Emil Berkanovic

Structural and Social Psychological Factors in the Decision to Seek Medical Care for Symptoms

Panel data are presented from the Los Angeles Health Survey, in which 1 year of symptom experience is analyzed. Of the 1,210 individuals originally in the panel, 769 reported at least one symptom in reinterviews conducted every 6 weeks during the study year. The dependent variable in the analysis is whether or not the individual decided to seek medical attention for his symptoms. Hierarchical multiple regression was used to organize the independent variables into five groups: 1) need; 2) social structure; 3) organization of care; 4) general social network patterns and health orientations; and 5) social network influences and personal beliefs specific to the symptoms. Of the 57 per cent of the variance explained by the entire set of independent variables, need factors accounted for 12 per cent and network influences and personal beliefs specific to the symptom accounted for 42 per cent. In spite of the amount of variance explained in this analysis, the allocation of the explained variance among the predictor variables raises some disturbing questions regarding our ability to understand the decision to use health services.

Mexican-American, Black-American and White-American differences in reporting illnesses, disability and physician visits for illnesses

This paper presents data on the reporting of illnesses, disability due to illnesses and the decision to seek medical attention for illnesses among a representative sample of Mexican-Americans, Black-Americans and White-Americans in Los Angeles. Few differences were observed among these groups with respect to the reporting of illnesses, disability due to illnesses or in the frequency with which illnesses were brought to medical attention. Hierarchical stepwise multiple regressions were run for each of these variables within each of these subgroups. Some differences were found among these groups in the variables that predicted illness reporting, disability and the use of physician services for illnesses. These differences indicate that ethnicity affects health behavior through its interaction with other variables. Speculations are offered regarding the meaning and historical sources of the differences observed.

Social Networks, Beliefs, and the Decision to Seek Medical Care: An Analysis of Congruent and Incongruent Patterns

This article focuses on the impact of congruent and incongruent patterns of symptom specific beliefs and social network advice on the decision to seek medical care for symptoms. Data from 769 individuals who reported symptoms in the Los Angeles Health Survey are used to examine this issue. Further, the role of more general health orientations and social network influences in the decision to seek care is examined under these congruent and incongruent conditions. It is concluded that the more general factors, which have little effect on the aggregate, may play a role in decision making when beliefs and advice are incongruent. Further, it is concluded that reports of beliefs and advice about specific symptoms that have been given after the decision has been made to seek care may be valid and not the result of retrospective reconstruction.

Satisfaction with Health Services: Some Policy Implications

Although consumer satisfaction with health services is a frequently measured variable in health services research, the relevance of this variable for health policy is not always clear. The present paper suggests two criteria for specifying the relevance of satisfaction with health services for policy at the organizational level. First, it should be shown that consumer satisfaction is the result of organizational behaviors that are manipulable by policy. second, where he has a choice, it should be shown that satisfaction affects the organizationally relevant behavior of the consumer. Data are presented that support both criteria. Several suggestions are made for maximizing the policy relevance of future studies of satisfaction.

Can money buy the apporpriate use of services? Some notes on the meaning of utilization data.

This paper takes note of the convergence of both research and opinion supporting the assertion that perceived symptoms and ability to pay are the major determinants of health services utilization. Four reservations pertaining to this body of evidence are offered and research supporting the role of culturalfactors in determining the utilization of services is cited. Several cultural barriers to the full utilization of services are discussed.

Care seeking for musculoskeletal and respiratory episodes in a Medicare population.

Responses to episodes of musculoskeletal illness, musculoskeletal injury, and respiratory illness are examined separately. Data are from a 1-year longitudinal study of the illness experiences of 885 Medicare recipients. Unlike studies examining aggregate use of medical services, this study examines both episodes for which medical care was sought and episodes for which no medical care was sought. Both factors associated with the decision to seek medical care for each type of episode and the illness response patterns associated with whether medical care is sought are analyzed. The three types of episode have different characteristics and profiles of illness response. Perceived seriousness and duration of the episode are the best predictors of physician visits for all episode types. However, the relative effect of predisposing and need variables on the decision to seek medical care is greatest for musculoskeletal illness episodes. These data also bear on the relationship between self-care, informal care, and the use of formal medical care. Use of nonprescription medications is shown to substitute for medical care in a significant number of illness episodes. Lay consultation and restricted activity are often linked with physician visits; however, they cannot be assumed to precede care seeking. The analytic strategy of examining responses to specific types of episodes suggests that both characteristics of the person and characteristics of the illness affect how people respond to illnesses and that the relative importance of each type of characteristic is specific to each illness type. Implications of these findings for health education are discussed.

