Influence Health Seeking Behaviour Research Articles

Health-Seeking Behavior of Rural Ethnic Women in Bangladesh: A critical analysis through intersectional lens

The paper aims to investigate the health seeking behavior of rural ethnic women in Bangladesh through the lens of intersectionality. The paper sheds light on the healthcare seeking behavior of rural ethnic women by exploring the barriers of their healthcare accessibility, role of community organizations and traditional healers in shaping health seeking behavior, analyzing the impact of education, health literacy and healthcare awareness, and evaluating the role of family and community level power imbalance over the health seeking behavior of rural ethnic women. The study is based on both primary and secondary data. The findings of the paper highlight that various social and cultural factors, including gender, ethnicity, and socio-economic status, intersected to influence health seeking behavior among rural ethnic women in Bangladesh. Access to healthcare was found to be limited due to a lack of resources, transportation, and information. The paper argues that Community organizations and traditional healers played a minimal yet important role in shaping health seeking behavior, while the existing power imbalance in the family and community level has been found to be associated with health seeking behavior. The paper concludes the importance of addressing the multiple and intersecting factors that shape health seeking behavior among rural ethnic women in Bangladesh.

Health-seeking behaviour, referral patterns and associated factors among patients with autoimmune rheumatic diseases in Ghana: A cross-sectional mixed method study.

BackgroundChallenges exist in the diagnosis and management of autoimmune rheumatic diseases in low and middle income countries due to factors, such as poverty and under-resourced healthcare infrastructure. Furthermore, other contributory factors such as societal, cultural and religious practices influence health seeking behaviour which has a bearing on access and delivery of healthcare.ObjectivesTo examine the health seeking behaviour and referral patterns of Ghanaian patients with autoimmune rheumatic diseases and assess the associated factors that influence these.MethodA cross-sectional study using an explanatory sequential mixed method design was carried out in a Rheumatology clinic at a national referral centre. 110 participants were purposively recruited for the quantitative phase. The qualitative phase comprised 10 participants for in-depth interviews and 10 participants for a focus group discussion. Analysis using descriptive statistics, t-tests and logistic regression models were performed. Transcripts generated from the interviews and focused group discussion were analysed using thematic analysis.ResultsMedian duration from onset of symptoms until seeking help was 1 week (IQR = 12); from seeking help until obtaining a final diagnosis was 12 months (IQR = 33). Multiple factors determined the choice of first facility visited, X2 (12, N = 107) = 32.29, p = .001. Only twenty-one participants (19.6%) had knowledge of their disease prior to diagnosis. Education predicted prior knowledge [OR = 2.6 (95% CI = .66–10.12), p < .021]. Unemployed participants had increased odds of seeking help after a month compared to those who were employed [Odds ratio = 2.60 (95% CI = 1.14–5.90), p = .02]. Knowledge of autoimmune rheumatic diseases was low with multiple causative factors such as biomedical, environmental and spiritual causes determining where patients accessed care. Forty (36.4%) participants utilised complementary and alternative treatment options.ConclusionWe observed that knowledge about autoimmune rheumatic diseases among Ghanaian patients was low. Patients sought help from numerous medical facilities, traditional healers and prayer camps often contributing to a delay in diagnosis for most patients. This was influenced by individual perceptions, cultural beliefs and socioeconomic status. Active awareness and educational programmes for the public and healthcare workers are required, as well as strategic planning to integrate the biomedical and traditional care services to enable earlier presentation, accurate diagnosis and better clinical outcomes for the patients.

