Health Behavior Emerging Research Perspectives Health Behavior Emerging Research Perspectives

Edited by David S. Gochman Raymond S. Kent School of Social Work University of Louisville Louisville, Kentucky

SPRINGER SCIENCE+BUSINESS MEDIA, LLC Library of Congress Cataloging in Publication Data

Health behavior: emerging research perspectives / edited by David S. Gochman. p. cm. Includes bibliographies and index.

1. Health behavior. I. Gochman, David S. RA776.9.H43 1988 88-19672 613-dcl9 CIP

ISBN 978-1-4899-0835-3 ISBN 978-1-4899-0833-9 (eBook) DOI 10.1007/978-1-4899-0833-9

109 8765

No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher This book is dedicated to the cherished memory of my parents, Edward B. and Vesta Gabriel Gochman, who early in my life encouraged me to persevere, to seek quality, and to pursue scholarship; and to Esselyn C. Rudikoff, a psychologist and treasured friend, whose example and insights inspired me to understand behavior. Contributors

Arnold Arluke Department of Sociology and Anthropology, Northeastem University, Boston, Massachusetts

Alice J. Baumgart School of Nursing, Queen's University, Kingston, Ontario, Canada

Zeev Ben-Sira School of Social Work, The Hebrew University of Jerusalem, Mount Sco• pus, Jerusalem, Israel

Philip K. Berger Martin School of Public Administration, University of Kentucky, Lex• ington, Kentucky

John G. Bruhn School of Allied Health Sciences, University of Texas Medical Branch, Galveston, Texas

Patricia J. Bush Laboratory for Children's Health Promotion, Department of Community and Family Medicine, Georgetown University School of Medicine, Washington, D.C. Henry P. Cole Department of Educational and Counseling Psychology, University of Kentucky, Lexington, Kentucky Edith A. Costello School of Nursing, Queen's University, Kingston, Ontario, Canada

Robert E. Davidson Department of Social Science, Illinois Institute of Technology, Chi• cago, Illinois

Alice E. Fusillo U.S. Department of Health and Human Services

Eugene B. Gallagher Departments of Behavioral Science and Sociology, University of Kentucky, Lexington, Kentucky

Thomas F. Garrity Department of Behavioral Science, University of Kentucky, Lexing• ton, Kentucky

Reed Geertsen Department of Sociology, Utah State University, Logan, Utah

David S. Gochman Raymond A. Kent School of Social Work, University of Louisville, Louisville, Kentucky vii viii CONTRIBUTORS

James R. Greenley Department of Sociology, University of Wisconsin, Madison, Wisconsin

Marie R. Haug Center on Aging and Health, Case Western Reserve University, Cleve• land, Ohio

Ronald J. Iannotti Laboratory for Children's Health Promotion, Department of Com• munity and Family Medicine, Georgetown University School of Medicine, Washington, D.C.

Stephen Kaplan Department of Psychology, University of Michigan, Ann Arbor, Michigan

John P. Kirscht School of Public Health, University of Michigan, Ann Arbor, Michigan

Lloyd J. Kolbe Office of School Health and Special Projects, Division of Health Edu• cation, Center for Health Promotion and Education, U.S. Centers for Disease Control, Atlanta, Georgia

Richard R. Lau Department of Social and Decision Sciences, Carnegie-Mellon Univer• sity, Pittsburgh, Pennsylvania

Philip R. Nader Department of Pediatrics, University of California at San Diego, La Jolla, California

Christian Ritter Department of Sociology and Anthropology, Kent State University, Kent, Ohio

Debra L. Roter Department of Behavioral Sciences and Health Education, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland

James F. Sallis Department of Pediatrics, University of California at San Diego, La Jolla, California

Alexander Segall Department of Sociology, University of Manitoba, Winnipeg, Manitoba, Canada

Ingrid Waldron Department of Biology, University of Pennsylvania, Philadelphia, Pennsylvania

