Health-care Seeking Behaviour of Jamaicans

Published on April 11, 2006 By Paul Bourne In Health & Medicine

By Paul Andrew Bourne, B.Sc. (Hons); Dip. Edu.

INTRODUCTION

Health is the bedrock upon which all human societies exist. Thus, the health status of a populace plays an imperative role in the wellbeing of people within a topology and social space. Many people throughout the world and in particular Jamaica conceptualize health and health care as the absence of physical pain and as such, those indicators primarily constitute health from a one-dimensional positivistic space. This is based on the biomedical conceptualization of the phenomenon. Human existence is continuously interfacing social, cultural, psychological, and political experiences and so the biomedical theorizing is a simplistic perspective on the subject matter as health is the absence of illness and the psychosocial well-being of an individual. People casually perceive health or primarily from the perspective of physical illnesses much so that in the absence of certain physiological indicator they perceive of themselves to be healthy, and so they will address matters relating to its care based on their socio-cultural attitude and valuation. Health, despite its fundamentality to existence, is not limited to a single space (i.e. quantification) as human beings are physiological, social, psychological and highly subjective. Thus, health care-seeking behaviour should not be constricted to mere absence of physical illnesses because this is quantifiable but the phenomenon must be analyzed from within a psychosocial space in addition to the traditionalist theorizing.

The dominance of positivistic science in measuring health speaks to a number of the psychosocial ills that are unaddressed to by countless Jamaicans, and this will continue in the distant future if the traditional viewpoint of health is not abated with proper education. Furthermore, if the level of education of a group of people is relatively low or even mediocre, what are the possible outcomes of their perspective on many issues including that of health care?

Health and its care are not only indicators of well-being but health status is also a determinant of human development, and so must become a concern for policy-makers. Thus, the one-dimensional perspective of health and health care permeates the human space and explains the high preponderance of research on this conceptual definition. This explains why there are no statistical agencies in Jamaica that are collecting data on issues such as frequency of visits to gymnasiums, knowledge and healthy eating and ¡®best practice¡¯ in regards to preventative care. It is because of the importance of this phenomenon that has fostered the author¡¯s investigation of the matter. In order to present a perspective of Jamaicans on health care, the author will use a secondary data source. The purpose of this approach is to establish external validity, and to formulate a framework on the health seeking behaviours of Jamaicans. This paper is structured in three categories. Firstly, in order that the reader will thoroughly grasp the data analyzed that will come in the latter section of the work, the author thought it fitting to present the methods that were used in the interpretation and assessment of the data. Secondly, a theoretical framework coupled with a literature review of past materials on the area is presented to guide the concept of health care seeking behaviour for the readers. Finally, the data and their interpretations are presented with summary of the entire paper.

It is extremely difficult to define health in an operational term that simple, as the concept is multi-dimensional, in part, and must include a social realm. Hence, health will be conceptualized within the operationalization of the WHO¡¯s Constitution of 1946: ¡°Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (Quoted in Lamb and Siegel, 2004, p.342). This, therefore, comprise biomedical conditions, lifestyle habits, access to care and quality of life conditions. Abramson and Abramson¡¯s (1999) view on the subject aptly describes the matter, that health is to be judged from the aspects of how well people perform everyday activities, to what extent he/she is capable of taking part in social activities, and the harmonious relationship that he/she has with the environment.

This study seeks to explore the determinants of health care seeking behaviour. Jamaica¡¯s population continues to increase while the youth male adults are experience-increasing injuries in addition there are concerns for care for the elderly. Injuries, for example, are among the leading causes of discharge from government hospital, and thus demand the continuous use of such facilities. This diagnosis is very costly to the government of Jamaica in order to effectively plan for health care for the populace. Therefore, the researchers strongly believe that this would be of paramount importance to health analysts, health practitioners and planners. Within the construct of the socio-demographic realities of this society, this research seeks to postulate a causal relationship between the health care seeking behaviour and other factors.

Rationale

Health care seeking behaviour in Jamaica is an important policy issue. It is encouraged, especially in light of preventative care that is cheaper than curative care as well as less costly on the government¡¯s health budget. This paper seeks to explain the variation in health seeking behaviour of Jamaicans who are between 15 and 99 years old when combined for levels of education, poverty (using quintiles), union status, gender, per capita consumption, health insurance, injuries, illness and age of respondents.

Theoretical Framework

Pender, Murdaugh, & Parsons (2002) cited social psychological theory, developed by Lewin. He conceptualized the life space in which an individual exists as composed of regions, some having negative valence, some having positive valence, and others being neutral. Illnesses are conceived to be regions of negative valence applying a force moving the person away from the region. Health-protecting behaviours are strategies for avoiding the negatively valenced regions of illness.

A group of writers who carried out an analysis of a secondary data set (1995 Guatemalan Survey of Family Health (EGSF)) on ¡®health seeking behaviour for children with illness in Guatemala¡¯ discovered that a causal relationship exists between a number of illnesses and health seeking behaviour (Noreen Goldman1 and Patrick Heuveline, 2000). Many studies have shown that illnesses determine the degree of health-care seeking behaviour of people. The typologies and severity of diseases are primarily factors that deal to health-seeking behaviour. Studies have shown that men are less likely to seeking health care compared with females because of socialization and it interpretation of ¡®machoism¡¯ but in the even that the illness is chronic (i.e. heart disease, stroke, cancer), there is no distinction between the sexes in regard to the desire for health-care seeking behaviour.

Pender, Murdaugh, & Parsons (2002) cited Ajzen and Fishbein proposed Theory of Reasoned Action (TRA) in which attitudes and subjective norms, both constitute the building blocks of this theory. The determinant of intention, attitude toward behaviour, is a function of beliefs concerning the consequences of performing the behaviour and evaluation of each of these consequences as either positive or negative. Evaluation of outcomes of behaviour desirable results is a positive attitude, and if undesirable, it is negative. Another determinant of intention, subjective norms is a function of what significant others expect a person to do; that is, what they would approve or disapprove. The TRA assumes that behaviour is under volitional control.

