Thakker-Desai, Bayjool
(1992)
Health attitudes and personal health-care decisions in Bombay, India.
PhD thesis, London School of Economics and Political Science.
Abstract
Utilisation of medical sources other than the modern Western medicine (Allopathy) is characteristic of most societies. Health-care utilisation studies, in medically pluralistic societies, fall short of providing adequate explanation of how and why different medical sources are used. The present thesis is an attempt to delineate the social psychology of the health-care utilisation behaviour of people in Bombay by concentrating on the interplay between the individual, the social environment and the culture. It, therefore, benefits from disciplines both within and outside mainstream psychology like societal psychology, sociology, anthropology and medicine. The study addresses a twofold question: how are treatment related decisions made and what are their determinants. To answer these questions, an understanding of variables pertaining to the person as well as a consideration of the societal context is necessary. Following a quantitative pilot study, the research involved retrospective data collected with the help of a partially structured questionnaire using a quota sample of 480 Gujarati-speaking adults. The quotas were set for sex, income and illness types. The survey instrument elicited information on predisposing (demographic, social structural, belief and social), enabling (family resources and prior access) and illness (type and manifestation) variables as well as the process of seeking care. The results, highlight that health-care utilisation behaviour in a medically pluralistic setting is not a singular act but a continuously evolving decision-making process wherein sources are used differentially. Typically, the treatment-seeking process began with the use of non-formal sources, followed by an entry into the professional sector, invariably through an Allopathic family doctor. Subsequently, the individuals either revert back to non-formal sources, continue to remain within Allopathy or exhibit an irreversible shift to non-Allopathic formal sources. Accordingly, there exists a need to redefine health-care utilisation behaviour in terms of sequential patterns of usage. These patterns, are determined by individually based variables belonging to all three categories as mentioned above. However, in contrast to certain trends, the effect of demographic, social structural and income variable was very small. Between 18-42% of the respondents within each illness cluster, used two or more formal medical systems. Compared to their counterparts who used only one formal system, the multiple users were more likely to suffer from chronic illnesses, rely on lay advice, prefer non-Allopathic systems and already have an access to non-Allopathic sources of care.
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