Publicatie datum

All in the family?: context matters.

Cardol, M., Groenewegen, P.P., Bakker, D.H. de, Spreeuwenberg, P., Dijk, L. van, Bosch, W. van den. All in the family?: context matters. European Journal of Public Health: 2004, 14(4 Suppl.) 22. Abstract. 12 th Annual EUPHA meeting: Urbanisation and health: new challenges in health promotion and prevention in Oslo, Norway, 7-9 october 2004.
Background: Efforts from general practitioners to promote a healthy lifestyle or to influence consultation patterns may conflict with patients’ family habits and attitudes at home. Families share beliefs and behaviours on illness and health, thereby influencing each other’s utilisation of doctor’s care. Aim: Given an increasing focus on individuality in health care and daily living, changes in parenting and family composition we wanted to examine to what extent living
together as a family still influences individual utilisation of general practitioners’ care. If so, an important second step is to identify families ‘at risk’ for overuse and those ‘at risk’ for underuse of general practice care. Methods: Data from the Second Dutch National Survey of General Practice were used. In 2001 all contacts of patients during one calendar year were registered. Data for this study contained 42.262 families with children between 2-21 yrs of age registered in 96
Dutch practices. Multilevel modelling was used to analyse contact frequencies of individuals within families within practices. Results: Corrected for patients’ age and gender, sibling analysis shows that 22% of the variance in frequencies of contacts can be ascribed to family resemblance, almost 6% of the variance refers to differences between practices and 73% of the variance refers to individual differences. Strongest correlations were found between mothers and children and between children. Further analysis showed that 8% of the families were at risk for overuse of general practitioners’ care and 1,4% was at risk for underuse. Conclusions: The results of the study stress the importance of still considering the family as an important contextual factor in health promotion and help-seeking behaviour. In the resentation the families at risk will be further compared with other families. Furthermore, in health (services) research, clustering of individuals in their social context has a surplus value in terms of controlling for contextual influence as well as evaluating the size of contextual influence.