With reference to ¡°Theory of Planned Behaviour/ Reasoned Action¡± the Theory of Reasoned Action suggests that a person's behaviour is determined by his/her intention to perform the behaviour and that this intention is, in turn, a function of his/her attitude toward the behaviour and his/her subjective norm. (Smith, R., and Biddle, J. 1999; Eysenck, M., 2004; Harry, P. et al., 2005) The best predictor of behaviour is intention. Intention is the cognitive representation of a person's readiness to perform a given behaviour, and it is considered the immediate antecedent of behaviour. Three things determine this intention: their attitude toward the specific behaviour, their subjective norms and their perceived behavioural control. The theory of planned behaviour holds that only specific attitudes toward the behaviour in question can be expected to predict that behaviour. In addition to measuring attitudes toward the behaviour, we also need to measure people¡¯s subjective norms ¨C their beliefs about how people they care about will view the behaviour in question. To predict someone¡¯s intentions, knowing these beliefs can be as important as knowing the person¡¯s attitudes. Finally, perceived behavioural control influences intentions. Perceived behavioural control refers to people's perceptions of their ability to perform a given behaviour. These predictors lead to intention. A general rule, the more favorable the attitude and the subjective norm, and the greater the perceived control the stronger should the person¡¯s intention to perform the behaviour in question.

The Social Cognitive Theory (SCT) is relevant to health communication. First, the theory deals with cognitive, emotional aspects and aspects of behaviour for understanding behavioural change. (Bandera, 2004; Easton, M. and LaRose, R., 2005) Second, the concepts of the SCT provide ways for new behavioural research in health education. Finally, ideas for other theoretical areas such as psychology are welcomed to provide new insights and understanding.

Many writers who have written on ¡°Social Cognitive Theory¡±, views human behaviour as a triadic, dynamic, and reciprocal interaction of personal factors, behaviour, and the environment (Martin, J. and Kulinna, P., 2005). Based on this theory, each of these three factors uniquely determines an individual¡¯s behaviour. While the SCT upholds the behaviourist notion that response consequences mediate behaviour, it contends that behaviour is largely regulated antecedently through cognitive processes (Rogers, L et al., 2005). Therefore, response consequences of a behaviour are used to form expectations of behavioural outcomes. It is the ability to form these expectations that give humans the capability to predict the outcomes of future behaviour. In addition, the SCT posits that most behaviour is learned vicariously.

The SCT¡¯s strong emphasis on one's cognitions suggests that the mind is an active force that constructs one's reality, selectively encodes information, performs behaviour based on values and expectations, and imposes structure on its own actions. Through feedback, a person's own reality is formed by the interaction of the environment and one's cognitions. Cognitions change over time because of maturation and experience. It is through an understanding of the processes involved in one's construction of reality that enables human behaviour to be understood, predicted, and changed.

With reference to ¡°Expectancy-Value Theory¡±, behaviour is a function of the expectancies one has and the value of the goal toward which one is working. Such an approach predicts that, when more behaviours are possible, the behaviour chosen will be the one with the largest combination of expected success and value. Expectancy-value theories hold that people are goal-oriented beings. The behaviours they perform in response to their beliefs and values are undertaken to achieve some end. Other factors influence the process. For example the social and psychological origins of needs, which give rise to motives for behaviour, which may be guided by beliefs, values, and social circumstances into seeking various gratifications.

LITERATURE REVIEW

International perspectives

One writer forward the perspective that ¡°studies that have examined the health-seeking behaviour of elderly people in developing countries reveal several important determinants: age, sex and poverty (18); expectations about aging (19); interpretation and experience of symptoms (20); and the degree of social integration into community (21) among other¡± (Ahmed, et al., 2005). Although this research is not fashioned with the ambits of the former, the determinants were factors in determining health-care seeking behaviour of particular age cohorts; and so this research will apply those same variables but for individuals between 15 and 99 years old.

According to the writers Kazanjian, Morettin and Cho (2004) who did a study on the utilization of health care by Canadian women, women are twice as likely as men to report a regular family physician, but that proportion could be regarded as insignificant. In Canada, researchers stated that women are more regular users of health services than men are. Sex differences in health services utilization is disease specific, reflecting the biomedical approach to exploring health and illness. The researchers identified data from Statistics Canada which show that while 81.3% of the population, 12 years and older, had contact with medical doctors in the preceding 12 months, 87.2% of the female population reported such contact in the same period. On the other hand, women and girls were less likely to have had no contact with medical providers than men and boys.
There is a significant probability for women than men to present themselves for medical care or consultation. Women are dependent on the health care system to guarantee, control or terminate their fertility. Healthy women are expected to have their regular female related check ups, as a result they could be regarded as over users of the system relative to men.
The writers Kazanjian, Morettin and Cho (2004) postulated that there is a greater expectation for women than men to present themselves for medical care or consultation. Although women¡¯s passage through the life cycle is both social and biological processes, in medical terms the focus is on the biological process. Medical management of men occurs only in the military and sometimes at the beginning of employment.

Cost is yet another factor discouraging utilization of mental health services. Minorities are less likely than Caucasian to have private health insurance, but this factor alone may have little bearing on access to such schemes. Public sources of insurance and publicly supported treatment programs fill some of the gap. Even among working class and middle-class African Americans who have private health insurance, there is under representation of African Americans in outpatient treatment. Yet studies focusing only on poor women, most of whom were members of minority groups, have found cost and lack of insurance to be barriers to treatment. The discrepancies in findings suggest that much research remains to be performed on the relative importance of cost, cultural, and organizational barriers, and poverty and income limitations across the spectrum of racial and ethnic and minority groups.

The World Health Organization¡¯s (WHO) (2005) ¡°Poverty and social exclusion are the greatest threats to their well-being (10). Elderly women are especially disadvantaged due to their marginal position in the society (11)¡± perspective clearly indicates that the problematic framework of low-income people concerning social exclusion in relation to health care seeking behaviour is ideographic of the difficulties that they interface continuous in their daily lives. Steinman (2004) postulated that African Americans with low incomes and low literacy levels disproportionately suffer poor health outcomes from many preventable diseases. Low functional literacy and low health literacy impede millions of Americans from successfully accessing health information. These problems are compounded for African Americans by cultural insensitivity in health materials. Inaccessible health information also contributes to a higher burden of disease. Many groups encounter obstacles in accessing health information. Low socioeconomic status (SES) African Americans with substandard literacy skills has been shown to suffer excessively from preventable complications of diseases such as breast cancer and diabetes.

