A Theory of

Care-seeking Behavior
Diane Lauver

Although much research has focused upon why people do and do not
engage in recommended health behaviors, there is a need to develop more
accurate theories to explain and predict engagement in health behaviors.
Because health behaviors differ in important ways, it could be most fruitful to
understand one type of health behavior, such as secondary prevention
behavior. Thispaper proposes a theory of care-seekingbehavior (CSB), based
on a theory of general behavior by Triandis. Other popular theories about
health behavior (i.e., Health Belief Model and Theory of Reasoned Action)
also are reviewed. Empirical support for the variables identified in the theory
of CSB is presented, drawing from the literature on secondary prevention for
cancer. The theory of CSB is applied to the situation of seeking care for cancer
symptoms. Directions for future research based upon this theoryare delineated.

[Keywords: prevention; health-related behavior; cancer control;

adherence; care-seeking behavior]

T
he fact that people do not engage in health behaviors as
recommended has been discussed frequently and docu-
mented consistently (Becker, 1985; Becker & Maiman,
1975;Eraker, Kirscht & Becker, 1984;Kaplan & Simon,
1990; Montano, 1986; Sackett & Snow, 1979). This
phenomena has been called noncompliance, noncooperation and
nonadherence (Becker, 1985; Heiby & Carlson, 1986; Stunkard,
1981). Because these terms imply clients’ failures in meeting
professional expectations, terms such as engagement and lack of
engagement in recommended health behaviors are preferred
(Kristeller & Rodin, 1984); these terms suggest that useful
explanations of health behaviors may be derived from general
theories of behavior and convey less judgment and value.
Both researchers and clinicians have addressed the problem of
the lack of client engagement in recommended health behaviors.
The Health Belief Model and the Theory of Reasoned Action are
popular theories that have guided such research. Although much
research has focused on understanding health behavior, most
theories have not provided the desired accuracy in prediction and
adequacy of explanation (Mullen, Hersey & Iverson, 1987;
Wallston & Wallston, 1984).If better theories could be identified
to predict and explain engagement in particular health behaviors,
then health care practitioners could use these theories to guide
interventions to promote recommended behavior. The main
purpose of this paper is to propose a theory of care-seeking
behavior. Additional aims are to review and compare alternative
IMAGE: journaf of Nursing Scholarship- Volume 24, Number 4, Winter 1992
theoretical models of health behavior.
To develop accurate theories of health behavior, it is critical to
recognizethe heterogeneityof health-relatedbehaviors (Andersen,
1968; Baric, 1969; Lauver, 1987; Rosenstock, 1990).Preventive
behaviors are characteristicallydifferent from behaviors to man-
age illness or disease (Rosenstock, 1990). Preventive behaviors
are most often undertaken in an asymptomatic state, whereas
illness behaviors are often associated with symptoms. Many,
although not all, preventive behaviors are undertaken as part of
a person’s life style, and are independent of the health care
system. Many, although not all, illness behaviors involve seeking
care either for evaluations or treatment from health care practi-
tioners and, thus, are undertaken in the context of the health care
system. However, preventive behaviors are not homogenous.
More specifically, prevention behaviors include both primary
and secondary prevention. The goal of primary prevention is to
prevent disease. A person engages in primary prevention behav-
ior in the absence of symptoms, such as by adopting a high-fiber,
Diane Lauver, RNC, PhD, Beta Eta is Assistant Professor, School of
Nursing, University of Wisconsin. The reviews of an earlier draft of this
manuscript by Karen A. Pridham, RN, PhD and RichardW. Hoops, MS are
most appreciated as is the assistance of Patricia Feltskog and Lisa
Sornermeyer in the preparation of this manuscript. Correspondence to
School of Nursing, University of Wisconsin, 600 Highland Avenue CSC-
K6/262, Madison, WI 53792-2455.
Accepted for publication on April 6, 1992.
28 1
A Theory of Care-seeking Behavior
low-fat diet to prevent cancer. However, some primary preven-
tion behaviors, for example, exercise or diet, meet goals other
than disease prevention and have positive consequences, such as
feeling and looking good.
In contrast to primary prevention, the goals of secondary
prevention are to diagnose disease, detect disabilities in early
stages and treat diseases to prevent sequelae. The different goals
of primary and secondary prevention may be recognized more
