Alexander Segall

Gender differences in health related behaviour: Some unanswered questions

To date, no single explanation has accounted for discrepancies between male and female morbidity rates and health care utilization patterns. The sociomedical approach to sex/gender differences in health related behaviour has generated a variety of hypotheses. However, despite extensive study, many unanswered questions remain. The findings of this study fall short of offering conclusive evidence as to the causes of variations in morbidity and health services use between women and men. However, an effort is made to identify the salience of social role and related social status characteristics (e.g. labour force participation) in accounting for variation in health, illness and sick role behaviour. This paper utilizes data from the 1983 Winnipeg Area Study. Findings of this study raise questions about the adequacy of current concepts and measures for studying sex/gender differences in health related behaviour. The study concludes with a critical discussion of conceptual, methodological and theoretical issues which must be considered in our efforts to advance our understanding of why women experience greater longevity, but experience greater morbidity and make more extensive use of health services.

Perceived control in relation to socioeconomic and behavioral resources for health

Perceived control is a personality characteristic that contributes to well-being, but few studies have attempted to integrate the functions of perceived control with those of other determinants of health. This research tested two hypotheses about the functions of perceived control: (a) individual differences in perceived control would account for socioeconomic differences in self-rated health status; (b) performance of health-related behaviors would account for the health benefits of perceived control. Using data from adult, nonproxy respondents in the National Population Health Survey of Canada (1995; n = 11, 110), confirmatory factor analysis supported a measurement model of self-rated health status composed of two correlated factors: physical health (i.e., chronic conditions. restricted activities, self-rated general health, physical functional capacity) and mental health (i.e., distress, depression). Structural equation modeling supported the first hypothesis, but not the second, regarding perceived control as a determinant of self-rated physical and mental health. Health-related behaviors partially mediated age differences in self-rated health, but different behaviors functioned in this way for men than for women. The findings suggest that psychological process, that of perceiving control over life events, underlies social inequality in health. Health-related behaviors appear not to serve as the primary mechanism through which perceived control influences health.

Exploring the correlates of self-provided health care behaviour

Self-care has been characterized as the basic level of health care in all societies. However, little is known about existing self-care behaviour. Although it is clear that laypersons do indeed routinely self-evaluate and self-treat many of their health problems as a part of daily living, the nature and extent of these self-care practices are not well understood. It is not clear whether self-care behaviour is equally prevalent among different social groups; whether self-care is used for both health maintenance and the treatment of illness; and whether self-care is used only in response to selected symptomatic conditions. More studies of general lay populations are needed to provide this type of information. Particularly, studies which recognize that laypersons are not only consumers of professional care, but are also primary providers and active participants in the health care process. The purpose of the present study was to identify the range of self-care practices used at this time by Canadians and to explore some of the correlates of this behaviour. Data were obtained in 1983 through personal interviews with a randomly selected cross-sectional sample of 524 residents of Winnipeg, Canada. The dimensions of self-care investigated were: symptomatic self-treatment responses; recent self-medication activity; and the use of home remedies. Potential correlates considered include: sociodemographics; perceived health status; understanding of medical knowledge; attitudes toward medical care; and health maintenance/lifestyle beliefs and internal preventive control beliefs. A correlational analysis was performed to test the nature and strength of the association between all of the variables measured.(ABSTRACT TRUNCATED AT 250 WORDS)

Social rejection of the mentally ill: a replication study of public attitude

SummaryA replication survey of public attitudes toward the mentally ill was completed after a decade had elapsed which employed similar measures across the same urban area. Prior research evidence was empirically corroborated which indicated that attitude toward the mentally ill is not a uni-dimensional phenomenon, but is tied to differing social contexts. It does appear that a distinction can be made between attitudes in regard to social relations (personal contact) and social responsibility (impersonal contact). It was found that rejection of the mentally ill in situations of social relations was linked to prior personal experience with mental illness, perceived dangerousness of the mentally ill, and age of the survey respondent. Rejection of the mentally ill in circumstances involving social responsibility contracts (employment, housing, community affairs) was found to be largely tied to education of respondent. No significant differences were found in levels of public rejection of the mentally ill over the comparison ten year period.

