A review of health seeking behavior: problems and prospects

Author: Sara MacKian Article reviewed by: Dr Nihar Ranjan Ray

INTRODUCTION:

Health seeking behavior refers to all those things humans do to prevent diseases and to detect
diseases in asymptomatic stages. In contrast illness behavior refers to all those activities designed to
recognize and explain symptoms after one feels ill, and sick role behavior refers to all those activities
designed to cure diseases and restore health after a diagnosis has been made.

I agree to the author that there is growing recognition, in both developed and developing countries,
that providing education and knowledge at the individual level is not sufficient in itself to promote a
change in behavior. We need do something extra or focus to a different dimension to bring effective
changes in health indicators. One more important thing that the author has insisted that factors
promoting ‘good' health seeking behaviors are not rooted solely in the individual, they also have a
more dynamic, collective, interactive element. Understanding of the social capital and proper
understanding of health seeking behavior could reduce delay to diagnosis, improve treatment
compliance and improve health promotion strategies in a variety of contexts. Author has given utmost
importance to make studies of health seeking behavior more useful from a health systems
development perspective. In initial part of the article the author suggested the two approaches namely

(a) Health care seeking behaviors: utilization of the system

(b) Health seeking behaviors: the process of illness response

According to author variety of studies were conducted on the basis of macro analysis. Taking age, sex,
geographical region etc.. But author aptly suggested that these determinants can be further broken to
smaller fragments like Status of women, Elements of patriarchy, Social Age and sex, Socioeconomic
Household resources Education level, Maternal occupation, Marital status, Economic status, ‘Cultural
propriety', Economic Costs of care Treatment, Travel time, Type and severity of illness Geographical
Distance and physical access, Physical, Organizational Perceived quality and so many to identify the
reality of the back ground problems. Despite the ongoing evidence from different studies that people
do choose traditional and folk medicine or providers in a variety of contexts which have potentially
profound impacts on health, few studies recommend ways to build bridges to enable individual
preferences to be incorporated into a more responsive health care system. I find it most interesting
that has been quoted by (Needham et al, 2001). As they suggested "the need to improve integration
of private sector providers with public care to tackle this problem in a better way" And with the Indian
perspective at least I can't agree with Ahemad et al that the training to these non formal providers are
wrong. At least we can use their community motivation in a modern way so that the health seeking
behavior of these people will change gradually.

Now it is time to focus upon to understand the psycho logical process of these people as discussed in
the section Health seeking behaviors: the process of illness response. The understanding of the
‘healthy choices', in either their lifestyle behaviors or their use of medical care and treatment. Among
the different models discussed here namely (a) social cognition models (b) Health belief model (c)
health locus of control

•(a) social cognition models:

Predicting health behavior with social cognition models as per the figure illustrates I am completely
agree with the author as she criticizes the model as "The downfall of these models is that most view
the individual as a rational decision maker, systematically reviewing available information and forming
behavior intentions from this. They do not allow any understanding of how people make decisions, or
a description of the way in which people make decisions."

•(b) Health belief Model:

The health belief model is a largely accepted theory and like any other theory it has its limitation also
like the author writes "The health belief model has been criticized for portraying individuals as asocial
economic decision makers, and its application to major contemporary health issues, such as sexual
behavior, have failed to offer any insights" Any how I personally feel this can be a model of reference
for contemporary diseases. and also what I feel this model is still holds good in describing the STIs
though stigma, shame ness and sexual conservativeness comes into play.

