Variations in Lay Health Theories: Implications for Consumer Health

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Variations in Lay Health Theories: Implications for Consumer Health Care Decision Making Renée Shaw Hughner and Susan Schultz Kleine Qual Health Res 2008; 18; 1687 originally published online Oct 27, 2008; DOI: 10.1177/1049732308327354 The online version of this article can be found at: http://qhr.sagepub.com/cgi/content/abstract/18/12/1687

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Variations in Lay Health Theories: Implications for Consumer Health Care Decision Making

Qualitative Health Research Volume 18 Number 12 December 2008 1687-1703 © 2008 Sage Publications 10.1177/1049732308327354 http://qhr.sagepub.com hosted at http://online.sagepub.com

Renée Shaw Hughner Arizona State University, Mesa, Arizona, USA

Susan Schultz Kleine Bowling Green State University, Bowling Green, Ohio, USA Wide variations in how contemporary consumers think about health and make health care decisions often go unrecognized by health care marketers and public policy decision makers. In the current global environment, prevailing Western viewpoints on health and conventional biomedicine are being challenged by a countervailing belief system forming the basis for alternative health care practices. The ways American consumers once thought about health have changed and multiplied in this new era of competing health paradigms. Our study provides empirical evidence for this assertion in two ways. First, it demonstrates that in the current environment consumers think about health and health care in a multiplicity of very different ways, leading to the conclusion that we should not classify health care consumers as either conventional or alternative. Second, the results provide clues as to how individuals holding diverse health theories make health care decisions that impact health behaviors, treatment efficacy, and satisfaction judgments. Keywords: practices

U

health; health behavior; health care, decision making; health concepts; health policy; lay concepts and

nderstanding how consumers make decisions about health care products and services lies at the heart of one of the biggest challenges of the twenty-first century. United States health-related expenses totaling $2 trillion in 2005 (Catlin, Cowan, Heffler, & Washington, 2007) are expected to double by 2015, reaching $4 trillion (Borger et al., 2006). The United States spent 16% of its gross domestic product (GDP) on health care in 2005; it is projected that the percentage will reach 20% in the next decade (Borger et al., 2006). Lifestyle-related chronic diseases account for an estimated 70% of the nation’s medical care costs (Fries, Koop, Soklov, Beadle, & Wright, 1998). Unhealthy lifestyles often lead to chronic, incurable disease, requiring years of expensive treatments (e.g., Fellows, Trosclair, Adams, & Rivera, 2002; Hogan, Dall, & Nikolov, 2003; Ogden, Flegal, Carroll, & Johnson, 2002). Understanding consumer decision making in the health care arena is key to confronting the societal health care challenge. Underpinning consumers’ decisions about health care products and services are their theories about health and illness. Such lay health understandings

mediate relationships impacting consumers’ health behaviors and health outcomes (Leventhal, Leventhal, & Robitaille, 1998; Moorman & Matulich, 1993). For example, consumers’ lay health theories influence their interpretations of physical symptoms or decisions of when to seek professional medical care. Variation in theories about health affects consumers’ responses to health directives (e.g., vaccination programs), efficacy of self-health care behaviors (e.g., diet and exercise practices), and choice and efficacy of conventional vs. alternative products and services. “Perhaps more than any other area, ordinary lay people’s ideas, beliefs and theories about their own and others’ physical health have important consequences for diagnosis, medication and the advice that they give to others” (Furnham, 1988, p. 123). Authors’ Note: The authors extend their gratitude to Drs. Michael Mokwa and John Schlacter for their guidance on this project. The authors posthumously thank Dr. William Mermis for his unwavering support and jovial spirit. The financial support of the Center for Services Leadership at Arizona State University is gratefully acknowledged. 1687


1688 Qualitative Health Research

Despite the potential importance of lay health theories to understanding consumption choices in health care, there remains a gap in our understanding of these theories. This gap exists for at least four reasons. One, the vast majority of health beliefs research in the social sciences consists of studies measuring the scientific correctness of consumers’ itemized, illnessspecific beliefs as opposed to portraying how people think about health and make decisions about health care. Two, most research examining health beliefs is not about health, per se, because it examines specific illnesses or medical conditions as opposed to overarching belief systems that drive specific beliefs and behaviors (Stainton Rogers, 1991). Three, health behavior compliance research is based on the assumption that consumers’ health behaviors are driven by the resemblance of their beliefs to professional medical knowledge (Mercado-Martinez & Ramos-Herrera, 2002). This assumption continues despite empirical results demonstrating that lay views are not just watered-down versions of expert knowledge, but incorporate dimensions lying outside the boundaries of professional knowledge (Cheyney, 2008; Clouser & Hufford, 1993; Furnham, 1988; Hughner & Kleine, 2004; Kleinman, 1986; O’Connor, 1995; Stainton Rogers, 1991). Four, it remains unclear how consumers integrate into their personal theories the substantially different worldviews underlying conventional biomedical vs. increasingly popular alternative healing approaches. The purpose of the project presented here was to explore, in depth, the nature of lay health theories held by a variety of individuals and to analyze these lay theories for clues about consumer decision making for health care products and services. The results demonstrate two key things: one, contemporary consumers hold various theories of health, none of which align simplistically with the prevailing biomedical paradigm or countervailing alternative paradigms; and two, deep examination of these lay theories allows us to identify variations in consumers’ expectations for and their satisfaction with contemporary health care.

Background The term lay health theory refers to consumers’ understandings of health, organized into systems of thought possessing varying degrees of complexity and integration (Furnham, 1988). Lay health theories are belief systems encompassing general understandings about the meaning and importance of health and how

health is maintained and lost. Causes of illness, reliance on self vs. health care providers, role of spirituality in health, perspectives on biomedical vs. alternative medical practices, and so forth are included. Lay theories of health are not tied to particular illnesses or symptoms, but might influence how consumers interpret and respond to symptoms (Furnham, 1988; Leventhal, Leventhal, & Robitaille, 1998). Lay people integrate information from disparate, distinct, and sometimes opposing sources, reworking it into a system of loosely related understandings (Stainton Rogers, 1991). Health theories matter because consumers’ motivations to engage in health-related behaviors might be helped or hindered, depending on how they view health (Moorman & Matulich, 1993). A consumer whose understanding of health leads them to expect a physician simply to “fix me” will behave differently than someone who proactively controls their health in multiple and often unconventional ways because they view health to be a result of mind–body harmony and balance. A person who pops herbal capsules, thinking they are magic bullet pills for curing specific symptoms, might have different results than the consumer who sees herbal remedies as only one piece of an overlaying approach to health. Use of and satisfaction with health care services and products results from consumers’ expectations that derive from how consumers think about health. Social science research investigating lay beliefs most often focuses on specific illnesses or medical conditions (e.g., beliefs about causes of breast cancer). This includes the many studies employing attitude-based and other cognitive models to predict specific, discrete illness prevention and response behavior (e.g., Health Beliefs Model; Becker & Maiman, 1975; Leventhal, Brissette, & Leventhal, 2003; Rosenstock, 1966). These approaches do not capture the depth or variety of dimensions involved in consumers’ health perceptions (Blaxter, 1997; McGuire, 1988; O’Connor, 1995; Stainton Rogers, 1991; Warkentin 2000). The research gap, therefore, lies in understanding the nature of belief systems present in the current health care environment.

