Children’s perceptions of illness and health: An analysis of drawings

Abstract

Objective:

The purpose of this study was to explore possible age differences in children’s perceptions of illness and health and to what extent these differ from adults’ perceptions.

Design:

Cross-sectional design.

Setting:

Selected nursery and primary schools in Greece.

Method:

The sample consisted of 347 children aged 5–11 years and 114 adults – as a comparison group. Each participant was asked to create two drawings, depicting illness and health respectively, and to give an explanatory title for each. Drawings were categorised into three main categories, depending on the aspect of illness or health depicted, namely biomedical, psychosocial and lifestyle.

Results:

Older children produced more multifaceted depictions of illness and health than their younger counterparts, while the youngest group had difficulty to represent the two concepts clearly. A comparison of children’s perception of illness and health revealed that the first is perceived mainly as a biomedical phenomenon, while the latter as a psychosocial one. Finally, a comparison of adults’ and children’s representations showed that children understand illness mainly through its biomedical dimensions, unlike adults who seem to prefer to stress psychosocial ones.

Conclusions:

Knowledge of children’s subjective perceptions of illness and health may be useful in designing health prevention programmes and for medical professionals working with children experiencing chronic illness.

Keywords

Children drawings Greece illness and health perceptions

Introduction

Over the last three decades, several studies attempted to explore children’s perception of illness and health as well as the factors that influence and affect them such as age (Bibace and Walsh, 1981; Koopman et al., 2004; Zaloudikova, 2010), experience/knowledge (Campbell, 1975; Charman and Chandiramani, 1995; Fernandes et al., 2015; Williams and Binnie, 2002), anxiety (Brodie, 1974), mothers’ perceptions (Campbell, 1975) and gender (Green and Bird, 1986; Piko, 2007; Zaloudikova, 2010). Some of these studies have exclusively focused on perceptions of illness (Bibace and Walsh, 1981; Buchanan-Barrow et al., 2003; Charman and Chandiramani, 1995; Guite et al., 2000; Perrin and Gerrity, 1981), while others have investigated perceptions of health (Almqvist et al., 2009; Natapoff, 1978, 1982), and yet others have attempted to compare children’s perceptions of the two concepts (Altman and Revenson, 1985; Bird and Podmore, 1990; Green and Bird, 1986; Myant and Williams, 2005; Piko and Bak, 2006; Schmidt and Frohling, 2000; Zaloudikova, 2010).

Research has shown that children seem to perceive illness based mainly on its biological and medical characteristics (Buchanan-Barrow et al., 2003; Fernandes et al., 2015; Green and Bird, 1986; Piko and Bak, 2006; Schmidt and Frohling, 2000; Siegal and Share, 1990; Springer and Ruckel, 1992; Zaloudikova, 2010). They also seem to understand the social and emotional aspects of illness, since they often define this concept by referring to its accompanying feelings, as well as to the inability to participate in social life. However, it should be noted that there is also a tendency to define illness using negative terms, that is, by reference to what illness is not (Altman and Revenson, 1985; Campbell, 1975; Natapoff, 1978). The impact of environmental conditions such as atmospheric pollution is also included in children’s description of illness (Fernandes et al., 2015; Green and Bird, 1986; Piko and Bak, 2006; Zaloudikova, 2010). It appears that most children are able to give acceptable definitions of illness from an early age and to recognise its different dimensions. They form these understandings based mainly on their personal experience and knowledge (Buchanan-Barrow et al., 2003; Charman and Chandiramani, 1995; Eiser, 1989; Fernandes et al., 2015; Myant and Williams, 2005) as well as on social representations in line with dominant social and cultural trends (Moscovici, 1988).