Health seeking behavior among women diagnosed with breast cancer attending Kisii teaching and referral hospital in Kisii County

Background: Most women with breast cancer are diagnosed at an advanced stage of the disease leading to poor treatment outcomes. Therefore, this study aimed at determining the socio-economic and cultural factors that influence health seeking behavior among women diagnosed with breast cancer in Kisii County.Methods: 96 breast cancer women who were attending the Kisii Teaching and Referral hospital in Kisii County were purposively sampled. A descriptive study design was used. Structured and open-ended questionnaires were the data collection tools. Collected data was analyzed using Chi square and correlation analysis through SPSS.Results: 84.4% of the respondents were rural dwellers, 56.3% of the respondents were Protestants while 69.79% of the respondents were married. Majority (53%) of the respondents had attained a secondary level of education, 54.2% were self-employed while 80.2% of the respondents had a monthly income of KShs 10,000. There was no association between breast cancer treatment and an individual’s level of income (χ2=2.773, p=0.597). 2.1% of the respondents agreed that breast cancer is a curse. Witchcraft was not associated with health seeking behaviour (χ2=9.907, p=0.624). 67.7% of the respondents agreed that breast cancer is a killer disease that metastases fast within the body.Conclusions: The respondent’s education, employment status and level of income are the socio-economic factors that determine health seeking behaviour among women diagnosed with breast cancer in Kisii County. Majority of the victims use traditional medicine as a treatment option for breast cancer because it is cheaper than modern cancer therapy.

Stigma among tuberculosis patients and associated factors in urban slum populations in Uganda.

Stigma continues to be a major barrier to tuberculosis (TB) control particularly in urban populations. Stigma can influence health seeking behaviour and affect adherence to TB treatment, yet few studies have examined TB related stigma and associated factors in Uganda. This study was therefore conducted to determine the level of stigma and associated factors among TB patients in an urban setting in Kampala, Uganda. A cross-sectional study was conducted in Makindye division, Kampala among 204 patients with TB aged 18 years and above. Data were collected on socio-demographic, individual patient and HIV/AIDS related factors using an interviewer administered questionnaire. The outcome variable (stigma) was assessed on a four-point Likert scale from the participants' perspective. Stigma scores ranged from 0 to 36 which were summed up and a median stigma score calculated. Individuals with a stigma score equal or greater than the median were categorized as having high stigma. A multivariable logistic regression analysis was performed to determine factors associated with TB stigma. Over half (52%) of the participants were found to have high TB stigma. Knowing someone who had died of TBAOR = 4.42, 95% CI (1.69 - 11.50) and believing that TB and HIV symptoms were similarAOR = 3.05, 95% CI (1.29 - 7.22) were positively associated with high TB stigma. The odds of having high stigma were 79% lower among individuals who had been previously treated for TBAOR = 0.21, 95% CI (0.09 - 0.52). Stigma towards TB was high in this urban population and mainly associated with knowing a person who had died of TB, perception that symptoms of TB are similar to those of HIV/AIDS, and previous TB treatment. Interventions to mitigate TB stigma are needed in urban populations and should also address HIV/AIDS related stigma.

Evaluating the Usefulness of YouTube as a Source of Patient Information for Neurosurgical Care in Africa: A Study Protocol.

Background:A significant proportion of the public rely on the internet for their health information, and social media has emerged as the principal information source. YouTube is the world’s largest and most popular video library, and it has emerged as a primary health information source because it offers animated and interactive content. However, little is known of its usefulness of neurosurgery videos to African YouTube users. We aim with this study to evaluate the usefulness of YouTube as a source of patient information for neurosurgical care in Africa.Methodology:This observational study will be conducted using YouTube. A search will be carried out to identify neurosurgery videos suggested to African YouTube viewers from inception to September 2021. An internet browser (Google Chrome, Google Inc., CA, USA) with its cache cleared will be used to execute the search. The default YouTube search setting of “relevance” will be used to replicate what a search attempt performed by a patient would be. The first 50 results from each keyword search will be registered in a Microsoft Excel spreadsheet (Microsoft, WA, USA). The primary outcome measure is the reliability of the videos. Data will be analyzed using SPSS version 26 (IBM, WA, USA). Odds ratios and their 95% confidence intervals will be calculated. The statistically significant level will be set at 0.05. Also, a linear regression analysis will be performed to examine the effects of independent variables on continuous dependent variables.Dissemination:The study findings will be published in an academic peer-reviewed journal, and the abstract will be presented at an international conference. English and French visual and video abstracts of the methods and key findings will be designed and disseminated widely on social media.Highlights: A significant proportion of the public rely on the internet and social media for health information.YouTube has emerged as the world’s largest video library, and has emerged as a primary health information source.There are few safeguards to avoid dissemination of false or biased information on the platform this could negatively influence health seeking behaviorWe aim to evaluate the usefulness of YouTube as a source of patient information for neurosurgical care in Africa.The findings of this study will help evaluate the volume and quantity of African neurosurgical video content and identify best practices.

