A CASE-STUDY OF ILLNESS BEHAVOUR AMONG CHINESE MALE CORONARY AND HYPERTENSIVE OUTPATIENTS IN MALAYSIA
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Date
1983-01-20
Authors
HAJI ARSHAD, MOHD. BAKHORI
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Abstract
This thesis represents an attempt to study how pea~
resnond to and cope with a chronic illness. Two chronic dise~
Coronarjr Heart Dise2.:3e a.n(l Primary }ly~Jertension 9 were chosen :f
study. ,-~uotc:~ samples of fifty coronary ru1d fiftJ hypertensivE
male Chinese outpatients were selected from outpatients attend
the polyclinics of the University Hospital in Kuala Lumpur. T
findings are based on interviews ~ith respondents as well as
specific case-studies. In the interviews with the respondents
n structured interview questionnaire was used.
The illness process w~s conceptu~lized as a series o:
events that begins with the experience of initial symptoms.
~tlaTenesa of illness is transl~ted into efforts to seek medical
care. A professional therapeutic programme and lay therapeutic
me~sures ~re means of ~an~ging a chronic illness.
The costs expended in the provision of modern medical
c~re facilities need to be justified by the optimum use of such
facilities. The study of two 2reas of the illness process,
namely the seeking and continuity of medic~l c~re are considerec
import~nt for an underst~nding of the selection ~nd utilization
of medical care facilities. The initi2tion of treatment is to
provide relief from the discomfort ~ssoci~ted with the symptoms
of a disease. Therefore, the symptom experience of the
respondents was also taken into consider~tion.
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The findings showed th~t the decision to seek treat
w~s rel~ted to the severity of the symptoms 2nd the lay
etiologic~l me~nings th~t were 2ccorded to these symptoms.
Symptoms that did not interfere with occupational and social
nativities were not attcmded to. On the other h::cnd, cerL:'.in
symptoms were so incapacitating thnt there was no hesitntion
deciding to seek medical care. Symptoms thnt were defined in
terms.of personal attributes like nge nnd obesity were nlso
ignored. In addition~ it was also found that awareness of
illness did not lend to the seeking of medical care when a mar
urgent need had to be fulfilled.
The selection of medical care was made from a vnriet;
of sources. '.Jhether seJ.f .. medic~tion "'-'ยท'lB .:.ttemoted or efforts
were made to secu~e the services of either the 1sinseh 1 , mediw
or the western-trained doctor depended on several factors. Fo1
the majority of the respondents 1 the seeking of medical care
wns ~n el~bor~te process of referral from one source to another
The nssoci~tion of c~us~tion with nn appropriate form
of treatment determined whether a particular illness condition
deserved a modern or traditional treatment. There was eith~r
delay in seeking treatment or resort to self-medication when
symptoms were rationalized in terms of the work situation and sc
habits. The findinss did not indicate any stntistically
significant relationship between socinl class attributes and
medical knowled~e. ~espondents acquired knowledge of illness
through social interaction. The proven efficacy of a particular
treatment and the outcome of an existing treatment also
XV
contributed to the referral process. Sources of medical care
that were associated with convenience and efficiency were
preferred to other sources. Family members and friends exerted
an important influence on both the seeking and selection of
medical care.
The control of a chronic disease depends very mucn on
adherence to a carefully drawn-up therapeutic programme.
However, it was found that not every respondent was faithful to
the various aspects of the programme. In addition, respondents
also resorted to alternative forms of treatment.
Fear of resusceptibility to further episodes of the
disease compelled many respondents to comply to medical advice.
On the other hand, those who did not recognise the severity
and implications of their illness were less faithful to the
therapeutic programme. Denial of illness was very much
influenced by the apparent feeling of good health and the
ability to continue with occupational and social activities.
Rationalization promoted compliance to the therapeutic progr~m~c
while lack of proper understanding of the programme, which can
be attributed ~artly to the deficiencies of the doctor-patient
relationshj.pt hindered compliance.
In so far as the therapeutic programme was consonant
with cultural beliefs, there was compliance. Some respondents
were non-compliant because of problems associated with treatment
The influence of family members was either a positive or
negative factor in promoting compliance. Illness had also
resulted a change of roles for some respondents.
xvi
Alternative ther2pcutic measures were adopted to eithe;
modify or supplement the Hospitnl 1 s therapeutic 9rogr~mme.
RefcrrRl was m~de to the isinseh 1 \Tith the intention of overcomi1
the side~effect8 of western medicine and to obtain a 9ermanent
cure. Spiritu~l cures were attempted to offset the ill-effects
of cert~in forces. Respondents ~lso ~aid for private bloodpressure
readings at private clinics to obt~in further informatic
about their illness and to assess the effects of some traditional
remedy and non-compliance.
The first chapter discusses the theoretic2l background
to the study. The second chapter explains the methodology while
an outline of the Chinese health belief ~nd practice systems
are presented in the third chapter. The findings pert~ining to
the seeking of medical care and 9 the ways of coping with a
therapeutic programme and the effects of a chronic illness are
presented and discussed in the fourth and fifth chapters
respectively. The conclusions and theoreticnl implications are
considered in the sixth 2nd final ch~oter.
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A CASE-STUDY OF ILLNESS BEHAVOUR AMONG CHINESE MALE CORONARY