SO 100: MEDICAL SOCIOLOGY

5.0 HEALTH SEEKING BEHAVIOUR,

ACCESS AND UTILIZATION OF
HEALTH SERVICES

Dr Joseph R. Mwanga
PhD (Education)
MSc. Sociology of Medicine
B.A.(Hons.) Sociology
5.1 SOCIAL CONSTRUCTION OF
HEALTH AND ILLNESS:

SOCIAL
CONSTRUCTIONISM
 SOCIAL CONSTRUCTIONISM
 What is social constructionism?
This approach takes the view that disease
labels (cf. topic 4.) are social constructs
much further than does the
medicalization thesis. Rather than
regarding special cases, such as
hyperkinesis and mental illness, as
socially constructed, it regards all
medical categories as social constructs
which define and give meaning to certain
 SOCIAL
CONSTRUCTIONISM…
• Sedgewick (1982) captures the
essence of social constructionism
when he points out that natural
events, such as fractures of bones,
raptures of tissues, and tumorous
growths, do not constitute illnesses,
sicknesses or diseases prior to the
human social meaning we attach to
them.
 5.2.1 HUMAN RESPONSE TO ILLNESS:
ILLNESS BEHAVIOUR

 Health and Illness Behaviour

• Definitions of ‘Health’ and ‘Illness’ vary
within cultures, sub-cultures and
communities, and even within
households, between generations for
example. There may gaps too between
lay and medical concepts.
• Before embarking on Health Seeking
Behaviour, it is important to understand
ILLNESS BEHAVIOUR
What is illness behaviour?
 ILLNESS BEHAVIOUR…
 Illness Behaviour is:
’’The ways in which given symptoms may be
differentially perceived, evaluated and acted
upon (or not acted upon) by different kinds of
people. ” (Mechanic, 1962);

• Following David Mechanic’s original

work, various studies have explored
the factors which encourage or hinder
people’s attendance at medical
facilities.
 5.2.2 HEALTH CARE SEEKING BEHAVIOUR…
• To think of why people seek or decline to seek professional
help is to begin to theorize aboutIllness Behaviour.
• It s crucial to recognize whether or not people consult their
doctors does not depend only upon the presence of disease,
but also upon how they, or others respond to its symptoms.
Mechanic (1978) has listed 10 variables known to influence
consulting behaviour:
1. Visibility, recognizability or perceptual salience of signs and symptoms;
2. The extent to which the symptoms are perceived as serious (that is, the
person’s estimates of the present and future probabilities of danger);
3. The extent to which symptoms disrupt family, work and other social
activities;
4. The frequency of appearance of signs or symptoms, their persistence, or
their frequency of recurrence;
5. The tolerance threshold of those who are exposed to and evaluate the
signs and symptoms;
 HEALTH CARE SEEKING BEHAVIOUR…
• Variables known to influence consulting behaviour:
6. Available information, knowledge and cultural assumption
and understanding of the evaluator;
7. Basic needs that lead to denial;
8. Needs competing with illness responses;
9. Competing possible interpretations that can be assigned to
the symptoms once they are recognized; and
10. Availability of treatment resources, physical proximity and
psychological and monetary costs of taking action (not
only
physical distance and cost of time, money and effort, but
also such costs as stigma, social distance and feeling of
humiliation).
 HEALTH CARE SEEKING BEHAVIOUR…
 Are symptoms normal or abnormal?
Symptoms and their perceived dangers are subjected to some form of
evaluation. Symptoms which are unusual or atypical in form or context
are seen as most threatening:
1. Certain symptoms are classified as normal probably because of
their wide prevalence in society;
2. Normality may not be defined by reference to total society but also
smaller groupings within the community (i.e. old age-more general
aches);
3. Earlier events may also be called upon to normalize the presence of
a symptom (e.g. a rodent ulcer might be seen as a bruise which has
not healed from an earlier bump on the forehead or the lump of a
breast cancer might be explained away by some half-forgotten
injury; as it grows very slowly in size its characteristics are not seen
as abnormal as it increasingly ‘has always been like that.’ It is
sometimes only when the cancer breaks down and fungates that
the patient comes to the doctor complaining of the abnormal and
socially unacceptable smell.
 HEALTH CARE SEEKING BEHAVIOUR…
 There are variety of alternative strategies-which
are not necessarily mutually exclusive-available
for people who experience symptoms:
1. Ignore the symptoms;
2. The patient may consult with friends and relatives.
It has been suggested that advice given by friends
and relatives constitute a lay referral system
analogous to the medical system, in which a
patient is referred to lay consultants with
successively greater claim to knowledge or
experience of the symptom in question;
3. The patient may use self-medication or self help;
4. The patient may consult with professional health
care provider.
 5.3 UTILIZATION OF HEALTH SERVICES
AND HEALTH CARE SEEKING BEHAVIOUR
 A number of studies have documented the socio-
demographic characteristics of users and non-users
of medical services:
 Women consult more than men;
 Children and elderly more than young adults and
middle aged;
 Other factors which have been shown to be related to
utilization are:
-Social class,
-Ethnic origin,
-Marital status and,
-Family size.
• These studies tell us who does and who does not
make use of the services rather than why?
 HEALTH CARE SEEKING BEHAVIOUR…
• Health-seeking studies focus on people (MacKian et al.,
2004);

