Introduction user, to a more person-centred model of healthcare.



World Health Organisation (WHO) defined health in 1948 as a, “state of complete
physical, mental and social wellbeing and not merely the absence of disease or
infirmity.” (WHO, 2018). This definition highlights the fact that it is not
merely the physical ill-health of a service user that should be considered by
healthcare professionals, but also the factors relating to their psychological and
social wellbeing. Since the 1990’s, the idea of person-centred care has
appeared with increasing regularity in United Kingdom health policy (The Health
Foundation, 2014). As a result, a transition has emerged from the traditional
medical model of healthcare, which focussed on the anatomical and physiological
symptoms of the service user, to a more person-centred model of healthcare.
This more holistic approach considers their entire wellbeing, as individuals
within their own community, who have specific needs and values that are
important to them. Research has shown that if the broader wellbeing of the
patient is addressed, they are more likely to be treated with the respect,
dignity and compassion that they deserve (British Medical Association, 2011).

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essay summarises some of the underlying psychological and social factors that
may affect service users attending the radiography department. These important
factors should be considered by radiography department staff when communicating
with patients in order to achieve person-centred care. There are an abundance
of factors that could be discussed; examples include gender roles, disabilities,
income, social class, wealth, occupation, culture, educational background,
media influence, relationships, mental illness, anxiety, anger and alienation.  This essay will however focus on socioeconomic
factors and patient stress and anxiety.


Social Factors


association between a person’s health and their social class is one that is
well documented and applies to all aspects of health including mortality rates,
life expectancy and likelihood of accessing public health services.  In spite of the fact that the NHS is a
service accessible to all, a report on England from the Office for National
Statistics highlighted major differences in a number of health related issues across
the different social classes.

person’s social class is usually determined by their educational background,
occupation, income and wealth.  People in
the United Kingdom in higher social classes tend to have jobs that provide
substantial income, favourable working conditions and a higher status. As a
result, they experience better than average health and wellbeing.  In contrast, lower social classes tend to
have more manual, less stimulating, lower status jobs with poor working
conditions.  Therefore being part of a
low social class can have a detrimental impact on a person’s physical and
emotional wellbeing, compared with people belonging to the higher social
classes, who tend to have better paid jobs with more favourable working
conditions.  The more manual,
uncomfortable nature of low income occupations puts members of the lower social
classes at more risk of occupational hazards. Direct effects on their health
and wellbeing include accidents leading to fractures and soft tissue injuries,
musculoskeletal pain from repetitive actions and respiratory problems due to
poor air quality in places such as factories and workshops.  A study carried out by Charles Court-Brown et
al. (2013), investigated the relationship between social deprivation and the
incidence of adult fractures. The investigation was performed at The Royal
Infirmary of Edinburgh and concluded that fracture incidence significantly
increases in the most deprived 10% of the population.  The study suggests that people belonging to
the lowest social classes are more prone to falls and accidents and, in
particularly, high-energy proximal tibia fractures.

belonging to high social classes usually have a greater income and as a result
become wealthier. Consequently, this gives them levels of disposable income
that members of the lower social classes do not have. Wealthier families tend
to have a better quality of life and have more potential to reduce their health
risks because they have greater opportunity to make positive health decisions. More
disposable income means that wealthier people can invest in gym memberships and
are more likely to exercise for leisure. Although the lower classes tend to
have more manual occupations, this physical activity does not adequately effect
their cardiorespiratory system for it to be beneficial and, after a hard day’s
work, they are unlikely to want to partake in even more physical exercise.  Wealthier families also tend to have
healthier diets as they can afford to buy better quality and more nutritious
foods, whilst poorer families tend to eat more fatty, processed and convenience
foods. Studies have also linked lower socioeconomic groups with heavier alcohol
consumption and increased tobacco use. Research into alcohol consumption of
members of the adult population of Wales found that participants from the most
socially deprived areas were most likely to binge drink. Suggested reasons for
this are that people of low social class use alcohol as a coping mechanism to
deal with the stresses of everyday life, and also that cheap alcohol is more
readily available in socially deprived areas due to there being a higher
density of alcohol outlets( ).  When on
clinical placement in the accident and emergency department of the Royal Stoke
University Hospital, it was observed that the majority of people who were
referred for ultrasound scans specifically to look for liver problems, were
people of middle age who had alcohol dependencies. Some were unemployed and
others had no fixed abode. The vast majority were unkempt and some were still under
the influence of alcohol at the time of the scan. All of them were found to
have varying degrees of fatty liver disease and cirrhosis.

cumulative effect of poor diet, inadequate physical exercise, excessive alcohol
consumption and tobacco use means that being part of the lower social classes
is related to increased risks of obesity, heart disease, myocardial infarction,
liver disease, diabetes and increased susceptibility to certain cancers ().


