Healthcare-seeking Decisions Research Articles

Psychometric Assessment of the Farsi Version of Perceived Barriers to Healthcare-Seeking Decision in Iranian Cardiovascular Patients.

Background and Purpose: This study was undertaken to assess the psychometric properties of the Perceived Barriers to Healthcare-Seeking Decision (PBHSD) scale in Iranian patients with acute coronary syndromes (ACS). Methods: In this methodological study conducted from February to June 2022, 255 patients with ACS completed the Farsi version of the PBHSD scale. The study focused on evaluating the face, content, and construct validity of this scale. Additionally, reliability was assessed through measures of internal consistency, including Cronbach's alpha (α) and McDonald's omega, and stability through test-retest analysis. Results: The mean age of the patients in the study was 47.12 (SD = 17.25). Construct validity analysis revealed a single independent factor with an eigenvalue greater than 1, explaining 61.23% of the extracted variance. Cronbach's α and intraclass correlation coefficient were both greater than 0.70 that proved validity of the PBHSD scale. Conclusions: The study's findings indicate that the Farsi version of the PBHSD is both valid and reliable. Consequently, it can be effective to assess and evaluate healthcare-seeking decisions in Iranian patients with ACS.

Factors Influencing the Healthcare-seeking Decisions of Diabetic Patients in Ghana

Factors Influencing the Healthcare-seeking Decisions of Diabetic Patients in Ghana

Barriers and facilitators to healthcare utilisation by Arab sexual minority women migrants in the USA

Limited research on sexual minority women migrants demonstrate that they face elevated rates of mental health problems compared to their heterosexual and male counterparts, and less is known about their healthcare seeking behaviours. This study aimed to identify barriers and facilitators to mental and physical healthcare utilisation among first-generation (foreign-born) Arab sexual minority women migrants in the USA and to assess whether Penchansky and Thomas’ theory of access can be used to understand their healthcare utilisation behaviours. We conducted 20 semi-structured interviews via Zoom. Employing community-engaged research methods, four advisors, Arab sexual minority women migrants and a mental health service provider, assisted in recruitment and thematic data analysis providing a rich and nuanced understanding of study findings. Five main themes demonstrated the pivotal role of cultural humility from providers and access to medical insurance in shaping healthcare-seeking decisions. Difficulties finding therapists and navigating the referral process and wait times encouraged participants to seek care outside of the USA in their Arab countries of origin. Stigma and social support further influenced participants’ decisions to seek mental healthcare. The study findings inform policy and practice to foster the development of inclusive healthcare services grounded in cultural humility and to develop support groups specifically for Arab sexual minority women migrants to the USA.

Parent Care-Seeking Decisions for Pediatric Acute Respiratory Tract Infections in the United States: A Mental Models Approach.

To understand US parent health care-seekingdecisions in the context of multiple in-person and telehealth care options. As the health care landscape evolves, new research is needed to explain how parents now decide when and where to seek acute pediatric health care. We applied a mental models approach, focusing on the archetypal example of care-seeking for pediatric acute respiratory tract infections (ARTIs), by first reviewing pediatric ARTI guidelines with 16 health care professionals to inform 40 subsequent semi-structured interviews with parents of young children in 2021. Interviews were qualitatively coded using thematic analysis, with code frequency and co-occurrence informing the final influence model of parent health care-seeking decisions. Parent interviewees identified 33 decisional factors which were synthesized into seven dimensions influencing care-seeking decisions: perceived illness severity, perceived child susceptibility, parental self-efficacy, expected accessibility of care, expected affordability of care, expected quality of clinician, and expected quality of site. The first three dimensions (perceived severity, perceived susceptibility, parental self-efficacy) influenced an initial decision about whether to seek care, while all seven factors influenced a subsequent decision about where to seek care (eg, in-person primary care, primary care-based telehealth, urgent care, direct-to-consumer telehealth). Uncertainty was present within many dimensions (eg, severity, access, quality) indicating potential targets to support parent decision-making processes and optimize care-seeking behaviors. A mental models approach identified dimensions influencing parent choice to seek care and choice of care site for children with ARTIs, suggesting targets to advance family-centered practice and policy.

Home-Isolation Care in Newly COVID-19-Positive Elderly Patients: A Caregiver-Centric Explanatory Framework.

