PL3242: Health Psychology - Position Paper
Position Paper on Implications of Reseach on Illness Cognition for Dealing with Emerging Infectious Diseases
Tan Jia Xin Jacinth, Group 1
Question Addressed:
This position paper seeks to address the question: What are the implications of research on illness cognition for dealing with emerging infectious diseases such as SARS or bird flu?
Discussion Summary:
The group discussion comprised types of illness representation revealed through research, their effects on people’s understanding of SARS and bird flu, and applying this knowledge to developing possible coping responses to these infectious diseases.
In examining the various illness representations, there was general agreement that disease prototypes held by people were largely influential on how they react at respond to the disease. A particularly common disease prototype of SARS was presented by a member which stated fever as the initial characteristic symptom, close contact with SARS-infected people as the usual means of contagion, and death as a likely consequence, to name a few. Such a schema was the basis for how people react and respond to the disease.
For instance, one member pointed out that perception and interpretation of common symptoms such as fever differed on occasion. Since fever was a characteristic symptom for SARS, there was inevitably major concern towards fever. As such, people might pay greater attention to body temperature, which could be translated into perceived feelings of body warmth and duly interpreted as fever, a sign of SARS infection. This would lead to feelings of panic and immediate medical help would be sought.
With death frequently reported as a consequence, one member noted that it is no wonder that SARS was considered a disease of fear. Another member gave further elaboration by highlighting a research study which showed that psychological distress and anxiety can influence the way people make sense of their symptoms. Under such states, people are likely to misinterpret any symptoms, typically in the worst sense, which could result in wastage if time and resources were to be misdirected to them.
In view of these problems, a number of coping responses were suggested by members in dealing with infectious diseases. Members unanimously proposed the indispensable role that the media and government should play. Since knowledge of illness influences one's interpretation, detection and control of disease, the media and health authorities handling any disease crisis like SARS or bird flu must send out clear messages to the masses and provide accurate information and knowledge on the exact symptoms and the best course of action to be taken. It was also suggested that by educating the public on the exact nature of SARS or bird flu and how to react calmly towards possible symptoms, time and health care resources can then be appropriately focused on those who are really in need of them.
On the government’s part, most members pointed out the importance of government transparency in reporting the number of cases of infection during the crisis. One member quoted the example of China’s cover-up of number cases reported in both the SARS and bird flu pandemic which led to many undetected cases and its citizens unaware of the precise seriousness of the pandemic. Such ignorance can result in complacency of the public in taking social responsibility to contain the disease.
Other coping responses suggested include having medical personnel to take safety precautions, so as to prevent discrimination and misunderstanding of the health status of doctors and nurses, as well as developing measures directed towards breaking the chain of transmission of SARS and bird flu such as having quarantine, since they are largely transmitted via human contact.
Illness Cognition: Dealing with Emerging Infectious Diseases
The understanding of illness is often developed through cognitive schemas that people use to organize information about illness. More specifically referred to as disease prototypes, such representations of illness are known to “provide the basis for the person’s active attempts to understand and appropriately respond to potential health threats” (Bishop, 1991b).
Despite being a standard representation of illness, prototypes of the same disease can vary according to the kind of information obtained by individuals and interpretations of these prototypes can be subjective. Such varying understanding of disease would subsequently affect how people cope with them.
This issue is especially pertinent to emerging infectious diseases such as SARS and bird flu, which vast research and literature has been dedicated to both since their appearance in mainly Asian countries. In this paper, the types of perception and interpretation of infectious diseases, namely SARS and bird flu, revealed from research thus far will be addressed. The reasons and effects of holding such illness representations on people will be examined and following which, the major implications of these effects on coping responses to SARS and bird flu will be discussed.
Looking at SARS, a particularly common disease prototype indicated fever as the initial characteristic symptom, close contact with SARS-infected people as the typical means of contagion, and death as a likely consequence (Washer, 2004). These components apparently had an effect on how people reacted and responded to their own symptoms and the disease.
With fever, a common symptom, noted as a characteristic symptom for SARS, there was an inevitable major concern towards having it. As such, people might pay greater attention to body temperature, which could be translated into perceived feelings of body warmth and duly interpreted as fever, a sign of SARS infection. This would lead to feelings of panic, which perhaps would raise body temperature again since they are aroused. Not discounting the fact that some fever cases may be true symptoms of SARS, a good number of cases could be a result of such over reaction towards the disease.