• They apply pathway models and follow sick persons step by

step from the recognition of symptoms through different
types of help seeking until they feel healed or capable of
living with their conditions;

• Health-seeking studies provide a deeper understanding of

why, when and how individuals, social groups, and
communities seek access to health care services, and
investigate interactions between lay people and
professionals (Montgomery et al., 2006);

• In this perspective, social actors are the potential driving

force for improving access to effective and affordable
 HEALTH CARE SEEKING BEHAVIOUR…
Patterns of Resort: Kleinman’s model
• Health seeking behaviour is probably the topic most studied
in medical anthropology/sociology;
• In every contemporary society a wide range of health care
options exist medical
( pluralism );
• The strategies that people employ to decide which option to
use at which stage of illness are calledpatterns of resort .
• Kleinman (1980) see therapeutic choice as outcome of a
sequence of transactions;
His study in Taiwan disclosed two major patterns in health
seeking behaviour:
1. Simultaneous resort
2. Hierarchical resort
 HEALTH CARE SEEKING BEHAVIOUR…
• Almost all episodes of illness were at first self-treated, often within
the family network; If this did not produce symptomatic relief,
recourse was made to family members, neighbours, pharmacists,
Simultaneous resort occurred
or professional or folk practitioners.
when several treatments options were used at the same time
usually in the case of a serious childhood sickness.
• Hierachical resort occurred when different health care choices
were made in sequence through various sectors of health care,
usually a chronic disorder or a recurrent sickness in an adult;
Patterns of health seeking in Taiwan were thus associated with
different types of illness problems. According to Kleinman (Kleinman,
1980:188-189) the type and severity of symptoms, the course of
illness and the labels and etiologies attached to it (explanatory models)
play an important role in determining health care seeking behavior, as
do other relevant factors such as socio-economic status, age, sex,
educational level, family role, urban or rural settings and the
availability of services.
Kleinman, A. (1980)Patients and Healers in the Context of Culture. Berkeley: University of
California Press,
 HEALTH CARE SEEKING BEHAVIOUR…
The costs and benefits of seeing the
1. Therapeutic doctor
The doctor can offer some form of treatment which
may benefit the patient. Patients may have their own
ideas of what treatment the doctor can offer and this
may influence the decision to consult;
2. To ease the transition from being a ‘person’ to
being a ‘patient.’
Although people may feel unwell they may not be
socially accepted as being ill, for example by their
employers, unless a doctor ‘legitimate’ the illness. In
Western societies only the doctor has the social
authority to legitimate illness and admit the person to
what Parsons described as the ‘sick role.’
 HEALTH CARE SEEKING BEHAVIOUR…
Importance of illness behaviour for the
doctor
• Why do people go to the doctor?
There is no simple answer. However, studies in the
field of illness behaviour have shown that seeking
medical help is not necessarily related to the
occurrence or severity of symptoms.
The way in which ‘symptom’ is processed, both in
individual and social terms, will determine what
action is finally taken. Here this action has been
described as ‘decision-making process’ on the part
of the patient.
Of course not all patients follow this pattern or take
all these factors into consideration. The reasons
which brings a patient to the consultations are
 Question for
Discussion
How does access to health
care influence health care
seeking behaviour?
 5.4 ACCESS TO HEALTH
CARE
In accessing health care, poor
people had to resort to short-term
