Intrinsic and Extrinsic Barriers to Health Care: Implications for Problem Gambling
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To establish guidelines for research into help for problem gambling, this paper reviews literature on barriers to access and utilisation of health care for alcohol abuse, substance abuse and mental health problems. Research findings from international and New Zealand studies are examined, highlighting gender differences and cultural aspects. Intrinsic factors are presented within the transtheoretical model of change (TTM). Extrinsic barriers consist of predisposing, enabling and need factors, according to the socio-behavioral model (SBM). The dynamic interaction between intrinsic and extrinsic factors is explained by the network-episode model (NEM) which emphasises the importance of social networks and events. Personal, socio-cultural and institutional reasons for delays in seeking help are presented. The greatest barriers to seeking health care are intrinsic. Specific research questions regarding the implications for barriers to help for problem gamblers and their families are proposed. In conclusion, the SBM and the NEM seem to explain barriers to health care access and utilisation for addictive disorders and mental health problems better than the TTM. Barriers to health care access and utilisation for substance abuse and mental health problems may have some relevance to similar barriers for problem gamblers and their families.
KeywordsProblem gambling New Zealand Transtheoretical model of change Socio-behavioral model
The research on which this paper is based was funded by a grant from the New Zealand Ministry of Health (MOH: 467589/303177/00).
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