Changing Worldviews and Multiple Lay Health Theories We expect there to be multiple, differing health theories among U.S. consumers. This is because of contemporary conditions in which the prevailing


Hughner, Kleine / Variations in Lay Health Theories 1689

Western medical paradigm (biomedicine) is being challenged by a countervailing, Eastern way of thinking about health. Although the origins and healing therapies within the alternative paradigm are quite diverse, analysts believe most of them rest on similar logic (Barnum, 1999; Donnelly, 1999). Several sets of prevailing and countervailing ideas underlie the variance between the biomedical paradigm and alternative views. One is the biomedical model’s reductionist logic (“the body is a set of parts”) vs. the holism (body, mind, spirit, and environmental interconnectedness) of alternative methods. Scientific logic drives biomedical practices, whereas faith, judgment, discernment, and experience form the basis for many alternative approaches. Opposing logics about what comprises legitimate evidence of treatment efficacy, standardized vs. individualized treatment, hard vs. soft diagnostic methods, and patient vs. practitioner locus of control all flow from reductionist vs. holistic thinking. The biomedical view puts greater emphasis on physician control, eradicating foreign substances from the body, and using scientifically proven remedies to fix organ or system specific problems. Spirituality and prayer or meditation, important elements in folk accounts for health and wellness (Kinsley, 1996; McGuire, 1988), also are embraced by alternative approaches but have been dismissed as irrelevant in the traditional scientific paradigm (Longino & Murphy, 1993). The two health paradigms are incommensurate in their ideal forms. Theoretically, one cannot adhere to holism, believing that a host of internal and external elements bring on suboptimal health, while remaining satisfied that illness can be cured through reductionist approaches. It is inconsistent to believe that the body is naturally self-healing, but to consider medical prescriptions as optimal cures. Although the mainstream health care system increasingly embraces alternative methods, the paradigm on which alternative methods rest opposes the paradigm of biomedical orthodoxy (Longino & Murphy, 1993). The obvious dichotomies in paradigms associated with biomedical vs. holistic viewpoints leave us short of understanding how consumers construct their own theories. In-depth studies of health beliefs indicate that consumers do not pattern their thinking after the professional sector (e.g., Hughner & Kleine, 2004), although it is informed by the professional sector (Kleinman, 1986). How do consumers integrate into their thinking beliefs flowing from inherently different worldviews, what kinds of lay theories result, and

how might consumers make health decisions differently, depending on their health theories?

Methodology and Procedures We used an interpretive methodology to examine deeply the nature of participants’ health theories. The method we used—Q-methodology combined with indepth interviews—allowed us to penetrate the subjective views of participants and portray the opinions, priorities, themes, and issues shaping lay theories. This method is ideal for deeply exploring areas of complex beliefs (Brown, 1980; McKeown & Thomas, 1988); its efficacy has been demonstrated in the context of health care (e.g., Brown, 1996; Stainton Rogers, 1991). Our use of the method involved a small sample of participants who performed a comparative sorting task followed by an open-ended, in-depth interview. The sorting task requires participants to express their thoughts about a given statement in the context of all other statements. Participants model which combinations of statements are most useful for describing their viewpoints. The sorting task is a projective device assisting participants to express thoughts that might otherwise be too difficult to articulate. During the postsorting interview the researcher explores in greater depth the participant’s reasoning.

Procedures Participant selection. Thirty-five individuals performed Q-sorts, comprising a sample size common in Q-method research (e.g., Brown, 1980; McKeown & Thomas, 1988; Stainton Rogers 1991). Participants ranged in age from 22 to 78. The objective in selecting participants was to seek diversity in health theories. Participants were recruited from a large metropolitan area in the southwestern United States where the alternative health community thrives and awareness of its products and services is relatively high. Based on clues from prior research, we recruited individuals highly involved in particular activities (e.g., yoga), belonging to particular communities (e.g., religious, working), leading “alternative” lifestyles (e.g., gay, voluntarily simplistic), displaying differing health behaviors (e.g., smokers, nonsmokers), attending a naturopathic medical school, and representing minority subcultures (e.g., Native American, Hispanic). Participants believed to be mainstream in their thinking were also recruited to be participants.



Q-sample. The Q-sample is the set of stimuli participants use to articulate their viewpoints about health (Dennis, 1987, 1990; Stainton Rogers, 1991). We developed 63 statements based on a literature review and previous in-depth interviews; these provided the concourse (universe of statements from which we sampled) and language from which a representative Q-sample was drawn. The Q-sample is semistructured (McKeown & Thomas, 1988). The structured/theoretical component includes statements drawn from the indepth interviews and the literature reflecting the two theoretically driven professional paradigms—the conventional or biomedical paradigm of health, and all other philosophies of health, which are considered in Western culture to fall under the alternative, or unconventional paradigm. We also added concepts we suspected would help portray different viewpoints of health. A pretest and pilot study supported the sufficiency of the 63-statement Q-sample. Interview procedures. At each site where participants were interviewed, a large table was used for sorting. Participants received instructions and familiarized themselves with the statements printed on index cards. Participants began by sorting the statements into three piles: “most characteristic of my views,” “least characteristic of my views,” and “neutral.” Next, participants sorted the three piles into an 11-column, quasi-normal distribution, ranging from “most (+5) to least (-5) like my view” (see Appendix A for a depiction). Once finished, the participant re-examined the sort to ensure it represented his or her thinking. An investigator conducted a postsort interview. The investigator began with a question about the Q-sort experience, offering participants the chance to offer additional statements or to identify difficulties they experienced. The investigator then questioned the participant about his/her Q-sort reasoning, opinions about the overall health care environment, satisfaction with health care products and services, health care behaviors, and sources of health care information. Interviews lasted about 1 hour. Confidentiality was protected by using pseudonyms in the article.