In survey in Bangladesh and Vietnam, Ahmed, Tomson, Petzold, & Kabir (2005) conducted a research to elicit information on the health-seeking behaviour of household members over 20 years. It was discovered that socioeconomic indicators were the single most pervasive determinant of health-seeking behaviour among the study population, overriding age and sex, and in case of health-care expenditure, and types of illness. It was discovered that no major differences in health-seeking behaviour between elderly people and younger adults. On average about 35% of those who reported having been ill during the previous 15 days in both age groups chose self-care/self treatment; for both age groups the most commonly consulted type of provider was a paraprofessional such as a village doctor, a medical assistant or a community health worker. Patients¡¯ level of education affected whether they avoided self-care/self-treatment and drugstore salespeople and instead chose a formal allopathic practitioner. Despite the advanced statistical technique (i.e. logistic regression) that used the researcher, they admitted that the findings lack external validity. The sample was particular district in which four localities were chosen. The selected villages were within one district; and these were selected because of the close proximity (3 miles) to a starting point. The findings on the sampled population, therefore, cannot be used to generalized on the population (i.e. Bangladesh); but this research unearth valuable information that forms the basis of for a study in other topologies within the context of the use of probability sampling techniques on the nation (i.e. country).

Case, Menendez, & Ardington, (2005) cited that at older ages, fewer individuals sought treatment at public medical facilities. The use of traditional healers increases among persons who died in their late twenties, of whom almost 60 percent sought care from a traditional healer. Traditional care declines at older ages, and there is a small downward trend in the use of non-prescribed treatment with age. It is therefore evident that care seeking declined above age 60.

Case, Menendez, & Ardington, (2005) examined patterns of health seeking behaviour of some individuals who lived in the Northen KwaZulu-Natal prior to their death. It was discovered that significant positive associations between individuals¡¯ socioeconomic status, measured using household ownership of a variety of durable goods, and their use of medical services. The researchers found out that asset ownership correlate significant to health status and health seeking behaviour. Individuals with greater economic resources are significantly more likely to seek treatment from private doctors, and spend considerably more for all types of health services. Individuals who are ill for a longer period before death are reported to see a greater number of health providers. While almost everyone interacts with Western medicine, those who are ill longer also see traditional healers and take non-prescribed medication. According to Jimba (2002) research when rural Nepalese feel sick, they seek healthcare only when the sickness is moderate and severe. Mild illnesses are treated at home. When the villagers seek health care, they preferred to visit traditional healers first, before visiting other health workers.

Latin America and Caribbean perspectives

Social health must receive focus and intervention. Changing social norms related to violence, avoidable injuries, responsible sexual behaviour, and a clean environment, for example, will become more critical. Use of appropriate interventions: information, communication, legal and fiscal measures and persuasion, will necessitate new ways of working and new partners with whom to work, in the public and private sector (Caribbean Epidemiology Centre, 2000).

The Caribbean Epidemiology Centre¡¯s monograph in its ¡°Annual Report, 2000¡±is a summation of number of the socio-demographic factors that are of importance in the social research within the context of health. This setting is primarily so because health is beyond the tradition definition of physical ill-health to social and psychological wellbeing of the individual, which include many social conditions that continuously interface the people in their environ. This organization has laid the foundation for an investigation of determinants of health-seeking behaviour of Caribbean nationals. In a study on Jamaican elderly Eldermire highlights a number of socio-economics conditions that determine health-seeking behaviour (Eldemire, 1997). She forwards the perspective that access to health insurance is aids the health-care behaviour of elderly, which concurs with the findings of Ahmed et al. (2005).

Eldemire argues that the situation of older person in developing countries is largely due to the consequences of social and cultural change in all countries of the third world (Eldemire, 1997, p.76)
The perspective of Eldemire is an illustration of the Caribbean Epidemiology Centre¡¯s stance of the social conditions that are imperative determinants of health-seeking behaviour of Caribbean nationals. Ahmed et al. and other non-Caribbean researchers always uttered those positions. On like the former authors, the latter¡¯s findings are external validity, and so are usable for generalizability of the Jamaican populace. I will apply the conditions that exist in determining health-seeking behaviour of the elderly as a proxy for all other age categorizations.

A research that was done in Mexico which was sponsored by the World Bank revealed a number of findings that were similar to those unearth by Eldemire and Ahmed et al, and other writer, that

Education is likely to increase demand for health services as it raises the
productivity of health production, the household's appreciation of the benefits of better health care, and its potential labor market earnings (Although theoretically education could reduce health service utilization by increasing the opportunity cost of time devoted to health care, most studies show that education have a positive effect, implying that its opportunity cost effect is less than the other putative effects of education.);

The time (distance) it takes to access a health service reduces the use of that service; it may, however, increase the use of other health services, depending on whether they are substitutes or complements;

Health insurance increases demand for health care, since it reduces the price of health service use;

The demand for preventive, curative and other health services can then be expressed as a function of household wealth, the price of health services, the environmental health threats, and other exogenous factors such as education, age and culture that either affect the production function, the resource constraint, or the household's utility function.

. . .health insurance, education, urban-rural residence, and wealth
appear to be significantly positive determinants of perceived health status.

The research carried out in Mexico used probabilistic sampling frame and so is external validity as a tool of generalizability of the people¡¯s social setting. In a critical perusal of findings of the World Bank study on Mexicans, information obtained were on all people, which highlight the issue that the determinants of health-seeking behaviour for adults are those for all concerned. Pan American Health Organization (PAHO) (2003) in one of its presentations concurs with the World Bank, Eldemire, Ahmed et al. and other writers that

The family is the key social institution that joins individuals related by birth or by choice into a household or a domestic unit. The family is the setting where health behaviour and health decisions are first established. In the Americas, cultural factors in families influence significantly on access to, and on health- seeking behaviour; for example, women may assign a lower level of priority to their health needs giving preference to other family needs such as food and education. This priority setting may adversely affect the health of the family; however, it is in the context of the family that this behaviour is best modified;

Families are often a reflection of the community and provide the first level of education for its members about healthy behaviours that should be followed, unhealthy behaviours to be avoided or changed, and their roles and responsibilities to themselves and to society. Sometimes elements in the family setting are not conducive to promoting or protecting the health of some of its members. It is therefore important that the community have family support systems in place in cases where the health of family members is threatened by violence, abuse, neglect, or abandonment.

Within the perspective of PAHO, the determinants of health-seeking behaviour are social, economic and cultural. It should be noted from the viewpoint of PAHO that culture begins the socialization of health-seeking behaviour, and it is through this medium that social and other variables are introduced. With this perspective, the determinants of health-care seeking behaviour of the elderly are the same for other age cohorts. All the writers have agreed with each other that education, access to health care, duration of illnesses, income, social class, and cultural factors determine health-care seeking behaviour of ¡®people¡¯. There is a consensus among the sapiential powers that health-seeking behaviour is a function of educational level, gender, age, access to health insurance, household composition, and cultural factors (PAHO; World Bank; Ahmed, et al., 2005, Eldermine, 1997; Caribbean Epidemiology Centre; Case et al. 2005).

