saunders, 1954;Koos, 1954;Zola, 1966;Zborowski, 1969;Angel and Cleary, 1984;Sternbach and Tursky, 1965;Hochschild, 1981;Barnett, Biener, Baruch, 1987;Cleary and Mechanic, 1983;Kessler, Brown, and Broman, 1981;Mechanic, 1972;Koopman, Eisenthal and Stoeckel, 1984;Pennebaker, 1982;Lipton and Marbach, 1984;Cleary, Mechanic, and Greenley, 1982). For example, in a classic study conducted at the Massachusetts General Hospital in Boston, Zola (1966) examined the effect of culture on patients' presentation of symptoms. ...
... The degree to which symptoms are perceived, labeled and acted upon has been shown to be significantly related to gender, ethnicity, and social class (Zborowski, 1952;Saunders, 1954;Koos, 1954;Zola, 1966;Zborowski, 1969;Angel and Cleary, 1984;Sternbach and Tursky, 1965;Hochschild, 1981;Barnett, Biener, Baruch, 1987;Cleary and Mechanic, 1983;Kessler, Brown, and Broman, 1981;Mechanic, 1972;Koopman, Eisenthal and Stoeckel, 1984;Pennebaker, 1982;Lipton and Marbach, 1984;Cleary, Mechanic, and Greenley, 1982). For example, in a classic study conducted at the Massachusetts General Hospital in Boston, Zola (1966) examined the effect of culture on patients' presentation of symptoms. He examined 29 patients at one of the clinics who had no apparent medical disease. ...
... While there remains no precise measurement of despair, it has occasionally been used as a placeholder for an indeterminate combination of physical and psychological pain. As described in Zola (1966), social factors are relevant to understanding the overlap between physical and psychological pain, including the question of a split between the two: who expresses their suffering as physical pain, who expresses their suffering as psychological symptoms, and who expresses their suffering as both. Indeed, in her xiii interviews with low-income residents of a former manufacturing town in Pennsylvania, describes how she had to build a "glossary of pain" in order to better categorize participants' "self-described emotional, existential, and physical pain" (pg. ...
... If physical and psychological pain represent elements of a common expression of despair, they could illustrate the true depth of suffering, including among groups whose psychological well-being on its own might seem paradoxical. Social factors are relevant to understanding the overlap between physical and psychological pain, including the question of a split between the two: who expresses their suffering as physical pain, who expresses their suffering as psychological symptoms, and who reports both (Zola 1966). ...
This dissertation contains three chapters on adult mental health and pain in the contemporary United States, paying special attention to social inequalities therein. In the first chapter I use data from the 2002-2014 National Health Interview Survey Linked Mortality Files (NHIS-LMF) to explore sociodemographic differences in the intersection of physical and psychological pain (referred to as the “pain–distress nexus”) and its relationship to mortality among adults ages 25 to 64. I find the combination of both high distress and high pain is most prevalent and most strongly predictive of mortality among socioeconomically disadvantaged, non-Hispanic Whites. In the second chapter I use data from the 2015, 2017, and 2019 Behavior Risk Factor Surveillance Survey (BRFSS) to examine associations between informal caregiving and self-rated pain intensity among middle-aged and older adults with provider-diagnosed arthritis. I find that informal caregiving status is associated with higher pain intensity. Among informal caregivers, caring for a spouse/partner, providing care for 5+ years, providing care for 20+ hours/week, and helping with personal care or household tasks were all linked to higher pain intensity. Associations were stronger for male caregivers than for female caregivers. In the third chapter, I use data from the 2002-2018 National Health Interview Survey (NHIS) to examine and decompose trends in mental distress among non-Hispanic White and Black adults aged 25-44 and 45-64. I find that mental distress significantly increased over time among all groups. Steep increases in mental distress among Whites, particularly among those aged 25-44, suggest narrowing Black-White disparities over time. My decomposition analyses reveal that changes in population composition, specifically the increase in heavy alcohol use and physical pain, largely explained the increase in mental distress among Blacks, while the increase in mental distress remained largely unexplained among Whites. Together, these three chapters illustrate the intricate nature of inequalities in psychological and physical pain.
... Culture is defined as shared values, norms, feelings and ways of thinking that are learned and passed down from generation to generation and that shape a group's beliefs, attitudes and behaviours (Airhihenbuwa, 1995;Al-Bannay et al., 2013;Kagawa Singer et al., 2016). Culture actively influences and shapes perceptions of health (Zola, 1966), the meaning of illness (Arnault, 2018;Dumit et al., 2016;Ruiz-Montero et al., 2015), presenting symptoms (Arnault, 2018;Zola, 1966) and health behaviours Karimi & Clark, 2016). Cultural factors support changes in health behaviour at the individual level, which may be instrumental in reducing health disparities (Singh et al., 2017). ...
