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South -Asian Journal of Multidisciplinary Studies (SAJMS) ISSN:2349-7858:SJIF:2.246:Volume 4 Issue 5

HEALTH CARE SEEKING BEHAVIOURS: CONTRIBUTING FACTORS-

A REVIEW

M.Megha

(MA student, Department of Psychology, University of Delhi, North Campus, New Delhi, India)

Maria Zafar

(MA student, Department of Psychology, JamiaMilliaIslamia, New Delhi, India)

Dr. Neera Pant

(Associate Professor, Department of Psychology, Gargi College, University of Delhi, New Delhi, India)

Abstract

Health care seeking behaviours can be defined as incidences wherein an unhealthy/sick

individual seeks help to cure his/her illness. These are different from health seeking behaviours-

activities healthy individuals engage in to maintain or promote their health. Both kinds of

behaviours do not exist in isolation but involve biological, sociological and psychological

considerations. The present paper is a critical review of literature devoted to health care seeking

behaviours. It reveals various contributing factors such as an individual’s gender, belief system,

ethnicity, socio-economic status, role of internet, etc. Moreover, the reviewers focus on the type

of health issue (mental/physical), knowledge about its symptoms and severity, awareness about

available treatment options which could further influence the possibility of seeking help. In this

paper, we categorise the major themes observed in regard to health care seeking behaviours.

With critical evaluation, we identify certain gaps in the existing literature and suggest

subsequent recommendations for future researchers.

Keywords: Health, Health care seeking behaviours (HCSB), Health seeking behaviours (HSB).

INTRODUCTION

The World Health Organization (1948) has defined health as ―a state of complete

physical, mental and social well-being and not merely the absence of disease or infirmity‖. By

understanding that health is more than just the absence of illness, one can classify ‗health

seeking‘ behaviours (HSB) as activities healthy individuals engage in to maintain or promote

their health. These activities may involve information seeking or making lifestyle changes (such

as maintaining a healthy diet, exercising regularly, meditating, etc.). HSB can be differentiated

from ‗health care seeking‘ behaviours (HCSB). The latter can be defined as incidences wherein

an unhealthy/sick individual seeks help to cure his/her illness. This ―help‖ can involve either

seeking treatment from medical professionals or through information which can be obtained

from different sources (MacKian, 2003). The difference between the two lies in the health

condition of the person before seeking help. Having differentiated the two, it is important to note

that such behaviours (both HSB and HCSB) don‘t exist in isolation but involve biological,

sociological and psychological considerations. Sometimes these terms (HSB and HCSB) are

used interchangeably. However we feel that HCSB should be studied separately, as from the

psychological point of view, care is more important.

The definition of health given by WHO emphasizes both physical and mental well-being

of an individual. It is therefore important to study the attitudes people exhibit towards physical

and mental illnesses, and the subsequent healthcare seeking behaviours shown for these different

kinds of issues. The present review, thus, focuses on differences in health care seeking

behaviours for mental and physical health problems.

METHOD

A number of databases were used in the search for published articles including PsycNET,

PsycINFO, PubMed, ScienceDirect. Articles for the review were drawn from published papers,

articles, reports, and reviews. The terms used for search purposes included, but were not

restricted to: ‗health seeking behaviour‘, ‗health care seeking behaviour‘, ‗health seeking

behaviour for mental problems‘. Due to the breadth of subjects covered, the literature review

concentrates more on recent researches published majorly from 2000 to 2016. Most researches

have used the term HSB to signify seeking medical help due to the presence of illness. However,

as suggested by MacKian (2013) our paper outlines the subtle differences between HSB and

HCSB, we have thus modified the terms to mean the latter wherever necessary.