frequently by clinicians than clients. Clients engage in secondary
prevention not only when they seek screening tests in an
asymptomatic state, such as hemoccults and mammograms, but
also when they seek care with symptoms or for diagnosed
diseases. Secondary prevention behaviors share an important
characteristic: the possibility of discovering an abnormal condi-
tion that could have a negative consequences, such as being
diagnosed with a chronic disease or dysfunction. Engaging in
care-seeking behaviors, especially for the goals of screening or
evaluating symptoms, means that clients inherently expose
themselves to the threat of learning that something is seriously
wrong (Baric, 1969; Lauver, 1987).
Recognizing special characteristics of one type of preventive
health behavior, such as care seeking for secondary prevention,
would help to explain this type of health behavior more fully. If
a valid theory for explaining one type of care-seeking behavior
could be identified and supported empirically, then this theory
could be applied to other, similar types of care-seeking behav-
iors.
In the following sections, alternative theoretical models of
health-related behavior are compared. Variables central to the
theory of care-seeking behavior (CSB) are defined and proposi-
tions delineated. Empirical support for the theory is reviewed,
drawing frequently from the literature on care-seeking and
secondary prevention for early detection of cancer. Although the
theory was developed with a focus on care-seeking behavior for
secondary prevention, it is not limited to such behavior. Direc-
tions for future theoretically guided research are delineated.
Models of Health Behavior
Health Belief Model
One widely known model used to study the lack of engagement
in recommended health behaviors is the health belief model
(HBM). Originally developed to explain preventive behaviors,
the HBM also has been used to study illness behaviors (Becker
& Maiman, 1975; Rosenstock, 1990). The variables central to
this model include: perceived susceptibility and perceived sever-
ity of a disease or condition, barriers and benefits to action, a cue
to action and general health motivation. From this model, it is
proposed that clients would be more likely to engage in such
behavior if they had high perceptions of susceptibility to and
severity of a disease or condition, low barriers and high benefits
to engaging in a related preventive behavior, a cue to act, and a
high motivation for health behavior in general. This set of
concepts is intuitively appealing to both clinicians and research-
ers and has guided voluminous research on health behavior.
However, there are limitations of the HBM. Cognitions are
central to the HBM and affect is not integrated explicitly. Affect,
282
such as feelings about engaging in the recommended behavior,
could be important to explanations of health behaviors associated
with a threat.
Also, research guided by the HBM has not yielded consistent
support for the model variables. For example, when studied in
combination with other variables, perceived severity has been
associated consistently with illness behavior (Janz & Becker,
1984)but less often associated with prevention behavior (Becker
& Maiman, 1975;Champion, 1985,1987; Rimer, 1990). Tests of
relationships of the HBM variables with breast self-examination
(BSE) performance have not revealed consistent relationships
between these variables and BSE performance (Champion, 1985,
1987,1988; Jacob, Penn & Brown, 1989; Lauver, 1987; Lauver
& Angerame, 1988; Rutledge, Hartmann, Kinmann & Winfield,
1988). More specifically, 26-28 percent of the variance in BSE
frequency has been explained by some of the HBM variables,
especially barriers, but not necessarily by all of these variables
or only by them (Champion, 1985, 1987; Rutledge, 1987).
Differences in findings from studies using the HBM may be
explained partly by differences in measurement of the HBM
variables; they have not been operationalized consistently
(Cummings,Jette & Rosenstock, 1978;Hill, Gardner & Rassaby,
1985;Jette, Cummings, Brock, Phelps & Naessens, 1981;Mullen
et al., 1987; Rimer, 1990; Rutledge et al., 1988; Wallston &
Wallston, 1984).
Support for the HBM may be limited because of different
interpretations about how to test it. Although indirect relation-
ships are suggestedby the model and in literature about it, explicit
propositions about how the variables could interrelate have not
been articulated by proponents of the HBM (Becker & Maiman,
1975; Janz & Becker, 1984). Most researchers have tested only
direct relationships between the HBM variables and health
behavior (e.g., Becker, Maiman, Kirscht, Haefner & Drachman,
1977; Champion, 1987; Maiman, Becker, Kirscht, Haefner &
Drachman, 1977; Rutledge et al., 1988). Furthermore, the appli-
