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1. Introduction
Here you give the background of your topic. Go to the literature and do some literature reviews
using the key words as I showed you when we met at my office previously.
Here you tell the problem from the empirical level, and also a research gap. You tell briefly what
has been done about that problem (by going to the literature, and what has not been done)
1.3 objectives
2. Literature review
Here you go to the literature and search the work which have been done by others that relate to
your work. The aim is to know that has been done so that you come up with what remains to be
done. So use the key words of your title and search using the Google and Google scholar.
3. Methodology
What type of data source will you use collect? (usually we have primary and secondary
data sources)
Usually we have focus group discussion (FGD), household survey, key informants
4. schedule of activities
Here you make a table which has activities and proposed dates when these activities will
be conducted
5. proposed budget.
Here you have the cost item and the amount of money that is proposed for each cost item.
6. References
All the authors you have cited in the introduction and literature review and elsewhere in
E.g. Mahonge, C.P. (2010). Mismatch between boundaries of the state and local people.
The University of British Columbia
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1 Introduction
2 Health Seeking Behaviour: 2 Models
o 2.1 Pathway Model
o 2.2 Determinants Model
3 Methods Used in Studying Health Seeking Behaviours
o 3.1 Household surveys
o 3.2 Facility-based surveys
o 3.3 Other quantitative studies
o 3.4 Other qualitative studies
o 3.5 Mixed-methods surveys
4 Patterns of Resort
5 Factors that affect Health- Seeking Behaviours
o 5.1 Illness types, severity
o 5.2 Accessibility & Availability
6 Social Determinants of Health and Health-Seeking Behaviour
o 6.1 Socio-Economic Status (SES) and Health-Seeking Behaviour
o 6.2 Gender and Health-Seeking Behaviour
o 6.3 Culture and Health-Seeking Behaviour
o 6.4 Implications for the Healthcare System
7 Stigma and Health-Seeking Behaviour
8 References
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. [1]
In the broadest sense, health behaviour includes all behaviours associated with
establishing and maintaining a healthy physical and mental state ,(Primary
[2]
Prevention) . Health-seeking behaviours also include behaviours that deals with any
[3]
digression from the healthy state, such as controlling (Secondary Prevention) and [4]
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
[6]
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. [7]
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. [9]
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. [12]
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.
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
[15]
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
[17]
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 . [18]
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
[20]
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 . [22]
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.
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
[25]
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).[27]
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
[28]
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
[28]
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).[28]
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.ht
ml
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/
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Jump up to:28.0 28.1 28.2 28.3
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for related information. Knowledge of patient information seeking behavior can provide
Article Figures
health information, it is easily possible to prevent some chronic diseases, many people
ming people about the progress of these diseases and useful prevention methods is of
vide us with useful strategies for effective transfer of information to the patients, thus Article Access Statistics
d theories related to information seeking behavior of patients.
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s first introduced in the scientific information conference of Royal society in 1948. This [TAG2]
[TAG3]
[TAG4]
ar and straightforward. According to Cease these differences are due to factor such as
of the seeker (student, expert, patient, care provider), information sources (personal,
ocess of seeking information using different methods and each person, based on the
information seeking behavior is to satisfy the information need of the people.
search for health information. If information seeking is done by patients and in order to
ed a health decision making process. [5] Health information seeking behavior includes
done by a person. [6] The following are among concepts related to health information
seeking. Today, many people actively seek information that can improve their lifestyle.
[39]
seeking behavior. The extent and nature of the gathered health-related information
health information seeking behavior sometimes acts as a predecessor for other health
mation are more likely to visit doctors for minor problems and partake in more medical
seek health related information. [40]
urces, information seeking behavior, especially health seeking behavior or people has
for the patients and the patient can get involved in active seeking of health information
the medical practitioners about this new information. [41]
hreatening situations and try their best to gain as much information as possible about
situations [6],[7],[8],[9],[10],[11],[12],[21],[22],[28],[29],[30],[31],[36],[38],[42]
decision making
health situation. These type of people also expect the medical experts to listen to their
reach a better decision. [6],[14],[15],[16],[17],[22],[31]
preventive behavior
lthough information seeking alone can't grantee healthy behavior, it seems that having
s. [19] According to Lambert and Loiselle, outputs of health information seeking are as
outputs
outputs
outputs
outputs
results
ealth care services worldwide and easy and widespread access to different medical
to keep and improve their health. [19] However, even today many patients lack proper
ortance. Some of the results of these studies are as follows:
the disease
self-management
seeking barriers
uraging them to seek related information. [39] Educators working in health and medical
and therefore their information needs helping them in creating more effective methods
to the patients. [33]
of the family
mily and sociality. [44],[45],[46],[47] Investigation of the patients' information seeking behavior
ng minor and major strategies for confronting these chronic diseases.
ion from medical experts due to misunderstandings regarding the information needs of
s and health care providers, improving the relation between patients and their doctors.
information systems
esign a suitable system for health information. [1] By better understanding of information
uch studies are useful for both patients and their relatives and for designers of medical
information systems.
n seeking patterns
zation founded by National Cancer Institute of United States in 1975. [2],[3],[4],[5] CSI used
acquisition model of Freimuth has six stages: (1) Stimulus (2) information goal setting
ese stages are part of a decision making flowchart in which the decision in each stage
gate personal or contextual factors effecting information seeking behavior. The strength
information evaluation stage to determine whether the gathered information is enough
rocess until a suitable result is obtained. Newer models of health information seeking
information seeking
. In this model four factors effected the information seeking which are: (1) Demographic
e and (4) beliefs of people
ors include age, gender, education, Ethnicity and socioeconomic status of information
eople's social network. [41]
ng (41, P. 26)
rding to Dervin, salience information is information that acts as a bridge to cover a gap,
[2]
main driving force behind information seeking.
