GRO 325 Aging & Health WK5-D2

THE SICK ROLE:

What is the “sick role”?

· The sick role can be thought of as part of the normal stages of being ill and recovering

· Stages of illness:

· Perception of symptoms and determination of illness

· Assuming the “sick role” – giving up normal social obligations and roles

· Seeking medical care

· Assuming the dependent patient role to receive care

· Responding to care and achieving recovery

· Participating in rehabilitation to restore normal function

· Illness as deviance:

· Society provides the “gift of deviance” so that the individual is excused from normal social roles and obligations – this allows the person to seek care, obtain treatment, and recover

· Society does not blame the sick person for being ill and endorses the dependent patient role

Factors maintaining the sick role:

· Secondary gain:

· interpersonal or social advantage gained as a consequence of illness

· a perceived value in being ill

· Operant conditioning: 

· positive attention from others is a reward that  reinforces symptoms

· increased solicitousness and care may actually slow recovery

· Relief of responsibility:

· Relief of responsibility for school, work and other obligations as a consequence of illness

· May be influenced by self-efficacy (belief in one’s competence and mastery)

· Vulnerability:

· Vulnerability – the individual is in need of care due to biological factors related to the actual illness

· Being made vulnerable – the individual is socialized as being vulnerable by caregivers and society 

Factors causing variability in the sick role:

· Cultural beliefs may impact the “gift of deviance” :

· Despite illness, culture may not support excusing the individual from normal social obligations and roles

· Socioeconomic factors may prevent the individual from adopting the sick role:

· Despite illness, the person may need to continue to work a job

· Despite illness, the person may not be able to afford medical care

· Society’s view of specific illnesses:

· Some conditions are no longer viewed as medical illnesses – e.g., homosexuality

· Some conditions are no longer viewed as voluntary “choices” – e.g., alcoholism (now viewed as a medically-treatable illness)

· Some conditions may be viewed as the fault of the patient – e.g., lung cancer in smokers

· Increase in the desire for self-care:

· Individuals may desire to take more control of medical care options and resist the dependent patient role

· Resistance of traditional medical treatments may cause the individual to seek out alternative treatments

Leaving the sick role:

· Recovery from serious illness (such as cancer) includes a return to normal function

· This return to normal function often includes return to work (RTW)

· There are often very intense emotions surrounding a return to normal function and activities

· Preparation for a return to normalcy may take months of personal reflection and can be viewed as a type of behavioral change that progresses through stages of change (precontemplation, contemplation, preparation, action, maintenance) as described by the Transtheoretical Model (TTM) of behavior change

· Factors important in leaving the sick role:

· Vulnerability – being vulnerable (biological factor) or being made vulnerable (social factor)

· Self-efficacy – belief in personal competency (psychological factor)

· Cognitive – being able to analyze risks and benefits (psychological factor)

BARRIERS TO HEALTHCARE UTILIZATION AND HEALTH EQUITY:

Healthy People 2020:

· Healthy People is the federal government initiative that is the foundation of health promotion (prevention) efforts in the USA

· It is part of the U.S. Department of Health and Human Services (HHS)

· There are specific goals identified by this program to “create a healthier nation”

· Homepage:  http://www.healthypeople.gov/2020/default.aspx (Links to an external site.)Links to an external site.

· Specific Strategies and Goals:  http://www.healthypeople.gov/2020/topics-objectives (Links to an external site.)Links to an external site.  

· One goal of Healthy People 2020 is to: “Improve access to comprehensive, quality health care services”

The goal of health equity:

· From the Centers for Disease Control (CDC) website:

· “Health equity is achieved when every person has the opportunity to “attain his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.”

· See:  http://www.cdc.gov/chronicdisease/healthequity/ (Links to an external site.)Links to an external site.

· Part of promoting health equity is to eliminate health disparities (inequities)

· Impact of health inequities:

· mortality (length of life)

· quality of life (QOL)

· rates of disease (incidence – rate of new diagnosis of disease in a population; prevalence – amount of existing disease in a population)

· disability

· severity of disease states (health outcomes)

· access to treatment 

Health maps – mapping social determinants of health:

· Social determinants that drive health disparities

· These determinants include socioeconomic status, transportation, housing, access to health services, factors creating discrimination (race, gender, class), social or environmental stressors (e.g., natural disasters, pollution), having health insurance, having a primary care provider (PCP)

· The CDC provides health maps – for instance, for the social determinant of poverty:  http://www.cdc.gov/dhdsp/maps/sd_poverty.htm (Links to an external site.)Links to an external site.

· The Health Resources and Services Administration (HRSA) also provides data maps for various determinants of health equity (disparities):  http://www.hrsa.gov/data-statistics/index.html (Links to an external site.)Links to an external site.

Initiatives to reduce health disparities:

· The Agency for Healthcare Research and Quality (AHRQ) provides toolkits and maintains data regarding healthcare disparities

· The main area that maintains this information is the National Healthcare Quality and Disparities Reports (NHQR/DR) on the AHRQ website:  http://nhqrnet.ahrq.gov/inhqrdr/ (Links to an external site.)Links to an external site.

· Important basic health services for children:

· Infant exams to check for developmental milestones and general health

· Immunizations for vaccine-preventable diseases

· Screening for overweight/obesity, lead poisoning, anemia and other common childhood ailments

· Important basic health services for adults:

· Screening for and managing abnormal body weight, blood pressure and cholesterol

· Screening as appropriate for age and sex for cancers to improve early detection (e.g., breast, colon, skin)

· Screening and treatment of sexually transmitted diseases (STDs) to improve the health of the community and prevent infertility

· Senior health checkups to screen for age-related conditions (e.g., sensory losses in vision and hearing)

Centers for Disease Control (CDC). (2013) Percentage of Percentage of persons of all ages who failed to obtain needed medical care due to cost at some time during the past 12 months: United States, 1997–2012.  Early Release of Selected Estimates Based on Data From the 2012 National Health Interview Survey, from: http://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201306_03.pdf (Links to an external site.)Links to an external site.