cations of the HBM to prevention behaviors differ sometimes
from applications to illness-focused behaviors (Rimer, 1990;
Rosenstock, 1990). Also, variables that were not identified
originally in the HBM can offer significant explanation of health-
related behaviors, such as social influences, prior experience
with the health care system and perceived confidence in or
efficacyofthebehavior(Champion, 1985,1987,1988;Cummings,
Becker & Maile, 1980; Lauver & Angerame, 1988; Mullen et al.,
1987; O’Leary, 1985; Olson & Mitchell, 1989; Walker & Glanz,
1986).
Theory of Reasoned Action
Another theoretical perspective of health behavior, the theory
of reasoned action (TRA) (Ajzen & Fishbein, 1980; Fishbein,
1980),has been used frequently to guide health-related research,
for example, on contraceptive and weight-reduction behavior
(Davidson, Jaccasd, Triandis, Morales, Diaz-Guerrero, 1976;
Jaccard & Davidson, 1975; Pender & Pender, 1986; Valois,
Desharnais & Godin, 1988). Variables central to the original
theory include attitude, subjective norm and intention. Attitudes
and social norms determine intentions, which, in turn, determine
behavior. The relationship between intentions and behavior rests
IMAGE: Journal of Nursing Scholarship Volume 24, Number 4, Winter 1992
~ ~~
on the assumption that the behavior of interest is one that people
can initiate voluntarily. More specifically, attitudes are deter-
mined by both perceived consequences of the behavior and
evaluations of those consequences. Subjective norms are deter-
mined by beliefs of social referents that one should or should not
perform the behavior and by the motivation to comply with these
beliefs. An extension of the TRA is the theory of planned
behavior. In it, clients’ perceived behavioral control (i.e., per-
ceived resources and opportunitiesto engage in the behavior) also
influencebehavior, both directly and indirectly, through intention
(Ajzen & Madden, 1986).
There are limitations of the TRA, however. Inherent in the
theory is an emphasis on explaining intentions rather than behav-
ior (Montano, 1986). Although intention to act is often strongly
correlated with behavior that is under volitional control, the
ultimate goal of clinicians and researchers in health care is to
understand health behavior (Fishbein, 1980; Montano, 1986;
Smetana & Adler, 1980; Valois et al., 1988). Also, the theory rests
heavily on cognitions and rational thought. However, affective
dimensions are incorporated somewhat in the concept of attitudes
and sometimes in the measurement of attitudes (Lierman, Young,
Kasprzyk & Benoliel, 1990; Rimer, 1990).
Furthermore, research has not supported propositions from the
TRA consistently.The influence of attitudes on behavior has been
found to be direct, rather than indirect through intentions (Bentler
& Speckart, 1979; Liska, 1984). Also, subjective norms have not
been found to explain intentions consistently (Lierman et al.,
1990; Pender & Pender, 1986; Valois et al., 1988). Variables that
have not been incorporated in the theory, such as previous
experience with the behavior or symptoms, have been found to be
important in explaining behavior (Bentler & Speckart, 1979;
Pender & Pender, 1986; Songer-Nocks, 1976). For example,
whereas 39 percent of the variance in BSE frequency was
explained by variables from the TRA, 60 percent of the variance
in BSE frequency was explained by variables from the TRA plus
variables representing facilitating factors for BSE (Lierman,
Kasprzyk, Benoliel, 1991; Lierman et al., 1990). Also, proposi-
tions from the TRA may not hold similarly for those with and
without prior personal experience with the target behavior
(Brubaker, Prue & Rychtarik, 1987). Propositionsfrom the theory
of planned behavior may not hold for persons with and without a
family history of cancer (DeVellis, Blalock & Sandler, 1990).
The measurement of the variables in the TRA deserves consid-
eration. Proponents of the TRA maintain that the behavior of
interest must be specified regarding temporal and contextual
factors. To maximize validity of measures, specific items are
derived from open-ended interviews about the behavior of inter-
est. Also, measures of each predictor variable refer specifically to
the particular behavior. To explain jogging behavior of 20
minutes duration every other day for a month, measures of social
norms and intentions would refer to jogging every other day for
20 minutes in the next month (Ajzen & Fishbein, 1980; Carter,
1990). The specificity of such measures may explain why inten-
tions to engage in a particular behavior and actual engagement in
it are highly related. However, the development of situation-
specific measures for each health behavior is time consuming and
may be impractical (Rimer, 1990).
