Non-Attendance for Health Care: When Rational Beliefs Collide

Abstract

Some patients choose not to attend for health care despite health concerns or an opportunity for improved health. Social norms that privilege professional expertise, and good health, deem this choice irrational. However, this paper explores how a particular version of rational choice theory suggests 'positive choices' for such non-attendance. These are cognitive and subjectively rational decisions, which are made freely with potentially positive consequences and are not social problems if respect for personal autonomy trumps obligations to others. Specifically, Boudon's 'cognitivist theory of action' is used to conceptualise nonattendance as both a rational and irrational choice, from different perspectives. Because the perspective of non-attendees has been marginalised, the paper also suggests a typology of instrumental and non-instrumental 'strong reasons' for rational non-attendance. This may help groups such as professionals to understand and accept that non-attendance can be subjectively rational, without relinquishing their own perspective that it is irrational. Acceptance of the defensibility, if not the rightness, of the perspective of non-attendees is needed to show respect for non-attendees' moral agency and to begin to repair relationships with these individuals, who may seek help from health professionals in the future. This paper explores the potential of rational choice theory to cast light on the issue of non-attendance for health care. Some patients want to attend but are denied access by real or perceived external barriers to system entry (Beck, 1997;Lewis, 1977). In the absence of such barriers, other, competent patients (potential attendees or their surrogates) 'freely' choose not to attend in at least some circumstances. This is despite their awareness or suspicion of having a health need that may benefit from attendance, or their recognition of a possible opportunity to gain improved health. This paper challenges the dominant view of the irrationality of this choice by discussing a particular version of rational choice theory that elucidates the conditions under which individuals' purposive decisions for non-attendance can be subjectively rational. This focus on individual action complements attempts to conceptualise the process of decision making through the process of decision making through social The Sociological Review, 55:3 (2007)

Help-seeking for genitourinary symptoms: a mixed methods study from Britain’s Third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

“…Considering help-seeking in the context of people’s lives helps understand their priorities for health and healthcare and reasons for non-attendance 13. Our findings about individuals’ rationales for non-attendance are similar to those found in a study by Buetow14 and include the narrowing gap between patient and professional knowledge (due to alternate information sources) and reluctance to share misfortune with others (leading to concealment and not seeking care).…”

“…There is, however, currently little evidence about help-seeking among people with genitourinary symptoms,13 especially choices that do not involve visiting health services. Non-attendance is irrational from a medical perspective but may be rational for individuals depending on their subjective values and beliefs about health and healthcare14 (eg, to avoid stigmatisation).…”

Non‐attendance in chronic disease clinics: a matter of non‐compliance?

“…Recently, there has been a critique of how researchers have conceptualised non‐attendance as necessarily resulting in negative outcomes, entirely rational and within the patient’s control. Buetow (2007) proposed that some people may have valid reasons for not attending a chronic disease clinic and that in fact, their health outcomes are better because they do not attend. Everett et al.…”

Roads less taken: Pathways to care before near-lethal suicide attempts

“…The Network-Episode Model (NEM) discusses how the pathway to care for people with a mental illness is a muddling-through process mainly shaped by the influences exerted by surrounding social and cultural networks (Pescosolido et al, 1998). The Health Belief Model and Cognitivist Theory focus on why people do or do not use services, including subjective perceptions of potential benefits of medical care for health problems (Rosenstock, 2005) and the positive gains of non-attendance, not ceding control of self to professional advice and not giving up priorities that are treasured more than health Boudon, 1996, 2017; Buetow, 2007). The Cycle of Avoidance (COA) model shows how not seeking help was considered a viable strategy by young people who normalized emotional distress to accommodate or deny their problems (Biddle et al, 2007).…”