Social Networks, Lay Consultation and Help-Seeking Behavior

This article considers the question: What is the apparent role of the family, its kin and friendship networks in the use of health and welfare services? Eighty-seven working-class families (consisting of two subsamples of carefully defined "utilizing" and "underutilizing" respondents) were studied in Aberdeen, Scotland over a period of roughly one and a half years. After controlling for socioeconomic status, parity, education level, proximity to services, and length of residence in the city, noteworthy differences were found between the utilizers and underutilizers on various aspects of their social networks. The underutilizers relied on an undifferentiated group of readily available relatives and friends as lay consultants before using the service, while utilizers appeared to both differentiate between relatives and friends, and be independent of both of these sources of social control. An attempt is made to trace some of the implications of these differences for the understanding of help-seeking behavior. Although of considerable potential, the concept of a social network is one of the most underdeveloped and underemployed concepts in present day sociology. In a recent discussion, Mitchell (1969) observed that while prompting a number of useful inquiries, it has seldom been employed as an explanatory tool, and much of the work to date appears to have associated the concept almost exclusively with the notion of conjugal roles.? Its considerable utility and explanatory power, when incorporated in propositions relating to other areas of social behavior has yet to be fully explored. Perhaps it is truistic to point out that the family, its kinship and friendship networks, influence the manner in which individuals define and act (or fail to act) upon symptoms or life ' This article reports some of the results of an intensive exploratory study, supported by the Nuffield Provincial Hospitals Trust, of the utilization behavior of a lower working-class subculture in Aberdeen, Scotland. I would like to acknowledge the debt I owe Mr. Gordon Horobin (Aberdeen University), Professor J. Clyde Mitchell (Manchester University), and Sonja McKinlay (Harvard University) for comments on earlier versions of this paper. I Of particular interest in this regard is the classic study by Bott (1957) of conjugal roles in London families. In this study she correlated some of the characteristics of the social networks of the families she was investigating with the pattern of conjugal roles within the family. crises. Suchman (1965) found that three quarters of the respondents in his New York Study reported discussing their symptoms with some other person (most often a relative) before seeking formal medical care. Zola (1964) included the influence of others ("the presence of sanctioning") as a key trigger in a person's decision to seek medical care. Lee (1969) employed network concepts while describing the process of obtaining an abortion. Various models of prepatient health and illness behavior have recently been interpreted in network terms by Bloor (1970). Apart from such studies however, there have been remarkably few direct attempts to specify the nature of social network influences on help-seeking behavior, and many unanswered-and often unformulated-questions await attention. For instance, is it possible to detect intrafamily patterns of utilization behavior? Are there certain conditions or medical states in which the members of the total family play a more important role in defining, consulting, and referring, while others involve noticeably fewer members? Does the geographical proximity of the family, related kin and friends, affect the nature of its influence on utilization behavior? Are kin and friends more important determinants of the use of services than such variables as social class, ethnic group, or even region? Does the total family play a more in-