Abstract
BackgroundIn this article we describe a phenomenological lifeworld study based on the theory of communicative action of 13 women with noncommunicable disease (NCDs) in a rural area in South Africa. The purpose of the study was to generate key concepts of health care access and the management of NCDs in a rural South African context.MethodsThe study employed a qualitative methodology with serial semistructured interviews. We used a content analytical approach to analyse key themes and patterns in participants’ narratives of NCDs and health care access.ResultsThe findings are reported by theme and include analyses of narrative sequences related to 1) family environment, 2) experiences of NCDs, 3) understandings of the causes of NCDs, 4) accessibility of formal health care services, 5) experiences of formal health care services, 6) treating NCDs, and 7) experiences of informal health care services. The findings suggest that participation in the routines prescribed by formal health care services and reinforced by families and faith-based communities normalises the experience of NCDs to the extent that narratives of NCDs form the background, rather than the focus of broader illness narratives. Such narratives rather tend to focus on significant life events and relationships. The key features of the narratives include connections between social or autobiographical and biological understandings of NCDs, the appropriation of modern concepts of disease in illness narratives, and reflexive commentary on the modern features of NCDs. In the context of such narrative expertise formal health care services have a high level of acceptability in this rural area.ConclusionLifeworld analysis of health care access based on the theory of communicative action places consensual understandings of NCDs and their treatment as central to the health care experience. Our findings suggest that such analyses can facilitate potential feedback processes between health care users and professionals which generate consensus as well as institutional reform within formal health care services.
Highlights
In this article we describe a phenomenological lifeworld study based on the theory of communicative action of 13 women with noncommunicable disease (NCDs) in a rural area in South Africa
This study addressed the question: “How do women with NCDs experience their illness and access health care in a rural South African setting?” We answered this question with a qualitative methodology, using serial semistructured narrative interviews with women with NCDs
The findings begin with contextual findings related to family support, and continue to describe experiences and explanations of NCDs, access to and experiences of formal health care services, self-managed treatment of NCDs and the use of informal health care services
Summary
In this article we describe a phenomenological lifeworld study based on the theory of communicative action of 13 women with noncommunicable disease (NCDs) in a rural area in South Africa. The use of a variety of health care service providers, and the delayed use of modern allopathic health care services are prevalent themes in much of the health access literature in low- and middle-income and rural settings in Africa [4,5,6,7,8]. Such health-seeking practices are characterised by “healer shopping” (switching numerous times between healers), poor knowledge of allopathic or formal clinical diagnosis, and using formal health care facilities such as the clinic as a last resort after traditional or informal therapies are judged to have failed [9]. We describe a qualitative study conducted with 13 women with NCDs in rural north eastern South Africa
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