心理科学进展, 2019, 27(4): 676-688 doi: 10.3724/SP.J.1042.2019.00676

研究前沿

常人疾病观及其对医患关系的影响

吕小康1, 唐磊,1,2, 姜鹤1, 汪新建1

1南开大学周恩来政府管理学院, 社会心理学系, 天津 300350

2南开大学外国语学院, 天津 300071

Lay theories of illness and their influences on doctor-patient relationships

LÜ Xiaokang1, TANG Lei,1,2, JIANG He1, WANG Xinjian1

1 Department of Social Psychology, Zhou Enlai School of Government, Nankai University, Tianjin 300350, China

2 College of Foreign Languages, Nankai University, Tianjin 300071, China

通讯作者: 唐磊, E-mail: ltang@nankai.edu.cn

收稿日期: 2018-03-16   网络出版日期: 2019-04-15

基金资助: * 教育部哲学社会科学研究重大课题攻关项目.  15JZD030
天津市哲学社会科学规划项目资助.  TJJX18-001

Received: 2018-03-16   Online: 2019-04-15

摘要

常人疾病观是普通人对于某一疾病的认知、解释和态度的集合。与专业医务人员相比, 普通人更关注心理、家庭和社会因素而非生物学因素的致病作用, 就医选择多元而并不遵循标准化的就医模式, 同时更愿意将疾病体验视为个人生活的特殊问题加以建构性理解。常人疾病观与科学医学观之间的不一致性可能降低患者的就医满意、对医信任和医嘱依从性, 从而影响治疗效果。立足中国社会的医学文化与医疗制度, 研究中国人的常人疾病观, 并探讨其对医患关系的影响作用与社会心理机制, 可为改善当下中国医患关系紧张现状提供有益建议。

关键词: 常人理论 ; 常人疾病观 ; 医患关系 ; 医患沟通

Abstract

Lay theories of illness are a collection of lay people’s knowledge, explanations, and attitudes toward a particular disease. Compared with medical professionals, lay people are more concerned with the pathogenic effects of psychological, family and social factors than biological factors. They choose diverse medical treatments rather than follow the standardized medical model; they are more willing to treat the disease experience as a special issue of personal life and develop a constructive understanding. The discrepancies between lay theories of illness and scientific medical theories can lower patient’s satisfaction with medical care, trust in medical practitioners, and adherence to doctor’s advice, thereby affecting treatment outcomes. It is believed that studying Chinese lay theories of illness, their impact on doctor-patient relationships and the social psychological mechanism thereof, in the context of the Chinese medical culture and medical system, will provide useful suggestions for reducing the current tension between doctors and patients in China.

Keywords: lay theories ; lay theories of illness ; doctor-patient relationships ; doctor-patient communication

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本文引用格式

吕小康, 唐磊, 姜鹤, 汪新建. (2019). 常人疾病观及其对医患关系的影响. 心理科学进展, 27(4), 676-688

LÜ Xiaokang, TANG Lei, JIANG He, WANG Xinjian. (2019). Lay theories of illness and their influences on doctor-patient relationships. Advances in Psychological Science, 27(4), 676-688

医患关系紧张有诸多社会心理学成因, 其中不可忽视的一个方面就是医患双方就同一疾病在沟通过程中所持的不同观念。虽然疾病的诊断与治疗通常涉及专业的现代医学知识, 但患方仍常因自身持有的、不同于医方所代表的现代医学知识的各种朴素信念, 而选择是否就医、是否相信诊断、是否遵从医嘱等。医患沟通虽在某种程度上是一种专家与被指导者之间的关系, 但患方对疾病、健康、医疗服务、就医期待等问题所持有的主观的认知和态度也在很大程度上影响医患沟通的质量。健康与疾病的专业知识与日常信念之间通常存在隔阂甚至冲突, 这会成为医患沟通不畅的一个诱因。“常人疾病观” (lay beliefs/theories of illness, 又译常人疾病理论)的提出和相关研究, 可丰富对医患视角之间不一致性的理解, 并对建设和谐医患关系提出有益的社会心理学建议。

1 常人疾病观的概念内涵与研究历程

1.1 常人、常人理论与常人疾病观

在日常生活中, 人们总是以自己所持有的对于事物的一定观念来指导自身行为, 即使这些行为本质上可能需要专业的、未经职业培训难以获得的知识与经验。所谓“常人” (layman), 意指普通的、非专业领域的人士, 也就是普通人、平常人的意思。当然, 专业与否是相对而言的。神经外科的专家, 完全可能是计算机专业的常人。常人对于世界万物的本质、各种社会事物运作、日常琐碎问题等都有自己的一套非科学、内隐式、非正式的解释方法, 这就是所谓的常人理论。Kelly (1963)将常人理论定义为“普通人所持有的关于事物如何运作的观念”。它如同滤镜一般, 影响人们对各种日常问题的认知和态度, 并指导人们的相应行为。

常人理论这一概念包含两个层面:广义上泛指人们对于世界上人、情、物等各种现象的整体观念体系, 可被视为普通人的朴素处世哲学; 狭义上则指人们对于某一具体问题的解释、看法, 是相对具体的、有关某方面的个人建构。常人理论内容涉及不同学科、不同方面, 因此又可进一步分为如常人教育观(Savani, Rattan, & Dweck, 2017)、常人经济观(Leiser & Krill, 2017)、常人幸福观(Agbo & Ome, 2016)、常人疾病观(Cameron & Leventhal, 2014; Knettel, 2017)等等。

常人理论之所以被称为“理论”是因为它与科学理论(scientific theories)具有一定的相似性:在内容上受科学性理论启发(Jayaratne et al., 2006); 在结构上是具有一定内部结构的信念、规则和概念体系(Furnham, 1988); 在功能上支持人们理解世界、进行预测和控制, 从而降低认知不确定性(Plaks, Grant, & Dweck, 2005)。然而, 常人理论并不是普通人的科学性理论, 其所包含的假定与公理通常是内隐的、模棱两可的; 多以归纳式逻辑证实自身对事物的解释, 而并不关心证伪问题; 经常将两个变量的相关关系错判为因果关系; 通常通过实际观察得出对某一现象的具体解释, 但并不将具体的解释抽象为可以解释同一属性内不同现象的一般性原则(Furnham, 1988)。因此, 常人理论属于“弱理论(weak theories)” (Furnham, 1988), 是普通人藉由理解日常生活的现象学建构(Levy, Chiu, & Hong, 2012)。

在医疗情境中, 常人通常指没有相关医学背景的患方, 包括就诊的患者本人及其亲属或代理人。常人疾病观是患方所持有的对于某一种或某一类疾病的病因、疗法、病情发展、意义与影响等问题的认知、解释和态度的集合, 是常人理论在疾病与健康领域的具体应用与体现(Furnham & Kirkcaldy, 2015); 其对立面则是受过专业医学训练的医方所持有的科学医学理念, 也就是当下的生物医学理念。从本质上来说, 它是普通人结合实证观察、个人经验、媒体报道等渠道所获取知识而形成的对某一种或某一类疾病相关现象的解释模型。当然, 这并非指患方常人观绝对不符合科学医学理念, 也不是说所有医务人员持有的一切观念都一定符合科学医学理念。只是总体来说, 医患双方持有的医学知识不对等, 甚至往往存在一定的知识鸿沟, 遇到具体疾病时所通常诉诸的疾病解释和求医策略也存在一定的不同。强调“常人疾病观”的“常人”性, 仍可在一定程度上突出未经现代医学训练的普通人对医学现象的朴素理解。这就像使用医方和患方的词汇描述两个群体时, 并不是指“医方”就完全不可能成为“患方”, 医生也可能生病而成为患者, 但他们显然不同于普通患者。因此, 做出一定的区分仍可在理论阐释及学术交流中起到突出重点的作用。

像所有其它领域的常人理论一样, 常人疾病观通常是不具体的, 不基于系统观察的, 没有明确的量化法则, 研究对象界定不够清晰, 无法对事物发展做出直接精准的预测。但从功能上看, 常人疾病观支持个体理解病情、对疾病发展进行预测和控制, 从而降低认知不确定性, 它直接影响患方的疾病观念、就医行为、医患沟通、对医嘱的依从性等诸多影响医患关系的基本要素。

1.2 常人疾病观的研究历程

西方常人疾病观的研究历史迄今已有约50年。1972年, Antonovsky (1972)从严重性(seriousness)、可控性(controllability)、可察觉性(salience)和易患病性(susceptibility)四个维度测量了以色列城市犹太民众对癌症、心脏病、精神病和霍乱这四类疾病的常人观, 并发现不同年龄、性别、教育背景的各个群体对于以上四类疾病所持的观念高度一致。这一研究发现使人们认识到常人疾病观无论对公共健康管理还是对个体健康行为都有重要影响。此后, 社会心理学家在这一领域开展了大量研究, 在研究内容、研究方法和测量工具方面积累了一定成果。

Antonovsky (1972)研究的影响, 早期对于常人疾病观的许多研究主要关注通用常人疾病观, 建立通用的理论模型。Ben-Sira (1977)同样以四种疾病为例(心脏病、肥胖症、呼吸系统疾病和肠道疾病)研究了以色列主妇对疾病的可预防性、可察觉性、易患病性的认识和了解程度, 发现具有不同人口统计学特征的常人群体持有相似的疾病观:当常人认为某一疾病易患病性越高, 其可察觉性就越高, 因此更愿意主动了解该疾病相关知识, 并对其可预防性和预防措施了解更多。这一研究虽一定程度上揭示了常人对于疾病不同方面的观念及其内部关系, 但并不能解释常人感知疾病、判断疾病、应对疾病这一心理过程。Leventhal, Meyer和Nerenz (1980)的研究试图解决这一问题, 他们提出了自我调节常识模型(common-sense model of self-regulation)。这一模型将危险控制(danger control)作为原则, 认为常人会首先识别疾病风险, 形成疾病表征(illness representations), 然后采取应对行动降低风险, 并评估所采取行动的有效性, 进而调整下一步行动。其中, 常人对于疾病的表征包括疾病识别(identity)、病程(timeline)、病因(causes)、结果(consequences)、可控性(control)这五个维度。疾病识别维度指常人对疾病症状或体征感受的判断或辨识。病程指常人对疾病发病时间、持续时间、会否复发等疾病发展时间线的观念。病因指常人对引起疾病原因的判断。结果指常人认为疾病会造成什么样的影响或结果。可控性指常人认为疾病是否可治愈, 或者自己是否有能力应对该疾病。常人在这五个维度对疾病的表征会影响其应对疾病的策略。比如, 常人若感受到某种病症, 并且持续时间较长, 影响较严重, 其更有可能求诊(Leventhal, Phillips, & Burns, 2016)。随着研究深入, Leventhal等(2016)修订该模型, 认为常人从以上五个维度形成疾病表征后, 会采取什么样的应对策略还取决于其所持有的疗法表征(treatment representations), 即常人会根据过往经验、观察、或获取的相关知识, 形成不同疗法的原型(treatment prototypes)。当其形成了一定的疾病表征, 相关疗法原型被激活, 二者之间的最为匹配的应对策略即被选择。

几乎同一时期, Kleinman (1980)提出了另一个常人疾病观通用模型——疾病解释模型(explanatory model of illness), 试图揭示常人对某一疾病及其治疗方法的观念。根据该模型, 常人对于任一疾病的理解都包括:(1)什么原因引起疾病?(2)为什么会在某个时刻生病?(3)这病在身体里会怎么发展?(4)这病会带来什么影响?(5)该怎么应对这病?当感受到身体异样时, 常人会用所处文化或社会环境赋予的知识内容去从以上五个方面理解疾病。

尽管自我调节常识模型和疾病解释模型在具体内容维度上稍有差别, 但从本质上讲, 二者都是将常人疾病观的内容结构化, 具有结构主义特征。虽说可在一定程度上揭示常人疾病观, 但其试图用简单的规律和模型解释丰富复杂的心理内容, 有削足适履、牵强附会的弊病。实际上, Kleinman自己在研究后期也承认对模型(model)一词“感到不适”, 认为这过于形式化, 是符号主义和形式主义作品留给他的“残渣(residue)” (Kleinman, 1995), 他本人的研究也开始转向常人对特定疾病感受的叙事性研究。而另一方面, 自我调节常识模型建构的理论和实证研究则基本上是由Leventhal及其同事完成的(Cameron & Leventhal, 2014; Leventhal et al., 2016), 其他学者更多的是应用该模型对有关特定疾病的常人疾病观进行研究(Garg, Meraya, Murray, & Kelly, 2017; Shiloh, Heruti, & Leichtentritt, 2016), 这也从侧面证明了通用常人疾病观研究的局限性。

研究者发现常人针对不同疾病的观念并不能一概而论, 因此越来越多的研究者开始将焦点转向某一疾病或某一类疾病的常人观, 即特定常人疾病观。早期的特定常人疾病观研究聚集于心理疾病, 后拓展至躯体疾病。Furnham和Lowick (1984)通过访谈与问卷的方法研究了酗酒症常人观, 此后研究者开展了大量有关心理疾病常人观的研究, 如厌食症(Gulliksen, Nordbø, Espeset, Skårderud, & Holte, 2017)、自闭症(Qi, Zaroff, & Bernardo, 2015)、精神分裂症(Park, Lee, Furnham, Jeon, & Ko, 2017)、抑郁症(Markova & Sandal, 2016)等。随着对心理疾病常人观研究的开展, 社会心理学家也开始关注有关躯体疾病的常人疾病观, 如帕金森症(Werner & Korczyn, 2010)、癌症(Wang, Lam, Wu, & Fielding, 2014)、艾滋病(Nyundu & Smuts, 2016)、肥胖症(Mcferran & Mukhopadhyay, 2013)、肺结核(Asiimwe, Cross, & Haberer, 2015)、风湿性关节炎(Williams, 2009)、高血压(Buckley, Labonville, & Barr, 2016)等。此类研究多把目光聚集于慢性疾病, 对其它短病程疾病和急性病的研究较少。

目前, 针对各种类型疾病的特定常人疾病观研究仍在不断增加。研究者发现, 尽管由于教育普及、媒体宣传、主动学习等因素的影响使得常人疾病观与作为现代医学主流的生物医学观念存在一定的一致性(Furnham & Buck, 2003; Mitchell & Locke, 2015), 现代医学教育以不同的方式渗透于社会, 使得现代医学知识也成为常人所拥有的知识和信念, 但二者之间的差异仍然普遍存在, 并未随着医学教育的普及而完全消失。分析这些差异, 有助于人们进一步认识医学教育的局限, 并对现代生物医学的治疗模式进行进一步的反思。

2 常人疾病观的特征与研究方法

2.1 常人疾病观的特征

常人理论的特征通常是与某一专业领域的专家知识相比较而言的。就常人疾病观而言, 其比较基准自然是主流的生物医学理念。Kleinman (1980)在提出常人疾病解释模型后, 综合了其与生物医学解释模型的内容结构, 提出了可用于对比二者的通用解释模型, 该模型认为无论是常人疾病解释模型还是生物医学解释模型都包括以下五个方面:病因(etiology)、病程(course of illness)、病理生理(patho-physiology)、症状(symptoms)和疗法(treatment)。尽管这一对比模型仍然带有结构主义色彩, 但却为常人疾病观和生物医学观的比较提供了基本维度。因此, 从理论上讲, 与生物医学理论相比, 常人疾病观的特征应体现在以上五个方面。但梳理现有常人疾病观研究发现, 二者的差异性主要体现在对疾病的归因模式、治疗方法选择以及对疾病症状感知和意义建构这三个方面, 对于病程和病理生理两个方面常人疾病观的研究尚不明确。