Data Analysis and Results The data matrix of 63 statements by 35 participants was analyzed using principal components analysis. Guidelines used to determine the number of factors (viewpoints) to retain for interpretation included (a) retaining factors on which at least two participants load significantly, (b) scree plots, (c) factor loading patterns, and (d) the conceptual robustness of the

factor solution (Brown, 1980; McKeown & Thomas, 1988). The in-depth interview data were especially informative for determining the conceptual sensibility of alternative factor solutions. This procedure identified six factors (lay health theories). Next, a prototypical sort was calculated for each theory, using factor scores to rank the statements from most indicative to least indicative of that theory. To present the six lay theories, we weave into the discussion the most characteristic (+5, +4, +3) and least characteristic (-3, -4, -5) statements from the six prototypical sorts. Six numbers follow each statement to identify the placement of that statement in the Qsort prototype for each factor. If a statement is followed by the numbers +5, -4, +1, 0, +3, -1 that statement was very characteristic of Lay Theory 1’s viewpoint (+5), very uncharacteristic of Lay Theory 2’s viewpoint (-4), not informative for Lay Theory 3 or Lay Theory 4’s viewpoint (+1, 0), somewhat characteristic of Lay Theory 5’s view (+3), and did not inform Lay Theory 6’s viewpoint (-1). Selected quotations from participants whose beliefs are closely correlated with that particular theory help explain each health theory. The lay theories are designated by “F1” through “F6,” with the numbers corresponding to the lay theory. For example, Lay Theory 1 is designated by “Fl,” Lay theory 2 is designated by “F2,” and so forth. The same statement might be used to inform more than one lay theory and might be interpreted in different ways; as such, some statements are listed more than once.

Lay Theory 1 Participants expressing this theory included 3 students studying to become naturopathic physicians, 3 business professionals, and 1 social worker. Two suffered from terminal illnesses. Each found the medical establishment unfavorable; all used alternative health care. This group conformed least to the conventional paradigm of medicine. This group had well-articulated health beliefs, spoke passionately and at length about the subject, and expressed strong concerns about consumers’ health. Good health occupies an overriding goal to individuals in this segment.

37 I have more important goals in my life than the pursuit of optimal health.


F1

F2

F3

F4

F5 F6

−5

0

0

−2

0

0


Participants believe they can control wellness via attitude, diet, exercise, and social and physical environments.

4 The mind, body, and spirit are all connected; all need to be in sync for good health.

F1

F2 F3

F4 F5 F6

+4

0

0

+2

+4 +1

Barbara explained her interpretation of statement 4 in the following discourse: I think health is all essentially energetics and the vibrations of each cell. . . . They [cells] resonate at a certain frequency and when that frequency is off, then disease has the option to be created. And I think if, say 50% of the vibrations are okay, I mean are resonating at a frequency they’re supposed to, then it’s very likely that disease will not happen. But say there’s something that tips the balance, then disease may occur . . . you can affect the frequency and the vibrational levels of literally each and every cell and tissue in your body through yoga, diet, exercise, attitude, outlook.

I can maintain a pretty extraordinary level of health if my biggest focus is on the way I think. . . . I think you either come from a perspective of love or you come from a perspective of fear. And if you come from a perspective of fear, eventually you’re going to manifest disease.

Also characteristic is the view that individuals, rather than physicians, are most knowledgeable about their own bodies. F1

F2

F3 F4

F5

F6

−4

0

–1 +5

–1

+2

Illness is believed to be a result of poor environmental surroundings and lifestyle choices.

F2

F3 F4

F5

F6

+5

+2

–3 0

0

+4

In this theory, the body is self-healing and illness something the body can recover from naturally without the help of chemical remedies. F1

F2

F3 F4

F5

F6

+5

0

–3 –4

–4

–1

40 The best way to get over an –5 illness is through conventional medication (such as antibiotics and prescribed medicines).

+1

–2 +2

+3

+3

35 Vaccinations (such as for the flu and measles) are necessary for good health.

+2

+2 –1

+5

+3

47 I would prefer to be treated by an alternative approach such as herbals or homeopathy than by conventional medicine.

Participants repeatedly asserted the belief that individuals must assume a high degree of responsibility for health. Spirituality also significantly influences health. Here, spirituality is free from religious connotation. As Tina exemplified, “I just believe in a sort of universal spirit world.” Spirituality, to these individuals, means getting in touch with one’s inner self—largely achieved through meditation, yoga, and one’s outlook. As Barbara summarized,

8 Medical doctors (MDs) are the primary health experts and authorities.

32 Many diseases of modern life result from the stressful and polluted environment in which we live.

F1

–4

The desired attributes of alternative methods include approaching health holistically, looking at causes (as opposed to symptoms) of illness, finding nontoxic ways to treat diseases, and focusing on prevention. Participants believed alternative approaches stress optimization of health and wellness, even when no illness is present. Strong sentiments about the harmful affects of modern drugs and antibiotics accompany this understanding of health. This theory places a premium on the patient–care provider relationship. Care providers need to have personal understanding of the patient to adequately care for them. Lynn describes the reasons for her satisfaction with her naturopathic physician: The primary element was the amount of time that was spent with me. Just that genuine concern for what’s wrong and what can we do to help you. And by taking that time involved, you’re able to do the history access—physical, mental, emotional parts of the person. I appreciate that this person is getting to know me on a deep level to help figure out the emotional cause of an illness.

This theory includes the idea that the individual is ultimately responsible to learn from illness to avoid future sickness.



F1

F2

F3 F4

F5

F6

26 If I am better after an illness, –4 I can return to my normal way of doing things.

–2

4

+2

+1

–4

This viewpoint captures strong dissatisfaction with conventional biomedical healthcare. Dissatisfaction stems from the perception that biomedicine approaches wellness in a reductionist manner, focusing on symptoms as opposed to causes, and failing to consider the totality of the individual in diagnosis. Tina expressed her frustration: I have a lot of different, weird symptoms, and whatever their [the doctors’] specialty is, that’s what’s wrong with me. But I think it’s all holistically related. And they just take my body parts, no matter what my symptom is, that’s what they find. They don’t look at it as a whole.