... Culture is defined as shared values, norms, feelings and ways of thinking that are learned and passed down from generation to generation and that shape a group's beliefs, attitudes and behaviours (Airhihenbuwa, 1995;Al-Bannay et al., 2013;Kagawa Singer et al., 2016). Culture actively influences and shapes perceptions of health (Zola, 1966), the meaning of illness (Arnault, 2018;Dumit et al., 2016;Ruiz-Montero et al., 2015), presenting symptoms (Arnault, 2018;Zola, 1966) and health behaviours Karimi & Clark, 2016). Cultural factors support changes in health behaviour at the individual level, which may be instrumental in reducing health disparities (Singh et al., 2017). ...
Aim
To understand and identify cultural factors influencing the self‐care practices of African immigrants living with chronic illness in countries outside Africa.
Background
The influence of cultural factors on self‐care is relatively unexplored in African immigrants with non‐communicable diseases (NCDs).
Design
Systematic Mixed Studies review.
Data sources
PubMed, Psych Info, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Anthropology Plus and Sociological Abstract computerized databases. No limit was placed on publication date.
Review methods
Results‐based convergent design was used. The Mixed Method Appraisal Tool was used to evaluate the studies. Quantitative studies were synthesized narratively while qualitative studies were synthesized using thematic synthesis.
Results
We identified 251 articles and nine fulfilled our inclusion criteria. The studies were published between 2006 and 2019, with six qualitative and three quantitative studies. Studies were conducted in the United States, Australia, Sweden, the Netherlands and the United Kingdom. Most studies examined the influence of culture on self‐care of diabetes (n = 6), while the rest focused on hypertension (n = 3). Findings highlight that cultural norms and practices, non‐Western approaches to interpreting and managing illness, cultural connotations of health behaviours and structural challenges influencing self‐care. Cultural food preferences made adherence to prescribed diets challenging. Family support facilitated self‐care. Maintaining cultural identity was both a driver and constraint to engaging in self‐care.
Conclusion
The complex interplay of cultural and structural factors influences the willingness of Africans who have immigrated to a developed country to follow recommended self‐care practices. Considering these cultural norms and structural barriers can help to explain the self‐care behaviours of African immigrant populations.
Impact
Clinicians and policymakers who account for structural factors and integrate cultural factors into care facilities, treatment protocols and policy can be influential in promoting self‐care in African immigrant populations.
... All these items focus on symptom perception and coping with persistent or deteriorating symptoms. The item non-invariance may be related to the interplay between culture and symptoms, as the perception and response to symptoms are shaped by the dominant value orientation in a society (Irving, 1996). For Italians, a previous study identified 'over-expression' and 'dramatization' as typical patterns of symptom perception and response (Irving, 1996). ...
... The item non-invariance may be related to the interplay between culture and symptoms, as the perception and response to symptoms are shaped by the dominant value orientation in a society (Irving, 1996). For Italians, a previous study identified 'over-expression' and 'dramatization' as typical patterns of symptom perception and response (Irving, 1996). Italians may not hesitate to express symptom severity and location and perhaps to dramatize its dysfunctional impact because such expressions are socially acceptable and may decrease associated negative emotions. ...
Aim
The Self‐Care Self‐Efficacy Scale (SCSES) was newly developed as a self‐report measure for self‐care self‐efficacy for chronic illness. This study investigated its measurement equivalence (ME) in different cultural groups, including United States, China (Hong Kong), Italy, and Brazil.
Design
A multi‐national study for cross‐cultural validation of the Scale.
Methods
From January 2015 ‐ December 2018, investigators recruited 957 patients (United State: 200; Hong Kong: 300; Italy: 285; and Brazil: 142) with chronic illness from inpatient and outpatient settings. The SCSES was administered and clinical and demographic data were collected from participants. Based on the Meredith framework, multi‐group confirmatory factor analysis evaluated the configural, metric, scalar, and strict invariance of the scale across the four populations through a series of nested models, with evaluation of reliability and coherence of the factor solution.
Results
The mean ages of the groups ranged from 65–77 years, 56.4% was male. The Cronbach's alpha coefficients of the single‐factor SCSES were 0.93, 0.89, 0.92, and 0.90 for the United States, China (Hong Kong), Italy, and Brazil, respectively. Three of the four levels of ME were partially or totally supported. The highest level achieved was partial scalar invariance level (χ² [52] = 313.4, p < 0.001; RMSEA = 0.067; 95% CI = 0.056–0.077; CFI = 0.966; TLI = 0.960, SRMR = 0.080).
Conclusion
Patients from the four countries shared the same philosophical orientation towards scale items, although some of the items contributed differently to represent the concept and participants shared the same schemata for score interpretation.
Impact
Self‐efficacy is important in producing effective and sustainable self‐care behavioural changes. Cultural ideation shapes the ways individuals interpret and report their self‐care self‐efficacy. The study findings support cross‐cultural and cross‐national utility of the SCSES for research on self‐care across United States, China (Hong Kong), Italy, and Brazil.
