A Review of Health Seeking Behaviour: Problems and Prospects 1 Understanding Health Seeking Behaviour

(DFID) supports policies, programmes and projects to promote international development. DFID provides funds for this study as part of that objective but the views and options expressed are those of the author(s) alone. Summary This review of health seeking behaviour outlines the main approaches within the field, and summarises some of the key findings from recent work around the probes. However, it also suggests that health seeking behaviour is a somewhat over-utilised and under-theorised tool. Although it remains a valid tool for rapid appraisal of a particular issue at a particular time, it is of little use as it stands to explore the wider relationship between populations and health systems development. If we wish to move the debate into new and more fruitful arenas, this review reaches the conclusion that we need to develop a tool for understanding how populations engage with health systems, rather than using health seeking behaviour as a tool for describing how individuals engage with services. This opens up into the broader arena of community organisation, social capital and citizenship; of political and non-political pressure points on the system. The paper suggests one way in which we might start to frame the debate in the context of this programme of work, using social capital and reflexive communities as key theoretical and analytical concepts. Health promotion programmes worldwide have long been premised on the idea that providing knowledge about causes of ill health and choices available, will go a long way towards promoting a change in individual behaviour, towards more beneficial health seeking behaviour. However, there is growing recognition, in both developed and developing countries, that providing education and knowledge at the individual level is not sufficient in itself to promote a change in behaviour. An abundance of descriptive studies on health seeking behaviour, highlighting similar and unique factors, demonstrate the complexity of influences on an individual's behaviour at a given time and place. However, they focus almost exclusively on the individual as a purposive and decisive agent, and elsewhere there is a growing concern that factors promoting 'good' health seeking behaviours are not rooted solely in the individual, they also have a more dynamic, collective, interactive element. Academics have therefore started to explore the way in which the local dynamics of communities have an influence over the well-being of the inhabitants. This reflects a growing interest across the social sciences in the contested concept of social …