Health Seeking Behaviour Research Articles

Association Between Physical Activity and Sleep Health Among Community-Dwelling Adults Aged ≥50 in Ghana: The Mediating Role of Psychosomatic Factors

ABSTRACT Objectives Data on the direct and indirect associations between physical activity (PA) and sleep quality in old age via psychosomatic mechanisms (e.g. mobility, pain, loneliness, depression, and anxiety) remain scarce in low- and middle-income countries (LMICs). We explored the association of PA with poor sleep quality (PSQ) among individuals aged ≥ 50 in Ghana and explored the potential mediating factors in this association. Methods We analyzed community-based data from the Aging, Health, Psychological Well-being, and Health-seeking Behavior Study. We assessed PA using the International Physical Activity Questionnaire (IPAQ). Two items on nighttime and daytime sleep problems in the last 30 days were used to measure PSQ. Multivariable ordinary least square (OLS) regressions and bootstrapping models were performed to evaluate the associations. Results Overall, 1,201 participants (Mage = 66.15 ± 11.58 years; 63.3% female) were included in the analysis. PA was independently associated with decreased PSQ in the overall sample (B = −0.181, 95%I = −0.271 to −0.092) and in women (B = −0.195, 95%I = −0.305 to −0.084). The association was stronger in the ≥ 65 (B = −0.138) than in the 50–64 age group (B = −0.213). Mobility (37.06%), pain (23.66%), loneliness (6.71%), and comorbid anxiety and depression (8.95%) mediated the PA-PSQ association. Conclusions PA was associated with decreased PSQ levels, which was particularly explained by psychosomatic factors. Clinical implications Clinicians encourage older adults to engage in regular PA and manage psychosomatic problems may improve their sleep health.

Cultural and religious structures influencing the use of maternal health services in Nigeria: a focused ethnographic research

BackgroundCultural and religious structures encompass a set pattern of values, beliefs, systems and practices that define a community's behaviour and identity. These structures influence women's health-seeking behaviour and access to maternal health services, predisposing women to preventable maternal health complications. However, most maternal health policies have focused on biomedical strategies, with limited attention to women’s cultural challenges around childbirth. The overall aim of this paper is to provide a thick description and understanding of cultural and religious structures in Nigeria, their meaning and how they influence women’s use of maternal health services.MethodsRoper and Shapira’s (2000) focused ethnography comprising 189 h of observation of nine women from the third trimester to deliveries. Using purposive and snowballing techniques, 21 in-depth interviews and two focus group discussions comprising 13 women, were conducted in two Nigerian primary healthcare facilities in rural and urban area of Kogi State. Data was analyzed using the steps described by Roper and Shapira.ResultsUsing the PEN-3 cultural model, nine themes were generated. Positive factor, such as the language of communication, existential factor, such as religion, and negative factors, such as the use of prayer houses and lack of women’s autonomy, were either positive or negative enablers influencing women’s use of maternal health services. Additionally, women's perceptions, such as their dependency on God and reliance on cultural norms were significant factors that influence the use of maternal health services. We also found that the use of herbal medicine was a negative enabler of women’s access to facility care. At the same time, family support was also a positive and a negative nurturer that could influence how women use facility care. Finally, factors such as religion, Ibegwu, and male child syndrome were negative nurturers influencing women’s contraceptive use.ConclusionCultural and religious structures are significant factors that could promote or limit women’s use of maternal health services. Further studies are needed to understand culturally focused approaches to enhance women’s use of maternal health services in Nigeria.