Psychological Factors


factors refer to the thoughts and feelings that affect the functioning of the
human mind. These factors affect a person’s behaviour, attitude and decisions towards
their healthcare. Psychological factors subconsciously influence how people deal
with the dynamics of different health issues during their lifetime.

illness and pain can have a profound negative impact on a person’s emotional
wellbeing. Attending hospital inflicts added stress onto a patient due to the
unfamiliarity of the clinical environment, particularly the technical equipment
and surroundings of an imaging department. Anxiety is an important
psychological factor that must be considered by radiography staff in order to
get the best possible outcomes for the patient. Service users undergoing
radiographic examinations for diagnostic purposes will have increased feelings
of anxiety due to the uncertainties of the outcome of their illness and fear of
the unpleasant nature of certain radiographic procedures. A study carried out
in 2011 on behalf of the Radiological Society of North America assessed the levels
of distress of women in the waiting room of an imaging department who were
attending for radiological procedures. The results showed that the women that
were attending for diagnostic breast biopsy, and the women attending for
invasive treatment of malignant liver cancers and uterine fibroid treatment,
experienced abnormal levels of perceived stress, depressed mood and negative
impact of events. Interestingly however, it was only the women attending for
breast biopsies that experienced highly alleviated levels of anxiety.  This suggests that the invasiveness of the procedure
has less influence on patient anxiety than the uncertainty of the test results
(   ). The patients attending for
treatment rather than diagnostics already knew that they had cancer or fibroids
and so the fear of the unknown was not as influential on their emotional

of anxiety and stress can stop patients from retaining information and can also
affect how they respond to instructions. During was an extremely anxious lady came
for a barium swallow examination. The high anxiety levels of the lady meant
that she found it difficult to follow basic instructions such as holding the
barium in her mouth and swallowing at the correct time. Even when the
radiologist explained to the patient after the examination that there was nothing
significant to worry about, she continued to question the radiologist as though
she could not believe the positive outcome. The patient’s abnormal level of
anxiety was partly a result of the fact that prior to her appointment, she had
convinced herself that she was going to be diagnosed with a tumour. The temptation
of patients to self-diagnose is a prevalent issue in modern healthcare, and can
often increase feelings of depression and anxiety in service users. People are
now less passive in their attitude towards their healthcare and will use online
resources to try to have greater understanding about healthcare issues. Unfortunately,
when this information is not accurate and a healthcare professional has not
also been consulted, it can cause unnecessary worry to an already anxious
patient and as a result has a profound negative influence on their psychological
health and wellbeing.

of intense anxiety or stress can cause physiological changes in the body that
mirror the symptoms of other illnesses. People who are abnormally anxious can
experience increased heart and breathing rates, profuse sweating, trembling
sensations and gastro-intestinal problems. 
Patients will often have numerous radiographic examinations because of
these symptoms and will still not get an answer because their symptoms are
anxiety related. They may be referred for a chest X-ray or ECG because of an increased
heart rate, or for a virtual colonoscopy because of digestive problems, but the
imaging will often not show any physical cause of the symptoms.

factors such as stress and anxiety must be considered by radiography staff to
ensure that service users do not feel like their psychological wellbeing is
being ignored. Radiographers are therefore faced with the challenge of not
letting the technicalities of the radiographic examination distract them from
being attentive to the patient’s emotional health and wellbeing.


Discussion and Reflection   


makes service users vulnerable and scared. They are forced to trust that the
healthcare professionals they encounter on their patient journey will do the
best for them as individuals and will consider their entire wellbeing, not just
their anatomical and physiological symptoms.

traditional passive role of the patient is becoming a thing of the past and
they are now encouraged partners in their own care, collaborating with
healthcare professionals in decisions regarding their treatment. The Planetree
model encompasses this patient-centred approach to healthcare suggesting that
cultural transformation and staff engagement is essential if we are to provide
a more value-based health service. It is the responsibility of all healthcare
workers to consider the psychological and social factors that may affect service
users on an individual basis (Planetree, 2018).  When applied to radiographic practice, the Society
of Radiographers Professional Code of Conduct (2013) states that all of the
professional workforce for diagnostic imaging and radiotherapy must, “Listen to
and respect the wishes of patients, seeking to empower them to make decisions
about their care and treatment.” The code of conduct puts patient-centred care
at the heart of radiographic practice which it insists must be based on values
such as respect, trustworthiness and empowerment (Society of Radiographers,
2013). Radiographers consequently have a responsibility to consider the broader
wellbeing of the patient, including the social and psychological factors that
may influence their everyday lives.

between socioeconomic status and health shows that health improves incrementally
moving upward through the social classes. Members of lower social classes are
more likely to suffer from chronic illnesses, it could therefore be deduced
perhaps that diagnostic radiography departments in particular will see more
patients from the middle to lower social classes.

factors such as stress and anxiety put emotional strain on service users
attending radiographic examination appointments and can create added challenges
for radiographers who already have to contend with consistently stretched resources
and time constraints.  Radiographers must