Non-use of physicians: Methodological approaches, policy implications, and the utility of decision models

This paper considers ethnographic approaches to the study of health-care choice making in medically pluralistic settings. It focuses on the ways in which different methodological orientations may lead to varying explanations for the non-use of Western-style medical treatment, having dissimilar implications for policies concerning the delivery of health services in such settings. Several approaches are evaluated in terms of their utility for determining the relative effects of endogenous, culturally derived influences, as compared with exogenous, primarily accessibility-related factors, as constraints on the choice of a physician's treatment. Results of the application of a cognitively-oriented decision modeling approach in a rural Mexican community are described, and the comparative advantages of this approach are emphasized.