Since death as a consequence is featured in disease prototypes due to frequent reports of death toll in affected areas, SARS evolved partially into a “disease of fear” and was thought to be “a ‘mystery’ disease, with the aura of being able to strike anyone, anywhere, anytime” (Smith, 2006). This would contribute to psychological distress and anxiety and which research has shown can influence the way people make sense of their symptoms (Cheng, Chong, Chang & Wong, 2006). Under such states, people are likely to misinterpret any symptoms, typically in the worst sense, which could result in wastage if time and resources were to be misdirected to them.
Learning that one of the major means of transmission of SARS as direct contact with those infected can result in over-cautious behaviour such as staying home as much as possible to prevent contact with anyone, as well as discrimination towards SARS patients, survivors and those at risk of SARS, particularly the health care professionals. While over-cautious behaviour is not all that bad apart from how the person’s daily life activities could be affected, discrimination has been shown to cause significant psychological distress for patients and survivors (Lee, Chan, Chau, Kwok & Kleinman, 2005), which in turn affects their “perceived impact” and “coping efficacy” on their stressful experience with SARS (Cheng, Chong, Chang & Wong, 2006).
Similarly, research has illustrated that individual’s understanding of bird flu affects their reactions and responses to the disease. However, as much as research has found that “age, avian influenza contagion worries, husbandry threat, avian influenza threat, and avian influenza anxiety predicted perceived sickness risk” (Fielding, Lam, Ho, Hedley & Leung, 2005), people’s actual perceived sickness risk towards bird flu is still very limited (Zwart, Velhuijzen, Elam, Aro, Abraham, Bishop, Richardus & Brug, 2007).
Research by Fielding et al. in 2005 offered three reasons for the general population’s high-risk behaviour which was a result of their low perceived risks of contracting bird flu. Firstly, some people are doubtful about certain dangers that were told to them and are thus, unlikely to change their behaviour. Secondly, some feel the helplessness in dealing with the disease and lastly, some of them have had frequent exposure to hazards and the fact that they survived meant unnecessary focus on risk. Such cognitions they have of the risk of contracting bird flu consequently led them to respond to the disease with little caution and complacency.
The low level of risk perception among people in bird flu infected areas has also been attributed to their “proximity to the current outbreak and the experience with the SARS epidemic”. Slightly different from the earlier reasons given, these experiences have created the belief that infectious diseases can be controlled and such optimism accounts for their reduced risk perception (Zwart et al., 2007).
So far, in examining the different cognitions people have of SARS and bird flu and how it affects their reactions and responses to these diseases, it seems that while their understanding of the disease have largely impacted their behaviour, these behaviour seem to be antagonistic to each other. Cognitions of SARS typically result in an over reactive and anxious response whereas cognitions of bird flu result in indifference and complacency towards their risk perception. Nevertheless, the understanding of these differences has important implications on developing appropriate coping responses to these infectious diseases.
Since information that people obtain about diseases would determine the prototypes they form of them, sources of information, particularly the media, must be able to send clear and accurate messages regarding the disease and the situation. This seems to be exceptionally challenging because many problems discussed earlier on were mainly the doings of the media.
SARS as a disease of fear was developed due to the media “manufacturing threats to public health by drawing upon past and present cultural myths of dangerous ‘others’, and in so doing contribute to unwarranted public fear, intolerance, and distrust” (Smith, 2006). A survey conducted regarding the quality of Canadian media in communicating information about SARS revealed that conflicting messages were often conveyed which brought about confusion to the public and their coverage was considered “excessive, sometimes inaccurate, and sensationalist” (Smith, 2006). Discrimination towards SARS infected patients and survivors were also attributed to “miscommunication by the media in rapidly amplifying stigma toward an unfamiliar illness” (Lee et al., 2005). Thus, before the media can be utilized as an accurate means of disseminating disease related information, it has to undo the harm it has caused initially.
Perhaps in face of any disease crisis in future, the media should gear towards working closely with the health organizations to understand the precise nature of the disease so as to ensure that the information they communicate to the public ultimately is credible. The media should also refrain from loading reports of the disease with any values and judgments and simply present the health warnings and information as they are. This would prevent any form of sensationalized news that could evoke unnecessary anxiety or emotions in the people.