1MAGE:)ournalof Nursing Scholarship Volume 24, Number 4, Winter 1992
A Theory of Care-seeking Behavior
Triandis’ Theory of Behavior
Triandis’ theory of behavior (1977, 1980, 1982) could guide
research on health behavior. Variables central to the theory
include: affect, perceived consequences and values of such
consequences, social factors, habit, facilitating conditions and
physiologic arousal regarding a particular behavior. Affect is
defined as an individual’s “direct emotional response” and
“immediate and certain emotion” connected with the thought of
engaging in the behavior (Triandis, 1980, 1982). Perceived
consequencesrefer to the probabilities that salient consequences
will result from the behavior. Values refer to the evaluation of
these consequences. Social factors include: social norms, that is,
perceptions of how others believe one should behave; personal
norms, that is, self-instructions to behave in a manner that is
morally acceptable to oneself; and interpersonal agreements to
engage in the behavior. Habit refers to the degree of an estab-
lished pattern regarding the behavior and to prior experiences in
carrying out the behavior. Facilitating conditions are objective
environmental conditions that enable persons to engage in the
behavior. Physiologic arousal refers to the degree of relative
arousal that would drive or promote behavior, such as the role of
hunger in buying food.
Intentions and habits, as modified by facilitating conditions
and physiological arousal, determine the probability of action.
Intentions are a function of affect, perceived consequences of
action as well as values of those consequences,and social factors.
Triandis (1980) has expressed these theoretical relationships
mathematically, stating explicitly how these variables could be
related.
The Probability of a Behavior = (wJntentions + w,Habit)
(Facilitating conditions X Physiological arousal). Intentions and
habit are weighted based on individual and situational factors.
However, these weights are defined as theoretical rather than
statistical constructs (Triandis, 1980). Intentions may influence
an established behavior only weakly whereas habits may do so
strongly. Intentions may strongly influence behavior in a novel
situation whereas habits may do so weakly.
Furthermore,Intention = waAffect+ wc(Probabilitycx Valuesc)
+ wnNorms. Theoretical weights are incorporated to reflect
individual and situational factors. The middle term represents a
subjective utility factor; it is the sum of the products of the
expected likelihood of consequences of the behavior and the
values of those consequences. Propositions regarding how these
variables are related (e.g., regarding the subjective utility term)
complement ideas from the HBM that address only what vari-
ables are important (RoNs & Harel, 1989). Because this theory
incorporates a direct measure of affect as well as measures of
habit and facilitating conditions, it incorporates concepts that are
lacking in the theories previously discussed. Thus, it could
explain behavior more fully.
Variables from Triandis’ theory have explained 33 percent to
66 percent of the variance in health behaviors or intentions
(Montano, 1986; Seibold & Roper, 1979; Valois et al., 1988).
Intentions have been used as an indicator of health behaviors
because the two have been highly associated when persons can
engage voluntarily in the behavior (Fishbein, 1980; Montano,
283
A Theory of Care-seeking Behavior
1986; Smetana & Adler, 1980; Valois et al., 1988). Two studies
based upon and offering support for the Triandis model are
noteworthy in that a longitudinal design was used, measuring the
explanatory and outcome variables separately (Montano, 1986;
Valois et al., 1988). In another study, 60 percent of the variance
in BSE frequency was explained with the variables from the
TRA plus measures of facilitating factors (Lierman, Kasprzyk,
Benoliel, 1991).
Concepts similar to Triandis’ theory (i.e., expectations, values
and norms) have been compared with the concepts from the
HBM (i.e., perceived susceptibility and severity, barriers and
benefits) and the former have been found to be more useful in
explaining behavior (Hill et al., 1985; Mullen et al., 1987;
Wallston & Wallston, 1984). When Triandis’ theory has been
compared with the TRA, Triandis’ theory: a) is more compre-
hensive because it includes the concepts of affect, habit, and
facilitating conditions; b) can be more powerful and sensitive to
differences among persons of differing socioeconomic status;
and c) is as useful in explaining behavior (Jaccard & Davidson,
1975; Montano & Taplin, 1991; Seibold & Roper, 1979; Valois
et al., 1988). Although Triandis’ model may not be simple, it
may be more complete and useful in explaining health behaviors
(Wallston & Wallston, 1984).
