have been aware. Thus the knowledge and social support available to an individual can affect
accessibility of specific health care services.
Second, culture shapes not only illness treatment, but also illness recognition, perception
of illness severity, and confidence in the efficacy of specific treatments for specific illnesses.
For example, in many cultures, dementia in elderly is viewed as a normal process of aging; thus
it does not necessitate medical treatment. However, in the United States, dementia is considered
an illness requiring professional medical care (Ikels, 2002). As such, variance in health care
utilization can result due to cultural knowledge and understandings of illness.
Likewise, categories and perceptions of illness are often cultural. Conceptual-
incompatibility is a hypothesis frequently used to explain why members of another culture refuse
to utilize health services. A person with conceptual-incompatibility would be unlikely to utilize
available health care because the treatment conflicts with their culturally rooted knowledge of
illness (Young & Young-Garro, 1982). For example, if a person staunchly believes they are
infected with influenza yet are told by a healer that they are actually infected with malaria, the
person may not have faith in the treatment prescribed. If a person lacks confidence in the ability
for a healer to treat their illness, they may be unlikely to visit this healer for further treatment.
As such, belief in the efficacy of treatment, influenced by cultural categories of illness, can shape
adherence to prescribed treatment and ultimately the use of health care services.
Beyond faith in efficacy, cultures can have differing notions of the self which may
influence health services utilization. For instance, in the United States as well as many other
western nations, there are two main conceptions of self, one that is autonomous and one that is
heteronomous (Gaines, 1992). If an individual is a member of a culture that considers the self as
heteronomous, they are likely to have their course of treatment determined by people within their
social network (Kleinman, 1980; Ikels, 2002). Conversely,