Lay health concepts and response to medical advice about lifestyle modiffication : the case of people with a diagnosis of non-insulin dependent diabetes

Murphy, Elizabeth Ann (1992) Lay health concepts and response to medical advice about lifestyle modiffication : the case of people with a diagnosis of non-insulin dependent diabetes. University of Southampton, Doctoral Thesis.

Abstract

This thesis explores the relationship between lay concepts of health and illness and response to medical advice about lifestyle. Interviews were carried out with four general practitioners and thirty of their patients, with a diagnosis of non-insulin dependent diabetes. In the interviews with the general practitioners, beliefs about non-insulin dependent diabetes were expolored to allow comparison with patient beliefs. The patients were each interviewed twice and these interviews were tape-recorded and transcribed in full. The first interview focused upon experiences of and thinking about health and illness at a general level. The second interview was concerned with diabetes in particular. Informants' thinking in both these areas was explored using a narrative approach. In telling stories, informants displayed verbally the taken-for-granted assumptions with which they operated. Data were also collected about patients, behavioural responses to the lifestyle advice they had been offered. The general practice notes of the patients were reviewed for details of attendance, blood glucose control, weight and any evidence that lifestyle advice had been given.

Constructions of health, illness causation and diabetes are described and the implications for response to current, fashionable medical advice about lifestyle modification are considered. Considerable variation in patients' thinking about diabetes was found and incongruence between the thinking of a number of patients and their doctors is reported. A number of aspects of the patients' constructions were found to be associated with their behavioural responses to advice about lifestyle modification.

While patients and their doctors were often operating with incongruent conceptual models, there was evidence that this incongruence is rarely made explicit in doctor-patient interactions. The patients were found to be far from passive recipients of medical advice about lifestyle. Their varied responses to the advice they had been given are seen to have been rational in the light of their broader thinking about health and illness, and their particular understandings of diabetes.

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