A Theory of Care-seeking Behavior
Because Triandis’ (1977, 1980, 1982) theory of behavior
could be especially useful in explaining health behavior, a
theory of care-seeking behavior (CSB) has been developed
based upon it (Figure 1).The probability of engaging in health
behavior is a function of psychosocial variables (affect, expec-
tations and values about outcomes, habit and norm) and facili-
tating conditions regarding the behavior.
Affect refers to feelings associated with care-seeking behav-
ior, such as anxiety about a serious diagnosis or embarrassment
about an examination. Expectations refer to beliefs about the
likelihood of relevant outcomes of care seeking and values
refer to the importance of those outcomes. When correspond-
ing expectation and value ratings about particular desired
outcomes of care seeking are multiplied together and summed,
a utility term is computed, based on subjective expected utility
theory (Schoemaker, 1982). Utility reflects the overall worth of
care seeking; it is similar to the measure of attitudes in the TRA
and the idea of benefits from the HBM, but is measured
I Clinical l F l
and
socio-
- Utility
IExpecraclnrrs
and Values &)uf
Oufcorne\’,
Swking
Behavior
demographic Norms Facilitating
Variables Habits
Figure 1 : Theory of Care-seeking Behavior
284
differently from the latter.
Normative influences include social and personal norms as
well as interpersonal agreements to engage in care seeking.
Social norms are others’ beliefs about care seeking. Personal
norms are one’s own beliefs about morally correct behavior
regarding care seeking. Interpersonal agreement to act reflects a
promise with another to engage in care seeking.
Habit refers to how one usually acts when one has symptoms
(e.g., whether or not one seeks care promptly with symptoms).
Thus, habit reflects one’s usual care-seeking behavior and re-
flects past experience with care seeking. Facilitating conditions
are specific, objective, external conditions that enable one to seek
care, such as having health insurance. They are the opposite of
conditions that would inhibit seeking care. As such, measures of
facilitating conditions may reflect barriers identified in the
HBM.The selection of these variables as the major explanatory
variables of behavior rests on the assumption that behavior is
influenced by many factors (i.e., persons’ feelings, cognitions,
social influences, past experiences and objective, external facili-
tators regarding the behavior).
The relationships among the theoretically identified vari-
ables are proposed as follows. Psychosocial variables could
influence behavior in interaction with facilitating conditions
(i.e.. be conditional upon), as proposed by Triandis (1977,
1980). This proposition rests on the assumption that the pres-
ence of the conditions reflected by the psychosocial variables
are necessary, but not sufficient, to engage in care-seeking
behavior. However, the influences of psychosocial variables on
behavior could be direct, as suggested by clinically based
research that is reviewed below. Psychosocial variables are
proposed to be the sum of a) affect, b) the products of
corresponding expectations and values about outcomes (i.e.,
utility), c) norms and d) habit. Variables extrinsic to the theory,
such as clinical and demographic factors, are proposed to
influence behavior only indirectly, that is, by mediation through
the theoretically identified variables. The latter proposition
rests on the assumption that clinical and demographic factors do
not influence behavior per se. These factors could influence the
theoretical variables, (e.g.. expectations, values, norms) which,
in turn, influence behavior.
The theory of CSB differs from Triandis’ theory in two ways.
Intention is not included as a separate concept focusing on
variables that could explain health behavior. Also, physiologic
arousal is not included as a separate predictor of behavior. The
physiological arousal associated with a health threat (e.g., cancer
or dysfunction) would be likely to result in negative affect (e.g.,
anxiety about receiving a serious diagnosis or depression about
confirming a loss of function). Thus, by including affect, which
is assumed to be an indicator of arousal, the inclusion of arousal
would not be necessary. Furthermore, actual physiologic arousal
that is relevant to health behavior is difficult to identify and
measure.
Empirical findings regarding these propositions are reviewed
below, drawing on examples of care seeking for secondary
prevention of cancer. Affective variables, such as anxiety, fear of
cancer, depression and denial, have been related directly and
negatively to prompt care seeking among breast cancer clients
IMAGE: Journal of Nursing Scholarship Volume 24, Number 4, Winter 1992

