CHAPTER 2 REVIEW OF RELATED LITERATURE

Chapter 2 presents the review of related literature and studies that support and

contextualize the present investigation. It is organized into two major sections: (1)

Health-Seeking Behavior, (2) Synthesis

Part One, Health-Seeking Behavior, discusses how individuals recognize,

interpret, and respond to illness from the initial perception of symptoms to

decisions about whether and where to seek care. While encompassing a broad

range of actions and choices, this section focuses on how cultural beliefs,

perceived severity of illness, expected effectiveness of treatment, accessibility of

services, and contextual constraints influence the selection of traditional,

spiritual, or biomedical forms of care. It emphasizes the adaptive and context-

dependent nature of health-seeking behavior, particularly in communities where

plural medical systems coexist.

Part Two, Synthesis, presents a cohesive analysis of how individuals perceive

and. respond to illness, the factors that influence their healthcare decisions, and the

patterns of care they adopt.

Plural Health-Seeking Behavior

Conceptual Literature
Health-seeking behavior is defined as the sequence of actions individuals undertake to

recognize, interpret, and respond to perceived health problems. Conceptually, this

process is understood as dynamic and adaptive, rather than linear, as individuals

continuously reassess symptoms, available resources, and perceived risks. Illness

perception plays a central role, as symptoms are evaluated based on cultural beliefs,

prior experiences, and shared community interpretations, which influence whether

individuals view illness as manageable through self-care or requiring professional

intervention.

From a sociocultural perspective, health-seeking behavior is embedded within belief

systems, traditions, and social relationships. In many communities, traditional healing

practices, spiritual explanations of illness, and reliance on family or peer advice coexist

with biomedical care. These plural medical systems shape early care-seeking decisions,

particularly when formal services are perceived as inaccessible, costly, or culturally

incongruent. Plural health-seeking behavior is therefore viewed as a rational and

context-sensitive response to health needs.

Structural and systemic factors further influence health-seeking behavior. Geographic

accessibility, transportation availability, cost of services, staffing levels, and perceived

quality of care shape both the timing and type of care sought. These concepts frame
health-seeking behavior as an interaction between individual agency and external

constraints, providing a theoretical foundation for examining behavior within specific

community contexts.

Empirical Literature

Foreign Studies

Pham et al. (2021) conducted a cross-sectional quantitative study examining patterns of

healthcare utilization among community-dwelling adults. Using structured

questionnaires, the authors assessed initial responses to illness and timing of

professional consultation. Findings revealed that a large proportion of participants first

engaged in self-care or sought advice from family members before consulting

healthcare professionals. Delays in formal care were strongly associated with

accessibility barriers, including cost and distance, leading the authors to conclude that

delayed care-seeking reflects adaptive decision-making rather than negligence.

Alor et al. (2024) employed a mixed-methods design to explore health-seeking behavior

among individuals with chronic illnesses. Quantitative survey data identified patterns of

repeated movement between community-based and biomedical care, while qualitative

interviews provided insight into patient reasoning. The study found that participants

regularly reassessed treatment options based on perceived effectiveness, affordability,

involves iterative and flexible care-seeking pathways.

Lee et al. (2025) utilized a longitudinal qualitative approach to examine care-seeking

behavior in settings with multiple healthcare options. Through repeated interviews, the

study documented how individuals modified their care-seeking decisions over time in

response to changing symptoms and treatment outcomes. The findings highlighted

health-seeking behavior as an evolving process shaped by lived experience rather than

a fixed pattern.

Mabetha et al. (2021) conducted a cross-sectional study on caregivers of children,

focusing on early responses to childhood illness. Data analysis showed that caregivers

who initially relied on home remedies or informal providers were more likely to delay

professional care. The authors concluded that early decision-making plays a critical role

in determining child health outcomes.

Haquea and Mohd (2025) investigated healthcare-seeking behavior among caregivers

of children under five using survey methods. Their findings indicated that reliance on
self-care and traditional providers was common when symptoms were perceived as

mild. Socioeconomic status, maternal age, and geographic location significantly

influenced delays in seeking formal care, leading to the conclusion that structural

inequities remain central determinants of care-seeking behavior.

Zhou et al. (2021) analyzed national survey data to assess how health system structure

influences care-seeking. The study found that uneven distribution of healthcare facilities

prompted individuals to seek care from the most accessible sources, often delaying

professional consultation. Shen and Tao (2022), using qualitative methods, further

demonstrated that distance and transportation difficulties discouraged timely utilization

of formal healthcare. Both studies emphasized the need for decentralized services.

