Medical Care-seeking Behavior Research Articles

Self-reported medical care seeking behaviour of doctors in Nigeria

BackgroundThere is need for information on the medical care seeking behaviour of Nigerian doctors. PurposeThis work was therefore designed to study the medical care seeking behaviour of Nigerian doctors in Nigeria. MethodsIt was a cross-sectional survey among doctors in Nigeria. ResultsData from 522 doctors were included in the analysis. Majority of them (80.5%) had one form of illness or the other in the year preceding the survey. Only 35% of them reportedly consulted another doctor during their illness. Most of the consultations (61.2%) were informal in the form of over the phone (45.6%), Corridor (33.3%) and home visit (21.1%) and just 18.4% of the consultations occurred within 24h of onset of illness. A low 19.5% of them had a regular source of medical care. Screening for illnesses was generally below expectation. Just 6 out of the 436 (1.4%) male doctors had screened for prostate cancer while 39 out of 86 (45.3%) females had screened for cervical cancer. A significantly higher proportion of general practitioners (p=0.01) and doctors above 45 years of age (P=0.004) consulted informally. Higher proportion of general practitioners and resident doctors based their consultations on their familiarity with the doctors consulted (p=0.001) and privacy during consultation (p=0.001). Delay in consultation for more than 24h after onset of illness was more likely in those above below the age of 45 years (p=0.001). ConclusionThis study has shown that Nigerian doctors are often reluctant patients who frequently tend to delay medical care. The teaching of appropriate medical care seeking behaviour should be incorporated into medical curriculum in Nigeria.

Development Of Community Psychiatric Crisis Management Indicators And Assessment Framework In Taiwan: A Focus Group Study

This study was to develop the Community Psychiatric Crisis Management (CPCM) Model for community-dwelling psychiatric patients of Taiwan. Purposes of this study were: 1. To develop psychiatric patients’ community crisis management indictors; 2. To develop the psychiatric patients’ community crisis management framework. Methods: Three focus group interviews involving a total of 42 experts, included psychiatrists, psychiatric nurses, social worker, and community mental health service providers were implemented. Interview data were analyzed with qualitative content analysis. Results: The model of CPCM concretized the objectives, crisis assessment indicators, and crisis intervention services for community psychiatric patients, and proved to be an important part of CPCM. The level of crisis severity and impact of patient can be assessed by the four indicators: medical care seeking behaviors, psychiatric symptom severity and impact, history of violence and substance abuse, and protective factors of family and social support system. In addition, the severity and impact of CPCM score could be implement to provide home visiting care and crisis management interventions. The recommended CPCM model enabled community mental health care professionals’ assessment and management the patient’s crisis problems in three stages, from crisis, acute and maintenance stage. Conclusions: The CPCM model was improved practically, and the contents of the intervention were constructed. It is important to integrate crisis management with the preventive intervention to the community psychiatric patient care.

Exploration of a pilot project for medicine and pharmacy separation reform and its impact on medical insurance fund and medical care seeking behavior of patients covered by such fund

Objective To study the impacts of medicine and pharmacy separation reform on medical insurance fund and medical care seeking behavior of such patients. Methods The insurance data of patients was collected from year 2011 to year 2014 at the hospital of the author. The differences of hospitals' revenue from insurance, the use of insurance fund and medical care seeking behavior of patients, before and after the reform were analyzed. Results The results showed that the effect of medicine and pharmacy separation reform in achievingtranslation; the proportions of drug and per-patient drug expenses were reduced. However, the demand of insurance fund was increased, and the fund used in outpatients began to exceed that used in inpatients after the reform. Totally, the choices of outpatients on doctor's technical titles were influenced by the pricing, as more outpatients tended to choose the intermediate title doctors, and the proportion was increasing. The differences of the choices on the outpatient in superior departments were very small, while those in non-dominant departments were very big, the same as the total patients. Conclusion There are both advantages and disadvantages in impacts of the reform on medical insurance fund conducted in some hospital in Beijing. The advantages included that the hospitals' revenue was not decreased from insurance patients, the use of insurance on paying drugs were reduced by management of proper medication, and out-of-pocket burden of the insurance patients was reduced. Yet the disadvantages contained that because of cheaper drugs and favorable insurance policy on the reform, the outpatients preferred higher level hospitals to buy drugs only, and the reform might lead to the increase of the requirement of insurance fund. Key words: Beijing; Separation of medicine and pharmacy; Medical insurance fund; Medical care seeking behavior