Objectives: This community-based study aimed to identify the effect of different behavioral factors of family caregivers on the decision for home-isolation-based treatment of a new COVID-19-diagnosed elderly individual. It also explored the facilitators and barriers contributing to the decision-making process. Methods: A mixed-methods design was adopted to study the role of behavioral constructs such as risk tolerance, risk aversion, regret aversion, loss aversion, self-efficacy, and risk perception in healthcare-seeking decisions. By integrating the findings from the quantitative and qualitative parts, a framework was developed. Results: Self-efficacy, risk perception, and risk tolerance related to different issues were crucial factors behind the healthcare decision. However, regarding the various issues under consideration, risk perception followed by risk tolerance were the significant predictors for decision-making. Conclusion: To enhance appropriateness and equity in emergency healthcare-seeking, interventions should target risk tolerance and risk perception, taking into account the awareness levels of caregivers and the target population's risk and regret aversion. Such integrated approaches can improve the quality of care for elderly patients in home-based settings.

Perceptions of Relatives about Symptoms and Signs in Older Adults with Sepsis: A Cross-Sectional Study

Sepsis is a common health condition in older adults that may present with typical or atypical symptoms and signs. The perception of warning symptoms and signs by relatives is important in their decision to seek hospital medical treatment. This cross-sectional study was conducted to explore the symptoms and signs of sepsis in older adults as perceived by their relatives, the awareness of symptoms and signs of sepsis, and the duration from the symptom onset to hospital arrival at a tertiary care hospital in Bangkok, Thailand. Seventy-seven dyads of older adults with sepsis and their relatives were recruited. Data were collected using the Personal Information of Older Adults and Relatives Questionnaire and the Symptoms and Signs of Sepsis Questionnaire. Descriptive statistics and Fisher’s exact test were used to analyze the data. Results revealed that both typical and atypical symptoms and signs occurred in older adults with sepsis. The top five typical presentations were drowsiness/deep sleep, rapid breathing, fever, chilling, and difficulty breathing. The top five atypical presentations were malaise or fatigue, loss of appetite, signs of dehydration, comorbidity exacerbations, and decreased activities of daily living. Atypical presentations were the most common presentations that relatives were unsure of and did not recognize as sepsis. The majority of older adults with sepsis (72.7%) arrived at the emergency department within 24 hours of the onset of symptoms or signs. There was no significant difference between the number of participants arriving at the emergency department within ≥24 hours, classified by typical and atypical presentations. These findings point to the important role of relatives to be proactive in the management of sepsis in older adults, starting at home. Nurses should teach relatives about early detection and timely seeking of medical care in hospitals. A system of telehealth consultations through phone or video calls should be established to facilitate healthcare-seeking decisions prior to clinical deterioration.

Impacts of Internet Use on Chinese Patients' Trust-Related Primary Healthcare Utilization.

Background: The internet has greatly improved the availability of medical knowledge and may be an important avenue to improve patients’ trust in physicians and promote primary healthcare seeking by reducing information asymmetry. However, very few studies have addressed the interactive impacts of both patients’ internet use and trust on primary healthcare-seeking decisions. Objective: To explore the impact of internet use on the relationship between patients’ trust in physicians and primary healthcare seeking among Chinese adults 18 years of age and older to understand the varieties of effects in different cities. Methods: Generalized linear mixed models were applied to investigate the interactive impacts of internet use and patients’ trust in physicians on primary healthcare seeking using pooled data from the China Family Panel Study of 2014 to 2018. We also compared these effects based on different levels of urbanization, ages, and PHC services. Results: Overall, a higher degree of patients’ trust (p < 0.001) was able to directly predict better primary healthcare seeking, and internet use significantly increased the positive effect of patients’ trust on primary healthcare seeking (p < 0.001). However, the marginal effect analysis showed that this effect was related to the level of patients’ trust and that internet use could reduce the positive effect of patients’ trust on primary healthcare seeking when the individual had a low level of trust (≤ 3 units). Further, the heterogeneity analysis indicated that the benefits from internet use were higher in cities with high urbanization, high aging, and high PHC service levels compared to cities with low levels of these factors. Conclusions: The internet use may enhance patients’ trust-related PHC utilization. However, this impact is effective only if patients’ benchmark trust remains at a relatively high level. Comparatively, the role of internet use is more effective in areas with high urbanization, high aging and high PHC level. Thus, with increasing accessibility to the internet, the internet should be regulated to disseminate correct healthcare information. Moreover, in-depth integration of the internet and PHC should be promoted to provide excellent opportunities for patient participation, and different strategies should be set according to each city’s characteristics.