常人对于某一疾病的归因是指其如何解释某种疾病发病原因、如何判断一些可能造成某种疾病的危险因素。相对于以生物和遗传解释为主的专业医学理论, 研究者发现常人在对疾病归因时更关注心理、社会和家庭等因素(Harvey et al., 2013; Wang et al., 2014)。例如, Harvey等人(2013)对失眠症常人观的研究发现, 常人无论是对自身失眠症的病因判断还是对他人失眠症的病因解释都集中在情绪情感(emotions)和思考习惯(thinking patterns)两个方面。同时其研究还发现, 常人认为造成失眠症的因素包括压力、情绪、睡眠习惯、环境、饮食、体育锻炼、遗传等27类之多。而Ahn, Proctor和Flanagan (2009)的研究却发现医护专业从业者更倾向于以生物学角度去解释失眠的发病。另一项Mitchell和Locke (2015)对自闭症常人观的研究也发现除了被生物医学证实的基因或神经缺陷这一主要病因, 相当一部分常人认为环境因素、心理问题、某种疫苗带来的副作用、孕期营养不良、日常饮食营养不良、家庭影响、父母教养方式、滥用药物等都可能是致病因素。此外, 对于高血压、糖尿病、癌症等躯体疾病的常人疾病观研究也发现普通人对病因的判断不同于科学生物医学理论的解释(Akinlua, Meakin, Fadahunsi, & Freemantle, 2016; Mwaka, Okello, Kiguli, & Rutebemberwa, 2014)。

治疗方法选择指常人对于某一疾病的治疗倾向于采取哪种方法、认为哪种方法更为有效。一些研究发现常人对于精神或心理疾病疗法的选择异于生物医学治疗方案:常人一般倾向于选择精神疗法来治疗精神或心理疾病(Furnham & Kirkcaldy, 2015), 而精神医学普遍认为药物治疗是对抗精神和心理疾病最为有效的方法(Furnham & Bower, 1992)。此外, 研究还发现常人对疾病病因的解释直接影响着其对治疗方式的选择。Furnham和Haraldsen (1998)研究常人对四种性变态疾病的归因与疗法选择的关系, 结果发现常人对病因判断与对疗法选择呈现强相关。Furnham和Buck (2003)对自闭症和强迫症常人观的对比研究也验证了这一点。由于前述常人对疾病的归因五花八门, 若他们将疾病归因为生物医学因素, 则倾向于选择药物疗法; 若将之归因为心理或社会因素, 则更相信心理疏导、自我管理等其它疗法(Furnham & Kirkcaldy, 2015); 更有甚者倡导宿命论, 在选择疗法时求助于一些所谓的“超自然”力量。这与通常采用标准化就医模式和问诊渠道的生物医学理论背道而驰。

此外, 常人疾病观与生物医学观念的差别还体现在常人对于疾病病症感知和意义建构方面, 即常人基于原有知识经验, 如何看待疾病给个人的身体、心理带来的变化, 并在此过程中如何生成意义、建构理解的过程。首先, 不同于生物医学对于疾病病症的客观描述, 常人对于病症感知多是综合了心理、生活、社会等多种因素。Mahon, O’Brien和O’Conor (2014)研究发现患有不同慢性疾病的病人除了生理病痛外, 普遍感到“失落感”、“愤怒与沮丧”、“不确定与压力”并且要“调整适应新生活”。一项对于软组织肉瘤患者病痛感受的综述性研究也发现患者对自身病症的感知包含对自身生活质量的影响, 如对精神健康的影响、对身体形象的影响、对照顾孩子的影响、对工作的影响等(Winnette, Hess, Nico, Tai, & Copley-Merriman, 2017)。

其次, 与生物医学观相比, 病症感知后的意义建构是常人疾病观研究一项特有的内容, 也是某种程度上促进生物医学向人文医学转变的一项极具意义的内容。常人对于疾病态度的形成和对疾病给自身带来的影响的认识并非仅从简单的生理反应或病痛感受角度出发, 而是结合个体自我意识、政治经济历史等宏观社会因素、以及人际交往等微观社会因素, 且这种意义建构方式与疾病种类和病情程度无关(Kirk, Cockbain, & Beazley, 2008)。Bury (1982)发现常人对于慢性疾病的观念并非单纯地从生理病痛角度思考, 而是把疾病放在人生发展和自我意识的多维框架中, 将疾病视为扰乱其人生轨迹的一段经历(biographical disruption), 换言之, 疾病会导致常人重新思考人生、认识自我。D’Houtaud和Field (1984)发现常人的疾病经验感受不仅与疾病本身有关, 还受其社会经济地位影响。低社会地位阶层倾向于关注疾病对个体工作生活能力的影响, 高社会地位阶层则更关注疾病对于健康本身的影响。Bendelow (1993)发现社会对男女两性的角色期待和刻板印象会使男性和女性对于疼痛产生不同的感知和耐受力。此外, 还有研究说明常人的患病经验感受会受夫妻关系、人际关系等微观社会层面因素的影响(Colson, 2016)。与此相反, 传统的生物医学是将患者客观化与去人性化, 将其视为没有自我的生物体, 企图从纯科学的角度理解各种病症(Lawton, 2003)。受此观念影响, 很长一段时间无论是医学教育还是医护实践都过分“注重了机体和器官的还原, 忽略了较之更丰富的心理和精神的还原”, “对人的疾病诊治过程中忽视了对人的整体性的关注” (段志光, 2017)。20世纪70年代常人疾病观研究兴起, 同一时期医学人文概念出现(段志光, 2017), 尽管前者是否促使后者产生这一问题尚待考证, 但从二者研究进程看, 常人疾病意义建构研究将有助于促进医学对于人作为生命体而非单纯的生物体的关怀。

Kleinman提出的对比解释模型中还包括病程和病理生理两方面, 但目前对于这两方面的研究并未得到充分的展开。常人对于病程的认识是指常人认为某种疾病会如何发展变化, 如果不加以治疗会怎么样。几乎所有的研究都将这一部分内容简化为常人对于某种疾病是慢性还是急性的判断。一部分研究发现常人对疾病急慢性判断存在与科学医学不一致的情况(Akinlua et al., 2016; Odusola et al., 2014), 但也有相当多的研究发现二者在此方面存在一致性。造成这种研究结果高度不一致的情况可能有两方面原因:一是将常人对于病程的认识等同于急慢性病判断, 极大地简化了研究问题和可能的答案, 自然使被调查者的回答呈现急性或慢性两极分化。实际上, 想要了解常人对病程的理解还可以从不同方面提问, 比如发病的速度、持续时间、是否反复、没有症状是否即是无病等。Halm, Mora和Leventhal (2006)的研究就发现, 对于哮喘, 常人基本可以正确判断其为慢性病, 但同时有53%被试却认为他们只有在出现哮喘症状时才患此病, 没有症状时就是健康的。这显然与简单的急慢性判断不一致。二是由于医学常识的普及, 常人对于这样相对简单明显的判断题基本可以给出较为科学的答案, 事实上许多发现前面所述不一致性的研究都是针对受教育水平较低、经济发展较为落后的群体或地区开展的(Moorley, Cahill, & Corcoran, 2016; Mwaka et al., 2014), 这也证明了医学常识普及教育对常人有关急慢性病判断的影响。另外, 病理生理方面指常人对于疾病所带来的机体变化如何给出生物医学的解释。常人疾病观针对这一方面的研究尚需进一步开展, 这可能是由于这一问题本身太过专业, 常人很难作答, 故相关研究还较少。因此这两方面问题, 未来研究值得关注。

2.2 常人疾病观的研究方法

常人疾病观的研究资料主要基于研究对象的自我报告, 通过自编问卷和访谈的形式要求患方报告关于所患疾病的观念。例如, Furnham和Buck (2003)为了测量自闭症常人观和强迫症常人观, 采用了自制封闭式问卷收集数据, 该问卷主要包含病因与疗法和相关知识两个部分, 通过统计分析, 研究发现常人认为自闭症病因为生物因素, 而强迫症为心理因素。Werner, Goldberg, Mandel和Korczyn (2013)进行了一项关于老年痴呆症常人观性别差异的研究, 该研究采用的方法是电话调查, 主要有6个封闭式问题, 分别测量常人对于老年痴呆症的认识、易患病性判断、焦虑、恐惧、相关知识和熟悉度。Moorley等(2016)在研究有关中风病因的常人观时, 采用了半结构化深度访谈法搜集数据, 并运用解释现象学分析方法(Interpretative Phenomenological Analysis)对数据进行解构, 最终筛选出两项常人认为的中风病因:生活方式和超自然因素。

随着常人疾病观研究的深入, 研究者开始考虑建构通用的测量工具。相对于常人疾病观研究的数量来说, 能被广泛接受的量表还很少。这其中最为典型的通用式常人疾病观测量工具是疾病感知问卷(Illness Perception Questionnaire)。它以Leventhal等创立的疾病自我调节理论为基础, 由Weinman, Petrie, Moss-morris和Horne (1996)编制第一版, Moss-morris等(2002)对其进行修订, 形成了疾病感知问卷修订版(Illness Perception Questionnaire-Revised)。修订版问卷包括三部分, 共70个条目:第一部分测量维度是病症识别(identity), 包含疼痛、恶心、气短等14项基本症状, 被访者选择自认为与被研究疾病相关的症状条目, 累计形成病症感知分数, 分数越高表明感知的症状越多。第二部分共38个条目, 分为7个维度:病程(急慢性)、周期性、后果、个人控制、治疗控制、疾病一致性及情感陈述。第三部分为病因维度, 共18个条目, 但各条目间彼此独立, 不作累加记分。2006年, Broadbent, Petriea, Maina和Weinman简化问卷条目, 形成了包括9个维度, 每个维度1个条目的疾病感知问卷简易版(Brief Illness Perception Questionnaire)。疾病感知问卷实质上是通过结构性问卷法搜集患方对于疾病观的自我报告, 问卷所涉维度涵盖了上述对于常人疾病观研究的主要方面, 即常人如何判断病因(病因维度)、如何选择疗法(个人控制、治疗控制维度)、如何建构疾病的意义(后果、情感陈述维度)。从问卷所包含的具体条目来看, 该问卷并非只测量常人对于生物医学因素的判断, 而是结合常人观研究成果, 将心理、情绪、社会等因素加入。例如后果维度某些条目为“我的病给我的生活带来严重后果”、“我的病会严重影响到别人对我的看法”; 情感维度有些条目为“得这种病让我很焦虑”、“我的病让我感到害怕”; 病因维度某些条目为“压力或烦恼”、“家庭问题”。此外, 在大的框架下, 该问卷允许研究者根据不同疾病特点调整具体条目, 形成更有针对性的测量问卷, 测量不同疾病的常人观。该系列问卷问世后, 已被译成法语、德语、意大利语、西班牙语、中文等多种版本, 广泛用于各种急慢性疾病的研究, 具有良好的信效度(梅雅琪 等, 2015; Keskin et al., 2017; Min, Chang, Lee, Choe, & An, 2017)。

当然, 由于人们对不同类型疾病的具体感受与理解存在明显不同, 更多的研究都只针对某一类型的疾病构建特定的常人观测量工具。例如, Lobban, Barrowclough和Jones (2005)在疾病感知问卷修订版基础上, 调整部分条目, 形成了精神分裂症感知问卷(Illness Perception Questionnaire for Schizophrenia), 用于专门测量有关精神分裂症常人观。该问卷后经部分研究检验, 具有较好的心理测量学特性(Shokrgozar et al., 2017)。Harvey等为测量常人失眠理论, 开发了自我失眠归因问卷(Causal Attributions of My Insomnia Questionnaire)。该问卷包含6个问题, 每个问题选项设计12个可能导致失眠的因素, 采用Likert 7级评分, 测量常人对自我和他人失眠的归因。该研究自我汇报问卷具有较好的信效度, 但这一结论仍需其他研究证实。Knettel (2017)开发了精神疾病归因问卷(Mental Illness Attribution Questionnaire), 该量表从超自然力量(supernatural forces)、社会压力、生活方式、健康、药物使用(substance use)、遗传和个人缺陷(personal weakness)这7个维度测量常人对于精神疾病的归因, 经检验具有良好的信效度。

上述特定常人疾病观测量工具多在西方背景下得出, 是否适用于中国或其他非西方文化还有待验证。对于常人疾病观这一受本土疾病观、身体观、价值观等文化价值因素影响的概念来说, 简单地移植某一文化下的测量工具往往会造成信效度的缺失或变异, 因此开发具有本土契合性的测量工具仍是未来研究的重点之一。

3 常人疾病观对医患关系的影响

常人疾病观对医患关系的影响主要通过它对医患沟通质量和医学治疗效果的影响而达成。其中, 医患沟通也有狭义与广义之分。狭义上的医患沟通是指医务工作者在日常诊疗过程中与患方的沟通, 主要以医疗服务的方式进行; 广义的医学沟通则泛指医务工作者和医疗卫生行业人员以非诊疗服务的方式与社会各界就医疗卫生和健康服务的法律法规、政策制度、伦理道德、服务规范等内容进行的沟通(王锦帆, 尹梅, 2013)。目前多数常人疾病观研究都是在狭义层面上探讨其对医患沟通的影响。在这一层面, “较低的满意度、对医生较低的信任感和尊敬程度、诊疗和恢复过程中的负性情绪体验等, 都可作为医患沟通出现障碍的反应指标。” (王丹旸, 朱冬青, 2015)普通患者所持的一系列与疾病相关的朴素信念, 会通过是否遵从医嘱、是否信任医方、是否对医疗服务满意等方式影响治疗过程与结果, 从而影响到医患沟通的质量与医患关系的和谐。

由于患方所持的常人疾病观与科学医学观的不一致性, 它很容易影响医患沟通的满意度, 降低患方对医方的信任。Bromme和Jucks (2018)认为专业人士和常人在某一领域知识方面的差异不仅体现在其内容与广度上, 专业人士在学习专业知识的过程中对所学领域的认知会整体重构, 形成高度整合的知识体系和思维方式, 而这种用于解决专业问题的体系和方式恰恰被证明会成为专家与常人沟通的障碍。这一结论也被多项常人疾病观研究证明。Donovan (1991)对54名风湿病患者的研究发现, 他们通常从生活环境中寻找致病因素并判断疾病严重程度, 而并非从生物医学角度解释发病与病情程度。由于这种差异, 患者表现出对就诊过程的各种不满意, 比如超过一半的被试抱怨就诊过程过于仓促, 医生并没有耐心听取病人对自身疾病的叙述, 担心医生并没有真正了解自己的病情, 认为医生过于冷静客观等; 超过三分之一的被调查者不能接受就诊中所要求进行的全面身体检查, 因为他们认为关节炎只是某关节部位的病症, 完全没有必要进行全身检查, 这是一种经济浪费。Nápoles‐Springer, Santoyo, Houston, Pérez‐Stable和Stewart (2005)对美国移民的研究发现, 患者普遍表示医生简单粗暴地拒绝他们所信任的一些替代疗法(alternative treatments), 感到“不受尊重”, 甚至觉得医生是“受制药商的影响而强销抗生素”。相反, 当医生能认可患方所推崇的一些替代疗法时, 患方常感到“耳目一新(refreshing)”。此外, Schlomann和Schmitke (2007)通过对2000~2005年间在美国发表的11篇有关高血压常人观的质性研究进行元分析还发现, 医患双方就高血压这一病症, 在症状感知和疗法选择两方面存在尤其明显的差异, 而且这种差异会降低患方对医嘱的依从性并进而导致医患之间的不信任; 此研究还进一步发现如果医方试图简单对病人进行生物医学知识灌输, 以纠正其已有的常人观, 还会加剧这种不信任。此后, 另有一篇元分析文献发现, 对高血压治疗的不依从性与患者自身对高血压之所以产生的因果解释有关, 且这种解释多与其文化背景相关。要提升依从性, 就需要去了解患者自身的疾病观、症状体验及其对药物负作用的担心, 而不仅仅只是提供基于生物医学观念的沟通(Marshall, Wolfe, & McKevitt, 2012)。

