Concepts of Health and Illness: Section 4. Lay Health Beliefs and Illness Behaviour

The findings of sociological research into lay health beliefs which focus on discovering the rules and meanings that different social groups use to order their lives and make sense of their experience of health and illness have been of great value to clinicians. Such findings demonstrate the sophistication and complexity of lay beliefs about health, and point to the need for health professionals not to treat patient views as merely 'incorrect knowledge' and so improve the patient-professional relationship.

" Ordinary people develop explanatory theories to account for their material, social and bodily circumstances. These they apply to themselves as individuals, but in developing them they draw on all sorts of knowledge & wisdom, some of it derived from their own experience, some of it handed on by word of mouth, other parts of it derived from highly trained practitioners. Thus lay explanations go beyond common sense, in that explanations beyond the immediately obvious are included "  (Stacey:1988:142)

Most sociological studies of lay health beliefs agree that public conceptions of health and illness vary according to the immediate material & social circumstances in which people find themselves. These circumstances can act to constrain the possibilities for action to change an 'unhealthy lifestyle'. Nevertheless, health promotion strategies have in the past assumed that persuading people to adopt healthy 'lifestyles' was largely about changing individual attitudes. However, as the work of Davison et al (1991) has shown, to oppose so-called 'lifestylism' (the awareness of the causes and possible ways to avoid illness through behaviour change) to 'fatalism' (life is full of random chance events outside of my control), is to misunderstand the real situation for most people. In their fieldwork in South Wales, the researchers found that:

'…only very few informants whose belief in randomness led them to deny or ignore the possible benefits of lifestyle change. Rather, the recognition of a pervasive uncertainty in the field of illness and death existed side by side with a common-sense approach to taking appropriate care' (Davison et al:1991:106)

At least in part, one consequence of such lay beliefs research was to bring about a shift of focus in the health prevention strategy of the government. The New Labour government Public Health White Paper, Saving Lives: Our Healthier Nation (1999), for example explicitly recognised that:

' Past health strategies have tended to focus excessively on lifestyle issues…People were treated as passive recipients of information and services, rather than active partners. This contributed to a widening of the health gap: we now know that the better off are more likely to act on health information to change behaviour…Although people may know what affects their health, they can find it difficult to act on what they know, setting up a downward spiral of deprivation and poor health ' DoH: 1999:3.2 / 4.10).

In 2001, in recognition of the cumulative sociological evidence of the potential for dissatisfaction and misunderstanding resulting from the different perspectives of treatment and care existing between doctors and patients, the Department of Health set out guidelines for a new approach to Doctor-patient relations that it termed 'The Expert Patients Initiative' (DoH:2001). This shift in clinical focus is all about formally recognising the intimate (and rational) knowledge and experience that patients have of their illness, and encouraging patients to take an 'active role in their own care'.

Sociological research into these lay health beliefs spans a thirty year period, Table 1 below is an attempt to summarise the main findings and give examples of how such beliefs play out in the real world ('indicators').

Table 1 : Summary of Sociological Studies of Lay Health Beliefs (Crinson:2007)

Models of 'help-seeking' or illness behaviour:

The sociological approach of Zola (1973) found that people`s responses to symptoms were contingent upon their cultural values / beliefs concerning health. That is, their perception of what is 'normal'. Accordingly, the decision to seek professional medical help was either promoted or delayed by social factors. Zola`s (1973) model (set out in Figure 2 below) identified five different types of incident which `triggered' the decision to seek medical care, incidents which threaten people`s notions of normality.

However, the interesting feature of the model is that the decision to seek help does not necessarily lead directly on a path to the medical professional. People draw upon what is termed a 'lay referral' system which includes family, friends and the local community - so for example a young mother faced with a baby that is continually crying may choose not to go direct to the G.P because they may be afraid that they will be categorised as an 'anxious mother' and so instead approach their own mother or other mothers with older children for advice. People also increasingly are engaging in 'self-medication' as generic drug treatments become more widely available over the counter. They may also be one of the hundreds of thousands of people each year who opt for what is loosely termed 'alternative' medical care; now a multi-billion pond industry in Britain.

Figure 2 : Zola's Help-Seeking Model 

Despite the influence of such help-seeking models, health policy over the past two decades has generally been less concerned with illness behaviour than with developing strategies to promote health maintenance (health behaviour). Here both social psychological models and sociological approaches to understanding lay health beliefs have been applied in attempting to bring about health & lifestyle change.

© I Crinson 2007