After reviewing information regarding healthcare seeking behaviours for physical and

mental illnesses, we have identified the following areas as having maximal research backing:

gender (Doherty & Doherty, 2011; Nakagawa, et al, 2001; Pronyk et al, 2001; Rosenstock et al,

2015, etc), education (Abdulraheem&Parakoyi, 2009; Mashreky et al., 2010; Peng et al., 2010;

Yadav, 2010; Zhang, Liu, Bromley & Tang, 2007, etc), culture (Ghosh, Chakrabarti,

Chakraborty & Biswas, 2013; Hashimoto & Kim, 2012; Jang, Chiriboga& Okazaki 2009;

Thaker, 2008, etc), age (Jacobsen et al., 1993; Macfarlane, Blinkhorn, Davies, Kincey&

Worthington, 2003; Yadav, 2010; Yerpude, Jogdand&Jogdand, 2014, etc), beliefs/perceptions

(Domininc, Shashidhara&Nayak, 2013; Girma&Tesfaye, 2011; Jack-Ide &Uys, 2013; Maneze et

al, 2015; Pradhan, 2013, etc), severity of illness (Burton et al., 2011; Jimba, Poudyal&Wakai,

2003; Plowden& Miller, 2000; Webair& Bin-Gouth, 2013, etc), and the role of

technology/internet (Basoglu, Daim, Atesok&Pamuk, 2010; Burns et al, 2010; Farmer, 2014;

Horgan & Sweeney, 2010; Jensen, King, Davis &Guntzviller, 2010; Weaver et al, 2010, etc). We

have discussed and compared these in the following sections. Other factors such as stigma (Atre

et al., 2008; Davies et al., 2010; Möller-Leimkühler, 2002; Rao et al., 2012, etc), SES (Abebe et

al., 2010; Ahmed, Haque, Haque& Hossain, 2009; Mashreky et al., 2010; Yadav, 2010; Zhang,

Liu, Bromley & Tang, 2007), and place of residence (Mashreky et al., 2010; Okeke&Okeibunor,

2010) have also been mentioned and explained briefly.

DISCUSSION

GENDER DIFFERENCES PHYSICAL HEALTH PROBLEMS.The review has clearly indicated that the

incidence of HCSB is largely dependent on the gender of the individual. Many studies have

shown that gender does influence the incidence of health care seeking behaviour (Ahmed,

Adams, Chowdhury, Bhuiya, 2000; Pronyk et al, 2001; Rosenstock et al, 2015). Delay in the

occurrence of HCSB has been found to be attributed to different factors for males and females.

Yamasaki-Nakagawa, et al (2001) focused on a particular type of disease, TB and the gender

differences involved in the related health care seeking behaviours. In the case of TB, women

were found to have a longer total delay before diagnosis than men. Also, more women visited

traditional healers before diagnosis than men, and were more likely to receive more complicated

charms from traditional healers. Men tended to visit the government medical establishment first

if they knew that free TB treatment was available, but women did not. Johansson, Long,

Diwan&Winkvist (2000) found that for males, it is due to the fear of individual costs of

diagnosis and treatment. Men have also been found to disregard symptoms until the disease

reached a crucial stage which results in them heading directly for public health services. For

women, the delay for seeking help was often due to fear of social isolation, be it from the family

or the community. In contrast to men, they tend to seek out private services and indulge in self-

medication before seeking public services. However it is important to note here that this study

was based in Vietnam, thus cultural factors will also come into play which shape gender roles.

There may be instances wherein gender, which is a by-product of societal norms,

influences the health care professional‘s attitude. Adamson, Ben-Shlomo, Chaturvedi, Donovan

(2003) reported that gender, socioeconomic status and race were not a factor when it came to

reporting immediate health care seeking in response to the clinical vignettes.

In the case of sexually transmitted diseases, shame is a very prevalent factor which

influences one‘s health seeking behaviour or lack thereof. Mercer et al., (2003) on a study based

in Britain found that more women sought help for sexually transmitted diseases, but men were

more likely to than women to seek help at a genitourinary clinic. In a draft protocol submitted by

WHO in 1995 it was found that in some populations it may be easier for a man with an STD to

go and ask for help whereas in certain population, it may be inappropriate for a woman to discuss

genital problems with another man.