... Ovi pojedinci su problematizirali pitanja promocije zdravih životnih stilova, percepcije zdravlja i bolesti, pristupa zdravstvenoj zaštiti, zadovoljstva sistemom zdravstvene zaštite te zadovoljstva načinom liječenja. Oni su doprinijeli zdravstvenim disciplinama ukazujući na značaj utjecaja kulture i društvenih interakcija na percepcije bolesti i životne stilove koji do njih dovode (Zola, 1966.;Mechanic, 1995). ...
Summary Medical sociology has become a major sociological discipline and the most developed branch within the association of sociologists worldwide. Its role in fields such as public health, management in health care, nursing and clinical medicine, is gaining in importance. This text considers the position of sociology of medicine in Bosnia and Herzegovina and preconditions for its further development, especially in the field of empirical researches in health.
... t tendance à la nier. Les premiers ont une expérience de la douleur qui s'inscrit dans l'immédiat, tandis que les Juifs sont plus préoccupés par les effets à long terme. Le rôle imparti au médecin diffère alors selon les groupes, les seconds attendant de lui moins de faire cesser la douleur que de détecter le mal dont la douleur n'est que le signe.Irving K. Zola (1966) a également interrogé la variable du groupe ethnique à propos de la perception et de la discrimination des symptômes organiques par les patients. En comparant des malades irlandais et italiens appariés selon le sexe, le diagnostic primaire, la durée et la gravité du trouble, et, quand cela était possible, l'âge, l'état-civil et l'instru ...
Le milieu hospitalier est le lieu d’un apparent paradoxe où les professionnel·les affirment qu’on « soigne tout le monde pareil », mais que « chaque patient·e est différent·e ». L’adaptation et la modulation des discours et des pratiques de soins y sont à la fois revendiquées comme un impératif à la réalisation du travail (para)médical et niées comme productrices de différenciations. À partir de ce constat empirique, je me suis intéressée aux usages sociaux par les professionnel·les de santé des caractéristiques sociales de leurs patient·es. Ce travail consiste en une comparaison située basée sur une enquête de terrain par observations et par entretiens. Celle-ci a été menée pendant environ un an au sein de plusieurs services de maladies chroniques du métabolisme (obésité, diabète, médecine interne) dans trois centres hospitalo-universitaires, situés pour deux d’entre eux à Paris et en région parisienne et pour le dernier à Montréal. Il ne s’agit pas de traiter de manière symétrique les « deux côtés ». Le choix d’une observation microsociologique a été au contraire délibérément effectué dans le but de dénaturaliser le cadre « national » et d’en questionner la prééminence. Malgré l’existence de certaines différences (présence différentielle de la religion majoritaire, bilinguisme français-anglais très répandu au Québec...), la prise en compte et les pratiques autour des besoins ou demandes des patient·es y sont largement similaires. L’analyse de la prise en compte des caractéristiques sociales des patient·es par les professionnel·les semble dans les deux contextes répondre d’abord aux mêmes enjeux : celui d’organiser et de permettre le travail dans un contexte où celui-ci est relationnel et sur l’humain. Au croisement de plusieurs champs (la sociologie du travail, la sociologie de l’État et la sociologie des rapports sociaux et des inégalités) et à partir d’une analyse au niveau de la relation et les interactions entre professionnel·les de santé et patient·es à l’hôpital public, cette thèse explore la chaîne ou la somme des petites décisions, réalisées de façon routinière et permanente, par les professionnel·les hospitalier·es, de classement, de priorisation ou de négligence. Celles-ci constituent le phénomène du tri des patient·es à l’hôpital. Elles sont prises dans la tension permanente entre personnalisation du soin et différenciation sociale des traitements. Elles fondent également la production localisée de la « différence », de classe, de race et de sexe, dans la configuration étudiée qu’est la prise en charge à l’hôpital public.
... Clinicians commonly recognize that an individ ual's culture alfects the way he or she experiences and expresses symptomatology (Linn, Linn, & Stein, 1982). These differences in symptom ex pression have been verified by sociomedical an thropologists (Harwood, 1971;Mechanic, 1974;White, 1982;Zola, 1966); however, clinical appli cation of this knowledge in therapeutic transac tions, has been limited (Chesla, 1987;Good & Del Vecchio-Good, 1980;Kleinman, 1988). Kleinman and colleagues (1978) proposed a "meaning centered" approach as an alternative form of "translating concepts from cultural an thropology into clinical language for practical application" (p. ...
Children of differing cultural backgrounds experience, interpret, and respond to illness differently. This exploratory descriptive study investigated those explanations of their illness offered by 23 Hispanic children diagnosed with acute lymphoblastic leukemia. Content analysis of their interviews disclosed the following information: (a) culturally based treatment interventions were an important component of care, (b) Hispanic parents disclosed little information about the disease process to their children, (c) children tended to explain their illness in terms of symptomatology and side effects, and (d) all physician advice was held in high esteem.