As Brian stated, “I am really disillusioned with what we call health care, it’s really disease care.” In line with the general nonconformity of Lay Theory 1 is the perspective that government and big business serve to undermine society’s health. Participants elaborated upon practices condoned by the government and the food industry they believed to be harmful to society’s health. Examples include the dairy industry’s milk campaign (i.e., human consumption of cow’s milk is not believed to be beneficial), the government’s recommended daily allowances of vitamins and minerals, the Food and Drug Administrationcondoned practices with farm animals, and food growing and processing practices. These participants believe information has been withheld from the public, resulting in Americans being unable to fully evaluate food choices. Regarding nutritional information, Jill exclaimed, “The power has been taken away from the people!” Growing societal health problems such as attention deficit disorder and allergies are attributable to the way food is grown, processed, and prepared. As Tina stated, “I think it’s pretty sad that we have to compromise people’s health to maintain, to maintain big business.” Mike explained how society’s approach to health is similar to the way many societal issues are approached: I think our culture dictates our health care system. Our health care system seems to be undergoing some kind of reform, but still it’s largely based on “take substance X, for condition Y.” If our health care is a reflection of our social consciousness then I think as

social consciousness goes, we’re more reactionary. Like gun control, the issue is whether or not to pass laws to restrict people from buying guns. But that seems to be more like a “patching up.” That’s just treating a symptom, rather than getting to the root cause.

Conventional biomedicine is the approach of choice for acute care, whereas alternative approaches are believed to be superior for chronic conditions. To learn more about health-related issues, participants consult books, health food stores, the Internet, and alternative care providers (generally in that order). Access to health information is highly valued; the information environment is deemed manageable.

Lay Theory 2 Primary emphasis on lifestyle defines this theory.

3 Diet, exercise, and stress management are the main ingredients to a healthy lifestyle.

F1

F2

F3 F4

F5

F6

+4

+5

+1 0

+1

+3

When queried about what “healthy lifestyle” meant, responses centered on proper diet and exercise. Participants proudly recounted their physical and nutritional endeavors: Pam is an avid runner, logging approximately 35 miles a week; Brad, deciding to kick his smoking habit and lower his blood pressure, turned to a low-cholesterol diet and a daily running regime—he has not missed a day of exercise in nearly 2 years; Diane attends aerobic classes regularly and has made a conscious attempt to monitor her diet; Dana hikes; Bob runs; and Leslie, at age 78, swims 5 days a week. Living a particular lifestyle pertains to health maintenance as opposed to health recovery. For treating illness, over-the-counter (OTC) remedies and prescription drugs are acceptable. Minor illnesses (e.g., flu, ear infections) are handled through self-care and diagnoses (OTC and prescription drugs). A desire for active participation and consultation with a physician characterizes this theory; understanding treatments prescribed is important. Whether physicians take time to communicate with patients is a source of dissatisfaction with health care providers. These individuals eschew hand-holding by physicians. As Pam stated, “To create tranquility and inner peace? No, I don’t think he needs to spend his time counseling people. There are counselors for that. I think that that is out of his [the physician’s] realm.”



An extreme skepticism of physicians and their diagnoses is present in this theory. Many expressed the belief that physicians’ need to protect themselves legally too often dictates the choice of treatments prescribed. Pam illustrates the hostility associated with this perspective: I think that my health beliefs have recently turned against the medical profession. . . . I think that it used to be that one revered the medical profession. I think as of late, people have seen that they are people like any other person. There are good, there are bad, and they shouldn’t be taken and believed as if they are not infallible. . . . I am skeptical of them. I don’t think they know everything.

Much of the skepticism stems from bad personal experiences with the medical profession. Incidents mentioned included rude or incompetent physicians, physicians’ tendencies to overprescribe and overcharge, poorly performed or unnecessary surgeries, and hurried visits during which patients felt they were not being taken seriously. F1 56 Medical doctors too often 0 overtreat their patients (e.g., writing prescriptions or recommending surgery when not truly necessary).

F2

F3 F4

F5

F6

+5

+2 –5

0

+4

Although wary of biomedical practitioners, participants still rely heavily on conventional treatment. At the same time they clearly differentiated their viewpoint from that of individuals more dependent on the medical profession, referring to the difference between themselves and their parents’ generation. This viewpoint also includes a preference for the scientific basis of biomedicine and values technical competence over personal qualities.

17 Technical expertise and knowledge is far more important in a doctor than personal qualities.

F1

F2

F3 F4

F5

F6

–3

+4

0

0

+2

–5

Participants were open to alternative types of treatments in worst-case scenarios, yet expressed an aversion to religious, spiritual, or psychological approaches to health as being soft and unproven.

F1

F2

F3 F4

F5

F6

0

–4

+2 –3

+4

–3

63 Optimal health is achieved +1 by following one’s heart— being true to one’s self.

–4

+1 0

+1

0

49 God is the source of all healing. He has given us the knowledge and other tools which enable health and wellness.

+2

–5

–1 –3

+5

+2

2 I believe that maintaining good health includes meditation or prayer.

+3

–5

+1 +1

+4

0

28 God works in mysterious –1 ways—health and sickness is part of the divine plan—meant for a reason.

–5

0

+2

+5

6 Faith healing can restore wellness.

–1

As she studied the Q-statements, Leslie asked incredulously, “Did someone actually say this, ‘be true to your heart?’” And when questioned about why she practices yoga, Diane quickly replied, “Oh, not for meditation, just for stretching, to keep my body limber.” Pam’s comment offers further insight: I don’t think praying is going to get rid of any disease. I don’t think having faith is going to get rid of any disease. I think that if something is medically wrong with you, having faith that something supernatural or spiritual is going to take it away, having faith that your cancer will disappear because you pray, it’s unfounded, there’s nothing that has proven that that happens.

This theory encompasses skepticism of alternative approaches, yet it also exhibits a strong desire for consumer choice in health care options. Although participants were uninterested in alternative medicine, they did not want their options decided by insurance companies. These participants had the most to say about the current conditions of health care delivery, indicating they were generally dissatisfied with health care because of unequal accessibility and the “charlatans and con-artists” who overcharge for health care. Although they count themselves among the privileged, it angers them that others are excluded. These individuals keep abreast of health information as part of their regular activities. Information sources include the newspaper and news programs.



They expressed satisfaction with the health information available, in particular with information related to lifestyle.

Lay Theory 3 Participants holding this belief system vary widely in terms of age (37 to 67), gender, religion, and political beliefs. Yet they are achievers who are highly educated, self-confident, and successful in their professional careers. Avid readers, they view themselves as knowledgeable on current issues. Juggling demanding careers with their personal lives, these nononsense individuals wasted little time with small talk during the interviews and gave direct, concise answers to questions. It was of little surprise that statement 33 characterizes this view. F1

F2

F3 F4

F5

F6

33 As long as I keep going, –3 I tend not to get sick— keeping busy doesn’t allow one to have the time to get sick!

–2

+3 –1

–2

–1

Although retired, Debbie had no time for complacency: When my arthritis acts up, well, I tend just to push forward . . . it’s very important for me to keep active and moving. I’m not the kind of person who sits too well. I tell myself it’s better if I move.