MENTAL HEALTH PROBLEMS.Research has shown that gender differences exist

within the subset of mental health problems too. Doherty & Doherty (2010) attempted to

examine the socio-demographic and health status factors that predict help seeking for self-

reported mental health problems for males and females from a general practitioner. The findings

showed more factors (socio demographic, psychological) influencing attendance at the general

practitioner for males than for females (social limitations, accessibility). Nam et al (2010) who

examined gender differences in attitudes toward seeking professional psychological help. Female

students were found to have more positive attitudes toward seeking help than their male

counterparts. Nonye&Oseloka (2009) studied the health seeking behaviour of mentally ill

patients in Enugu, Nigeria. They found that socio-cultural practices such as male dominance and

the stigmatizing nature of mental illness could explain the observed gender difference in health-

seeking behaviour of mentally ill patients. Rickwood, Deane & Wilson (2007) found that young

men and young people from indigenous and ethnic minority groups tend to be those most

reluctant to seek help. Another study by Mackenzie, Gekoski& Knox (2006) found similar

results. Their research revealed that older age and female gender were associated with more

positive help-seeking attitudes. Moreover, they found that women exhibited more favourable

intentions to seek help from mental health professionals than men, likely as they hold a more

positive attitude concerning psychological openness. Oliver et al. (2005) found that males, young

people and people living in affluent areas were least likely to seek help for mental health

problems.

As is obvious from the review, when it comes to consciously seeking treatment for

physical problems, men seem to be driven by internal factors such as fear of being seen as weak,

unfit, whereas women are influenced by social factors such as isolation by the family, being

ousted from society, etc. Moreover, men tend to benefit more from health care facilities when it

comes to physical illness. For mental health problems, it is observed that women are more likely

to demonstrate HCSB as they are more emotional beings and have more positive attitudes when

it comes to psychological openness. For men on the other hand, seeking help for mental health

problems such as anxiety and depression is probably viewed as a question to their masculinity.

EDUCATION PHYSICAL HEALTH PROBLEMS.Education levels of individuals have been found

to be significantly related to their likelihood of engaging in HCSB. An individual‘s level of

education influences his/her choice of treatment sought (home remedies vs. professional help)

and time gap between occurrence of first symptom and seeking of help. Peng et al. (2010), for

example, found education levels to be significantly associated with the HCSB of Chinese

migrant workers, with higher educated workers more likely to go see a doctor when they fell

sick. Zhang, Liu, Bromley & Tang (2007), studying the poor rural communities of Inner

Mongolia, too found that less educated people were less likely to seek care for tuberculosis.

Numerous researchers have found that in case of HCSB for children, higher parental

(mostly maternal) education is associated with a greater likelihood of getting professional

treatment for the children (Abdulraheem&Parakoyi, 2009; Mashreky et al., 2010; Webair& Bin-

Gouth, 2013; Yadav, 2010). Probable reasons for this may be that the literacy and numeracy

skills that women acquire in school enhance their ability to recognize illness and seek treatment

for their children, or the increased number of years in school make them more receptive to

modern medicine (Abura, Ciera & Kimani-Murage, 2012). Ogunlesi&Ogunlesi (2011) too found

that low maternal education has a significant relationship with delayed health care seeking and

the use of home remedies, while immunization coverage rates for immigrants have been found to

increase with mother‘s educational attainment (Kusuma, Kumari, Pandav& Gupta, 2010).

However, in rural communities, cultural beliefs and practices often overshadow other

factors like education, and lead to self-care, home remedies and consultations with traditional

healers. These factors result in delay in treatment seeking and more common amongst women,

not only for their own health, but for their children‘ illnesses too (Nakagawa et al., 2001, as cited

in Shaikh & Hatcher, 2004).

MENTAL HEALTH PROBLEMS.Unlike in the case of physical health issues, where

higher education levels mostly lead to a greater likelihood of engagement in HCSB, the review

for mental health problems shows an unclear pattern. Fortney et al. (2016) found that a

substantial gap exists between the prevalence of probable mental health disorders and treatment

seeking among community college students. Knipscheer&Kleber (2005) found that lower

educated respondents reported a more negative attitude towards consulting mental health

services. Such findings follow the expected pattern as one generally assumes that people with

higher levels of education would be more open to seeking help for psychological problems.

However, the issue of stigma attached with mental health can be a strong barrier to HCSB even

among educated individuals. To avoid the label of mental illness and the harm it brings, people

decide not to seek or fully participate in care (Corrigan, 2004). Chew-Graham, Rogers & Yassin

(2003) also found perceptions of stigma associated with mental health to lead to avoidance of

appropriate HCSB among medical students.