Children’s perceptions of health have been classified into three basic categories: (a) biomedical, (b) psychosocial and (c) healthy lifestyle representations (Campbell, 1975; Natapoff, 1978; Piko and Bak, 2006; Zaloudikova, 2010). These categories are consistent with the categories specified in the official definition of health given by the World Health Organisation (WHO, 1946, 1984). More specifically, the biomedical category contains representations of health related to biological and medical processes or is based on the absence of specific diseases and symptoms (Campbell, 1975; Natapoff, 1978; Piko and Bak, 2006; Reeve and Bell, 2009; Zaloudikova, 2010). The psychosocial category includes perceptions of healthy and cheerful humans (Piko and Bak, 2006) able to perform joyful activities (Natapoff, 1978; Piko and Bak, 2006; Zaloudikova, 2010). The lifestyle category refers to activities that could potentially affect people’s health, for example, specific eating habits and exercise (Piko and Bak, 2006; Youssef et al., 2010; Zaloudikova, 2010). Previous findings suggest that children define health by incorporating all its different dimensions (Onyango-Ouma et al., 2004; Reeve and Bell, 2009; Youssef et al., 2010), which suggests that children have assimilated dominant social representations with respect to health (Moscovici, 1988).

Among the factors which seem to affect children’s perception of illness and health, age is significant (Altman and Revenson, 1985; Bird and Podmore, 1990; Campbell, 1975; Eiser et al., 1983; Green and Bird, 1986). Researchers such as Bibace and Walsh (1981) and Koopman et al. (2004) have attempted to interpret developmental changes in children’s perceptions of illness on the basis of Piaget’s (1930) theory of cognitive development and have proposed a stage-like understanding of the concept. Generally, it seems that young children as well as older ones use mainly biological terms in their definitions of illness (Bird and Podmore, 1990; Charman and Chandiramani, 1995; Springer and Ruckel, 1992). With increasing age, however, definitions become more scientific (Charman and Chandiramani, 1995) and enriched with references to other aspects of life that illness may influence (Campbell, 1975; Myant and Williams, 2005; Schmidt and Frohling, 2000). For example, mention may be made of lifestyle in reference to harmful habits – such as smoking (Myant and Williams, 2005; Zaloudikova, 2010) or to the consequences for people’s social life, something which is rarely recognised by younger children (Springer and Ruckel, 1992).

Regarding developmental changes in children’s perceptions of health, it has been argued that younger children perceive health as a lack of sickness and symptoms, while older ones understand it as an abstract and complicated concept, not necessarily to be confused with sickness (Myant and Williams, 2005; Natapoff, 1978; Schmidt and Frohling, 2000; Zaloudikova, 2010). With increasing age, a combination of the different dimensions (biomedical, psychosocial, emotional, lifestyle) can be identified, with definitions becoming more complicated and comprehensive, reflecting children’s level of cognitive development and approaching adults’ ideas (Bird and Podmore, 1990; Natapoff, 1978; Schmidt and Frohling, 2000; Youssef et al., 2010; Zaloudikova, 2010).

Children’s perceptions of illness and health are also shaped by social context. People seem to rely on social representations that take shape in a given culture in order to ‘… classify persons and objects, to compare and explain behaviours and to objectify them as parts of our social setting’ (Moscovici, 1988: 214). These representations in turn provide a framework for other aspects of thinking and behaviour.

When children are asked to compare their views of illness and health, they tend to use non-specific terms and oppositional dipoles such as happiness for health and sadness for illness (Altman and Revenson, 1985; Schmidt and Frohling, 2000). The two concepts are mainly differentiated with respect to their duration. Health is considered as a permanent situation while illness as a short-term event that interrupts health (Campbell, 1975; Natapoff, 1978). Their simultaneous coexistence is perceived mainly by older children (Natapoff, 1978). There is also evidence to suggest that it is easier for children to define illness than health (Zaloudikova, 2010).

