title: Use of medical tourism for hip and knee surgery in osteoarthritis: a qualitative examination of distinctive attitudinal characteristics among Canadian patients.
abstract: BACKGROUND
  Medical tourism is the term that describes patients' international travel with the intention of seeking medical treatment. Some medical tourists go abroad for orthopaedic surgeries, including hip and knee resurfacing and replacement. In this article we examine the findings of interviews with Canadian medical tourists who went abroad for such surgeries to determine what is distinctive about their attitudes when compared to existing qualitative research findings about patients' decision-making in and experiences of these same procedures in their home countries.
  
  
  METHODS
  Fourteen Canadian medical tourists participated in semi-structured phone interviews, all of whom had gone abroad for hip or knee surgery to treat osteoarthritis. Transcripts were coded and thematically analysed, which involved comparing emerging findings to those in the existing qualitative literature on hip and knee surgery.
  
  
  RESULTS
  Three distinctive attitudinal characteristics among participants were identified when interview themes were compared to findings in the existing qualitative research on hip and knee surgery in osteoarthritis. These attitudinal characteristics were that the medical tourists we spoke with were: (1) comfortable health-related decision-makers; (2) unwavering in their views about procedure necessity and urgency; and (3) firm in their desires to maintain active lives.
  
  
  CONCLUSIONS
  Compared to other patients reported on in the existing qualitative hip and knee surgery literature, medical tourists are less likely to question their need for surgery and are particularly active in their pursuit of surgical intervention. They are also comfortable with taking control of health-related decisions. Future research is needed to identify motivators behind patients' pursuit of care abroad, determine if the attitudinal characteristics identified here hold true for other patient groups, and ascertain the impact of these attitudinal characteristics on surgical outcomes. Arthritis care providers can use the attitudinal characteristics identified here to better advise osteoarthritis patients who are considering seeking care abroad.
authors.affiliation: Department of Geography, Simon Fraser University, 8888 University Dr, Burnaby, BC, V5A 1S6, Canada. crooks@sfu.ca
authors.forename: Valorie A
authors.initials: VA
authors.lastname: Crooks
authors.forename: Keri
authors.initials: K
authors.lastname: Cameron
authors.forename: Vera
authors.initials: V
authors.lastname: Chouinard
authors.forename: Rory
authors.initials: R
authors.lastname: Johnston
authors.forename: Jeremy
authors.initials: J
authors.lastname: Snyder
authors.forename: Victoria
authors.initials: V
authors.lastname: Casey
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000523:psychology; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology; D001294:Attitude to Health; D002170:Canada; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D057193:Medical Tourism / Q000523:psychology*; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery*; D020370:Osteoarthritis, Knee / Q000601:surgery*; D017060:Patient Satisfaction