Healthcare seeking in gastro-oesophageal reflux disease: a qualitative study

Gastro-oesophageal reflux disease (GORD) is a common problem in the community, and many patients do not seek medical attention despite potential morbidity and the availability of effective therapeutic interventions. The factors which determine healthcare seeking in GORD are not well understood.

To examine the symptom experience and health and illness beliefs in people with GORD, who had either been diagnosed with the condition, or were dealing with the symptoms themselves.

A total of 12 focus groups and 65 face-to-face interviews were conducted in the USA, UK, France and Germany, and involved 164 participants, who had either been diagnosed with GORD or were identified as having GORD in the community, using a random digit dialling telephone method. Transcripts of focus groups and interviews were analysed thematically, using a constant comparative approach, to identify key factors associated with healthcare seeking.

Patients' descriptions of GORD symptoms were often vivid, with the use of unexpected imagery and unusual beliefs about causality. We were able to identify four factors associated with healthcare seeking for GORD which were: the characteristics of symptoms (intensity and control), the perceived seriousness of symptoms, interference by symptoms with daily life and views about medicines and the medical profession.

Patients with GORD, using both self care and formal medical care, have a surprising range of ideas about the causes and best treatments of their symptoms. Physicians' awareness of these beliefs, coupled with an understanding of the factors associated with healthcare seeking for GORD, is likely to be important in enhancing clinical management and in patient and public education.