The research methods used for investigating perceptions of illness and health vary, as many studies used open and/or structured interviews (Bibace and Walsh, 1981; Bird and Podmore, 1990; Piko and Bak, 2006; Schmidt and Frohling, 2000), while some others implemented alternative methods such as ‘draw and write technique’ in which drawing is used in conjunction with an interview (Bradding and Horstman, 1999; Fernandes et al., 2015; Piko and Bak, 2006; Pridmore and Bendelow, 1995; Youssef et al., 2010; Zaloudikova, 2010).

Drawings constitute the drawer’s representations of mental images, social experiences and emotions and are considered important tools for social investigators especially when combined with other methods (Fernandes et al., 2015; Guillemin, 2004; Horstman et al., 2008; Morrow, 2001; Youssef et al., 2010). They have been used in research exploring children’s perceptions in a variety of issues including illness and health (Onyango-Ouma et al., 2004; Piko and Bak, 2006), death (Bonoti et al., 2013; Tamm and Granqvist, 1995), the social environment (Hume et al., 2005; Morrow, 2001) and science (Christidou et al., 2009, 2012; Pluhar et al., 2009).

It has been argued that through drawings, children express with images their understandings of the world and their feelings about it (Pridmore and Bendelow, 1995; Punch, 2002; Thomas and Silk, 1990). Additionally, drawing allows children to take an active role in the research procedure, while giving them enough time to think in a climate of trust with the researcher (Boyden and Ennew, 1997; Punch, 2002).

Piko and Bak (2006) have used drawings combined with interviews in order to investigate perceptions of health in children aged 8 to 11 years. Drawings were analysed according to three specific-content categories, each representing a different dimension of health: (a) the biomedical, (b) the holistic, that is, the general state of psychic and physical health and (c) a dimension related to the promotion of a healthy lifestyle. Zaloudikova (2010) also used drawings and interviews in order to investigate 7- to 12-years-olds’ perceptions of health and found that these reflected three different ways of understanding health as: (a) a biomedical phenomenon (biological and medical characteristics, healthy lifestyle), (b) a psychological phenomenon (joyful feelings and activities) and (c) a holistic phenomenon (combination of biomedical and psychosocial dimension).

According to Zaloudikova (2010), the ‘subjective perception of health and illness has fundamental influence on the behaviour of the given person in respect to his or her own health’ (p. 124). Therefore, the investigation of children’s perceptions may be extremely useful for designing health prevention programmes, aiming at improving children’s health. This was the aim of the present study, which attempted to explore possible age differences in children’s pictorial representations of illness and health. Taking into account the fact that studies assessing the development of various concepts in childhood often include adults as a comparison group, an adult sample was also included in order to explore to what extent adults’ perceptions differ from that of children. We hypothesised that there would be age differences regarding the categories most frequently depicted in children’s drawings, as well as the number of combined categories chosen in order to depict illness and health. Based on previous findings (Green and Bird, 1986; Natapoff, 1978, 1982), we also hypothesised that children would represent illness through different aspects than those used to depict health. Finally, it was expected that children’s and adults’ drawings would focus on different aspects of illness and health, since previous research has shown that health and illness perceptions vary across different stages of life (Backett and Davison, 1992).

Method

Participants

The sample consisted of 347 children (189 boys, 158 girls) divided in four age groups: 5 years old (N = 40, 25 boys, 15 girls), 6–7 years old (N = 107, 53 boys, 54 girls), 8–9 years old (N = 105, 56 boys, 49 girls), and 10–11 years old (N = 95, 56 boys, 39 girls) from the school population of Volos, a medium sized city in Greece. The adult sample used as a comparison group consisted of 114 men (N = 8) and women (N = 106) who were undergraduate students with mean age 20.6 recruited from the University of Thessaly in Greece.

Drawing tasks

Two white sheets of paper and coloured markers were given to each child. He/she was asked to draw on the first page ‘The first thing that comes to your mind when you hear the word illness’ and on the second page ‘The first thing that comes to your mind when you hear the word health’. No further explanation that might influence children’s depictions was given. Participants were asked to draw illness first, since research has shown that children find it easier to define illness than health (Zaloudikova, 2010). In both cases, children were asked to give a title to what they drew (as a kind of explanation of the drawing), choose a nickname (requested in order to easily identify the two drawings produced by each child) and indicate their gender and their date of birth. In cases where children were unable to write, the title was written down by the researcher and in cases where children did not know their exact date of birth, the information was requested from their teacher. The same procedure was followed in collecting adult drawings.

