Patient education literature and help seeking behaviour: perspectives from an evaluation in the United Kingdom.

Decisions by patients upon when to use health care services are a major influence on the consumption of health care resources. Patient education--often based upon written information on how to identify symptoms of common illnesses, when to seek help and how to self-treat--is an increasingly popular strategy to rationalise demand. A large body of literature, in evaluating the impact of such written information, has though overlooked the possession or acquisition of comparable publications by respondents in the course of the studies. This study attempted to overcome this limitation in considering the impact of a prominent patient education booklet that makes reference to over 40 common ailments. Questionnaire data from a cohort sample of residents (n = 495) in an area within which the booklet was circulated and that from a comparison area (n = 509) suggests that such literature exerts a modest influence in orienting patients towards "appropriate" self-referral and self-care behaviour. Reasons for this limited impact emerged however in semi-structured interviews with a sub-sample of respondents (n = 85). These data show that understanding of the way in which written advice for patients is perceived has to focus upon the ways in which diverse sub-populations process and attribute meaning to "official" and "unofficial" sources of advice. More fundamentally, the increasingly sophisticated and specialised nature of medical and scientific knowledge may be distancing expert knowledge from individuals and society such that "lay" responses to "expert" advice now reflect a continuing process of risk assessment, trust or the withholding of trust.