Hazel H. Weidman Office of Transcultural Education and Research, Department of Psy• chiatry, University of Miami School of Medicine, Miami, Florida

Bruce A. Whitehead College of Information Studies, Drexel University, Philadelphia, Pennsylvania

Fredric D. Wolinsky Department of Sociology, Texas A & M University, College Station, Texas Preface

HEALTH BEHAVIOR AS BASIC RESEARCH

Health behavior is not a traditional discipline, but a newly emerging interdisciplinary field. It is still in the process of establishing its identity. Few institutional or organizational structures, i.e., departments and programs, reflect it, and few books and journals are directed at it. The primary objective of this book is thus to identify and establish health behavior as an important area of basic research, worthy of being studied in its own right. As a basic research area, health behavior transcends commitment to a particular behavior, a specific illness or health problem, or a single set of determinants. One way of achieving this objective is to look at health behavior as an outcome of a range of personal and social determinants, rather than as a set of risk factors or as targets for intervention strategies directed at behavioral change. The book is thus organized pri• marily in terms of the size of the determinants of concern, rather than in terms of specific health behaviors, or specific health problems or conditions. With the first part of the book establishing working defmitions of health behavior and health behavior research as basic frameworks, the second part moves from smaller to larger systems, informing the reader about basic research that demonstrates how health behavior is determined by personal, family, social, institutional, and cultural factors. These distinctions reflect some arbitrar• iness: the family, organizations, and institutions, for example, are social units. Moreover, families, social groupings, and organizations reflect elements of the culture in which they exist. Furthermore, the categorizing and sequencing of sections and chapters in no way reflects an attempt to exclude material that deals with other levels of determinants; it serves primarily to facilitate focusing more on one of these determinants than on others. Because so much of health behavior is determined by encounters with the care delivery system, particularly with health professionals, the third part of the book examines the way such encounters determine health behaviors, and how health behaviors and the care de• livery system affect one another. This part includes a section on perceptions and inter• actions, and a section on power, compliance, and control. The final part considers the relevance of knowledge generated by health behavior research in the training of health professionals, in health promotion and education, and in clinical applications, as well as future research directions and issues. To emphasize and ensure the basic research commitment, contributors were advised that the book was not intended to be yet another volume on behavioral aspects of treatment, or on behavior and the medical model. They were asked to describe current knowledge relevant to their topics, to focus heavily on research dealing with basic concepts, and to ix x PREFACE include critical discussion of research and theoretical issues, together with their thoughts about future research directions. At appropriate stages, outlines and manuscripts were monitored carefully to encourage contributors to refer as much as possible to empirical data, and to ensure that there was no inappropriate emphasis on interventions and pro• grammatic descriptions.

THE STATE OF THE ART

A second objective of the book is to present a representative selection of current health behavior research findings in a single volume. Although texts and books of readings are available in related areas, such as medical sociology (e.g., Mechanic, 1978, 1980; Wolinsky, 1988), health psychology (e.g., Sanders & Suls, 1982; Stone, Cohen, & Adler, 1979), and behavioral health (e.g., Matarazzo, Weiss, Herd, Miller, & Weiss, 1984), none of these were intended to address health behavior systematically. Accordingly, none present a broad spectrum of basic, representative health behavior research. The present volume thus presents the reader with "the state of the art" in health behavior research.

DIVERSITY OF PERSPECTIVES

A third objective is to ensure that the reader is exposed to varied perspectives in conceptual models, disciplines, populations, and methods, as well as to nonmedical frames of ref• erence. This book exposes the reader to role theories, the health belief and locus of control models, sociology of knowledge frameworks, path analyses, organizational theory, con• cepts related to physical space, "health culture," as well as other conceptual paradigms. The contributors have training or professional involvements in anthropology, education, health education and health promotion, information sciences, nursing, medicine, psy• chology, public health, social work, and sociology.