Using evidence-based infographics to increase parents' understanding about antibiotic use and antibiotic resistance: a proof-of-concept study.

BackgroundCommunities need to see antibiotic stewardship campaigns as relevant to enhance understanding of antibiotic use and influence health-seeking behaviour. Yet, campaigns have often not sought input from the public in their development.ObjectivesTo co-produce evidenced-based infographics (EBIs) about antibiotics for common childhood infections and to evaluate their effectiveness at increasing parents’ understanding of antibiotic use.MethodsA mixed-methods study with three phases. Phase 1 identified and summarized evidence of antibiotic use for three childhood infections (sore throat, acute cough and otitis media). In phase 2, we co-designed a series of prototype EBIs with parents and a graphic design team (focus groups). Thematic analysis was used to analyse data. Phase 3 assessed the effect of EBIs on parents’ understanding of antibiotic use for the three infections using a national online survey in the UK.ResultsWe iteratively co-produced 10 prototype EBIs. Parents found the evidence displayed in the EBIs novel and relevant to their families. Parents did not favour EBIs that were too medically focused. Parents preferred one health message per EBI. We included eight EBIs in a national survey of parents (n = 998). EBIs improved knowledge by more than a third across the board (34%, IQR 20%–46%, P < 0.001). Respondents confirmed that EBIs were novel and potentially useful, corroborating our focus groups findings.ConclusionsCo-designed EBIs have the potential to succinctly change parents’ perceptions about antibiotics for acute respiratory tract infections in children. Further research should test EBIs in real-world settings to assess their reach as a potential public-facing intervention.

The variation of health seeking behaviour in urban households: an assessment on two selected residential areas in Sylhet

Background: The study of health seeking behavior is a useful research for developing society like Bangladesh. Many factors such as socio-demographic, socio-cultural, socio-economic and health service system influence health seeking behavior. This study assessed the health seeking behavior among the households’ areas in Sylhet city.Methods: This study has used multistage cluster sampling method for data collection. Using multistage cluster sampling, 150 were selected. A household survey questionnaire was used to collect data. Information about socio-demographic characteristics, socio-economic factors, socio-cultural factors by residential areas, and their influences on seeking health care have been gathered. Chi-square and uni-variate analysis has been applied in this study.Results: The association between socio-economic status and the status of residential area has a significant relationship. The p value (0.005) indicates most of the socio-demographic factors except sanitary system associated with the status of residential households. The association among income range, total expenditure, medical expense, income interfere by perceiving illness, health insurance, main source of health care, reason for choosing specific source of health care and the pattern of health seeking behavior of the residential areas are statistically significant. Uni-variate analysis is an interaction between residence and reason for choosing specific health care on main source of health care among the households of the residential areas under this study (p=0.001).Conclusions: Understanding of health seeking behaviour is essential to provide need-based health care services to the population. Many factors like gender, age, type of illness influences the health seeking behaviour.

The role of community leaders on adolescent\u2019s HIV and sexual reproductive health and rights in Mulanje, Malawi

BackgroundWe conducted this study to understand roles of community leaders on adolescent’s HIV and Sexual and Reproductive Health (SRH) rights in Mulanje-Malawi. We discussed how each role can influence health seeking behaviour and improve SRH rights among adolescents from the local perspective.MethodsA qualitative study approach was used. We conducted 17 Key Informant Interviews (KIIs) and 12 Focus Group Discussions (FGDs) with community leaders. Purposive sampling technique was used to select study participants for KIIs. We also used purposive sampling technique to identify two villages from each of the six Traditional Authorities (TAs) where FGDs were conducted. All participants in FGDs were purposively selected. Inductive thematic content analysis was done guided by the study objectives to generate emerging themes.ResultsCommunity leaders have many roles on adolescents HIV and SRH. These roles include advisory, encouragement, regulating and restricting cultural practices, formulating bye-laws and handling sexual abuse complaints. However, community leaders with religious affiliation have shown to have different views with those representing other institutions not affiliated to religion. In addition, the majority of community leaders indicated low level of knowledge on adolescent’s SRH rights.ConclusionWe suggest that the roles of community leaders differ depending on the position held and institution represented. Those not affiliated with religious institutions can encourage certain behaviour in adolescents while those from religious background are discouraging it. Stakeholders involved in the fight against HIV, promotion of SRH and rights should invest more on capacity building among the community leaders.

