Chris McManus

Lay beliefs about health and illness

Risky behaviours promote and healthy behaviours reduce disease risks The evidence is clear: risky behaviours can lead to health crises and healthy behaviours can delay and avoid health crises. Cigarette smoking increases the probability of multiple types of cancer in addition to lung cancer, including cancers in organs as far from the mouth and lungs as the cervix. Cigarette smoking also greatly increases the likelihood of cardiovascular disease. Yet lung cancer has now exceeded breast cancer as a cause of death among women. Obesity is a risk factor for a broad range of diseases (Thompson & Wolf, 2001) and we are facing an epidemic of Type 2 diabetes, formally seen among the elderly and now increasingly diagnosed among teenagers (Mokdad et al ., 2001). The epidemic is occurring in spite of the clear evidence that weight loss and exercise can reduce the risk of diabetes. A multi-centre trial with over 3000 participants, each of whom was at high risk for becoming diabetic, found that exercise and dietary changes resulted in a 58% reduction in the number of individuals becoming diabetic whilst medication resulted in a 31% reduction relative to a control group receiving placebo (Knowler et al ., 2002). In short, despite knowledge of risk many people smoke, eat unhealthy, high fat, high calorie foods and are physically inactive. Knowledge of risk does not translate into risk avoidant behaviour (see also ‘Health related behaviours’).

Health-related behaviours: common factors

Introduction Any behaviour that affects a persons health status, either positively or negatively, is considered to be a health-related behaviour. Daily habits involving diet, exercise, safety practices and substance use are not only related to the prevention of disease, but also affect the management of chronic illness and degree of disability (Fries, 2002). It is difficult to imagine any activity or behaviour that does not affect our health in some way, either directly or indirectly. Common health-related behaviours include diet, exercise, smoking, alcohol use, safety practices and participation in health screening examinations such as testing for cholesterol levels, breast and prostate cancer (Fishbein et al ., 2001). Among the health-related behaviours most often encouraged in health promotion programmes is regular physical exercise because of its positive impact on health, disease prevention, psychological wellbeing and overall longevity (Johnson, 2003). Regular physical activity is associated with lower death rates for adults of any age, even when only moderate levels of physical activity are performed (Center for Disease Control, 1999). Regular physical activity decreases the risk of death from heart disease, lowers the risk of developing diabetes, reduces the risk of colon cancer and helps reduce blood pressure (Center for Disease Control, 1999). In 1999, only 65% of adolescents engaged in the recommended amount of physical activity. Even more disappointing, in 1997, only 15% of adults performed the recommended amount of physical activity, and 40% of adults engaged in no leisure time physical activity (Center for Disease Control, 1999).

Delay in seeking help

Following the detection of a symptom, the majority of individuals do not seek professional help, but instead do nothing or self-medicate (Freer, 1980). Whilst these responses may play a useful role in limiting the burden on healthcare services for benign and minor conditions, a continuing and important issue is delay in seeking help for symptoms that are indicative of life-threatening diseases. The intention of this chapter is to summarize the theoretical approaches used to study and understand help-seeking behaviour, with particular reference to delay in seeking help for symptoms of cancer and myocardial infarction (as these have been the most widely researched areas), and finally to discuss the implications of this research. Delay in help-seeking or ‘patient delay’ (Pack & Gallo, 1938) is the time taken from the detection of a symptom to the first consultation with a healthcare professional for that symptom. This is distinct from ‘professional delay’ (the time from the first consultation with a healthcare professional regarding a symptom to the receipt of a definitive diagnosis). The overall duration of delay has been divided in such a manner because an undifferentiated measure like ‘total delay’ (the time from the detection of a symptom to the receipt of a definitive diagnosis) may confound the effects of multiple factors that influence delay (Safer et al ., 1979). For instance, the factors that hinder a patients decision to seek help following the self-discovery of a breast lump may be quite different from those that cause a delay in reaching a definitive diagnosis of breast cancer following the first consultation with a healthcare professional.