AIMST University, Faculty of Medicine

Unit of Community Medicine

Case Studies in Sociology
Perceptions & Experiences of Illness and Disability
Case Study 1

Please read the following case study and discuss in your group.

Identify the points that indicate Client perception and classify them on the basis of
the Levanthals common sense model (CSM) of Illness perception.

How do you think an understanding of patients perception will help in managing

the patient (ie controlling/curing the disease in the patient)

Extracts from a research study

Changing illness perceptions in patients with poorly controlled type 2 diabetes, a randomized
controlled trial of a family-based intervention: protocol and pilot study
Karen M Keogh*1, Patricia White1, Susan M Smith1, Sinead McGilloway2,
Tom O'Dowd1 and James Gibney3 BMC Family Practice 2007, 8:36
This article is available from: http://www.biomedcentral.com/1471-2296/8/36

FC, male mid 50's, with poorly controlled type 2 diabetes. He says he understands very
little about his diabetes except that it is called kenching manis, but that he feels it has a
huge impact on his life e.g. he hates taking the medication, he is tired all the time etc. He
also feels in the long term he may lose his leg. FC doesn't believe lifestyle factors are
important in controlling his illness, because he believes the causes of the illness are
purely genetic (he believes he inherited the illness from his mother). His wife, MC,
believes that while she does not understand the diabetes, her husband understands his
diabetes very well, but that it has very little impact or effect on his life; She also thinks
that he is over-reacting when he complains about it. She believes his diabetes was caused
by stress, and if he stopped working so much and took more time to relax, his condition
would improve. She also does not recognize the importance of lifestyle factors such as
diet and exercise for controlling diabetes, because she thinks the illness is stress-related
and continues to prepare high-fat, high-sugar meals for her husband.

Case Study 2
Please read the following case study and discuss in your group.
Identify the points that indicate Client perception and classify them on the basis of
the Levanthals common sense model (CSM) of Illness perception.
How do you think an understanding of patients perception will help in managing
the patient (ie controlling/curing the disease in the patient)
Extracts from a research study
Perceptions of HIV/AIDS and caring for people with terminal AIDS in southern Thailand - Songwathana
P; Manderson L AIDS Care Vol.10 No. 2 Jun.1998 Pp.155-165

Rok sang khom rung kiat, or a disease of social loathing, is generally used by lay
people. 'Woman disease' is also used for AIDS.
'If a person has AIDS, he or she has bad blood and it may be possible to transmit [the
infection], I am not quite clear about AIDS when it gets into the body but I think it is very
dangerous to come into contact with blood. I have seen black blood taken
from someone who is sick in hospital, I think someone with AIDS would have
black blood too ... black blood is bad and dangerous.'
Because no vaccine or effective treatment is available ( the situation has changed now),
people respond to AIDS patients with considerable fear and anxiety. Patients themselves
perceived that once they were infected with AIDS (HIV is not used in lay terminology by
southern Thais), the destination is death only. Death from AIDS is perceived to be
different from death from other causes. Key informant interviews and participant
observation suggested that AIDS deaths are regarded as bad deaths (tai mai dee) rather
than good deaths (tai dee), because the death follows prolonged suffering and
disfigurement and usually, the untimely deaths of young people. However, good or bad
death is also linked to previous behaviour and the present status of the individual
according to his or her karma.
People all believed that the main source of transmission of HIV was through sex or
needle sharing. However some also said He did really bad things, for example telling
lies, stealing inheritance from his brother and sister, being promiscuous, gambling. All of
these are wrong and immoral. It is a sin. So, he must be punished to have this disease
(Interview, patient's oldest sister).
In the village where there were known cases, most villagers who lived nearby feared
contact. They were concerned about the possibility of contamination from sharing water
from a common well, or serving cooked food to the patient or sharing it with them once
the diagnosis was common knowledge.
'When I became sick, I didn't know where to go for treatment, I didn't know
from whom and from where to ask for help.' This was expressed by a patient
who came to a temple which has become especially popular for HIV/AIDS
sufferers through its offer of cure.