... Assim, de acordo com um estudo de IrvingZola (1935Zola ( -1994, é possível que existam vários determinantes não fisiológicos para a procura de ajuda, incluindo a disponibilidade de assistência médica, as possibilidades financeiras do doente, o fracasso ou sucesso dos tratamentos anteriores efetuados fora do sistema de cuidados de saúde, o modo como o doente percebe o problema, e o modo como as outras pessoas à sua volta, finalmente, percebem o problema(Zola, 1973). Um estudo anterior, aliás, tinha já identificado vários "disparadores" não fisiológicos da consulta médica, a saber(Zola, 1966): uma crise interpessoal; uma perceção de interferência com as relações interpessoais; um outro indivíduo, no lugar do doente, assumiu a responsabilidade pela decisão de procurar ajuda médica; uma perceção de interferência com o trabalho ou a atividade física e, finalmente, um estabelecimento de critérios temporais externos ("se isto não melhorar dentro de três dias… vou ao médico"). Estes estudos, relativamente datados, ilustram bem a ideia de que a ida ao médico não depende só de razões médicas, no sentido estrito do termo. ...
... A disease must first be perceived, and a sign of disease that is particularly prevalent in the population is generally perceived as normal, natural, and inevitable [19]. Additionally, the decision to seek treatment was generally not taken until it was realized that complaints, symptoms, and signs were the expression of a disease [2] [4]. ...
... Sociologists have produced an innovative but relatively modest body of research on chronic pain, including early examinations of ethnic and gender differences in pain experiences and expression (Bendelow 1993;Zola 1966). Important more recent developments include qualitative examinations of the experiences of women with painful conditions such as fibromyalgia and migraine (Barker 2005;Kempner 2014;Pryma 2017) as well as studies published in the Journal of Health and Social Behavior that link early life course disadvantage to adult pain (Goosby 2013) and analyze pain management disparities at safety-net hospitals (Rubin et al. 2018). ...
Chronic pain is a common, costly, and consequential health problem. However, despite some important analytic contributions, sociological research on pain has not yet coalesced into a unified subfield. We present three interrelated bodies of evidence and illustrative new empirical findings using 2010 to 2018 National Health Interview Survey data to argue that pain should have a central role in sociological investigations of health. Specifically, we contend that (1) pain is a sensitive barometer of population health and well-being, (2) pain is emblematic of many contested and/or chronic conditions, and (3) pain and pain treatment reflect and have wide-ranging implications for public policy. Overall, whether pain is analyzed quantitatively or qualitatively-focusing on its distribution in the population, its social causes and consequences, or its subjective meanings for individuals-pain reflects social conditions, sociopolitical context, and health-related beliefs of a society. Pain is thus an important frontier for future sociological research.
... Este relevant, totodată, să menționăm câteva momentele de început ale comunicării în sănătate. În acest sens, avem unele inițiative venite din domeniul sociologiei medicale, cum ar fi studiul lui Zola (1966) în care se analizează impactul culturii asupra felului în care pacienții își prezintă problemele medicale în fața personalului medical. În concluziile studiului, autorul insistă pe necesitatea înțelegerii de către cadrele medicale a background-ului cultural și informațional al pacienților, pentru a se putea comunica eficient cu aceștia. ...
... Take, for example, a young child who falls: the child often looks to see the response of surrounding adults before starting to cry. Pain is a cultural event that is felt and interpreted in specific contexts (Arney and Neill 1982;Bendelow 1993;Bendelow and Williams 1995;Foucault [1977Foucault [ ] 2012Freidson 1970;Glucklich 2001;Kleinman 1988;Kleinman and Kleinman 1991;Morris 1991;Nettleton 1992;Scarry 1985;Zborowski 1952;Zola 1966). As Robert Fuller wrote: ...
This article leverages ethnographic research on spiritual journeys to expand traditional definitions of theodicy. Embodied theodicy builds upon embodiment literature to demonstrate how bodily experiences have real emotional consequences—they have the potential to change how individuals make sense of their suffering. Whereas in some cases the bodily experience of pain leads to suffering, in others, pain provides individuals with perspective on their suffering and helps them overcome it. Data from two spiritual journeys, El Camino de Santiago and a Vipassana meditation retreat, introduce three models of embodied theodicy: pain as purifier, pain as teacher, and pain as solidarity. Embodied theodicy bridges the meaning-making concerns of classical and neoclassical literature with the embodiment theories of poststructuralists and contemporary scholars.