Thus, education levels of an individual seem to be quite important in determining

whether they engage in health care seeking behaviours for physical problems. Individuals having

higher education often are more aware of illnesses and the various treatment options available to

them. Even for health care seeking behaviours for their children, parental education levels

determine the kind of help sought. For mental health problem, however, the issue of stigma

associated with mental illnesses becomes more salient, and hinders even the educated individuals

from seeking help for their illness.

CULTURE

PHYSICAL HEALTH PROBLEMS.Culture has been found to play a monumental role

in the manifestation of health care seeking behaviours. We have viewed the studies highlighting

culture from two perspectives, that being individualistic and collectivistic cultures. Within the

collectivist cultures factors such as family attitudes and opinions and relationships matter a lot.

Factors such as joint family structure, role of other family members do influence health care

seeking behaviours among individuals (Ghosh, Chakrabarti, Chakraborty & Biswas, 2013;

Shaikh & Hatcher, 2004). Thaker (2008) attempted to understand the role of culture in the health

related behaviours of older Asian Indian immigrants. An analysis of the findings also addressed

three cultural values that influenced these immigrants‘ health behaviours: Establishing a personal

relationship with their health care professional, high level of family involvement during

treatment and also daily maintenance of health, and valuing alternative medicine.

There haven‘t been many researches that focus specifically on the individualistic aspects

that may influence health care seeking behaviours. But having discussed the collectivistic values

involved in such behaviours we could say that in the individualistic cultures, health care seeking

would probably not be as heavily dependent on the views of other family members. Instead it

may eventually come down to the individual deciding himself/herself whether s/he should seek

health care. In such a scenario, other factors such as convenience, stigma, knowledge about

treatment, etc. would have greater weight and influence.

MENTAL HEALTH PROBLEMS.Within the realm of mental health problems, there

too are differences among people from individualistic and collectivistic cultures in seeking health

care. It has been found that individuals belonging to collectivistic cultures rely more on social

support and are thus more reluctant to seek professional help as compared to individuals

belonging to individualistic culture (Lee et al, 2009; Mojaverian, Hashimoto & Kim, 2012).

Jang, Chiriboga& Okazaki (2009) studied the age-group differences in Korean American adults

in their attitudes toward mental health services. This study, though focused on age differences

still helps demonstrate the influence of culture. For example, older adults were observed to view

a mental illness as bringing shame to the entire family.

We can hence say that a culture can influence HCSB to a high degree. The influence of

culture across both physical and mental health problems is quite similar except it‘s slightly more

enhanced in the case of the latter. For collectivistic cultures, health care seeking in the context of

physical health problems are almost always determined by other family members, whereas

individualistic cultures may not see as much involvement of the family in making such decisions.

For mental health problems, where stigma is anyway a very strong factor, collectivistic cultures

often see less of HCSB as a problem with one family member is viewed as a problem with the

whole family which brings in a lot of shame. Conversely, collectivistic cultures emphasize social

support and familial ties which may also reduce the incidence of going to a professional.

AGE

PHYSICAL HEALTH PROBLEMS.Age as a factor influencing HCSB of individuals

shows mixed patterns. Studying the aged population of South India, Yerpude, Jogdand&Jogdand

(2014) found that though the majority of the older population seeks treatment for their physical

health problems, compliance to treatment generally was low, while Abebe et al. (2010)

established that age was not a contributing factor to HCSB of individuals. Macfarlane,

Blinkhorn, Davies, Kincey& Worthington (2003) also found the likelihood of seeking treatment

to increase linearly with age. Jacobsen et al. (1993) found that after adjusting for symptom

severity and sociodemographic characteristics, older men were likely to seek treatment than

middle aged men for urinary symptoms experienced in the past year. This trend of increased

HCSB with increase in age could be attributed to the fact that physical deterioration generally is

accepted as an outcome of aging. Thus, older individuals may be more open to seeking treatment

as, unlike the younger individuals, they are not ‗expected‘ to be physically fit. Also, younger

individuals who are the working population, may give their work more priority than their health,

leading to less HCSB.