Mass media based health behavior change: Televised smoking cessation program

This report describes the 1-year follow-up assessment of a television-based smoking cessation program shown as a part of local news in the Los Angeles area. The post-broadcast experiences of two distinct samples was considered: individuals who wrote in for additional materials (Registrants) and a cross section sample (CS) contacted by a random survey method. Results showed significant between-group differences in demographic characteristics and smoking behavior outcomes. Compared to the CS sample, registrants displayed more quitting attempts during the 1-year follow-up period (70.7% and 49.8%) and more abstinence (6.2% and 2.4%, respectively). When compared to results from a comparison survey, both registrant and CS subjects made significantly more quitting attempts in the three week period following broadcast. In terms of abstinence, only registrant results significantly differed from the comparison survey (6.2% vs. 2.9%). Few correlates of outcome were identified. Overall, analyses suggest that the televised quit smoking program encouraged viewers to initiate more numerous attempts to quit smoking than otherwise would have been expected. In terms of maintaining nonsmoking over time, however, only registrants experienced significantly greater success than might have been observed in the general population. Implications for research and policy recommendations of televised health promotion programs are proposed.

Sociological concomitants of health orientations: a partial replication of Suchman.

The present paper is a partial replication of the late Edward Suchmans study of health orientations in Washington Heights. Data were collected for a representative sample of Los Angeles County, and Suchmans medical orientation, health knowledge, and preventative behavior items were asked. In addition, several community orientation items that difler from Suchmans, but partake of the same theoretical domain as those he used were asked. The data are analyed for Mexican-Americans, Blacks, and Whites-Anglos, and within categories of income. The results difler from those Suchman found in Washington Heights in a number of important respects. Several diflerences of time and place are suggested as variables that might account for the diflerences observed between the two samples.

Psychological Distress and the Decision to Seek Medical Care Among a Medicare Population

Although there have been a number of studies linking psychological distress to the demand for medical care, few studies have examined this relationship among the aged. The issue is important, however, partly because it has been suggested that distress might cause some individuals to seek unneeded medical care. The financial impact of the aged seeking unneeded care on Medicare is, thus, a matter of public concern. This study presents results from a prospective investigation of the impact of psychological distress on the seeking of medical care among a sample of 1,009 Medicare recipients. Following a baseline interview that assessed, among other things, psychological distress, the respondents were reinterviewed six times over the course of one year. Respondents reporting episodes of illness at each interview were asked a series of questions regarding how they responded to the episode. The present analysis examines the impact of a series of variables, including psychological distress, on the decision to seek care for each of the episodes about which the respondent was queried. It also examines the impact of psychological distress on the total number of physician visits requested by the respondent over the study year. Finally, since a panel of 22 geriatricians rated whether or not the episodes reported by the respondents should have resulted in a physician visit, the impact of psychological distress on the medical necessity of the visits made by these respondents is analyzed. The analyses found no relationship between psychological distress and any of these outcomes. Thus, it does not appear that, among these respondents, psychological distress has any impact either on the frequency of physician visits or the medical necessity of visits made for episodes of illness.

Behavioral science and prevention

Abstract The present paper explores three questions: 1. What can the behavioral sciences contribute to a general understanding of personal health behavior? 2. What techniques from the behavioral sciences can be used to change personal health behavior? 3. What strategies promise to be most useful in applying the principles of the behavioral sciences to prevention? Although there have been a number of models in the behavioral sciences that are applicable to personal health behavior, there is one comprehensive model that has been developed specifically to explain health behavior at the level of individual decision making. The Health Belief Model is described and its implications for preventive health behavior are explored. Although the model identifies several variables that are important determinants of individual health behavior, taken alone, it does not provide a sufficient base for the planning of intervention strategies. Thus, it is important to identify the social networks that influence individual behavior. It is through these networks that specific informational, persuasional, and behavior modifying techniques must function. Finally, it is suggested that controlled field studies are strategically important in testing the efficacy of specific intervention strategies distilled from the behavioral sciences.