A selective systematic overview is provided of the literature on the utilization of health and welfare services that appeared in the United States and Europe mainly within the last two decades. Methodological questions that appear to characterize much of the work to date are discussed and analytically distinct approaches or research strategies in the study of utilization behavior are presented. The paper traces the emergence of work in this area questions the wisdom of investigators proceeding along traditional research lines and highlights a number of promising new possibilities for research. (authors)

Some approaches and problems in the study of the use of services--an overview.

Anthropological and socio-medical health care research in developing countries.

The family as a basic unit in health and medical care: A social-behavioral overview

• This study provides a map of variations of families and some of the core relationships between types of family and the mental health of children. Family types in a poor, black urban community were defined in terms of the adults present at home. The resulting taxonomy is based on two populations: half of the community's 1964 first-grade children and families and the entire 1966 first-grade children and families. Eighty-six family types were found, falling into ten major classes. Family type was found to be strongly related over time to the child's social adaptational status (SAS) and his or her psychological wellbeing. The results suggest that (1) mother alone families entail the highest risk in terms of social maladaptation and psychological well-being of the child; (2) the presence of certain second adults has important ameliorative functions—mother/grandmother families being nearly as effective as mother/father families, with mother/stepfather families similar to mother alone in regard to risk; and (3) the absence of the father was less important than the aloneness of the mother in relation to risk.

Family structure and the mental health of children. Concurrent and longitudinal community-wide studies.

This article reports on the construction and testing of eight health perception scales from 32 items on a standardized survey instrument designed for self-administration, the Health Perceptions Questionnaire (Form II). The scales measure perceptions of prior health, current health, health outlook, resistance/susceptibility to illness, health worry/concern, sickness orientation, rejection of sick role, and attitude toward going to the doctor. Field testing revealed that the scales are valid, reliable, and stable over time for diverse populations. It is recommended that the scales be used in studies requiring general health measures. Suggestions for future research are offered.

Scales for measuring general health perceptions

It was hypothesized that among subjects who perceive themselves to be in poor health those with fewer or less urgent symptoms, whose life situation makes it more difficult to seek care, and who lack faith in the medical care system would be most likely to fail to seek medical attention. The hypothesis was tested with a population of applicants for social security disability benefits. The hypothesis was only partially confirmed. Two life situational factors of income and welfare contact, and three measures of system orientation were found to be related to the seeking of medical care but urgency and number of symptoms were not. Subjects with low income, recent welfare contact, and negative system orientations were most likely to fail to seek medical attention. Moreover, negative system orientations proved to be associated with low income and welfare experience suggesting that negative orientations may be created by situational factors and serve as rationalizations for failure to seek care when situational factors make it difficult to do so.

Self perception of sickness and the seeking of medical care.

Disability of the breadwinner has serious consequences for the family. In addition to severe economic problems, such families experience a disruption of roles and strained interpersonal relations. This paper is concerned with the variations in structure of families with a disabled breadwinner. Family types were constructed utilizing age, sex, and marital status of the disabled person in addition to presence and age of children and generational factors as important dimensions. The distribution of a disabled population of breadwinners among these family types is presented. Factors believed to bear an influence upon family structure are introduced: sex, age, race, size of community of residence, and severity of disability. This paper is a step toward bridging the gap in research between theoretical models of family structure and empirical reality.

Family Structure in a Disabled Population

Two groups of disability applicants and their wives, one in which the applicants were dependent on their wives in activities of daily living and one in which applicants were not dependent, were compared to examine the effects of dependency on conjugal roles, household decision-making, and interaction with friends and relatives. Dependent husbands and their spouses spent more time together and less time with friends and relatives. Dependent husbands were less likely to be involved in decision-making and were more likely to reflect conjugal role flexibility.

Disability, Dependency, and Conjugal Roles.

The general hypothesis tested was that the degree of physical limitation, the dependency status resulting from that limitation and social isolation each have a negative effect upon the mental health of an impaired individual The hypothesis was tested in a study population of former applicants for social security disability benefits Mental health was measured through the use of an index composed of six psychiatric symptoms which correlated highly with clinically diagnosed mental illness in another context Physical limitation was measured by the degree of physical mobility of study subjects Dependency was measured by the need for the help of others required in personal care as well as in terms of economic independence Isolation was measured with respect to the degree of social contact that study subjects had with others on a visiting basis Physical limitation, dependency and social isolation were all found to be associated with poor mental health Control tables suggested that each exerted an independent influence on the mental health of disability claimants included in this analysis

Dependency, social isolation and mental health in a disabled population

Statistics show that the risk of dying from an illness while in the hospital is many times greater than the risk of dying from an illness while at home. By the same token, there is a strong association between dying and being in bed. While most of us may not be able to precisely identify and explain the logical fallacies implied by this type of statistical reasoning, the nonsense of it is sufficiently apparent so that no one is likely to avoid beds or hospitals in order to prolong his life. Yet the same sort of statistics too often finds its way into the general health literature and mass media where the errors of logic are less apparent and pass unrecognized. No one would deny the important contributions that the proper use of statistics has made to the advancement of medicine and public health. Epidemics are brought under control, drugs

Edward G. Ludwig

Papers

Self perception of sickness and the seeking of medical care.

Family Structure in a Disabled Population

Disability, Dependency, and Conjugal Roles.

Dependency, social isolation and mental health in a disabled population

Some misuses of health statistics.