Procedure

Initially, the school headteacher, class teachers as well as parents were informed about the purpose of the study and their consent was obtained. The children were tested in their classrooms by the researcher and in the presence of their class teacher. The whole procedure lasted 30 minutes with children being given the chance to withdraw from the study at any time. In the adult sample, participants were informed about the purpose of the research, their consent was obtained and they completed the task in about 20 minutes. Adult participants were tested in groups of 20 in a room at their university.

Coding of drawings

Content analysis was conducted (Cohen and Manion, 1994) in order to code the drawings. The thematic categories used were those proposed by Piko and Bak (2006) for the classification of children’s drawings of health and were slightly modified to be applicable to illness drawings as well. More specifically, raters analysed all drawings in a systematic way, attempting to identify the general themes portrayed. One hundred and forty drawings were scored independently by two of the authors, who had previous experience in drawings analysis. Agreement between raters was 92% for classifying drawings of illness and 94% for the drawings of health. Because agreement between the two raters was high, in subsequent analysis one of the classifications was randomly selected. Table 1 presents in detail the categorisation of drawings.

Table 1.

Categorisation of drawings.

		Illness	Health
Biomedical aspects		Hospital, nurses, doctors, disease, disease symptoms, blood, images of the human body with dysfunction, medicines, thermometers, pharmaceutical symbols	Hospital, nurses, doctors, images of the human body with the proper function, medicines, pharmaceutical symbols
Psychosocial aspects	Emotions	Sadness, fear, tears	Happiness, laughter
	Social life	Lying on bed, abstention from school or play, death scene, grave	School, playing, going for a walk
	Abstract thoughts	Negative manifestations of nature, bad weather, wilted plants, sad landscapes	Sun, rich nature of blooming flowers and trees, colourful/cheerful landscapes
Lifestyle aspects		Smoking, alcohol, drugs, AIDS, environmental pollution	Gymnastics, jogging, swimming, brushing teeth fruits, vegetables, dietary supplements, vitamins

Results

Initially 922 drawings were collected (694 produced by children and 228 by adults), 461 of them depicted illness while 461 depicted health. Drawings were coded regarding the different aspects of illness or health shown and their probable combinations. More specifically, three content-specific categories were identified: (a) biomedical which include drawings depicting medical and/or biological dimensions of illness/health, (b) psychosocial which involves drawings expressing feelings, social activities or any kind of abstract thoughts and (c) personal lifestyle which includes drawings depicting healthy or unhealthy attitudes and behaviours (e.g. nutrition, exercise, smoking, drugs, etc.). Some participants could not depict what was requested, either by returning a blank page or by producing depictions that were not related to the theme. Their drawings were integrated into an additional category, which reflected failure of depiction. Representative drawings of each category are presented in Figure 1.

Figure 1.

Representative drawings of illness and health.

Intending to investigate possible age differences in children’s perceptions of illness, an analysis was carried out which showed that the depiction differs significantly as a function of children’s age, χ²(21, N = 347) = 147.22, p < .001, V = .37. Table 2 presents the category or the combination of categories, which was chosen across children’s age groups in order to depict illness. Despite the fact that there were differences in the order of the preferred categories in the different age groups, the biomedical category, the psychosocial one as well as their combinations were the most popular choices in all age groups. It should be noted, however, that 37.5% of the 5-year-olds were unable to draw images that could be placed in any of the categories under examination. In order to find out which category was the most popular in each age group, the number of participants who chose it alone or in combination with others was summed for each category (Table 3). No significant differences were found between the four age groups in relation to the most popular category depicted.