A people's beliefs about themselves and the world around them are the defining factor
aren't simply about facts but also effect the relation of people with the current situation
situation possible naturally will never search for information related to the problem. On
ading to seeking new information. [2] The final component of Johnson's comprehensive
previously mentioned the health information acquisition model of Freimuth is a linear
seeking model
seeking stimulus
information goals
ation or not. This decision is derived from the amount of previous information available,
ormation, naturally they won' seek more. Also is situations such as financial difficulties,
rmation can outweigh anticipated benefit of active information seeking, people refuse to
s of active information seeking. Patient might believe active information seeking to be
ions from their doctors because they believe that the doctors will provide them with all
information
behavior
and codification
formation is new and relevant or new and irrelevant. New and relevant information is
encouraging further search behavior. [43]
whether information seeking needs to continue or stop. The criteria for this evaluation
st- benefits analysis of information seeking or based on information goals determined
nformation seeking process.
n lead to a premature termination of the search, while factors like curiosity and interest
are cognitive and behavioral changes in the information seeker. [43]
blunting hypothesis
uations. [48] When active seekers of information are confronted by threatening situations,
that refuse active information seeking don't look for new information. [40]
ms compared with others. Active information seekers tend to gather a massive amount
ds, while those refusing to actively seek information have minimum information in these
s longer than those refusing to actively seek information. Although active information
us. Gathering massive amounts of information during information seeking helps relieve
rent situation and pay more attention to health care and prevention methods. [49]
ituations, while search for information during critical but controllable situations. On the
tions while actively seeking information seeking uncontrollable satiations. This process
s. [50] During uncontrollable critical situations and when enough relevant information isn't
e better results. Of course, this methods requires that people be trained to distinguish
to willfully ignore new information. [40]
ormation seekers because they are not equipped to deal with hopeless and malicious
oral and cognitive endeavors for managing internal and external needs. Coping consists
ocused coping method, people concentrate more on the problem that is the root of the
for dealing with stressful situations and therefore attempt to gather information, resolve
In emotion based coping methods, people seek to reduce the negative feeling resulted
sibility or blame (4) self-control over the expression of feeling (5) seeking social support
re of these two coping methods.
Evaluation of the stressor and personal abilities for dealing with them happens in three
r and (3) when person experience a chance for mastery or gain. [51]
the problem. On the other hand pessimistic and timid people evaluate the stressors
therefore avoid actively dealing with the problems. [51]
n. Coping in an anticipatory context allows people to control situations that are about to
h the situation, the coping methods are more about dealing with Consequences and
anges. [52] Therefore for better understanding of the relation between emotions, coping
with problems and their thoughts, actions and interpersonal relations. [53]
se. [19] The initial design of this model was created by Longo et al. in the year 2005 in
del, Longo et al. investigated the information seeking behavior of diabetic patients and
tative data and has a conceptual structure. [41]
(28, P. 337)
ctors include demographic and socioeconomic factors, health history, genetics, anxiety,
actors include health situation, healthcare structure, delivery of healthcare, information
orts and networks. [28] Lango in his model counts both active information seeking and
details of which is available in [Figure 3]. [41]
bsent in all previous models. [41] The output of active information seeking and passive
nt, ease of everyday activities and finally better health status. Longo's et al. model is
liner model. [28]
in helping people quit sm oking [Figure 4]. The main theory of TTM is that the stages in
roughout the way, some of which are merely brief stops, while others are temporary or
428)
stage
stage
key factor of this stage is that the person seriously starts to consider the pros and cons
possible solutions,
stage
stage
n this stage, the problem is being worked on but the solution is still not at hand
stage
(4, P. 429)
nges. Probably the most interesting aspect of TTM is hidden and apparent reliance on
is involved in increasing the available information about self and the problem using
and book therapy
not necessarily a clinical technique applicable to all sorts of behaviors because the
always come to pass. [4]
people still lose their lives or suffer from disease complications due to lack of proper
vestigating the health information seeking behavior of patients, identifying whether the
rovide solutions for more efficient transfer of information to the patients, increasing the
stop the progress of it.
massive number of studies in this area, the need for such studies is still growing. The
and ways to confront them. Every year new theories and models for the information
prehensive model which can cover all health information seeking behavior of patients
seases (such as cancer, cardiovascular, diabetes, arthritis, smokers, etc.,) is due to
or which the information seeking takes place.
tics and few of the models discussed above have been investigated in those countries.
o improvement in the society's health situation, it is necessary to pay more attention to
world countries.
Publishing; 2012.
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who sought cancer information: A preliminary analysis of HINTS 2007. Proc Am Soc
cine (CAM) by male cancer patients: Information-seeking roles and types of evidence
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tion and communication needs and internet use. A qualitative study. PLoS One
ast, prostate, and colorectal cancer patients: Results from a population-based survey.
8-22.
ar disease for health information seeking: A qualitative study. J Agric Environ Sci
nts: A description of the situation. Patient Educ Couns 1993;22:35-46.
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