It may be right that the way Mc Phill et all thinks "developed country research has a better track
record of exploring this broader contextual picture, whilst work in developing countries tends not to
acknowledge the poor relationship between knowledge and health seeking behavior." Apart from the
KABP model I find the description of the Reflexive communities are interesting .Reflexive communities
reflect the particular ways of behaving, thinking and reaching decisions of individuals or groups, that
in turn reflect the social construction of their position in wider society at a particular place and time.
Information regarding health seeking has many facets and determinants like ‘moral, affective,
aesthetic, narrative and meaning dimensions'. So more scientific way of approach will be ‘aesthetic
reflexivity' which "means making choices about and/or innovating background assumptions and shared
practices upon whose bases cognitive and normative reflection is founded" In order to understand how
people reach the decision we need to know also how the underlying, unspoken, unconscious feelings
and assumptions which support that cognitive process. These concepts that are been discussed here
are seems to be more theoretical to practice . But still these issues are need to be addressed aptly for
events like HIV/AIDS . I and I am completely agreed with Harvey that "the way people perceive risks
and experience risk should be a matter for public policy"

Health seeking behavior and the probes: a review

Health seeking behavior differs for the same individuals or communities

when faced with different persons, times& illnesses. The article has described some of the examples
here. They have given a very nice example here regarding the health seeking practices of women
when faced with abnormal vaginal discharge, as opposed to malaria. I think this is more a big problem
in countries like India & Bangladesh than the developed worlds. Again the shortage of the female
Health care staffs worsens the problem. And the most important thing that I feel is most of the
sensitive illnesses or diseases or public health problems are having this problem. Or thinking in the
reverse way that due to this embedded problem it is very difficult to address these problems or not
getting quick results. Among the examples I try to touch them in short. Only the key issues are given
as described the author. I think she has identified it very nicely from different studies.

Tuberculosis

(a) Late presentation and delayed diagnosis are problems for TB, reflecting both

individual and social factor. Delay can be related to social stigma, gender, fear or multiple health
seeking.

(b) Culturally sensitive and situated understanding of health seeking behavior may

Provide better treatment compliance and shorten delay of diagnosis.

©Health education should be started at family and community level to improve

awareness and to avoid stigma.

(d)The doctor-patient relationship may need particular attention in relation to TB due to the lengthy
treatment period.

Maternal and child health

(a) The way in which women reach the decisions they can have a great influence

on child morbidity and mortality and is therefore worthy of continued study.

(b) There may be a better ways of exploring women's involvement in health

system and social structures .

Diabetes Type 1

(a)Perhaps the lack of material suggests there is more work needed in this area?

(b)The doctor-patient dynamic can potentially be used to promote ‘good' health

seeking behavior and compliance with treatment, and is an issue reflected across

the probes.

Social capital and Health & Development

Social resources norms and networks or processes and conditions within society that allow for the
development of human and material capital. So social capital is created and used through individual
participation. Bonding social capital which links members of a particular group, and bridging social
capital which links across groups. So the first one when addresses the Horizontal Equity the later
addresses the Vertical Equity. Social capital provides a means of shifting the focus from individuals to
social groups, and the social involvement of the actions of individuals. Though it varies from
community to community but social capital also has implications for the operation of health systems
description of that in detail is beyond the scope of this literature.

Health seeking behavior in the context of health systems

Non formal practitioners and birth attendants so embedded in the existing social

fabric and reflexive communities so that mostly the women deny delivery in favour of trained public
service doctors. And in the Indian sub-continent public doctors running private clinics alongside their
public role, where they can charge patients they have referred from the public system, may have the
effect of undermining trust in the wider system.

Conclusion

"To begin to picture the resources and constraints...the way the actor experiences them, is to take a
crucial step towards understanding why and how people do what they do"

This statement by Wallman and Baker I think we always need to remember be coz Health care is a
system that is so much embedded into the society and individuality of the people that if you search for
the influencing the factors than finally you will get all the branches of science on your table. So to be
practical is more important than criticizing any issue theoretically and parallely we can't ignore any
issue how ever that may seem impractical. That is the beauty and problem of designing the policy for
the Health care. What I feel like head of the family neglects himself in due course of taking care of
other family members we should not land in a troubled water by focusing more on the peripheral
issues of Health care delivery system than the center stage. We should not forget to address the
problems of the internal clients to provide a better motivated care to the external clients. Which in my
view very poorly addressed in international, national & regional level. And last but not the least is the
financing system and its proper management is the key issue.

Dr Nihar Ranjan Ray

Indian Institute Of Public Health, Gandhinagar