Review of the literature

In the last ten years, there has been keen research, especially in the USA, into the social and psychological reasons influencing the approach to community health resources. Many workers have studied the approach to hospitals, outpatient clinics, private practitioners and healers, and the reasons for taking this step. The studies have revealed that women visit hospitals more frequently than men and that the frequency increases among both sexes with age (99). It has also been shown that the utilization of health resources varies in direct proportion to the social class (48). Holders of health insurance policies use medical care facilities, especially hospitals (14). As a rule, these studies have sought to elucidate the social background factors in detail. They have not explained why people seek medical advice, why some delay while others do not, why some consult physicians and others go to healers. The replies to these questions have been sought in various motivation studies, in which the medical behaviour of the public ,has been studied systematically. A partial reason for the poor results achieved in the studies may be the evident difficulty of establishing objectively measurable quantities in human behaviour and its measurement in the socio-psychological field. One of the studies in this field that ranks as almost classical is that of Merril and co-workers (1958) on the attitudes of Californians to poliomyelitis vaccination. They showed that friends, neighbours and the family doctor decided the issue. Several other factors have also been found to influence the illness behaviour in the diseases of adults (1, 23, 25, 45, 47, 48, 50, 52, 63, 71, 85, 86, 93). The wellknown English field study conducted under the supervision of Spence (1954) showed that there was no correlation between the socio-economic status of the family and the probability of hospital admission for the child. But they found a distinct correlation between the child’s hospital admission and maternal capacity. A child whose mother could not manage to care for it was admitted to hospital twice as often as a child whose mother could look after it satisfactorily. The authors considered the mother’s ability to care for her child as the decisive factor governing the hospitalization of children. O n the other hand, this maternal factor was not important enough to produce a significant correlation with social class. In many respects the book by Miller and co-workers (1960) was a continuation of Spence’s work. Diseases in children were followed for 5 years, and 20.4 per cent of the children were admitted to hospital at least once in the 5 years. After the first year, a few children had repeated admissions, but there was no significant correlation of admission with the mother’s capacity. One of the most complete and detailed studies of the influence of social and psychological factors on children’s hospital admissions was the one carried out by Straus in 1961 among the population of Paris (92). He started from the observation that a considerable number of children were admitted to hospitals in Paris for commonplace diseases. The children were slightly ill, diagnosis produced no