Table 2.

Categories or combination of categories used to depict illness by age.

	Failed		Biomedical		Psychosocial		Lifestyle		Biomedical & Psychosocial		Biomedical & Lifestyle		Psychosocial & Lifestyle		Biomedical & Psychosocial & Lifestyle		Total
	f	%	f	%	f	%	f	%	f	%	f	%	f	%	f	%	f	%
5 years	15	37.5%	20	50.0%	3	7.5%	0	0.0%	2	5.0%	0	0.0%	0	0.0%	0	0.0%	40	100%
6–7 years	3	2.8%	35	32.7%	49	45.8%	0	0.0%	20	18.7%	0	0.0%	0	0.0%	0	0.0%	107	100%
8–9 years	2	1.9%	52	49.5%	20	19.0%	0	0.0%	28	26.7%	1	1.0%	0	0.0%	2	1.9%	105	100%
10–11 years	0	0.0%	38	40.0%	14	14.7%	3	3.2%	33	34.7%	2	2.1%	3	3.2%	2	2.1%	95	100%
Total	20	5.8%	145	41.8%	86	24.8%	3	0.9%	83	23.9%	3	0.9%	3	0.9%	4	1.2%	347	100%

Table 3.

Frequency of categories used to depict illness by age.

	Biomedical		Psychosocial		Lifestyle
	f	%	f	%	f	%
5 years	22	55.0%	5	12.5%	0	0.0%
6–7 years	55	51.4%	69	64.4%	0	0.0%
8–9 years	83	79.0%	50	47.6%	3	2.8%
10–11 years	75	78.9%	52	54.7%	10	10.5%

Regarding age differences in children’s perceptions of health, analysis showed that depictions differ significantly depending on children’s age, χ²(21, N = 347) = 146.85, p < .001, V = .37. Table 4 summarises the category or the combination of categories used by different age groups. Categories which reflect the psychosocial and the lifestyle aspects of health appeared more frequently in the drawings of all children. Regarding children’s ability to depict health, 62.5% of the 5-year-olds failed in this representation. No significant age differences were found in the frequency with which each category appeared (Table 5), although it seems that older children combine more categories to represent health than their younger counterparts.

Table 4.

Categories or combination of categories used to depict health by age.

	Failed		Biomedical		Psychosocial		Lifestyle		Biomedical & Psychosocial		Biomedical & Lifestyle		Psychosocial & Lifestyle		Biomedical & Psychosocial & Lifestyle		Total
	f	%	f	%	f	%	f	%	f	%	f	%	f	%	f	%	F	%
5 years	25	62.5%	1	2.5%	11	27.5%	3	7.5%	0	0.0%	0	0.0%	0	0.0%	0	0.0%	40	100%
6–7 years	9	8.4%	1	0.9%	53	49.5%	31	29.0%	0	0.0%	0	0.0%	13	12.1%	0	0.0%	107	100%
8 – 9 years	4	3.8%	11	10.5%	53	50.5%	21	20.0%	3	2.9%	1	1.0%	12	11.4%	0	0.0%	105	100%
10–11 years	2	2.1%	9	9.5%	35	36.8%	26	27.4%	7	7.4%	1	1.1%	14	14.7%	1	1.1%	95	100%
Total	40	11.5%	22	6.3%	152	43.8%	81	23.3%	10	2.9%	2	0.6%	39	11.2%	1	0.3%	347	100%

Table 5.

Frequency of categories used to depict health by age.