... Il ruolo dei fattori culturali nel generare l'esperienza di dolore è noto nella letteratura antropologica e sociologica. In uno studio, diventato un classico della sociologia del dolore, Zola (1966) confronta le modalità di comunicazione della propria malattia di italiani e irlandesi ad un consulto medico ed individua differenze sostanziali tra i due gruppi: (a) differenze nell'individuazione della zona del corpo oggetto di lamentele; (b) gli irlandesi più degli italiani, con uguale diagnosi, affermano che il dolore non sia parte della loro esperienza; (c) gli irlandesi descrivono il loro dolore nei termini di una specifica disfunzione mentre gli italiani di una difficoltà diffusa; (d) gli italiani, nonostante ricevessero la stessa diagnosi degli irlandesi, riportano più sintomi, in più parti del corpo e individuano più disfunzioni; (e) l'autore individua una certa indipendenza negli italiani tra la zona del corpo che la diagnosi individua come malata e la zona del corpo oggetto di preoccupazione, ovvero gli italiani, a differenza degli irlandesi, non dimostrano preoccupazione e sofferenza per la zona oggetto di diagnosi; (f) gli irlandesi più degli italiani raccontano di essere stati seriamente malati, coerentemente la loro storia clinica presenta più visite mediche, più diagnosi di malattie, più operazioni chirurgiche e, nel consulto che Zola registrava, maggiore preoccupazione e senso di urgenza da parte del medico indipendentemente dalla gravità della condizione presentata. Le differenze tra i due gruppi danno sostanza all'ipotesi della condivisione nei gruppi di un sistema di credenze che guida quantomeno la comunicazione della sofferenza, sebbene le osservazioni "d", "e" ed "f" dimostrino come sistemi di credenze e modalità di comunicazione generino effetti di realtà che segnano l'esperienza psicologica di dolore creando una frattura tra quanto diagnosticato e quanto raccontato dai pazienti. ...
The paper investigates the phenomenon of physical pain by analyzing how this phenomenon is constructed in the theories of common sense and within the medical model. Subsequently, an interactionist perspective throughout which the experience of pain can be reconsidered in ways that do not correspond with nociception, will be outlined.
... Psikoloji gibi tıbbi sosyoloji de Kreps vd.'ne göre sağlık iletişimi alanının gelişimine etki etmiştir. Örneğin Zola (1966) hastaların sağlık problemlerini sunma şekillerine kültürün etkisini incelediği ünlü çalışmasında her hastanın geçmişini anlamayı ve duruma uygun olarak iletişim stratejisi geliştirmek gerektiğini göstermiştir (Kreps vd, 2003: 4). Hastalık salt hastalık olarak değil hastanın koşullarıyla birlikte ele alındığında sağlık iletişimi devreye girmektedir. ...
Health communication is a field of study that has been included in the communication world since the 1970s. Health communication has a field of application carried out by individuals and media-mediated communication in health service delivery and health promotion. Health communication is an applied field of study because it examines both the pragmatic effects of human communication on the provision of healthcare and public health promotion and studies in this area are often used to improve the quality of healthcare delivery. Health communication campaigns are prepared to reveal desired health behaviors in society and to prevent risky health behaviors. However, whether these campaigns achieve their goals is an issue that is rarely discussed. Health communication and its applications at the mass communication level are realized through health communication campaigns. The success of a health communication campaign is measured by comparing the current situation before and after the campaign. This brings us to the concept of evidence-based health communication. This study describes the design stages of evidence-based health communication, which is an effective phenomenon in measuring campaign success. The similarities and differences among non- experimental, quasi-experimental and experimental designs were revealed in the study. The aim of the study is to explain the campaign design stages of evidence-based health communication and provide a guide to the pre-campaign preparation process for practitioners. Thus, practitioners will be able to choose the most suitable design for their target audience and avoid application mistakes.
... Illness on the other hand is a perceived change in one's state of being which impacts on function. Illness is linked to disease, but also majorly determined by personality, attitude, coping strategies, social matrix and the cultural milieu (3,4). In such a way, two different people with identical diseases can experience vastly different illnesses. ...
Pain is influenced by a combination of innate and acquired factors that evolve over an individual’s lifetime. Elements such as genetics, biological sex, and race play a role in determining our predisposition to have a high or low pain threshold or to be more or less susceptible to developing chronic pain. However, external factors such as the environment and learning experiences significantly modulate the acquired factors to the extent that two individuals with similar acquired factors may exhibit entirely different responses to pain and its treatment. Our unique sets of acquired and innate factors shape our reactions to another person’s pain. For clinicians, being mindful of potential unconscious biases can facilitate their correction and promote openness to diverse pain reactions and responses to treatment.
From the perspective of sociologists involved in various project activities in the field of health, the affirmation of medical sociology in BiH society is undoubtedly necessary. It is not only about strengthening its theoretical and educational components, it is also about its development as an applied discipline, which has the capacity to solve complex social issues in the field of health, and to be recognized as such by health professionals. The potential of qualitative methodology is underutilized in research studies and public policy analysis. The paper seeks to point out the contribution of applied medical sociology to the creation of public health policies and to the affirmation of a qualitative approach to conducting research in this field.
