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Methodology and Associated Work Plan

Overall strategy and general description 


Theoretical concepts and approaches

The theoretical framework of the project will be based on the multivariate model of transcultural health care utilisation. This model identifies a series of actors which interact with utilisation to varying degrees, as studied by Professor L. J. Slikkerveer (Slikkerveer, 1990). These factors are divided into five “blocks” which include system variables and variables at the individual level, such as predisposing, enabling and perceived-morbidity factors which have an impact at the individual level.

Predisposing factors

A decision at the individual level to use health care facilities in the event of illness is influenced by a number of sociodemographic and psychosocial factors, which can either encourage or discourage utilization of systems of health care delivery. The sociodemographic factors selected for this research comprise of the variables: sex, age, educational status, marital status, ethnicity, religion. The psycho-social factors include opinions of medical knowledge and skills of the transitional medical system, opinions of the attitude of transitional personnel to patients, opinions of the medical knowledge and skills of the modern medical system, opinions of the attitudes of modern personnel to patients, and the presence of elementary medical-biological knowledge on the part of patients.

Enabling factors

The enabling factors affect the cost aspect of illness behaviour, which can hardly be changed by the individual itself. They refer to factors determining the possibility of using health care at the individual level, that is the socioeconomic status and the financial costs paid for treatment.

Perceived morbidity factors

Perceived morbidity is the observation and interpretation of symptoms of illness that initiate the decision making process of seeking and obtaining medical help. Socio-cultural determinants, also, influence the perception and interpretation of illness. Factors of the plural medical system Geographical and financial accessibility (availability and accessibility) affects and stipulates the influence of the medical system on the choice of health care type.

Factors of health care utilisation

Utilisation is measured as reported instances of contact with a medical institution, or its representatives, as a result of illness. The extent and the type of OTC medicine use will be explored assessing a number of community pharmacists. A cross-sectional study that will use forms in previous community-based programmes will identify a number of intervention strategies to reduce medicines misuse (MacFadyen, et al., 200.

In an attempt to identify and explain the psychosocial factors, which determine prescribing patterns and guidance compliance, we intend to borrow the popular conceptual framework of the Theory of Planned Behaviour (TPB) (Ajzen, 1991 and Conner and Sparks, 1996). This theory has been successfully applied in efforts at acquiring a better understanding of health-related behaviours, including exercising, donating blood, using illegal substances and many more health-related issues (Blue, 1995; Sutton, 1998; Armitage and Conner, 2001; Hagger et al., 2002; Ajzen and Fishbein, 2005). We propose that this conceptual framework can be applied for the purposes of our project.

On the basis of this theory, we will focus on the subjective norms of physicians, as determined by normative beliefs concerning the expectations of patients and the motivation of clinicians to satisfy with these expectations. On the other hand, we can modify favourable intention to desirable prescribing behaviour only by strengthening their perceived behavioural control. And only when this is accurate, can it be used for the prediction of the prescribing behaviour of physicians, accordingly to our objectives (Rashidian and Russell, 2003, and Rashidian and Russell, Proceedings of the International Society of Technology Assessment in Health Care (ISTAHC)2003). The “Theory of Planned Behaviour” (TPB) also has significant implications for interventions designed to produce changes in patient intention and behaviour towards use of medicines. By identifying some of the important determinants in their consumer behaviour, TPB permits us to design behavioural interventions and to trace the effects of such interventions from beliefs to attitudes, subjective norms and perceptions of control through intentions to behave regarding use of medicines (Godin and Kok, 1996).

Quantitative and qualitative methodology will be used to assess and identify the influential factors, including semi-structured interviews, focus groups assessment and patient questionnaires, which will be structured on the basis of the TPB (Francis et al., 2004). This methodology is clearly illustrated in the work packages, and will explore information regarding the extent primary care patients use OTC medication to treat any illness or health problem in the past month, the type of the OTC medication, and whether they inform their primary care physician. Descriptive statistics, logistic regression models and hierarchical modeling could be used in the statistical analysis (Sleath et al., 2001, and Rashidian et al., 2006).