The Medical Home Experience of Low-income Children with Non-Urgent Encounters in Acute Care Settings.

Assess relationships between having a medical home and health care-seeking behavior attitudes among parents of low-income children with non-urgent encounters in acute settings (emergency, urgent care centers). We analyzed data from 1,743 publicly insured children within non-urgent encounters. Parents completed surveys assessing medical home access and attitudes regarding health care-seeking behavior. Multivariate logistic regression analyses were conducted to investigate relationships between medical home access and attitudes. Forty percent of children with non-urgent acute care encounters had medical homes. Having a medical home was positively associated with always calling the doctor before going to acute care settings and preference to take a child to their doctor if the doctor's office was open evenings and weekends. Although having a medical home is associated with positive attitudes regarding health care-seeking behavior, it may not suffice to overcome other barriers that precipitate non-urgentencounters.

Foodborne Diseases Active Surveillance Network-2 Decades of Achievements, 1996-2015.

The Foodborne Diseases Active Surveillance Network (FoodNet) provides a foundation for food safety policy and illness prevention in the United States. FoodNet conducts active, population-based surveillance at 10 US sites for laboratory-confirmed infections of 9 bacterial and parasitic pathogens transmitted commonly through food and for hemolytic uremic syndrome. Through FoodNet, state and federal scientists collaborate to monitor trends in enteric illnesses, identify their sources, and implement special studies. FoodNet's major contributions include establishment of reliable, active population-based surveillance of enteric diseases; development and implementation of epidemiologic studies to determine risk and protective factors for sporadic enteric infections; population and laboratory surveys that describe the features of gastrointestinal illnesses, medical care-seeking behavior, frequency of eating various foods, and laboratory practices; and development of a surveillance and research platform that can be adapted to address emerging issues. The importance of FoodNet's ongoing contributions probably will grow as clinical, laboratory, and informatics technologies continue changing rapidly.

The relationship between type 2 diabetic patients' early medical care-seeking consistency to the same clinician and health care system and their clinical outcomes.

The literature has demonstrated that the continuity of diabetes care can lower medical service utilization and expenses. However, few studies have examined the effects of patients' medical care-seeking behaviors in the early stage after the diagnosis of diabetes on their long-term prognoses. This study aimed to examine the association of medical care-seeking behavior in the first year following diabetes diagnosis on the occurrence of diabetes-related complications among patients in Taiwan. This is a retrospective data collection with follow-up analysis and a nationwide population-based dataset in Taiwan. A total of 89,428 newly diagnosed type 2 diabetes mellitus patients during the period from 2000 to 2006 were followed up until 2010. The patients' medical care-seeking behaviors were classified as follows: high consistency to a physician, high consistency to a medical setting, medium consistency to providers, and low consistency to providers. The occurrence of diabetes-related complications and all-cause mortality were the primary outcomes of this study. Chi-square tests, ANOVAs, and Cox proportional hazard models were applied to examine the relationships between the predictors and medical outcomes. Compared to the patients with high medical care-seeking consistency to a physician, the multivariate-adjusted hazard ratios of diabetes-related complications occurrence among patients in the high consistency to a medical setting, medium consistency, and low consistency categories were 1.112 (95% CI 1.089-1.136, P < 0.001), 1.226 (95% CI 1.205-1.248, P < 0.001), and 1.536 (95% CI 1.504-1.567, P < 0.001) in outpatient visits and 1.032 (95% CI 0.992-1.074, P = 0.121), 1.056 (95% CI 1.022-1.092, P = 0.001), and 1.208 (95% CI 1.164-1.254, P < 0.001) in complication-incurred hospitalizations, respectively. The monotonic trend was sustained across different strata of age, gender, and disease complexity. The findings of this study suggest that the incentives of continuity of care and physician-patient relationship management should be reinforced during the early stage of diabetes care in future medical care systems.