Poverty

Many writers who have presented a perspective on the poverty-discourse generally agree that the people involved are primarily only able to survive (i.e. food consumption) because of their financial inadequacies (Henry-Lee, 1995, 2001; PIOJ, 2000; Maxwell, 1999; Haveman 1987; Townsend, 1979). From Henry-Lee¡¯s monograph, ¡®food poverty¡¯ and ¡®ultra poverty¡¯ befall a number of Jamaicans (Henry-lee, 2001, p.199). Within those two conceptualizations lie the meager existences of people. This social reality represents a miniscule number of people (¡®food poverty¡¯ ¨C 5% and ¡®ultra poverty¡¯ ¨C 10%) but within the explanation are hidden human sufferings and their inability to accept other social services.

From Henry-Lee¡¯s theorizing, poverty is an implied illustration that can be use to justify the causal relationship of poverty on health-seeking behaviour. The argument is simple: if an individual is primarily preoccupied with food, he/she is highly unlikely to access other social services. Hence, Osei describes a perspective on poverty eradication that includes expenditure on health care, education and other social services. Osei is of the view that social change of the poor is embedded in the acquisition of land, and other transferable position. With the incapabilities of the poor, the researcher is forwarding a thesis that poverty is a determinant of lower health-care seeking behaviour.

Gender differences in health-care seeking behaviour

One writer forwarded the view that socio-cultural conditions influence health behaviour of people; and added that gender is the most significant of them all (Courtenay, 2000; 2002). This situation further predicts the female gender on health promoting behaviour. Many writers, because of this view, establish an association between male and female, and mortality. As a result, mortality differences between the gender and socialization explain heath-seeking behaviour. This social reality is not subjected to a particular topology but is common to ethnicity, nationality and religiosity (Hicks, 2003; Astrachan, 1999). Hick (2003) viewpoint was that men are in the background when it comes to taking care of their health, as they are invariably embarrassed because of the macho socialization process.

Hicks, a medical doctor, helps us to understand how he formulated his perspective on behaviour of men concerning health-seeking. He believes that one of the factors that determine men¡¯s reluctance in health-care behaviour is the ¡®misbelief¡¯ that the issue to gradually disappear. This is found complication a number of simple medical conditions into chronic issues that sometimes result in impairment and death. On the other hand, women are highly interesting in ascertain the simplest of matter may is self-unexplainable. Astrachan (1998) concurred with Hicks in his findings that traditional male-gender role helps to cultivate this reluctance in health-seeking behaviour, and this may be costly. Astrachan¡¯s research is on young men between the age cohorts 15 to 17 years in the United States; and so helps us to understand the behaviour of all men. Another potent reason was the matter of ¡®homophobiaism¡¯. Men unlike their women counterpart believe that it is feminine to arbitrarily seek health care unless one is ¡®really¡¯ ill (i.e. chronically sick). He argues homophobia influences the man by way of discouragement concerning health-care behaviour. Another writer¡¯s view was men who subscribe to the social-gender prescription are relatively unconcern about their health and well-being (Courtenay, 2000).

A number of academics carried out a research on 401 undergraduate male students (in United States) by deductively testing stereotypical male roles in relation to health attitude and other social factors; and they discovered that restrictive emotional attitude of men was able to predict a decrease in help seeking behaviour (Good et al., 1989). Their justification was based on the number of people who actually met to the doctors for preventative. Approximately 66% of those people who visited the health service for psychological help were female. The result that showed one in three women and one in seven men who sought mental health care at some point in their lifetime further compounded this situation. A number of writers cite that traditional masculine attitudes do indirectly influence the men¡¯s willingness to seek psychological assistance, and secondly external interventions (Robertson et al., 1992).

Courtenay (2002) conducted a research on college men and women in respect to ¡®Gender Difference in Health Beliefs and Behaviour¡¯ the study were exploratory. From the research, the findings revealed a consistent gender difference with males and females about risky behaviour and the perception of risky behaviour. Men indulge in more risky behaviour than women do, and females are medically compliant. One writer from his research found that American men have only limited contact with physicians and the health care system (Sandman, 2000). The findings did not cease there as many men failed to get routine medical checkups, preventative care, and health counseling, and they often ignore symptoms or delay seeking medical care when they were sick or in pain. This social reality helps to explain the lack of preventative care and the irregular visits to traditional health services. Social taboos or socialization within the context of embarrassment is another factor that explains men¡¯s silence on health issues along with their willingness to discuss such matters.

Henry-Lee et al. (2001) and PAHO (2000) and other research are from different topologies, and the findings converge on a general principle that biomedical conditions are only the only determinants of health-care seeking behaviour of humans. From the slant of the WHO¡¯s definition of health, the variable is multi-dimensional and so include social, cultural and psychological conditions in addition to the tradition perspective on health conditions. All the research from Europe, Africa, United States and Latin America and the Caribbean are testament to the external validity of determinants of health-seeking behaviour of people.

A few writers, in a non-generalizable study in Bangladesh, aptly forward a perspective that justifies the researcher¡¯s willingness to investigate the health-seeking behaviour of Jamaicans. They wrote:
[Mostly,] people possess imprecise and wrong perceptions about their health. It has been found that people are indifferent to their health needs, and in most cases, they defer or delay treatment by conscious choice when they are sick and need medical support. It is, therefore, important to understand how people perceive their health and health needs, and how and at what stage they decide to go to health providers for treatment or medical consultation (S.M. Nurul Alam, Rasheda Khanam & Shahed Hossain, 2000).

In preparation of topic, which is to determine the causal factors of this research, the researcher analyzed the findings of other academics¡¯ works and writers on the subject matter, based on the literature review, to establish a logistic model. As a result, the researcher forwards this theorizing that health-seeking behaviour is a function of gender, age, union status, poverty, household size, educational level, access to health care, ownership of health insurance, severity of illnesses and duration of illnesses.

RESEARCH DESIGN

Survey Design

In order to accomplish the analytical objective of the secondary data set as it relates to comparative demographic changes, the statisticians drew information from the Household Expenditure Survey (HES) and the Population Census. This was not the only referent as the Gini coefficient (an economic concept) was used in order to present a measure of the degree of inequality in consumption distribution. The Housing Quality Index benchmarks were the right to use piped water, access to electricity, exclusive access to flush toilets and kitchens and one person for each habitable room.