(Green & Roberts, 1974; Magarey, Todd & Blizard, 1977; Smith
& Anderson, 1987; Worden & Weisman, 1975). In contrast,
anxiety and intense emotional responses about breast changes
also have been associated positively with intentions to seek care
and actual prompt care seeking for breast symptoms (Cameron &
Hinton, 1968; Lauver & Chang, 1991; Timko, 1987). The
direction of the relationship between negative affect and behav-
ior is not clear. Also, negative affect may be related to care-
seeking behavior in a nonlinear manner or in combination with
other variables, such as prior experience with a similar situation
(Green & Roberts, 1974; Hackett, Cassem & Raker, 1973).
Expectations about outcomes of care seeking, (e.g., beliefs
about the prevalence of cancer and effective treatments) have
been associated with care seeking for cancer symptoms
(Bransfield, Hankey &Wesley, 1989; Cochran, Hacker & Berek,
1986;Green & Roberts, 1974;Smith & Anderson, 1987;Worden
& Weisman, 1975). Furthermore, the sum of the products of
corresponding expectations and values about outcomes has been
related directly to intentions to engage in breast self-examination
and cervical cancer screening, intentions to seek care with breast
symptoms, actual breast self-examination and mammography
screening (Hill et al., 1985; Lauver & Chang, 1991; Lierman et
al., 1990; Montano & Taplin, 1991; Seibold & Roper, 1979;
Timko, 1987). Social norms and personal norms have been
related to actual and intended health behaviors, including cancer
screening and mammography (Hill et al., 1985; Lierman et al.,
1990; Page1 & Davidson, 1984; Seibold & Roper, 1979; Timko,
1987; Valois et al., 1988; Zapka, Stoddard, Costanza & Greene,
1989). The influence of interpersonal agreement to engage in a
particular behavior rarely has been included in tests of Triandis’
theory (Montano, 1986;Jaccard & Davidson, 1975; Valois et al.,
1988). In an exception, the influence of interpersonal agreement
was studied in combination with social and personal norms and
was a significant predictor of intentions to get Pap tests (Seibold
& Roper, 1979). Habits (e.g., having engaged in prior breast
cancer screening and having sought symptomatic care) have
been associated with engaging in screening behaviors for breast
cancer (Burack & Liang, 1989; Lauver, 1989; Samet, Hunt,
Lerchen & Goodwin, 1988; Taplin, Anderman & Grothaus,
1989) and intentions to seek care for breast cancer symptoms
(Lauver & Chang, 1991).Thus, the variables of expectations and
values about outcomes, norms and habits could have direct
influences on care-seeking behavior.
Facilitating conditions (e.g., health insurance and having a
regular health care practitioner) have been related directly to
health behaviors, including seeking mammography (Lane,
Poldenak & Burg, 1989; Montano & Taplin, 1991; Safer,
Tharps, Jackson & Leventhal, 1979; Weissman, Stern, Fielding
& Epstein, 1989). The interaction effects of facilitating condi-
tions with the other theoretical variables have not been tested
often or well (Davidson et al., 1976; Hill et al., 1985; Seibold
& Roper, 1979). In one study, prompt care-seeking behavior for
breast cancer symptoms was explained, in part, by the interac-
tion of anxiety and having a regular health practitioner. Women
with low anxiety and no regular practitioner delayed longer than
women with either high anxiety or a regular practitioner (Lauver
& Ho, 1991). Also, having no-cost mammography and breast
IMAGE:Journal of Nursing Scholarship. Volume 24, Number 4, Winter 1992
A Theory of Care-seeking Behavior
symptoms were found to interact to influence clients’ use of
mammography (Lane & Fine, 1983). To the extent that facilitat-
ing conditions are a function of economic status, research that
addressed socioeconomic status could be relevant. Socioeco-
nomic status has been found to modify the relationship of affect
and beliefs about cervical cancer with intentions to seek Pap tests