Symptoms of depression in a canadian urban sample

The prevalence and correlates of symptoms of depression in a Canadian urban sample were examined. A random sample of 524 respondents completed the CES-D scale and a variety of socio demographic questions. In this Sample, 15% of the males and 19% of the females had scores above the depression cut-point of 16 on the CES-D scale. These rates were very similar to results reported in various U.S. centres. Symptoms of depression were most common among the younger, less educated, and those employed in trades and farming. Depression was lowest in the older, more educated, the married and those employed in professional and management roles. Taken as a whole the set of sociodemographic predictors explained 11%) of the variance in symptoms of depression.

Sociocultural variation in sick role behavioural expectations.

Abstract The general objectives of the present study were to determine: (1) how closely lay expectations regarding the rights and duties of the sick role correspond to the Parsonian conceptual model; and (2) whether systematic sociocultural differences exist in perception of and willingness to adopt the sick role. The study focused upon the sick role behavioral expectations held by hospitalized Anglo-Saxon Protestant and Jewish female patients. The two groups of patients displayed basically the same expectations in regard to the sick role, although their perception of the way in which a sick person should “ideally” behave offered little support for the Parsonian model. The study also revealed that the Anglo-Saxon Protestant patients objected to the dependency upon others which accompanies the adoption of the sick role, but were as willing as the Jewish patients to accept the other dimensions of the role, such as the sick persons obligation to try to get well and to seek competent help.

Age, Relative Autonomy and Change in Health Locus of Control Beliefs A Longitudinal Study of Members of a Health-promotion Facility

Health locus of control (HLC) describes an individual’s characteristic attribution of health outcomes to internal or external causes. This four-year longitudinal study examined changes in HLC beliefs among 124 members of a health-promotion facility, related to their age (22—81) and relative autonomy toward health-related goals. HLC beliefs changed with age as developmental theories of control striving would predict. Holding age aside, the pursuit of health goals with more relative autonomy significantly offset the growth of external-chance HLC beliefs. Lack of autonomy thus appears to permit development of fatalistic attributions that may affect later coping with adverse health events.

Maybe on my Street The Politics of Community Placement of the Mentally Disabled

The increasing deinstitutionalization of the mentally disabled has instigated research on neighborhood receptivity to this group. Using a random household sample from a midwestern Canadian city, we investigate the contribution of neighborhood types and individual characteristics in predicting the likelihood of supportive or opposing political responses from residents. Overall, twice as many respondents consider the placement of community mental health facilities in their neighborhood as desirable compared to those considering such facilities undesirable. Neighborhood types, however, are not particularly good predictors of attitudes or intended political actions. Supporters of such facilities consistently are more likely than those opposed to report a willingness to take political action consistent with their viewpoint.

Self-determination and functional persuasion to encourage physical activity

This research advances a novel approach to promoting physical activity, based on the principle of functional matching in persuasion, and the self-concordance (SC) of peoples motivations for physical activity. We propose that SC establishes a positive or negative orientation toward the challenge inherent in physical activity, and that the maximum yield of participation will be achieved by communications that appeal to each orientation. In two studies, we compared how messages emphasizing challenge versus available social support would influence recipients’ self-reported practices of physical activity and attitudes toward a physical activity setting. As hypothesized, these messages had differential effects for recipients whose pursuit of physical activity varied in SC, such that favorable outcomes were more reliably associated with challenge-oriented messages among respondents higher in SC versus support-oriented messages among respondents lower in SC. The findings suggest the merits of using self-regulatory, compared with object- or personality-based, constructs and measures to indicate psychological functions of ongoing health-related behaviors.

Cultural Factors in Sick-Role Expectations

“Every human society faces the prospect of sickness and each one has developed its own general cultural adaptations for it, which constitute its solutions” (Simmons & Wolff, 1954, p. 74). Culture serves as a subtle, but systematic influence upon the way in which the members of any society perceive the world around them. The distinctive way of life which characterizes a particular group or subgroup of a society includes the health-related behavior of its members. For example, “cultures and subcultural groups vary in the extent to which they perceive a set of circumstances as constituting illness or health, abnormality or normalcy, as calling for action or disregarding” (King, 1962, p. 67).