Barriers and enablers of help-seeking among the psychologically distressed in primary care setting of Hong Kong

Abstract

Introduction and Project Objectives: Most of the previous studies on help seeking for psychological distress were derived from Western countries. This project investigated the barriers and enablers to helpseeking for psychological distress among Chinese primary care attenders in Hong Kong. Methods: Nine focus groups and 6 individual interviews were conducted among Chinese primary care attenders with/without known distress, patients' significant others and the general public. The identified barriers and enablers were investigated in a questionnaire survey with data from 1626 primary care attenders (response rate of 72.3%) recruited from 13 private clinics and 6 public clinics. Results: Worries about side effects of drugs (79.9%) and drug dependency (74.7%) were rated as the top barriers in the survey. Qualitative interviews found both worries and actual experience of the side effects of drugs, which weakened patients' trust in the treatment. Factor analysis on all barrier items suggested three factors: 1) worries of treatment, 2) uncertainties on primary care doctors' capacity, 3) public's limited knowledge on distress and sources of help. Distress level, education level and age were associated with factor 1, whereas distress level and healthcare setting were associated with the other two factors. Qualitative interviews revealed that not having a regular primary care doctor in the public setting discouraged disclosure of psychological problems. The top five enablers perceived by the survey respondents who had ever sought professional help for distress (n= 231) were crisis caused by distress (94.2%), distress affecting daily life (92.9%), wanting to treat associated physical symptoms (90.6%), having trust in doctor (90.1%) and encouragement by family/friends to seek help (88.3%). Qualitative interviews found that the patients often somatised their psychological problems. Family members were highly involved in help seeking whereas the doctors were the authoritative figures to convince the patients for treatment. Conclusions: Relevant public education in a Chinese context should target at reducing patients' worries of drug treatment and strengthening the image of primary care doctors as a feasible source of help. In line with Western findings, crisis and interference in daily life due to distress are the top enablers of Chinese patients in Hong Kong to seeking help. Other three key enablers including treating psychosomatic symptoms, doctors' authority and strong family involvement are likely to be influenced by Chinese culture.