Basic cultural values and differences in attitudes towards health, illness and treatment preferences within a psychosomatic frame of reference

Background: Regarded from a biopsychosocial point of view, a culturally determined differential impact of values, lifestyles and attitudes can be expected on health and illness concepts, exerting a potential influence on the general satisfaction with the health care system as well as on subjective treatment preferences. Methods: 57 men and 63 women between 16 and 86 years of age in the Netherlands and 45 men and 39 women aged between 15 and 78 years in Japan took part in the study. Questions to the subjects were not exclusively restricted to medical care but comprised the potential relationship between health and illness on the one hand, and lifestyles, values, attitudes and treatment preferences on the other. On the basis of previous experience with data from the Dutch sample 27 questions were selected and, using the whole sample, submitted to a factor analysis. Furthermore subjective health and illness attributions were compared by means of a projective technique. Results: The factor analysis resulted in five dimensions: relaxation, work, hedonistic goals versus social status, family life versus career making, alternative versus conventional medical care, with three significant differences between the two countries and two significant gender effects. The projective technique revealed two cultural differences in illness attributions. Conclusions: The implications of these results for possible health promotion campaigns and a differential choice of health-care strategies are discussed from within a psychosomatic frame of reference. It is hypothesized that the revealed differences can also be useful for attempts at a group-specific increase of acceptance and compliance of certain treatments.