Developmental levels in adult's conceptions of health and disease

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Abstract

A socio-cognitive developmental perspective suggests that conceptions regarding health and disease processes may present different levels of openness, flexibility, inclusiveness and differentiation, and thus can be ordered into different levels. We present a qualitative study on lay significations regarding health and disease processes, endorsed by 67 adults. The results show that these adults have different socio-cognitive developmental competences related to health and disease processes. For each dimension of significations of health and disease, it is possible to sequence lay person's conceptions developmentally. Each level is distinct qualitatively, including responses characterized by a higher degree of differentiation, integration and complexity than the previous level. Finally, the implications of this approach to clinical and educational methods are discussed.

Translated abstract

Na perspectiva do desenvolvimento sociocognitivo, as concepções de saúde e doença podem apresentar diferentes níveis de abertura, flexibilidade, inclusividade e diferenciação e podem ser ordenadas em diferentes níveis de desenvolvimento. O presente estudo incidiu sobre as significações leigas de saúde e doença de um grupo de 67 adultos. Os resultados indicam que esses adultos se situam em diferentes níveis nas suas competências de desenvolvimento sociocognitivo relacionadas com os processos de saúde e doença, tendo sido possível sequenciar as suas significações em níveis distintos. Cada nível é distinto qualitativamente, incluindo respostas caracterizadas por uma maior diferenciação, integração e complexidade em relação ao nível precedente. As implicações dessa abordagem para os métodos clínicos e educativos são discutidas.

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The growth of interpersonal understanding

RL Selman, R. SELMAN, R Selman … (1980)

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There's a demon in your belly: children's understanding of illness.

P Gerrity, F E Perrin (1981)

Knowledge of how children come to understand the processes of causation, prevention, and treatment of illness is needed to help health professionals and educators in their work with children. Healthy children attending kindergarten through eighth grade were asked a series of standardized questions about illness, and their responses were scored on a scale corresponding to Piaget's theoretical framework of cognitive development. Children's responses varied widely at all ages, but there was a consistent systematic progression in their understanding of illness-related concepts with age. Kindergarten children typically understand illness causation as quite magical, and/or as the consequence of their transgression of rules. At fourth grade, children believe all illness to be caused by germs whose very presence is sufficient to make a child sick. The complexity of the mechanisms that must interrelate to cause illness is not understood until eighth grade at the earliest. At approximately 12 or 13 year of age children begin to understand that there are multiple causes of illness, that the body may respond variably to any or a combination of agents, and that host factors interact with the agent to cause and cure illness. This sequence in the development of understanding about illness parallels conceptual development in other content areas such as physical causality, although it seems to lag a bit. The delineation of the concepts typical of children at each developmental stage, as provided in this paper, will help to guide educational efforts and future research.