DIVERSITY OF READERS

This book is intended for persons in a number of fields who are interested in issues related to research in health behavior. These include researchers in the social and behavioral sciences who want to know more about health behavior in general, or particular aspects of it, or who want to develop their own health behavior research; students in courses that integrate social and behavioral science and health, in disciplines such as anthropology, psychology, and sociology, and in professional programs in dentistry, medicine, nursing, public health, and social work; professionals who provide, plan, implement, and evaluate health services and programs: health eductors and promoters; health planners; public health dentists, nurses, and physicians; physicians in community and family practice; social workers; family planners; and hospital administrators.

DELIBERATE OMISSIONS

Notably absent from this book are chapters devoted to research on topics such as "Type A" personality, psychosomatics, and stress. While these are closely linked to health status, and sometimes to health behavior, they have been omitted because they are more generally models for understanding the etiology of disease and illnesses. Furthermore, although PREFACE xi wholism has become a catchword among many who disavow the traditional medical model, the term has come to include charlatanism and cultism, as well as some impressive ap• proaches to treatment. Presently, it remains more a statement of faith suggesting future research alternatives, than a body of well-thought-through, rigorously conducted research. Moreover, caution against a reverse "ethnocentrism," and overly romanticized views of non-high-technology medicine is cogently provided by Eisenberg and Kleinman (1981, p. 10): "Healing ceremonies can be efficacious, but hardly substitute for antibiotics or sur• gery." Accordingly, a section on "wholism," "wholistic medicine," or "wholistic health" does not appear in this book.

THE PRACTICAL RELEVANCE OF HEALTH BEHAVIOR

The practical value of increasing knowledge about, and understanding of, health behavior through rigorous, systematic research is implicit in the grave concern with health status in many contemporary societies (e.g., Knowles, 1977). Improvements in health status are less likely to be found in high-technology medicine than in environmental and psychosocial factors (e.g., Dubos, 195911977; Matarazzo, 1984; Powles, 197411980). Although solutions to an appreciable number of health problems require large-scale efforts at local, regional, and national levels to develop and enforce policies to control, minimize, and ultimately reduce the air, land, and water pollution; the hazards of transportation; and the risks of the workplace environment, solutions to other health problems require policies, programs, and processes that involve the personal health behavior of individuals and the population at large, in their family, social, and community milieus (e.g., LaLonde, 1974; Preventive Medicine, 1976). Attempts to change individual health behaviors, either through individual therapeutic interventions or through larger-scale health promotion or health education programs, have been less than impressive. Many attempts are purely programmatic, hastily conceived, and lacking in theoretical rationale or empirical foundation. A major reason for this is the lack of basic knowlege about the target behaviors, about the contexts in which they occur, and about the factors that determine and stabilize them. Basic research in health behavior, aside from being worthy of study in its own right, may very well increase the effectiveness of interventions and programs designed to bring about behavioral change. Although dem• onstrations of the practical relevance of health behavior research are not a major objective of this book, the potential applications of such research to interventions and programs add to its value as a basic area of study.

REFERENCES

Dubos, R. (1977). The mirage of health. In J. H. Knowles (Ed.), Doing better and feeling worse: Health in the United States. New York: Norton. (Reprinted from R. Dubos, Mirage of health: Utopias, progress, and biological change, 1959, pp. 17-23, New York: Harper & Row) Eisenberg, L., & Kleinman, A. (Eds.). (1981). The relevance ofsocial science for medicine. Dordrecht: Reidel. Knowles, J. H. (1977). The responsibility of the individual. In J. H. Knowles (Ed.), Doing better and feeling worse: Health in the United States. New York: Norton. LaLonde, M. (1974). A new perspective on the health ofCanadians: A working document. Government of Canada. Matarazzo, J. D. (1984). Behavioral health: A 1990 challenge for the health sciences professions. In J. D. Matarazzo, S. M. Weiss, J. A. Herd, N. E. Miller, & S. M. Weiss (Eds.), Behavioral health: A handbook of health enhancement and disease prevention. New York: Wiley. xii PREFACE

