Pescosolido Bernice A, Olafsdottir Sigrun
Department of Sociology, Indiana University, 1022 East Third Street, Bloomington, Indiana;
Department of Sociology, Boston University, 96 Cummington Street, Boston, Massachusetts 02215.
Sociol Forum (Randolph N J). 2010 Dec;25(4):655-676. doi: 10.1111/j.1573-7861.2010.01206.x.
Culture has long affected individuals' response to problems. A classic puzzle in the sociology of health and illness is discrepancy between theory and research regarding cultural beliefs and knowledge of medical care service use. "Utilization research," examining individuals' responses to the onset of health problems, has not consistently affected culture on the uptake of formal treatment. First, while ethnographic research often describes how culture shapes illness behaviors, survey-based studies rarely find significant beliefs or predispositions once "need" is controlled. Second, in quantitative studies, individuals report supportive treatment beliefs or predispositions to use services but low utilization levels, reinforcing claims about lack of utility of cultural ideologies in health-care decision making. We ask whether innovations in the sociology of culture and cognition provide theoretical scaffolding to conceptualize and measure culture in health service utilization. Rather than estimating effect of cultural beliefs on health-care decisionmaking, we question the measurement of cultural beliefs in understanding service use. Examining data from the General Social Survey, we focus on how approaches to culture might explain the paradox of high cultural predispositions and low actual use. Children with mental health problems provide a comparison between suggestions and endorsements. Suggestions, sources of care offered by individuals in response to a case description without any other social cues, align with new cultural approaches, and are measured by responses to open-ended questions about what should be done for the child described (with clinical criteria for ADHD, major depression, asthma, or "daily troubles"). Endorsements, requiring less cognitive work and cultural resistance, align with traditional conceptualizations of culture, and are measured by closed-ended questions that ask respondents to agree or disagree with seeking help from different treatment options placed later in the survey. Suggestions reveal cultural predispositions to use services corresponding closely to reported utilization levels; endorsements reveal high, unrealistic cultural predispositions to use services. Further, suggestions are associated with sociodemographics that proxy culture (e.g., race), while endorsements are associated only with perceived need.
长期以来，文化一直影响着个体对问题的反应。健康与疾病社会学中的一个经典难题是，在关于医疗服务使用的文化信仰和知识方面，理论与研究之间存在差异。“利用研究”考察个体对健康问题发作的反应，但在正式治疗的采用上，并未始终如一地影响文化。首先，虽然人种志研究常常描述文化如何塑造疾病行为，但一旦控制了“需求”，基于调查的研究很少发现显著的信仰或倾向。其次，在定量研究中，个体报告了支持治疗的信仰或使用服务的倾向，但利用率较低，这强化了关于文化观念在医疗保健决策中缺乏效用的说法。我们要问，文化与认知社会学的创新是否能提供理论框架，以便在卫生服务利用中对文化进行概念化和测量。我们质疑的不是文化信仰对医疗保健决策的影响，而是在理解服务使用时对文化信仰的测量。通过分析综合社会调查的数据，我们关注文化研究方法如何解释高文化倾向与低实际使用之间的矛盾。有心理健康问题的儿童为建议与认可之间的比较提供了依据。建议是个体在没有任何其他社会线索的情况下，针对病例描述提供的护理来源，与新的文化研究方法一致，通过对关于应该为所描述儿童做什么的开放式问题的回答来衡量（符合多动症、重度抑郁症、哮喘或“日常烦恼”的临床标准）。认可需要较少的认知工作和文化抵抗，与传统的文化概念一致，通过封闭式问题来衡量，这些问题要求受访者同意或不同意从调查后期列出的不同治疗选项中寻求帮助。建议揭示了与报告的利用率水平密切对应的使用服务的文化倾向；认可则揭示了使用服务的过高且不切实际的文化倾向。此外，建议与代表文化的社会人口统计学特征（如种族）相关，而认可仅与感知到的需求相关。