Those areas were in the form of student enrolment, academic achievement, and students¡¯ attendance measured by parents¡¯ efforts to send their children to school for a 20-day reference period.
Operationalization

Health care seeking behaviour: is defined as people visiting a health practitioner or health consultant such as doctor, nurse, pharmacist or healer for care and/ or advice.

Levels of education: This is denominated into the number of years of formal schooling that one has completed.

Poverty: This is based on STATIN¡¯s (Statistical Institute of Jamaica) predefined groups for social classes, namely, the poorest group (quintiles 1, 2 and 3) compared to the richest (quintiles 4 and 5).

Union status: This variable was recoded into a nominal level measurement ¨C ¡°0¡± being without an intimate partner and ¡°1¡± being having an intimate partner.

Gender: This is the state of being male or female.

Per capita income: This is used a proxy for income of the individual by analyzing the consumption pattern.

Ownership of Health insurance: Individuals who possess of an insurance polic/y (ies).

Injuries: A state of being physically hurt. The examples here are incidences of disability, impairments, chronic or acute cuts and bruises.

Illness: A state of unwellness.

Age: The number of years lived up to the last birthday.

General Hypothesis:

The health care seeking behaviour of Jamaicans is a function of educational level, poverty, union status, illnesses, duration of illnesses, gender, per capita consumption, ownership of health insurance policy, and injuries. [ Health Care Seeking Behaviour = f( educational levels, poverty, union status, illnesses, duration of illnesses, gender, per capita consumption, ownership of health insurance policy, injuries)]

Specific Hypotheses:
Ho: Variation in health care seeking behaviour is not caused by changes in poverty levels;
Ha: Variation in health care seeking behaviour is caused by changes in poverty levels;

Ho: Variation in health care seeking behaviour is not as a result of changes in educational levels;
Ha: Variation in health care seeking behaviour is as a result of changes in educational levels;

Ho: Changes in severity of illnesses do not influence on health care seeking behaviour;
Ha: Changes in severity of illnesses directly influence health care seeking behaviour;

Ho: Increases in duration of illnesses will not lead to a positive change in health care seeking behaviour;
Ha: Increases in duration of illnesses will lead to a positive change in health care seeking behaviour;

Ho: the larger the household size, this will result in reduction in health care seeking behaviour;
Ha: the larger the household size, this will result in reduction in health care seeking behaviour;

Ho: Gender does not influence health care seeking behaviour;
Ha: Gender influences health care seeking behaviour;

Ho: Females have direct causal effect on health care seeking behaviour as against there male counterparts;
Ha: Females have direct causal effect on health care seeking behaviour as against there male counterparts;

Ho: People with partners have a direct effect on health care seeking behaviour as against those without;
Ha: People with partners have a direct effect on health care seeking behaviour as against those without;

Ho: Increases in age does not result in an increased demand for health care seeking behaviour ;
Ha: Increases in age result in an increased demand for health care seeking behaviour;

Methods

A secondary data set from a reputable statistical organization was used for the analysis of the variables. Data were analyze using SPSS (Statistical Packages for the Social Sciences) 12.0. Firstly, prior to the bivariate analyses that were done, univariate frequency distributions were done so as to pursue the quality of the specified variables. Some variables were not used because, the non-response rate was high (i.e. >20%) or the response rate was low (i.e. < 80%). In addition, before a number of variables were further used in analysis, because they were skewed, they were logged to attain normalcy. Secondly, the researcher selected ages that were greater than or equal to 15 years. Thirdly, the independent variables were chosen based on their statistical significance from a bivariate analysis testing and on the literature. Next, logistic regression analysis was performed in order to identify the determinants of health-seeking behaviour of Jamaicans.

Data transformation

Dependent variable

Part A, question 9, ¡°Has a doctor, nurse, pharmacist, midwife, healer or any other health practitioner been visited¡± was combined with Part A, question 30, ¡°Have you visited a health practitioner for any other reason, during the last 12 months?¡± This is a nominal variable and was recoded and given a variable name ¡°Health care seeking behaviour¡±. This was then further dichotomized into ¡°yes = 1¡± and ¡°no = 0¡±

Independent variables:

Part B, question 21 ¡°What type of school did¡ [Name] ¡.last attends. This is an ordinal variable which when recoded was given a value of ¡°0¡± for primary education, ¡°1¡± for secondary and a value of ¡°2¡± for tertiary level education.

Q7: This ordinal variable dealt with the five (5) quintiles; poverty was recoded as Poor for quintiles 1 and 2, Middle for quintiles 3 and 4, and Rich for quintiles 5 and 6.

The variable Union Status was a nominal variable, given to question 7 on the Household Roster was and grouped as (0) with partner and (1) without partner.

From the Household roster, Round 16, the question, Sex, dichotomous variable) (1) Male, (2) Female, was recoded as Gender, (0) Male (1) Female.

Per Capita Consumption for all individuals, an interval ratio, was logged to removed skewness

The variable health insurance, in Part A, question 29, was recoded as yes (1) (i.e. having health insurance) and no (0).

Part A, question 6 that asks, ¡°Have you had any illnesses other than that due to injury?¡± was named Injuries and recoded into yes (1) and no (0).

Part A, question 7 ¨C ¡°For how long did this last episode of illness last¡± was named Illnesses ¨C where (1) represents yes (1) and (0) no.

The interval variable, Age, located on the Household Roster, remained as is for analysis.

Duration of illnesses

DATA INTERPRETATIONS

SOCIO-DEMOGRAPHIC INFORMATION

Table1 (a): AGE PROFILE OF RESPONDENTS (N = 16,619)

Particulars Years

Mean 39.740
Standard deviation 19.052
Skewness 0.717

From table 1 above, the skewness of 0.717 shows that there is a clear indication that the data set is not normal, and so the researcher logged this variable in order to reduce the skewness so that the value will be a relative good statistical measure for the sampled population (n=16,619 respondents). The mean age of the sampled population is 39 years and 9 months (39.740 years). Of the population sampled, the minimum age was 15 years and the maximum age was 99 years. The standard deviation (of 19.052) shows a wide spread from the mean of the scatter values of the sampled distribution.

Table1 (

: LOGGED AGE PROFILE OF RESPONDENTS (N = 16,619)

Particulars Years

Mean 3.5983
Standard deviation 0.47047
Skewness 0.014
Kurtosis -1.014

From table 1 (

above, after the variable was logged (age), the skewness was 0.014 which shows minimal skewness that is a better relative statistical measure for the sampled population (n=16,619 respondents). The sampled population has a mean age of of 3 years and 7 months (3.5983 years) with a standard deviation of 0.47047 that shows a narrow spread from the mean of the scatter values of the sampled distribution.

