The topic of consultation with health services or ‘help-seeking’ remains an issue of utmost importance given the conflicting targets of service providers—to manage increasing demand while ensuring appropriate and timely utilization by those who could benefit from care. Research interest in consultation patterns has varied over the last 30 years. The resulting literature is vast, methodologically varied and often conflicting, in part as a result of input from differing disciplinary perspectives. Despite this, there are some residual messages that prevail within clinical parlance about who is more or less likely to consult for particular symptoms. Most commonly these focus around socio-demographic characteristics of the population, namely gender, age and socio-economic position.
Much of the interest in socio-demographic patterning of consultation arises from a desire for equity in access to health care. It has been noted that following Tudor Hart’s demonstration that good medical care tends to vary inversely with the need of the population served, the ‘inverse care law’,1
a tradition of research has followed with the aim of investigating whether those of lower socio-economic position do have less access to health care.2
Similarly, there has been a parallel agenda to highlight the problems women face when accessing care, although more recently there has been more emphasis on barriers to help-seeking among men.3
This, together with an interest in identifying and addressing ageism within service provision,4
has produced a body of work attempting to highlight inequalities in access to care across socio-demographic characteristics. Work considering equity in access to health care has tended to draw the distinction between factors associated with the users of health care, providers of health care and the interface between the two. Here we focus on the user aspect of consultation.
It is a commonly held view that women are more likely than men to consult in primary care. On average, in the UK and elsewhere, women consult their GP more than men, especially in the reproductive years.6
It is widely presumed that this means that men are less willing to consult, although few studies have compared patterns of consultation in men and women with similar morbidity.7
In addition, there is a body of evidence that has contributed to the widely held view that older people may be less likely than other age groups to seek medical intervention. Following work from the 1960s that suggested that multiple health problems and disabilities among a community sample of older people were not known to their GP,8
other studies have noted that older people can be reluctant to seek treatment,9
due to, for example, the ‘normalization’ of their symptoms in relation to their age, otherwise known as ‘age attribution’.10
The perceptions relating to the impact of deprivation on health care consultation are mixed, which reflects the changing evidence base on this topic. Macrostudies, predominately from the 1980s, did suggest underutilization of primary care services in relation to need among more deprived groups,11
and this a view that prevails among some practitioners. However, among others there is a strong sense that those from more deprived backgrounds consult with GPs more frequently than those from less deprived backgrounds, perhaps with the exception of consultation for preventative measures.12
There remains debate regarding whether the observed higher attendance among differing socio-demographic groups can be explained by greater ‘need’, although measurement of need is very complex. By studying consultation for specific illnesses or symptoms, it may be easier to demonstrate whether ‘need’ is similar across socio-demographic groups.11
Therefore, we have examined these commonly held assumptions about the characteristics associated with consultation behaviour using low back pain as an exemplar. Low back pain is common within the population; accounts for a significant work load within primary care and importantly, while physically and socially disruptive for the individual, only rarely is an indication of a serious life-threatening condition. It is frequently seen in primary care and is associated with high economic costs13
and reduced quality of life. It is estimated that ~6.5% of adults will consult with back pain over a 1 year period, with only 25% of these consulters having undergone complete recovery in terms of pain and disability after 12 months.14
Many large-scale studies that consider consultation patterns using routine data do so by examining the characteristics of only those individuals who have consulted for a given condition or symptoms. This does not allow for comparisons between those who have symptoms who either do or do not consult with health services. By reviewing the literature on consultation for back pain ‘among people with symptoms back pain’, we were able to examine studies that were able to compare users and non-users of health care. Using systematic methods, we aimed to identify studies that had examined the relationships between socio-demographic characteristics and consultation. Through summarizing the literature on gender, age and socio-economic position, we wished to see if the commonly held beliefs about the consultation patterns of these groups were upheld within the literature on consultation for back pain.