Regarding the HCSB of parents for their children, mothers were, in a study, found to be

more likely to seek treatment for their malaria-infected children who were younger in age

(Yadav, 2010). This could be because of mother‘s perceptions regarding their younger children

being more vulnerable to developing the disease more seriously than older children, who might

be believed to be stronger physically and thus have higher immunity. Besides the child‘s age, the

age of mothers too may be related to HCSB for their ill children, as was found by Kusuma,

Kumari, Pandav& Gupta (2010) when immunization coverage rates, which were lower for

immigrant children, increased with mother‘s age.

MENTAL HEALTH PROBLEMS.Unlike for physical health problems, the review on

HCSB for mental health issues shows a clearer relationship between individual‘s age and their

likelihood of engaging in HSB: age has been found to be positively correlated to mental health

help-seeking (Mackenzie, Gekoski& Knox, 2006; Mojtabai, Olfson& Mechanic, 2002; Oliver,

Pearson, Coe &Gunnell, 2005; Stead, Shanahan, Neufeld, 2010). This trend may be explained by

the fact that younger people often feel that they have their entire lives ahead of them: they are

starting out in their careers, will soon be starting a family, etc. Thus, they are more likely to

brush off their symptoms and not seek help. Again, the associated stigma may be another barrier

to their seeking treatment. People who suffer from or have suffered from some mental illness, are

discriminated against in different walks of life: job, education, marriage prospects etc. Older

individuals, on the other hand, do not have the pressures of jobs and careers, making them more

open to seeking help with mental professionals. They are also more likely to be married and thus

experience greater support from their spouse than younger, unmarried individuals might get from

their friends.

As can be seen from the review, older individuals are more likely to engage in health care

seeking behaviour s for both physical as well as mental health problems, as compared to their

younger counterparts. A probable reason for this trend could be the fact that older individuals do

not have to face the pressures of jobs and taking care of their families, making them more open

to the prospect of seeking help for both the kinds of problems.

BELIEFS/PERCEPTIONS

PHYSICAL HEALTH PROBLEMS.Beliefs, attitudes and perceptions are shaped by

society and culture. The way individuals perceive a health problem does influence their

likelihood of seeking health care. Perceptions may also be shaped due to experiences of others or

due to societal views and opinions. Cultural beliefs and practices can work both as a facilitator

and as well as a barrier (Maneze et al, 2015). In the case of deciding whether to opt for public or

private health care, such perceptions do play a big role (Domininc, Shashidhara&Nayak, 2013).

Pradhan (2013) explored the health and healthcare seeking behaviouramong tribals in

Sundargarh district of Orissa. The study found that the cause of illness and healing system was

found to be associated with the magicoreligious beliefs. Treatment options were also influenced

by factors such as illness type, severity, beliefs regarding the causes, etc. Zhang, Liu, Bromley &

Tang (2007) found that perceptions of TB were associated with their gender, socio-economic

status, gender, age, education level. These factors then influenced their likelihood of seeking

professional health care. Scheppers et al (2006) studied the potential barriers to the use of health

services among ethnic minorities. They found that cultural perceptions about symptoms may act

as a barrier, as needs may be differently expressed. Presentation of classical symptoms may also

be different which could result in a misdiagnosis. Perceptions may also be influenced by gender.

For example, men in the United States are more likely than women to adopt risky beliefs and

behaviours, and are less likely to engage in healthy behaviours (Courtenay, 2000). Specific

physical diseases such as STDs, TB, also have various perceptions attached to them. These

perceptions too affect individuals‘ health care seeking behaviours.

MENTAL HEALTH PROBLEMS.In the context of mental health problems,

perceptions play a comparatively bigger role as the aspects of stigma and shame are associated

with them. In addition to such factors, there is less information and clarity about mental health

problems as compared to physical health problems. This ambiguity may result in the fostering of

skewed perceptions. Jack-Ide &Uys (2013) too found that culture among other factors was a

major barrier in the occurrence of health care seeking behaviours. Within the realm of culture,

aspects such as stigma, discrimination, and shame were also at play. Individuals may also believe

that mental health problems are not as important as physical health problems. They might even

attribute causes for mental illnesses as being natural or supernatural, spiritual possession, evil

eye (Girma&Tesfaye, 2011). In the case of young people who are quite susceptible to external

perceptions and beliefs, factors such as stigma, shame, poor knowledge about mental health, and

preference for self-reliance are some of the major hurdles to help seeking. Positive past

experiences, social support and encouragement were found to be facilitators (Gulliver, Griffiths

& Christensen, 2010). The belief that mental health professionals may not be able to help is also

a factor that reduces the likelihood of seeking health care (Bayer &Peay, 1997).

