Illness behaviour and health-seeking in the community

What it is

Illness behaviour is the term Mechanic and Volkart introduced for the different ways people respond to their own symptoms: how they notice them, what meaning they give them, and what they then do. Health-seeking behaviour is the sequence of actions a person takes to keep well or to get treated. Disease is what the doctor finds; illness is what the patient experiences; and the two do not move together.

Causes and risk

What decides whether a symptom becomes a consultation:

• Past experience of illness, personality, and the way the person copes.
• Family and cultural norms about what counts as being ill.
• Current relationships and what other people in the household say.
• The meaning attached to the symptom, which matters more than its severity.
• Access: distance, cost, time off work, and who is available to bring them.

How it presents

**The symptom iceberg.** Most symptoms in a community are never brought to a doctor. Population surveys repeatedly find that the great majority of symptoms experienced are managed at home, with family advice, or with a pharmacy remedy, and only a small fraction reach general practice. So the patients a clinic sees are not a sample of the ill; they are a sample of those who decided to come.

Two consequences you are expected to draw:

• A person who comes may not be sicker than one who stays away. Something else changed.
• The presenting complaint may not be the reason for the visit.