to one’s own behaviour may lead to reduced motivation to seek professional help.
Third, beliefs about consequences, including the perceived severity of symptoms. Fourth,
timeline, refers to people’s expectations regarding the duration of symptoms and their
perceptions of whether symptoms (e.g. of diabetes or asthma) are chronic or acute can
have important implications for health seeking and adherence. Finally, beliefs about
control and treatment effectiveness, including, for example, perceptions of whether the
illness can be cured strongly affect help seeking. For example, Leventhal et al.(1997)
found that help seeking is more likely if ambiguous symptoms are detected when
someone is also stressed but only if the stress has lasted for three weeks or more. Initially
stress may be seen as the cause of a symptom and so it may be expected to be short-
lived or to have only minor consequences but if the stress is perceived to be stable
symptoms may be regarded as more serious and long term. Perception of bodily
sensations and symptoms is also affected by individual goals and coping strategies
(Cioffi, 1991).
Note how the findings of Berkanovic et al.(1981, see above) highlight two of the
categories of beliefs proposed by Leventhal and colleagues, namely, perceived symptom
seriousness (consequences) and perceived efficacy of care (control and treatment
effectiveness). Note too that these five categories of illness beliefs overlap with beliefs
specified by the social cognition models we studied in Chapter 7. For example, the
health belief model and the theory of planned behaviour identify beliefs about
consequences as important to intention and action and the theory of planned behaviour
and social cognitive theory emphasize the importance of perceived control to action.
Finally, look back at Activity 8.1 and compare patients’ questions about medication
to the beliefs associated with consultation.
Personality and emotional responses affect symptom
interpretation
Emotional responses affect symptom reporting and health service usage. For example,
Rietveld and Prins (1998) found that negative emotions did not affect objective
measures of children’s asthma but made it more likely that children would interpret
normal exercise-related sensations (e.g. heart pounding and fatigue) as indicating
asthma. Those experiencing more negative emotions reported greater breathlessness,
regardless of objective symptoms. Patterns of emotional responding are predicted by
personality assessments (see Chapter 6) so that, for example, those high in neuroticism
report more symptoms (Watson and Pennebaker, 1989). For example, in a study of
cold infections, Feldman et al.(1999) found that while neuroticism was not related to
objective measures of infection, this trait was associated with symptom reporting among
healthy people. Those scoring in the top third of the neuroticism distribution reported
more than twice as many symptoms as those in the bottom third. These researchers
suggest that this is because higher neuroticism leads to greater attention to somatic
experiences and potential symptoms; a conclusion supported by other research (Kolk
et al., 2003).
Other personality factors shape symptom detection and perception. For example,
while pessimism may be bad for one’s health (see Chapter 6), pessimists seem to be
more accurate in assessing their health. Leventhal et al.(1997) report that self-reported
ratings of health were better predictors of mortality 5 years later among pessimists than
232 RELATING TO PATIENTS