Emergency department and urgent care for children excluded from child care.

Children in child care are frequently unnecessarily excluded for illness. We investigated parental use of urgent medical evaluation for sick children unable to attend child care. In May 2012, authors conducted a nationally representative survey of parents, who completed online questions regarding child illness causing absence from child care and their medical care-seeking behavior. Main outcome was parents' use of emergency department or urgent care (ED/UC). Overall survey participation rate was 62%. Of participating parent cohort with children 0 to 5 years old, 57% (n = 357) required child care, of which 84% (n = 303) required out-of-home child care. Over 88% of parents sought acute medical care for their sick children unable to attend child care. Approximately one-third of parents needed a doctor's note for employers and/or child care. Parents sought medical evaluation (>1 option possible) from primary care (81%), UC (26%), or ED (25%). ED/UC use was most common for rash (21%) and fever (15%). Logistic regression indicated ED/UC use was significantly higher among single/divorced parents (odds ratio [OR] = 4.3; 95% confidence interval [CI]: 2.5-13.5); African American parents (OR = 4.2; 95% CI: 1.2-14.6); parents needing a doctor's note (OR = 4.2; 95% CI: 1.5-11.7); and those with job concerns (OR = 3.4; 95% CI: 1.2-9.7). A substantial proportion of parents whose sick children cannot attend child care seek care in ED/UC. Training child care professionals regarding appropriate illness exclusions may decrease ED/UC visits by lowering child care exclusions.

Abstract T P251: Factors for Delayed Medical Care Seeking among Elderly Stroke Patients in Korea

Background: Stroke is the second leading cause of death in Korea and the prevalence of acute ischemic stroke among older adults continues to grow, which is known to be related to delayed hospital arrival after the onset of symptoms. Thus, decreasing the incidence of elderly stroke is a major health promotion objective in Korea, yet little is reported about the factors associated with the delayed medical care seeking behavior among elderly stroke patients in Korea. Purpose: The purpose of this study was to understand factors of delayed medical care seeking among elderly stroke patients in order to develop intervention strategies to improve the health of this population. Methods: A cross-sectional, descriptive study was conducted in a convenience sample of 233 hospitalized elderly patients with acute ischemic stroke using a self-administered survey. Descriptive statistics and chi-square test were used for data analysis. Results: More than half of them were male (60.5%) with age of 61 and older (76.9%), and relied on the opinion of their children or friends when deciding medical care for stroke (58.3%). Regarding the reasons of seeking medical care, there was no statistical significance between individuals who arrived at a hospital within three hours of the onset of symptoms and who arrived after three hours. Reasons for delayed hospital arrival were significantly different between groups (individuals of hospital arrival within three hours vs. individuals with hospital arrival after three hours), which include lack of knowledge about the severity of stroke and unawareness of symptoms (χ2 = 24.1), or inconvenience of a hospital visit, waiting for the effects of alternative medications, and stroke during sleep (χ2 = 55.1) with p &lt;0.001. Conclusions: In conclusion, this study helped identify factors delaying hospital arrival after the onset of symptoms among Korean elderly stroke patients. Interventions should include stroke education focusing on the severity of stroke and related symptoms. The stroke education should target not only elderly stroke patients but their family members and friends. It may result in overall national health by decreasing prevalence of stroke among Korean elderly population.