We can thus observe that when it comes to physical illnesses, most of the perceptions

regarding the symptoms are culture or society based. Also, treatment practices are also

influenced by culture as doctors and health professionals need to be sensitive to the cultural

practices and beliefs of individuals. In the context of mental health, cultural beliefs play a role in

deciding whether a problem can or cannot be helped/cured. Natural and supernatural ideas

regarding mental health problems also stem from culture. Also, the major aspect surrounding all

mental health problems, that is stigma, shame and the resultant discrimination is also a product

of one‘s perceptions and beliefs about the disorder.

SEVERITY OF ILLNESS

PHYSICAL HEALTH PROBLEMS.Illness severity is one of the most significant

factors that dictates whether an individual seeks help or treatment for their problem or not.

Webair& Bin-Gouth (2013) found that seeking medical care was frequently initiated for illnesses

that did not improve or worsened; the caretakers sought medical care significantly more when

the illness was perceived as severe. Studying health care seeking behaviour s in rural Nepal,

Jimba, Poudyal&Wakai (2003) found that the people would treat mild illnesses at home; even

when moderately or severely ill, they seek health care from traditional healers first. Plowden&

Miller (2000) found that among urban African-American men, for most, seeking care was done

after all other measures failed to relieve symptoms; perceived disability and death from an

illness, unrelieved symptoms, were internal motivators to seek help.

Even in cases of parents seeking treatment for their children, seeking health care at health

facilities was more likely for children with more symptoms of severe illness (Burton et al.,

2011); mothers were more likely to seek treatment for their malaria-infected children when they

perceived their condition to be severe and showing no improvement (Yadav, 2010); parents were

more likely to seek emergency help even for non-urgent issues when they perceived their child‘s

condition to range from moderate to very serious (Williams, O‘Rourke & Keogh, 2009).

Abdulraheem&Parakoyi (2009) too found that care seeking for child depends on illness severity

and number of symptoms exhibited.

For illnesses that are perceived to be less severe, self-medication or home remedies are

often preferred, while professional help is only sought when symptoms start getting worse. This

was seen by Abebe et al. (2010), who found that some reasons for not seeking treatment for TB

among the people studied included the perception that the disease will improve and considering

disease to be harmless. Not seeking treatment for less severe illnesses may also be related to

factors such as non-availability of health services (if such services are not easily available to

people, they would only go for these when the ill individual‘s condition badly deteriorates) or the

high cost of treatment (again, people would be open to incurring high treatment costs only when

they know that the illness is serious).

MENTAL HEALTH PROBLEMS.In case of mental health problems too, illness

severity to a large extent determines whether individuals seek help or not. On being asked when

it is appropriate to seek professional help for mental health issues, people suggested that patients

should seek care in a psychiatric hospital or mental institution only for the most severe

symptoms (van der Ham, Wright, vo Van, Doan &Broerse, 2011). Satyanarayana, Enn, Cox

&Sareen (2009) found that individuals suffering from chronic depression are more likely to go

for health service use. Beşiroğlu, Çilli&Aşk℩n (2004) studied why some people with obsessive-

compulsive disorder do not seek treatment while others do. They found that non-health care

seekers scored significantly lower on a measure of illness severity than did health care seekers.

This belief of seeking treatment only when the condition becomes severe may be due to certain

factors such as the financial burden incurred by the patient‘s family for the person‘s treatment,

along with the emotional burden of taking care of a patient, when often one family member

always has to stay with the patient.

Thus, as the review shows, severity of illness as a determinant of health care seeking

behaviour s has shown a clear trend over time: positively related to seeking help for both

physical and mental problems. Individuals often start out with brushing off their minor

symptoms as not serious, engaging in self-medication, etc. However, as gradually the symptoms

begin to worsen, they become more likely to seek professional help for both their physical and/or

mental problems.