Abortion beyond 13 weeks in Argentina: healthcare seeking experiences during self-managed abortion accompanied by the Socorristas en Red

BackgroundIn Argentina, a group of feminist activists, the Socorristas en Red, provide information and accompaniment to people seeking abortions, including beyond 13 weeks gestation. Recently-released WHO guidelines for abortion care acknowledge that abortion trajectories vary and people may seek services and support from a range of settings in the process of an abortion. It follows, therefore, that people who self manage abortions beyond 13 weeks with the support of accompaniment groups may interact with health professionals in the public and/or private sector. Understanding the reasons for and experiences with these interactions can help to inform best practice.MethodsIn 2016, we conducted 23 exploratory interviews among women who self managed abortions beyond 13 weeks gestation accompanied by Socorristas, to understand healthcare-seeking decisions and experiences. We used narrative inquiry as an interview technique and coded interviews using first a holistic coding and, second, a content analysis technique to identify emergent themes in the text and subsequently identify themes relevant to study aims.ResultsWe found that many participants had disclosed their abortion intentions to health professionals prior to their abortions. Some were provided with emotional support and referrals to the Socorristas, while others were admonished and warned of serious health consequences. Most participants sought post-abortion care in public or private-sector health facilities; for fear of legal repercussions, many participants did not share that they had used abortion medications with post-abortion care providers. During care seeking, some participants reported poor treatment, in several cases because they were suspected of inducing abortion, while others reported supportive care from health professionals who had previously-established relationships with the Socorristas.ConclusionsThis study illuminates the important role that supportive health professionals can play to ensure that, regardless of the trajectory of an abortion, people feel comfortable accessing clinical services during their abortion process, even in restrictive settings. Feminist activists can help build bridges with the medical system to ensure that providers who interact with people seeking abortion-related services are empathic, understand their legal rights, and provide supportive care.

The Rural Household Production of Health Approach: Applying Lessons from Zambia to Rural Cancer Disparities in the U.S.

The recent focus on rural–urban cancer disparities in the United States (U.S.) requires a comprehensive understanding of the processes and relations that influence cancer care seeking and decision making. This is of particular importance for Black, Latino, and Native populations living in rural areas in the U.S., who remain marginalized in health care spaces. In this article, we describe the household production of health approach (HHPH) as a contextually-sensitive approach to examining health care seeking and treatment decisions and actions. The HHPH approach is based on several decades of research and grounded in anthropological theory on the household, gender, and therapy management. This approach directs analytical attention to how time, money, and social resources are secured and allocated within the household, sometimes in highly unequal ways that reflect and refract broader social structures. To demonstrate the benefits of such an approach to the study of cancer in rural populations in the U.S., we take lessons from our extensive HHPH research in Zambia. Using a case study of a rural household, in which household members had to seek care in a distant urban hospital, we map out what we call a rural HHPH approach to bring into focus the relations, negotiations, and interactions that are central to individual and familial health care seeking behaviors and clinical treatment particular to rural regions. Our aim is to show how such an approach might offer alternative interpretations of existing rural cancer research in the U.S. and also present new avenues for questions and for developing interventions that are more sensitive to people’s realities.

The Covid-19 cascade of care in Mexico: symptoms, positivity, and health care seeking decisions amid the pandemic.

The study describes health care services utilization contextualized by the needs of the Mexican population during the Covid-19 pandemic. We used data from the National Health and Nutrition Survey, Covid-19. Among the population with symptoms compatible with Covid-19, we describe the proportion who sought care, received care, were tested, were diagnosed positive, and survived, and whether they received care in public or private services. We estimated factors associated with the probability of seeking and receiving care. Out of 7.1% of the population with symptoms compatible with Covid-19, 64.4% received care, and 15.4% tested positive; 74.5% received care in the private sector, even among the population with social security. Those with social security, in contact with a suspected or confirmed Covid-19 case, and with at least one comorbidity had a higher probability of seeking and receiving care. The most relevant finding of our study is the large proportion of the population with Covid-19 symptoms who sought and received care in private facilities an essential aspect for decision-makers to consider as the current health reform moves forward in Mexico.