as well as the relationship of personal norms about family
planning with intentions to engage in contraceptive behavior
(Davidson et al., 1976;Seibold & Roper, 1979).Whether particu-
lar facilitating conditions interact with the psychosocial vari-
ables to influence care-seeking behavior is unclear. Whether
findings about the interactive effects of facilitating conditions,
based on studies of asymptomatic health behavior, generalize to
symptomatic behavior is not known.
Clinicalfactors (e.g., presence and type of symptom as well as
history of prior related problems) have been related directly to
cancer screening and to intended and actual care seeking
(Bransfield et al., 1989; Cochran et al., 1986; Funch, 1988;
Gould-Martin, Paganini-Hill, Casagrande, Mack & Ross, 1982;
Lauver & Chang, 1991; Lauver & Rubin, 1990; Mettlin, Reese
& Murphy, 1980; Michielutte, Diseker, Young & May, 1985;
Smith & Anderson, 1987). These findings may not be consistent
with the proposition that variables extrinsic to the theory explain
health behavior only by mediation through the theoretical vari-
ables. Whether or not clinical factors influence behavior when
controlling for theoretical variables is an issue that warrants
further study.
In general, demographicfactors (e.g., age and education) have
not been related consistently to cancer screening or care seeking
for cancer symptoms (Burack & Liang, 1989; Funch, 1988;
Greenwald, Becker & Nevitt, 1978; Lierman, 1988; Samet et al.,
1988;Taplin et al., 1989). These findings support the proposition
that variables extrinsic to the theory explain health behavior only
through theoretical variables.
Overall, empirical findings support the proposed relationships
between the variables identified in the theory of CSB with regard
to care seeking for secondary prevention. However, few studies
have incorporated the complete set of the theoretical variables or
have assessed fully the propositions identified from Triandis’
theory of behavior. Much of the empirical support comes from
separate studies that were guided by different theories of health
behavior; some support comes from atheoretical research. Test-
ing the combined influences of the theoretical variables and the
manner in which they influence behavior is essential to assess the
usefulness of the theory.
Future research on health behavior could build on previous
clinically based research by using a behavioral theory that
incorporates relevant variables. Also, future research on health
behavior could build on theoretically based research by testing
ideas derived from the theory of CSB. This research could
address: 1) whether facilitating conditions interact with the
psychosocial variables to influence care-seeking behavior and 2)
whether clinical and demographic variables influence behavior
only indirectly by mediation through theoretical variables. De-
veloping and using similar measures of variables from the theory
of CSB across different situations not only would be efficient but
also important to assess the usefulness of the theory. Findings
285
A Theory of Care-seeking Behavior
from such research could offer better explanations of CSBs,
clarify inconsistencies and address omissions in past research.
By applying the theory of CSB to one type of health behavior,
such as CSB for secondary prevention, researchers could extend
theoretical research to explain clients’ engagement in behaviors
for cancer control. Health care professionals could use these
explanations to design interventions to promote care-seeking
behaviors, for example, early cancer detection in an effort to
improve survival with cancer. If explanations of care-seeking
behavior were supported empirically for one condition, such as
cancer, then these explanations could be tested in relation to care
seeking for similarly threatening conditions and other health
behaviors.@Q
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SOURCES AND RESOURCES