Matarazzo, J. D., Weiss, S. M., Herd, J. A., Miller, N. E., & Weiss, S. M. (Eds.). (1984). Behavioral health: A handbook of health enhancement and disease prevention. New York: Wiley. Mechanic, D. (1978). Medical sociology: A comprehensive text (2nd ed.). New York: Free Press. Mechanic, D. (Ed.). (1980). Readings in medical sociology. New York: Free Press. Powles, J. (1980). On the limitations of modern medicine. In D. Mechanic (Ed.), Readings in medical sociology. New York: Free Press. (Reprinted from R. L. Kane (Ed.), The challenge ofcommunity medicine, 1974, pp. 89-122, Berlin: Springer) Preventive medicine, USA: Health promotion and consumer health education. (1976). A task force report sponsored by the John E. Fogarty International Center for Advanced Study in the Health Sciences, National Institutes of Health; and the American College of Preventive Medicine. New York: Prodist. Sanders, G. S., & Suls, J. (Eds.). (1982). Social psychology of health and illness. Hillsdale, NJ: Erlbaum. Stone, G. C., Cohen, F., & Adler, N. E. (Eds.). (1979). Health psychology-A handbook: Theories, applications, and challenges of a psychological approach to the health care system. San Fran• cisco: Jossey-Bass. Wolinsky, F. D. (1988). The sociology of health: Principles, practitioners, and issues (2nd ed.). Bel• mont, CA: Wadsworth. Acknowledgments

Over a period of years, many persons helped in the preparation of this book. lowe all of them my thanks. But some helped in such appreciable ways that they deserve acknowl• edgment here. I especially wish to thank Linda A. Exton for her excellent secretarial assistance, particularly in the timely and responsible preparation of formal invitations to contributors, and letters acknowledging receipt of materials and manuscripts; Charlotte A. Ford for her coordination of a variety of support activities; Jane Isert and Mary Ann Ostertag for their expeditious and careful photocopying of what must have seemed like tons of edited material; Professor Joan ten Hoor of the Ekstrom Library at the University of Louisville, for her invaluable assistance in generating computer searches relevant to my own chapters and to the editorial material introducing different sections of the book; Fr. Donald Duffy for his efforts in helping secure reprints; and Professor Donald W. Beless, Director, for the Kent School of Social Work's generosity in the use of its material and personnel resources, and for facilitating the approval of the sabbatical leave that enabled me to complete the editorial tasks in a timely way. A great debt is owed each of the contributors for the care they devoted to their chapters and for their receptivity and constructive responses to the high density of editorial sug• gestions made throughout their chapters' progress. Moreover, the suggestions of Eugene B. Gallagher and Thomas F. Garrity in response to my inquiries about potential contrib• utors are particularly appreciated. Most of all, I want to thank Professor Helen G. Deines for her insightful suggestions, and for her continuous encouragement and enthusiasm for the book's basic conception and focus.

DAVID S. GOCHMAN

xiii Contents

PART I CONCEPTIONS OF HEALTH BEHAVIOR...... • . . . 1

Chapter 1 Health Behavior: Plural Perspectives 3 David S. Gochman Health Behavior ...... 3 A Working Definition ...... 3 Preventive and Protective Behavior, Illness Behavior, and Sick-Role Behavior ...... 4 Health Behavior Research ...... 5 Antecedent or Consequent; Input or Outcome ...... 5 What Health Behavior Research Is Not ...... 6 Health, Illness, and Disease ...... 7 Personal Perspectives ...... 9 Sociocultural Perspectives ...... 11 Consensus and Confusion ...... 13 Issues for Future Research ...... 13 References ...... 14

