This thesis identifies and describes some of the main accounts for health and illness that are current in British culture, placing them within broader contexts of psychological, sociological, traditional, religious and moral discourses; within broader explanatory frameworks; and, by way of an analysis of these ecological aspects, seeks to illuminate our understanding of such accounting. A combination of Q and ethnographic methods were used to elucidate a variety of alternative ways that people "make sense" of health and illness. Three main studies were conducted. The first two investigated accounting for health and illness within a broad framework of accounts as "explanations"; as moral judgements and prescriptions; and as defining meaning. The third study focussed on the external/internal explanatory framework, and demonstrated that accounting is far more complex than the Wallston and Wallston (1981) "Health Locus of Control Construct' would suggest. Some accounts stressed "internality", some "externality", some a combination of both, and others viewed this construct as non-salient. These latter included accounts about personal autonomy, and, importantly, the 'medical model" account. In the thesis overall, among the accounts identified were ones based upon notions of : "the wonders of modern medicine"; "stress"; "the cultural critique'; 'a healthy lifestyle", 'tradition"; "individual autonomy", 'Theism'; and "Willpower". These accounts are assumed to operate both within individual subjectivity and popular discourse, offering people a variety of complementary 'texts' with which to weave narratives, drawing upon different 'texts" according to situational and other demands. Thus accounting is portrayed as an active, thoughtful and sometimes contradictory 'storymaking" activity, and people as competent negotiators of reality.

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Breast cancer is a leading cause of mortality among women in the United States. Women with chronic disabling conditions such as multiple sclerosis (MS) are less likely to participate in routine mammography screening than women without disabilities due to multiple barriers. Underuse of mammography screening may lead to a diagnosis of a later stage breast cancer and consequently higher breast cancer mortality rate. This study examined the influence of several factors including, severity of MS-related functional limitations, demographic characteristics, family history of breast cancer, beliefs related to mammography screening and breast cancer, and personal resources on usual screening mammography in a sample of women with MS. The conceptual framework guiding this study was synthesized from The Explanatory Model of Health Promotion and Quality of Life in Chronic and Disabling Conditions and the Health Belief Model. Data from an ongoing longitudinal study (R01NR003195) focused on health promotion of persons with MS were combined with primary data for this prospective descriptive correlational study. The nonprobability sample consisted of 274 women ages 39-85 years who were primarily White (92%), married (66.1%), and unemployed (64.1%) with a 22 year average length of diagnosis with MS. Data were collected over two years using a mailed survey. Descriptive statistics and hierarchical logistic regression analyses were used to address the research questions. The annual mammography rate in this sample was 62%. Perceived susceptibility to breast cancer (AOR = 3.0, p < .05), family history (AOR = 2.5, p < .05), economic adequacy (AOR = 1.6, p < .05), and perceived barriers to mammography (AOR = .98, p < .05) significantly predicted mammography use, adjusted for severity of functional limitations. Though severity of limitations was negatively associated with mammography, it was not a significant predictor in the overall model. These findings suggest that for women with chronic disabling conditions, health beliefs, family history, and personal resources influence mammography screening. Clinicians need to continue to eliminate the barriers to mammography screening to improve screening and reduce overall breast cancer mortality rate in this vulnerable population. / text

Background: In the United States, Cardiovascular Disease (CVD) is the leading cause of death for both men and women. According to National Vital Statistics Report (2009), heart disease was the number one killer in the United States and it can be prevented. The primary purpose of this study was to determine knowledge and health beliefs about CVD among selected undergraduate university students and find out the potential risk of developing CVD in this population. The secondary purpose was to assess the relationship between knowledge, health beliefs, and personal risks; the tertiary purpose was to determine the factors that predict the relationship between demographic variables and cardiovascular risk factors among these students. Methods: A cross-sectional, descriptive, and correlational survey design was used in this quantitative study. An existing knowledge and health belief instrument was adapted with the permission from the authors. In the 2012 Spring semester, over 600 undergraduates from Foundation of Human Health, First Aid and CPR, Medical Terminology, Math, History, and Geography classes at a mid-western university were surveyed to access knowledge and health beliefs about CVD. The Health Belief Model provided the theoretical framework for this study. Results: Demographic data provided descriptive overview of the participants in this study. Majority of the participants were whites, lived off campus, and were domestic students. Results from data analysis revealed that overall knowledge about cardiovascular disease was low among these university students. Individual health beliefs such as perceived susceptibility, severity, and barriers regarding CVD were low; however perceived benefits of preventing CVD were found high. Most of the undergraduate university students were at potential risk of developing cardiovascular disease. Smoking and stress causing CVD were lesser known among undergraduate university students. Time to cook healthy meals and unaffordability of buying healthy foods were significant barriers in protecting cardiovascular health among university students. There was a positive statistically significant correlation between CVD knowledge, knowledge subtypes, and health belief subscales. Correlations between knowledge and health beliefs were weaker while comparing to correlation between CVD knowledge and knowledge subtypes. Race/ethnicity, age, family history, international/national, live on/off campus, and number of health classes were the better predictors of cardiovascular knowledge, while perceived barrier was the strongest predictor of health belief about CVD among undergraduate university students.

