Health care supply and illness perceptions: contextual effects on individual beliefs

Abstract

Background. The common-sense model of health and illness assumes that illness perceptions guide how people respond to illness. It further proposes that illness perceptions are founded in a socio-cultural context, but this assumption is rarely tested. This study examines in how far the health care access affects individual illness perceptions. Access to primary health care is of particular relevance to older adults with multiple illnesses. This study therefore examines in how far district-level primary care supply affects individual illness perceptions, both directly and as a buffer of functional limitations. Methods. Longitudinal study in 271 older adults with 6 months interval. Illness perceptions and functional limitations were assessed using the B-IPQ and SF-36. Multilevel analyses in which district-level primary care supply was matched to individual records were used to analyse data. Findings. Primary care supply predicted and moderated the impact of functional limitations on illness perceptions, with better supply (GPs per 100,000 inhabitants/district) acting as buffer. Discussion. Contextual variables affect individual illness perceptions, indicating that people consider their social and economical context in thinking about their illnesses.