Table 2: HOUSEHOLD SIZE (ALL INDIVIDUALS) OF RESPONDENTS

Particular Individuals
Mean 4.741
Median 4.000
Standard deviation 2.914
Skewness 1.503

The findings from the sampled population of the Survey of Living Condition (SLC 2002) in table 1 above shows a skewness of 1.503 that is a unambiguous indication that the data set is not close normal and so is not a relative good statistical measure of the measure of central tendency of this population sampled (n=16,619 respondents). Therefore, the researchers used the median, as this is a better measure of central tendency. The median number of individuals within the sampled population is four persons. Of the population sampled, the minimum number of individuals with a household was one person and the maximum was 23 people. The standard deviation (of 2.914) shows a relatively close spread from the median of the scatter values of the sampled distribution.

Of the sampled population (n=16,619 people beyond and including 15 years), there were 8,078 males (i.e. 48.6 %) and 8,541 females (i.e. 51.4%). Furthermore, 92.1 percent (n=13,339) of the sampled respondents had secondary education and lower [see Table 3(ii)] compared with 7.9 percent (n=1142) at the tertiary level. The valid response rate in regards to type of education was 87.1 percent (that is, of the sampled population of sixteen thousand, six hundred and nineteen people). In addition, 14,009 cases were included in the analysis (or 84.3 percent) with 2,610 missing cases (or 15.7 percent).

Table 3 (i): UNION STATUS OF THE SAMPLED POPULATION (N=16,619)

Particular Frequency Percent
Married 3,907 25.4
Common law 2,608 16.4
Visiting 2,029 12.7
Single 5,638 35.4
None 1,757 11.0
Total 15,939 100.0

Based on the findings of this survey, of the sampled population (n =16,619), the valid response rate to union status was 95 percent. The survey showed that 35.4 percent (n = 5,638) of the sample was single, 25.4 percent (n = 3,907) was married, 16.4 percent (n = 2,608) was in common law union and 11.0 percent (n = 1,757) of the same sample was in no union. Union status was further classified into two (2) main groups; firstly, living together and secondly, not living together. Collectively, 51.9 percent of the respondents (n = 8,272) were not living together and 48.1 percent (n = 7,667) were living together. Comparatively, the response rate was 95.9 percent (n = 15,939) to none response rate of 4.1 percent (n = 680).

Table 3 (ii): OTHER UNIVARIATE VARIABLE OF THE EXPLANATORY MODEL

Particular Frequency Percent

Gender
Male 8078 48.6
Female 8541 51.4

Dummy educational Level

F %

Primary 7294 50.4
Secondary 6045 41.7
Tertiary 1142 7.9

Health Insurance

F %
Yes 1919 11.8
No 14292 88.2

Dummy union Status

F %
With a partner 8544 53.6
Without a partner 7395 46.4

Poverty
Poor 5844 35.2
Middle 6762 40.7
Rich 4013 24.1

From Table 3 (ii), of the sampled population (n=16,619), 51.4 percent (N=8541) were females compared with 48.6 percent (N=8078) males. The findings revealed that were 35.2 percent (5844) poor people compared with 40.7 percent (N=6762) within the middle class with 24.1 percent (N=4013) of the sample in the upper (rich) categorization. With regard to the union status of the sampled group, 53.6 percent (N=8544) had a partner compared with 46.4 percent (7395) who did not have a partner. Furthermore, the educational level of the respondents was 50.4 percent (N=7294) in primary category with 41.7 percent (N=6045) in the secondary grouping compared with 7.9 percent (N=1142) in the tertiary categorization. With respect to the issue of availability of health insurance, the findings revealed that 88.2 percent (14,292) of the sampled population did not possess this medium compared with 11.8 percent (1919) that had access.

Table 4: VARIABLES IN THE LOGISTIC EQUATION

Particular ¦Â S.E Wald df Significant Exp (¦Â)

Illnesses (1) 2.336 .075 969.894 1 .000 10.338
Injuries (1) .863 .181 22.655 1 .000 2.370
Poverty 45.938 2 .000
Poverty 1 .127 .056 5.128 1 .024 1.135
Poverty 2 .332 .050 44.601 1 .000 1.394
Per capita consumption .094 .030 10.117 1 .001 1.099
Union status -.169 .040 18.024 1 .000 0.845
Gender (1) .793 .039 418.533 1 .000 2.2210
Health insurance(1) .664 .064 106.383 1 .000 1.942
Age .022 .001 359.375 1 .000 1.022
Levels of education (1) .274 .085 10.332 1 .001 1.315
Constant - 3.024 .319 89.691 1 .000 0.049

Logistic regression equation:

Z = a + b1X1 + b2X2 + b3X3 + b4X4 + b5X5 + b6X6 + b7X7 + b8X8 + b9X9 + ei
Health seeking behaviour = constant + b1(illnesses) + b2(injuries) + b3(poverty) + b4( per capita consumption) + b5(union status) + b6(gender) + b7(health insurance) + b8(age) + b9(levels of education) + ei

Z = -3.024+ 2.336(illnesses1) + 0.863(injuries1) + 0.127(quintile1) + 0.332(quintile2) + 0.94(per capita consumption) ¨C 0.169(union status) + 0.793(gender) + 0.664(health insurance) + 0.022(age) + 0.274(levels of education) + ei

Note: If the Pvalue ¡Ü 0.05, then this indicates that, the corresponding variable is significantly associated with changes in the baseline odds of not seeking health care.

Based on table 4, illnesses contributes the most (i.e. Exp (¦Â) =10.338) to health seeking behaviour. The relationship between illnesses and health seeking behaviour is significant (Pvalue = 0.000 ¡Ü0.05). Furthermore, positive ¦Â values of 2.336 as it relates to illnesses indicate that as people move from no illnesses to illnesses, they will seek more health care. Given that, the logit is positive for illnesses, so we know that being ill increases the odds of seeking health care.

The value in table 4 in regards to injuries is not surprising as is inferred from the literature. This variable second ranked (injuries) in contributing to health seeking behaviour (i.e. Exp (¦Â) = 2.370) for individuals, ages 15 to 99 years. Furthermore, a positive ¦Â value of 0.863 indicates that with the increasing number of injuries, the sampled population sought more health care (or health seeking behaviour increases). With the Pvalue = 0.000 ¡Ü0.05, the logit is positive for injuries, and this suggests that being injured increases the odds of seeking health care.