Effect of Gender on the Utilization of Maternal and Child Health Services among Pastoralist Caregivers in Somali Region of Ethiopia

Ethiopia has made great effort in recent years to improve maternal and child health outcomes, however the uptake of services by women in the pastoralist communities of the country is still very low. This study was a cross-sectional study aimed to identify the effect of gender on the utilization of health services among pastoralists women. The study was conducted in Somali Region of Ethiopia between February and March 2020. A mix of qualitative and quantitative methods was used, and study population were married caregivers aged 15years and above. Bivariate analysis was done using t test and chi-square to test association among variables and p value was set at significant level of 5%. Husbands were reported as the main influence of the respondents’ decision about almost all the key households’ activities including health care seeking and financial decision making. Almost all caregivers (93.6%) who used the health facility took permission from their husbands and the test of association shows significant relationship between level of education and permission from respondents’ husbands which decreases with increasing level of education, p&lt;0.05) but not affected by age. The care givers visited the health facilities because of their children more than themselves(58 per cent compared to 49.5 per cent for themselves) due to fear of being attended to by male health work. The study demonstrated the negative effect of gender inequities on health care seeking behaviours with women having limited control over family resources and decision-making over their health or that of their children.

Influence of type and source of electronic word-of-mouth on consumers' health care-seeking decisions

We examined the influence of the type (positive vs. negative) and source (patients' online community vs. general online community) of electronic word-of-mouth (eWOM) on consumers' health care-seeking decisions. Participants in this 2 × 2 between-subjects study comprised 160 patients who had sought medical advice at a large Tier 3, Class A hospital in China in 2019. The results show that negative (vs. positive) eWOM had a greater influence on consumers' health care-seeking decisions, with similar results for the patients' (vs. general) online community. In addition, positive eWOM from the patients' (vs. general) online community had a greater influence on participants' health careseeking decisions but the result was not significant for negative eWOM. Credibility of eWOM also mediated the relationship between eWOM and health care-seeking decision. Practical and theoretical implications are discussed.

Decision Making Capacity and Constraints Faced by Rural Women while Seeking Maternal and Child Health Care Services in Northeastern Bangladesh

The aim of the study was to determine the association between rural women’s decision-making power and the constraints faced by them while seeking Maternal and Child Health care services in northeastern Bangladesh. The study sample consisted of 150 mothers living in northeastern Bangladesh who had accessed institutional MCH care services during their pregnancy, childbirth and the postpartum period. Data were collected through a structured questionnaire using simple random sampling technique from January-April, 2018 and analyzed using descriptive statistics, decision making index and constraints facing indexing method through SPSS and Microsoft Excel. The study results showed that, decisions about treatment-seeking, consultation with the doctor during the prenatal and postnatal period, institutional birth preference and use/not use of contraceptives was always taken by the husband because the index was closer to the weighted value 200. But while making decisions about purchasing household daily needs, medicines, taking the first child or having more than two children, both husband and wife participated equally. On the other hands, constraint facing index showed that lack of medicine and vaccination, unhealthy environment and unprofessional behavior of the clinic’s people with CFI 651, 316 and 304 respectively, were the most commonly faced constraints by the rural women which discouraged them to seek institutional MCH care services. Though rural women were not completely suppressed in the northeastern region of Bangladesh, healthcare-seeking decisions were completely under the supervision of the men of families. Along with the socio-economic barriers, unprofessionalism, unavailability and mismanagement of the offered services also discouraged them to access institutional MCH care services. Awareness building among the rural people, especially in the recipients of this service along with Government and policy maker’s intervention to ensure a better quality of MCH care services can change the scenario of MCH care-seeking attitude of rural women in northeastern Bangladesh.

Narratives of women presenting with abortion complications in Southwestern Nigeria: A qualitative study.

Unsafe abortion continues to impact negatively on women’s health in countries with restrictive abortion laws. It remains one of the leading causes of maternal mortality and morbidity. Paradoxically, modern contraceptive prevalence remains low and the unmet need for contraception continues to mirror unwanted pregnancy rates in many countries within sub-Saharan Africa. This qualitative study assessed women’s knowledge; their expectation and experiences of the methods employed for abortion; and their health care-seeking decisions following a complicated abortion. Women who presented with abortion complications were purposively sampled from seven health facilities in south-west Nigeria. In-depth interviews were conducted by social scientists with the aid of a semi-structured interview guide. Coding schemes were developed and content analysis was performed with WEFTQDA software. Thirty-one women were interviewed. Misoprostol was used by 16 women; 15 women used other methods. About one-fifth of respondents were aged ≤ 20 years; almost one-third were students. Common reasons for terminating a pregnancy were: “too young/still in school/training”; “has enough number of children”; “last baby too young” and “still breastfeeding”. Women had little knowledge about methods used. Friends, nurses or pharmacists were the commonest sources of information. Awareness about use of misoprostol for abortion among women was high. Women used misoprostol to initiate an abortion and were often disappointed if misoprostol did not complete the abortion process. Given its clandestine manner, women were financially exploited by the abortion providers and only presented to hospitals for post-abortion care as a last resort. Women’s narratives of their abortion experience highlight the difficulties and risks women encounter to safeguard and protect their sexual and reproductive health. To reduce unsafe abortion therefore, urgent and synergized efforts are required to promote prompt access to family planning and post-abortion care services.