PART II DETERMINANTS OF HEALTH BEHAVIOR ...... • • . • • ...... 19

PERSONAL DETERMINANTS: COGNITIVE DETERMINANTS • • • • • • • • • • • • • • • • • • • • • • • 21

Chapter 2 The Health Belief Model and Predictions of Health Actions 27 John P. Kirscht Introduction ...... 27 The Model ...... 27 Predictions of Health Actions ...... 28 Prevention ...... 29 Screening and Detection ...... 30 Healthy and Risky Behaviors ...... 32 xv xvi CONTENTS

Children's Health Beliefs 33 Sickness Behavior ...... 33 Threatening Health Communications ...... 35 Conceptual Issues ...... 36 References ...... 38

Chapter 3 Beliefs about Control and Health Behavior 43 Richard R. Lau Control and Stress ...... 43 Learned Helplessness ...... 44 Health Locus of Control Beliefs ...... 45 Locus of Control as a Theoretical Construct ...... 45 Review of Past Research ...... 45 How Should Health Locus of Control Beliefs Be Linked to Health Behaviors? ...... 46 The Measurement of Health Locus of Control Beliefs ...... 47 The Carnegie-Mellon University Health Project ...... 48 Scale Norms for the Lau-Ware Health Locus of Control Measure ...... 49 Health Locus of Control Beliefs and Health Behaviors: Some Representative Data ...... 51 Value Correlates of Health Behaviors ...... 53 The Development and Stability of Health Locus of Control Beliefs ...... 55 Summary and Conclusions ...... 58 References ...... 60

PERSONAL DETERMINANTS: PERsONAL CHARACTERISTICS AND LIFE-STYLE ••••••••••• 6S

Chapter 4 Life-Style and Health Behavior . . • • . . . . • • . • . . . • • • . . • • • . • • • 71 John G. Bruhn Factors Affecting the Learning of Life-Style and Personal Health Behaviors 71 The Relationship between Life-Style and Health Behavior ...... 71 A Developmental Conceptual Framework ...... 73 Factors That Shape Life-Style and Health Behaviors ...... 74 Risk, Responsibility, Reward, and Needs ...... 77 Changing Life-Styles and Health Behavior ...... 79 Barriers to Change ...... 79 Facilitators of Change ...... 80 Value Choices and Trade-OtIs of a Healthy Life-Style ...... 80 Future Research Directions ...... 82 References ...... 84

Chapter 5 Pathways to Health Behavior •.•••.•.••...••••..•.••••••• 87 Patricia J. Bush and Ronald J. Iannotti Introduction ...... 87 Advantages of Path Analysis ...... 88 CONTENTS xvii

Disadvantages of Path Analysis ...... 93 Approaches to Path Analysis ...... 95 Path Analysis to Compare Models among Subgroups ...... 96 Hierarchical Path Analysis ...... 97 Path Analysis in Longitudinal Studies ...... 98 Path Analysis to Compare Models in the Same and Different Populations .... 99 Summary ...... 100 References ...... 101

FAMILY DETERMINANTS ••••••••••••••••••••••••••••••••••••••••• 103

Chapter 6 Family Determinants of Health Behaviors 107 James F. Sallis and Philip R. Nader The Changing Nature of Families ...... 108 Family Aggregation of CVD Risk Factors ...... 108 Family Influences on Preventive Health Behaviors ...... 109 Smoking Behavior...... 109 Risk-Related Dietary Behaviors ...... 110 Physical Activity Behaviors ...... 111 Mechanisms of Family Influence ...... 111 Family Environment ...... 113 The Operant Core...... 113 Modeling ...... 114 Antecedents ...... 114 Consequences ...... 115 The Time Dimension: Family Stages ...... 116 Summary ...... 116 Implications for Intervention ...... 116 Summary and Conclusions ...... 118 References ...... 119