As also indicated in table 4, there is a significant relationship between gender and health seeking behaviour (Pvalue = 0.000 ¡Ü0.05). Based on the Exp (¦Â) of 2.210, gender contributes the third most to the health seeking behaviour. In addition, a positive ¦Â value of 0.793 indicates that females sought more health care in comparison to males. Further, a positive logit in relation to gender suggests that being female increases the odds of seeking health care.

The findings in table 4 concur with the literature as it spoke to a positive relationship between possessing health insurance and individual seeking health (Pvalue = 0.000 ¡Ü0.05). Herein, health policy contributes the fourth most to the model of health seeking behaviour (Exp (¦Â) of 1.942). The positive ¦Â (of 0.664) suggests that an individual who holds a health policy is more likely to seek health care in contrast to no-health policyholders. In addition, this positive logit of the sampled population infers that having a health insurance increases the odds of seeking health care.

The literature review spoke to a direct relationship between moving from lower education to higher education and health seeking behaviour (¦Â of 0.274, Pvalue = 0.000 ¡Ü0.05). The positive ¦Â reinforced the literature that health seekers are more of a higher educational type. Further, a positive logit in relation to levels of education suggests that being within a higher education type increases the odds of seeking health care.

In respect to ages of the respondents (15 years ¡Ü ages ¡Ý99 years), there is a statistical significant relationship between the older one gets and an increase in his/her health seeking behaviour (Pvalue = 0.000 ¡Ü0.05). This means that for each additional year that is added to ones life, he/she seeks additional health care. Furthermore, positive logit (based on table 4) suggests that as age increase by each additional year, the odds of seeking health care increases.

The information presented in table 4 with regard union status indicates that people who had partner are more likely to seek health care compared with those who do not ¦Â (of -0.169) and a Pvalue of 0.000 ¡Ü0.05. The reality was that union status contributes the least to the health seeking behaviour (or the model). With a negative logit (from table 4) in regards to union status, this suggests that as union status decrease from living to not living together, the odds of seeking health care decreases.

The per capita consumption of the sampled population clearly indicates that a direct significant relationship exists between this variable and dependent variable (health seeking behaviour, Pvalue of 0.001 ¡Ü0.05). The Exp (¦Â) of 1.099 values determines that per capita consumption contributes the third least to the model. Furthermore, the positive ¦Â indicates that as per capita consumption increases by one additional dollar, health-seeking behaviour increases. Given that, the logit is positive, so we know that increases in per capita consumption, increases the odds of seeking health care.

Table 5: CLASSIFICATION TABLE

Predicted

Health seeking behaviour Percentage
Correct
Observed No Yes
No 6,452 1.191 84.4
Yes 3,008 3,358 52.7
Overall percentage 70.0

The literature review perspective was that there were relationships between the dependent and the independent variables, the findings of this survey unanimously support those positions. This means that there were statistical significant relationships between each hypothesis (i.e. Pvalue ¡Ü 0.05). The variables tested in the model all predict the health seeking behaviour of Jamaicans (of ages 15 to 99 years) but to varied degree (Exp (¦Â). From the model predictor; illnesses, injuries and gender offered the strongest influence. This, therefore, means that people generally tend to seek health care when they are ill or injured and of a particular gender (female). Based on table 5 above, the model correctly predicts 52.7 percent of people in the sample will seek health care. However, the model correctly predicts that 84.4 percent of the will not seek health care. In respect to the overall predictor of the model, 70.0 percent is correctly predicted from the variable chosen of the sample size. The Nagelkerke R square of .284 indicates that, 28.4 percent of the variation in health care seeking behaviour of Jamaicans of ages 15 to 99 years is explained by the nine variables in the model.

SUMMARY OF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS

The theorizing presented in the literature review offered a researched perspective on the issue of health care seeking behaviours of Jamaicans, to which this survey overwhelmingly agrees (¦Ö2(10) is 3,346.016, Pvalue of 0.000). Generally, the researched findings provide a knowledgeable understanding of health seeking behaviour of Jamaicans with particular socio-demographic characteristics. Hence, policy makers will be able to effective address issue of health promotion that will be geared towards more preventive care health seeking behaviour rather than that of curative care. From the understanding of these findings, policy maker can gear social marketing campaigns towards positive health seeking behaviour for men. The relatively new National Health Fund (providing health insurance for all especially the needy) in Jamaica is a move in the right direction in addressing men as well as women health seeking behaviour. Despite the general predictability of the survey, the model does not explain approximately 70 percent of the variation in health care seeking behaviour and those factors may be of a cultural nature. As such, the researchers are recommending that a number of socio-cultural factors within the Jamaican society be investigated in order to ascertain their relevance. The examples here are (1) exercise, (2) best practice lifestyle ¨C periodic doctor visits, good personal hygiene, avoidance of risky behaviour, periodic dentist visits, avoidance of particular foods and adhering to daily dietary requirements; (3) massage therapy, (4) perception of best practices, (5) perception of wellness, (6) practice of non-traditional medical therapy ¨C spiritual healings, self-medication and alternative medicine, (7) social activities and (8) sleep quality. This is within the context of other research on those factors and their influence on health-seeking behaviour.

REFERENCE

Abramson, J & Abramson, Z. (1999). Survey methods in community health (5th). Edinburgh: Churchhill Livingstone Press.

Ashmed, S., Ran, A., Chowdhury, M. & Bhuiya, A. (2000) Measuring perceived health outcome in non-western culture: does SF-36 have a place? 20. Journal of Health Population and Nutrition.

Ahmed, S.M., Tomson, G.T., Petzold, M., & Kabir, Z.N, (2005). Socioeconomic status overrides age and gender in determining health-seeking behaviour in rural Bangladesh. World Health Organization

Astrachan, A. (1988). How men feel: Their response to women¡¯s demands for equality and power. New York: Doubleday Press

Bertakis, K. D. (2000). Gender differences in the utilization of health care services. Journal of Family Practices. Retrieved March 24, 2005, from http:/www.findarticles.com/p/articles/mi_m0689/is_2_49/ai_60039858

Bandura, A. (2004). Health promotion by social cognitive means, 31. Health Education & Behaviour, 143-164.

Case, A., Menendez, A., & Ardington, C. (2005). Health seeking behaviour in Northen KwaZulu-Natal. Retrieved April 22, 2005, from http://www.wws.princeton.edu/~rpds/downloads/case_etal_hsb.pdf

Courtenay, W. (2002). Gender and ethnic differences in health beliefs and behaviours, 7. Journal of Health psychology, 21-25.

__________. (2000). Engendering Health: A social constructionist examination of men¡¯s health beliefs and behaviour, 1. Psychology of men and masculinity, 4-15.

