Concepts of illness causation and attitudes to health care among older people in the Republic of Ireland.

Fifty-one older people (26 of them women) in the Republic of Ireland were interviewed using a semi-structured schedule on their health and illness experiences at three different time points in their lives; as children, as young adults and presently. Of particular interest were their views about the causes of heart disease, cancer and tuberculosis and their experiences of the prevailing health care system during their lifetime. Participants were recruited by letter from a database of respondents to a previous national quantitative survey of older people. Of 247 people originally contacted 127 (51%) responded by letter and 51 of these took part in the interview study. Data were analysed according to principles of content analysis using NUDIST software. Reported ideas about causes of illnesses were multicausal. These were categorised as behavioural, biological, psychosocial or other explanations. While respondents placed most emphasis on behavioural explanations, this was accompanied by more complex views and critical questioning of formal health education messages. There was a strong allegiance to current biomedical concepts and practices. This appeared to be explained in part by reported negative experiences of health care treatments during childhood, particularly in hospitals, now perceived to be much improved. Advances in biomedicine were discussed with accounts of benefits received or observed by participants. An analysis of the history of health services in Ireland suggests that some of the attitudes reported reflect the experiences of the respondents as a generation rather than as older people per se and hence highlights the impact of public policy on people's experiences of and attitudes toward health and health care systems.

[1]  M. Wiley.  Critique of Shaping a Healthier Future: A Strategy for Effective Healthcare in the 1990s , 2001 .

[2]  R. Pill,et al.  Concepts of illness causation and responsibility: some preliminary data from a sample of working class mothers. , 1982, Social science & medicine.

[3]  O. Holsti.  Content Analysis for the Social Sciences and Humanities , 1969 .

[4]  J. Cornwell.  Hard-Earned Lives: Accounts of Health and Illness from East London , 1985 .

[5]  R. Doll,et al.  There is no such thing as aging , 1997, BMJ.

[6]  M. Murray,et al.  Health beliefs, locus of control, emotional control and women's cancer screening behaviour. , 1993, The British journal of clinical psychology.

[7]  J. Morse.  Critical Issues in Qualitative Research Methods , 1993 .

[8]  Michael Quinn Patton,et al.  How to use qualitative methods in evaluation , 1987 .

[9]  C. Davison,et al.  Rational or reasonable? Perceptions of health at different stages of life , 1992 .

[10]  D. Bromley,et al.  Personality description in ordinary language , 1977 .

[11]  E. A. Stead,et al.  Health and Illness , 1997 .

[12]  J. Pierret.  Constructing discourses about health and their social determinants , 2002 .

[13]  Rory Williams.  Concepts of Health: An Analysis of Lay Logic , 1983 .

[14]  Sue Ziebland,et al.  Analysing qualitative data , 2000, BMJ : British Medical Journal.

[15]  Lyn Richards,et al.  From filing cabinet to computer , 1994 .

[16]  P. Skrabanek.  Promoting health. , 1992, Irish medical journal.

[17]  M. McGrath,et al.  Socio-demographic variations in perspectives on cardiovascular disease and associated risk factors. , 1999, Health education research.

[18]  David J. Silverman,et al.  Qualitative methodology and sociology , 1985 .

[19]  S. Cowman.  View from Ireland ... "Shaping a healthier future: a strategy for effective healthcare in the 1990s.". , 1996, Quality in health care : QHC.

[20]  Klaus Krippendorff,et al.  Content Analysis: An Introduction to Its Methodology , 1980 .

[21]  B. K. Tones.  Health education and the ideology of health promotion: a review of alternative approaches , 1986 .

[22]  W. Rogers,et al.  Explaining health and illness : an exploration of diversity / Wendy Stainton Rogers , 1991 .

[23]  K. Wallston.  The importance of placing measures of health locus of control beliefs in a theoretical context , 1991 .

[24]  L. Strain.  Use of health services in later life: the influence of health beliefs. , 1991, Journal of gerontology.

[25]  D. E. Powell.  There is no such thing as ageing , 1998, BMJ.

[26]  R. Bunton,et al.  Health promotion : disciplines and diversity , 2002 .

[27]  J. Williamson.  HEALTH IN OLD AGE: MYTH, MYSTERY AND MANAGEMENT , 1995 .

[28]  M. Fog.  [The causes of disease]. , 1958, Danish medical bulletin.

[29]  Ruth Pushkin.  Worlds of Illness: Biographical and Cultural Perspectives on Health and Disease , 1994 .

[30]  Children.  Cardiovascular Health Strategy: Building Healthier Hearts , 1999 .

[31]  M. Blaxter.  The causes of disease : Women talking , 1983 .

[32]  C. Guest,et al.  AIDS and its metaphors. , 1989, Social science & medicine.

[33]  M. Blaxter.  Whose fault is it? People's own conceptions of the reasons for health inequalities. , 1997, Social science & medicine.

[34]  Peter M. Chisnall,et al.  Questionnaire Design, Interviewing and Attitude Measurement , 1993 .

[35]  L. Henderson.  On the Social System , 1993 .

[36]  A note on a proposed census-based irish social-class scale for epidemiological health research , 1982 .

[37]  C. Kelleher.  Measures to promote health and autonomy for older people: A position paper , 1993 .

[38]  M. Blaxter,et al.  Why do the victims blame themselves , 2002 .

[39]  R. Barrington.  Health, medicine and politics in Ireland 1900-1970. , 1987 .

[40]  M. H. Quenouille,et al.  Survey Methods in Social Investigation , 1973 .

[41]  C. Davison,et al.  The limits of lifestyle: re-assessing 'fatalism' in the popular culture of illness prevention. , 1992, Social science & medicine.

[42]  A. Radley.  Worlds of Illness: Biographical and Cultural Perspectives on Health and Disease , 1993 .

[43]  C. Parvanta,et al.  Health and Culture-Beyond the Western Paradigm , 1996 .

[44]  M. Blaxter.  Health and lifestyles , 1990 .