Are urban residents seeking appropriate care for malaria? evidence from an exploratory qualitative study in two cities in nigeria

BackgroundUnplanned and rapid urbanization within Nigerian cities with the attendant environmental consequences may hinder achieving malaria elimination goal. Presently, there are limited qualitative studies on malaria case management and care-seeking patterns by settlement type in urban areas in Nigeria. This study, investigated malaria-related health seeking behaviours among different settlement types in Ibadan and Kano metropolises, Nigeria.MethodsThis qualitative study involved conduct of nine Focus Group Discussions (FGDs) sessions among community members and 20 Key Informant interviews (KIIs) with healthcare providers and community stakeholders in each metropolis. Participants were purposively drawn from three settlement types – formal, informal and urban slum. Pretested FGD and KII guides were used to collect data. Data were subjected to thematic content analysis.ResultsGovernment-owned health facilities especially Primary Health Care (PHC) facilities was a major place identified as where many community members prefer to seek care for suspected malaria infection. Reasons adduced included proximity of facilities and services affordability. A common viewpoint was that most community members in informal and slum communities in both metropolises often patronize Proprietary Patent Medicine Vendors (PPMVs) or drug sellers as the first point for treatment of suspected malaria infection. Adduced reasons included poverty and non-availability of 24 h services in PHC facilities. High cost of treatment, poor attitude of health workers, long waiting time and cultural beliefs were identified as key factors influencing community members’ decision not to seek care in health facilities. It was noted that the rich prefer to seek treatment in private hospitals, while the poor usually visit PHCs or resort to other options like buying drugs from PPMVs or use herbal drugs.ConclusionThe standard practice of seeking care in health facilities was influenced by diverse factors including treatment cost, health workers’ attitude and waiting time in health facilities. A commoner practice of seeking care from patent medicine vendors and herbal drug sellers among informal settlements and slums dwellers calls for public health interventions. Specifically, the provision of free or affordable malaria care in health facilities and patient-friendly environments; and training of non-formal care providers on appropriate malaria care and referral to health facilities are recommended.

Social norms and maternal health information-seeking behavior among adolescent girls: A qualitative study in a slum of Bangladesh.

Adolescent girls of reproductive age who actively seek information on maternal health often tend to have better health-seeking behaviors and maternal health outcomes. Due to scant research on reproductive aged adolescent girls' maternal health information seeking behavior in slum, in connection with social norms, we aimed for this particular study. Adopting an explorative qualitative research approach, we collected data from purposively selected married and unmarried adolescent girls aged 15-19 of different occupation by implying 12 in-depth interviews (IDIs), 2 focus group discussions (FGDs) with the same categories employed for IDIs, and 2 key informant interviews (KIIs) with a traditional birth attendant and a drug seller. Furthermore, the data were subjected to thematic analysis. Care's Social Norms Analysis Plot (SNAP) framework was undertaken as an interpretative tool for data that was emerging rather than serving as the foundation for the study's conduct and design. Thematic analysis was followed to analyze primary data. Findings show that most girls rely on maternal health-related information from unverified sources, including family members, traditional birth attendants, and drug sellers, which increases health risks. The majority reported that adolescent girls need professional healthcare providers in their area who would work according to their work schedule as most of the girls are engaged in income-generating work for about 9-11 hours, and the scope of work (daily wagers) hardly supports 'leave with pay'. Therefore, there is a critical need for professional healthcare services tailored to the girls' work schedules. Social norms and stigma further restrict access to reliable health information, especially for unmarried girls. Socioeconomic disparities also shape health-seeking behaviors, with wealthier adolescents having greater access to formal healthcare services. Addressing these barriers is crucial for improving maternal health outcomes. The results might be useful for informed policy formulation and program design to ensure better health outcomes for marginalized adolescents.

Ensuring quality information for patients tool to assess patient information on CABG websites: Systemic search and evaluation.

Coronary artery bypass surgery (CABG) is the most common cardiac surgical procedure worldwide. The Internet is often the first place for patients to obtain medical information and may influence their health-seeking behaviour. This study aimed to assess the quality of online CABG information for patients. A review was conducted on the available CABG information online using four search terms in Google: "coronary artery bypass grafting", "CABG", "bypass surgery", and "coronary surgery". Websites on the first three pages of each search term were assessed by two independent assessors using the Ensuring Quality Information for Patients (EQIP) tool (score 0-36). 71 websites in total were eligible for the evaluation. Most websites originated from the USA and the UK (35% for both). The median EQIP score was 16.5. Most websites used everyday language (94%) in short sentences (83%). More than half (60%) of the websites addressed qualitative complications and risks of surgery. Only 1/3 of the websites described treatment alternatives, precautions before surgery, and warning signs after surgery. Only about 1/10 of websites could address quality-of-life issues and resolution of complications. Most online sites concerning CABG scores were low in EQIP tool assessment in terms of quality and readability with insufficient sources. Minimal information is provided regarding the quantitative risks and complications. Enhancement of the credibility and informativeness of websites is needed to reduce patients' anxiety about surgical procedures and help with treatment options for coronary artery disease. Education and investigation on the consistency of high-quality websites may help patient identify high quality medical information.

