This is the first study to develop a list for assessing the trend in choosing lay and professional care in HSB and verifying its validity and reliability. The two phases of the study were designed to confirm content validity through various forms of data collection and testing. This list can provide a stepping-stone for further research regarding HSB of individuals and health outcomes.
Content validity of the list was examined through diaries of symptoms, review of previous studies, and one-to-one interviews. Content validity is vital for lists because it ensures the list accurately evaluates what the study intends to measure, which this study accomplished through a survey assessing patients’ real HSB, providing real situational evidence to various HSB choices [16, 17]. Existing studies were also used when developing list items because they discuss the categorization and concepts of the severity of symptoms [16, 17]. Furthermore, the one-to-one semi-structured interviews deepened the understanding of the behaviors, allowed for further inquiry into possible behaviors, and confirmed behaviors suggested in the analysis of the diaries and research reviews.
The analysis exemplified the list’s high construct validity and reliability by comparing the real activities and results of the checklist and test-retest. Through this comparison, a strong correlation was found between the two; therefore, the list has high validity . As the participants were allowed to simultaneously choose multiple items in the list, the correlation and test-retest were performed for both lay and professional care, and high reliability and validity in both categories were found .
The patients’ symptoms in this study were similar to those in previous studies, but the rate of using primary care physicians was higher and the rate of self-care was lower than other studies [16, 24, 25]. This finding may be due to the medical conditions of older patients in developed countries, especially rural Japan . Older patients tend to have a variety of symptoms and may have difficulties managing those symptoms . In addition, as many older people are isolated and live only with their partners without enough help, this can lead to a trend of depending on medicine. Opposingly, the rate of self-care and self-medication with mild symptoms (using home medicine and over-the-counter medicine) was high . This finding may reflect the trend of older people changing their behaviors and being more motivated to take care of their health. This may be because older people can have vague/irregular symptoms in combination with aging, meaning that there are unavoidable symptoms accompanied by prejudices [24, 26, 27, 28]. However, there has been no study on the relationship between HSB and health outcomes, as well as aging [29, 30]. Future research should investigate this relationship and interventions for improving older people’s HSB should be developed.
There are several limitations to this study. Regarding validity, although the content validity was clarified, the construct validity for professional care with mild symptoms was not clarified. The various presentations of mild symptoms, such as durations and timing, affect HSBs, making identifying real HSBs difficult. HSB can depend on the individual’s situation. Living environment can change HSB in terms of three factors: accessibility, availability, and affordability [31, 32]. The setting of this study was rural, so these three elements may have been low, potentially causing minimal use of primary care and other medical institutions. As the list is comprehensive and contains various behaviors, it can be used in different settings, clarifying multiple types of HSB. Another limitation is the difference in health insurance between countries. Japan’s medical system is a free access system; thus, Japanese people can access medical institutions anytime and anywhere . When applying this list to other countries’ settings, other possible behaviors should be considered based on the local medical systems.