Women's utilization of maternal health care facility is an important health issue with regard to the wellbeing and survival of both the mother and her child during childbirth which has implications on the maternal and child mortality rate in human society. However, in most third world countries and Nigeria in particular there are certain factors that inhibit pregnant and women in patronizing maternal health facilities during childbirth. It is these factors that this paper investigated among pregnant women in the two Local Government Areas of Borno State. The methods of data collection adopted in the study were the survey methods: Seventy eight (78) questionnaires were administered; six (6) in-depth interviews and four sessions of focus-group discussion (three sessions in each of the 2 LG Areas) were conducted. INTRODUCTION The demand for and utilization of maternal health services depends on numerous factors, many beyond a woman's direct control, including the physical accessibility of facilities to her home; direct and indirect costs of obtaining services including not only fees for medication, transportation, feeding and accommodation charges but also the convenience of opening hours and average waiting times, the extent to which staff are competent, providing quality care and demonstrating cultural sensitivity to her needs, and the availability of other needed key health care inputs including essential drugs and food supplements (Lashman, 2006).
The incidence of medically unexplained symptoms (MUS) or conditions is over 50–80%. So-called functional disorders are unexplained sets of symptoms. Such people manifest illness behaviour in the absence of illness. As a result, the demand for medical care exceeds the need for medical care.
Background:
To explore the role of children's residential environment on opioid prescribing patterns in a predominantly Latinx sample.
Methods:
We connected geocoded data from electronic medical records in a diverse sample of pediatric patients to neighborhood environments constructed using latent profile modeling techniques. We then estimated a series of multilevel models to determine whether opioid prescribing patterns vary by residential context.
Results:
A stepwise pattern exists between neighborhood disadvantage and pediatric opioid prescription patterns, such that higher levels of disadvantage associate with a greater likelihood of opioid prescription, independent of the patient's individual profile.
Conclusion:
In a largely Latinx sample of children, the neighborhood in which a child lives influences whether or not they will receive opioids. Considering the differences in patient residential environment may reduce variation in opioid dispensing rates among pediatric patients.
Background and Purpose
Chemotherapy-induced peripheral neuropathy (CIPN) is a multidimensional symptom cluster induced by neurotoxic chemotherapy agents among patients with cancer. A well-developed tool for assessing CIPN can help with the early detection and timely management of patients. This study assessed the reliability and validity of the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT) in Korean women with breast cancer who were treated with chemotherapy.
Methods
A psychometric analysis of the Korean version of CIPNAT was conducted with 207 patients with breast cancer who were treated with chemotherapy. Patients were assessed using the CIPNAT and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy-20 (CIPN-20). Analyses of internal consistency reliability, concurrent validity, and construct validity (based on structural and discriminant validity testing) were performed to evaluate the psychometric properties.
Results
The Korean version of the CIPNAT had good internal consistency (Cronbach’s alpha = 0.95; the item-total correlation coefficients ranged 0.34–0.76). The CIPNAT and CIPN-20 were moderately correlated ( r = .67). Confirmatory factor analyses showed a four-factor structural model with acceptable model fit indices. Discriminant validity was supported by differences between individuals treated with and without taxane-based chemotherapy ( p < .001).
Implications for Practice
The Korean version of the CIPNAT was a valid and reliable screening tool for identification of CIPN symptoms and functional interference in Korean women who received chemotherapy for breast cancer. The instrument can be useful for the timely and routine assessment of CIPN symptoms and functional limitations of patients with cancer by oncology nurses.
p>Use of complementary and alternative medicine (CAM) is substantial in the UK. This thesis is about why people return to CAM, in other words why people continue to use adhere to CAM.
Two new questionnaire measures were developed. The CAM Beliefs Inventory (CAMBI) was developed as a generic measure of treatment beliefs relevant to CAM which can be used in a range of CAM settings. The Treatment Process Questionnaire (TPQ) was developed as a generic measure of peoples’ experiences of non-pharmacological treatments and can be used in both CAM and non-CAM settings.
Two questionnaire studies were conducted to examine the relative importance of different beliefs in ongoing CAM use. The cross-sectional study found that beliefs in holistic health were the most important predictors of CAM use across different CAM treatments. The prospective questionnaire study examined the relationship between beliefs, experiences of treatment, and adherence to CAM. This study showed that positive experiences of treatment are the most important predictors of adherence to CAM, compared to treatment and illness beliefs.
A qualitative study using ethnographic and grounded theory techniques was conducted to examine the process involved in ongoing CAM use. This study developed a process-oriented model of CAM use which suggested ways in which people experience and evaluate CAM therapies, and highlighted the way in which individuals’ health care decisions are embedded in the socio-cultural context.
Overall this programme of research has provided rigorous and well-validated insights with questionnaire measures and valuable theory-driven processes in a much under-researched and over-debated area.</p
p>The purpose of this study was to make a contribution to the earlier diagnosis of lung cancer through seeking to understand the experience of developing and being diagnosed with the disease. Of particular interest was how individuals interpret the symptomatic experiences associated with lung cancer and why individuals may not interpret them as related to it.
Situated within the interpretive paradigm and adopting a case study approach, this study sought to develop an understanding of the pre-diagnosis experience of lung cancer. The principal data were illness narratives generated in interviews with 33 individuals who had been diagnosed with the disease, though other data were also drawn upon to facilitate the understanding. Techniques of ‘narrative analysis’ and ‘analysis of narrative’ (Polkinghorne, 1995) were applied to the illness narratives.