Culturally Embedded Strategies for Lung Cancer Awareness in Hard-to-reach Communities in the Eastern Cape: Insights from Field Observations

Lung cancer is the leading cause of cancer death worldwide. The lack of knowledge and awareness about the signs and symptoms of lung cancer often results in late diagnosis in low- and middle-income countries (LMICs). Traditional beliefs, cultural practices, and social norms may influence health-seeking behaviours and contribute to misconceptions about lung cancer. This piece intimates the readers how culturally embedded communication strategies could promote lung cancer awareness in hard-to-reach communities in the Eastern Cape. We found that cultural barriers and challenges in raising awareness about lung cancer exist, highlighting the need for culturally appropriate communication approaches, emphasizing the importance of cultural sensitivity and community engagement. This engagement has implications for future interventions, providing valuable insights into best practices for addressing lung cancer awareness in similar contexts.

Paradox within the Healthcare System: An Intersectional Analysis of Health Seeking Experiences of Migrants in the U.S.

ABSTRACT This study examined the complexities surrounding migrants’ health-seeking behaviors in the United States. Using intersectionality as a guiding analytic, we conducted in-depth interviews with 15 visa-holding migrants from West African, East, and Southeast Asian countries to understand their experiences navigating healthcare in another country. Participants mentioned the convergence of three power systems: nativity/language of origin status, education status, and migration (legal) status. Based on participants’ experiences navigating these converging systems, we identified two paradoxes migrants’ experience when seeking health information: (1) the empowerment and disempowerment in the pursuit of health information and (2) the scarcity and sufficiency in the accessibility of health information. Our findings offer a more nuanced understanding of migrant health processes. In particular, we propose that more theorizing and practical interventions should consider intersectional tensions and paradoxes that emerge from individuals whose identities grant them both access and limitations when it comes to seeking healthcare information.

Socioeconomic Factors Affecting Health-Seeking Behaviors of Bangladeshi Migrant Workers Living in Malé, Maldives

Socioeconomic Factors Affecting Health-Seeking Behaviors of Bangladeshi Migrant Workers Living in Malé, Maldives

Improving transparency in malaria programme funds: A business case for connected diagnostics in Kenya.

International vertical health financing programmes risk functioning in parallel with existing domestic funding in low- and middle-income countries (LMICs), leading to inefficient service delivery and concomitant poor health outcomes. We assessed the opportunities offered by digitalised diagnostics (ConnDx) to target and monitor health funds to those in need objectively and transparently. ConnDx was rolled out in five private health facilities in Kisumu, Kenya. The ConnDx process was codeveloped with the local Department of Health of Kisumu. We used the quantitative data generated by ConnDx. We also calculated the costs for ConnDx and standard care to assess potential cost reductions. In total, 2199 malaria cases were detected among 11 689 patients with fever. ConnDx allowed for the identification of malaria hotspots, semi-real-time assessment of patient health seeking behaviour across facilities and insights in doctor's prescription behaviours. Based on these insights, we estimated a 25% reduction in costs can be realised, while simultaneously better quality indicators can be monitored. The concept of ConnDx can be used for any medical condition that can be diagnosed in a digital manner and linked to mobile payment systems. The generated data can contribute to better quality services for individual patients while at the same time support local health policy makers and managers for more targeted interventions. The ConnDx approach can help decision makers in LMICs to channel disease-specific funds to the right patients for the right disease at the right time, which can potentially accelerate the way to universal health coverage.

