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Abstract: We all get ill and social scientific interest in how we respond – the study of illness behaviour – continues unabated. Existing models are useful, but have been developed and applied within disciplinary silos, resulting in wasted intellectual and empirical effort and an absence of accumulation of knowledge across disciplines. We present a critical review and detailed comparison of three process models of response to symptoms: the Illness Action Model, the Common Sense Model of the Self-Regulation of Health and Illness and the Network Episode Model. We suggest an integrated framework in which symptoms, responses and actions are simultaneously interpreted and evaluated in the light of accumulated knowledge and through interactions. Evaluation may be subconscious and is influenced by the extent to which the symptoms impose themselves, expectations of outcomes, the resources available and understanding of symptoms' salience and possible outcomes. Actions taken are part of a process of problem solving through which both individuals and their immediate social network seek to (re)achieve ‘normality’. Response is also influenced by social structure (directly and indirectly), cultural expectations of health, the meaning of symptoms, and access to and understandings of the legitimate use of services. Changes in knowledge, in embodied state and in emotions can all be directly influential at any point. We do not underestimate the difficulty of operationalising an integrated framework at different levels of analysis. Attempts to do so will require us to move easily between disciplinary understandings to conduct prospective, longitudinal, research that uses novel methodologies to investigate response to symptoms in the context of affective as well as cognitive responses and interactions within social networks. While challenging such an approach would facilitate accumulation of knowledge across disciplines and enable movement beyond description to change in individual and organisational responses. [Copyright &y& Elsevier]

Abstract: The conventional definition and classifications of breast cancer delay are based on arbitrary empirical time cut-offs. In general, studies of cancer delay are based on these traditional definitions of patient and provider delay and are essentially atheoretical. If we aim to better understand delay, a reconsideration of its traditional conceptualisation and study methods is warranted. We propose a multidimensional model of breast cancer delay grounded in data from in-depth interviews with symptomatic patients and nested in the theory of illness behaviour. Our results show that delay prior to the first encounter with health services has to do with more than simply the patient as an individual, and delay posterior to this encounter is not due only to the health care providers. In fact, delay is a result of the interplay between the patient’s socio-cultural context, individual characteristics that influence symptom interpretation and decision-making, interaction with the social network and types of support obtained, and aspects of the local health services. Future research on cancer delay should approach the problem integrally, taking into account the diverse dimensions involved. [Copyright &y& Elsevier]

Abstract: Across all health care settings, certain patients are perceived as ‘difficult’ by clinicians. This paper’s aim is to understand how certain patients come to be perceived and labelled as ‘difficult’ patients in community mental health care, through mixed-methods research in The Netherlands between June 2006 and October 2009. A literature review, a Delphi-study among experts, a survey study among professionals, a Grounded Theory interview study among ‘difficult’ patients, and three case studies of ‘difficult’ patients were undertaken. Analysis of the results of these qualitative and quantitative studies took place within the concept of the sick role, and resulted in the construction of a tentative explanatory model. The ‘difficult’ patient-label is associated with professional pessimism, passive treatment and possible discharge or referral out of care. The label is given by professionals when certain patient characteristics are present and a specific causal attribution (psychological, social or moral versus neurobiological) about the patient’s behaviours is made. The status of ‘difficult’ patient is easily reinforced by subsequent patient and professional behaviour, turning initial unusual help-seeking behaviour into ‘difficult’ or ineffective chronic illness behaviour, and ineffective professional behaviour. These findings illustrate that the course of mental illness, or at least the course of patients’ contact with mental health professionals and services, is determined by patient and professional and reinforced by the social and mental health care system. This model adds to the broader sick role concept a micro-perspective in which attribution and learning principles are incorporated. On a practical level, it implies that professionals need to look into their own role in the perpetuation of difficult behaviours as described here. [Copyright &y& Elsevier]

Abstract: Asthma affects a considerable proportion of the population worldwide and presents a significant health problem in Australia. Given its chronic nature, effective asthma self-management approaches are important. However, despite research and interventions targeting its treatment, the management of asthma remains problematic. This study aimed to develop, from a theoretical basis, an asthma self-management model and implement it in an Australian community pharmacy setting in metropolitan Sydney, using a controlled, parallel-groups repeated-measures design. Trained pharmacists delivered a structured, step-wise, patient-focused asthma self-management program to adult participants over a 9-month period focusing on identification of asthma problems, goal setting and strategy development. Data on process- clinical- and psychosocial-outcome measures were gathered. Results showed that participants set an average of four new goals and six repeated goals over the course of the intervention. Most common goal-related themes included asthma triggers, asthma control and medications. An average of nine strategies per participant was developed to achieve the set goals. Common strategies involved visiting a medical practitioner for review of medications, improving adherence to medications and using medications before exercise. Clinical and psychosocial outcomes indicated significant improvements over time in asthma symptom control, asthma-related self-efficacy and quality of life, and negative affect. These results suggest that an asthma self-management model of illness behaviour has the potential to provide patients with a range of process skills for self-management, and deliver improvements in clinical and psychosocial indicators of asthma control. The results also indicate the capacity for the effective delivery of such an intervention by pharmacists in Australian community pharmacy settings. [Copyright &y& Elsevier]

Effects of illness and disability on job separation result from both voluntary and involuntary processes. Voluntary processes range from the reasoned actions of workers who weigh illness and disability in their decision-making, to reactive stress-avoidance responses. Involuntary processes include employer discrimination against ill or disabled workers. Analyses of the effects of illness and disability that differentiate reasons for job separation can illuminate the processes involved. This paper reports on an evaluation of effects of illness and disability on job separation predicted by theories of reasoned action, stress, and employer discrimination against ill and disabled workers. Effects of four illness/disability conditions on the rate of job separation for 12 reasons are estimated using data from a longitudinal study of a representative sample of the Canadian population—the Survey of Labour and Income Dynamics (SLID). Two of the four effects that are statistically significant (under conservative Bayesian criteria for statistical significance) are consistent with the idea that workers weigh illness and disability as costs, and calculate the costs and benefits of continuing to work with an illness or disability: (1) disabling illness increases the hazard of leaving a job in order to engage in caregiving, and (2) work-related disability increases the hazard of leaving a job due to poor pay. The other two significant effects indicate that: (3) disabling illness decreases the hazard of layoff, and (4) non-work disability increases the hazard of leaving one job to take a different job. This last effect is consistent with a stress-interruption process. Other effects are statistically significant under conventional criteria for statistical significance, and most of these effects are also consistent with cost–benefit and stress theories. Some effects of illness and disability are sex and age-specific, and reasons for the specificity of these effects are discussed. [Copyright &y& Elsevier]