Taking stress to the doctor: A cross sectional survey of patients beliefs about stress and help seek

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Taking stress to the doctorA cross sectional
survey of patients beliefs about stress and help
seeking behaviour
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Questions

• Why some patients present to the GP complaining
  of stress? What do they mean?
• Is stress an aggravating or a mitigating factor
  that makes people to see the doctor?
• Is it true that the use some people make of the
  term stress can be influenced by their cultural
  background or ethnicity?
• Why is stress such a common complaint in
  general practice?

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Objective

• What is the meaning of stress for general
  practice patients?
• Does this differ by ethnic group?
• To explore the association between
• beliefs about patients help
• what stress means seeking behaviour

• Do any associations differ according to
• ethnic group?

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Method Setting Participants

• One inner South London practice
• Patient sample was taken from all patients
  entering practice over a four week period
• Patients were offered a questionnaire by the
  receptionist as they booked in to see any GP
• 135 men (28) and 346 women (72)
• 34 Black Caribbean
• 10 Black African
• 39 White British

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Tool used The Questionnaire

• A 25-item questionnaire was designed over a 6
  month period.
• 38 random patients attending to see the
  researcher during normal consultations were asked
  to write the symptoms they experienced when
  feeling stressed and what they meant by stress
  when using this word.

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The Questionnaire (2)

• A list of 42 symptoms was drawn and a draft
  questionnaire was designed asking two questions
  on a 5 point Likert scale
• 1. How much do you think that each one of these
  symptoms is a sign of stress?
• 2. How likely would you be to see the doctor
  for any of the following symptoms?
• 15 different patients were presented with the
  questionnaire and asked to amend it if required.
• A 25 item questionnaire was finally designed.

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Results

• A significant majority of patients believes that
  stress is a legitimate problem for which to see
  the GP.
• Symptoms attributed to stress are seen as a
  legitimate reason to see the GP by a majority of
  patients.
• Ethnic background is not a significant factor in
  the attribution of symptoms to stress.
• Ethnic background is a significant influencing
  factor in the help seeking behaviour for symptoms
  attributed to stress.

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Implications for Clinical Practice (1)

• Stress may function as a ticket of entry to the
  health system, which confirms previous research
  that shows it is a increasingly common complaint
  in general practice.
• GPs should be aware that patients beliefs about
  the term stress is not uniform and is often an
  aggravating, rather than a mitigating factor.
• A significant majority of Black patients are less
  likely than Whites to seek help when symptoms are
  attributed to stress.

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Implications for Clinical Practice (2)

• Deeper knowledge of patients health beliefs and
  their reasons to seek medical help will aid GPs
  to uncover hidden agendas and meet patients
  needs, hence improving the care they provide.
• This study supports the belief that a holistic
  approach to patients in general practice is an
  important factor in the care GPs provide beyond
  the bare box ticking of quality markers.