Correction: Distance, accessibility and costs. Decision-making during childbirth in rural Sierra Leone: A qualitative study

[This corrects the article DOI: 10.1371/journal.pone.0188280.].

Delays in seeking and receiving health care services for pneumonia in children under five in the Peruvian Amazon: a mixed-methods study on caregivers\u2019 perceptions

BackgroundDelays in receiving adequate care for children suffering from pneumonia can be life threatening and have been described associated with parents’ limited education and their difficulties in recognizing the severity of the illness. The “three delays” was a model originally proposed to describe the most common determinants of maternal mortality, but has been adapted to describe delays in the health seeking process for caregivers of children under five. This study aims to explore the caregivers’ perceived barriers for seeking and receiving health care services in children under five years old admitted to a referral hospital for community-acquired pneumonia in the Peruvian Amazon Region using the three-delays model framework.MethodsThere were two parts to this mixed-method, cross-sectional, hospital-based study. First, medical charts of 61 children (1 to 60 months old) admitted for pneumonia were reviewed, and clinical characteristics were noted. Second, to examine health care-seeking decisions and actions, as well as associated delays in the process of obtaining health care services, we interviewed 10 of the children’s caregivers.ResultsHalf of the children in our study were 9 months old or less. Main reasons for seeking care at the hospital were cough (93%) and fever (92%). Difficulty breathing and fast breathing were also reported in more than 60% of cases. In the interviews, caregivers reported delays of 1 to 14 days to go to the closest health facility. Factors perceived as causes for delays in deciding to seek care were apparent lack of skills to recognize signs and symptoms and of confidence in the health system, and practicing self-medication. No delays in reaching a health facility were reported. Once the caregivers reached a health facility, they perceived lack of competence of medical staff and inadequate treatment provided by the primary care physicians.ConclusionAccording to caregivers, the main delays to get health care services for pneumonia among young children were identified in the initial decision of caregivers to seek healthcare and in the health system to provide it. Specific interventions targeted to main barriers may be useful for reducing delays in providing appropriate health care for children with pneumonia.

Distance, accessibility and costs. Decision-making during childbirth in rural Sierra Leone: A qualitative study.

BackgroundSierra Leone has one of the highest maternal mortality ratios in the world. Efforts to reduce maternal mortality have included initiatives to encourage more women to deliver at health facilities. Despite the introduction of the free health care initiative for pregnant women, many women still continue to deliver at home, with few having access to a skilled birth attendant. In addition, inequalities between rural and urban areas in accessing and utilising health facilities persist. Further insight into how and why women make decisions around childbirth will help guide future plans and initiatives in improving maternal health in Sierra Leone. The objective of this study was to explore the perceptions and decision-making processes of women and their communities during childbirth in rural Sierra Leone.Methods and findingsData were collected through seven focus group discussions and 22 in-depth interviews with recently pregnant women and their community members in two rural villages. Data were analysed using systematic text condensation. Findings revealed that decision-making processes during childbirth are dynamic, intricate and need to be understood within the broader social context that they take place. Factors such as distance and lack of transport, perceived negative behaviour of hospital staff, direct and indirect financial obstacles, as well as the position of women in society all interact and influence how and what decisions are made.ConclusionsPregnant women face multiple interacting vulnerabilities that influence their healthcare-seeking decisions during pregnancy and childbirth. Future initiatives to improve access and utilisation of safe healthcare services for pregnant women need to be based on adequate knowledge of structural constraints and health inequities that affect women in rural Sierra Leone.

