The role of knowledge and beliefs in help seeking behaviour for cancer: a quantitative and qualitative approach

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Abstract

The study involved quantitative methods to assess the relationship between knowledge about cancer related symptoms and help seeking behaviour and qualitative methods to explore the role of patient's beliefs about cancer in explaining the gap between knowledge and behaviour. Patients (288) (response rate 72%) from one urban general practice completed a questionnaire consisting of 25 symptoms which they rated for whether they were cancer symptoms (knowledge) and whether the symptoms would prompt them to visit the doctor (hypothetical help seeking behaviour). Twenty patients were then selected who represented a range of knowledge levels and help seeking behaviour and interviewed about their beliefs about cancer. The results showed that the majority of patients had fair knowledge and appropriate help seeking behaviour and indicated a significant association between these variables. However, this relationship was not absolute and although significant the correlation was low. Accordingly, although the subjects knew which symptoms were indicative of cancer, this knowledge was not entirely predictive of their help seeking behaviour. The interviews provided insights into the beliefs which may explain the knowledge/behaviour gap. In particular, analysis of the interviews indicated that the interviewees represented cancer in terms of feelings of fear and death, that they described the process of symptom recognition as involving a fear of finding out the truth, they regarded screening programmes as something to be avoided and understood the causes of cancer either in terms of personal behaviour and internal causes which may result in recriminations or external causes which were beyond their control. The results are discussed in terms of the role of beliefs in mediating the association between knowledge and behaviour and the possible implications for developing educational programmes.

Introduction

Research has consistently indicated that the relationship between symptom experience and help seeking behaviour is complex 1, 2. Accordingly, whilst a symptom for one individual may prompt a visit to the doctor a similar symptom may be ignored either by someone else or by the same individual in a different situation 1, 2. Mechanic and colleagues 3, 4recognised this variability and argued that the aim of medicine was to effect “the arrival of `ill' persons at medical settings so that treatment can be effectively administered”. In line with this he promoted patient education as a means to “teach populations to accept and behave in accordance with the definitions made by the medical profession”. Within this perspective the accepted explanation of why patients seek help from their doctor emphasised the role of knowledge. Therefore a patient with sufficient knowledge about the possible symptoms associated with an illness would visit their doctor who would endeavour to identify the underlying cause. In contrast, both patients with symptoms who either failed to visit their doctor or attended once the problem was too far advanced and those who attended for relatively trivial complaints were regarded as having poor knowledge 3, 4.

Over recent years this simple model has been questioned. In parallel with the recognition that knowledge about unhealthy behaviours such as smoking and unsafe sex may not prevent smoking initiation or result in condom use 5, 6, that knowledge about the effectiveness of healthy behaviours such as cervical screening may not promote screening attendance [7], recent research has emphasised the role of a range of other factors in the link between knowledge and help seeking behaviour. For example, research has emphasised the role of the patient's health beliefs which have either been examined using qualitative methods 8, 9or have been assessed using structured cognition models such as the health belief model [10], the theory of reasoned action [11]and the protection motivation theory [12]. The latter of these models has also emphasised the role of an individual's affective state in the form of fear [12]. Research has also explored help seeking behaviour in terms of the individual's model of illness 13, 14. In particular, Leventhal and colleagues 15, 16have argued that individuals have complex but consistent ways of making sense of their illnesses and have highlighted beliefs about causes, consequences, time line, illness identity and control as the central dimensions to these models. Further, Leventhal and coworkers suggest that these illness representations influence their coping and attempts to seek help 15, 16. Research has also examined the role of symptom perception directly and has suggested that cognitions and affective state influence the extent to which an individual focuses on or perceives their symptoms [17].

Therefore, research has highlighted that knowledge about illness is not sufficient to result in help seeking behaviour, and has suggested a role for cognition and affect. However, no research to date has specifically focused upon the role of knowledge about symptoms. The present study aimed to explore patient's knowledge about symptoms and their association with help seeking behaviour using a quantitative approach. Further, in the light of research emphasising the role of the patient's beliefs, the study aimed to examine the complexity of this association as a means to explore the range of additional factors which may determine whether or not an individual decides to seek help using a qualitative approach. In addition, given the suggestion that cancer is seen as the most terminal of illnesses for the majority of people [18]it seemed particularly pertinent to examine the relationship between symptom knowledge and help seeking behaviour in the context of cancer.

Section snippets

Subjects

The study was conducted in an urban, four doctor practice, representing most social groups. This was a two stage study involving two sets of subjects. For the quantitative component a random sample of 400 patients, between the ages of 17 and 70 years were selected from the practice population and sent the questionnaire. The response rate was 72% (n=288). For the qualitative component, 20 patients were selected to represent a range of cancer knowledge and help seeking behaviour and consisted of

The questionnaire

The results of the questionnaire were analysed to describe the subject's profile characteristics in terms of their knowledge of cancer symptoms and hypothetical help seeking behaviour using descriptive statistics and in terms of the relationship between these two variables using correlations.

The mean scores for knowledge and hypothetical help seeking behaviour are shown in Table 1.

Discussion

The present study aimed to assess the association between knowledge of cancer symptoms and hypothetical help seeking behaviour and to explore the complexity of this relationship. The results showed that patients' knowledge of cancer symptoms was fair with the majority of respondents correctly identifying the cancer warning signs. The results also showed that the patients' help seeking behaviour for these symptoms was also in the main appropriate. In addition, the results indicate that these two

Acknowledgements

This project was completed as part assessment for the M.Sc. in General Practice at the Department of General Practice, UMDS, London, UK.

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