The concept of health-seeking behaviour continues to permeate the development literature, and this paper reviews the main approaches. However, it also suggests that health-seeking behaviour is a somewhat over-utilized and under-theorized 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, 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. The paper suggests one way in which we might start to frame the debate, using reflexive communities and social capital as key theoretical and analytical concepts.

Perinatal depression among Black Caribbean women in the UK remains an intriguingly under-researched topic. Despite high levels of known psychosocial risks, Black Caribbeans remain relatively invisible among those seeking/receiving help for depression during and after pregnancy.In-depth interviews were undertaken with a purposive sample of twelve Black Caribbean women selected from a lager sample (n=101) to examine prevalence and psychosocial risks for perinatal depression among this ethnic group. The study also sought to explore women's models of help-seeking. During analysis, the context in which help-seeking/giving is mediated emerged as a key issue. We explore the nature of these encounters thereby opening up the possibility of finding common ground between service users and providers for enabling women to receive the care and support they need.Whether or not women configure depressive feelings as 'symptoms' requiring external validation and intervention is a reflection both of the social embeddedness of those individuals and of how 'help-givers' perceive them and their particular needs. We suggest that the ways in which helpseeking/giving are commonly conceptualised might offer at least a partial explanation for apparently low levels of diagnosed perinatal depression among Black Caribbean women. Popular approaches to health seeking behaviours within health promotion and practice focus on individuals as the fulcrum for change, tending to overlook their embeddedness within 'reflexive communities'. This might serve to reinforce the invisibility of Black Caribbean women both in mainstream mental health services and associated research. Alternative approaches may be required to achieve government targets to reduce inequalities in access, care, and treatment and to deliver more responsive and culturally-appropriate mental health services.

Objectives: This study aimed to describe social problems presented to general practitioners (GPs) in UK inner cities and GPs' responses; describe patients' help-seeking pathways; and consider how these pathways can be improved. Methods: The study involved a pilot survey and follow-up qualitative interviews with patients in two inner city areas in London and Salford in 2001-2. The pilot survey involved five practices in each locality. GPs completed questionnaires on 57 people presenting with social problems. A diversity sample of 12 patients were followed up for interview. Results: Study results are presented in two parts. This paper focuses on the GP survey results. People were presenting with a wide range of social problems, and multiple problems were also common. Problems with welfare benefits and housing were the most common, but GPs were most likely to refer to counselling services and to a lesser extent to generic advice services. Some GPs would have preferred to refer patients to more problem-specific services but did not believe these were available. Conclusions: The study highlights the role GPs play in helping people deal with social problems but also identifies limitations in their response to these problems. It points to the need for more integrated pathways to help and advice for social problems. Primary care can make existing pathways more visible and accessible, and create new pathways through, for example, the new commissioning role and extending the scope of social prescribing. Many commentators have highlighted the potential role for primary care in the public health arena.

Objectives: This study aimed to describe social problems presented to general practitioners (GPs) in UK inner cities and GPs' responses; describe patients help-seeking pathways; and consider how these pathways can be improved. Methods: The study involved a pilot survey and follow-up qualitative interviews with patients in two inner city areas in London and Salford in 2001-2. The pilot survey involved five practices in each locality. GPs completed questionnaires on 57 people presenting with social problems. A diversity sample of 12 patients was followed up for interview. Results: Study results are presented in two parts. Here (Part II) qualitative research results are reported highlighting four themes: the complex and enduring nature of social problems; the persistence people display seeking help; the fragmented and problematic pathways available; and the roles GPs play as: primary medical adviser; formal gateway to another service; advocates or facilitators to another service; and sources of support and advice during a process of recovery. Commonly, GPs occupied more than one role. Conclusions: GPs do help people deal with social problems, but their responses are limited. More integrated pathways to help and advice for social problems are needed. Existing pathways could be more visible and accessible, and new pathways developed through commissioning and extending social prescribing. More partnerships across sectors may create more co-ordinated provision, but these are notoriously difficult, and other trends such as the focus on lifestyle issues and long-standing conditions may make it more difficult for people with social needs to access support. T his is the second part of a two-part paper reporting on research that aimed to contribute to the development of a more effective role for general practice in particular and primary care in general in addressing the social causes of ill health. As we noted in Part I, 1 although many commentators have highlighted the potential role for primary care in the public health arena, 2-11 the development of a public health dimension to primary care has lacked strategic direction in the UK. In particular, the role of primary care in ameliorating the social causes of health inequalities has remained largely underdeveloped. Relevant background literature to the study was reviewed in Part I of the paper. In particular, in that paper we argued that whilst current models of the social causes of health inequalities highlight the multifactorial character of the pathways leading to health inequalities and are strongly social in their orientation, the macro perspective inherent in such models neglects the lived experience of inequalities at the individual level. Without this parallel micro focus, we suggest, explanations for health inequalities will tend to be deterministic in their orientation: failing to recognise that the individuals involved are not passive victims of social processes, but consciously act to protect and promote their own health and that of others, albeit within struc...

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