Psychometric evaluation of the Perceived Barriers to Health Care-seeking Decision in Chinese patients with acute coronary syndromes

ObjectivesThis study aimed to develop the Chinese version of the Perceived Barriers to Health Care-seeking Decision (PBHSD-C) and evaluate its psychometric properties in Chinese patients with acute coronary syndromes (ACS). BackgroundThe assessment of the level of perceived barriers in the care-seeking trajectory of ACS patients is important for the understanding of its impact on pre-hospital delay in seeking care. MethodsThe psychometric properties of PBHSD-C were evaluated among 114 ACS patients in the cardiac unit of two major hospitals in Hong Kong. ResultsThe Content Validity Indexes were ranged from .88 to 1. The Cronbach's alpha of the PBHSD-C was .74. The intraclass correlation coefficients of all items were above .80. The convergent validity of the PBHSD-C was also supported. ConclusionThe PBHSD-C is reliable and valid to be used to assess the level of perceived barriers in the care-seeking of Chinese patients with ACS.

Dissecting the Doctor‐Dancer Relationship: Health Care Decision Making Among American Collegiate Dancers

To examine perceptual influences on dancers' health care-seeking decisions and whether dancers' beliefs correlate with actual use of provider services when they are injured. Secondary aims were to understand how dancers may select physicians and what they consider to be the most important features of the medical consultation. Prospective cohort study. University and conservatory dance departments. Forty American collegiate dancers. Before the start of the dance semester, all participants completed a retrospective survey that included baseline demographic data, dance experience, a dance-related injury (DRI) inventory, previous health care exposures, and perceptions regarding health care treatment providers. Data regarding new DRIs and health care exposures were then prospectively collected every 2 weeks for 6 months. A DRI was defined as any neuromusculoskeletal condition sustained as the result of dancing activity that caused a dancer to stop or modify his or her dancing for more than 3 consecutive days. Dancers perceived dance teachers to be first-line treatment providers (47.5%), followed by physical therapists (PTs; 30%). Physicians were ranked third (12.5%) and only marginally higher than a dance colleague (10%). The dancers expressed a strong preference for nonsurgical rather than surgical physicians (87.5% versus 5.0%), and among physicians, the majority of dancers preferred subspecialists (60%), namely nonsurgical sports medicine doctors and physiatrists. During the 6-month prospective data-collection period, 25 dancers (69.4%) sustained 55 unique injuries, with 22 dancers (88%) and 34 injuries (61.8%) undergoing evaluation. Only 17.7% of injuries were evaluated by a physician. Dancers showed greater incongruity between their preinjury perceptions and postinjury use of physicians than they did with PTs (P= .0002). Although dancers did not perceive physicians to be first-line treatment providers for DRIs, these perceptions about physicians were poorly correlated with use. Instead, injured dancers' health care-seeking behaviors were more likely related to relatively decreased barriers to other nonphysician providers, as well as pre-existing referral pathways to PTs.

Coping with uncertainty during healthcare-seeking in Lao PDR.

BackgroundUncertainty is regarded as a central dimension in the experience of illness and in the processes of alleviating it. Few studies from resource-poor settings have investigated this and how it interacts with other factors. This study aims to shed light on how healthcare-seeking develops in the context of multiple medical alternatives and to understand what bearing uncertainty has on this process.MethodsThe study was conducted in six purposively selected rural communities in Lao PDR. In each community, two focus group discussions were held: first with mothers and then with fathers of children younger than five years old. Eleven in-depth interviews with caregivers of severely sick children were conducted. Subsequently, traditional healers, drug vendors, community health workers, nurses and medical doctors were recruited for interviews or group discussions. The data were transcribed and key themes and similarities were identified. Additional readings were conducted to better understand the interactions of factors during which uncertainty was identified as one of several factors mentioned during interviews and focus group discussions.ResultsCare-seekers expressed a strong preference for initially seeking local providers. Subsequently, multiple providers were consulted to increase the chances of recovery. This resulted in patients leaving the health facilities before recovery and in ending the recommended treatment regime prematurely. These healthcare-seeking decisions reflect the social significance of being a responsible caregiver and of showing respect for household norms. In general, healthcare-seeking was shrouded in uncertainty when it came to selecting the right provider, the likelihood of finding the real cause of the illness, spending savings on treatments and ultimately the likelihood of recovery.ConclusionsCare-seekers’ initial strong preference for local providers irrespective of the providers’ legitimacy indicates the need for a robust primary healthcare system. Care-seekers’ subsequent consultations must be understood in the light of their uncertainty regarding the skills of the available providers. The social connotations of seeking healthcare including the vulnerability of poor households in public health facilities were taken into account to only a limited extent by health workers. Health workers should have greater awareness of the social and cultural aspects of seeking care.