The Cultural Turn in Sociology: Can It Help Us Resolve an Age-Old Problem in Understanding Decision Making for Health Care?

Abstract

Culture has long shaped individuals’ response to problems. A classic puzzle in the sociology of health and illness is discrepancy between theory and research regarding cultural beliefs and 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. While ethnographic research often describes how culture shapes illness behaviors, survey-based studies rarely find significant effects of predispositions once “need” is controlled. 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 the theoretical scaffolding to conceptualize and measure culture in health service utilization. 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 meeting clinical criteria f or 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. We find that 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.

The Public Stigma of Mental Illness

“…We hypothesized that the former required respondents to actively search for options using deliberative processing and reflecting individuals’ cognitive toolbox of strategies, whereas the latter required only a passive posture using automatic processing and reflecting larger cultural values. Overall, spontaneous mentions were more in line with actual service use rates and sociodemographic proxies thought to measure cultural differences (Pescosolido and Olafsdottir 2010). …”

Constructing illness: How the public in eight Western nations respond to a clinical description of “schizophrenia”

“…The debate of the impact of culture has a long-standing tradition within the social sciences (Kleinman, 1977). On the one hand, some argue that attitudes toward help-seeking are largely or even exclusively based on need; and in fact, large-scale quantitative studies have frequently failed to capture cultural impact of attitudes toward mental illness (Pescosolido & Olafsdottir, 2010). On the other hand, specific cross-cultural accounts continue to show the profound impact of culture on individual responses to health and illness (Kirmayer, 2001; Kleinman and Good, 1985; Marmanidis et al, 1994; Papadopoulos et al, 2004; Silveira and Allebeck, 2001).…”

Risk as Social Context: Immigration Policy and Autism in California1

“…Underdiagnosis may also stem from lower utilization of medical and mental health services by Latinos, even when access is available. The process of seeking help for a health condition can be complex, and highly constrained by institutional and social structures (Pescosolido, 1992; Pescosolido and Olafsdottir, 2010). Minority and poor families may wait longer than others to seek care and can have an especially difficult time obtaining a specialist referral (Liptak et al, 2008).…”