患者对医嘱的理解程度和医患双方对疾病风险的认知差异, 也是影响医患沟通质量的重要因素(Grigorescu et al., 2015)。个体在沟通中并非信息的被动接受者, 而是主动加工者(Jiang, 2017), 常人对医患沟通过程中医生传达的信息也并非百分百理解, 而是放到自身常人疾病观的框架中进行加工。当常人疾病观与科学医学理论相一致时, 医方所传递的信息就能得到较好的理解, 反之则不然(Williams, 2009)。Frosch, Kimmel和Volpp (2008)研究了常人高血压归因方式对其药物疗法有效性判断的影响, 结果发现当实验启动被试与科学医学不一致的常人观时, 医患信任度较低的被试对药物治疗有效性的认可明显低于医患信任度高的被试, 从而影响其对医嘱的遵守程度。Baines和Wittkowski (2013)梳理了13项利用疾病感知问卷及其修订版进行的有关精神疾病常人观的研究, 发现常人疾病观与患方就医行为和对医嘱的依从性有很大关系, 当患方认为自己的疾病可控可治时, 其表现出更大的依从性和更积极的配合态度。此外, Akinlua等人(2016)对尼日利亚民众高血压常人观的研究也发现, 常人视角下的高血压病因与疗法会影响患者对医嘱的遵守程度。针对其他类型疾病的研究也得到了类似的结论(Linetzky, Jiang, Funnell, Curtis, & Polonsky, 2017; Tefera, Hailay, Lillian, & Tesfahun, 2016)。

有关病人自述就医体验的研究也间接反映了常人疾病观对治疗效果的影响。病人自述就医体验(patient report experience)是指研究者通过问卷、调查等方式搜集到的患者对于就医过程中医患沟通、医治及时性、用药解释、就医环境等方面满意度的数据, 它多被用来作为反映医疗护理质量的一个指标(Price et al., 2014)。由于病人自述的就医体验实际上是患方基于自身对于疾病和就诊的观念或期待而对医方服务做出的评价(Manary, Boulding, Staelin, & Glickman, 2013), 因此它在一定程度上体现了患方常人疾病观与科学医学理论之间的差异, 其对治疗结果的影响也可间接反映患方常人疾病观对其健康恢复状况的影响。尽管此方面研究结论不尽相同, 但已有研究表明患方就医体验与因病死亡率负相关(Ruggieri, Berta, Murante, & Nuti, 2018)。Kennedy, Tevis和Kent (2014)的研究对美国171所医院在2011~2012年度病人HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems, 患方对医护人员及医疗系统的评估)满意度调查数据、治疗结果数据等进行了搜集和分析, 结果表明低因病死亡率始终与高患方满意度相关。Vermeulen, Schirmbeck, van Tricht和De (2018)对654名非情感性精神病人的研究也发现高满意度的患者无论是在他评治疗效果还是自评治疗效果方面评分都明显高于中、低满意度患者。一项对患方体验与治疗有效性的综述性研究也发现患方就医体验与治疗有效性正相关(Doyle, Lennox, & Bell, 2013)。

此外, 常人疾病观还会直接或间接影响患者的健康恢复情况, 从而影响医患之间的合作关系。Swift和Callahan (2009)通过对涉及2300名患者的26项相关研究的元分析发现, 当患者从常人角度认为的有效疗法与医生对其采取的疗法相一致时, 其病情更可能好转而且不易放弃治疗。另外两项关于抑郁症患者的常人疗法倾向对治疗结果影响的研究也证实, 当患者自我倾向的疗法和医生实际施予的疗法不一致时, 病人病情较少得到减轻, 抑郁症状更加严重, 产生更大的身心消耗, 造成较差的医患合作(Kwan, Dimidjian, & Rizvi, 2010)。同时, 常人疾病观还可以通过患方信任、依从性等中介变量, 对患者恢复状况产生间接影响。研究表明患方信任与治疗效果及患方健康生活质量呈现正相关(Platonova, Kennedy, & Shewchuk, 2008)。Lee和Lin (2011)通过对中国台湾614名II型糖尿病患者历时一年的纵向分析发现患方信任对患者血糖控制和身体健康状况具有促进作用。Fernandez, Seligman, Quan, Stern和Jacobs (2012)对美国糖尿病患者的研究也证实了这一结果。另外, 还有一些研究发现患方信任可通过依从性、自我效能、或患方对疗效的期待等中介变量对治疗效果产生影响(Lee & Lin, 2009; Saha, Jacobs, Moore, & Beach, 2010)。

但是, 目前有关常人疾病观对医患关系影响研究的重点仍在于其对个体疾病应对策略或治疗效果的影响, 至于两者之间的影响路径和作用机制, 以及医患关系或沟通是否会反过来影响常人疾病观, 还较少得到关注, 值得进一步的探究。

4 总结与展望

医患关系中的患方作为非专业医护工作者, 其所持有的常人疾病观, 直接影响他们对于疾病的判断、治疗方案的选择以及后续的就医行为。患方在就医时如同“朴素的医护工作者”, 带着自己一套复杂的常人观与医方进行交流。若后者的诊断与治疗决定不能与之相符, 则容易造成医患沟通的障碍, 进而影响治疗质量与医患关系。显然, 并非所有的常人疾病观都与主流医学相符, 有些常人疾病观甚至可能是缺乏科学依据、无助于病情恢复的。但是, 由于现代医学知识体系的高度专业性, 使得普通人已无法掌握与专业医务工作者同等的医学知识, 常人观与“科学观”之间的差距甚至矛盾, 将是当代社会与当代医学一个近乎永恒的主题。在这一大背景下, 准确地掌握患方的常人疾病观, 了解其与科学医学观之间的异同, 对于实行更为精准的治疗措施并确保干预效果具有重要的实际意义。立足中国的医学文化与医疗制度来研究中国人的常人疾病观, 并探讨其对医患关系的影响作用与社会心理机制, 进而提出改善当下中国医患关系紧张现状的干预建议, 是一个可行的研究方向。以下试从三个方面提出这一方向未来研究的方法论路径。

第一, 综合医学心理学、医学社会学和医学人类学的视角与相关成果, 对中国民众一般性的常人疾病观, 以及具体疾病的常人疾病观进行综合性的调查, 并开发具有中国本土特色的常人疾病观测量工具与研究方法。常人疾病观受本土文化影响至深, 谈论常人疾病观的过程, 实际上就是挖掘本土文化下的身体观、疾病观、诊疗观的过程。因此, 在任何文化下开展常人疾病观的研究, 必须结合当地文化进行。尤其是近代以来的中国社会, 长期处于以中医为代表的中国传统医学理念与现代医学理念交织震荡、“共存而不共融” (吕小康, 汪新建, 2013)的局面, 这使得当下中国人的常人疾病观具有“中西医糅合”的独有特征:“现代的中国人虽然通过学校教育和大众传媒的传播, 接受了诸多西式的生理学知识和医学名词, 但这并不妨碍他们同样通过大众传媒和日常生活经验, 潜移默化间传承了许多传统的思想观念, 并以混合杂糅的方式看待自己的身体和疾病。” (吕小康, 汪新建, 2012)这更增加了当下中国人常人疾病观的复杂性, 不能简单地借用西方的工具与方法进行研究。在某种程度上, 常人疾病观研究更应突出的是其文化独特性而非通用性, 不必过分追求国际化的跨文化比较而丧失自身的独有特征。在这方面, 社会心理学的研究可从医学社会学、医学人类学的研究方式与研究主题中汲取经验与启发。

第二, 以前述对常人疾病观的调查为基础, 进一步探析常人疾病观对医患沟通的社会心理机制与作用路径。患者自身信念对就医行为与满意度的影响, 并不是最近研究才关注的主题, 但此类研究多只将其作为“背景因素”之一, 泛泛而谈地讨论其对医患沟通的影响, 或是局限于某些特殊的个案介绍和经验式总结, 更为深入细致、可以导出因果关系的研究还不多见。这部分研究应结合现场实验的方式, 在不同科室和治疗情境下, 结合社会信任理论、风险认知理论等相关领域的研究成果, 探索常人疾病观对医患沟通和医患关系的影响过程。尤其是对慢性病、精神疾病等对护理照料需求较高, 治疗过程中体验性因素(如医务人员的诊疗服务态度、就医过程的便捷性等)对医患关系影响较大的科室或疾病类型, 需要重视常人疾病观对医患沟通质量和医患信任的影响。待相关机制明确后, 再进一步向医疗机构提出硬件环境改造、就诊流程优化、沟通模式改善等针对性的干预措施并验证其成效。

第三, 在前述研究基础上, 进一步反思当代生物医学治疗模式的优劣处, 反思当下医学教育、医学知识普及和医院管理模式中存在的不足, 并探索弥合科学医学观与常人医学观之裂缝的有效途径。常人疾病观的成份复杂多元, 常常会有一些误导性、伪科学的信念, 还可能与宗教信仰或民间信仰高度相关, 尤其当患者出现“因病致贫、因病返贫”、“因病信教”的情况时, 部分个体可能产生极端化的信念, 从而助长反社会倾向, 成为引发医患冲突的潜在风险因素(韩静舒, 谢邦昌, 2016; 梁振华, 齐顾波, 2015; 周浪, 孙秋云, 2017; Callander & Schofield, 2015; Keshet & Liberman, 2014)。如何通过教育、媒体、社会活动等手段操控常人疾病观, 引导其向健康科学的方向发展, 从而减少其与科学医学理论的差异, 努力提升患者的现代医学常识水平, 使患者的就医期待处于合理的水平, 是从社会文化层面改善医患关系的一个长远路径。这实质上是广义上的患者教育和医学科普的过程, 这种教育和普及不能局限于医疗机构场景, 而需要深入到教育机构、社区和社会生活的各个层面, 对大众进行疾病预防、科学用药、理性就诊等方面的宣传教育, 将患者教育的阵线前移, 并充分发挥网络时代新媒体和新传播方式的作用(蔡博宇, 徐志杰, 2016; Gielen & Green, 2015), 进一步探索平易近人、效果突出的科学医学知识传播途径。

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统计与信息论坛, 31, (7), 49-54.

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为定量分析医疗支出对家庭经济水平的冲击,以贫困脆弱性指标作为家庭经济风险的代理变量,利用微观调查数据构造反事实框架估计就医行为对家庭经济境遇的冲击,验证了医疗与家庭致贫效应的因果关系和影响程度。家庭成员在过去半年内若因病住院,对家庭福利会造成损失,损失幅度因贫困标准、样本年份而不同。2012年在贫困线标准为2美元条件下,家庭经济风险概率值增加0.31。分城乡和收入高低不同组估计,农村居民以及低收入群体的福利水平受就医影响幅度大于对应的其他群体。

梁振华, 齐顾波 . ( 2015).

疾病的宗教性建构: 理解农民因病信教的行为和动机——以一个河南乡村基督教会为例

中国农业大学学报(社会科学版), 32, (4), 39-47.

URL     [本文引用: 1]

近年来,农村地区的一些村民在身患重病难以得到医疗救治的情况下,会尝试将信仰基督教作为一种替代治疗方案。豫东陈村教会农民因病信教现象表明,本土化的基督教为农民的疾病医治提供了一套"合理"的解释体系。通过"神医结合"的方式,有些农民疾病的痊愈得以可能,"疾病"和"苦难"被赋予新的意义,被构建为"神拣选之前的考验",继而导向皈依基督教。农民最初的功利性信仰,会经由宗教仪式的出席和宗教实践的参与而逐渐形成对基督教的理解和体验。农民因病信教成为基督教民间信仰化和本土化实践的重要表现形式。

吕小康, 汪新建 . ( 2012).

意象思维与躯体化症状: 疾病表达的文化心理学途径

心理学报, 44, (2), 276-284.

URL     [本文引用: 1]

意象思维是中国人的传统思维模 式,它通过观物取象和取象比类的方式认知世界、推演联系。这种思维模式塑造了中国人特有的身心不分而非两分的身体观、疾病观和治疗观。在中国人的观念中, 身体不仅仅是一具生理躯体,还具有气、阴阳、五行等本土概念所体现的弥合物质与精神、联结生理与心理的模糊性与开放性。人们在表达疾病感觉时通常不分生理 与心理,任何一方面出现不适感觉即可认为自己生病,在面对心理医生时也倾向于同时报告躯体状况与心理感觉,从而使得临床报告出现较高的躯体化报告率。这正 是文化心理影响疾病表达的体现。这也使得疾病不仅是一种医学现象,也是一种文化现象;医学不仅需要生理知识,也需要人文知识。

吕小康, 汪新建 . ( 2013).

因果判定与躯体化: 精神病学标准化的医学社会学反思

社会学研究, (3), 29-46.

URL     [本文引用: 1]

象思维是中国人的传统思维模式,它注重体验联想、以主体意向判定事物之间的联系。这种文化归因模式塑造了中国人特有的身体观、疾病观和治疗观,使得中国人对自身的躯体化求诊方式和躯体形式障碍问题不同于现代西方医学的文化特征。在精神病学诊断的标准化过程中,应结合本民族的文化心理与治疗传统,厘清医学问题的文化脉络,重新定义相关疾病的治疗边界,从而寻找到更适合的躯体化及其他精神疾病的本土化干预途径。

梅雅琪, 李惠萍, 杨娅娟, 苏丹, 马兰, 张婷, 窦婉君 . ( 2015).

中文版疾病感知问卷简化版在女性乳腺癌患者中的信效度检验

护理学报, 22, (24), 11-14.

URL     [本文引用: 1]

目的:评价中文版疾病感知问卷简化版在女性乳腺癌患者中应用的信度和效度。方法采用中文版疾病感知问卷、 心理一致感量表对安徽省某2家三级甲等医院300名女性乳腺癌患者进行问卷调查,分析量表的信度和效度。结果中文版疾病感知问卷简化版 Cronbach’sα信度系数为0.77,折半信度为0.81;各条目与量表总分之间的相关系数在0.306~0.832,且差异均有统计学意义 (P<0.01);中文版疾病感知问卷简化版量表总分与心理一致感量表总分的 Pearson相关系数为-0.671(P<0.01);因子分析提取的3个公因子共同解释了74.391%的总方差。结论中文版疾病感知问卷简化 版具有较好的信度和效度,适合在女性乳腺癌患者人群中应用。

王丹旸, 朱冬青 . ( 2015).

医患沟通障碍的心理解析: 信息交换视角

心理科学进展, 23, (12), 2129-2141.

URL     [本文引用: 1]

医患沟通指医生与患者之间信息交换的过程。基于信息交换视角,通过建构医患沟通模型,解读医患沟通障碍研究的被试获取、衡量指标和心理根源。其中.获取医患研究对象的方式包括直接选取医患群体或医学生和非医学生,以及通过启动的范式操纵医患角色;衡量指标指患者的心理反应,包括患者的心理感受、对医嘱的认知、对医嘱的遵从、健康恢复等:心理根源可归为医患个体特征的作用差异和沟通需求的结构不匹配。未来研究需要进一步拓展研究视角,丰富启动方法,补充认知指标,深化心理根源,开发教育模式。

王锦帆, 尹梅 . ( 主编).( 2013).

医患沟通

北京: 人民卫生出版社.

[本文引用: 1]

周浪, 孙秋云 . ( 2017).

因病信教农民的宗教心理及其演变: 试论把握“信念”概念对理解中国农村宗教实践的启示

社会, 37, (4), 1-31.

URL     [本文引用: 1]

本文通过对苏北望村基督徒因病信教现象的考察,关注信教农民的宗教心理及其演变。用"信念"来把握农民"信"的起点心理,它蕴含了个体面临生命困境时寻求宗教帮助并对之赋以期许的自然心态和家庭伦理。"信念"的宗教建构、"信念"的情感嵌入以及"信仰"要求三个宗教操演环节促使个体心理的由俗入圣。基于原有病型及其疗效基础上的个体与宗教间的互动,信徒发生了信念坍塌、信念过渡和信仰升级三种类型的心理分化。"信念"操演与分化构成了农民宗教心理演变的机理,也形塑了农民的信仰方式。文章进一步探讨"信念"对于理解中国农村宗教实践中的个体宗教心理、宗教皈信、宗教复兴等议题所具有的启发。

Ahn W-K., Proctor C. C., & Flanagan E. H . ( 2009).

Mental health clinicians’ beliefs about the biological, psychological, and environmental bases of mental disorders

Cognitive Science, 33, (2), 147-182.

