THE ROLES OF ILLNESS COGNITION AND HEALTH BELIEFS IN THE UTILIZATION OF DIFFERENT TYPES OF MEDICINE

Abstract

This study looked at possible differences between individuals who consult only Western doctors (mono utilizers) and individuals who consult both the sinseh and the doctor (dual utilizers) in seeking treatment for illness. It was expected that dual utilizers would consider more disease attributes or concepts as relevant in the understanding of illness than would mono utilizers. It was also expected that dual utilizers would express a greater level of endorsement of Chinese health beliefs than would mono utilizers. Finally, differences between the two patient groups were predicted with regards to levels of satisfaction and perceptions of competence of the doctor and the sinseh. To test these hypotheses, patients at two Western medical practices and two Chinese medical practices were requested to complete a questionnaire. 128 questionnaires (61 dual utilizers and 67 dual utilizers) were completed and suitable for analysis. Multidimensional Scaling revealed that both dual utilizers and mono utilizers considered both general and specifically Chinese diseases attributes or concepts as relevant in their understanding of illness. However, the two groups weighted the dimensions differently. Dual utilizers considered a higher proportion of general disease attributes to be irrelevant in their understanding of 12 illnesses as compared to mono utilizers. These differences were largest for the two general attributes "contagiousness" and "physically vs. psychologically caused". With regards to health beliefs, dual utilizers expressed a greater level of endorsement for most of the Chinese health beliefs than did the mono utilizers. When asked to rate their satisfaction. dual utilizers also perceived the sinseh as being more concerned with the patient's well- being than the doctors. Also, dual utilizers perceived that sinsehs listen more to what patients have to say. Mono utilizers, however, indicated greater levels of satisfaction with the doctor than did dual utilizers. An exploratory discriminant analysis revealed that the average level of endorsement of Chinese health beliefs, the proportion of general disease attributes or concepts considered irrelevant and the language medium of education significantly discriminate between the two patient groups. Such results underscore the importance of cognitive variables in affecting help - seeking behaviour, Implications for future research are discussed.