Health is a normal state, almost taken for granted. Sickness is a response to overworking.

27 Illnesses are often wake-up calls or messengers trying to get our attention.

F1

F2

F3 F4

F5

F6

–2

+1

+4 0

0

0

Ginny explained, “I don’t think we give as much credence to some of the signals as we could. I think things happen before the illness and we just slough it off and say, ‘Oh, I can continue to work as long as I’m going.’” However, in this theory there is a disconnection between fast-paced lifestyles and chronic illness. Upon incurring illness, a person takes the time he or she needs and then gets right back to running hard. F1

F2

F3 F4

F5

F6


–2

+4 +2

+1

–4

These individuals value industrialization and modern technology, and believe ensuing medical advancements have been extremely beneficial to society. Characteristic of this theory is a take-charge attitude. Responsibility for health is exerted in two ways: through lifestyle and decision making. A healthy lifestyle includes some exercising, controlling junk food intake, and taking time to slow down as needed. Most participants had experienced health-related problems, providing impetus for adopting these beliefs. Guilt is also salient in this theory. Although health is within the individual’s control, people often become too busy or are insufficiently diligent in practicing their beliefs. As John stated, “There’s a tendency to get sucked in . . . you’re pressed at lunch and you revert to bad habits, fatty foods and you end up overindulging.” Nancy, who had just gone through chemotherapy for breast cancer, admitted she still had difficulty making time for healthy behaviors. Interviewer: Why do you think you’re not there? Nancy: Competition. There’s just so many things. So many things. Many of them work. Many of them pleasure. Sometimes fatigue. There’s just not enough hours in the day. And then, though, if I were sort of to bisect that, I would say I’ve got my priorities screwed up. It’s like if this is important, if your health is important, then sit down and meditate.

Most participants echoed these same sentiments regarding the difficulty of making time for activities they believed defined a healthy lifestyle. Members adhering to Theory 3 value health information, believing those who are uninformed receive inferior care. Information is an important way to exert control over health and enables involvement in health-related decisions. Trust in science weighs strongly in this thinking. Science and technology have made major contributions to health; the biomedical physician plays an integral part in health, as well.

43 Modern drugs have made a major contribution to fighting disease.

F1

F2

F3 F4

F5

F6

–1

+1

+4 +5

0

+2

+5

–3 0

+2

–1

46 I’d prefer to use treatments 0 or remedies that are proven scientifically, but am willing to try unproven remedies if they’ve worked for other people.



Adherents to this theory only accept scientifically proven treatments, as Nancy’s comment illustrates:

John explained his thoughts behind this sentiment by saying:

Homeopathy, as I understand it, is taking a substance and diluting it down until there is one molecule in the particular syrup, drug, injection—whatever the treatment modality is. And that will then be effective. It would be effective for the placebo effect, which is fine. I just don’t buy that one molecule of something by itself is going to do anything.

I think that there are some people in the alternative medicine side that are a little too far out there, a little quacky. And I think a line has to be drawn. I think alternative medicine should be available, but I don’t want to fund it. Health care costs are already very high, and I think if you give people the opportunity to also use their health insurance to go out and see an acupuncturist, which I don’t believe really helps. . . . I would prefer that you spend your own money to do that. I would not want my . . . premiums [to] increase, even a tad, to cover that. You feel that it works; spend your own money.

Similarly, John stated his preference for data to evaluate herbal supplements. “I’d rather have the black-and-white study, if there is one out there. But I need to see the evidence first, before I believe their claims, I want to see the studies that prove it works.” Health encompasses the mind and spirit along with physical components. Balance and positive mental outlook are keys to health. Illness is within individuals’ control. F1

F2

F3 F4

F5

F6

29 The spread of germs and viruses is the main cause of most illnesses.

–1

+3

–4 +2

+3

0

31 The power of a positive outlook or attitude can prevent sickness.

+1

0

+5 +1

+2

–3

This theory attributes illness to fast-paced lifestyles. Illness is a sign of overwork and the need to slow down temporarily. Having the right attitude helps prevent illness; however, it is not simply a cheery attitude that maintains health. Health maintenance is more of a control issue; individuals exercise their will to keep going and to persist in their endeavors. I’m someone who says that I won’t allow myself to get sick. . . . I have just willed myself that I will not get that way. And part of that is a control feature. I very much believe that I should be able to control my body. And I can do it to a great degree.

F1

F2 F3 F4

F5 F6

+5

+4

–3

–4 +1

Members holding this theory vary in gender, education (highest degree attained ranged from high school to college graduate), social class, and ethnic background. The uniting feature of this theory is strong faith in all aspects of conventional biomedicine. Each of the participants is considerably overweight. Both in their 30s, Marsha and Doug had yet to experience severe health problems, whereas Ron, in his 50s, had recently been diagnosed with diabetes. Participants think of health in physical terms. Health equals the lack of physical illness symptoms and is given little consideration in daily life.

8 Medical doctors (MDs) are the primary health experts and authorities.

F1

F2

F3 F4

F5

F6

–4

0

–1 +5

–1

+2

These individuals rely heavily on doctors and medication when they are sick; however, they do not seek or engage in preventative care.

Participants will consider low-risk alternative therapies if supported by scientific studies. They believe in meditation for health because a growing body of evidence shows it is health-promoting. They remain skeptical of what they regard as unscientific alternative remedies.

23 All types of remedies (including alternative methods such as acupuncture) should be covered by insurance programs.

Lay Theory 4

+3

F1 9 I rely on my doctor to take 0 care of my health; that’s what he or she gets paid for.

F2

F3 F4

F5

F6

–3

–5 +3

–4

0

Participants look to physicians and medicine to fix them. Doug is satisfied with his health care: Generally if I’ve gone to get something fixed, it’s gotten fixed. So, that’s what I go to a healthcare provider for.

Physicians’ personal qualities are important to these individuals. Downloaded from http://qhr.sagepub.com at La Trobe University on July 30, 2009


F1

F2

F3 F4

F5

F6

17 Technical expertise and knowledge is far more important in a doctor than personal qualities.

–3

+4

0

0

+2

16 Medical doctors should maintain a detached professional relationship with their patients. I feel more comfortable with a physician who maintains some distance.

–4

0

–1 –4

–1

–2

–5

think that if a doctor prescribes antibiotics and rest, if the patient does not take the antibiotics for the full time and does not rest, they can’t blame the doctor for not getting better.” Similarly, now diagnosed with diabetes, Ron reflects his enlightened view of his responsibility: Now that I’ve had the experience about being diagnosed diabetic and all, I think I would go to the doctor more quickly. Rather than, “Oh well, I’m not really that bad off. My leg ain’t falling off so that blackness isn’t nothing to it.”

