What causes the differences in attitude among the educational groups?
At this point, it is essential to emphasise that we have only investigated hypothetical behaviour with regard to seeking medical attention, and these data can therefore not reveal whether the observed patterns correspond to actual patterns of use of medical services by these groups. There is a possibility that the respondents report help-seeking strategies that they perceive to be more socially acceptable (7). Similarly, a stated intention to seek medical attention is no guarantee that a doctor will be contacted when the need arises, since a number of factors may restrict the individual’s freedom of action in the given situation, irrespective of whether he or she may or may not be in control of these circumstances (3, 11). These circumstances may include issues pertaining to place of residence (such as local availability of medical services), financial situation, family situation and social networks, as well as state of health, prior experience of the health services and health-related norms and values. If we restrict the discussion to this latter issue, we may interpret the responses as expressions of individual and cultural variations related to:
Expectations of bodily function and health, including the interpretation of bodily symptoms, tolerance of physical afflictions and opinions as to the meaning of good health.
Confidence in personal abilities to cope and in professional medical expertise.
Norms pertaining to seeking medical attention; what individuals believe one ought to hold to be an acceptable use of medical services.
These three factors – the degree of acceptance of afflictions, beliefs regarding the best source of help and norms about what we ought to do – are likely to interact in a complex and unsystematic manner. The conviction that we should not see a doctor before this is absolutely imperative is not necessarily accompanied by a pronounced confidence in personal capabilities and a high degree of tolerance; for example, we may be of the opinion that seeking medical attention should be avoided as far as possible, but still have a high confidence in professional medical assistance and a low degree of tolerance. This complexity makes it difficult to draw any conclusions regarding the implications of the results of the analysis.
Since the threshold for hypothetical seeking of medical assistance is composed of a number of different factors, while the pattern in the responses is relatively consistent, it is unlikely that the threshold hypothesis alone may explain our findings. An alternative hypothesis, therefore, is that the systematic patterns indicate that the informants should be perceived as carriers of culture, and that their individually espoused attitudes should be interpreted as expressions of cultural norms and values within the educational group to which they belong. In this case, the results of the analyses are expressions of cultural variations between educational groups, since cultural norms and values associated with seeking medical attention are systematically correlated with levels of education among women. One example: What norms and values will apply when the question concerns whether it is good or bad to see a doctor in order to address minor physical conditions? The results indicate that the norm «one should seek to rely on oneself» has a stronger position among women with higher levels of education than among those with less education. In other words, it may be less socially and culturally acceptable for a highly educated woman to report that she goes to see a doctor for a headache or a sore throat – and thereby possibly admit that she has little confidence in her own abilities or is unable to cope with this on her own – than for a woman with a lower level of education.