CAIE A-Level Psychology 3.1.3 Misusing health services

Use Table A: AO1 Knowledge and understanding to mark candidate responses to
this question.
Candidates must describe a study for both reasons for delay in seeking treatment
and Munchausen, but they do not need to use the Safer et al. or Aleem and Ajarim
studies.
Likely responses:
Any studies that investigate reasons for delay in seeking treatment and
Munchausen are creditworthy.
Delay in seeking treatment (Safer, 1979)
Study done in waiting room of 4 clinics of large city hospital. 93 patients ( $38 \mathrm{~m}, 55 \mathrm{f}$ )
average age 44. Patients with severe illness were excluded. Most patients had
'mild' complaints, 45 -minute interview and questionnaire interviewed (questions
asked about types of delay= DV and predictors of delay = IV). Measured total
delay (made up of appraisal, illness and utilisation). Results found there are three
stages/types of delay: appraisal, illness and utilisation. A variety of factors predict
the length of the delay for each of the three stages. For example, for appraisal -
awareness and evaluation of symptoms - well defined and specific shortened
appraisal delay/attempting home remedies. For illness delay - whether the illness
is perceived as mild or severe, beliefs about benefits/discomfort of treatment. For
utilisation delay - effort to make and attend appointment, costs of treatment,
complications in life setting that might prevent seeking treatment (e.g. availability
of childcare). Concluded that a wide variety of factors affect total delay in seeking
treatment. Strong sensory signals (e.g. high levels of pain) led to shorter delays.
The more patients researched their illness, the longer the delay.

6

Award up to 4 marks where the
response has described only part of
the question even if the response
otherwise meets the criteria for
Level 3.

12(a)

Munchausen syndrome (Aleem and Ajarim, 1995)

Munchausen's syndrome is a psychological disorder where someone pretends to be ill or deliberately produces symptoms of illness in themselves. Aleem and Ajarim report a case study of a 22 year old woman with Munchausen who reported with swelling on her body. She had been seen on numerous occasions in the hospital since she was 17 and given various treatments. Suspicions were raised by the hospital when it was felt that the ailments she had did not appear to have a physical cause. Upon admittance to the psychiatric ward the nursing staff eventually found a needle with faecal material in it. Believed the patient had injected this into her breast tissue. The patient left the hospital when confronted after becoming very angry and did not return again.

Other appropriate responses should also be credited.

Use Table B: AO3 Analysis and evaluation to mark candidate responses to this question.

A range of issues could be used for evaluation.

Likely evaluation points:

- Named issue - case study method

Strengths - Detailed results often qualitative data; insight into someone with a unique experience - gives deep understanding of disorder, may lead to further research into a topic.

Weaknesses - generalisations from findings, researcher bias, evaluation of qualitative data.

- Reductionism versus holism

Both Safer et al. and Aleem and Ajarim are fairly holistic. The reasons for total delay in seeking treatment given at various levels of explanation including both physical sensations to cognitive appraisals. Aleem and Ajarim is an in-depth analysis of a case of Munchausen with a focus on potential childhood trauma leading to the disorder. Most of the focus of the study is on the symptoms and diagnosis of the disorder.

10

Credit evaluation of studies used in