This research explores the relationship between perceptions of pain and illness and the social characteristics of the individual, with a focus on the role of gender. It emphasizes the meaning and understanding of the phenomenon of pain, which as an area of research has been neglected by medical sociology. A survey of sociological, medical, psychological, anthropological and literary perspectives on pain reveals a consensus that pain is a 'subjective' phenomenon, and that there are therefore limitations in applying 'objective' measurements. Recent developments in the sociology of health and illness, particularly in the area of emotions, offer potential theoretical and methodological frameworks and these are explored. To try to broaden the definition of pain beyond the traditional biomedical approach a multi-method form of enquiry was adopted. A self-completion questionnaire examining health beliefs, and experiences of illness and pain during the life-cycle, was administered to a random sample of 107 men and women attending a GP practice in North West London. Significant gender differences were found with respect to the role of the emotions and social expectations of coping ability. These themes formed the basis of the second stage of fieldwork, in which a sub-sample of 21 men and women participated in a semi-structured in-depth interview, including the use of visual imagery. This explored definitions and experiences of pain. Responses were taperecorded and transcribed. Analysis of both the transcripts and the material relating to the use of visual imagery revealed complex and abstract conceptualisations of pain, related to the social context of the individual. Expenences of pain were found to incorporate feelings and vulnerabilities, and existential and religious beliefs as well nociceptive or sensory components. The attribution to women of superior capacities in coping with pain were phenomenologically linked to female biological and reproductive functioning, but also seen to be underpinned by gendered socialization and role-expectations.

This research was concerned with how parents from different ethnic groups manage their children's respiratory and febrile illnesses, and their consultations at the general practitioner (GP). A review of the few British studies looking at parental health behaviour revealed that parents are continually having to make complex decisions, in which the clinical characteristics of the illness and the behaviour of the child are the most important factors in predictions of what the parent will do. Despite the belief among some GPs that their Asian patients consult more often and for trivial illnesses, we predicted that consultations, however many there are, will reflect rational decisions on the part of the parents. What may appear trivial to a doctor may not be for a parent. Including our pilot studies, we interviewed parents of 159 children - aged between two and eleven years - from three general practices in the inner-city area of Leeds. These parents were either white and indigenous, Muslims, Sikhs or Afro-Caribbeans; and approximately half of the children had been taken to see the doctor in the previous fortnight with a respiratory/febrile complaint, whereas the other half had not been to see a doctor for at least four months.

No / This chapter considers responses to epilepsy in members of the Pakistani community living in Bradford, a city in the north of England. A complex picture is presented of allegiance to the epistemology of Western medicine and adherence to its medication, while at the same time there is widespread use of folk and religious remedies. People live with a plurality of health beliefs and undertake practices that are apparently contradictory. Belief in therapeutic efficacy is only one element in the intricate mix of factors which influenced a person's use of a particular therapy. Other influences include family and community pressures, opportunity and cost. Over-riding all these are the uncertainty and sense of desperation experienced when conventional biomedicine fails to effect either a cure or adequate control of seizures. Considering beliefs about epilepsy and examining choices about care allows us to explore how the interaction of structural factors and individual preferences in making choices is influenced by the existence of differing health systems and beliefs. The resulting hybrid experience, we argue, is likely to be a characteristic of migrant communities worldwide.