SOCIAL DETERMINANTS: SOCIAL STRUCTURE AND NETWORKS ••••••••••••••••••• 125

Chapter 7 Social Group Characteristics and Health Behavior 131 Reed Geertsen Early Contributions ...... 131 Suchman's Model ...... 132 Group Structures and Medical Orientation ...... 133 Testing the Model ...... 134 Reactions to the Suchman Model ...... 135 An Alternative Model ...... 136 Empirical Inconsistencies ...... 136 Cultural Orientations ...... 137 Other PopUlation Groups ...... 137 Gypsies ...... 137 Mexican-Americans...... 138 xviii CONTENTS

Blacks 140 Implications from Other Groups ...... 140 Network Approaches to Social Group Structure ...... 140 Measuring Social Networks ...... 141 Longitudinal Dimension of Social Networks ...... 142 Network Advice ...... 143 Sociocultural Variables ...... 143 Problems and Implications ...... 144 Social Networks ...... 144 Research Problems ...... 145 References ...... 146

Chapter 8 Social Supports, Social Networks, and Health Behaviors 149 Christian Ritter Introduction ...... 149 Social Supports, Social Networks, and Health Status ...... 150 Lack of Conceptual Clarity ...... 150 Social Supports, Social Networks, Social Ties: Conceptual Distinctions ..... 151 Social Supports, Social Networks, and Utilization ...... 153 Social Ties and Health Status ...... 154 Mechanisms of Influence ...... 155 Future Directions ...... 157 References ...... 159

SOCIAL DETERMINANTS: SOCIAL ROLES 163

Chapter 9 The Sick-Role Concept 169 Arnold Arluke The Model ...... 169 Structural-Functional Approach ...... 169 Sick-Role Expectations ...... 169 Secondary Gains ...... 170 Social Control ...... 171 Criticisms ...... 172 Limited to Acute Disorders ...... 173 Iatrogenesis ...... 174 Medicocentrism ...... 174 Culture-Bound and Class-Bound ...... 175 Future Research Possibilities ...... 176 Psychological Basis of Sick-Role Behavior ...... 177 Psychological Consequences of Sick-Role Adoption ...... 177 References ...... 178 CONTENTS xix

Chapter 10 Sick-Role Legitimization 181 Fredric D. Wolinsky Introduction ...... 181 The Sick Role in Light of American Values and Social Structure ...... 181 Sick-Role Legitimization as a Contemporary Issue ...... 184 The Prevalence of Sick-Role Legitimization ...... 186 The Taking of Sick Leave ...... 186 The Receipt of Prescription Medications ...... 187 Implications for Health Care Delivery and the Social System ...... 188 Implications for the Health Care Delivery System ...... 188 Implications for the Social System ...... 189 References ...... 190

Chapter 11 Gender and Health-Related Behavior 193 Ingrid Waldron Introduction ...... 193 Smoking ...... 194 Alcohol Consumption ...... 198 Accidents ...... 200 Dieting and Eating Disorders ...... 201 Physician Visits ...... 201 Conclusions ...... 204 References ...... 205

INSTITUTIONAL DETERMINANTS ••••••••••••••••••••••••••••••••••••• 209

Chapter 12 Organizational Influences on Patient Health Behaviors. • • . . . • . • •• 215 James R. Greenley and Robert E. Davidson Introduction ...... 215 Theoretical Perspective...... 216 Organizational Processes and Patient Behaviors ...... 217 Choice of Service Provider...... 217 Volume of Services ...... 219 Patient Satisfaction ...... 221 Effect of New Organizational Forms...... 223 Response of Managers, Practitioners, and Patients ...... 224 Future Research Directions ...... 225 Conclusion ...... 226 References ...... 227

Chapter 13 The Design of Physical Environments and Health Behavior. . • . . • •• 231 Bruce A. Whitehead, Alice E. Fusillo, and Stephen Kaplan Introduction ...... 231 Participatory Health Behavior ...... 232 xx CONTENTS