ROLE OF INTERNET/TECHNOLOGY

PHYSICAL HEALTH PROBLEMS.Various researches have attempted to study the

influence of technology on health information seeking behaviour (Basoglu, Daim,

Atesok&Pamuk, 2010; Jensen, King, Davis &Guntzviller, 2010; Weaver et al, 2010). Often

individuals with health issues search for their symptoms and treatment options online before

deciding to visit a doctor. There are also cases wherein individuals who are not suffering from

any health problem still use the internet to look for health related information. Farmer (2013)

studied the issues in teen technology use to find health information. The results of her study

indicated that teen health information interests vary by age, gender, social situation, and

motivation. Moreover, her paper refers other studies that have found that the most popular topics

deal with sexual health or drugs and teens tend to seek information out of need or fear, such as

having a personal problem, rather than as a proactive effort to be healthy, such as eating

nutritionally. Atkinson, Saperstein &Pleis (2009) found that those seeking health information

were more likely to be women, have cable or satellite Internet connections or DSL connections,

have Internet access from work or from home and work, and report more hours of weekday

Internet use. Educated individuals were less likely to search for health information. Older

individuals and married individuals were more likely to purchase medicine or vitamins online.

Gray et al (2005) aimed to study the role of the internet in health information-seeking behaviour

in adolescence. They found that internet health information was regarded generally as

significant. Its relevance was increased through active searching and personalization. However

perceived credibility varied as expertise and trustworthiness were often tough to determine. Cline

& Haynes (2001) elucidate diverse purposes of using the internet to access health related

information. They claim that the internet is useful as it provides health web pages, online support

groups, and online interaction with health professionals. They also list out various benefits such

as widespread access to health information, interactivity, potential for anonymity, etc. with

benefits come certain costs. The disadvantages according to them are information overload,

disorganization, searching difficulties, overly technical language, etc.

MENTAL HEALTH PROBLEMS.Among the youth, the internet is seen as a big

source of information for mental disorders. Young people will seek information online even if

they are not suffering from a mental health problem themselves (Burns et al (2010). It has been

found that young people are willing to use the Internet for mental health information and it

represents a viable source of support for this age group (Horgan & Sweeney, 2010). A study by

Powell & Clarke (2006) revealed that eighteen per cent of all internet users (in their study) had

used the internet for information related to mental health. The likelihood of using the internet for

health information increases if the individual is suffering from psychological distress or has a

past history of mental health problems. Being able to access reliable disease information online

has been found to reduce anxiety, increase feelings of self-efficacy, and decrease utilization of

ambulatory care. Moreover, studies report that Internet health information seekers are more

likely to have health concerns, see themselves as having poor health, or demonstrate actual

symptoms of clinical impairment as compared to non-seekers (Ybarra & Suman, 2006).

From the review we can hence understand that in the scenario of physical health

problems, the internet is seen as an important source of health information. It is advantageous in

the sense that it allows complete anonymity, thus preventing shame or stigma in case there is

any. It also has a host of online communities which can help the individual having the physical

problem. This could probably be helpful for patients with chronic illnesses and also reduce the

physical act of seeking health care. In the context of mental health problems, it is observed that

being able to access the internet for health related information in itself reduces anxiety.

Moreover, those who do seek health information on the internet may already have had or are

currently experiencing clinical symptoms, depression, anxiety, etc. They are thus merely seeking

further information about their symptoms. Also, many individuals tend to seek information

related to mental health despite not having any mental illnesses themselves.

OTHER FACTORS: STIGMA, SES, RESIDENCE

Besides the above mentioned factors, the literature review also highlighted certain other

factors such as stigma associated with illness, socioeconomic status/income and place of

residence. Be it a physical or mental illness, the stigma associated with the illness has always

been shown to be a barrier to individuals seeking help. In case of physical health issues, a lot of

stigma is often attached to sexually transmitted infections (STIs) which stops people from taking

modern medicine, even after they acknowledge that it is the best treatment against STIs (Rao et

al., 2012). Even with diseases like TB, the associated stigma hinders people suffering from the

disease to start treatment (Atre et al., 2009). With mental illnesses, the issue of stigma is even

more prominent, and acts as a great barrier to help seeking, as was studied by Verger et al.

(2010), who found that less than half of the university students with a psychiatric disorder sought

professional help.