Le et al. (2024) employed a qualitative design informed by the Health Belief Model to

examine treatment-seeking behavior for suspected dengue infection. Semi-structured

interviews revealed that participants initially engaged in self-management practices due

to perceived service limitations and long waiting times. The authors concluded that

perceived benefits and barriers strongly shaped delayed professional consultation.

identify determinants of healthcare utilization. The study found that geographic distance,

travel time, financial capacity, and prior experiences with medication influenced both the

decision to seek care and provider choice. The authors concluded that access and

economic factors jointly shape health-seeking behavior.

Local Studies

Evangelista and Lorenzo (2021) explored health-seeking behavior in rural Philippine

communities using qualitative interviews. The study documented a common sequence

of care beginning with home remedies and traditional healers before progressing to

barangay health centers or hospitals. The authors concluded that care-seeking

decisions are shaped by cultural validation and social relationships.

Jardeleza et al. (2025) conducted a descriptive study examining traditional health

practices among Filipino households. Findings showed persistent use of herbal

medicines and hilot as first-line responses to illness, reflecting belief systems centered

on balance and harmony. The study emphasized the cultural embeddedness of early

care-seeking decisions.
Rondilla et al. (2021) investigated healthcare utilization in urban populations using

survey methods. Results indicated that cost, convenience, and previous negative

healthcare experiences contributed to delayed biomedical consultation. The authors

concluded that plural care-seeking persists even in urban settings.

Soberano et al. (2023) examined age-related differences in health-seeking behavior

through community surveys. Older adults were more likely to follow formal referral

pathways, while younger individuals combined traditional, informal, and biomedical

strategies, highlighting the influence of age and health literacy.

Kawi et al. (2024) used qualitative methods to assess sources of health information in

underserved communities. The study found that family and informal networks were

primary sources of guidance, leading to delayed formal consultation. The authors

concluded that limited access to reliable health information shapes early care-seeking

behavior.

To et al. (2025) examined adults with undiagnosed hypertension using mixed methods.

Findings revealed delays in formal diagnosis due to limited screening access and
financial constraints, resulting in reliance on self-management. The study emphasized

the role of accessible primary care.

Cruzada (2025) conducted a cross-sectional study in island barangays and documented

significant delays in accessing professional healthcare due to transportation challenges,

weather conditions, and financial limitations. The study concluded that geographic

isolation compounds existing access barriers.

Reñosa et al. (2020) examined caregiver responses to childhood respiratory infections

and found that perceived severity and access constraints influenced reliance on home

remedies and drugstores. Lincoln et al. (2020) highlighted the role of social trust in

engagement with formal health programs. Estrada (2024) identified systemic barriers

including infrastructure gaps, workforce shortages, and sociocultural factors shaping

health-seeking behavior in underserved communities.

Synthesis

The reviewed literature consistently portrays health-seeking behavior as a dynamic and

adaptive process influenced by cultural beliefs, social relationships, and structural

informal support and transitioning to formal healthcare as symptoms persist or worsen.

Empirical findings highlight recurring themes such as the influence of perceived illness

severity, prior healthcare experiences, geographic accessibility, and financial capacity.

Vulnerable populations, including children, older adults, and residents of geographically

isolated communities, are particularly affected by early care-seeking decisions.

Despite extensive research on pluralistic care-seeking, limited attention has been given

to how these factors interact within island and underserved settings. By examining

health-seeking behavior in a specific local context, the present study builds on existing

literature and contributes to a more contextualized understanding of care-seeking

patterns.

SYNTHESIS
Health-seeking behavior is a dynamic and adaptive process influenced by individual,

social, cultural, and systemic factors. Individuals often rely initially on self-care, informal

networks, or traditional remedies, delaying engagement with formal healthcare due to

accessibility, financial limitations, or perceived service constraints. Decisions are

iterative and context-dependent, shaped by symptom severity, treatment outcomes,

prior experiences, and social networks. Structural factors such as geographic isolation,

uneven distribution of healthcare facilities, transportation challenges, and limited

primary care services further affect the timing and type of care sought. Vulnerable

populations, including children and older adults, are particularly affected, as early

decisions by caregivers or patients can directly influence health outcomes, while

pluralistic pathways reflect both cultural norms and pragmatic adaptation. In the

Philippine context, informal networks and traditional practices continue to guide initial

care-seeking, with age, health literacy, and resource availability shaping engagement

with formal services.

Despite extensive research on adaptive and pluralistic care-seeking, there is limited

understanding of how these behaviors unfold in geographically isolated and

underserved communities, particularly on islands where access, culture, and

socioeconomic factors intersect uniquely. Examining local patterns can clarify the

barriers residents face and provide insights into how health systems and community-

based strategies can be adjusted to support more timely and appropriate utilization of

formal healthcare. Understanding these dynamics contributes to improving access,

enhancing primary care, and supporting interventions that respond to both the cultural

and structural realities of these communities.