Health Seeking Behaviour

Introduction

Health-seeking behaviour has been defined as a “sequence of remedial actions that individuals undertake to rectify perceived ill-health.” In particular, health-seeking behaviour can be described with data collected from information such as the time difference between the onset of an illness and getting in contact with a healthcare professional, type of healthcare provider patients sought help from, how compliant patient is with the recommended treatment, reasons for choice of healthcare professional and reasons for not seeking help from healthcare professionals.

In the broadest sense, health behaviour includes all behaviours associated with establishing and maintaining a healthy physical and mental state,(Primary Prevention) . Health-seeking behaviours also include behaviours that deals with any digression from the healthy state, such as controlling (Secondary Prevention) and reducing impact and progression of an illness (Tertiary prevention).

The concept of studying health seeking behaviours has evolved with time. Today, it has became a tool for understanding how people engage with the health care systems in their respective socio-cultural, economic and demographic circumstances. All these behaviours can be classified at various institutional levels: family, community, health care services and the state. In places where health care systems are considered expensive with a wide range of public and private health care services providers, understanding health seeking behaviours of different communities and population groups is important to combat unaffordable costs of health care.

Health Seeking Behaviour: 2 Models

Health-seeking model: Various studies demonstrated that one’s decision to engage with a particular medical channel is influenced by a variety of soci-economic variables, sex, age, social status of women, type of illness, access to services and perceived quality of the service

Pathway Model

Suchman was the first to use the pathway model to describe the steps of the process from identification of symptoms to the use of particular health care providing facilities. This model aims to identify a logical sequence of steps. It also analyses how social and cultural factors affects this sequence. This has been primarily an anthropological approach, using qualitative methods of investigation.

Fabrega then developed a theoretical model of illness behaviour, which concentrates on the information that an individual might be expected to process during an illness episode. This approach is basde on economics and elementary decision theory and the principle of cost-benefit is used to evaluate the action. Since health-seeking behaviour is a social process that involves individual’s interaction with the social network, it is crucial to look at the decision-making processes from this perspective.

Determinants Model

This model is based on a more bio-medical and quantitative approach. Instead of focusing on the steps one would take to preserve or improve health, this model focuses on highlighting a set of determinants which are associated with the choice of different kinds of health service.

There are various models to explain the different determinants of Health-seeking behaviours. Andersen’s grouping of factors influencing determinants into 3 main categories: population characteristics, health care systems and the external environment. Next, another researcher focused on the individual’s health behaviour and adoption of the sick role. This model specifically focuses on one’s health behaviour and it ignores the effect of social network on the decision-making process.

All of these models of determinants and factors influence health-seeking behaviours are vital as it helps us to understand how and why one would seek care earlier than others. As for illnesses that require immediate care, such models are informative as it contributes to interventions for the reduction of transmission and complications arising from neglect.

Methods Used in Studying Health Seeking Behaviours

Household surveys

Household surveys are the most commonly used method to study health seeking behaviours. Most of the household surveys administered are disease specific. Sample size varies each time, but usually around an average of 1000-2000 respondents for each survey. These household surveys are usually conducted using structured interview questionnaires. The World Bank provides guidelines and advice on how to design ‘multi-topic household surveys’ . According to them, a household survey should include modules such as: consumption, education, health, employment, anthropometry, non-labour income, housing, price data, environmental issues, fertility, household income, savings, household enterprises and time use.

Facility-based surveys

Facility based surveys are usually patient surveys and are often disease specific in areas such as Tuberculosis or neonatal care . Clients are recruited at health care providing facilities and followed up using either qualitative or quantitative methods . Conclusions drawn from facility or household surveys may appear mundane or obvious, but they still hold significant importance.

Other quantitative studies

Quantitative techniques have been used to analyse the effect of contextual influences on health care seeking and outcomes. For example, a study in Nigeria (sample size 4000) analysed the individual and social background characteristics of families with children with protein energy malnutrition . Predictably, the study found that social characteristics (wealth index) were associated with health care seeking and outcomes. The study by Sharma and Vong-Ek (2009) examined the association of individual and community characteristics with obstetric morbidity and care-seeking behaviour in Thailand. Multi-level logistic regression analysis among 930 women living in 86 villages showed that community impoverishment rather than social and health infrastructure was associated with the likelihood of seeking appropriate care.