The “Ideal Man”: How Gender Norms and Expectations Shape South African Men’s Masculinity, Sexual Identities, and Well-Being

Dominant gender norms among South African males promote ideals of masculinity characterized by control, emotional stoicism, and power, which can impact overall health. This study explores South African men’s perceptions of the “ideal” man, societal expectations, and how sexual identities intersect with masculinity, health-seeking behaviors, and HIV prevention. We conducted 40 interviews with men who have sex with women and men who have sex with men, aged 18–35 years who resided in Johannesburg or Cape Town municipal areas. Participants described their idea of the “ideal man” as a provider, protector, and role model, though these ideals varied across contexts. High family and community expectations created both stress and motivation. Barriers to sexual healthcare included resistance from male-dominated communities and stigma towards non-heteronormative sexual identities, particularly among men who have sex with men. Addressing these challenges requires promoting more inclusive understandings of masculinity and improving healthcare access by challenging gender norms.

Health Seeking Behavior of Tharu Ethnic Population about Sickle Cell Disease

Health Seeking Behavior of Tharu Ethnic Population about Sickle Cell Disease

Four New Patient-Reported Outcome Measures Examining Health-Seeking Behavior in Persons With Type 2 Diabetes Mellitus (REDD-CAT): Instrument Development Study.

The management of type 2 diabetes mellitus (T2DM) includes mastery of complex care activities, self-management skills, and routine health care encounters to optimize glucose control and achieve good health. Given the lifelong course of T2DM, patients are faced with navigating complex medical and disease-specific information. This health-seeking behavior is a driver of health disparities and is associated with hospitalization and readmission. Given that health-seeking behavior is a potentially intervenable social determinant of health, a better understanding of how people navigate these complex systems is warranted. To address this need, we aimed to develop new patient-reported outcome (PRO) measures that evaluate health-seeking behavior in persons with T2DM. These new PROs were designed to be included in the Re-Engineered Discharge for Diabetes-Computer Adaptive Test (REDD-CAT) measurement system, which includes several other PROs that capture the importance of social determinants of health. Overall, 225 participants with T2DM completed 56 self-report items that examined health-seeking behaviors. Classical Test Theory and Item Response Theory were used for measurement development. Exploratory factor analysis (EFA; criterion ratio of eigenvalue 1 to eigenvalue 2 being >4; variance for eigenvalue 1 ≥40%) and confirmatory factor analysis (CFA; criterion 1-factor CFA loading <.50; 1-factor CFA residual correlation >.20; comparative fit index ≥0.90; Tucker-Lewis index ≥0.90; root mean square error of approximation <0.15) were used to determine unidimensional sets of items. Items with sparse responses, low-adjusted total score correlations, nonmonotonicity, low factor loading, and high residual correlations of high error modification indices were candidates for exclusion. A constrained graded response model was used to examine item misfit, and differential item functioning was examined to identify item bias. Cronbach α was used to examine internal consistency reliability for the new PROs (criterion ≥0.70), and floor and ceiling effects were examined (criterion ≤20%). Four unidimensional sets of items were supported by EFA (all EFA eigenvalue ratios >4; variance for eigenvalue 1=41.4%-67.3%) and CFA (fit statistics all exceeded criterion values). This included (1) "Health-Seeking Behavior: PCP-Specific" (6 items); (2) "Health-Seeking Behavior: General Beliefs" (13 items); (3) "Health-Seeking Behavior: Family or Friends-Specific" (5 items); and (4) "Health-Seeking Behavior: Internet-Specific" (4 items). All items were devoid of differential item functioning for age, sex, education, or socioeconomic status factors. "Health-Seeking Behavior: General Beliefs" was developed to include both a computer adaptive test and a 6-item short form version; all other PROs were developed as static short forms. The psychometric reliability of these new PROs was supported; internal consistency ranged from acceptable to excellent (Cronbach α=.78-.91), and measures were free of significant floor or ceiling effects (floor effects range: 0%-8.9%; ceiling effects range: 0%-8.4%). The new REDD-CAT Health-Seeking Behavior PROs provide reliable assessments of health-seeking behaviors among those with T2DM.

