St Claire L, Watkins C J, Billinghurst B
Department of Primary Health Care, University of Bristol, UK.
Fam Pract. 1996 Dec;13(6):511-6. doi: 10.1093/fampra/13.6.511.
Many health-related behaviours, particularly non-compliance with medical advice, seem irrational to professionals. 'Health' is a planned goal of health care but the extent to which doctors and patients agree about its meaning is unknown. We hypothesized that general practitioners (GPs) construe health as an absence of disease (medical model) to a greater extent than their patients in general and that asthmatic patients construe health in a manner biased to preserve their self-esteem.
Forty-eight patients with asthma, 48 matched well patients and 34 GPs each gave up to six personal definitions of 'health'. Their definitions were classified into nine categories of meaning.
Results showed significant differences in the ways in which general practitioners and patients defined 'health' (chi-squared between GPs and asthmatics was 98, df = 7, P < 0.0001; chi-squared between GPs and well patients was 85, df = 7, P < 0.0001). As hypothesized, the category of meaning used most by general practitioners was an absence of disease, whereas patients expressed the meaning of health in terms of 'being able', 'taking action' and 'physical well-being'. Support for the second hypothesis, although consistent, was weak.
The way in which differences in beliefs provide a basis for understanding apparently irrational patient behaviours is discussed in the context of social identity theory. Implications for doctor-patient communication and the psychological validity of subjective health status and quality of life measures are also noted.
许多与健康相关的行为，尤其是不遵从医嘱的行为，在专业人士看来似乎是不理性的。“健康”是医疗保健的一个既定目标，但医生和患者在多大程度上对其含义达成共识尚不清楚。我们假设，全科医生（GPs）比普通患者更倾向于将健康理解为没有疾病（医学模式），并且哮喘患者对健康的理解方式存在维护自尊的偏差。
48名哮喘患者、48名匹配良好的健康患者和34名全科医生分别给出多达六个关于“健康”的个人定义。他们的定义被归类为九种意义类别。
结果显示，全科医生和患者对“健康”的定义方式存在显著差异（全科医生与哮喘患者之间的卡方值为98，自由度 = 7，P < 0.0001；全科医生与健康患者之间的卡方值为85，自由度 = 7，P < 0.0001）。正如所假设的，全科医生使用最多的意义类别是没有疾病，而患者则从“有能力”、“采取行动”和“身体安康”的角度来表达健康的含义。对第二个假设的支持虽然一致，但较为微弱。
在社会认同理论的背景下，讨论了信念差异如何为理解明显不理性的患者行为提供基础。还指出了对医患沟通以及主观健康状况和生活质量测量的心理效度的影响。