URL     PMID:2857376      [本文引用: 1]

The current experiments examine mental health clinicians' beliefs about biological, psychological, and environmental bases of the DSM-IV-TR mental disorders and the consequences of those causal beliefs for judging treatment effectiveness. Study 1 found a large negative correlation between clinicians' beliefs about biological bases and environmental/psychological bases, suggesting that clinicians conceptualize mental disorders along a single continuum spanning from highly biological disorders (e.g., autistic disorder) to highly nonbiological disorders (e.g., adjustment disorders). Study 2 replicated this finding by having clinicians list what they thought were the specific causes of nine familiar mental disorders and rate their bio090009psycho090009environmental bases. Study 3 further found that clinicians believe medication to be more effective for biologically based mental disorders and psychotherapy to be more effective for psychosocially based mental disorders. These results demonstrate that even expert mental health clinicians make strong distinctions between psychological and biological phenomena.

Akinlua J. T., Meakin R., Fadahunsi P., & Freemantle N . ( 2016).

Beliefs of health care providers, lay health care providers and lay persons in Nigeria regarding hypertension. A systematic mixed studies review

Plos One, 11, (5), e0154287.

URL     PMID:27148880      [本文引用: 3]

Hypertension is a major health risk factor for mortality globally, resulting in about 13% of deaths worldwide. In Nigeria, the high burden of hypertension remains an issue for urgent attention. The control of hypertension, among other factors, is strongly determined by personal beliefs about the illness and recommended treatment. The aim of this review is to systematically synthesize available data from all types of studies on beliefs of the Nigerian populace about hypertension We searched the following electronic databases; Medline, EMBase, PsycInfo, AMED from their inception till date for all relevant articles. A modified Kleinman explanatory model for hypertension was used as a framework for extraction of data on beliefs about hypertension. The search yielded a total of 3,794 hits from which 16 relevant studies (2 qualitative, 11 quantitative and 3 mixed methods studies) met the inclusion criteria for the review. Overall, most health care providers (HCPs) believe that stress is a major cause of hypertension. Furthermore, reported cut-off point for uncomplicated hypertension differed widely among HCPs. Lay Health Care Providers such as Patent Medicine Vendors beliefs about hypertension seem to be relatively similar to health care professionals in areas of risk factors for hypertension, course of hypertension and methods of treatment. Among Lay persons, misconception about hypertension was quite high. Although some Nigerians believed that life style habits such as alcohol intake, exercise levels, cigarette smoking were risk factors for developing hypertension, there was discordance between belief and practice of control of risk factors. However, beliefs across numerous ethnic groups and settings (urban/rural) in Nigeria have not been explored. In order to achieve control of hypertension in Nigeria, interventions should be informed, among other factors, by adequate knowledge of beliefs regarding hypertension across the numerous ethnic groups in Nigeria, settings (rural/urban), age and sex.

Agbo A.A., &Ome B. ( 2016).

Happiness: Meaning and determinants among young adults of the Igbos of Eastern Nigeria

Journal of Happiness Studies, 18, (1), 151-175.

URL     [本文引用: 1]

The present study explored the constituents of lay conceptions of happiness and its determinants among young adults of the Igbos of Eastern Nigeria. Participants were asked to define happiness and out

Antonovsky A. ( 1972).

The image of four diseases held by the urban Jewish population of Israel

Journal of Chronic Diseases, 25, (6-7), 375-384.

URL     PMID:4650933      [本文引用: 2]

This study has applied the Semantic Differential for Health technique, developed by Jenkins, in a study of the images of cancer, heart disease, mental illness and cholera held by a random sample ( N = 1770) of the Israeli Jewish adult urban population in 1971. Six scales were used to represent the dimensions of seriousness, control, personal susceptibility, and salience. The data show that the images of these four diseases vary considerably from each other, with cancer being the most anxiety-providing, while mental illness is most mysterious and distant. The image of heart disease is not radically different from that of cancer, yet nonetheless is significantly less pessimistic. The possible fatal consequences of cholera are recognized, but in overall terms the image held is one of confidence. Analysis of the disease images held by age-sex and ethnicity education subgroups leads to the unanticipated conclusion that, despite a number of specific differences, in overall terms the disease images are not distributed differentially along these demographic lines. Some of the possible implications of the findings for action by health authorities are discussed.

Asiimwe C., Cross R., & Haberer J . ( 2015).

Lay perceptions about tuberculosis among Non-UK-Born black Africans in the United Kingdom

Journal of Tuberculosis Research, 3, (4), 161-170.

[本文引用: 1]

Baines T., &Wittkowski A. ( 2013).

A systematic review of the literature exploring illness perceptions in mental health utilising the self-regulation model

Journal of Clinical Psychology in Medical Settings, 20, (3), 263-274.

[本文引用: 2]

Bendelow G . ( 1993).

Pain perceptions, emotions and gender

Sociology of Health & Illness, 15, (3), 273-294.

URL     [本文引用: 1]

http://doi.wiley.com/10.1111/1467-9566.ep10490526

Ben-Sira Z . ( 1977).

The structure and dynamics of the image of diseases

Journal of Chronic Diseases, 30, (12), 831-842.

URL     PMID:591610      [本文引用: 1]

By the application of the concept of the ‘image of disease’, developed in previous studies, a theoretical framework has been proposed, indicating the (a) process of response to the threat of contracting a disease from an arousal of emotional distress toward its possible resolution; (b) the chances of passing successfully from one stage to the following of this process; and (c) the conditions for successful passing. Data from a study carried out among a representative sample of Israeli housewives supported the proposed theoretical framework, showing a consistent patterned structure of relations among the dimensions of the image of four diseases. This structure may be interpreted as involving the dynamics of a motivational process where the threat of contracting a disease increases emotional distress which may initiate instrumental behavior aimed at its reduction by gathering information, possibly increasing the belief in the preventability of the disease—thus strengthening the preconditions for preventive behavior. Differences in the perceived properties of various diseases and of properties of subgroups in the population revealed theoretically explained differences of the structure of the image of the diseases having theoretical as well as practical significance.

Broadbent E., Petrie K. J., Main J., & Weinman J . ( 2006).

The brief illness perception questionnaire

Journal of Psychosomatic Research, 60, (6), 631-637.

URL     PMID:16731240     

This study evaluates the Brief Illness Perception Questionnaire (Brief IPQ), a nine-item scale designed to rapidly assess the cognitive and emotional representations of illness. We assessed the test–retest reliability of the scale in 132 renal outpatients. We assessed concurrent validity by comparing the Brief IPQ with the Illness Perception Questionnaire–Revised (IPQ-R) and other relevant measures in 309 asthma, 132 renal, and 119 diabetes outpatients. Predictive validity was established by examining the relationship of Brief IPQ scores to outcomes in a sample of 103 myocardial infarction (MI) patients. Discriminant validity was examined by comparing scores on the Brief IPQ between five different illness groups. The Brief IPQ showed good test–retest reliability and concurrent validity with relevant measures. The scale also demonstrated good predictive validity in patients recovering from MI with individual items being related to mental and physical functioning at 3 months' follow-up, cardiac rehabilitation class attendance, and speed of return to work. The discriminant validity of the Brief IPQ was supported by its ability to distinguish between different illnesses. The Brief IPQ provides a rapid assessment of illness perceptions, which could be particularly helpful in ill populations, large-scale studies, and in repeated measures research designs.

Bromme R., &Jucks R. ( 2018).

Discourse and expertise-The challenge of mutual understanding between experts and laypeople

In M. F. Schober, D. N. Rapp, & M. A. Britt (Eds.), The Routledge Handbook of Discourse Processes(pp. 222-246). New York: Routledge.

[本文引用: 1]

Buckley L., Labonville S., & Barr J . ( 2016).

A systematic review of beliefs about hypertension and its treatment among African Americans

Current Hypertension Reports, 18, (7), 52-60.

URL     PMID:27193774      [本文引用: 1]

The prevalence of hypertension and uncontrolled hypertension is higher among African Americans than any other ethnicity in the USA. Certain patient medical beliefs may lead to adverse health behaviors

Bury M . ( 1982).

Chronic illness as biographical disruption

Sociology of Health & Illness, 4, (2), 167-182.

URL     PMID:10260456      [本文引用: 1]

Abstract The paper is based on semi-structured interviews with a series of rheumatoid arthritis patients. Chronic illness is conceptualised as a particular type of disruptive event. This disruption highlights the resources (cognitive and material) available to individuals, modes of explanation for pain and suffering, continuities and discontinuities between professional and lay thought, and sources of variation in experience.

Callander E.J., &Schofield D.J . ( 2015).

Effect of asthma on falling into poverty: The overlooked costs of illness

Annals of Allergy Asthma Immunology, 114, (5), 374-378.

URL     PMID:25817460      [本文引用: 1]

Studies on the indirect costs of asthma have taken a narrow view of how the condition affects the living standards of patients by examining only the association with employment and income. To build on the current cost-of-illness literature and identify whether having asthma is associated with an increased risk of poverty, thus giving a more complete picture of the costs of asthma to individuals and society. Longitudinal analysis of the nationally representative Household Income and Labour Dynamics in Australian survey to estimate the relative risk of income poverty, multidimensional poverty, and long-term multidimensional poverty between 2007 and 2012 and population attributable risk method to estimate the proportion of poverty between 2007 and 2012 directly attributable to asthma. No significant difference was found in the risk of falling into income poverty between those with and without asthma (P02= .07). Having asthma increased the risk of falling into multidimensional poverty by 1.35 (95% confidence interval [CI], 1.01–1.83) and the risk of falling into chronic multidimensional poverty by 2.22 (95% CI, 1.20–4.10). Between 2007 and 2012, a total of 5.2% of income poverty cases (95% CI, 5.1%–5.4%), 7.8% of multidimensional poverty cases (95% CI, 7.7%–8.0%), and 19.6% of chronic multidimensional poverty cases (95% CI, 19.2%–20.0%) can be attributed to asthma. Asthma is associated with an increased risk of falling into poverty. This should be taken into consideration when considering the suitability of different treatment options for patients with asthma.

Cameron L.., &Leventhal H. ( 2014).

The self-regulation of health and illness behaviour.

London:Computer-Assisted Foreign Language Education.

[本文引用: 2]

Colson M.H . ( 2016).

Sexual dysfunction and chronic illness. Part 1. Epidemiology, impact and significance

Sexologies, 25, (1), e5-e11.

[本文引用: 1]

D’Houtaud A., &Field M.G . ( 1984).

The image of health: Variations in perception by social class in a French population

Sociology of Health & Illness, 6, (1), 30-60.

URL     [本文引用: 1]

In order to determine how a population defines the meaning of health, a study was made using a sample of 4,000 respondents from Lorraine, in the north-eastern part of France. The respondents, all of whom were undergoing a health examination, were asked to respond to an open-ended question on what health meant to them. A total of 6,172 replies were obtained whose contents were classified into 41 main themes themselves regrouped under 10 heading (or groups of themes). The responses were clearly linked to the socio-economic class position of the respondents, which was the most discriminating variable, and the one discussed here. There was a gradient from the higher, non-manual classes to the lower manual classes, the former conceiving health more in personalized, positive and expressive terms, and the latter more in negative, socialized and instrumental terms, thus reflecting the complementary positions of social classes as mediated through the occupational structure.

Donovan J .( 1991).

Patient education and the consultation: The importance of lay beliefs

Annals of the Rheumatic Diseases, 50, Suppl 3), 418-421.

URL     PMID:2059092      [本文引用: 1]

The major diseases associated with HLA-B27 (Reiter's disease, ankylosing spondylitis, acute anterior uveitis, and psoriatic arthritis) all occur much more commonly in men. Published evidence indicates that the antigen HLA-B27 is associated with high testosterone concentrations in men. Moreover, the antigen HLA-B44 exerts a protective effect on one of these diseases (psoriatic arthritis), and there are external grounds for supposing that HLA-B44 indexes an antiandrogenic process. These data are interpreted as support for the hypothesis (first adumbrated nearly 20 years ago) that HLA antigens index unusual hormone concentrations, which in turn are causally related to the diseases. An examination of published reports suggests that sibs of probands with ankylosing spondylitis (and perhaps Reiter's disease) contain an excess of men, and that sibs of probands with rheumatoid arthritis contain an excess of women. These data lend further support to the hypothesis.

Doyle C., Lennox L., & Bell D . ( 2013).

A systematic review of evidence on the links between patient experience and clinical safety and effectiveness

BMJ Open, 3, (1), 57-60.

URL     PMID:3549241      [本文引用: 1]

To explore evidence on the links between patient experience and clinical safety and effectiveness outcomes. Systematic review. A wide range of settings within primary and secondary care including hospitals and primary care centres. A wide range of demographic groups and age groups. A broad range of patient safety and clinical effectiveness outcomes including mortality, physical symptoms, length of stay and adherence to treatment. This study, summarising evidence from 55 studies, indicates consistent positive associations between patient experience, patient safety and clinical effectiveness for a wide range of disease areas, settings, outcome measures and study designs. It demonstrates positive associations between patient experience and self-rated and objectively measured health outcomes; adherence to recommended clinical practice and medication; preventive care (such as health-promoting behaviour, use of screening services and immunisation); and resource use (such as hospitalisation, length of stay and primary-care visits). There is some evidence of positive associations between patient experience and measures of the technical quality of care and adverse events. Overall, it was more common to find positive associations between patient experience and patient safety and clinical effectiveness than no associations. The data presented display that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare. It supports the argument that the three dimensions of quality should be looked at as a group and not in isolation. Clinicians should resist sidelining patient experience as too subjective or mood-oriented, divorced from the eal clinical work of measuring safety and effectiveness.

Fernandez A., Seligman H., Quan J., Stern R. J., & Jacobs E. A . ( 2012).

Associations between aspects of culturally competent care and clinical outcomes among patients with diabetes

Medical Care, 50, 9 Suppl 2), S74-S79.

URL     PMID:22895235      [本文引用: 1]

Culturally competent care may be associated with clinical outcomes in diabetes management, which requires effective physician-patient collaboration. The recent development and validation of the Consumer Assessment of Healthcare Providers and Systems Cultural Competence tool enables investigation of possible associations. To assess whether 3 aspects of culturally competent care are associated with glycemic, lipid, and blood pressure control among ethnically diverse patients with diabetes. Survey and chart review study of patients recruited from urban safety net clinics in 2 cities. A total of 600 patients with type 2 diabetes and a primary care physician. We used multivariate logistic regression to assess the independent relationships between the 3 domains of the Consumer Assessment of Healthcare Providers and Systems Cultural Competence (Doctor Communication-Positive Behaviors, Trust, and Doctor Communication-Health Promotion) and glycemic, lipid, and systolic blood pressure control after adjusting for sociodemographic and clinical factors. In adjusted analysis, high Trust was associated with lower likelihood of poor glycemic control (odds ratio, 0.59; 95% confidence interval, 0.41-0.84) and high Doctor Communication-Health Promotion was associated with a higher likelihood of poor glycemic control (odds ratio, 1.49, 95% CI, 1.02-2.19). None of the 3 aspects of culturally competent care examined were associated with lipid or systolic blood pressure control after adjustment. Trust in physician, a core component of culturally competent care, but not doctor communication behavior, was associated with a lower likelihood of poor glycemic control in a safety net population with diabetes. Glycemic control may be more sensitive to patient physician partnership than blood pressure and hyperlipidemia control.

Frosch D. L., Kimmel S., & Volpp K . ( 2008).

What role do lay beliefs about hypertension etiology play in perceptions of medication effectiveness?

Health Psychology, 27, (3), 320-326.