Other qualitative studies

The ‘illness narratives’ method is commonly used too. For example, Målqvist, Nga et al (2008) used the narratives approach to collect information on births and neonatal deaths in the Quang Ninh province, located in Vietnam. The narratives included information about care-seeking in relation to delivery and illness. Results from the study showed that a quater of the neonatal deaths had no contact with any health care system or provider at the time of death, and that the chance neonatal deaths within 24hrs of birth increases when the mother does not seek health care during delivery. Mothers of ethnic minorities were also found to be more likely to express this care-seeking behaviour at delivery. Qualitative studies can provide more context to analyse the motivation for different health seeking behaviours. These studies can also shed light on how contextual influences affects illness causation and health-seeking behaviours. For example, Lawton and Ahmad et al (2007) conducted a study that looked at different ethnic groups in the United Kingdoms. A study of diabetes within that area highlighted an ethnic group’s perception of the role of social circumstances as the main cause of diabetic illness, while other ethnic groups emphasised the role of their own lifestyle ‘choices’ and ‘personal failings’ Furthermore, qualitative methods often research treatment pathways too. For example, a study by Asbroek, Bijlsma et al (2008)on Tuberculosis patients in Nepal revealed that revealed that patient factors (such as severity of complaints, the ability to pay for services, the availability of services and peer support for choosing a provider) as well as specific health services factors (perceived quality, costs and service level and lack of provider-initiated referral) affected how patients choice of health seeking behaviour.

Mixed-methods surveys

Some surveys used mixed methods for analysis. For example, in a study in Bangladesh of the attitudes of mothers to maternal care-seeking behaviour, both in-depth interviews and structured quantitative interviews were conducted for data collection. The qualitative interviews were used to identify the main care-seeking patterns while the quantitative survey determined the frequencies associated with this pattern.

Patterns of Resort

A person's approach to health-seeking behaviour can be described as a “pattern of resort.” According to the Encyclopedia of Medical Anthropology, people usually opt for the simplest form of treatment, which usually is the cheapest, most effective treatment they deem to be (2004.p,3-8). Only when the simplest form of treatment is proved unsuccessful do people seek higher level, more costly and unconventional treatments. Health-seeking is a dynamic process and can involve many aspects of medical units at the same time. Because of this, people are allowed to garner information and make informed choices about the wide range of medical services that are available to them.

Factors that affect Health- Seeking Behaviours

Illness types, severity

Depending on illness type, people seek different forms of treatments specific to the disease they are diagnosed with. In addition, depending on the severity of the diagnosed disease, people might select different forms of treatments and medication.

It was found that individuals perceived their illness to be either mild or not for medical treatment, which prevented them from seeking healthcare treatment. In addition, poverty emerged as a major determinant of health-seeking behaviour as treatments were often perceived as either a waste of money, lack of money, or poor attitude of health worker.

Accessibility & Availability

Depending on the area a person lives in, some treatment might be available but not other forms of treatments. Therefore, a patient is limited to what is accessible and available to them when seeking treatment for a disease.

Social Determinants of Health and Health-Seeking Behaviour

The World Health Organization defines the social determinants of health as the “conditions in which people are born, grow, live, work and age.” In 2011, the World Health Organization argues “the distribution of money, power and resources at global, national and local levels” creates these conditions. Socio-Economic Status (SES), gender, race, and education are factors of health-seeking behaviour that are influenced by the social determinants of health.

Socio-Economic Status (SES) and Health-Seeking Behaviour

A study done by John D. O’Neil (1989) stresses the importance of the “social relationship” between a doctor and patient in his article, The Cultural and Political Context of Patient Dissatisfaction in Cross-Cultural Clinical Encounters: A Canadian Inuit Study. In his paper, O’Neil explains that because of an unequal distribution of power and knowledge of health leads to patients being unsatisfied with their health care provider, which in turn leads to patients to stop seeking treatment http://onlinelibrary.wiley.com/doi/10.1525/maq.1989.3.4.02a00020/abstract.

Gender and Health-Seeking Behaviour

Lazarus, Ellen S. 1994. What do women want: Issues of choice, control, and class in pregnancy and childbirth. Medical Anthropology Quarterly 8(1):25-46.

