This is the area of the layperson who is not a specialist or professional, and it is often in this area that ill-health is first recognized. This sector includes all the therapeutic options available to the public that do not require payment or consultation with medical practitioners or folk healers. This area mainly includes self-medication, and a study by Dunnell and Cartwright in 1972 found that the use of self-prescribed medication was twice as common as the use of prescribed drugs. Self-medication was often used as an alternative to arranging an appointment to see the GP. Laxatives and aspirin are the most common self-prescribed drugs. Often the exchange of medication happens when someone who has been prescribed a drug or is taking a non-prescribed drug for abdominal pain that they found to work for them will offer this to a friend or neighbour who is exhibiting much the same symptoms. Hindmarsh (1981) termed this phenomenon 'over the fence physicians'. The influence of taking or not taking prescribed drugs is part of the popular health culture; it is influenced by lay evaluation of 'does this drug and what it will do make sense?' and this 'reasoning' affects compliance and non-compliance.
One very important area of the popular healthcare sector is the ever-expanding role of self-help groups, which have multiplied many-fold since World War II. In 1982 it was reported that there were about 355 self-help groups in the UK with many thousands of members (Helman, 1990). Most of the categories of self-help groups often overlap and Levy (1982) found that, although many self-help groups were for members who were afflicted and others were for the carers of those afflicted, other self-help groups would be made up of the afflicted and of doctors, nurses and pharmaceutical companies. Self-help groups often start because people feel that existing services in the biomedical area either are not suitable or do not exist, or because like-minded people recognize the value of mutual help. Self-help groups in ostomy care have evolved since the 1930s to help and support the patient with a stoma. Reissman (1965) described the helper therapy principle, implying that it is the helper who may benefit most from the helping role.
In 1963 a pilot scheme was organized at the Royal Marsden Hospital with funding from the King's Fund to establish whether there was a need for some form of group or association for patients who had undergone surgery and had a colostomy. After the initial pilot survey in London, a decision was taken to establish a charity for the purpose of providing guidance and assistance to colostomy patients in the UK, to help with rehabilitation and to enable them to have a better quality of life. The association became a registered charity in 1966 and is now known as the British Colostomy Association. Often those with 'stigmatized' conditions who feel marginalized within their community and society find that 'belonging' to a self-help group or organization helps them to explain and cope with their situation.
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