URL     PMID:18624596      [本文引用: 1]

Some people take the disease label "hypertension" literally; leading to the belief that increasing relaxation instead of medication is the best treatment for this condition. We experimentally tested the effect of such underlying beliefs on ratings of interventions for hypertension and compared alternative communication strategies to increase medication effectiveness ratings.Outpatients (N = 152) with a known diagnosis of hypertension read a vignette describing an asymptomatic condition and recommended treatment. Experimental factors were the disease label (Hypertension vs. Korotkoff's Syndrome) and type of argument designed to persuade the reader that medication is most effective (Causal vs. Correlational).Background measures included demographics, beliefs that stress causes health problems and trust in physicians. Outcomes were effectiveness ratings for interventions to treat the condition.Participants who read a vignette describing "Hypertension" rated "relaxing more" as significantly more effective than participants exposed to the same condition but with the unfamiliar "Korotkoff's Syndrome" label, [F(1, 141) = 5.22, p = .024]. However, medication, reducing salty foods and losing weight were rated as more effective than relaxing more. Intervention ratings did not differ by type of argument presented. There was a significant interaction of disease label and trust in physicians [F(1, 125) = 7.01, p = .009]. Individuals with low trust rated medication as significantly less effective when exposed to an unfamiliar disease label.This study confirms the effect of the hypertension disease label on ratings of different interventions for the condition. However, participants rated biomedically recommended interventions as more effective than those not endorsed.

Furnham A .( 1988). Lay theories: Everyday understanding of problems in the social sciences. New York: Pergamon Press.

[本文引用: 3]

Furnham A., &Bower P .( 1992).

A comparison of academic and lay theories of schizophrenia

British Journal of Psychiatry the Journal of Mental Science, 161, (2), 201-210.

URL     PMID:1521103      [本文引用: 1]

This study investigated lay subjects' theories of . A questionnaire examining the five identified main academic theories of (medical, moral-behavioural, social, psychoanalytic, and conspiratorial) along various dimensions (aetiology, , treatment, function of the hospital, and the rights and duties of both patients and society) was constructed for use in the study. The results from 106 lay respondents showed that no single model was favoured exclusively but seemed to point to a synthesis of several academic theories. The lay subjects stressed the importance of patient environment in the aetiology of rather than a physiological malfunction, but tended to stress the personal rights of the schizophrenic. The differences between lay and the currently dominant psychiatric models are discussed in terms of the function these models serve for each group.

Furnham A., &Buck C .( 2003).

A comparison of lay-beliefs about autism and obsessive-compulsive disorder

International Journal of Social Psychiatry, 49, (4), 287-307.

URL     PMID:14727695      [本文引用: 3]

Abstract The purpose of the two studies was to compare lay beliefs regarding the aetiology and treatment of autism (study 1) and obsessive-compulsive disorder (OCD) (study 2). It was hypothesised that beliefs about autism would be based primarily on a biomedical theory while beliefs regarding OCD primarily on psychological notions of cause and cure. Parents' interviews were conducted in study 1 and revealed that, as hypothesised, parents hold predominantly biomedical views about autism. Participants (n = 92) completed both questionnaires that involved rating a range of theories of aetiology and treatment approaches for each disorder. Statistical analysis confirmed that lay beliefs about autism were primarily biomedical and beliefs about OCD were primarily psychological. Multiple regression analyses indicated that a range of individual difference factors (religiousness, interest in mental illness, age and knowledge of autism) predicted beliefs about the importance of some of the five factors derived from factor analysis of belief statements. The relevance of investigating lay beliefs of aetiology and treatment of psychiatric disorders for clinical practice is also highlighted.

Furnham A., &Haraldsen E . ( 1998).

Lay theories of etiology and "cure" for four types of paraphilia: Fetishism; pedophilia; sexual sadism; and voyeurism

Journal of Clinical Psychology, 54, (5), 689-700.

URL     PMID:9696119      [本文引用: 1]

Abstract The current study set out to investigate the structure, determinants, and relationship between lay theories of the etiology and efficacy of "cures" for four types of paraphilia: fetishism, pedophilia, sexual sadism, and voyeurism. One hundred and five participants completed a four-part questionnaire, which was divided into (a) demographic details, (b) perceptions of the etiology, (c) ratings of cure for each paraphilia, and (d) the Eysenck Personality Questionnaire. Previous studies of lay theories have demonstrated a clear and interpretable factor structure similar to that of explicit academic theories, as well as a clear and logical relationship between perceived etiology and cure. A similar structure was expected to emerge in this study, together with positive correlations between the various factors and personality type. A factor analysis revealed a clear and logical factor structure for etiology and cure items. Further, etiology and cure factors correlated strongly with each other but only moderately with demographic details and personality differences. These findings are discussed in relation to growing literature in the field.

Furnham A., &Kirkcaldy B. ( 2015).

Lay people’s knowledge of mental and physical illness. Promoting psychological well-being in children and families.

Basingstoke, UK:Palgrave Macmillan.

[本文引用: 3]

Furnham A., &Lowick V. ( 1984).

Lay theories of the causes of alcoholism

Psychology & Psychotherapy Theory Research & Practice, 57, (4), 319-332.

URL     PMID:6518143      [本文引用: 1]

Abstract This paper investigates the range, structure and determinants of lay people's implicit theories of alcoholism. The different explicit medical and psychological theories are reviewed as are studies on lay beliefs about alcoholism and heavy drinking. After a number of interviews in which people were asked to list what they believed to be the major causes of alcoholism, 265 people completed a questionnaire in which they rated 30 explanations for their importance in explaining the causes of alcoholism. Females more than males believed alcoholics to be socially inadequate and anxious and that there was too much social pressure and not enough prohibitions against drinking. Middle-aged rather than younger or older people tended to explain alcoholism in terms of poor education, social and cultural pressures and biological or genetic mechanisms. However, there were few differences in the ratings of heavy, moderate, light and non-drinkers. Factor analysis revealed six factors labelled psychological stress, personal and social problems, psychoanalytic theories, sociocultural explanations, biological or genetic explanations and social desirability or pressure. The results are discussed in terms of the research on lay understandings of psychological and medical phenomena, and the relationship between explicit and implicit theories.

Garg R., Meraya A., Murray P. J., & Kelly K . ( 2017).

Illness representations of pertussis and predictors of child vaccination among mothers in a strict vaccination exemption state

Maternal and Child Health Journal, 22, (1), 137-146.

URL     [本文引用: 1]

Background Vaccine preventable diseases are making a comeback in the US. However, research is lacking on illness representations of vaccine preventable diseases and their application in improving childhood immunization. Objective We utilized the common sense model of self-regulation to examine illness representations of pertussis and their associations with child’s receipt of any vaccine, up-to-date vaccination status, and mothers’ intentions to follow the recommended vaccination schedule in the future. Methods We developed vaccine worry and vaccine hassles scales to assess mothers’ worries and hassles for child vaccination, and used an open ended question to assess mother’s illness representations of pertussis. We surveyed mothers with children <3 years old ( N 65=65160) in the Appalachian state of West Virginia, which only allows medical vaccine exemptions. Results Some children (5.0%) had received no vaccination, 15.0% were not up-to-date with the recommended vaccination schedule, and 13.8% mothers reported no intention to follow the recommended schedule in future (future intention). Illness representations included identity (17.8%), timeline (61.8%), consequences (58.6%), cause (35.0%), and cure/control (56.7%). Higher vaccine worry was associated with child receiving no vaccine. Not using daycare, higher vaccine worry, and difficulty breathing (identity) were associated with child not being up-to-date. Higher vaccine worry, cough (identity), and belief that vaccines are ineffective (cure/control) were associated with no future intention. Conclusions Vaccination interventions need to address mothers’ worry regarding vaccine safety. ‘Common Sense’ beliefs regarding vaccines need to be reconciled with scientific data about vaccine safety and effectiveness, even among those with high socio-economic status in a strict vaccination state.

Gielen A.C., & Green L.W . ( 2015).

The impact of policy, environmental, and educational interventions: A synthesis of the evidence from two public health success stories

Health Education & Behavior, 42, (1), 20S-34S.

URL     PMID:25829115      [本文引用: 2]

Abstract Motor vehicle safety and tobacco control are among the greatest public health achievements of the 20th century, according to the Centers for Disease Control and Prevention. As the number of miles traveled in the United States multiplied 10 times from the 1920s to the 1990s, the annual motor vehicle crash death rate per vehicle mile traveled decreased by 90%. Similarly, tobacco-related deaths from heart disease, stroke, and cancer were rapidly mounting over the first two thirds of the 20th century. Then, in the last third of the century, tobacco consumption decreased by more than 50%, and rates of heart disease and stroke deaths, and later cancer deaths, declined similarly. This analysis addresses the central question of what lessons can be learned from these success stories that will help public health professionals successfully tackle new and emerging health behavior problems of today and tomorrow? Surveillance, research, multilevel interventions, environmental modifications, and strong policies were key to reducing motor vehicle- and tobacco-related health problems. Generating public support and advocacy, and changing social norms also played critical roles in promoting the safer and smoke-free behaviors. Lessons learned include the need for evidence-based practices and interventions that are ecologically comprehensive with an emphasis on changing environmental determinants and capitalizing on the concept of reciprocal determinism. The analysis concludes with a description of how the PRECEDE-PROCEED planning framework can be used to apply the lessons from motor vehicle safety and tobacco control to other public health threats. 2015 Society for Public Health Education.

Grigorescu E-D., Lăcătuşu C. M., Botnariu G. E., Popescu R. M., Popa A. D., Onofriescu A., & Mihai B-M . ( 2015).

Communication as a key issue in the care of diabetes mellitus

Romanian Journal of Diabetes Nutrition & Metabolic Diseases, 22, (3), 305-310.

Gulliksen K. S., Nordbø R. H. S., Espeset E. M. S., Skårderud F., & Holte A . ( 2017).

Four pathways to anorexia nervosa: Patients’ perspective on the emergence of AN

Clinical Psychology & Psychotherapy, 24, (4), 846-858.

URL     [本文引用: 1]

Abstract Introduction: Studies show that patients' perception of their illness has a direct influence both on their utilization of health services and their adherence to treatment plans. This may be particularly relevant to the treatment of Anorexia Nervosa (AN). Previous studies on AN have typically explored single psycho-social factors that patients with AN relate to the emergence of their illness. There is a need for more coherent systematic descriptions of the complexity of the patients' narratives about how their illness emerged. In this study, we sought to identify common components in the participants' narratives. By identifying different combinations of these components in the narratives, we sought to describe differences in patients' perceived pathways to AN. Methods: Participants were 36 women aged 18-51years who had been treated for AN within the past 2years at five clinical institutions in Norway. Semi-open qualitative interviews were conducted, tape-recorded, transcribed and analysed using grounded theory techniques. Results: We identified the following four distinct perceived pathways into AN: 'The Avoidant', 'The Achiever', 'The Transformer' and 'The Punisher'. The pathways could be regarded as four different projects for mastering life's challenges. Discussion: Our results suggest that there seem to be at least four pathways into AN. This indicates that a common array of symptoms might cover very different psychological dynamics. These might need to be treated therapeutically in different ways and should probably be taken into account during the refinement of diagnostic tools.

Halm E. A., Mora P., & Leventhal H . ( 2006).

No symptoms, no asthma: The acute episodic disease belief is associated with poor self-management among inner-city adults with persistent asthma

Chest, 129, 3), 573-580.

URL     PMID:16537854      [本文引用: 2]

Asthma morbidity and mortality is highest among inner-city populations. Suboptimal beliefs about the chronicity of asthma may perpetuate poor asthma control among inner-city asthmatics. This study sought to characterize beliefs about the chronicity of disease and its correlates in a cohort of inner-city adults with persistent asthma. Prospective, longitudinal, observational cohort study. One hundred ninety-eight adults hospitalized with asthma over a 12-month period at an inner-city teaching hospital. Sociodemographics, clinical history, disease beliefs, and self-management behaviors were collected by interview. Information on self-reported use of inhaled corticosteroids (ICS), peak flowmeters, and regular asthma visits was collected during hospitalization, and 1 month and 6 months after discharge. This cohort was predominantly low income and nonwhite, with high rates of prior intubation, oral steroid use, and emergency department visits and hospitalizations. Overall, 53% of patients believed they only had asthma when they were having symptoms, what we call theno symptoms, no asthmabelief. Men patients, those 65 years old, and those with no usual place of care had greater odds of having the no symptoms, no asthma belief, and those receiving oral steroids all or most of the time or with symptoms most days had half the odds of having this belief (p < 0.05 for all). The no symptoms, no asthma belief was negatively associated with beliefs about always having asthma, having lung inflammation, or the importance of using ICS, and was positively associated with expecting to be cured. The acute disease belief was associated with one-third lower odds of adherence to ICS when asymptomatic at all three time periods (p < 0.02 for all). The single question, o you think you have asthma all of the time, or only when you are having symptoms?鈥 can efficiently identify patients who do not think about or manage their asthma as a chronic disease.

Harvey A. G., Soehner A., Lombrozo T., Bélanger L., Rifkin J., & Morin C. M . ( 2013).

‘Folk theories’ about the causes of insomnia

Cognitive Therapy and Research, 37, (5), 1048-1057.

URL     PMID:24187398      [本文引用: 2]

The present study investigates 'folk theories' about the causes of insomnia. Participants with insomnia (n = 69) completed a qualitative and quantitative assessment of their folk theories. The qualitative assessment was to speak aloud for 1 min in response to: 'What do you think causes your insomnia?'. The quantitative assessment involved completing the 'Causal Attributions of My Insomnia Questionnaire' (CAM-I), developed for this study. The three most common folk theories for both the causes of one's own insomnia as well as insomnia in others were 'emotions', 'thinking patterns' and 'sleep-related emotions'. Interventions targeting these factors were also perceived as most likely to be viable treatments. Seventy-five percent of the folk theories of insomnia investigated with the CAM-I were rated as more likely to be alleviated by a psychological versus a biological treatment. The results are consistent with research highlighting that folk theories are generally coherent and inform a range of judgments. Future research should focus on congruence of 'folk theories' between treatment providers and patients, and the role of folk theories in treatment choice, engagement, compliance and outcome.

Jayaratne T. E., Ybarra O., Sheldon J. P., Brown T. N., Feldbaum M., Pfeffer C., & Petty, E M . ( 2006).

White Americans’ genetic lay theories of race differences and sexual orientation: Their relationship with prejudice toward blacks, and gay men and lesbians

Group Processes & Intergroup Relations, 9, (1), 77-94.

URL     PMID:3832063     

Abstract This study examined the relationship between White Americans' genetic explanations, conceptualized as genetic lay theories, for perceived racial differences and for sexual orientation, and attitudes toward Blacks, and gay men and lesbians, respectively. Considering contrasting public discourse surrounding race and sexual orientation, we predicted that genetic lay theories would be associated with greater prejudice toward Blacks, but less prejudice toward gay men and lesbians. The findings, based on a representative sample of 600 White Americans, were consistent with expectations. Results are discussed in relation to the literature on essentialism and implicit theories of the malleability of traits. The present research broadens our view of lay theories by showing how they support either prejudice or tolerance, depending on the target group.

Jiang S . ( 2017).

Pathway linking patient-centered communication to emotional well-being: Taking into account patient satisfaction and emotion management

Journal of Health Communication, 22, (3), 234-242.

URL     PMID:28248629      [本文引用: 1]

Abstract In the United States, levels of emotional well-being remain low, with 40% of American adults reporting the experience of daily stress and excessive anxiety. The doctor-patient communication during medical encounters may play a significant role in improving people's emotional well-being. Based on Street and his colleagues' (2009) pathway mediation model linking communication to health outcomes, this paper illustrates a mechanism that underlies how patient-centered communication improves emotional well-being. The results showed that patient-centered communication had direct effects on emotional well-being. In addition to the direct effects, patient-centered communication also indirectly influenced emotional well-being, mediated by patient satisfaction and emotion management, supporting the partial mediation. The findings provide additional empirical evidence to the pathways from communication to health outcomes, one of the least developed areas of communication research, and also offer significant implications for the design of interventions to improve patients' emotional well-being.

Kelly G.A . ( 1963).

A theory of personality: The psychology of personal constructs.

Oxford, England: W. W. Norton.

Kennedy G. D., Tevis S. E., & Kent K. C . ( 2014).

Is there a relationship between patient satisfaction and favorable outcomes?

Annals of Surgery, 260, (4), 592-598.

