Introduction: Influenza illness is considered to be associated with high mortality, morbidity and economic loss. Numerous studies and mathematical simulations are conducted to understand the disease pattern, transmission dynamics, and psychosocial response of the population; however, little is known about the health seeking behavior of patients after the onset of respiratory infection symptoms. Respiratory infections exert substantial burden on the health care system of Hong Kong, therefore in addition to detecting the disease early, it is necessary to understand health care utilization behavior of the population. This information will not only benefit to formulate public health policies, it will also improve the preparedness plan to deal with future pandemics. Objective: To examine the influence of factors such as gender, age, education and occupation on the health seeking behavior of Hong Kong citizens and to understand the magnitude of health care utilization by the patients with respiratory infections. Method: This study is based on the data from a large randomized controlled trial of 703 households comprising of 2,586 individuals. Bi-weekly telephone contact was established with these households to assess the health seeking behavioral response of the individuals with respiratory infection episodes separately for laboratory confirmed influenza, and two other clinically defined infection episodes that are influenza like illness (ILI) and acute respiratory infection (ARI) episodes. Descriptive analyses were performed to assess the health care utilization within various health care delivery institutions. Multivariable logistic regression models were applied to determine the association of demographic factors with the health seeking behavior of individuals with respiratory infection episodes. Fischer exact test was used to analyze the association of promptness of health care contact with ARI and ILI episodes. Multivariable logistic regression model was used to analyze the association of demographic factors of ILI patients with early health care contact. Results: The results showed that seeking health care varied by the severity of illness and characteristics of the patients/ parents. As compared with the patients of ARI (non-ILI) episodes, higher proportion of ILI patients sought medical care and among all the health care delivery systems, private health care delivery system was attended by majority of the patients. Individuals with ILI episodes more likely to seek health care were male patients by 66% (Crude OR 1.66; 95% CI 1.01-2.77), and children below 10 years by 219% (Crude OR 3.19; 95% CI 1.30-7.79). Within the group of laboratory confirmed influenza patients, adjusted odds ratio showed male patients 243% more likely to seek health care (Adjusted OR 3.43; 95% CI 1.01-11.63). Unemployed ILI adult patients were less likely to seek medical care (Crude OR 0.39; 95% CI 0.15-0.98), and employed ARI (non-ILI) patients were 52% more likely to attend medical care (Crude OR 1.52; 95% CI 1.10-2.08). Health care contact within 24 hours of onset of symptoms was significantly associated with ILI patients (OR 1.85; 95% CI 1.33-2.59; p-value 0.0003) showing that patients with febrile ARI were more likely to seek early health care rather than patients with afebrile ARI. Conclusion: The differences in the health seeking behavior demonstrated in this study indicate inequalities in the health care services utilization. Higher and earlier utilization of health care services by patients with ILI episodes during low influenza activity period might result in the overburdening of the health care system. In order to address these issues, policy makers should have a clear understanding of populations’ preventive and enabling factors to seek health care, perceptions of the risk of disease, self-care behaviors and health education levels. / published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Education / Master / Master of Education

Wenhong Wang. / "December 2003." / Description based on full citation and abstract (viewed May 20, 2006) / Thesis (Ph.D.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (p. 125-143). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.