Of the 33 participants, only two had interpreted their symptomatic experiences as related to lung cancer prior to presenting for medical advice. Many of the remaining participants interpreted their symptomatic experiences as related to normal life or normal illness. It is proposed that individuals interpret their symptomatic experiences through drawing upon storied meaning and emplotting their experience into a narrative plot in a process of experiential emplotment. This positions interpretation as an active and creative process and acknowledges that any interpretation occurs within a particular social context. Many individuals who develop lung cancer cannot see themselves in the disease’s narrative and therefore cannot interpret their experience as related to it. Health education interventions based on this understanding would strive to construct and communicate narratives of lung cancer which are faithful to how the disease is experienced and in whom so as to influence the availability, visibility and acceptability of the narrative plot.</p
This article deals with cultural stereotypes toward Central American migrants in the Mexican healthcare system, which lead to the naturalization of the supposed cultural characteristics of these new users. Based on 21 interviews of health and administrative staff in the state of Nuevo Leon (northeastern Mexico), it shows the first recourse to culturalist explanations to describe any phenomenon related to migrants' health. According to this perspective, the health of migrants, their relation to illness, and their patterns of seeking healthcare would be mainly determined by characteristic cultural traits, which justify their penurious attendance at health centers, and their low adherence to treatments. The culturalist explanation of migrants' health behaviors may influence the care they receive, as well as their adherence to treatment, which ultimately reinforces the health inequalities initially highlighted. This culturalist excess is partly explained by the incorrect understanding of the directives of health authorities in favor of the integration of an intercultural perspective in healthcare. Despite some ongoing training in this area, it does not seem sufficient to correct this situation effectively.
The new SARS-CoV-2 coronavirus disease (COVID-19) started in Wuhan City of China on December 31st 2019As at August 3,2020 a total of 18,056,310 million cases had been diagnosed globally with over 689,219 deaths with cases in Nigeria snowballing gradually becoming lethal. Given Nigeria’s socio-economic and demographic significance to African continent, it is imperative to understand the cultural norms that may aid or obstructs prevention and treatment of the disease in order to halt its transmission. Data for study came from the Nigeria Centre for Disease Control and other publicly available data sources supported with PEN-3 cultural model developed in 1989 by Airhihenbuwa. The model places culture at the core of the development, implementation and evaluation of successful public health interventions. COVID-19 transmission increases with large population concentration in urban areas and proximity to major entry points to other adjacent states and countries. The paper suggested that dominant cultures, civilization and religious practices should be adhered to, adopted as the case may be for restrictions such physical distancing, hand hygiene, use of face masks and another prophylactic regimen to flatten the curve of the pandemic in Nigeria and likely occurrence of similar disease in future.
IntroductionDr Ian McWhinney argued that the behaviour of patients should be classified in parallel with the taxonomy of disease. Therefore, he proposed a Taxonomy of Patient Behaviour, taking the doctor–patient contact as the reference point.
AimTo assess McWhinney’s Taxonomy of Patient Behaviour and explore its associations with patient age and gender, type, modality and the weekday of the appointment, in the context of the coronavirus disease 2019 (COVID-19) pandemic.
Methods
This was a cross-sectional study in a Community Health Centre in Florianópolis, Brazil. We retrospectively collected data from electronic medical records and analysed 4 consecutive weeks of our clinical encounters where every appointment had the patient’s motivation for seeking their medical appointment coded as: ‘limit of tolerance’, ‘limit of anxiety’, ‘heterothetic’, ‘administrative’, or ‘no illness’.
ResultsThere were 647 appointments. The frequencies of the taxonomic classifications were: 27.8% ‘administrative’, 26.6% ‘limit of tolerance’, 21.8% ‘limit of anxiety’, 18.1% ‘no illness’, and 5.7% ‘heterothetic’. Female patients had more consultations classified as ‘heterothetic’ and ‘limit of anxiety’. ‘Limit of tolerance’ and ‘heterothetic’ were more frequent in face-to-face appointments than in remote (on-line) consultations, and most of the ‘limit of anxiety’ consultations were same-day appointments. The average patient age was slightly higher on appointments classified as ‘heterothetic’ and lower on ‘limity of anxiety’ appointments.
DiscussionThe COVID-19 pandemic may have influenced the higher ‘administrative’ and ‘limit of anxiety’ frequency presentations. We hope to encourage other family doctors to adopt this system during their consultations and teaching functions and, perhaps, inspire more complex investigations.
This article analyzes the ongoing dialogue between administrative research and critical studies in health communication, focusing on contrasts and points of tangency. Following Lazarsfeld's work, we conclude with a proposition to adopt an integrative approach to the study of health, balancing between administrative tools and critical concerns.
