Predictors of Avoiding Medical Care and Reasons for Avoidance Behavior

Abstract

Interventions to reduce patient delay could be improved by addressing the health-related behavioral, belief, experiential, and emotional traits associated with delay. Attention should also be directed toward the interpersonal communications between patients and providers.

Why do People Avoid Medical Care? A Qualitative Study Using National Data

“…[1][2][3][4]7,10,11,[32][33][34][35][36][37] Interestingly, the categories of reasons that emerged from the present study mapped almost directly onto a general psychological model of responses to negative events-Crisis Decision Theory 30 -which has not previously been used as a framework for understanding medical care avoidance. Crisis Decision Theory posits that people respond to negative events first by appraising the severity of threat, next by identifying available response options, and lastly by evaluating available response options.…”

“…Participants who responded "yes" (n=2,327) were then asked to what extent they endorsed three researcher-identified reasons for avoiding the doctor (i.e., feeling uncomfortable when their body is being examined, fear of having a serious illness, and because it makes them think of dying); results concerning these items have been published elsewhere. 5,7,18,24 Next, participants were asked whether there were "any other reasons why you avoid seeing your doctor," and either wrote their response in a small box if completing a mail survey or stated their response to an interviewer, who summarized their response, if completing a phone survey. Responses were brief and typically consisted of a short phrase or sentence.…”

“…A prior study reported the top five of these uncoded responses (i.e., preference for selfcare or alternative care, dislike or distrust doctors, fear or dislike of medical treatments, time, and money) and predictors of these responses. 7 For the present study, the three study authors analyzed these short phrases provided by the research company in conjunction with participants' raw responses using a general inductive data analysis approach, a method in which a theory or conceptual model is developed through an iterative process of coding, grouping codes into categories based on underlying concepts, and forming a model or generating hypotheses based on the data. 28,29 Coding was conducted by discussion of each participant response among all three authors; in rare cases when two authors disagreed, the third author acted as arbiter.…”

“…1,2,16 Of note, the term "patient delay" has also been used to describe phenomena related to avoidance, but guidelines for research on early cancer diagnosis have suggested instead using the more informative terms "appraisal interval" (the time taken to interpret symptoms) and "help-seeking interval" (the time taken to seek care after determining a need). 17 To date, research on avoidance of medical care has been limited in the extent to which it examines the broad spectrum of reasons for avoidance (but see 7 ), often focusing on specific factors such as barriers or psychological characteristics (e.g., lack of insurance, fear of a diagnosis). [4][5][6]15,[18][19][20][21][22][23][24] A conceptual review of reasons people avoid medical care identified only six qualitative or mixed-methods studies assessing participantgenerated reasons, all of which used convenience samples with predominately white participants.…”

“…[5][6][7] Even individuals with major health problems 4,8,9 or who are experiencing symptoms [10][11][12] avoid seeking medical care. For example, in one study, 17% of patients diagnosed with rectal tumors reported that they waited a year or more to seek medical consultation after noticing symptoms, with some waiting up to five years.…”