Courtright, C. (2004) "Health information-seeking among Latino newcomers: an exploratory study." Information Research, 10(2) paper 224 Retrieved April 22, 2005, from
http://www.InformationR.net/ir/10-2/paper224.html

Eastin, M. and LaRose, R. (2005). Alt.support: modeling social support online. 21 (6). Computers in Human Behaviour, 977-992.

Eysenck, M. (2004). Psychology: An International Perspective, (Chapter 18: Cognitive approaches to social psychology). Retrieved on October 08, 2005 from www.psypress.co.uk/pip/resources/ slp/topic.asp?chapter=ch18&topic=ch18-sc-01

Felix-Aaron, K. Weinick, R., Levine, D. & Burstin, H. (2001). Social integration into community: effect on health-seeking behaviours. Abstracts/AHSR Annual Meeting [Electronic resource], 18-21.

Good, G., Dell, D., & Mintz, L. (1989). Male role and gender role conflict: Relations to help seeking in men, 36. Journal of counseling psychology, 295-300.

Henry-Lee, A., Brenzel, L., & Lefranc, E (2001). Gender and equity in Jamaica and Barbados. Kingston: Mona Press

Henry-Lee, A. (1995). The dynamics of poverty in Jamaica, 1989-1999, 50 (1). Social and Economic Studies, 199-228.

______ (2001). Estimates of poverty in Jamaica, 1989-1993. Kingston: The Planning Institute of Jamaica.

Hicks, R. (2003). Men be aware. Retrieved October 10, 2005 form http://www.bbc.co.uk/health/feature/men_health_week.html.

Hospedales, C. (2000). Why is health so important to us in the Caribbean ?. Caribbean Epidemiology Centre (PAHO/WHO).

Impact Data - Study to improve the health-seeking behaviour of in-school adolescents ¨C Nigeria.
http://www.comminit.com/evaluations/id2001/sld-2458.html.

Lawson, D. (2004). Determinants of health seeking behaviour in Uganda ¨C It is just income and user fees that are important. Manchester: University of Manchester

Jimba, M. (2002). The need for linking health-care-seeking behaviour and health policy in rural

Kazanjian, A., Morettin, D, & Cho, R. (2004). Health care utilization by Canadian women. Retrieved March 24, 2005, from http://www.biomedcentral.com/1472-6874/4/SI/S33

Martin, J., Pamela, H. and Kulinna, P. (2005). A Social Cognitive Perspective of Physical-Activity-
related Behaviour in Physical Education, 24 (3). Journal of Teaching in Physical Education, 265.

Maxwell, S. (1999). The meaning and measurement of poverty. Odi Poverty Briefing. Nepal. April 22, 2005, from http://www.hsph.harvard.edu/takemi/RP199.pdf

Noreen Goldman1 and Patrick Heuveline. (2000). Health-seeking behaviour for child illness in Guatemala, 5 (2). Tropical Medicine and International Health,145-155.

Norcross, W. A. (1996). The influence of women on the health care-seeking behaviour of men. Journal of Family Practices. Retrieved March 24, 2005, from http://www.find articles.com/p/articles/mi_m0689/is_n5_v43/ai_1892

Osei, P. (2001). Has poor relief declined in Jamaica? A preliminary investigation, 50 (1). Social and Economic Studies, 229-262.

Pan American Health Organization (PAHO). (2003). 44th Directing Council. 55th Session of the Regional Committee

Pan American Health Organization (PAHO). (2000). Compliance and health intervention programs in the Caribbean. Retrieved on October 10, 2000 from http://www.paho.org/English/

Pender, N.J., Murdaugh, C.L., & Parsons, (2002). Health Promotion in Nursing Practice (4th ed.).
Upper Saddle River, NJ: Prentice Hall.

Planning Institute of Jamaica. (2000). Poverty estimates, 1989-2000. Kingston: Planning Institute of Jamaica.

Prapavessis, H. et al. (2005). Using theory of planned behaviour to understand exercise motivation in patients with congenital heart disease. 10 (4). Psychology, Health and Medicine.

Satcher, D. (no date). Mental health: A report by the surgeon general. Retrieved April 22, 2005, from
http://www.enterthefreudianslip.com/surgeon_general_mental_health_ch2_overview_of_cultural_diversity_mistrust.htm

Sandman, D. (2000). Out of touch: American men and the health care system. Retrieved October 11, 2005 from http://www.cmwf.org/programs/women/sandman-survey-bn-374.asp.

Rogers, L., Shah, P., Dunnington, G., Greive, A., Shanmugham, A., Dawson, B. & Courneya, K. (2005). Social Cognitive Theory & activity during breast cancer treatment, 32 (4). Oncology Nursing Forum, 807-815.

Smith, R., and Biddle, J. (1999). Attitudes and exercise adherence: Test of the Theories of Reasoned Action and Planned Behaviour, 17(4). Journal of Sports Sciences. Retrieved October 08, 2005, from http://taylorandfrancis.metapress.com.

Steinman, R. A. (2004). Online health information and low-literacy African Americans. Journal of Medical Internet Research 6(3). Retrieved April 22, 2005, from http://www.jmir.org/2004/3/e26/

Tarumi, K. Hagihara, A. & Morimoto, K. (1995). An investigation of the effects of lifestyle on care-seeking behaviour using data from health insurance claims. Retrieved April 22, 2005, from http://www.ncbi.nlm.nih.gov/

Tu Ha T. & Hargraves, J. L. (2003). Seeking health care information: Most consumers still on the sidelines. Retrieved April 22, 2005, from http://www.hschange.com/CONTENT/537/

Velicer, W.F., Prochaska, J.O., Fava, J. L., Norman, G.J., & Redding, C.A. (1998). Transtheoretical model. Retrieved April 20, 2005, from http://www.uri.edu/research/cprc/TTM/detailedoverview.htm

Odiit, M., Shaw, A., Welburn, S., F¨¨vre, E., Coleman, P., and McDermott, J. (2004). Assessing the patterns of health-seeking behaviour and awareness among sleeping-sickness patients in eastern Uganda, 98 (4). Annals of Tropical Medicine & Parasitology, 339¨C348

Comments

No one has commented on this article. Be the first!

Welcome Guest! Please take the time to register with us.
There are many great features available to you once you register, including:

Richer content, access to many features that are disabled for guests like commenting on the forums.
Access to a great community, with a massive database of many, many areas of interest.
Access to contests & subscription offers like exclusive emails.
It's simple, and FREE!