Human Needs and the Physical Environment ...... 233 Comprehension of the Environment ...... 236 Consumer Participation in the Design Process ...... 237 Conclusion ...... 239 References ...... 240

CULTURAL DETERMINANTS. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •• 243

Chapter 14 Cultural Factors in Sick-Role Expectations 249 Alexander Segall Sociocultural Determinants of Health-Related Behavior ...... 249 Situating the Sick Role in a Sociocultural Context ...... 250 Limitations of the Parsonian Sick Role Model ...... 250 Redefining the Rights and Duties of the Sick Role ...... 251 Exploring Sociocultural Factors and Sick-Role Behavioral Expectations ...... 253 A Review of Existing Research ...... 253 Some Recent Empirical Evidence ...... 255 Future Sick Role Research ...... 257 References ...... 259

Chapter 15 A Transcultural Perspective on Health Behavior 261 Hazel H. Weidman Introduction ...... 261 Definition of "Transcultural Perspective" ...... 261 The Health Culture Concept ...... 262 Macro-Level Concepts ...... 263 Micro-Level Concepts ...... 263 Analytic Dimensions of Health Culture ...... 263 Symptoms and Care-Seeking ...... 264 The Cognitive Dimension ...... 264 Symptoms ...... 264 Conditions ...... 265 Perceptions of Bodily Functioning ...... 265 Culture-Bound Syndromes ...... 267 Symbols of Power in Healing ...... 268 The Social System Dimension ...... 270 Health Maintenance Behavior ...... 272 The Health Care System ...... 272 Types of Specialists and Roles ...... 272 Methodological Issues ...... 274 New Research Directions ...... 275 Cognitive Directions ...... 275 Social System Dimensions ...... 276 References ...... 277 CONTENTS xxi

PART ill HEALTH BEHAVIOR AND THE CARE DELIVERY SySTEM .•••• 281

PERCEPI'IONS AND INTERACTIONS •••••••••••••••••••••••••••••••••••• 283

Chapter 16 Reciprocity in the Medical Encounter 293 Debra L. Roter Historical Perspective ...... 293 Interaction Process Methods ...... 293 Application of Bales's System to Medical Encounters...... 294 Roter's Interaction Analysis System ...... 294 Verbal Response Mode ...... 295 General Conclusions Drawn from the Literature ...... 296 Toward a Theory of Reciprocity in the Medical Encounter ...... 297 Task-Focused Domain...... 297 Socioemotional Domain ...... 297 Conceptual Framework ...... 298 Patient-Analogue Study ...... 299 Within-Domain Results ...... 299 Cross-Domain Results ...... 300 META-Analysis Results...... 301 Future Directions ...... 302 References ...... 303

Chapter 17 Affective Behavior and Perceptions of Health Professionals 305 Zeev Ben-Sira Introduction ...... 305 Stress-Disease Relationship and the Patients' Perceptions ...... 305 Coping Insufficiency and Disease: Analytical Framework ...... 305 The Tension-Alleviating Function of Affective Behavior ...... 306 The Study ...... 307 Scope ...... 307 Method...... 308 Results ...... 309 The Physicians' Affective Behavior: Importance and Demonstration ...... 311 The Need for Affective Behavior...... 311 The Physicians' Attitude toward Affective Behavior...... 312 Conclusions ...... 314 Appendix: Sample Characteristics ...... 315 References ...... 315

POWER, COMPLIANCE, AND CONTROL • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •• 319

Chapter 18 Power, Authority, and Health Behavior 325 Marie R. Haug Introduction ...... 325 Theories of Professional Power ...... 325 xxii CONTENTS

Factors in Patient Power ...... 327 Factors in Physician Power ...... 329 Contexts of Care ...... 330 The New Consumerism...... 330 Future of Power Relations ...... 332 Unanswered Questions ...... 333 References ...... 334