"Constantly justifying my existence": Lower-income, higher-weight Canadian adults' stigma coping mechanisms.

Individuals who are higher-weight and low-income may disproportionately experience weight and income stigmas in healthcare experiences compared to lower-weight, higher-income individuals. The ways that weight and income stigmas interact in healthcare should be better understood in order to provide better, less stigmatizing care to higher-weight, low-income patients. This study assesses how patients manage stigmatizing experiences in both healthcare and everyday experiences and how that impacts health seeking and stigma management behaviors through semi-structured interviews with 11 higher-weight (Body Mass Index ≥30), low-income adults (≥18 years of age) in an Atlantic Canadian province. Participants took part in two interviews that focused on healthcare experiences and both positive and negative places/spaces. The two face-to-face interviews for each participant (total 21 interviews) were audio-recorded and professionally transcribed verbatim. The transcripts were analyzed using thematic analysis to identify recurring concepts and patterns within the data. Two major themes emerged from the data, uptake of stigmatizing, neoliberal health messaging and coping with stigma. Coping with stigma included subthemes control over stigmatizing experiences and stoicism in the face of stigma. The findings suggest that individuals understand their health and wellness through a neoliberal lens and that they deploy strategies of control and stoicism to cope with the stigmas they face.

Telemedicine Integrated Care Versus In-Person Care Mode for Patients With Short Stature: Comprehensive Comparison of a Retrospective Cohort Study.

Telemedicine has demonstrated efficacy as a supplement to traditional in-person care when treating certain diseases. Nevertheless, more investigation is needed to comprehensively assess its potential as an alternative to in-person care and its influence on access to care. The successful treatment of short stature relies on timely and regular intervention, particularly in rural and economically disadvantaged regions where the disease is more prevalent. This study evaluated the clinical outcomes, health-seeking behaviors, and cost of telemedicine integrated into care for children with short stature in China. Our study involved 1241 individuals diagnosed with short stature at the pediatric outpatient clinic of Peking University Third Hospital between 2012 and 2023. Patients were divided into in-person care (IPC; 1183 patients receiving only in-person care) and telemedicine integrated care (TIC; 58 patients receiving both in-person and virtual care) groups. For both groups, the initial 71.43% (average of 58 percentages, with each percentage representing the ratio of patients in the treatment group) of visits were categorized into the pretelemedicine phase. We used propensity score matching to select individuals with similar baseline conditions. We used 7 variables such as age, gender, and medical insurance for the 1:5 closest neighbor match. Eventually, 115 patients in the IPC group and 54 patients in the TIC group were selected. The primary clinical outcome was the change in the standard height percentage. Health-seeking behavior was described by visit intervals in the pre- and post-telemedicine phases. The cost analysis compared costs both between different groups and between different visit modalities of the TIC group in the post-telemedicine phase. In terms of clinical effectiveness, we demonstrated that the increase in height among the TIC group (ΔzTIC=0.74) was more substantial than that for the IPC group (ΔzIPC=0.51, P=.01; paired t test), while no unfavorable changes in other endpoints such as BMI or insulin-like growth factor 1 (IGF-1) levels were observed. As for health-seeking behaviors, the results showed that, during the post-telemedicine phase, the IPC group had a visit interval of 71.08 (IQR 50.75-90.73) days, significantly longer than the prior period (51.25 [IQR 34.75-82.00] days, P<.001; U test), whereas the TIC group's visit interval remained unchanged. As for the cost per visit, there was no difference in the average cost per visit between the 2 groups nor between the pre- and post-telemedicine phases. During the post-telemedicine phase, within the TIC group, in-person visits had a higher average total cost, elevated medical and labor expenses, and greater medical cost compared with virtual visits. We contend that the rise in medical visits facilitated by integrating telemedicine into care effectively restored the previously constrained number of medical visits to their usual levels, without increasing costs. Our research underscores that administering prompt treatment may enable physicians to seize a crucial treatment opportunity for children with short stature, thus attaining superior results.

