Victim-blaming revisited: a qualitative study of beliefs about illness causation, and responses to chest pain.
BACKGROUND
Health promotion is an established part of the general practice consultation. It is widely acknowledged that risk-behaviours are strongly affected by socio-economic status and the structural constraints of the individual, but little is known about the possible negative effects of lifestyle advice.


OBJECTIVE
To examine the extent to which self-responsibility, blame for ill health and risk behaviours feature in accounts of respondents with chest pain, and to ascertain whether perceived victim-blaming influences lay interpretations and responses to chest pain, and to ill health in general.


METHODS
Qualitative interviews were carried out in two socio-economically contrasting areas of Glasgow, with 30 respondents (15 men and 15 women) from a socio-economically deprived area, and 30 respondents (15 men and 15 women) from an affluent area.


RESULTS
Respondents recognized the causative links between well-established cardiac risk factors and heart disease. Individuals blamed themselves for their heart disease and general ill health and many also believed that they would be blamed for their behaviour and health problems by doctors. For some respondents, self-blame and fear of blame appeared to contribute to a reluctance to seek care. Self-blame, experience of blame and fear of blame were more common in respondents from the deprived area.


CONCLUSIONS
Emphasis by doctors on "unhealthy" behaviours may deter patients from seeking medical care. Lifestyle advice should be given taking into account the health beliefs and the socio-economic context of individuals. Future studies should focus on the theme of blame in order to explore further the possible negative effects of lifestyle advice given by health professionals.
Richards
Helen
H
Highlands and Islands Health Research Institute, University of Aberdeen, Aberdeen, Scotland, UK. h.richards@abdn.ac.uk
Reid
Margaret
M
Watt
Graham
G
D001294:Attitude to Health; D002637:Chest Pain / Q000209:etiology* / Q000523:psychology; D004032:Diet; D005194:Family Practice; D005260:Female; D015438:Health Behavior; D006293:Health Promotion; D006801:Humans; D007407:Interviews as Topic; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012923:Social Class