Differences in meanings of health: and exploratory study of general practitioners and their patients.
OBJECTIVE
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.


METHODS
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
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.


CONCLUSIONS
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.
St Claire
L
L
Department of Primary Health Care, University of Bristol, UK.
Watkins
C J
CJ
Billinghurst
B
B
D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000523:psychology*; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology; D012933:Social Identification; D016312:Treatment Refusal