URL     PMID:4159721      [本文引用: 1]

Abstract OBJECTIVE: Patient satisfaction with the health care experience has become a top priority for Centers for Medicare and Medicaid Services. With resources and efforts directed at patient satisfaction, we evaluated whether high patient satisfaction measured by HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) surveys correlates with favorable outcomes. METHODS: Medical centers were identified from the University HealthSystem Consortium database from 2011 to 2012. Variables included hospital characteristics, process measure compliance, and surgical outcomes. Chi-squared analysis was used to evaluate for variables associated with high patient satisfaction (defined as hospitals that scored above the 50th percentile of top box scores). RESULTS: We identified 171 hospitals with complete data. The following variables were significantly associated with high overall patient satisfaction: large hospitals, high surgical volume, and low mortality (P < 0.001). Compliance with process measures and patient safety indicators, as well as length of stay, did not correlate with overall satisfaction. The presence of complications (P = 0.491) or increased rate of readmission (P = 0.056) were not found to affect patient satisfaction. Low mortality index was consistently found to be associated with high satisfaction across 9 of 10 HCAHPS domains. CONCLUSIONS: We found that hospital size, surgical volume, and low mortality were associated with high overall patient satisfaction. However, with the exception of low mortality, favorable surgical outcomes were not consistently associated with high HCAHPS scores. With existing satisfaction surveys, we conclude that factors outside of surgical outcomes appear to influence patients' perceptions of their care.

Keshet Y., &Liberman I. ( 2014).

Coping with illness and threat: Why non-religious Jews choose to consult rabbis on healthcare issues

Journal of Religion and Health, 53, (4), 1146-1160.

URL     PMID:23572239      [本文引用: 2]

Abstract Whereas modern and advanced medical services are available and accessible to all citizens of Israel, the phenomenon of consulting Orthodox rabbis (Jewish clerics) on healthcare issues is gaining ground among populations that do not identify themselves as religious. The objective of the research was to enquire why non-religious Jews choose to consult rabbis on medical issues. Fifty semi-structured open-ended interviews were conducted during 2009-2011 in northern Israel. The article presents the respondents' main motives, expectations, beliefs, and modes of consulting both physicians and rabbis. This study aims to contribute to discussion about conflating modern medicine with spiritual-religious beliefs in modern-secular society.

Keskin G. S., Güler S., Günes N., Çokal B. G., Yön M. İ., & Yoldas T . ( 2017).

Validation of the revised illness perception questionnaire for migraine patients and the effects of earthquake experience on perception of disease

Neuropsychiatric Disease & Treatment, 29, (1), 17-24.

Kirk S. F. L., Cockbain A. J., & Beazley J . ( 2008).

Obesity in Tonga: A cross-sectional comparative study of perceptions of body size and beliefs about obesity in lay people and nurses

Obesity Research & Clinical Practice, 2, (1), 35-41.

URL     PMID:24351676      [本文引用: 1]

BackgroundObesity is a major public health issue in Tonga, where prevalence is significantly higher than in Europe and North America. Obesity and its health-related complications are likely to increase as a result of western influences on diet and lifestyle. The aim of this study was to investigate perceptions of body size in Tongan lay people and nurses, and their beliefs about the causes of obesity and its consequences for health.MethodsA cross-sectional comparative study was conducted. Medical and surgical inpatients and outpatients were recruited from Vaiola Hospital in Tonga, over a 4 week period. Hospital nurses were included for comparison. Overall, 73 lay public and 34 nurses completed questionnaires about their beliefs about obesity, perceptions of their own body size and the health conditions associated with obesity. Subjects were also weighed and measured for calculating body mass index (BMI).ResultsBoth Tongan lay people and nurses underestimated their body weight and size, although the degree of underestimation was more marked in the lay group. The more accurate perception of body size in nurses may reflect their greater understanding of the health consequences of obesity.ConclusionsThis study has provided some insight into how obesity is viewed in Tonga, in particular differences between lay people and nurses in their own perception of weight, beliefs about obese people and the health consequences of obesity. Future research should aim to explore Tongans views of the health consequences of obesity as well as their perceptions of how serious these consequences are.

Kleinman A. M. ( 1980). Patients and healers in the context of culture. Berkeley,CA: University of California Press.

[本文引用: 2]

Kleinman A. ( 1995). Writing at the margin: Discourse between anthropology and medicine . Los Angeles, CA: University of California Press.

[本文引用: 1]

Knettel B.A . ( 2017).

Attribution through the layperson’s lens: Development and preliminary validation of an inclusive, international measure of beliefs about the causes of mental illness

Journal of Personality Assessment. doi: 10. 1080/00223891.2017.1329738.

[本文引用: 2]

Kwan B. M., Dimidjian S., & Rizvi S. L . ( 2010).

Treatment preference, engagement, and clinical improvement in pharmacotherapy versus psychotherapy for depression

Behaviour Research and Therapy, 48, (8), 799-804.

URL     PMID:2918721      [本文引用: 1]

Pharmacotherapy and psychotherapy are generally effective treatments for major depressive disorder (MDD); however, research suggests that patient preferences may influence outcomes. We examined the effects of treatment preference on attrition, therapeutic alliance, and change in depressive severity in a longitudinal randomized clinical trial comparing pharmacotherapy and psychotherapy. Prior to randomization, 106 individuals with MDD reported whether they preferred psychotherapy, antidepressant medication, or had no preference. A mismatch between preferred and actual treatment was associated with greater likelihood of attrition, fewer expected visits attended, and a less positive working alliance at session 2. There was a significant indirect effect of preference match on depression outcomes, primarily via effects of attendance. These findings highlight the importance of addressing patient preferences, particularly in regard to patient engagement, in the treatment of MDD.

Lawton J . ( 2003).

Lay experiences of health and illness: Past research and future agendas

Sociology of Health & Illness, 25, (3), 23-40.

URL     PMID:14498928      [本文引用: 1]

Abstract This article presents an overview and appraisal of work published during the 25-year history of Sociology of Health and Illness that has contributed to our understandings of lay experiences of health and illness. It highlights an important and welcome shift from an 'outsider' perspective as epitomised in the Parsonian concept of the 'sick role' to one that focuses directly upon people's subjective experiences within the contexts of their daily lives. Particular attention is paid to the ways in which early work by Bury (1982), Charmaz (1983), and Williams (1984) has helped pave the way to an understanding of lay experiences that is sensitive to a broad range of micro- and macro-contextual influences. The article looks to the future as well as the past by pointing to 'uncharted terrain' and 'missing voices' within the medical sociology literature. It discusses some recently published work in the Journal that has opened the door to what may prove to be a 21st century sociology of health and illness. It concludes with a call for medical sociologists to be more open-minded to the use of novel and seemingly unconventional theoretical and methodological approaches.

Lee Y-Y., &Lin J.L . ( 2009).

The effects of trust in physician on self-efficacy, adherence and diabetes outcomes

Social Science & Medicine, 68, (6), 1060-1068.

URL     PMID:19162386      [本文引用: 1]

Trust in physicians has been associated with a range of patient behaviors. However, previous research has not focused on the mechanisms by which trust affects health outcomes and mostly has made use of self-rated health. This study tested a theoretical model of variables influencing the relations of trust to both objective and self-rated health. We hypothesized that patients who trust their physicians more were likely to have stronger self-efficacy and outcome expectations. We expected this, in turn, to be associated with better treatment adherence and objective health outcomes. In addition, we hypothesized that highly trusting patients would be more likely to report better health status through enhanced self-efficacy. Data for this research came from a sample of 480 adult patients with type 2 diabetes in Taiwan. Patients completed measures of trust, self-efficacy, outcome expectations, adherence, and the SF-12 health survey. Objective outcomes, including body mass index, glycosylated hemoglobin, blood lipid, and diabetes-related complications, were assessed by follow-up chart review. The structural equation analyses which were implemented by LISREL VIII resulted in a proper solution that exhibited adequate fit. All hypothesized paths were statistically significant and in the predicted directions. The mediation roles of self-efficacy and outcome expectations were further confirmed by the results of structural equation modeling and bootstrap analyses. In the multivariate regression, although the relations of patient trust to blood lipid and self-rated health were confirmed, the direct link of trust to glycosylated hemoglobin was only significant in the bivariate model. This study clarifies the association of trust with different types of health outcomes and provides the empirical evidence that trust in physicians is associated with both self-rated health and therapeutic response. However, a more longitudinal study design is necessary to precisely determine both the strength and causality of these relationships.

Lee Y-Y., &Lin J.L . ( 2011).

How much does trust really matter? A study of the longitudinal effects of trust and decision-making preferences on diabetic patient outcomes

Patient Education and Counseling, 85, (3), 406-412.

URL     PMID:21269794      [本文引用: 1]

To examine the impact of trust on patient outcomes (satisfaction, HbA1C, physical and mental health-related quality of life (HRQoL)) and to investigate the role of decision-making preferences in the trust–outcome relationship. We conducted a one-year longitudinal analysis of 614 type 2 diabetic patients (mean age: 59.3 years; mean disease duration: 6.7 years). Patients’ self-administered questionnaires and medical record were used for the research. Multiple regression analyses were conducted to investigate the relationship among variables during a 12-month follow-up. Further, we used latent growth modeling (LGM) to assess changes in health outcomes and to examine how these changes were related to trust. Regression analyses revealed that trust was positively related to glycemic control, physical HRQoL, and satisfaction at 12 months. Patients with higher decision-making preferences experienced a greater increase in subsequent satisfaction. The results of LGM showed that higher levels of trust were associated with greater increases in physical HRQoL. Trust contributes to improvements in health outcomes. The relationship between trust and satisfaction may be stronger among patients with higher decision-making preferences. For healthcare providers, efforts should be made to cultivate patients’ trust and enhance their decision-making preferences to maximize satisfaction and improve outcomes.

Leventhal H., Meyer D., & Nerenz D. .( 1980) . The common sense representation of illness danger. In S. Rachman (Ed.), Contributions to Medical Psychology (pp. 7-30). New York: Pergamon Press.

[本文引用: 1]

Leventhal H., Phillips L. A., & Burns E . ( 2016).

Modelling management of chronic illness in everyday life: A common- sense approach

Psychological Topics, 25, (1), 1-18.

[本文引用: 3]

Levy S. R., Chiu C., & Hong Y-Y . ( 2012).

Lay theories and intergroup relations

Group Processes & Intergroup Relations, 9, (1), 5-24.

URL     [本文引用: 1]

Abstract Lay theory research on intergroup relations has rapidly grown over the past two decades. Drawing on articles in this Special Issue, we showcase the latest developments. First, we define lay theories, addressing the extent of overlap with scientific theories and differences among lay theories in terms of type of representation, level of articulation, frequency of activation and use, range of applicability, and degree of universality. Second, we describe advances in the understanding of the functions of lay theories. Third, we review the far-reaching implications of lay theories for group and intergroup processes. Fourth, we discuss the movement toward comparing and contrasting related lay theories. Taken together, these articles suggest the study of lay theories provides a fuller understanding of intergroup relations.

Linetzky B., Jiang D., Funnell M. M., Curtis B. H., & Polonsky W. H . ( 2017).

Exploring the role of the patient- physician relationship on insulin adherence and clinical outcomes in type 2 diabetes: Insights from the mosaic study

Journal of Diabetes, 9, (6), 596-605.

Lobban F., Barrowclough C., & Jones S . ( 2005).

Assessing cognitive representations of mental health problems. II. The illness perception questionnaire for schizophrenia

British Journal of Clinical Psychology, 44, (2), 147-162.

URL     PMID:16004652      [本文引用: 1]

Objective. To design a questionnaire to assess cognitive representations of mental health problems held by relatives of people diagnosed with schizophrenia.Background. The ways in which relatives respond to patients with a diagnosis of schizophrenia has been shown to impact on outcome. Understanding variation in relatives' responses is essential if successful interventions are to be developed. This study builds on previous research exploring attributions that relatives make about symptoms. The development of a new measure to assess beliefs that relatives have about schizophrenia is reported; The Illness Perception Questionnaire for Schizophrenia 鈥 Relatives version (IPQS-Relatives).Method. Sixty-two relatives completed the IPQS-Relatives, along with measures of general psychopathology, burden, appraisal of coping, and expressed emotion. The psychometric properties of the IPQS-Relatives were analysed, including internal consistency, test-retest reliability, and discriminant and concurrent validity.Results. IPQS-Relatives subscales were shown to be internally consistent and stable over time. Correlations with measures of general psychopathology, distress, burden, coping, and criticism indicate that the subscales have good concurrent validity.Conclusions. The IPQS-Relatives can be used to assess relatives' beliefs about schizophrenia. This measure may aid family interventions that target beliefs associated with negative outcome for patients and their relatives.

Mahon G., O’Brien B., & O’Conor L . ( 2014).

The experience of chronic illness among a group of Irish patients: A qualitative study

Journal of Research in Nursing, 19, (4), 330-342.

[本文引用: 1]

Manary M. P., Boulding W., Staelin R., & Glickman S. W . ( 2013).

The patient experience and health outcomes

New England Journal of Medicine, 368, (3), 201-203.

URL     PMID:23268647      [本文引用: 1]

http://www.nejm.org/doi/abs/10.1056/NEJMp1211775

Markova V., &Sandal G.M . ( 2016).

Lay explanatory models of depression and preferred coping strategies among Somali refugees in Norway. A mixed-method study

Frontiers in Psychology, 7, 1435.

URL     [本文引用: 1]

Objective:Refugees are at high risk of experiencing mental health problems due to trauma in their pasts and to acculturation stress as they settle in a new country. To develop efficient health services that meet the needs of refugees from different regions, an understanding is required of how they make sense of and prefer to cope with mental health problems. This study aims to investigate lay explanatory models of depression and preferred coping strategies among Somali refugees in Norway. Methods:The study used a mixed-method design with a vignette describing a moderately depressed person based on ICD-10 criteria. Firstly, a survey study was performed among Somali refugees (n= 101). Respondents were asked to give advice to the vignette character and complete the Cross-Cultural Depression Coping Inventory and the General Help-Seeking Questionnaire. Secondly, focus group interviews (n= 10) were conducted separately with males and females to examine the relationship between the explanatory models of depression and the preferred coping strategies. Results:The participants showed a strong preference for coping with depression by religious practices and reliance on family, friends, and their ethnic/religious community, rather than by seeking professional treatment from public health services (e.g., medical doctors, psychologists). Depressive symptoms were conceptualized as a problem related to cognition (thinking too much) and emotion (sadness), but not to biological mechanisms, and they were thought to result from spiritual possession, stress as a result of social isolation, and/or past trauma. Independently of time in exile, the participants showed a strong identification with their ethnic origin and associated values. Because participants emphasized the need to obey and follow the views of elders, fathers, and spiritual leaders, these authorities seemed to be atekeepers for access to mental health services. Conclusion:The results highlight that mental health programs for Somali refugees should actively involve the ethnic community, including spiritual leaders, in order to reach patients in need and to foster treatment compliance.

Marshall I. J., Wolfe C. D., & McKevitt C . ( 2012).

Lay perspectives on hypertension and drug adherence: Systematic review of qualitative research

BMJ, 345, e3953.

URL     PMID:3392078      [本文引用: 1]

Abstract OBJECTIVE: To synthesise the findings from individual qualitative studies on patients' understanding and experiences of hypertension and drug taking; to investigate whether views differ internationally by culture or ethnic group and whether the research could inform interventions to improve adherence. DESIGN: Systematic review and narrative synthesis of qualitative research using the 2006 UK Economic and Social Research Council research methods programme guidance. DATA SOURCES: Medline, Embase, the British Nursing Index, Social Policy and Practice, and PsycInfo from inception to October 2011. STUDY SELECTION: Qualitative interviews or focus groups among people with uncomplicated hypertension (studies principally in people with diabetes, established cardiovascular disease, or pregnancy related hypertension were excluded). RESULTS: 59 papers reporting on 53 qualitative studies were included in the synthesis. These studies came from 16 countries (United States, United Kingdom, Brazil, Sweden, Canada, New Zealand, Denmark, Finland, Ghana, Iran, Israel, Netherlands, South Korea, Spain, Tanzania, and Thailand). A large proportion of participants thought hypertension was principally caused by stress and produced symptoms, particularly headache, dizziness, and sweating. Participants widely intentionally reduced or stopped treatment without consulting their doctor. Participants commonly perceived that their blood pressure improved when symptoms abated or when they were not stressed, and that treatment was not needed at these times. Participants disliked treatment and its side effects and feared addiction. These findings were consistent across countries and ethnic groups. Participants also reported various external factors that prevented adherence, including being unable to find time to take the drugs or to see the doctor; having insufficient money to pay for treatment; the cost of appointments and healthy food; a lack of health insurance; and forgetfulness. CONCLUSIONS: Non-adherence to hypertension treatment often resulted from patients' understanding of the causes and effects of hypertension; particularly relying on the presence of stress or symptoms to determine if blood pressure was raised. These beliefs were remarkably similar across ethnic and geographical groups; calls for culturally specific education for individual ethnic groups may therefore not be justified. To improve adherence, clinicians and educational interventions must better understand and engage with patients' ideas about causality, experiences of symptoms, and concerns about drug side effects.