The experiences of women diagnosed with uterine fibroids in the Kingdom of Eswatini.

Uterine fibroids (UFs) are benign uterine growths that significantly impact women's daily activities, quality of life, fertility and expenditure. This study aimed to provide in-depth insights into the lived experiences of women diagnosed with UFs. The study was conducted in Eswatini health facilities across the four geographic regions. An explorative qualitative design was used; participants with confirmed UFs diagnoses or surgery related to UFs were purposively recruited for focus group discussions. Data collection was guided by the revised Wilson and Cleary model of health-related quality of life (HRQOL), which was iteratively analysed using Braun and Clark's thematic analysis framework. Sixty participants with confirmed UFs diagnoses or surgery related to UFs were included in this study. Five themes emerged: awareness of the disease, symptoms experienced, treatment and care, perceptions and beliefs and health-seeking behaviour. Most participants experienced physical symptoms, abdominal pain and vaginal bleeding. Among the emotional and psychological consequences experienced by the majority of participants were fear, worry, tension and (perceived) disrupted body image. The majority of the participants lacked knowledge of UFs, and their perceptions and health-seeking behaviour differed. Findings showed that most participants experienced physical, psychological, emotional and social challenges. These experiences were influenced by lack of knowledge, symptoms experienced, poor treatment and care and perceptions and beliefs about UFs. Health education, client involvement, early diagnosis and effective treatment are recommended to improve the experiences of UFs.

Social Determinants of Health-Seeking Behaviour among Street Children in Yenagoa City, Bayelsa State

Social Determinants of Health-Seeking Behaviour among Street Children in Yenagoa City, Bayelsa State

Older Adults' Perspectives and Experiences With Digital Health in Singapore: Qualitative Study.

Technology use among older adults is increasingly common. Even though there is potential in leveraging technology to help them manage their health, only a small fraction of them use it for health-related purposes. This study seeks to understand the perspectives of and experiences with digital health (DH) among older adults in Singapore. A total of 16 participants (age range 60-80 years; n=11, 69% female) were interviewed for approximately an hour (range 27-64 minutes) about their health, DH use, and DH experiences. The interviews were recorded, transcribed verbatim, and thematically analyzed. Five main themes emerged from the interview: support in developing DH literacy, credibility, cost and benefit considerations, intrinsic drive to be healthy, and telehealth. Older adults need support in familiarizing themselves with DH. When considering DH options, older adults often relied on credible sources and preferred DH to be free. Monetary incentives were brought up as motivators. The intrinsic drive to live longer and healthily was expressed to be a huge encouragement to use DH to help obtain health-related knowledge and achieve healthy living goals. The idea of telehealth was also appealing among older adults but was seen to be more suited for individuals who have issues accessing a physical clinic. Our findings offer insights into the various aspects that matter to older adults in the adoption of DH, which in turn can help reshape their health-seeking behavior and lifestyle. As such, policy makers and DH implementors are encouraged to take these into consideration and align their strategies accordingly.

An integrated empirical and computational study to decipher help-seeking behaviors and vocal stigma

BackgroundProfessional voice users often experience stigma associated with voice disorders and are reluctant to seek medical help. This study deployed empirical and computational tools to (1) quantify the experience of vocal stigma and help-seeking behaviors in performers; and (2) predict their modulations with peer influences in social networks.MethodsExperience of vocal stigma and information-motivation-behavioral (IMB) skills were prospectively profiled using online surveys from a total of 403 Canadians (200 singers and actors and 203 controls). Data were used to formulate an agent-based network model of social interactions on vocal stigma (self-stigma and social-stigma) and help-seeking behaviors. Network analysis was performed to evaluate the effect of social network structure on the flow of IMB among virtual agents.ResultsLarger social networks are more likely to contribute to an increase in vocal stigma. For small social networks, total stigma is reduced with higher total IMB but not much so for large networks. For agents with high social-stigma and risk for voice disorder, their vocal stigma is resistant to large changes in IMB ( > 2 standard deviations). Agents with extreme IMB and stigma values are likely to polarize their networks faster in larger social groups.ConclusionsWe integrated empirical surveys and computational techniques to contextualize vocal stigma and IMB beyond theory and to quantify the interaction among stigma, health-seeking behavior and influence of social interactions. This work establishes an effective, predictable experimental platform to provide scientific evidence in developing interventions to reduce health stigma in voice disorders and other medical conditions.