Burden of menstrual symptoms in Japanese women &amp;ndash; an analysis of medical care-seeking behavior from a survey-based study

BackgroundMenstrual symptoms are associated with various health problems in women of reproductive age, and this may impact their quality of life. Despite this, Japanese women are likely to hesitate seeking a specialist’s medical help for their menstrual symptoms.PurposeTo study subject parameters including symptom severity, gynecological disorders, and treatments in medical care-seeking women (outpatient) and women opting for self-care (nonvisit), to identify reasons why Japanese women do not see a gynecologist, and to document the benefit of gynecologist visits by assessing the impact on women’s daily lives.MethodsTwo online surveys were conducted among women aged 15–49 years. Sampling was structured to approximate the age and geographic distribution in Japan. Results of the first survey and part of the second survey on the overall current burden of menstrual symptoms are reported in a separate publication. Further outcomes from the second survey reported in this paper included data from the outpatient (n=274) and nonvisit (n=500) groups on symptom severity, gynecological disorders, medical treatment use, reasons for not seeking medical care, and the improvement of daily life.ResultsThe outpatient group tended to have greater symptom severity compared to the nonvisit group. Uterine fibroids, dysmenorrhea, endometriosis, and premenstrual syndrome were the most commonly self-reported diagnoses, and oral contraceptives were frequently prescribed at gynecologist visits. Nonvisit group subjects felt that gynecologist consultations were unnecessary or felt resistant to them. Daily life was significantly improved after medical treatment from a gynecologist visit with associated economic savings, whilst the nonvisit group had no change after taking over-the-counter drugs to relieve their menstrual symptoms.ConclusionThe present study results indicate that Japanese women who were suffering from menstrual symptoms could benefit from visiting a gynecologist for easing their symptoms, hence improving their daily life.

How cancer patients build trust in traditional Chinese medicine

IntroductionTraditional Chinese medicine (TCM) is popular in Taiwan, but little is known about how patients build their trust in TCM. This study explored Taiwanese cancer patients’ trust in traditional Chinese medicine. MethodsFor this descriptive qualitative study, 12 cancer patients were individually interviewed using a semi-structured guide. All interviews were audio-taped and transcribed verbatim. Data were concurrently collected and analyzed by constant comparative method to develop main themes and categories. ResultsOur first main theme was that participants’ trust in TCM was moulded by their cultural background and by their own and family members’ experience of using TCM. Our second major theme was that trust in TCM was augmented by the conventional medicine system: this included categories of doubts about TCM's effectiveness for cancer treatment, cooperation between the medical and TCM departments in the study hospital, and institutional guarantees. ConclusionsKnowing how advanced stage cancer patients build trust in TCM can increase understanding of their medical care-seeking behavior in TCM. These results may be helpful for clinicians in Asian countries where TCM is used along with conventional medicine and in countries treating Asian cancer patients.

The Effect of Parents' Insurance Enrollment on Health Care Utilization: Evidence from Ghana

Access to and utilization of health services are concerns in poor countries. If implemented correctly, health insurance systems may help solve this challenge. However it is difficult to determine whether joining an insurance scheme improves medical care-seeking behaviors because of selection and omitted variable bias. This paper examines how parental participation in the National Health Insurance Scheme (NHIS) affects health care utilization in Ghana, using an instrumental variable approach. The exogenous variation in enrollment comes from membership rules variations in the District Mutual Health Insurance Schemes (DMHIS). The data sets employed are the 2008 Demographic and Health Survey and a census of DMHIS in existence in 2008. We find insurance membership increases the probability of: i) seeking higher quality prenatal services and ii) parents becoming more active users of child curative and preventive care. IV estimates are larger than OLS ones indicating underlying heterogeneity in returns to NHIS participation.