Unlike the adherents of Theory 2, who valued doctor– patient communication for more accurate diagnosis, members adhering to Theory 4 value communication and other physician qualities that facilitate the patient’s comfort and help put them at ease in the medical environment. This view downplays the role of individuals in maintaining health. Beliefs about preventative measures included taking vitamins and eating less. Ron provided a fitting insight regarding his involvement in health with the following story: A lot of my medical opinions have changed in the last nine months. Before that, I used to have a standing joke with the workers, “My heart and I have a mutual agreement. I do nothing to stress it and it leaves me alone!”

Marsha hinted at the responsibility individuals have by stating the following: I look at a doctor as more than just a fix-it. It’s also someone who can, hopefully, have the information to help prevent, like “next time you should do this, this or this.”

However, Marsha, who is extremely overweight, goes to both a nutritionist and therapist on a regular basis. She claimed she knew the right way to eat, but stated, “I have no self-control,” attributing her poor diet to “basically laziness, lack of self-discipline, boredom. . . . And when I get bored, you know, I make poor choices, really bad choices. At lunch I make really lazy choices, I get the quarter pounder and super size the fries . . . you know what, my whole diet would change if I ate more protein.” In addition, she stated said she doesn’t like to cook and eats out often. Consistent with this theory’s lack of self-reliance, it appears Marsha goes to specialists to be fixed, but does little to fix herself. To these participants, patient responsibility means simply following doctors’ orders. Marsha stated, “I

Conventional biomedicine is relied upon heavily, especially pharmaceutical medications. F1

F2

F3 F4

F5

F6

25 Conventional medicine “patches up” the body instead of truly healing it.

+1

0

+2 –4

–4

–1

21 When I’m not feeling well, I prefer that my physician write me a prescription so that I can recover more quickly.

–2

–2

–5 +5

–3

0

Affirming her satisfaction with the health care received at urgent care clinics, Marsha stated, “Really the times that I’m sick, I’ve gone to those urgent cares. I only want a prescription. So, they provide my codeine and I’m happy!” Drugs aid in health maintenance. F1

F2

F3 F4

F5

F6

–1

+1

+4 +5

0

+2

56 Medical doctors too often 0 overtreat their patients (e.g., writing prescriptions or recommending surgery when not truly necessary).

+5

+2 –5

0

+4

39 To be healthy, it is best to live as natural a life as possible.

+4

+1 –5

+3

–2

43 Modern drugs have made a major contribution to fighting disease.

0

The ranking of statement 19 indicates that this theory includes attributions for health and illness to their own actions.

19 Many people suffer from illnesses caused by their own bad habits.


F1

F2

F3 F4

F5

F6

+4

+3

–2 +4

+1

+4


These findings might seem inconsistent with the ranking of other statements or interview content. However, the interviews revealed that participants’ ranking of the statements reflected what they had been told by their physicians, on whom a great deal of reliance is placed. Participants’ behaviors did not reflect these beliefs, nor did their other comments show they truly embraced the beliefs. As an example, Ron provided the following explanation when questioned as to why he believed that present health care is important to one’s future health: Because my entire diabetic thing is 99% of the effect that I’m overweight. That’s what the doctors have said, “Probably 90% of it is the fact that you’re overweight.” So that’s how come I say people are in control.

Doug explained, “Well, people suffer from lung cancer because they smoke.” Yet, later in the interview Doug stated, I just think there’s way, way, way too much information out there in terms of, this week it’s healthy to do this, next week, it’s not healthy to do this. . . . I don’t let it affect me or anything; I don’t buy into all those things. You know if I didn’t do everything I wasn’t supposed to do, I may as well sit in a little plastic bubble my whole life!

Participants were not clear about what activities were needed to prevent illness. The belief that individuals are in control of their own health appeared to be learned from physicians, but was not fully understood. Lay Theory 4 adherents are open to alternative approaches, though they are unaware of the principles behind them (e.g., holism and balance). Alternative techniques are regarded within an allopathic “magic bullet” framework—i.e., taking herbal supplements to help remedy a particular problem, in the same way prescription pills are taken. As Marsha exemplified, I’m a firm believer in herbal remedies, especially valarian root. It’s awesome for sleep! It’s not addictive. You know, herbs are not addictive. And if you have a lot of trouble sleeping, you can get addicted to sleeping medication, even over-the-counter stuff. But valarian root is the most wonderful! It’s a relaxant.

Spiritual, mystical, and religious elements were absent from this theory. Participants seek health-related information primarily from physicians and believe the information environment to be adequate, although at times confusing.

Lay Theory 5 In this lay theory, spiritual commitment and religious practice are keys to health, including spiritual and mental wellness. F1

F2

F3 F4

F5

F6

5 Spiritual commitment is essential to optimal health.

+4

–3

–1 –2

+5

–2


+3

–5

+1 +1

+4

0

6 Faith-healing can restore wellness.

0

–4

+2 –3

+4

–3

Spiritual commitment involves maintaining a good relationship with God. Bill explained his interpretation of statement 5: “It means Jesus is here, watching over us, protecting us. But we need to recognize His presence, we need to believe, and we need to be good Christians. This is where health comes from.” When discussing how her spiritual lifestyle contributes to her health, Gert replied, Gert: Every day I read my Bible. Interviewer: And do you feel that contributes to your health? Gert: Oh yes, definitely. I really believe it’s there for us. If God didn’t care about us, that’s one thing. But He does. And that’s why He provided the Bible, that’s why He provided Jesus.

These individuals view God as the source of health and healing, granting humans the knowledge to develop innovative remedies and treatments. F1

F2

F3 F4

F5

F6

49 God is the source of all +2 healing. He has given us the knowledge and other tools which enable health and wellness.

–5

–1 –3

+5

+2

Other components are important to health, in addition to spirituality. F1 4 The mind, body, and spirit are +4 all connected; all need to be in sync for good health.

F2

F3 F4

F5

F6

0

+2 0

+4

+1

Maintaining faith is important for health. As Bill explained, “It’s all related . . . if you have faith that



keeps you in good spirits, that keeps you strong— your mind, your attitude—so you’re not thinking bad things. All of that affects your body.” The others mirrored Bill’s sentiments. In this theory health is comprised of spiritual, mental, and physical aspects. These individuals believe it is a person’s responsibility to uphold personal health through prayer. Individuals’ responsibilities also include lifestyle choices such as taking vitamins, eating healthy foods, and avoiding harmful behaviors such as smoking. Taking control includes maintaining a positive outlook, achieving moderation, upholding faith, and adhering to physicians’ advice. All participants shared Susan’s explanation of patient responsibility:

Participants believe the information environment to be somewhat difficult, with society tending to obsess over unimportant details.