Exploring the Health Care Seeking Behavior of Rohingya Community during COVID-19 Pandemic

Introduction: COVID-19 was declared a 'pandemic,' and it was the most horrific diseases the world. Objective: The study aimed to explore the healthcare-seeking behavior of Rohingya people during the COVID-19. Materials and methods: It was conducted as a cross-sectional study involving a sample size of 200 participants. Respondents were chosen through convenience sampling methods. The study population was the Rohingya population residing in Cox’s Bazar. A well-designed and pretested set of structured questionnaires was used to collect the information. The total study duration was for 3 months. Informed consent was taken from the participants, and Ethical clearance was taken from the IRB of AIUB. Data were analyzed using IBM STATA 16. Place and period of study: The study was conducted at Cox’s Bazar Rohingya Camp in Bangladesh. Results Majority (40%) of the respondents was aged between 30 to 49 years and 51% of them were female. A significant majority, 88%, expressed a preference for treatment at a Refugee health camp, while 9% opted for a Pharmacy and 3% chose a Traditional healer. Overall, 88% of respondents demonstrated positive behavior, in contrast to 12% who exhibited negative behavior. The results of a multivariate logistic regression analysis indicated that factors such as low educational attainment, fear of visiting health facilities, and a lack of awareness regarding COVID-19 prevention were significantly associated with negative health-seeking behavior. Conclusion: The healthcare-seeking behavior exhibited by the Rohingya community in Bangladesh during the COVID-19 pandemic has been observed to be commendable.

Health seeking behaviour and diagnostic delays in SLE: A multi-ethnic Malaysian cohort study.

Heterogeneity of the clinical manifestations of systemic lupus erythematosus (SLE) may lead to diagnostic delays. This study is aimed at determining the health-seeking behaviour patterns and factors associated with diagnostic delays in a multi-ethnic SLE cohort in Malaysia. This was a cross-sectional study involving SLE patients who visited our institute between January 2020 and June 2021. A review of the medical records and face-to-face interviews were conducted to obtain sociodemographics, SLE disease characteristics and the intervals from the first symptoms to the diagnosis. Health-seeking behaviours were assessed by asking about the patients' first action during the initial symptoms and were divided into: (i) seeking professional health personnel; (ii) self-treatment; and (iii) the use of the internet as a primary source of information. Diagnostic delays were defined as the interval between initial symptoms and SLE diagnosis of more than 6months. Low-level disease activity state (LLDAS) at 12months was assessed from the medical records. Univariate and multivariate logistic regression analysis was subsequently conducted to determine factors associated with diagnostic delays. Among the 154 patients included in the study, 24% (n = 37) had delayed diagnosis. The delay was significantly higher among the Indian versus Malay versus Chinese (42.9% vs 28% vs 10.8%, p = 0.037). Patients with rash tend to have delayed diagnosis (37.8% vs 22.2%, p = 0.08) while fewer patients with frothy urine had delayed diagnosis (8.1% vs 21.4%, p = 0.09). No significant association was found between health-seeking behaviours and diagnostic delays. The rate of LLDAS at 12months was significantly lower among patients with delayed diagnosis (43.2% vs 70.0%, p = 0.006). Chinese ethnicity remained the only significant factor associated with lesser diagnostic delays in the multivariate analysis, with OR 0.30 (CI 0.09-0.93), p = 0.037. There were ethnic disparities in the early diagnosis of SLE in Malaysia, with Indian patients having a longer interval between the first symptom and diagnosis while the Chinese were associated with lower diagnostic delays. Early diagnosis predicted early attainment of LLDAS, suggesting that prompt recognition of the initial SLE symptoms is important.