A traditional Chinese herbal medicine compound preparation versus interventional therapy after resection of small hepatocellular carcinoma: 22-year follow-up

ObjectiveTo compare the long-term effectiveness of compound Ruanjianhugan (RJH) tablets and interventional therapy (IT) in patients after resection of small hepatocellular carcinoma (HCC). MethodsA retrospective study was conducted in 399 patients after resection of small HCC who were admitted between January 1987 and December 2008 in the Department of Hepatobiliary Surgery and Center of Minimlly Invasive Surgery, First Affiliated Hospital of Guangxi Medical University. Four groups were based on different therapy modes: a TCM-only (TCMO) group, a TCM combined with interventional therapy (TCM-IT) group, an interventional therapy-only (ITO) group, and a simple operation (SO) group. Prognostic factors were correlated with overall survival (OS) and OS rates were calculated with the Kaplan-Meier method, and multivariate analyses for factors affecting survival were evaluated by the Cox proportional hazard model. ResultsThe median OS was 151.20 months in the TCM-IT group, 43.87 months in the ITO group, and 20.77 months in the SO group. All survival rates of the TCMO group were higher than those of the other three groups (>50%). The 5-, 10-, and 15-year OS in the TCMO and ITO patients were 83.94%, 45.50%, and 71.22% and 33.34%, 55.58%, and 9.26%, respectively (risk ratio, 0.209; 95% confidence interval, 0.126–0.347; P=0.000). Multivariate analysis revealed that the independent risk factors were therapy mode (P=0.000), sex (P=0.005), family history (P=0.011), TNM Classification of Malignant Tumor staging (P=0.000), medical care-seeking behavior (P=0.021), and maximum diameter (P=0.030). ConclusionLong-term oral use of compound RJH tablets may improve OS for small HCC after resection compared with IT.

A survey of cardiologists, diabetologists, gynecologists and ophthalmologists practicing in Osaka on the medical consultation behaviors of myotonic dystrophy patients

An anonymous postal survey of cardiologists, diabetologists, gynecologists, and ophthalmologists in Osaka was performed to assess the medical care-seeking behaviors of and problems associated with the medical management of patients with myotonic dystrophy (DM). The questionnaires were sent to 927 cardiologists, 357 diabetologists, 882 gynecologists, and 915 ophthalmologists. Of these, 172 cardiologists, 85 diabetologists, 220 gynecologists, and 154 ophthalmologists responded. More than 30% of responders had provided care to DM patients, and approximately 10% had experience diagnosing DM patients. These facts suggest that DM patients receive medical care from various specialists due to complications involving multiple systems and some of them visit other specialists prior to neurologists. Some patients were diagnosed after perinatal or perioperative difficulties. Therefore, it seems important to improve the ability of physicians to identify DM patients. Because specialists with experience diagnosing DM paid more attention to the characteristic features of DM, such as grip myotonia and hatchet face, a simple screening test may be useful for detecting DM. Some responders pointed out the negative attitude of DM patients toward medical care and the lack of neurologists for consultation as problems in the medical management of DM patients. Cooperation among neurologists and other specialists and education of DM patients are important to improve the medical management of DM patients.

Self-reported health and medical care-seeking behaviour of uninsured Jamaicans.

Background:On examination of the literature in Latin America and the Caribbean, and in particular Jamaica, no study could be found that investigated the health and health care-seeking behaviour of uninsured people. This study bridges the gap in the literature by evaluating uninsured Jamaicans’ medical care-seeking behaviour and good health status.Material & Method:The study extracted a sample of 5,203 uninsured respondents 15 years and older from a national probability cross-sectional survey of 6,782 Jamaicans. Descriptive statistics were used to provide background information on the sample; cross-tabulations evaluated bivariate analyses, and logistic regression was used to model health and medical care-seeking behaviour.Results:Good health of uninsured Jamaicans is correlated -reported biological condition (OR =0.114, 95% CI = 0.090 -0 .145) followed by age (OR =0.952, 95% CI = 0.946- 0.959); gender (OR = 1.501, 95% CI = 1.221–1.845); consumption (OR = 1.000, 95% CI = 1.000–1.000); social class (upper class OR = 0.563, 95% CI = 0.357–0.888); education (secondary and above OR = 0.622, 95%CI = 0.402–0.963), and area of residence (other towns OR = 1.351, 95% CI = 1.026–1.778). Medical care-seeking behaviour is associated with age (OR = 1.020, 95% CI = 1.006 – 1.033); poor health status (OR = 2.303, 95% CI = 1.533–3.461), and marital status (married OR = 0.518, 95% CI = 0.325–0.824).Conclusion:The findings are far reaching and provide an understanding of the uninsured, and the information can be used to aid public health intervention and education programmes.