	Biomedical		Psychosocial		Lifestyle
	f	%	f	%	f	%
5 years	1	2.5%	11	27.5%	3	7.5%
6–7 years	1	0.9%	66	61.6%	44	41.1%
8–9 years	15	14.2%	68	64.7%	34	32.3%
10–11 years	18	18.9%	57	60%	42	44.2%

When children’s perceptions of illness were compared with those of adults, significant differences were found, χ²(7, N = 461) = 31.86, p < .001, V = .26. Table 6 presents children’s and adults’ choice of category or the combination of categories for the depiction of illness. It appears that most children depict illness through its biomedical aspects, while the majority of adults’ drawings reflect a combination of psychosocial and biomedical aspects. It should be noted however that 5.8% of children were not able to portray illness. Subsequently, in order to find the most popular category regardless of whether it was chosen alone or in combination with another one, the total number of children who chose each category was estimated and compared with adults’ choices. It became apparent that the majority of children seemed to prefer a biomedical representation of illness while adults preferred a psychosocial one.

Table 6.

Children’s and adults’ depictions of illness and health.

		Failed		Biomedical		Psychosocial		Lifestyle		Biomedical and psychosocial		Biomedical and lifestyle		Psychosocial and lifestyle		Biomedical and psychosocial and lifestyle		Total
		f	%	f	%	f	%	f	%	f	%	f	%	f	%	f	%	f	%
Illness	Children	20	5.8%	145	41.8%	86	24.8%	3	0.9%	83	23.9%	3	0.9%	3	0.9%	4	1.2%	347	100%
	Adults	0	0.0%	29	25.4%	35	30.7%	4	3.5%	44	38.6%	1	0.9%	1	0.9%	0	0.0%	114	100%
Health	Children	40	11.5%	22	6.3%	152	43.8%	81	23.3%	10	2.9%	2	0.6%	39	11.2%	1	0.3%	347	100%
	Adults	0	0.0%	13	11.4%	68	59.6%	11	9.6%	4	3.5%	1	0.9%	17	14.9%	0	0.0%	114	100%

A comparison of children’s and adults’ depictions of health revealed significant differences, χ²(7, N = 461) = 20.96, p < .05, V = .21. Children’s and adults’ choices of the different categories are presented in Table 6. It appears that both children (43.8%) and adults (59.6%) mostly chose the psychosocial category for their representation of health, whereas there was a small difference between the two groups in relation to the second most popular category.

In order to investigate possible differences in the depiction of illness and health, we compared children’s choices for both themes, using data as they appear in Tables 2 and 4. Interestingly, in the case of health, the failure rate (11.5%) was almost twice the failure rate for illness (5.8%). Finally, the most frequently depicted category – either alone or in combination with other(s) – in children’s drawings was calculated. As shown in Table 7, the biomedical dimension seemed to be the most popular choice for illness (67.7%) and the psychosocial dimension for health (58.2%).

Table 7.

Comparison of children’s depictions of illness and health.

	Biomedical		Psychosocial		Lifestyle
	F	%	f	%	f	%
Illness	235	67.7%	176	50.7%	13	3.7%
Health	35	10.1%	202	58.2%	123	35.4%

Discussion

This study aimed to explore children’s pictorial representations of illness and health. As regards depictions of illness, it was found that the biomedical aspect of illness was primarily chosen by almost all age groups, closely followed by the psychosocial, while very few children produced drawings depicting lifestyle themes associated with illness.

The finding that different age groups produce similar pictorial representations in order to express their perceptions of illness suggests that children regardless of their age understand illness in the same way, and more specifically, they rely on biomedical explanations in order to define illness (Green and Bird, 1986; Piko and Bak, 2006; Schmidt and Frohling, 2000; Springer and Ruckel, 1992; Zaloudikova, 2010).

It may be possible that children reproduce the network of concepts and images that are established in the wider cultural context to represent illness (Moscovici, 1988). The results are in accordance with Zaloudikova’s (2010) conclusions that a general lifestyle which consists of harmful habits is an aspect of illness that only older children (10–12 years old) recognise. Specifically, this study shows that younger children (5, 6 and 7 years old) did not focus on the lifestyle aspects to define illness, unlike their older peers. It is also interesting that older children depict illness using more than one dimension simultaneously, suggesting they understand illness as a multifaceted phenomenon (Bibace and Walsh, 1981; Campbell, 1975; Myant and Williams, 2005; Schmidt and Frohling, 2000).

