Consultation and illness behaviour in response to symptoms: a comparison of models from different disciplinary frameworks and suggestions for future research directions

We all get ill and social scientific interest in how we respond - the study of illness behaviour - continues unabated. Existing models are useful, but have been developed and applied within disciplinary silos, resulting in wasted intellectual and empirical effort and an absence of accumulation of knowledge across disciplines. We present a critical review and detailed comparison of three process models of response to symptoms: the Illness Action Model, the Common Sense Model of the Self-Regulation of Health and Illness and the Network Episode Model. We suggest an integrated framework in which symptoms, responses and actions are simultaneously interpreted and evaluated in the light of accumulated knowledge and through interactions. Evaluation may be subconscious and is influenced by the extent to which the symptoms impose themselves, expectations of outcomes, the resources available and understanding of symptoms' salience and possible outcomes. Actions taken are part of a process of problem solving through which both individuals and their immediate social network seek to (re)achieve 'normality'. Response is also influenced by social structure (directly and indirectly), cultural expectations of health, the meaning of symptoms, and access to and understandings of the legitimate use of services. Changes in knowledge, in embodied state and in emotions can all be directly influential at any point. We do not underestimate the difficulty of operationalising an integrated framework at different levels of analysis. Attempts to do so will require us to move easily between disciplinary understandings to conduct prospective, longitudinal, research that uses novel methodologies to investigate response to symptoms in the context of affective as well as cognitive responses and interactions within social networks. While challenging such an approach would facilitate accumulation of knowledge across disciplines and enable movement beyond description to change in individual and organisational responses.