Chapter 19 Analogues between Medical and Industrial Safety Research on Compliance Behavior ••••••.•••••.•••••.•••••••••••• 337 Henry P. Cole, Philip K. Berger, and Thomas F. Garrity Purpose 337 Method 338 Findings: Parallels in Compliance Boosting Research ...... 339 Frequency of Compliance ...... 339 Acute versus Chronic Health and Safety Threats ...... 339 Four Phases of Compliance ...... 340 Correlates of Compliance ...... 340 Principles and Procedures for Boosting Compliance ...... 342 Limitations of Behavioral Strategies ...... 344 Potential for Sharing Perspectives ...... 345 Behavioral Intentions ...... 345 Representations of IllnesslHealth States ...... 347 Goal Theory ...... 347 Conclusion: Possibilities for Further Connections ...... 349 References ...... 351

PART IV HEALTH BEHAVIOR: ITS RELEVANCE AND FUTURE • • • • • • • .• 355

Chapter 20 Health Behavior Research and the Training of Health Professionals .•••••••••••••••••••.••••••.••• 363 Alice J. Baumgart and Edith A. Costello The Medical and Nursing Work Force...... 364 The Educational Task ...... 364 Health Behavior and Medical Education ...... 364 The Behavioral Movement in Medical Education ...... 365 New Perspectives ...... 367 Health Behavior and Nursing Education ...... 370 Curricular Responses to the Surge of Interest in Health Behavior ...... 370 Health Behavior Concepts and Practicing Nurses ...... 372 The Future for Nursing ...... 374 Future Directions: The Training of Health Professionals...... 375 References ...... 376 CONTENTS xxiii

Chapter 21 The Application of Health Behavior Research: Health Education and Health Promotion •••.•••••••••..•••.•..••..•..••• 381 Lloyd J. Kolbe Human Behavior and Public Health ...... 381 Behavioral Epidemiology ...... 381 Health Behavior Research ...... 383 Typology and Methods ...... 383 Conceptual Stages of Health Behaviors ...... 384 Health Promotion and Health Education Strategies ...... 384 Three Definitions ...... 385 Increasing the Effectiveness of Health Promotion ...... 386 Improving Theory ...... 387 Focusing of Priority Behaviors ...... 388 Focusing on High-Risk Populations ...... 389 Policies ...... 390 Combining Interventions ...... 391 Health Behavior Indicator Systems ...... 391 The Objectives for the Nation...... 39'1 The Cancer Control Objectives ...... 392 The Behavioral Risk Factor Surveillance System ...... 392 The Model Standards for Community Preventive Health Services ...... 393 Research Synthesis ...... 393 Conclusion ...... 394 References ...... 394

Chapter 22 Chronic mness Management: A Focus for Future Research Applications ••.••..••..•..•...••.•...•.••••••••..• 397 Eugene B. Gallagher The Illness Management Situation ...... 398 Authority and Communication within the Illness Management Situation ...... 399 Chronic Illness and Adult Modes of Learning ...... 401 Medical Authority as a Negotiated Process ...... 402 Psychology and Sociology in the Study of Illness Management ...... 403 Patient Self-Concept ...... 403 The Communications-Authority Complex ...... 404 The Chronic Renal Patient ...... 404 Conclusion ...... 406 References ...... 406

Chapter 23 Health Behavior Research: Present and Future. • • • • • • • • • . • . • •• 409 David S. Gochman The Present: Late 1980s-Early 1990s ...... 409 Conceptual Advances ...... 409 Models ...... 410 Behaviors ...... 411 xxiv CONTENTS

Present into Future: Issues of Identity...... 412 Health Behavior and Medicine ...... 412 Health Behavior Research Is Interdisciplinary ...... 414 Health Behavior and "Ideology" ...... 415 Political Cooptation...... 415 The Future: A Research Agenda ...... 416 Meta Issues ...... 416 Research Areas ...... 417 The Search for Meaning...... 419 Summary ...... 421 References ...... 422

Index ...... 425