Programme no. 332-OP
Understanding healthcare seeking practices in two different social classes; an exploration into social inequality in cancer survival.
Camilla Hoffmann Merrild*1, Mette Bech Risør2, Peter Vedsted3, Rikke Sand Andersen4
1Research Unit for General Practice,Aarhus University,Aarhus,Denmark, 2General Practice Research Unit, Department of Community Medicine,UiT, The Arctic University of Norway,Tromsø,Norway, 3Research Unit for General Practice,Aarhus University,Aarhus,Denmark, 4Research Unit for General Practice,Aarhus University,Aarhus,Denmark
* = Presenting author
Objectives: The aim of this study is to understand how health care seeking is practiced in two diverse social classes in opposite ends of the social spectrum.
Background: Social inequality in cancer survival is well established. Research has suggested that this may partly be caused by differences in healthcare seeking, caused by differences in knowledge and symptom awareness. Accordingly, the significance of social class in relation with the way that people practice health, illness and their bodies differently has largely been left unexplored.
Among the higher middle class we encountered practices of healthcare seeking resembling notions of ‘health consumerism’, leading to engagements with a healthcare system in which such practices and rationales are sanctioned and encouraged. Yet, perhaps somewhat predictably, we also found that the adverse social conditions shaping life among the lower social classes framed the healthcare seeking practices in this group. As a consequence, health care seeking practices were informed by experiences of social suffering, where health concerns often were made meaningful in relation with the broader social context.
Overall, we illustrate how these different health care seeking practices correspond diversely with current forms of medical thinking, materialized in pro-active discourses of early diagnosis and in the organization of medical practice, as exemplified in Danish general practice.
Material/Methods: We carried out one year of ethnographic fieldwork, among two different social classes in Denmark. We followed 12 key informants in the lower working class and the higher middle class respectively, using the methods of participant observation, symptom diaries and repeated semi-structured interviews.
Conclusion: The sometimes diffuse and complex forms of social suffering of lower social classes, are difficult to accommodate within the health care system, whereas the direct and specific forms of health care seeking manifested in higher social classes are encouraged.
Points for discussion:
How can General Practice accomodate different forms of health care seeking practices?
How do current values of patient empowerment and patient involvement play into health care seeking practices in different social groups?
What role does General Practice play in reducing social inequalities in cancer survival?