Paradoxes in self-evaluated health data in a developing country.

Background:Statistics showed that males reported fewer illnesses and greater mortality rates than females, but are outlived by approximately 6 years by their female counterparts, yet their self-rated health status is the same as that of females.Aims:This study examines the following questions: (1) Are there paradoxes in health disparity between the sexes in Jamaica? and (2) is there an explanation for the disparity outside of education, marital status, and area of residence?Methods and Materials:The current study utilised a data set collected jointly by the Planning Institute of Jamaica and the Statistical Institute of Jamaica. The data set is a survey on the living conditions of Jamaicans. It was conducted between May and August of 2007. The JSLC is a modification of the World Bank's Living Standards Measurement Study. The sample size was 6,783 respondents, with a non-response rate being 26.2%.ResultsGood health status was correlated with self-reported illness (OR =0.23, 95% CI = 0.09-0.59), medical care-seeking behaviour (OR = 0.51, 95% CI = 0.36-0.72), age (OR = 0.96, 95% CI = 0.96-0.97), and income (OR = 1.00, 95% CI = 1.00-1.00). Self-reported illness is statistically correlated with sex (OR = 0.25, 95% CI = 0.10-0.62), head of household (OR = 0.33, 95% CI = 0.12-0.96), age (OR = 1.04, 95% CI = 1.01-1.07) and current good self-rated health status (OR = 0.32, 95% CI = 0.12-0.84).ConclusionThis paper highlights that caution must be used by researchers in interpreting self-reported health data of males.

Delayed use of healthcare services among the urban poor in Turkey

PurposePoor people often experience a delay in meeting their healthcare needs due to their economic situation. As a result, delayed diagnoses and treatment may increase disease severity, increase the risk of death, and enhance disease transmission in the community. The purpose of this paper is to provide important information about health service delays among the poorest people in Turkey.Design/methodology/approachA field study is conducted among the 92 poorest households in the Etimesgut region of Ankara in order to ascertain any delays in health services among the poor, as well as the factors related to those delays.FindingsThe results of the study show that 87 percent of the households lived on a daily income of US$2.15, and that household member's delay seeking healthcare services an average of 4.66±1.17 times in the past year. Reasons for delaying or not seeking healthcare services included the following: participants thought they would get better without doing anything (7.6 percent), by using traditional herbs (12.7 percent), by using pharmaceuticals already on hand (11.4 percent), the health facility was too far away (5.1 percent), and inability to pay (63.3 percent). Significant associations are found between the delaying behaviors, socioeconomic characteristics of households, and health status.Practical implicationsAt the end of the study, policy suggestions are provided for improving medical care seeking behaviors and treatment compliance among the poor.Originality/valuePoverty is a complex and multidimensional phenomenon that consists of income insufficiency, lack of education, malnutrition, and poor health. The relationship between poverty and poor health impacts those who live in poverty as well as communities, organizations and entire countries. Reducing health disparities and decreasing delays and difficulties in access to health care among poor households are important goals.

The effects of social variables on symptom recognition and medical care seeking behaviour for acute respiratory infections in infants in urban Mongolia

Objective: To investigate potentially modifiable factors associated with carers’ recognition of symptoms and timely presentation of infants with acute respiratory infections (ARI) in urban Mongolia. Methods: A prospective cohort study...