The government is another important source of information who can obtain a large wealth of information given its authority and connections. However, as in the case of the media, governments have been found to withhold certain information from the public, such as the precise number of cases of the disease and the resulting death toll, which renders them unreliable. The classic examples would be the
Such cover-ups can have a profound negative impact on people’s understanding of the diseases as well as their associated response. In both cases of SARS and bird flu, the inaccurate report of case numbers would mask the seriousness of the spread of disease in that country, which would also affect the level of caution its people would exercise. The undermining of the situation of the crisis is even more dangerous for bird flu, in which research has shown that the level of perceived risks among people of affected areas is already low. Withholding the true case numbers would encourage these people to persist in their complacency and continue to engage in behaviours that would put them at greater risk of contracting the disease. Thus, it is extremely crucial that government must, at all costs, be transparent in releasing information to the public regarding the any crisis situation.
The government should also play an active role in educating the public regarding the contagiousness of the disease and as far as possible, address possible stigmas that could be attached to patients and survivors. They could also regulate the media in the type of information they present, especially in disallowing any direct or indirect perpetuation of disease related stigmas to be published. Most importantly, “clarity of responsibility, authority and accountability during outbreaks, from local to the global levels, is imperative for effective action” (Smith, 2006) and so it is the duty of the government to ensure this.
With the knowledge of people’s tremendous concern, fear and anxiety towards SARS, health authorities or any related organizations and departments should assume the responsibility of dealing with these problems. They could devise a management guide which addresses the concerns people might have and suggest ways of dealing with them. An excellent example of how this could be done would be the guide for management of SARS in the psychological aspect formulated by the Social Welfare Department in
In this guide, the public’s concern and anxiety towards SARS were highlighted and acknowledged as natural and understandable. In helping them deal with such feelings, ways of coping responses were suggested, such as practicing relaxation and managing anxiety by limiting their exposure to news reports of SARS (Social Welfare Department, 2004). This method of helping the public cope with the crisis appears to be very useful and effective since their concerns are addressed directly and not dismissed, and as the welfare department demonstrates their understanding of the people’s possible thoughts and suggest ways to cope with them, these people can be calmed down and assured that they can be in control of the situation.
Lastly, as discussed earlier, people seem to be more apathetic towards the spread of bird flu because they are often unconvinced of certain indicated risks, have no perceived sense of control over the disease and have survived supposed risks which made them feel invulnerable. Therefore, it seems only appropriate that efforts in dealing with the disease should be directed at emphasizing risk communication, to greater impress upon them the importance of high risk perception, as well as developing ways to increase their sense of self-efficacy in dealing with the disease (Zwart et al., 2007).
For example, risk communication can be emphasized through heavy advertising by the media to bring up the various high-risk behaviours, such as buying live chickens, and underscore the consequences associated with such behaviour. Since these people appear to be more apathetic, fear appeals could possibly be used to induce some level of concern and anxiety in them. As for increasing their sense of self-efficacy with regard to the disease, a guide for coping responses similar to the one by the Hong Kong Social Welfare Department could be developed, for the same purpose of assuring people that they can be in control of the crisis and disease.
To recapitulate, understanding illness by means of disease prototypes can lead to subjective perception and interpretations of the disease, which then influences our reactions and response towards it. As such, once we are able to comprehend how and why people respond to diseases in a certain way, it can then form the basis on which problems associated with the instigator of their reactions and response can be identified and appropriate coping methods can be developed to help them better deal with any emerging infectious disease.
References
Bishop, G.D. (1994). Health Psychology: Integrating Mind and Body.
Cheng, Sammy K.W., Chong, George H.C., Chang, Sonia S.Y., Wong, Chee Wing, Wong, Connie S.Y., Wong, Mike T.P. & Wong, Kit Ching. (2006). Adjustment to severe acute respiratory syndrome (SARS): Roles of appraisal and post-traumatic growth. Psychology and Health, 21, 301-317
Fielding, Richard, Lam, Wendy W.T., Ho, Ella Y.Y., Lam, Tai Hing, Hedley, Anthony J. & Leung, Gabriel M. (2005). Avian Influenza Risk Perception,
Lee, Sing,
Smith, Richard D. (2006). Responding to global infectious diseas outbreaks: Lessons from SARS on the role of risk perception, communication and management. Social Science & Medicine, 63, 3113-3123
Social Welfare Department (2005). Management of the Severe Acute Respiratory Syndrome (SARS)– Psychological Aspects.
Washer, Peter. (2004). Representations of SARS in the British Newspapers. Social Science & Medicine, 59, 2561-2571
Zwart, Onno de, Veldhuijzen, Irene K.,
posted by jac jac @ 3:57 PM
0 Comments
0 Comments:
Post a Comment
Subscribe to Post Comments [Atom]
<< Home