E.T. Net is anonline computer conferencenetwork whose purpose is to electronically link developersand users ofinteractive technology in health
care education.E.T. Net allows users and developersto share reviews on available s o b a r e , hardware and videodiscs (information on those under
development and those which they would like to see developed) as well as new applications of interactive hardware to health science education.
Sponsored by the Educational Technology Branch of the Lister Hill National Center for Biomedical Communications, E.T. Net is open to
professionals engaged in either the development or use of interactive technology in health professional education. It is free, available 24 hours a
day, seven days a week. E.T. Net also includes NUCARE (NUrsing CAre REsearch) conference which provides opportunities for researchers to
exchange information significant to nursing care research. E.T. Net may be reached through a local Telenet number or via the Internet. For more
information, or help with access, contact: E.T. Net Coordinator, The LearningCenter for Interactive Technology, Lister Hill National Center for
BiomedicalCommunications,National Library OfMedicine, 8600 RockvillePike, Bethesda, Maryland 20894. Phone: (301)496-0508, FAX (301)
480-3035; E-mail: TL.C@lhc.n.m.nih.gov

SOURCES AND RESOURCES

IMAGE:/ourna/ ofNursing Scholarship. Volume 24, Number 4, Winter 1992 287

 Key Aspects of Caring for the Acutely Ill:
Technological Aspects, Patient Education, and Quality of Life
Fifih National Conference on Research for Clinical Practice

“Key Aspects of Caringfor the Acutely Ill”

Kathleen Dracup, DNSc, RN, FAAN
University of California, Los Angels

“Managing Technology and Complex Care” 6cCoorciinatingPatient and Family Education ”

Kathleen Stone, PhD, RN, FAAN Carol Lindeman, PhD, RN, FAAN
Ohio State University Oregon Health Sciences University

“Maintainingthe Patient’s Quality of Life” “Caringfor the Acutely Ill Child”

Carolyn Cooper, PhD, RN
University of North Carolina at Chapel Hill
April 22-24,1993,Chapel Hill, North Carolina
Clinicians, administrators, and researchers will examinecurrent
research and practice in caring for acutely ill patients--including
surgical patients, trauma patients, patients suffering from exacerba-
tions of chronicillness, immuno-compromised patients, and psychi-
atricpatients. Keytopicsincludemanagementofcomplexandhighly
technical care, patient and family education and preparation for
discharge, quality of life, and related issues. Discussions of the
practical uses of current research and suggestions for further study
will follow research presentations. The conference fee of $160
includes a book of research and discussions based on the conference.
A preconference workshop for clinicians and administrators
Barbara Turner, DNSc, RN, FAAN
Madigan Army Medical Center,Tacoma W A
will focusonassessingtheapplicability ofresearch forpradcesires,
overcoming barriers to using research, and implementing research
findings from the conference; individual guidance will be provided.
Workshop fee is $50, space limited.
The conferencehorkshop is funded by the Division of Nursing,
DHHS, and co-sponsored by the University of North Carolina at
Chapel Hill School of Nursing, Alpha Alpha Chapter of Sigma Theta
Tau, and the Southern Nursing Research Society.
Contact:Ruth Wiese, Projectcoordinator, CW7460Camngton
Hall, UNC-CH School of Nursing, Chapel Hill, NC 27599-7460,
(919)966-2263for registration materials.

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