coping strategies like selling critical
assets such as crops to pay for
health care, especially in times of
emergencies;
 Adequacy and acceptability in
terms of people’s judgments of
quality of care also played an
 ACCESS TO HEALTH CARE…
A review of literature from Tanzania found for
example,
 People consider the availability of essential drugs
as a prerequisite to the credibility of health
services (Mamdani & Bangser, 2004);
 Problems of accessibility, including long distances
to nearest dispensary or health centre, scarce
public transport, and lack of bicycles and other
private means continued to be major access
barriers;
 Issues related to affordability were also major
obstacles: complaints about fees were frequent,
and even if official fees were exempted (e.g. for
children under five) or waived (e.g. for persons
 ACCESS TO HEALTH
•
CARE…
Health service studies concentrate on factors
influencing access to health care, which are
commonly defined as utilization rates (Andersen,
1995);
• Access becomes an issue once illness is
recognized and treatment seeking is initiated. Five
dimensions of access influence the course of
health-seeking process:
 Availability;
 Accessibility;
 Affordability;
 Adequacy; and
 Five Dimensions of Access to Health Care Services
Dimension Questions
Availability What type of services exist?
Which organization offer these
The existing health services and goods services?
meet clients’ need Is there enough skilled personnel?
Do the offered products and services
correspond with the needs of poor
people?
Do the supply suffice to cover the
demand?
Accessibility What is the geographical distance
between the services and the homes of
The location of supply in line with the the intended users?
location of clients By what means of transport can they
be reached?
How much time does it take?
 Five Dimensions of Access to Health Care Services…
Dimension Questions
Affordability What are the direct costs of the services
and the products delivered through the
The prices of services fit the clients’ services?
income and ability to pay What are the indirect costs in terms of
transport, lost time and income, bribes,
and other ‘unofficial’ charges?

Adequacy How are the services organized?

The organization of health care meet the
clients’ expectation
Does the organizational set up meet the
patients’ expectations?
Do the opening hours match with
schedules of clients, for instance the
daily work schedule of small scale
subsistence farmer?
Are the facilities clean and well kept?
 Five Dimensions of Access to Health Care Services…

Dimension Questions

Acceptability • Does the information, explanation

and treatment provided take local
The characteristics of providers match illness concepts and social values
with those of the clients into account?

• Do the patients feel welcome and

cared for?

• Do the patients trust in the

competence and personality of the
health care providers?
5.5 THREE SECTORS OF
HEALTH CARE SYSTEM
 THREE SECTORS OF HEALTH CARE SYSTEM
• The Popular, Folk and Professional Sectors
Kleinman (1980) introduced the concept of the popular, folk
and professional sectors of health care;

Explanatory models (they offer explanation for the origins

of a condition and its treatment-through them meanings are
given to the symptoms) are likely to differ markedly between
the three sectors:

The popular sector comprises the lay, non-professional

domain where illness is first recognized and treated (home-
based sector);

The folk sector consists of local healers, such as herbalists

bone-setters, spiritual healers, diviners and traditional birth
attendants;

The professional sector is the domain of medical

specialists who enjoy the privileged position in the sense that
 Question for
Discussion
Is genuine cooperation
between traditional and
biomedical healers
possible? If yes, how?
If not, why?
 THE END
• Thank you for your
attention and God bless.