Although physical pain lies at the intersection of biology and social conditions, a sociology of pain is still in its infancy. We seek to show how physical and psychological pain are jointly parts of a common expression of despair, particularly in relation to mortality. Using the 2002–2014 National Health Interview Survey Linked Mortality Files (N = 228,098), we explore sociodemographic differences in the intersection of physical and psychological pain (referred to as the “pain–distress nexus”) and its relationship to mortality among adults ages 25 to 64. Results from regression and event history models reveal that differences are large for the combination of the two, pointing to an overlooked aspect of health disparities. The combination of both high distress and high pain is most prevalent and most strongly predictive of mortality among socioeconomically disadvantaged, non-Hispanic whites. These patterns have several implications that medical sociology is well positioned to address.
Functional Gastrointestinal Disorders (FGID) are Disorders of Gut-Brain Interaction (DGBI) recognized by a variety of symptoms caused by abnormalities within gastrointestinal (GI) motility, visceral hypersensitivity, altered mucosal and immune function, altered gut microbiota, and central nervous system gut afferent input processing. Functional gastrointestinal disorders are very common and have a significant impact on the quality of life. These disorders should be viewed from a holistic mind-body perspective and the biopsychosocial model is conceptually helpful in understanding that for overall health, the biological system needs to exist in harmony with the environment, which influences the psychological and social wellbeing of an individual. Therefore, illness is not the result of a single factor but rather a combination of factors including genetics, social relationships, intrinsic and extrinsic environment (gut microbiome and school), and psychosocial factors. This chapter provides an overview of the clinical approach to children with FGID and emphasizes the biopsychosocial care model.
Artigo sobre a dor e a sua configuração na prática artística.
ABSTRACT
Is culture relevant to the study of health and illness? Yes. Culture is not just one of many factors associated with health but is the context within which health-related behavior unfolds. Over the past few decades the consensus among sociologists and anthropologists has been strengthened by increasing evidence-based research. Both disciplines produce the bulk of systematic research on health-related behavior by applying a wide range of conceptual perspectives and methodological approaches; and relevant psychology research contribute pertinent information. This analysis proposes and explains why the inclusion of the cultural context is central to our understanding of health, illness, and health-related behavior. The analysis unfolds in three steps: the definition of culture; the link between culture and health behavior; and the link between culture and healing systems.
Background
Patient experience has a direct impact on patients' engagement in healthcare, their commitment to treatment plans, and their relationship with their healthcare providers, all of which can impact their health outcomes. The complexity of the healthcare system, the increasing health needs of the population, and the priority and knowledge differences among healthcare stakeholders impact how they conceptualize and seek to achieve the ideal patient experience and the weights that they give to different elements of this experience.
Aims
This study sought to understand the perspectives of healthcare providers and administrators in Ontario regarding the factors affecting the patient experience.
Materials & Methods
Qualitative data were collected between April 2018 and May 2019. Twenty‐one semi‐structured interviews were conducted. Interviewees included physicians, nurses, optometrists, dietitians, quality managers, and policymakers. Thematic analysis was used to analyse the data, utilizing and extending a previously developed patient experience framework.
Results
Several themes emerged in the data, and they represent two perspectives on patient experience: the biomedical perspective, which prioritizes health outcomes and gives high weights to healthcare experience factors that can be controlled by healthcare providers, while ignoring other factors, and the sociopolitical perspective, which recognizes the impacts of healthcare politics and the social context of health on patient experience in Ontario.
Conclusion
The study is timely in light of the current changes in the Ontario healthcare system and the healthcare reform started by the new government, as it sheds light on the possible negative impact on healthcare policy and politics on patient experience.
This thesis contains a review of the literature concerning chronic idiopathic facial pain (CIFP) its presentation, management and psychological aspects. A two part study is then described: i. Treatment uptake The aim of the study was to measure psychological and objective parameters in patients attending for treatment of CIFP and investigate their association with acceptance of treatment. An assessment of clinical and psychological factors was made in 848 patients; of those with CIFP (713), 46% of patients declined treatment, 28% opted for routine treatment (10% due to trial exclusion criteria) and 26% accepted treatment within the study. The only predictors of treatment uptake were pain severity (p<0.00l), presence of constant pain (p<0.05) and age and marital status (p<0.01). ii. Treatment outcome: A comparison of cognitive behavioural therapy alone and in conjunction with an antidepressant drug. This randomised placebo-controlled study aimed to assess the effectiveness of treatment of chronic idiopathic facial pain with either a) fluoxetine; b) placebo; c) fluoxetine and cognitive behavioural therapy (CBT) and d) placebo and CBT in a cohort of 181 patients, over a period of three months. Pain and psychological measures were made during the treatment phase and an additional nine month follow up. Three months treatment with fluoxetine alone or in combination with CBT improved measures of pain severity (p<0.005), distress (p<0.05) and interference (p<0.05). Control was improved in those patients receiving CBT (p<0.05). During the follow up period when trial drug therapy had ceased, these changes were not maintained. However the need for further medical therapy was less in the CBT group. The final pain score was predicted only by the initial pain severity scores (p<0.001) and the time in follow up (p<0.05).
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