Academic journal article Family Relations

Partnered Decisions? U.S. Couples and Medical Help-Seeking for Infertility

Academic journal article Family Relations

Partnered Decisions? U.S. Couples and Medical Help-Seeking for Infertility

Article excerpt

We examined male partners' influence on the decision to seek medical help for infertility using the National Study of Fertility Barriers. Building upon an existing help-seeking framework, we incorporated characteristics of both partners from 219 heterosexual couples who had ever perceived a fertility problem. In logistic regression analyses, we found an association between couple-level attitudes and medical help-seeking even when other predisposing and enabling conditions existed. Overall, the findings highlight that both partners contribute to the infertility help-seeking process, and that different factors may play a role in different stages of help-seeking. Studies of infertility help-seeking need to be more inclusive of the context that these decisions are embedded within to better understand service use.

Key Words: couples, decision-making, gender and infertility, help-seeking, infertility.

Medical help-seeking for infertility is a complex family health issue that is demanding increased attention. Since the 1980s, there has been growing demand for and availability of infertility services; nevertheless, less than one-half of women who meet criteria for fertility problems seek medical help (Stephen & Chandra, 2000). Despite the growth in the number of women seeking medical help for infertility, researchers remain puzzled why such a large proportion does not seek medical help (Kalmuss, 1987; Stephen & Chandra).

The majority of help-seeking studies for infertility have focused mainly on women despite long-standing acknowledgment that infertility is inherently a couple issue with social dimensions (Greil, 1997; Greil, Leitko, & Potter, 1988; Lorber& Bandlamudi, 1993; Matthews & Matthews, 1986; Stephen & Chandra, 2000). We suggest that medical help-seeking behavior for infertility cannot be understood by studying only individual partners because it is necessarily a dyadic process for couples (Greil et al., 1988). The onset, cognition, and outcome not only involve the individual afflicted with the medical problem but also affect the fulfillment of social roles for both partners.

Conceptual and Empirical Background

The health behavior model (Andersen, 1968), which was originally developed and subsequently expanded to address health care utilization, provides a useful framework for understanding medical help-seeking for infertility. This model organizes aspects of health care use into three main components: predisposing, enabling, and need factors. Predisposing factors are characteristics that "exist prior to the onset [of an illness episode]" and increase propensity to use health services. Specifically, Andersen pointed to "family composition, health beliefs, and social structure" (p. 15) as key predisposing factors. Enabling factors are the means or conditions through which health services are made available to people, such as individual and family resources like health insurance or community resources like local availability of services. Finally, need factors refer primarily to individuals' appraisals of their health or healthrelated experiences.

Revisiting his original health behavior model, Andersen (1995) observed that social relationships fit conceptually as an enabling factor, acting to either "facilitate or impede" health service use (p. 3). Andersen's observation is supported by a body of empirical work documenting the function of social relationships, particularly family member involvement in helpseeking and medical decision-making. Bass and Noelker (1987) pointed to the relationship between the family's ability to provide care and elderly patients' use of professional services. Looking at help-seeking pathways for patients with brain tumors, Salander, Bergenheim, Hamberg, and Henrikkson (1999) found that spouses played a key role in urging helpseeking and also provided useful information to physicians about symptoms and behavior that patients were not immediately aware of. …

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