  Health literacy as a tool to improve health equity:

· “The Patient Protection and Affordable Care Act of 2010, Title V, defines health literacy as the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions” (Centers for Disease Control and Prevention, 2015, para. 1) Retrieved from http://www.cdc.gov/healthliteracy/Learn/index.html (Links to an external site.)Links to an external site.

· Individuals cannot make decisions without accurate and reliable information

· Health literacy includes the ability to access such information, as well as the ability to interpret and understand how to apply this information to their own care

· Goals of health literacy:

· Provide everyone with access to accurate and actionable health information

· Deliver person-centered health information and services

· Supportlifelong learning and skills to promote good     

· Examples of health literacy tasks:

· Calculating medication doses

· Evaluating information for reliability and accuracy

· Interpreting medical test results

· Locating health information and analyzing risks and benefits of recommendations

· Skills needed to support health literacy:

· Various forms of literacy support health literacy

· Computer literacy, informational literacy, numerical/computational literacy, visual literacy

· Barriers to health literacy:

· Non-English speaking or English as Second Language (ESL)

· Minority, immigrant, and ethnic populations

· Cultural considerations (health beliefs and practices)

· Lifespan considerations (e.g., older adults)

· Impact of low health literacy:

· Reduced utilization of health promotion services (e.g., immunizations)

· Increased rates of hospitalization

· Increased rates of adverse health outcomes

· Increased mortality rates

· Plain language as a tool for health literacy:

· “Chunking” complex materials into smaller pieces to make it more understandable

· Organizing information so that the most important topics, facts or concepts are presented first

· Using simple language and being sure to define all technical terms; avoiding jargon

· Use the “active voice” – this is where the subject of the action performs the action designated by the verb:

· Passive voice:  “Immunizations were obtained by only one-third of the group”

· Active voice:  “One-third of the group obtained immunizations”

· National Library of Medicine (NLM) FAQ page:  http://nnlm.gov/outreach/consumer/hlthlit.html (Links to an external site.)Links to an external site.

· The Centers for Disease Control (CDC) has information on state health literacy activities:  http://www.cdc.gov/healthliteracy/ (Links to an external site.)Links to an external site.

· Agency for Health Research and Quality (AHRQ) has a Health Literacy Universal Precautions Toolkit (2015) that provides practical ways (actual tools) to address health literacy in the clinical setting: http://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/healthlittoolkit2.pdf (Links to an external site.)Links to an external site.

Advanced Planning and End of Life Decisions:

· Part of health literacy is knowing the availability of choices for end of life care

· This includes long-term care options as well as making advance decisions for healthcare at the end of life using instruments such as living wills

· For an overview, see the Mayo Clinic website: http://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/living-wills/art-20046303 (Links to an external site.)Links to an external site.

VIEW VIDEO: End of Life Decisions (Links to an external site.)Links to an external site.

PBS. (2012, September, 23). End of Life Decisions. [Video File] Retrieved from  http://www.pbs.org/wnet/need-to-know/video/video-end-of-life-decisions/14965/

Additional Resources:

The Sick Role:

1. Walker, L. S., Claar, R. L., & Garber, J. (2002). Social consequences of children’s pain: When do they encourage symptom maintenance? (Links to an external site.)Links to an external site. J Pediatr Psychol, 27(8): 689–698.   Retrieved from:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3145212/?report=classic

2. Tiedtke, C., de Rijk, A., Donceel, P., Christiaens, M., & Dierckx, B. (2012).  Survived but feeling vulnerable and insecure: A qualitative study of the mental preparation for RTW after breast cancer treatment (Links to an external site.)Links to an external site. . BMC Public Health, 12(538). doi:10.1186/1471-2458-12-538

Health Equity and Health Literacy:

1.  Access to health care (Links to an external site.)Links to an external site. . (n.d.). Retrieved from http://www.cdc.gov/nchs/fastats/access-to-health-care.htm

· CDC site providing data on access to health care (FastStats).

2.  AHRQ fact sheets (Links to an external site.)Links to an external site. . (n.d.). Retrieved from http://www.ahrq.gov/research/findings/factsheets/index.html

3. Brega, A. G., Barnard, J., Mabachi, N. M., Weiss, B. D., DeWalt, D. A., Brach, C.,…West, D. R. (2015).  AHRQ health literacy universal precautions toolkit (2nd ed.) (Links to an external site.)Links to an external site. . Retrieved from http://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/healthlittoolkit2.pdf

· This resource provides practical ways (actual tools) to address health literacy in the clinical setting.

4.  CDC website on Health Literacy (Links to an external site.)Links to an external site. . (http://www.cdc.gov/healthliteracy/introduction.html)

5.  NQS reports and annual updates (Links to an external site.)Links to an external site. . (n.d.). Retrieved from http://www.ahrq.gov/workingforquality/reports.htm 

· AHRQ reports on health disparities.

6. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). National action plan to improve health literacy (Links to an external site.)Links to an external site. . Retrieved from http://www.health.gov/communication/hlactionplan/pdf/Health_Literacy_Action_Plan.pdf

Course Text: Ferrini, A. & Ferrini, R. (2013). Health in the later years (5th ed.). New York, NY. McGraw-Hill