Stigma is an even more significant barrier for health care seeking among men than

women. Galdas, Cheater & Marshall (2005) too found ‗traditional masculine behaviour‘ as an

explanation for delays in seeking help among men who experience illness. Möller-Leimkühler

(2002) found that for emotional, depressive problems, social norms of traditional masculinity

make help-seeking more difficult for men. Davies et al. (2000) found that men have important

health needs but take little action to address them because of their socialization to be independent

and conceal vulnerability.

An individual‘s socioeconomic status becomes an important determinant of their HSBs,

as it addresses the issues of whether the health care services are available to people or not,

whether they can afford the services or not. Invariably, it has been found that individuals from

lower SESs are less likely to engage in health care seeking behaviour s (Ahmed, Haque, Haque&

Hossain, 2009; Zhang, Liu, Bromley & Tang, 2007). Even for health care seeking behaviour for

children, parental income is an important factor. Yadav (2010) found that mothers from high

income families were more likely to seek treatment for their malaria-infected children. Similarly,

for parents seeking treatment for their child with burn injuries, higher income parents are likely

to go for qualified service providers over unqualified ones (Mashreky et al., 2010). Abebe et al.

(2010), in their study, found that one reason participants cited for not seeking treatment of TB

was the lack of money for transportation, highlighting income as a factor that influences

behaviour s people show to deal with illnesses.

Lastly, the place of residence (rural/urban) can also influence the kind of help people

seek when they are sick. For example, Shah, Patel & Shah (2013) explored the differences in

health care seeking behaviour in rural and urban Ahmedabad. They found a significant difference

in the place of residence for the kind of treatment sought: more rural people took treatment from

faith healers than urban; majority of the rural people took treatment for chronic illness from

private practitioner than urban. Okeke&Okeibunor (2010), on the other hand, found that majority

of urban residents seek private or government health facilities for treatment, while majority of

rural residents go for self-treatment, going to hospitals only when problems persist or worsen.

Similarly, for parents seeking treatment for their child with burn injuries, parents residing in

urban areas are likely to go for qualified service providers over unqualified ones (Mashreky et

al., 2010).

This factor could be related to that of accessibility or convenience. Studies have shown

that convenience/ accessibility to resources is a factor that does influence HSB(Grundy &

Annear, 2010; MacKian, 2003; Selvam et al, 2007, etc.). For example, Nsereko et al. (2011)

studied perceptions of help-seeking behaviour among people with mental health problems in

Uganda. Results revealed that the accessibility of health facilities and financial costs associated

with care influenced help-seeking behaviour. Kaushal et al. (2005) evaluated the knowledge of

mothers and grandmothers regarding breastfeeding and health seeking behaviour for neonatal

sickness in a rural community in India. They found that most respondents preferred to try home

based remedies before seeking medical attention. In scenarios where medical attention was

crucial, they favoured unqualified village practitioners over government hospitals. Reasons

included distant location of hospital, long queues, and impolite and callous behaviour of the

staff. Tipping (2000) found that individuals usually go to nearby private drug sellers or to the

local drugstore. This behaviour is more common with women who have less time and income to

spend on searching for a place.

CONCLUSION

Through this review, we observe that various factors such as gender, age, culture,

severity of illness, beliefs/perception, education level, and role of technology/internet, stigma,

SES and place of residence, all influence the occurrence of health care seeking behaviours.

Moreover such behaviours do differ to some extent on the various dimensions depending on the

kind of problem the individual is suffering from (physical or mental). Having gone through

various papers, articles, reports and reviews, we have come to the conclusion that there is a

substantial amount of literature on HCSB in the context of physical illnesses, however mental

illnesses have not been given much focus/importance. Within the Indian context we observed

that culture plays a major role in effecting the likelihood of individuals engaging in HCSB. Our

suggestions for future researchers would be to attempt to fill this gap by exploring the various

HCSB, patterns and trends among mental health problems. Moreover, we feel it is important to

delve further into the psychological aspects of each factor that is seen to be influencing such

behaviour. For example, focusing on the individual‘s mental processes, thoughts, and emotions

that go into seeking health care and how they in turn are related to self-esteem, self-image might

be one area that future researchers could concentrate on studying. Moreover, since culture

influences all such psychological factors, it should also be studied in detail and its relation to

HCSB must be explored.

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