Variation in the choice of treatment in two Mexican communities

Abstract

This paper examines the relationship between lay illness beliefs, accessibility of Western health-care sources, and rates of physician utilization in two neighboring rural communities in Mexico. One of these communities--Pichátaro--has restricted access to sources of a physician's treatment, while the other--Uricho--has, comparatively, good access to physician's services, including some available at no cost. Data from illness case histories collected from samples of households in each town show the Uricho people to consult a physician in nearly twice as many cases. Systematically-elicited data on the illness beliefs of informants from each town are compared in order to evaluate two competing views of the relationship between adherence to traditional ethnomedical beliefs and the choice of a physician's treatment. One of these--the 'conceptual-incompatibility' hypothesis--emphasizes the importance of congruence between clients' conceptions of illness and scientific medical theory as a criterion for the choice of a physician's treatment. Accordingly, it would predict that, in comparison with the Pichátaro sample, the higher rate of use of a physician's treatment by the Uricho people should be accompanied by a greater orientation toward Western medicine in their beliefs. The second position--that emphasizing accessibility of services--would argue that traditional illness beliefs do not represent a primary barrier to the choice of a physician's treatment, and therefore differences in the beliefs of the two groups need not be anticipated and do not constitute a necessary prerequisite for the more frequent choice of a physician's treatment among the Uricho people. The findings from the illness belief interviews offer little support for the conceptual-incompatibility position. No basis is found upon which to claim significant differences between the responses of the two groups. This leads to the conclusion that the substantial variation in the use of a physician's treatment between the two samples, a consequence of differential access to such treatment, occurs without corresponding degrees of variation in residents' illness beliefs. Some reasons for this lack of divergence are discussed, and limits on the applicability of the study's findings are outlined.