The health service and help-seeking in older people: a qualitative study

Problem

Older smokers are at risk of getting several cancers. Not only are smokers less likely to believe that early diagnosis increases survival chances, they are also less likely to seek medical care early. Our aim was to explore the influence of the health service (primary, secondary and tertiary care) on help-seeking behaviour in older people, particularly smokers.

Approach

We purposively sampled people over sixty years old from a large Yorkshire general practice-based questionnaire study of smokers and non-smokers who had agreed to be interviewed (n=241). We conducted in-depth interviews either at the GP practice or the interviewee’s home. We explored help-seeking behaviour; pre-and post-consulting for a symptom; and the influence of the health service on help-seeking (both negative and positive influences). Interviews were recorded and transcribed. Data were analysed using a coding framework and NVivo. Regular discussions were held by the research team.

Findings

Forty two interviews (17 smokers, 16 ex-smokers and 9 never-smokers) were conducted. The health service was described both as a facilitator and barrier to help-seeking in older people. For example, the primary care issues included ‘the smoking conversation’ which was particularly a barrier among smokers; while the perceived messages before or after a consultation and access issues around making appointments particularly the interaction with receptionists, were barriers to help-seeking for both smokers and non-smokers.

Consequences

In order to improve the UK cancer outcomes, there is need to work towards eliminating or reducing barriers to presentation to and interaction with the health service. Targeted interventions to improve help-seeking, particularly among smokers, should be considered.