Prevalence, bowel habit subtypes and medical care-seeking behaviour of patients with irritable bowel syndrome in Northern Greece

Although irritable bowel syndrome (IBS) prevalence ranges between 10 and 20% in the general population, it appears to be considerably undiagnosed with only 25-50% of patients with IBS seeking medical advice. The aim of this study was to determine the prevalence of IBS in Northern Greece and the prevalence by symptom subtype including diarrhoea-predominant IBS, constipation-predominant IBS (C-IBS) and mixed type IBS; to identify factors contributing to the development of this syndrome; to assess its effect on health-related quality of life and to evaluate the medical care-seeking behaviour of IBS patients. Between January 2004 and December 2007, 3112 participants were requested to fill out a questionnaire during an interview with a primary health care clinician. Data on participants' demographics, medical history, symptoms and earlier health care-seeking behaviour were also recorded. The Rome II criteria were used to establish the diagnosis of IBS. The impact of IBS on the quality of life was examined using the EuroQol with five domains (EQ-5D) measure of health status. Out of 2397 participants [704 men (29.4%), mean age 46.1+/-15.0 years] included, 373 (15.7%) reported gastrointestinal symptoms compatible with IBS of whom 136 (36.5%) suffered from diarrhoea-predominant IBS, 165 (44.2%) suffered from C-IBS and 72 (19.3%) suffered from mixed type IBS. IBS patients were more likely to be female living in an urban area compared with healthy controls (P=0.03 and 0.0001, respectively). A significant decrease in health-related quality of life (impairment in two or more of measured parameters) was noted in 246 (66%) IBS patients. Female sex, older age and housekeeping were associated with C-IBS (P=0.02, 0.001, and 0.001, respectively). Female sex and IBS-M were associated with health care-seeking behaviour. The prevalence of IBS in Northern Greece is relatively high, mainly affecting female participants living in urban areas.

Medical care-seeking and health-risk behavior in patients with head and neck cancer: the role of health value, control beliefs and psychological distress

Health behavior plays an important role in the development, detection and course of cancer of the head and neck. Relevant health behavior includes prompt medical care seeking, and smoking and drinking cessation after diagnosis. This study examines the relationship between these health behaviors and health value and control beliefs, as well as psychological distress. Two hundred and sixty-four recently diagnosed head and neck cancer patients were interviewed about their health behavior, and they filled in a questionnaire on health beliefs and psychological distress. The results showed that one-quarter (25%) of the patients had waited more than 3 months before seeking medical care, 50% had continued to smoke and 80% had continued to drink after the diagnosis. The patients, particularly those who smoked and drank before diagnosis, reported lower levels of health value and perceived health competence than a general population sample with which they were compared. Patients who engaged in patient delay reported a lack of perceived health competence. Psychological distress and lack of perceived health competence were found to be more common among patients who continued to smoke. The implications of these findings are discussed with regard to interventions aimed at promoting these specific health behaviors.

Web‐based research of lower urinary tract symptoms that affect quality of life in elderly Japanese men: analysis using a structural equation model

To investigate the distribution of lower urinary tract symptoms (LUTS) in elderly Japanese men, to clarify which variables contributed to medical care-seeking behaviour, and to construct a structural-equation model (SEM) to explain overall quality of life (QoL). A dataset was obtained from 662 Japanese men aged 50-79 years who participated in the programme by accessing a website via the Internet between 10.30 hours on 19 February 2003 and 10.30 hours on 24 February 2003. The participants were queried about their International Prostate Symptom Score (IPSS), bother, QoL index and medical care-seeking behaviour. Of the 662 participants, 314 reported intending to seek medical care for LUTS (intention group); the remaining 348 answered that they did not intend to see a doctor (no-intention group). The characteristic of weak stream had the strongest correlation with the QoL index, not only in the intention (r = 0.58) but also in the no-intention group (r = 0.48). Among several SEMs proposed, one that included a latent variable termed 'QoL sensitivity' was the most appropriate to explain overall QoL. In this model it was assumed that 'QoL sensitivity' was affected by other latent variables, termed the 'voiding symptom factors' and 'storage symptom factors', and affected the degree of bother related to each symptom. In Japanese men, voiding symptoms, especially weak stream, contributed to overall QoL for medical care-seeking behaviour. Differences in 'QoL sensitivity' among men may be one of the reasons why symptomatic severity is not always correlated with symptom-related bother.