Regarding children’s representations of health, all age groups appear to perceive health mainly on the basis of the psychosocial elements that define it and secondly on specific lifestyle actions. These findings are in contradiction with those of previous researchers (Myant and Williams, 2005; Schmidt and Frohling, 2000; Zaloudikova, 2010), who argue that younger children to a greater extent than older ones, understand health more as a biomedical phenomenon and less as a social and emotional one.

Children’s ability to understand health as a complex and multifaceted situation seems to develop with age. Specifically, we noted that older children increased the number of different aspects of health depicted in their drawings, a finding which shows an increasingly holistic way of understanding health (Natapoff, 1978; Schmidt and Frohling, 2000; Zaloudikova, 2010) and probably reflects children’s cognitive development (Bird and Podmore, 1990).

It should be noted that many 5 -year-olds were unable to express through drawing aspects of the two concepts under investigation. This inability has also been reported by Myant and Williams (2005) who found that young children often were unable to give a definition of illness and health. This result might show young children’s difficulty to describe illness and health as both constitute quite complex and abstract concepts.

Comparing children’s and adults’ depictions of illness, a significant difference was found. The majority of children appear to represent illness mainly based on its biomedical aspects, while most adults choose the psychosocial ones. Regarding children’s and adults’ representations of health, no significant difference was found. Both children and adults seemed to perceive health as based on pleasant feelings and activities and joyful abstract images, and less on a lifestyle promoting good physical condition and biological or medical aspects. This result contradicts Schmidt and Frohling’s (2000) findings that adults’ perceptions of health are different from children’s regarding the life aspects that they chose to mention.

The comparison of children’s most popular representations of illness and health suggests that children understand illness and health as two different conditions (Green and Bird, 1986; Natapoff, 1978, 1982). Illness seems to be perceived through its biomedical correlates since the majority of children linked it to medical procedures and biological functions (Green and Bird, 1986; Piko and Bak, 2006; Schmidt and Frohling, 2000; Zaloudikova, 2010). On the other hand, children’s representations of health mainly point to the psychosocial aspects of the concept, suggesting that children perceive health based on its social dimensions and the role of the natural environment as a resource for health (Piko and Bak, 2006).

In conclusion, illness seems to be perceived as something more specific since it is related with obvious and objective features like illness’ symptoms, hospitals, medical professionals, medical tools and medicines. On the other hand, health seems to be considered as a subjective situation, since it is often associated with the way it affects personal life and one’s feelings.

The aspects of illness and health that were less frequently depicted in children’s drawings are also worth mentioning. Elements concerning a lifestyle which could be responsible for illness rarely appeared in children’s drawings. On the other hand, there was little reference to hospitals, or medical and biological procedures in drawings depicting health. These results show that children do not take into consideration the preventive dimension of both concepts, since they do not seem to take into account either the personal responsibility for illness or the biological and medical practices for health. Similarly, Youssef et al. (2010) reported children’s tendency to attribute illness and health to external factors ignoring personal responsibility for health promotion and illness prevention.

This study attempted to explore children’s perception of illness and health using drawing as a methodological tool. Future research might usefully explore children’s perceptions of the two concepts by combining drawing and interviews. Nevertheless, the results of this study may be useful in health education programmes. Informing children about matters related to illness and health requires deep knowledge of their pre-existing perceptions and the ways in which these change by age.

More specifically, findings regarding the less highlighted aspects of illness and health may be used for the design and implementation of educational programmes that emphasise the importance of establishing health-promoting attitudes in children. Moreover, knowledge of children’s understanding of illness and health can be used by medical professionals in hospital situations to generate age-appropriate explanations for children affected by chronic illness. They may also be useful when preparing children for medical procedures, as children frequently seem to display fear, guilt and anxiety before receiving treatment for illness (Myant and Williams, 2005).

Footnotes

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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