When I was in university, there is a module where we learnt about the models of lay health beliefs and illness behaviours. It is too detailed to explain to all what those are all about but in simplicity, we were taught (or more ineptly introduced,) to the concepts of what most people think health and illness are all about.
How do you define the word 'health'? How do you use the word 'healthy' in an everyday's context? Is it simply the absence of diseases? If one is to live without diseases or disabilities, are they truly healthy? Being healthy is not just about not having any diseases or illness. It is about the presence of general well-being that encompasses the physical, mental, and social aspects of an individual.
When we are sick, we sometimes seek treatment. Most of us go see a doctor. Others do self-medication, either by using alternative treatments like ointments or herbal products they bought in the market. Some people just ignore the symptoms and continue on with their lives, hoping that time to be the healer of all wounds. Sometimes they only seek treatment when the illness has manifested deeply and it is too late to treat it completely.
People react differently in the face of an illness. You may have a relative who stubbornly refused to go to see a doctor, claiming that their symptoms are not something to make a fuss about while you were worrying out of your mind, thinking that surely the symptoms they have are morbid-looking and prelude to something more sinister. You, on the other hand, may be the sensible one - seeking a treatment only when you deemed the symptoms that you have are serious.
In order to understand why and when people do (or don't) seeking a treatment, Zola published a paper in 1973 about the human behaviours when dealing with a disease or illness. In his study, he famously pointed out five reasons that prompt people to seek treatment and they are called the Zola's trigger:
1. The occurrence of an interpersonal crisis
'Interpersonal crisis' simply means when you have a problem with the normal functioning of your body. This is the most fundamental reason for seeking a treatment because the sufferer would want the 'crisis' to be resolved. Having difficulty to breathe, getting bloody diarrhoea or constipation, pressing chest pain, or hearing threatening voices in your head are some examples of the hundreds of interpersonal crisis you may encounter that prompt you to see a doctor.
2. Perceived interference with social and personal relations
People also seek treatment to their illness when that illness disabled them from going out socializing with their circle of friends or when relationships are affected. Some illness make it more difficult for the sufferer to go out and mingle. Think of chicken pox (herpes zoster) for example. Not only that it is contagious, it also causes rashes that may embarrass the sufferer from going out with friends.
3. Perceived interference with vocational and physical activity
Some people can handle their interpersonal crisis well and would not want to seek treatment until it interrupts their normal daily activities or work performance. A teacher with a sore throat and cough will most likely go for treatment as it most definitely will interfere with her teaching. Similarly, an athlete with a broken fibula will not play on the field (or even move around) until he gets his leg treated completely.
4. Sanctioning by other people
This is when other people, whether relatives or close friends, told the sufferer or bring them to see a doctor. In other words, this is when other people are concerned enough with the sufferer's illness that they decided a treatment would be the better choice. Often seen in scenarios where the stubborn parent is being brought to the clinic by their children who are worried about their parent's health. This trigger is least found in sick people who live alone or homeless, making it more difficult for healthcare professionals to detect and recognize the illness until it's too late.
5. Temporalising of symptoms.
The sufferer has specific ideas about how long certain complaints should last. For instance, we know that normal fever should last 1-2 days. We have, somewhere in our mind, that if by the third day the fever is still not subsiding, we may have to consider seeing a doctor. Come Day 4 and the fever is still there, you may think, "Okay, if I still have the fever on the fifth day, I will go see a doctor for sure." This trigger is one when the sufferer makes negotiations with his own symptoms, often in terms of number of days having illness (like the example above) or in terms of severity of the problems (if the temperature of my fever gets worse I'll see the doctor tomorrow).
It is important for us to recognize these triggers, both for the public and the healthcare professionals alike. It is often the case where the sufferer doesn't realise they have more than one reason to seek treatment, so by realizing these triggers to them (or by sanctioning it!) you can help them to get the treatment they deserved.
For the primary care physicians, identifying which triggers that prompted them to come to the clinic is equally important. Some triggers are presented together while in some cases only one trigger is predominately presented. Sactioning by proxy is proned to cause compliancy issue as patients feel forced to undergo treatment or taking medication. By addressing the issue with the patient, doctors can gauge the level of patient's understanding towards their health beliefs and help them to come into terms with their illness. This is vital as sometimes patients will present with denial as a grief step process when taking in the news of their illness.
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