The difference between gender roles is significant in the patterns of health-seeking behaviour between men and women. According to Currie and Wiesenberg(2003), women tend to engage in less health-seeking behaviour compared to their male counterparts. In their article, Currie and Wiesenberg (2003) highlights three components a woman’s decision-making process for seeking healthcare. Firstly, women generally are less likely to identify disease symptoms in the first place. Women might shrug of symptoms as normal everyday muscle aches or normal regular occurrence. To be able to recognize and identify a health problem, one needs to have some form of knowledge and awareness of symptoms and illnesses. Secondly, the study reveled that women tend to belief that they are more restricted compared to their male counterparts in terms of health care accessibility. This is due largely to cultural ideas about the social value of women, which is lower compared to men. Thirdly, it is revealed that women do not engage in healthcare treatments even if they recognized that they have a health problem (Currie and Wiesenberg, 889). This is partly due to restricted accessibility to health services given the social roles of women, which may limit their ability to visit healthcare facilitates when they are open during the day (Currie and Wiesenberg, 889).

Culture and Health-Seeking Behaviour

Factors such as cultural values and gender roles are significant in influencing the decision making process associated with health-seeking behaviour (Tung, 536). Asian-American cultures, for example, are strongly influenced by Confucian doctrines, which emphasized the importance of “interdependence,” “collectivism,” and “familism” (Tung, 536). These values reinforce the expectation of individuals to place the needs of the family before their own, which may discourage them to pro-actively seek healthcare in a timely manner. Furthermore, these values of Asian-American cultures suggest that physical and mental distress are family problems rather than an individual ones meaning that they should not be revealed to people outside their kin (Tung, 536). Seeking help from health care professionals or seeking financial aid from the government to pursue treatment would be exposing the problem beyond their family network, which is considered shameful and could pose a threat to the status or reputation of the family. Consequently, Asian-American people tend to turn to family members before pursuing external help, thereby delaying the act of seeking professional health care (Tung, 537).

Implications for the Healthcare System

It is important for health care professionals to understand the different factors that affects an individual’s decision to seek healthcare treatments. This is to ensure that professionals are better able to recommend treatments that are appropriate to the individual, so as to promote healths seeking behaviours, instead of providing options that patients might not feel comfortable with because of social norms or values. Having knowledge of the roles that cultural beliefs and gender roles play in terms of health-seeking behaviour can help healthcare providers improve their relationship professional-patient relationships and develop strategies to encourage people to seek appropriate treatments as soon as possible.

Stigma and Health-Seeking Behaviour

Erving Goffman (1963) describes stigma or social devaluation “as a mark of social disgrace” often leading others to see us as untrustworthy, incompetent, or tainted. Gender, race, social status, mental and physical health are topics vulnerable to stigma . It is important to note that some cultures or individuals feel that seeking treatment is a shameful thing because its akin to announcing to public that you have an illness. Therefore, education is needed to break this negative stigma in order to increase health-seeking behaviours. For example, people are Asia are usually reluctant to seek professional counselling help because they are afraid that their friends and family might shun away from them, thinking that they are "crazy".

References

Cultures-Cross-Cultural Anthropology. (2004). In C. Ember & M. Ember (Eds.), Encyclopedia of Medical Anthropology Health and Illness in the World's Cultures.

(Vol. 1, pp. 3-8). New York: Springer Science.

Lazarus, Ellen S. 1994. What do women want: Issues of choice, control, and class in pregnancy and childbirth. Medical Anthropology Quarterly 8(1):25-46.

Martucci,S.,& Gulanick, M. (2012). Health-Seeking Behaviors: Health Promotion; Lifestyle Management; Health Education; Patient Education. Retrieved from

http://www1.us.elsevierhealth.com/MERLIN/Gulanick/archive/Constructor/gulanick27.html

John D. O’Neil, 1989. “The Cultural and Political Context of Patient Dissatisfaction in Cross-Cultural Clinical Encounters: A Canadian Inuit Study,” in Medical Anthropology

Quarterly 3(4): 325-344.

Sandstrom, Kent L., Lively, Kathryn J., Martin, Daniel D., Fine, Gary A. (2014). Symbols, Selves, and Social Reality: A Symbolic Interactionalist Approach to Social Psychology

and Sociology (4th ed.) New York, NY: Oxford University Press. Goffman and Stigma Chapter 7-8.

World Health Organization. (2015). Social Determinants of Health. Retrieved from http://www.who.int/social_determinants/en/

World Health Organization. (2013). Progress on the implementation of the Rio Political Declaration. Retrieved from http://www.who.int/social_determinants/en/