Mcferran B., &Mukhopadhyay A. ( 2013).

Lay theories of obesity predict actual body mass

Psychological Science, 24, (8), 1428-1436.

URL     PMID:23740551      [本文引用: 1]

Obesity is a major public health problem, but despite much research into its causes, scientists have largely neglected to examine laypeople's personal beliefs about it. Such naive beliefs are important because they guide actual goal-directed behaviors. In a series of studies across five countries on three continents, we found that people mainly believed either that obesity is caused by a lack of exercise or that it is caused by a poor diet. Moreover, laypeople who indicted a lack of exercise were more likely to actually be overweight than were those who implicated a poor diet. This effect held even after controlling for several known correlates of body mass index (BMI), thereby explaining previously unexplained variance. We also experimentally demonstrated the mechanism underlying this effect: People who implicated insufficient exercise tended to consume more food than did those who indicted a poor diet. These results suggest that obesity has an important, pervasive, and hitherto overlooked psychological antecedent.

Min J., Chang Y., Lee K. M., Choe K. H., & An J. Y . ( 2017).

Transcultural adaptation and validation of the Korean version of the brief illness perception questionnaire for patients with pulmonary tuberculosis

Journal of Global Infectious Diseases, 9, (3), 113-116.

URL     PMID:5572195      [本文引用: 1]

react-text: 402 Interest in communication strategies, such as family meetings for intensive care unit (ICU) patients and their family members, is growing among the intensivists in South Korea. We report our experience of multidisciplinary meetings with family members of ICU patients. After seminars on communication and end-of-life care, a consensus on the guidelines for ICU family meetings was made. A weekly... /react-text react-text: 403 /react-text [Show full abstract]

Mitchell G.E., &Locke K.D . ( 2015).

Lay beliefs about autism spectrum disorder among the general public and childcare providers

Autism the International Journal of Research & Practice, 19, (5), 553-561.

URL     PMID:24852751      [本文引用: 2]

We conducted a survey of beliefs about autism among the general public in the United States and Canada (n = 823) and among individuals working in childcare facilities in the state of Idaho (n = 176). Results included the following. Almost all respondents correctly believed that autism's primary causes are genetic and neurological (not parenting, drugs, or current diet), that it can be identified in early childhood, and that helpful interventions exist. Respondents generally distinguished diagnostic from non-diagnostic traits, but approximately half incorrectly labeled constant squirming as diagnostic and difficulties in making friends as non-diagnostic. College graduates and childcare workers were more likely to have learned about autism in professional/academic settings and to correctly recognize diagnostic traits. Of concern, 10% of respondents considered vaccinations to be among the two main causes of autism. Accurate public understanding of autism spectrum disorders can facilitate early identification and effective intervention; our results suggest that efficient channels for conveying accurate information include broadcast and online media (from which the general public, especially members of ethnic minority groups, were most likely to learn about autism), and professional development courses for childcare providers.

Moorley C. R., Cahill S., & Corcoran N. T . ( 2016).

Life after stroke: Coping mechanisms among African Caribbean women

Health and Social Care in the Community, 24, (6), 769-778.

URL     [本文引用: 3]

Abstract In the UK, stroke is the third most common cause of death for women and the incidence in African Caribbean women is higher than that in the general population. Stroke burden has major consequences for the physical, mental and social health of African Caribbean women. In order to adjust to life after stroke, individuals affected employ a range of strategies which may include personal, religious (church) or spiritual support (i.e. prayer), individual motivation or resignation to life with a disability. This study explored these areas through the coping mechanisms that African Caribbean women utilised post stroke in the context of stroke recovery and lifestyle modification efforts needed to promote healthy living post stroke. A qualitative approach using interpretative phenomenological analysis was adopted. Seven women were recruited into the study. Semi-structured, in-depth interviews were audio recorded and were transcribed verbatim. Data were analysed using a four-stage framework: familiarisation, sense making, developing themes, and data refinement and analysis. Three main themes on coping emerged: the need to follow medical rules to manage stroke, strength and determination, and the use of religion and faith to cope with life after stroke. These findings illustrate both a tension between religious beliefs and the medical approach to stroke and highlight the potential benefits that religion and the church can play in stroke recovery. Implications for practice include acknowledgement and inclusion of religion- and church-based health promotion in post-stroke recovery.

Moss-Morris R., Weinman J., Petrie K., Horne R., Cameron L., & Buick D . ( 2002).

The revised illness perception questionnaire (IPQ-R)

Psychology Health, 17, (1), 1-16.

[本文引用: 1]

Mwaka A. D., Okello E. S., Kiguli J., & Rutebemberwa E . ( 2014).

Understanding cervical cancer: An exploration of lay perceptions, beliefs and knowledge about cervical cancer among the Acholi in Northern Uganda

BMC Women’s Health, 14, (1), 14-84.

URL     PMID:4114129      [本文引用: 1]

Background Cervical cancer is the most common cancer affecting women in Uganda; yet community understanding of the disease is limited. We explored community perceptions, beliefs and knowledge about the local names, causes, symptoms, course, treatment, and prognosis of cervical cancer in order to inform targeted interventions to promote early help-seeking. Methods Twenty four focus group discussions (FGD) with men and women aged 18 ??? 59 years and ten key informant interviews with persons aged?????????60 years were conducted at two sites in Gulu district between May and June 2012. A semi-structured interview guide informed by Kleinman???s illness explanatory model and literature on community awareness of cervical cancer was used to collect data. Data analysis was supported with use of ATLAS.ti 6.1 in coding, organizing and tracking data segments. We used content analysis technique in data analysis and organised data into a structured format under distinct themes and categories. Results Cervical cancer was known by the local name ???two remo???, meaning ???an illness that manifests with bleeding.??? Respondents believed that early onset of sexual activity, multiple male sexual partners and multi-parity cause cervical cancer. Respondents in half of FGDs also reported that use of condoms and family planning pills and injections cause cervical cancer. Symptoms of cervical cancer reported included vaginal bleeding, watery vaginal discharge and lower abdominal and waist pain. Respondents in most of the FGDs and key informants perceived cervical cancer as a chronic illness and that it can be treated with both modern and traditional medicines. The majority thought that cervical cancer treatment was supportive; the illness is not curable. Conclusions While some lay beliefs about the causes of cervical cancer suggest some understanding of aetiology of the disease, other perceived causes particularly those related to use of family planning and condoms are potentially hurtful to public health. Awareness campaigns to promote early help-seeking for cervical cancer symptoms need to be culturally-sensitive and context-specific; and include messages on symptoms, risk factors, course, treatment and prognoses.

Nápoles‐Springer A. M., Santoyo J., Houston K., Pérez‐Stable E. J., & Stewart A. L . ( 2005).

Patients’ perceptions of cultural factors affecting the quality of their medical encounters

Health Expectations, 8, (1), 4-17.

URL     PMID:15713166      [本文引用: 2]

Objective The aim of this study was to identify key domains of cultural competence from the perspective of ethnically and linguistically diverse patients.

Nyundu T., &Smuts L. ( 2016).

A different kind of aids: Folk and lay theories in South African townships

South African Review of Sociology, 47, (4), 132-136.

URL     [本文引用: 1]

There are a lot of contestations in South Africa when it comes to giving meaning to the HIV/AIDS pandemic. David Dickinson’s book puts at the centre of enquiry the struggles over explaining HIV/AIDS in one of the most affected areas in South Africa ― the townships. Despite close to 30 years of HIV/AIDS education, alternative and non-scientific explanations of HIV/AIDS are still prevalent in the townships. The book aims at examining how to think about such explanations and the various ways in which township residents make sense of the disease.

Odusola A. O., Hendriks M., Schultsz C., Bolarinwa O. A., Akande T., Osibogun A., & Skin K . ( 2014).

Perceptions of inhibitors and facilitators for adhering to hypertension treatment among insured patients in rural Nigeria: A qualitative study

BMC Health Services Research, 14, 624.

URL     PMID:25491509     

Background Universal health care coverage has been identified as a promising strategy for improving hypertension treatment and control rates in sub Saharan Africa (SSA). Yet, even when quality care is accessible, poor adherence can compromise treatment outcomes. To provide information for adherence support interventions, this study explored what low income patients who received hypertension care in the context of a community based health insurance program in Nigeria perceive as inhibitors and facilitators for adhering to pharmacotherapy and healthy behaviors. Methods We conducted a qualitative interview study with 40 insured hypertensive patients who had received hypertension care for???>???1 year in a rural primary care hospital in Kwara state, Nigeria. Supported by MAXQDA software, interview transcripts were inductively coded. Codes were then grouped into concepts and thematic categories, leading to matrices for inhibitors and facilitators of treatment adherence. Results Important patient-identified facilitators of medication adherence included: affordability of care (through health insurance); trust in orthodox ???western??? medicines; trust in Doctor; dreaded dangers of hypertension; and use of prayer to support efficacy of pills. Inhibitors of medication adherence included: inconvenient clinic operating hours; long waiting times; under-dispensing of prescriptions; side-effects of pills; faith motivated changes of medication regimen; herbal supplementation/substitution of pills; and ignorance that regular use is needed. Local practices and norms were identified as important inhibitors to the uptake of healthier behaviors (e.g. use of salt for food preservation; negative cultural images associated with decreased body size and physical activity). Important factors facilitating such behaviors were the awareness that salt substitutes and products for composing healthier meals were cheaply available at local markets and that exercise could be integrated in people???s daily activities (e.g. farming, yam pounding, and household chores). Conclusions With a better understanding of patient perceived inhibitors and facilitators of adherence to hypertension treatment, this study provides information for patient education and health system level interventions that can be designed to improve compliance. Trial registration ISRCTN47894401 webcite.

Park S., Lee M., Furnham A., Jeon M., & Ko Y-M . ( 2017).

Lay beliefs about the causes and cures of schizophrenia

International Journal of Social Psychiatry, 63, (6), 518-524.

URL     PMID:28658995      [本文引用: 1]

Abstract BACKGROUND: Lay beliefs about schizophrenia are an important factor associated with treatment-seeking behavior. AIMS: This study was conducted to investigate the lay beliefs about the causes and treatments of schizophrenia in South Korea. METHODS: A total of 654 adults (mean age, 35.9665±6511.3365years) completed two questionnaires assessing their views on the causes and cures of schizophrenia. The factor structures of lay beliefs about the causes and treatments of schizophrenia were then analyzed and the correlations between the resultant factors investigated. RESULTS: From the cause items, four factors were extracted: Health/Lifestyle, God/Fate, Social/Environmental and Biological. Four factors were also extracted from the treatment items: Self-Help/Stress Management, Physical Treatment/Health Management, Religious Help and Mental Health Service Utilization. Notably, most participants believed that items in the Social/Environmental and Biological factors were the causes of schizophrenia, while they believed that items in the Mental Health Service Utilization and Self-Help/Stress Management factors were the treatments. Participants' beliefs about the causes and treatments of schizophrenia were systematically correlated. CONCLUSION: Overall, laypeople have reasonably accurate beliefs and a multidimensional view of the causes and treatments of schizophrenia. Nevertheless, our results suggest that public education about the etiology and treatment of schizophrenia are necessary to increase actual usage of mental health services and treatments for schizophrenia.

Plaks J. E., Grant H., & Dweck C. S . ( 2005).

Violations of implicit theories and the sense of prediction and control: Implications for motivated person perception

Journal of Personality and Social Psychology, 88, (2), 245-262.

[本文引用: 2]

Platonova E. A., Kennedy K. N., & Shewchuk R. M . ( 2008).

Understanding patient satisfaction, trust, and loyalty to primary care physicians

Medical Care Research and Review, 65, (6), 696-712.

URL     PMID:18723450      [本文引用: 1]

The authors developed and empirically tested a model reflecting a system of interrelations among patient loyalty, trust, and satisfaction as they are related to patients' intentions to stay with a primary care physician () and recommend the doctor to other people. They used a structural equation modeling approach. The fit statistics indicate a well-fitting model: root mean square error of approximation =.022, goodness-of-fit index =.99, adjusted goodness-of-fit index =.96, and comparative fit index = 1.00. The authors found that patient trust and good interpersonal relationships with the are major predictors of patient satisfaction and loyalty to the physician. Patients need to trust the to be satisfied and loyal to the physician. The authors also found that patient trust, satisfaction, and loyalty are strong and significant predictors of patients' intentions to stay with the doctor and to recommend the to others.

Price R. A., Elliott M. N., Zaslavsky A. M., Hays R. D., Lehrman W. G., Rybowski L., … Cleary P. D . ( 2014).

Examining the role of patient experience surveys in measuring health care quality

Medical Care Research & Review, 71, (5), 522-554.

URL     PMID:25027409     

Patient care experience surveys evaluate the degree to which care is patient-centered. This article reviews the literature on the association between patient experiences and other measures of health care quality. Research indicates that better patient care experiences are associated with higher levels of adherence to recommended prevention and treatment processes, better clinical outcomes, better patient safety within hospitals, and less health care utilization. Patient experience measures that are collected using psychometrically sound instruments, employing recommended sample sizes and adjustment procedures, and implemented according to standard protocols are intrinsically meaningful and are appropriate complements for clinical process and outcome measures in public reporting and pay-for-performance programs.

Qi X., Zaroff C. M., & Bernardo A. B . ( 2015).

Autism spectrum disorder etiology: Lay beliefs and the role of cultural values and social axioms

Autism the International Journal of Research & Practice, 20, (6), 673-686.

URL     PMID:26408634      [本文引用: 1]

Recent research examining the explanations given by the public (i.e. lay beliefs) for often reveals a reasonably accurate understanding of the biogenetic basis of the disorder. However, lay beliefs often manifest aspects of culture, and much of this work has been conducted in western cultures. In this study, 215 undergraduate university students in Macau, a Special Administrative Region of China, completed self-report measures assessing two beliefs concerning etiology: (1) a belief in parental factors and (2) a belief in genetic factors. Potential correlates of lay beliefs were sought in culture-specific values, and more universal social axioms. Participants were significantly more likely to endorse parenting, relative to genetic factors, as etiological. A perceived parental etiology was predicted by values of mind-body holism. Beliefs in a parental etiology were not predicted by values assessing collectivism, conformity to norms, a belief in a family's ability to obtain recognition through a child's achievement, or interpersonal harmony, nor by the social axioms measured (e.g. social cynicism, reward for application, social complexity, fate control, and religiosity). Beliefs in a genetic etiology were not predicted by either culture-specific values or social axioms. Implications of the current results are discussed.

Leiser D.., &Krill Z. ( 2017).

How laypeople understand the economy. In R. Ranyard (Eds.),

Economic Psychology ( pp. 139-154). doi: 10.1002/9781118926352.ch9.

[本文引用: 1]

Ruggieri T. G., Berta P., Murante A. M., & Nuti S . ( 2018).

Patient satisfaction, patients leaving hospital against medical advice and mortality in Italian university hospitals: A cross-sectional analysis

BMC Health Services Research, 18, (1), 51-59.

