Health service users' help-seeking decisions in primary healthcare The effectiveness with which healthcare users make decisions about self-referred consultations has anecdotally been a cause of concern. Exploration of the detrimental effects of poor quality self-referral help-seeking decisions on patients' health and N'HS resources has been disjointed but is believed to be substantial. The project explored its main aims through four studies. The first study established definitional parameters of patients' effective and ineffective help seeking behaviour in self referral help seeking situations from the perspective of health care professionals. These definitional parameters enabled the objective measurement of patient mistargeted consultations in the second study where the scale of the issue of patients' ineffectively made help seeking decisions (mistargeted consultations) was assessed with general practitioners. It was found that 28.59% of all consultations made were mistargeted in some way.
The third study considered this issue from a patient's perspective. While it is acknowledged that the factors that underpin the decision to seek help are complex, this study identified several important themes. Respondents reported that they mostly want to consult a GP despite the increasing number of choices available and this array of choice led to conftision. Perceived knowledge and gaps in knowledge centred on the availability of services and of basic health issues were important antecedents to the decision to seek help. Other factors identified as important antecedents included those related to anxiety and to social supporL Theoretical explanations of these findings were sought which enabled more effective interpretation and thus prediction of help-sceking behaviour aiding the design of the fourth study.
'nie fourth study investigated whether factors thought to underpin help- seeking decisions were manipulable. The intervention with first time mothers was designed to directly increase social support and address any significant knowledge gaps and indirectly manipulate factors such as health locus of control, coping strategies and anxiety. Analysis indicated that health locus of control and some coping strategies were significantly affected by the intervention. Policy makers in Wales have recognised that this is an important issue with the Delivering Emergency Care (DECS) strategy. However, more research is needed to establish whether cost-effective interventions aimed at improving the quality of patients' help seeking decisions can be established.