Responses to hypothetical health scenarios overestimate healthcare utilization for common infectious syndromes: a cross-sectional survey, South Africa, 2012

Karen K. Wong, Adam L. Cohen, Neil A. Martinson, Shane A. Norris, Stefano Tempia, Claire von Mollendorf, Sibongile Walaza, Shabir A. Madhi, Meredith L. McMorrow, Cheryl Cohen

Asking people how they would seek healthcare in a hypothetical situation can be an efficient way to estimate healthcare utilization, but it is unclear how intended healthcare use corresponds to actual healthcare use. We performed a cross-sectional survey between August and September 2012 among households in Soweto and Klerksdorp, South Africa, to compare healthcare seeking behaviors intended for hypothetical common infectious syndromes (pneumonia, influenza-like illness [ILI], chronic respiratory illness, meningitis in persons of any age, and diarrhea in a child < 5 years old) with the self-reported healthcare use among patients with those syndromes. For most syndromes, the proportion of respondents who intended to seek healthcare at any facility or provider (99-100%) in a hypothetical scenario exceeded the proportion that did seek care (78-100%). More people intended to seek care for a child < 5 years old with diarrhea (186/188 [99%]) than actually did seek care (32/41 [78%], P < 0.01). Although most people faced with hypothetical scenarios intended to seek care with licensed medical providers such as hospitals and clinics (97-100%), patients who were ill reported lower use of licensed medical providers (55-95%). People overestimated their intended healthcare utilization, especially with licensed medical providers, compared with reported healthcare utilization among patients with these illnesses. Studies that measure intended healthcare utilization should consider that actual use of healthcare facilities may be lower than intended use.