Applying symptom appraisal models to understand sociodemographic differences in responses to possible cancer symptoms: a research agenda.
BACKGROUND
Sociodemographic inequalities in the stage of diagnosis and cancer survival may be partly due to differences in the appraisal interval (time from noticing a bodily change to perceiving a reason to discuss symptoms with a health-care professional). A number of symptom appraisal models have been developed describing the psychological factors that underlie how people make sense of symptoms, although none explicitly focus on sociodemographic characteristics.


METHODS
We therefore conducted a conceptual review synthesising all symptom appraisal models, and focus on potential links with sociodemographics that could be the focus of future research.


RESULTS
Common psychological elements across nine symptom appraisal models included knowledge, attention, expectation and identity, all of which could be sensitive to sociodemographic factors. For example, lower socioeconomic status (SES), male sex and older age are associated with lower health literacy generally and lower cancer symptom knowledge. Limited attentional resources, lower expectations about health and lack of social support also hamper symptom interpretation, and would be likely to be more prevalent in those from lower SES backgrounds. Symptom heuristics ('rules of thumb') may lead to symptoms being normalised because they are common within the social network, potentially disadvantaging older populations.


CONCLUSIONS
A better understanding of the processes through which people interpret their symptoms, and the way these processes differ by sociodemographic factors, could help guide the development of interventions with the aim of reducing inequalities in cancer outcomes.
Faculty of Health and Medical Sciences, School of Health Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK.
K L
KL
Whitaker
Unit of Social and Behavioural Sciences, King's College London Dental Institute, London SE5 9RW, UK.
S E
SE
Scott
Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London WC1E 6BT, UK.
J
J
Wardle
D000367:Age Factors; D001288:Attention; D057210:Delayed Diagnosis; D059026:Diagnostic Self Evaluation; D004739:England; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008960:Models, Psychological; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D012737:Sex Factors; D012923:Social Class; D012944:Social Support