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LAY BELIEFS ABOUT HEALTH AND ILLNESS: ILLNESS AND ITS MANAGEMENT - THE NUMBER OF EMPIRICAL STUDIES
The number of empirical studies which have examined decision rules that people use to decide what to do about health problems, using this particular perspective, is small. However, Cowie (1976) in a study of cardiac patients, examined the ways in which signs and symptoms were evaluated and how patients responded to them. He found that their responses were coloured by the context in which pain was experienced. Perception of the need for urgent medical attention was more likely to occur when the pain was sudden, acute and unexpected However, 16 of the 23 patients initially applied a common sense lay diagnostic category. Some identified the pain as a bout of indigestion and others related it to a recurrence of other minor illnesses they had recently had.
This process of normalization was upset by their failure to understand the physical experiences in terms of the interpretive framework available to them and by changes in the quality and duration of the problematic experience. Cowie reports that this sometimes happened when lay others, such as spouses, evaluated something as wrong when the sufferers were not behaving in accordance with their spouses' conceptions of how they normally behaved. Thus, decisions to seek medical care tended to occur when sufferers and significant others could no longer account for signs and symptoms within their framework of everyday knowledge.
Clearly, uncertainty about what is wrong is a significant influence on people's decisions to seek medical care. However, in relation to cancer, uncertainty can have an inhibiting effect. For example, a woman in a study by Calnan and Johnson (1983) stated that sometimes she was hesitant or nervous about seeking medical help. She explained when this occurred: 'If I have got something pretty foreign to me and I cannot sort of create a self-diagnosis, I automatically think the worst. I feel that this is what everybody does. . . .For instance, should I have a lump appear on me I would automatically think it must be cancer because I had a friend who was about 3 months younger than I was – she just suddenly died of cancer – and it hit me – and I thought that…’.
In these circumstances some women may consult their doctors because they feel they should and because they want to know what is wrong. However, others might prefer to stay ignorant because they believe that nothing can be done about it anyway. Robinson (1974) has suggested that sufferers, although aware of the salience of their signs and symptoms, still tolerate and accommodate them on the grounds that the social, psychological or economic costs of accepting the illness, in terms of the dependent sick role and seeking medical care, far out-weigh the benefits.
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