The MDs’ focus, or at least my impression is, that they’re looked upon to give you an answer, to write you a prescription or recommend that you have surgery or go to the hospital or whatever. And they don’t look so much at your mind and your spirit. So you look to them to help you with your body but at the same time, there’s a responsibility that you have to take care of your mind and your spirit.

I can’t keep up. I just, like I said, I just live my life in moderation, you know, no excesses. And I trust that the Lord will help me through.

F2

F3 F4

F5

F6

0

+2

0

+3

–4

+4

–2 0

+3

–5

60 Nowadays people often –2 spend too much time worrying about their health.

–1

When questioned about the adequacy of health information, Bill replied,

Lay Theory 6

For physical health, the doctor is most knowledgeable. Doctors, modern technology, and medicine are tools or agents provided by God. Trusting and following physicians’ advice upholds one’s health responsibility.

15 People should seek out as much information as possible about any health problem and decide for themselves whether to follow a doctor’s advice.

24 The amount of health care information available is often confusing and/or overwhelming.

F1

F1

F2

F3 F4

F5

F6

+2

+3

–1 0

–4

–1

These individuals were male, middle-aged, bluecollar workers. They represented health as being a complex phenomenon not readily explained by lifestyle or genetic makeup. Health is attributed externally, with one’s lifestyle playing a supporting role. F1

F2

F3 F4

F5

F6

28 God works in mysterious –1 ways—health and sickness is part of the divine plan—meant for a reason.

–5

0

+2

+5

–1

As Alan explained:

These participants did not seek close relationships with their health care providers; rather, expertise, comfort, and support were sought from other sources. These individuals believe strongly in the efficacy of conventional biomedicine and medical doctors, believing that modern medicine was given to mankind by God to help. They are also confident in the efficacy of drugs and medicines. Susan expressed strong opinions about the importance of vaccinations. Susan also explained how modern medicine and technology have helped her husband deal with multiple sclerosis. This theory excludes alternative approaches to health. Participants were either unfamiliar with, or had not tried, alternative practices.. These individuals do not view prayer or faith-healing as being alternative.

You see people who look fit, come down with stuff, and then people who abuse themselves, die old . . . it’s not anybody’s determined destination as to whether they’re going to be healthy or not. I think it’s just random. I don’t believe just because you come from a good gene pool that you’re going to be absolutely strong and healthy all the time. I think it’s just random and there’s no rhyme or reason to it.

This theory recognizes that health is more than the absence of illness, consistent with both participants suffering from chronic illnesses. F1

F2

F3 F4

F5

F6

1 If I am not sick (for example, –1 running a fever), I generally consider myself healthy.

+2

–1 +2

+1

–4



However, those holding this theory did not aim for optimal health but instead, regular use of biomedical treatments to eliminate symptoms. Kevin ranked the Q-statement “Many cold remedies are important to help the body feel better” as uncharacteristic of his beliefs. When questioned about this belief, he responded: A lot of what they sell nowadays over the counter doesn’t have enough remedy in there to make you feel better. . . . It’s just not strong enough to do anything for you, as far as I’m concerned. I hardly ever take aspirin. I never take cough medicine. It doesn’t work.

In addition to medicine, lifestyle is also important to health in this theory. A healthy lifestyle is defined as living in moderation and eating balanced meals. Contact with the physician is the primary way to maintain health, with the patient having the responsibility to seek and follow the doctor’s advice.

36 Having regular contact with a physician is the best way to avoid illness.

F1

F2

F3 F4

F5

F6

–1

–1

–5 0

0

+4

Both the individual and physician are accountable for the patient’s health. The physician is expected to help patients recover from illness and maintain health. The patient has the duty of seeking the physician’s help, communicating with the doctor, and then following his or her advice.

10 When it comes to medical treatment, patients should always follow their doctor’s advice.

F1

F2

F3 F4

F5

F6

–3

–1

0

0

+4

0

Communication and the personal qualities of physicians are especially important in this theory. Patients should follow their physician’s prescriptions, although individuals holding this theory also believe physicians have a tendency to overtreat patients. Yet perceptions that doctors overprescribe do not adversely affect satisfaction with physicians because the purpose of going to the doctor is to receive treatment. In contrast to other lay theories (e.g., Theory 4) this theory includes being conscious of health. During the interviews it became clear that these individuals value good health because it enables them to perform physically demanding work.

F1

F2

F3 F4

F5

F6

60 Nowadays people often –2 spend too much time worrying about their health.

+4

–2 0

+3

–5

Participants believed that often falling ill signaled the need for lifestyle change: F1

F2

F3 F4

F5

F6


–2

+4 +2

+1

–4

Kevin frequently drew on his experience of having quit smoking. This had been a major accomplishment. When discussing his ranking of statement 26, Kevin explained, “Well, I took that as meaning something major. I didn’t take it as just a common cold. Like if I fooled around and got cancer and they tell me it was due to smoking. Well, I can’t take back up [give up] smoking.” On the whole, sickness was externally attributed to the immediate, physical environment. In discussing statement 32, Kevin explained how working at the university places him in a high-risk environment during cold and flu season. F1

F2

F3 F4

F5

F6

32 Many diseases of modern +5 life result from the stressful and polluted environment in which we live.

+2

–3 0

0

+4

Participants rejected alternative approaches to health, believing them to be a last resort to health.

52 Alternative methods of health care are acceptable only for those people who have tried everything else.

F1

F2

F3 F4

F5

F6

–5

–2

0

–1

+5

–2

Kevin related one of his encounters with an alternative approach to healing. Kevin: Because I tried them [megavitamins] and they just got me sick. I ended up with diarrhea. I mean upset stomach. Interviewer: Why did you try them? Kevin: Because I had somebody tell me that the best way to stay healthy is just do a lot of vitamins. And after talking to a doctor, he said, “If you’ve got your



daily requirements, your body will reject whatever you take over that.” And I got sick from having too much in me. It’s just like getting sick from too many antibiotics. I’ve done that one before, too.

F1

The above illustrates the complications and dissatisfaction that can arise when individuals use remedies guided by a way of thinking different from the treatment paradigm. These participants were content with the health care received. Satisfaction stemmed largely from having insurance coverage. Kevin recounted a story about undergoing three surgeries, each of which turned out to be unnecessary. Kevin shrugged off the experience: Every surgery I’ve had was absolutely unnecessary but we didn’t know it until we got in . . . and after I found out what the scoop was, well, it’s a long story. But it was paid for so what the heck. I didn’t lose any money or anything like that!

