Avoidance of healthcare is defined as keeping away from medical care that is thought to cause mental or physical harm. On the face of it, seeking healthcare for medical conditions seems to be an intuitive thing to do. However, many people seek to avoid healthcare even when they need it. It is necessary to understand how often and why this happens to frame policies that will address this problem and reduce the proportion of people left out of mainstream healthcare.

In some studies, it has been shown that up to a third of participants reported avoiding medical consultations, even when they had concerning symptoms or known major medical illnesses. Some researchers noted that patients with diagnosed rectal tumors, for instance, waited to access medical care for up to five years following the onset of symptoms. This was despite knowing their condition.

Such delay reduces the success of treatment by delaying the detection of disease. Therefore, it is associated with reduced survival and may increase unnecessary patient suffering. This occurs in a voluntary fashion with most patients but may also be involuntary.

Factors leading to avoidance

Avoidance may occur at any point on the spectrum of disease, from failing to take preventive action or screen for asymptomatic disease, discounting symptoms that could be significant, and complying with the required treatment. The latter two are termed the “appraisal interval” and the “help-seeking interval,” respectively.

It is possible to differentiate three categories of reasons for avoiding health care: either the individual does not have money, time or transport, or other facilities to seek medical care; looks at medical care as largely unnecessary; or alternatively, has a negative attitude to some part of the process of seeking care; and finally, the individual personality could play a role.

Inability-related factors

In the first category, which accounted for the majority of avoid-ers, people were found to be too busy to access medical care; clinic hours were not convenient; there were transportation issues; they were too sick to get to the clinic or had other debilitating illnesses that prevented them from going.

Insurance barriers, or access barriers, may also be responsible for involuntary avoidance, among other factors. Financial reasons included excessively costly consultations or care or co-pays, or health insurance problems. Language barriers and not being able to see the doctor at the clinic were also cited by some people as the reason for avoiding healthcare.

Ignoring symptoms

In the second category, many people thought that medical problems would improve over time if left alone, unless they were very serious. A few of these resorted to over-the-counter medication, some of these being doctors or other healthcare-associated workers, or adopted natural or spiritual healing methods.

This could be due to low trust in doctors, perceiving symptoms as not very severe, emotional factors such as denial of the medical condition even though the patient knows it is present, deep down, and the desire to avoid worry, fear of being diagnosed with a dreaded disease, or being too embarrassed to admit the sickness.

Negative experiences

A third cause for poor experiences came from long delays in the waiting room, difficulty in getting appointments when needed rather than later, and a general feeling that making an appointment was a complicated job. Sometimes, the fear of being with sick people held individuals back from seeking healthcare.

About one in four said they felt uncomfortable during medical examination or were worried that they might be seriously sick. A history of earlier negative interactions with doctors and practical barriers may contribute to such avoidance as well.

Negative healthcare experiences related to physicians, mostly due to perceived poor communication or follow-up, dislike of being talked down to or rebuked for not following the physician’s advice, or feeling ignored. Sometimes doctors were the target of a generalized dislike or distrust, accusations of not caring for patients, and sometimes perceiving them as too busy.

Doctors were sometimes considered inept, with poor diagnostic skills, and a propensity to worsen the illness rather than make things better. This was sometimes applied to “today’s” doctors, especially in terms of the lucrative income assumed to be associated with modern medical practice. Unnecessary tests and medications were considered the norm in some cases.

Sometimes people felt fearful that they might be judged if they were to tell the doctor they had engaged in unhealthy practices, or for their excessive body weight, or other sources of discomfort. This group might also feel that they would not receive useful advice other than losing weight, quitting smoking, or taking medicines for chronic health conditions like hypertension.

Personality-related factors

Some individuals simply ascribed their avoidant behavior to laziness or procrastination. Depression, anxiety, unemployment, female sex, low educational level, and poor self-appreciated health all contributed to a higher risk of avoidance.

Corrective measures

Scientists have described these responses in terms of Crisis Decision Theory, which postulates an initial appraisal phase where the threat is evaluated for its severity, followed by identifying possible responses, and finally evaluating them for their relative value. Category 1 responses, therefore, related to the conclusion that the available options ruled out seeking medical care.

Category 2 responses may be attributed to either a high sense of control or a low sense of threat, moving the individuals to avoid healthcare. When the avoidance was due to poor experiences, the cost-benefit ratio was probably deemed unfavorable.

Potential solutions include educating patients about symptoms of common but serious health problems and the value of screening for asymptomatic conditions. Public health interventions such as reminders over the phone or postcards could help improve preventive and early therapeutic healthcare and monitor chronic conditions to prevent debilitating outcomes.

To increase the level of trust and communication between patients and providers, it could be useful to use telemedicine and digital patient gateways to help patients access healthcare more easily and manage their conditions better. Since the various categories are not exclusive, multipronged strategies may be more helpful in reducing avoidance, such as providing financial help or improving case management while enhancing the quality of patient-physician interactions.

References

• Taber, J. M. et al. (2015). Why do People Avoid Medical Care? A Qualitative Study Using National Data. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-014-3089-1. https://link.springer.com/article/10.1007/s11606-014-3089-1#citeas
• Splinter, M. J. et al. (2021). Prevalence and Determinants of Healthcare Avoidance During The COVID-19 Pandemic: A Population-Based Cross-Sectional Study. PLOS Medicine. https://doi.org/10.1371/journal.pmed.1003854. https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003854
• Byrne, S. K. (2008). Healthcare Avoidance: A Critical Review. Holistic Nursing Practice. https://doi.org/10.1097/01.hnp.0000334921.31433.c6. https://pubmed.ncbi.nlm.nih.gov/18758277/
• Ng B. P. et al. (2020). Factors Associated With Avoiding Health Care Among Community-Dwelling Medicare Beneficiaries With Type 2 Diabetes. Preventing Chronic Disease. DOI: http://dx.doi.org/10.5888/pcd17.200148. https://www.cdc.gov/pcd/issues/2020/20_0148.htm
• Moore, P. J. et al. (2004). Psychosocial Factors in Medical and Psychological Treatment Avoidance: The Role of the Doctor–Patient Relationship. Journal of Health Psychology. Psychosocial Factors in Medical and Psychological Treatment Avoidance: The Role of the Doctor-Patient Relationship.
• Levya, B. et al. (2020). Medical Care Avoidance Among Older Adults. Journal of Applied Gerontology. DOI: 10.1177/0733464817747415. Medical Care Avoidance Among Older Adults
• Spleen, A. M. et al. (2014). Health Care Avoidance Among Rural Populations: Results From a Nationally Representative Survey. Health, Behavior & Society Faculty Publications. DOI: http://dx.doi.org/10.1111/jrh.12032. https://uknowledge.uky.edu/healthbehavior_facpub/4.

Further Reading

• All Healthcare Content
• Healthcare Systems Around the World
• What is the Role of Regulatory Bodies in Healthcare?
• How is the ‘omics’ Revolution Changing Healthcare?
• Primary Healthcare Providers

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.