title: Barriers of Chinese primary care attenders to seeking help for psychological distress in Hong Kong.
abstract: BACKGROUND
  Most of the previous studies on help seeking for psychological distress were derived from Western countries. This study investigated the barriers to help-seeking for psychological distress among Chinese primary care attenders in Hong Kong.
  
  
  METHODS
  Nine focus groups and 6 individual interviews were conducted among Chinese primary care attenders with/without known distress, patients' significant others and the general public. The identified barriers were investigated in a questionnaire survey with data from 1626 primary care attenders recruited from 13 private clinics and 6 public clinics.
  
  
  RESULTS
  Worries about side effects of drugs (79.9%, 95% CI:(77.9%, 81.8%)) and drug dependency (74.7%, 95% CI:(72.5%, 76.8%)) were rated as the top barriers in the survey. Qualitative interviews found both worries and actual experience of the side effects of drugs, which weakened patients' trust in the treatment. Factor analysis on all barrier items suggested three factors: 1) worries of treatment, 2) uncertainties on primary care physicians' capacity, 3) public's limited knowledge on distress and sources of help. Distress level, education level and age were associated with factor 1, whereas distress level and healthcare setting were associated with the other two factors. Qualitative interviews revealed that not having a regular primary care physician in the public setting discouraged disclosure of psychological problems.
  
  
  CONCLUSIONS
  The findings were based on self-reported data from the respondents. Hong Kong is influenced by a mixed Chinese and Western culture.
  
  
  CONCLUSIONS
  Relevant public education in a Chinese context should target at reducing patients' worries of drug treatment and strengthening the image of primary care physicians as a feasible source of help.
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
authors.forename: Kai Sing
authors.initials: KS
authors.lastname: Sun
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong. Electronic address: tplam@hku.hk.
authors.forename: Tai Pong
authors.initials: TP
authors.lastname: Lam
authors.affiliation: Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong.
authors.forename: Kwok Fai
authors.initials: KF
authors.lastname: Lam
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong; Kwai Chung Hospital, Hong Kong.
authors.forename: Tak Lam
authors.initials: TL
authors.lastname: Lo
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong; Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Hong Kong.
authors.forename: David Vai Kiong
authors.initials: DV
authors.lastname: Chao
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
authors.forename: Edmund Wing Wo
authors.initials: EW
authors.lastname: Lam
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety; D044466:Asian People / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011320:Primary Health Care; D036301:Qualitative Research; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D035502:Trust; D055815:Young Adult
keywords: Barriers; Chinese; Help-seeking; Primary care; Psychological distress