Gary felt his health management organization (HMO) provider was “doing a fine job” because his insurance had always covered his family’s health problems. Gary also added that his chiropractic experience would “be better if it were covered by the HMO!” Participants did not believe the information environment to be taxing, instead they relied on physicians for answering their questions.

Statements of Meaning in Lay Theory Context Examining similar statement rankings in the context of each of the contrasting lay theories yields more accurate depictions of statement meanings. Members adhering to both Theory 1 (F1) and Theory 5 (F5) ranked statement 4 highly: F1 4 The mind, body and spirit are +4 all connected; all need to be in sync for good health.

F2

F3 F4

F5

F6

0

+2 0

+4

+1

Theory 1 places high priority on self-attainment of mind, body, and spirit harmony. In contrast, Theory 5 relies upon the physicians and faith in God for physical health, while assuming personal responsibility for spiritual health. Statement 4 played an insignificant role to Theory 2 and Theory 6, but for different reasons. Statement 56 also illustrates differences in ascribed meaning between theories.

56 Medical doctors too often 0 overtreat their patients (e.g., writing prescriptions or recommending surgery when not truly necessary).

F2

F3 F4

F5

F6

+5

+2 –5

0

+4

Individuals ascribing to Theory 2 are harshly critical of the medical profession’s mindset. In contrast, Theory 6 adherents are content to have a physician’s attention; overtreatment was par for the course and not necessarily harmful, assuming medical insurance availability. Participants adhering to Theory 1 and Theory 2 rank statements 38 and 19 similarly. F1

F2

F3 F4

F5

F6

38 How I care for myself in the present will largely determine my health in the future.

+3

+3

+1 +3

+2

+1

19 Many people suffer from illnesses caused by their own bad habits.

+4

+3

–2 +4

+1

+4

In both theories, individuals maintain health selfcare via lifestyle habits. However, Theory 1 emphasizes self-initiated diet, exercise, and spiritual practices, whereas Theory 4 follows doctor’s orders and asserts that bad habits include mainly reckless behaviors (e.g., smoking). F1

F2

F3 F4

F5

F6


+3

–5

+1 +1

+4

0

5 Spiritual commitment is essential to optimal health.

+4

–3

–1 –2

+5

–2

Theory 5 and Theory 1 emphasize meditation/ prayer and spirituality, but do so differently. In Theory 5, spirituality means strong religious faith involving prayer and church involvement. Theory 1 adherents view spirituality as connecting with a universal source of energy through meditation and related practices. F1

F2

F3 F4

F5

F6

+5 32 Many diseases of modern life result from the stressful and polluted environment in which we live.

+2

–3 0

0

+4



The Theory 1 belief system considers hectic lifestyles, dependence on automobiles, and unrestrained industry practices negatively affecting environmental quality as major causes of contemporary diseases. The Theory 5 belief system omits this concern with the larger environment and considers immediate factors (stressful jobs and workplaces) as key reasons for illness.

Discussion The study described here uniquely portrays, in depth, the nature of six U.S. consumer theories of health. Consumers’ lay theories of health vary in terms of ontology and meaning of health, provider vs. patient role, perceived self-efficacy and self-care practices, role of spirituality in health, trust in biomedical vs. alternative approaches, sources and use of health information, health behaviors, and satisfaction with health care. The results have implications for understanding and researching consumers’ health motivations and behaviors, the emergence of healthrelated role identities, consumer satisfaction judgments, and related public policy. First, the results draw attention to the role consumers’ lay health theories might play in health motivation and behavior. Lay health theories frame how consumers define the meaning of “healthy” or “unhealthy.” For example, consumers defining health as the absence of illness symptoms view their health and behave differently from those who view health as an optimal goal state. What consumers mean by “health” influences their answer to “How healthy am I?” and enhances or constrains motivation to engage in behaviors defined as healthy in the professional sector. Thus, taking into account consumers’ lay theories in future research might enhance understanding of consumer health motivation and behavior. Second, the results suggest that researchers should consider taking into account lay health theories to most effectively predict health behaviors. Applying multivariate attitude models to explain and predict health behavior usually involves comparing consumers’ beliefs against the prevailing paradigm (e.g., the correctness of consumers’ beliefs about smoking). Yet our results demonstrate that lay people’s belief systems do not conform to an attitudinal continuum

anchored by the prevailing and countervailing paradigms of health. Large-sample, attitude-based survey research might be enhanced by taking consumers’ lay theories into account. Third, our results demonstrate that lay health theories impact provider–patient relationships and consumers’ satisfaction judgments. For example, Lay Theory 1 is strongly anti-establishment; Lay Theories 3, 4, and 6 participants accept conventional practices; and Theory 2 participants seem skeptical of any health practitioner. For practitioner–consumer relationships to be most successful, consumers’ thinking should be compatible with practitioners’ views (Hausman, 2004). What affinities occur between particular lay theories and categories of health practitioners and how does this impact practitioner–consumer relationships and resulting satisfaction levels? A screening questionnaire based on the Q-sort results, to be administered by medical personnel, could be helpful in assessing the general health theories to which patients subscribe. Fourth, public policy issues and the effectiveness of health information campaigns could also be examined in light of lay health theories. Whereas health officials think in terms of conventional vs. alternative (or complementary or integrative concepts), consumers do not necessarily think along those lines; truly consumer-centric health policy would be based on an understanding of how different groups of consumers think about health. Our purpose was to assess the nature of lay theories, how they compared to one another, and how they registered relative to two ideal paradigms—the prevailing biomedical and countervailing alternative models. We were not aiming to identify every possible lay theory that exists. Future investigations could uncover other lay theories not identified in our study. Also, upon replicating our study procedures, we might find changes in the theories because of their natural evolution over time. Nonetheless, our general conclusions likely would remain steady even if specifics differed. Our study shows why it is important to adopt a consumer-centric perspective when studying health motivation and behaviors. Health researchers, health care product and service marketers, and public policy makers all could utilize an understanding of the different health belief-based segments of consumers in the U.S. market, and how they think about health and wellness.



Appendix A Q Sort Instrument

Participants were instructed to place the statements (indicated by spaces) beneath each of the 11 columns, which represented the degree to which a statement was characteristic of participant’s health belief. Least Characteristic –5

–4

–3

–2

–1

Neutral 0

1

2

3

4

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____

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____

____

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____

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5 Most Characteristic

____ ____ ____

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