Theories and evidence on how late consultation is caused and sustained
| Key concept 1: reaction to symptoms | |||
|---|---|---|---|
| Elements | Theoretical model | Relevant construct | Related evidence in chest disease |
| Knowledge | Illness Prototypes25 | Ideas of what symptom-sets are associated with particular conditions25,26 | Less delay if previous experience of serious acute chest disease but longer delay if previous experience of chronic chest disease and self-reported greater knowledge of lung cancer symptoms10 |
| Illness Action Model27 | ‘Stock of knowledge’— built up through personal experience, interacting with others and general media27 | ||
| Appraisal | Illness Action Model27 | Cognitive appraisal or interpretation based on what is known about symptoms27 | Systematic review found non-recognition of symptom seriousness was associated with delay.32,33 Most symptoms are not appraised as serious even in retrospect.10 Qualitative evidence that fear could deter consultation34 |
| Common Sense Self-Regulation Model24 | Identity, cause, timeline consequences, control/curability, emotional response to symptoms24 | ||
| Salience | Illness Action Model27 | Symptoms can be in the background, not foreground, of thinking depending on what else is happening in patient’s life unless they are force higher in ‘system of relevance’ | Less delay with some symptoms (usually more dramatic) than others (usually vague) Longer delay if live alone10 |
| Zola’s Triggers22 | Salience can be affected by interpersonal crises and interference with relationships and work | ||
| Key concept 2: approaches to coping with/action on symptoms | |||
| Common Sense Self-Regulation Model24 Illness Action Model27 | Continuous process of performing coping strategies/actions (for example ‘waiting to see’, self-treatment, seeing GP) as indicated by appraisal, and then re-appraising the health threat | Qualitative evidence that symptoms appraised as minor were attributed to benign causes, managed by ‘waiting to see’ and self-treatment or put to the back of patients’ minds until they could no longer do so10,33 | |
| Zola’s Triggers22 | Temporalisation — waiting to see what happened with symptoms before consulting | ||
| Key concept 3: attitude to consulting | |||
| Personal opinion | Theory of Planned Behaviour29,30 | Attitude to consulting at an early stage formed in response to beliefs about the consequences of consulting | Less delay if symptoms appraised as being serious.35 Qualitative evidence of smokers feeling discouraged from consulting because of doctors preoccupied with anti-smoking10,33 |
| Opinions of others | Zola’s Triggers22 | Interactions with others can lead to sanctioning of consultation or to advice for further ‘wait and see’ | Longer delay if live alone10 |
| Theory of Planned Behaviour29,30 | Subjective norm: social pressure to consult at an early stage | ||
| Network Episode Model28 | Responses shaped by interacting with others, resource sharing, suggestion, support, and nagging | ||
| Forming intentions | Theory of Planned Behaviour29,30 | Intentions to consult at an early stage formed in response to attitudes, subjective norms, and perceived behavioural control | |
| Key concept 4: carrying through to action | |||
| Self-efficacy | Social Cognitive Theory23 | Self-efficacy — confidence that one can make an appointment. This can be based on previous experience | Less delay from frequent consulters10 |
| Theory of Planned Behaviour29,30 | Perceived behavioural control — extent to which patient feels he or she has control over the behaviour (making an appointment) | ||
| Intention–behaviour gap | Implementation Intentions31 | Implementation intentions: forming precise intentions to enact a particular behaviour (for example making appointment with doctor) when a particular situation occurs | Qualitative evidence of patients saying they don’t want to waste doctor’s time10,33 |