The thesis examined McMaster University undergraduates’ beliefs about health and contagion, and their implication for antibacterial soap use. A qualitative methodology was used and 30 participants were interviewed, and the transcripts coded and analysed for emergent themes. Students understand health in terms of having energy, being disease free, and as something to be achieved through healthy lifestyle choices and cleanliness. These beliefs form an explanatory model of health that has several key components used to make health decisions, including using or not using antibacterial soap. The participants see their health as continually threatened by sources of illness. Contagion is one of the principal threats identified and understood as transmitted through the air, or on the surfaces of contaminated people and objects. Two modes of defence were articulated in the interviews. Internal components of defence involve maintaining immune rigour; external components drives activities such as personal hygiene and cleaning to protect against pathogens. Men tend to have a more internally focussed explanatory model of health, while women have a more external focus. This seems to explain why the women in this study were eight times more likely to use antibacterial soap than the men, a finding that was statistically significant (p=.O27). Social values are expressed through the explanatory model, including social boundaries and morality. The model also aligns very well with the biomedical paradigm in that it reduces health to its physical components, provides a mechanistic explanation of the body, and separates mind and body as discrete entities and as an object of control. Biomedicine seems to be broadening into new social domains, such as gender, social boundaries and morality, which are also reflected in students' beliefs about health. / Thesis / Master of Arts (MA)

Cancer and heart disease account for the largest proportion of morbidity and mortality among all adult diseases in the United States. Research has focused on identifying causal risk factors among adolescents. However, theories of health behavior change also stress the intermediary factors of intention and efficacy for effective behavior change. Existing research supports the potential of physical activity (PA), particularly learned through the domains of exercise and sport, as a means to developing these necessary skills (Danish, Petitpas, & Hale, 1993). The current investigation examined the influence of PA and television watching (TV) on intentions and efficacy to engage in health-enhancing behaviors. This was achieved by analyzing data from Building a BRIDGE to Better Health, a school-based health promotion program. Results indicate that independently, PA and TV significantly influence specific as well as general intentions and efficacy. These findings have important implications for adolescent health behavior.

Det svenska samhället blir alltmer mångkulturellt. I och med den ökade invandringen behöver hälso- och sjukvård uppmärksamma kulturens betydelse för patienters hantering av sin sjukdom. Utan förståelse för individers kulturella värderingar är det svårt för vårdpersonal att förstå hur individers copingmönster påverkas vid ohälsa. Syftet med litteraturstudien var att belysa hur kulturella hälsoövertygelser kan påverka människors copingmönster vid ohälsa. Till resultatet användes 13 artiklar (elva kvalitativa, en kvantitativ samt en som var både kvantitativ och kvalitativ) som granskades och analyserades. Resultatet visade att sociala relationer kunde ha både en negativ och positiv påverkan på individens copingmönster. Samhällets negativa värderingar kring ohälsa kunde leda till stigmatisering. Kulturella behandlingsstrategier kunde bidra till ökad coping men också skapa konflikt då det gick emot västerländsk medicinsk behandling. Andlighet och religiositet visade sig ha en viktig funktion för att förklara och hantera ohälsa. Individens kunskap kring hälsotillståndet hade en betydande påverkan vid hantering av ohälsa då brist på kunskap utgjorde ett hinder för coping. Vidare forskning bör genomföras och fokusera på hur kulturella hälsoövertygelser kan påverka individens copingstrategier. Sjuksköterskan bör utveckla en ökad kulturell medvetenhet i omvårdnaden av individer oavsett härkomst. / The Swedish society is becoming increasingly multicultural. With the increased immigration there is a need for healthcare to acknowledge the meaning of culture for patients coping with their illness. Without an understanding for individuals’ cultural values, is it difficult for health professionals to understand how individuals’ coping patterns are affected during ill health. The purpose of this study was to illustrate how cultural health beliefs can affect peoples coping during illness. 13 articles were used (eleven qualitative, one quantitative, and one that was both quantitative and qualitative) in the study, that were reviewed and analysed. The results showed that social relationships could have both a negative and positive impact on the individual's coping patterns. Society's negative values ​​regarding illness could lead to stigmatization. Cultural treatment strategies could help to increase coping but also create conflict when it went against western medical treatment. Spirituality and religiosity were shown to have an important role in explaining and dealing with illness. The individual's knowledge of health had a significant impact on the management of ill health, as a lack of knowledge was an obstacle to coping. Further research should be conducted, focusing on how cultural health beliefs may influence an individual's coping strategies. Nurses should develop a greater cultural awareness in the care of individuals, regardless of ancestry.