URL     PMID:5789648      [本文引用: 1]

Healthcare systems are increasingly focusing on outcomes that are the endpoints of care: patient health status and patient satisfaction. The availability of patient satisfaction (PS) data has encouraged research on its relationship with other outcomes, such as mortality. In Italy, an inter-regional performance evaluation system (IRPES) provides 13 regional healthcare systems with a multidimensional assessment of appropriateness, efficiency, financial sustainability, effectiveness, and equity. For university hospitals, IRPES includes the percentage of patients leaving hospital against medical advice (PLHAMA) and mortality rates at the ward level. This paper investigates the relationship between PS and PLHAMA across and within regional healthcare systems in Italy. Secondly, PLHAMA is used as a PS proxy to investigate its relationship with mortality at the ward level in the IRPES university hospitals. PLHAMA and mortality rates were gathered from administrative data, and PS scores from patient surveys. We explored the association between PS and PLHAMA through a correlation analysis, using data for the 13 IRPES regions. We tested this relationship also at the clinical directorate level in 28 hospitals in Tuscany (5482 interviewed patients in 100 clinical directorates). Secondly, we explored the association between PLHAMA and mortality at the ward level through correlation and regression analyses, using data of 405 wards of eight clinical specialties within 24 IRPES university hospitals. Lower PLHAMA rates were associated with a higher PS in both regional and clinical directorate levels. A positive association between PLHAMA and mortality was shown at the ward level for IRPES university hospitals, with different results for medical and surgical clinical specialties. PS is an important performance dimension that provides healthcare managers and professionals with useful insights for improving care quality and effectiveness. Based on the study results, the PLHAMA rate could be regularly measured to highlight patient dissatisfaction. Due to the association between PLHAMA and mortality, this study also provides evidence of the importance of the patient perspective in assessing the quality of healthcare services. This relationship proved to be significant for surgical clinical units, suggesting the need for further analysing outcomes considering their different determinants in medical and surgical care.

Saha S., Jacobs E. A., Moore R. D., & Beach M. C . ( 2010).

Trust in physicians and racial disparities in HIV care

AIDS Patient Care and STDs, 24, (7), 415-420.

URL     PMID:20578909      [本文引用: 1]

Mistrust among African Americans is often considered a potential source of racial disparities in HIV care. We sought to determine whether greater trust in one's provider among African-American patients mitigates racial disparities. We analyzed data from 1,104 African-American and 201 white patients participating in a cohort study at an urban, academic HIV clinic between 2005 and 2008. African A...

Savani K., Rattan A., & Dweck C. S . ( 2017).

Is education a fundamental right? People’s lay theories about intellectual potential drive their positions on education

Personality and Social Psychology Bulletin, 43, (9), 1284-1295.

URL     [本文引用: 1]

Abstract Does every child have a fundamental right to receive a high-quality education? We propose that people’s beliefs about whether “nearly everyone” or “only some people” have high intellectual potential drive their positions on education. Three studies found that the more people believed that nearly everyone has high potential, the more they viewed education as a fundamental human right. Furthermore, people who viewed education as a fundamental right, in turn (a) were more likely to support the institution of free public education, (b) were more concerned upon learning that students in the country were not performing well academically compared with students in peer nations, and (c) were more likely to support redistributing educational funds more equitably across wealthier and poorer school districts. The studies show that people’s beliefs about intellectual potential can influence their positions on education, which can affect the future quality of life for countless students.

Schlomann P., &Schmitke J . ( 2007).

Lay beliefs about hypertension: An interpretive synthesis of the qualitative research

Journal of the American Academy of Nurse Practitioners, 19, (7), 358-367.

URL     PMID:17680901      [本文引用: 2]

Purpose: The purpose of this interpretive synthesis was to explore lay beliefs about high blood pressure and its treatment in order to develop a foundation for better partnering with clients.Data sources: Meta-interpretation was used to analyze 11 qualitative research studies published in the United States between 2000 and 2005.Conclusions: Professional and lay beliefs about hypertension are not congruent. Historical factors, lack of congruence between belief systems, and poor relationships with providers lead many clients, especially African Americans, to distrust providers and impede the effectiveness of treatment plans. The most problematic discrepancies were related to beliefs about (a) the presence of symptoms, (b) the need to take medications for the rest of life, and (c) race-specific treatment plans. The interactions between nurse practitioners and hypertensive clients have not been explored.Implications for practice: Professional client interactions based on partnership models, with specific consideration for the above-stated discrepancies in beliefs, are necessary to improve hypertension control.

Shiloh S., Heruti I., & Leichtentritt R . ( 2016).

A common-sense model of injury perceptions

Journal of Health Psychology, 21, (8), 1516-1526.

URL     PMID:25432457      [本文引用: 1]

Abstract The aim of this study was to clarify the difference between perceptions of injury and illness. A qualitative study using semi-structured interviews was conducted with 38 individuals who had been injured in the past, 8 medical psychologists, 62 graduate psychology students, and 19 health professionals treating injured patients. Data were analyzed by modified analytic induction and constant comparison methods. Common-sense perceptions of injury overlapped with some perceptions of illness, and 4 new themes were elicited. It was concluded that there are themes unique to injury perceptions that should be recognized in research as well as in clinical interventions. The Author(s) 2014.

Shokrgozar S., Soleimani R. S., Abdollahi E., Fallahi M., Roshandel M., & Noori, S. Z. S . ( 2017).

An investigation of the psychometric properties of illness perception questionnaire for schizophrenia (IPQS) in Iran

Neuroquantology, 15, (3), 80-88.

URL    

The present study has been carried out in order to evaluate psychometric characteristics of Illness Perception Questionnaire for Schizophrenia. This is a descriptive correlational research. The study population consisted of all patients with schizophrenia aging 19 to 70 years old who were hospitalized in the Psychiatric Ward of Shafa Hospital, Rasht (2016). Out of this population, a sample size of 95 people was obtained using purposive sampling, Demographic Questionnaire, Illness Perception Questionnaire for Schizophrenia (IPQS), Positive and Negative symptoms Scale (PNSS), Scale to Assess Unawareness in Mental Disorder (SUMD), Beck Depression Inventory (BDI), and Calgary Depression Scale for Schizophrenia (CDSS). Exploratory factor analysis revealed that this questionnaire is composed of 10 dimensions, the first of which explaining 24.402 percent of all of variance. Besides, concurrent validity showed that the total IPQS score had a significant correlation with SUMD equal to 0.579 at the level of 1 percent; this correlation was 0.29 at the level of 5 percent and 0.615 at the level of 1 percent in relation to BDI and CDSS, respectively. However, no correlation was observed between IPQS score and PANSS. Cronbach's alpha coefficients of reliability for IPQS scale were 0.705, and, for the subscales, between 0.599 and 0.865. This result suggests a good reliability for the Illness Perception Questionnaire for Schizophrenia. The Illness Perception Questionnaire for Schizophrenia has helpful psychometric properties that make it an appropriate analysis tool.

Swift J.K., &Callahan J.L . ( 2009).

The impact of client treatment preferences on outcome: A meta-analysis

Journal of Business Ethics, 65, (4), 368-381.

URL     PMID:19226606      [本文引用: 1]

An important part of evidence-based practice is to include client preferences in the treatment decision-making process. However, based on previous reviews of the literature there is some question as to whether including client preferences actually has an effect on treatment outcome. This meta-analytic review summarized data from over 2,300 clients across 26 studies comparing the treatment outcome differences between clients matched to a preferred treatment and clients not matched to a preferred treatment. The findings indicate a small significant effect ( r =.15, CI .95: .09 to .21) in favor of clients who received a preferred treatment. The binomial effect size indicated that matched clients have a 58% chance of showing greater improvement, and further analysis indicate that they are about half as likely to drop-out of treatment when compared with clients not receiving a preferred treatment. Study design was seen to be a moderating variable in that partially randomized preference trials may underestimate the treatment preference effect. Implications for best practice standards are discussed. 2009 Wiley Periodicals, Inc. J Clin Psychol 65:1-14, 2009.

Tefera K., Hailay G., Lillian M., & Tesfahun E . ( 2016).

Diabetes related knowledge, self-care behaviours and adherence to medications among diabetic patients in southwest Ethiopia: A cross-sectional survey

BMC Endocrine Disorders, 16, (1), 28-38.

URL     PMID:27381349      [本文引用: 2]

The provision of health education involving self-care and good adherence to medications has been acknowledged to be a cost effective strategy for improving quality of life of diabetes patients. We assessed levels of knowledge about type 2 diabetes mellitus (T2DM), self-care behaviours and adherence to medication among DM patients. A facility based cross-sectional survey of 325 adults with T2DM patients attending Jimma University Teaching Hospital, Southwest Ethiopia was conducted. We used diabetes Knowledge Test, Expanded Version of the Summary of Diabetes Self-Care Activities and Morisky 8-Item medication adherence as tools to measure diabetic knowledge, self-care behaviours and adherence to medications respectively. Multinomial logistic regression analyses were used to assess the independent predictors of diabetes knowledge and adherence to medications. The binary logistic regression was applied for self-care behaviours. 309 respondents were included in the survey. Of all the respondents, 44.902%, 20.102% and 34.902% had low, medium and high level diabetic knowledge respectively. High level of diabetic knowledge was the reference group. Being illiterate (AOR65=653.1, 95%CI: 1.03-9.3), having BMI <1802kg/m2(AOR65=656.4, 95%CI: 1.2-34.9) and duration of DM65<65502years (AOR65=654.2, 95%CI: 1.9-9.5) were significantly associated with low level of diabetic knowledge. T2DM patients who practiced good self-care (AOR65=650.5, 95%CI: 0.3-0.9) were less likely to have low knowledge. Duration of DM65<65502years (AOR65=659.8, 95%CI: 3.2-30.2) was significantly associated with medium level of diabetic knowledge. 157(50.802%) patients had poor self-care behaviour and this was associated with level of education and adherence to medication. The proportions of patients with low, medium and high adherence to medication were 24.902%, 37.902% and 37.202% respectively. Being a merchant, having medium level of diabetic knowledge and having good glycemic control level were associated with low adherence to medications. Significant number of DM patients had low level of knowledge, poor self-care behaviours and low level of adherence to medications. These findings call for the need of integrated interventional management on diabetic knowledge, self-care behaviours and adherence to medications. To ensure effective T2DM management, a strategic approach that improves health literacy could be a cross cutting intervention. The online version of this article (doi:10.1186/s12902-016-0114-x) contains supplementary material, which is available to authorized users.

Vermeulen J. M., Schirmbeck N. F., van Tricht M. J., & De H. L . ( 2018).

Satisfaction of psychotic patients with care and its value to predict outcomes

European Psychiatry the Journal of the Association of European Psychiatrists, 47, 60-66.

URL     [本文引用: 1]

Wang L. D., Lam W. W., Wu J., & Fielding R . ( 2014).

Hong Kong Chinese women’s lay beliefs about cervical cancer causation and prevention

Asian Pacific Journal of Cancer Prevention, 15, (18), 7679-7686.

URL     PMID:25292046      [本文引用: 1]

This study aimed to seek insights into Chinese women's lay beliefs about cervical cancer causal attributions and prevention.Twenty-three new immigrant adult women from Mainland China and thirty-five Hong Kong adult women underwent semi-structured in-depth interviews. Interviews were audio taped, transcribed and analyzed using a Grounded Theory approach.This study generated three foci: causal beliefs about cervical cancer, perceived risk of cervical cancer, and beliefs about cervical cancer prevention. Personal risky practices, contaminated food and environment pollution were perceived as the primary causes of cervical cancer. New immigrant women more likely attributed cervical cancer to external factors. Most participants perceived cervical cancer as an important common fatal female cancer with increased risk/prevalence. Many participants, particularly new immigrant women participants, expressed helplessness about cervical cancer prevention due to lack of knowledge of prevention, it being perceived as beyond individual control. Many new immigrant participants had never undergone regular cervical screening while almost all Hong Kong participants had done so.Some Chinese women hold pessimistic beliefs about cervical cancer prevention with inadequate knowledge about risk factors. Future cervical cancer prevention programs should provide more information and include capacity building to increase Chinese women's knowledge and self-efficacy towards cervical cancer prevention.

Weinman J., Petrie K. J., Moss-morris R., & Horne R . ( 1996).

The illness perception questionnaire: A new method for assessing the cognitive representation of illness

Psychology & Health, 11, (3), 431-445.

[本文引用: 1]

Werner P., &Korczyn A.D . ( 2010).

Lay persons’ beliefs and knowledge about Parkinson’s disease: Prevalence and socio-demographic correlates

. Parkinsonism & Related Disorders, 16, (6), 415-417.

URL     PMID:20061175      [本文引用: 1]

Although studies have shown that lay persons' beliefs and knowledge about a disease are associated with increased adherence to health behaviors, there is a dearth of knowledge in this area regarding Parkinson's disease (PD). To assess the prevalence and socio-demographic correlates of lay persons' beliefs and knowledge about PD. A phone survey was conducted with a representative sample of 632 lay persons (mean age = 45) in Israel. Information regarding participants' perceptions about their susceptibility, worry, fear and knowledge about PD was assessed together with their socio-demographic characteristics. Lay persons perceived their risk to develop PD to be minimal. They also reported low levels of worry, fear and knowledge. Female participants and those with lower education reported higher levels of worry and fear while religious participants reported consistently lower levels of worry, fear and knowledge. These data suggest the need to expand this line of research and to encourage the development of programs aimed at disseminating knowledge about PD.

Werner P., Goldberg S., Mandel S., & Korczyn A. D . ( 2013).

Gender differences in lay persons’ beliefs and knowledge about Alzheimer’s disease (AD): A national representative study of Israeli adults

Archives of Gerontology and Geriatrics, 56, (2), 400-404.

URL     PMID:23219063      [本文引用: 1]

Although few, studies within the context of AD show that levels of worry and concern about AD are relatively low in lay persons. Since clear gender differences have been reported in the incidence and prevalence of dementia, as well as in its consequences, gender could be hypothesized as one of the factors influencing worry and concern about developing AD. The aim of the present study was to assess gender differences in public's beliefs about AD, and to examine whether men and women differ in their worries and concerns about developing the disease, as well as in their knowledge about it. A phone survey was conducted with a representative sample of 632 lay persons (mean age=45) in Israel. Information regarding males’ and females’ perceptions about their susceptibility, worry, fear and knowledge about AD was assessed. Males and females showed no statistically significant differences in their awareness of AD. Female participants consistently reported higher levels of perceived susceptibility, worry, fear, and knowledge about AD than male participants. Our findings highlight the need to improve the knowledge and awareness of the general public about AD, and particularly among men.

Williams G.H . ( 2009).

Lay beliefs about the causes of rheumatoid arthritis: Their implications for rehabilitation

International Rehabilitation Medicine, 8, (2), 65-68.

[本文引用: 2]

Winnette R., Hess L. M., Nicol S. J., Tai D. F., & Copley-Merriman C . ( 2017).

The patient experience with soft tissue sarcoma: A systematic review of the literature

The Patient - Patient-Centered Outcomes Research, 10, (2), 153-162.

URL     PMID:27744499      [本文引用: 1]

Abstract Background Soft tissue sarcomas (STS) are a heterogenous group of rare tumors that involve the connective tissue in the body (e.g. muscle, tendons). As with many rare tumors, little is known about the impact of STS on patient well-being. Objective The aim of this review was to better understand current knowledge related to patient experience and quality of life (QOL) following diagnosis of STS. Methods A systematic review of English-language articles published from 2005 to 2015 was conducted in the PubMed/MEDLINE, Embase, PsychINFO, and Evidence-Based Medicine databases. The review included recent conference proceedings and advocacy websites. Articles were eligible if they included adult STS patient-reported outcomes (PROs) or details on patient experience. Results Overall, 3430 articles were identified and 20 were eligible for inclusion. Of these, 14 were clinical studies that included PRO measures, 1 summarized PRO measures used in STS studies, and 5 described the STS patient experience. Patients with STS report a range of impacts on QOL, including emotional well-being, body image, functional deficit following surgery, and practical considerations such as child care and work. Conclusions Few studies have published either qualitative or quantitative data on the patient experience with STS. While STS has a measurable impact on QOL, there is a lack of detailed information in the published literature. Although PROs are used in clinical studies of STS, they are not STS-specific and may not capture the unique needs of this population. There is a need for qualitative research to better understand both patient and caregiver experiences in STS.

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