Factors Influencing Tuberculosis Knowledge among TB Patients in Gakenke District, Rwanda

Knowledge of tuberculosis has been shown to influence health seeking behaviour. The study aim was to assess knowledge of tuberculosis and identify the associated factors. This study was a cross sectional descriptive research design with quantitative approach. The target population was the TB patients visited health facilities in Gakenke District. A sample of 376 TB patients was randomly selected from three health centers. Interview-administrated structured questionnaire was used to collect data from 376 TB patients. Data was analyzed with SPSS-version 22. The study protocol was approved by Mount Kenya University Rwanda. The majority of respondents 71.0% were male, 51.6% were aged 45 years and above, 81.9% were married, and 65.2% had completed primary education. Few respondents identified a germ as the cause of TB (24.7%). This study revealed that 54.3% of TB patients had good knowledge about TB. The findings from multivariate analysis show that male were three times more likely to have good knowledge about TB compared to female (AOR=3.31, 95%CI: 1.98-5.53, p&lt;0.001). Compared to TB patients aged 45 years and above, respondents aged 25-34 years old were more likely to have good knowledge about TB (AOR=38.71, 95%CI: 9.22-162.48, p&lt;0.001). TB patients who live between 2-5 km from nearest health facility were more likely to have good knowledge about TB compared to those who live at more than 5 km (AOR=33.58, 95%CI: 14.95-74.40, p&lt;0.001). The ministry of health and other stakeholders in health sector need to continue the interventions that aim to reduce TB infection.

Beyond biomedical and comorbidity approaches: Exploring associations between affinity group membership, health and health seeking behaviour among MSM/MSW in Nairobi, Kenya

ABSTRACT We explored general health and psychosocial characteristics among male sex workers and other men who have sex with men in Nairobi, Kenya. A total of 595 MSM/MSW were recruited into the study. We assessed group differences among those who self-reported HIV positive (SR-HIVP) and those who self-reported HIV negative (SR-HIVN) and by affinity group membership. Quality of life among SR-HIVP participants was significantly worse compared to SR-HIVN participants. Independent of HIV status and affinity group membership, participants reported high levels of hazardous alcohol use, harmful substance use, recent trauma and childhood abuse. The overall sample exhibited higher prevalence of moderate to severe depressive symptoms compared to the general population. Quality of life among participants who did not report affinity group membership (AGN) was significantly worse compared to participants who reported affinity group membership (AGP). AGN participants also reported significantly lower levels of social support. Membership in affinity groups was found to influence health seeking behaviour. Our findings suggest that we need to expand the mainstay biomedical and comorbidity focused research currently associated with MSM/MSW. Moreover, there are benefits to being part of MSM/MSW organisations and these organisations can potentially play a vital role in the health and well-being of MSM/MSW.

The Profile, Health Seeking Behavior, Referral Patterns, and Outcome of Outborn Neonates Admitted to a District and Regional Hospital in the Upper West Region of Ghana: A Cross-Sectional Study.

Neonatal mortality is the major contributor to under-five mortality rates in many low and middle income countries. We examined the health practices, care-seeking behavior, and referral of sick outborn neonates to a district and regional hospital in the Upper West Region of Ghana. The study was a cross-sectional study conducted over an eight (8) month period in 2018. Data were obtained from caregiver interviews and case notes. Altogether, 153 outborn neonates were examined. Inappropriate practices including the use of enemas, cord care with cow dung, and herbal baths were found. Three babies treated this way died. The majority of caregivers sought care at a health facility. However, 67 (44%) sought care only after their babies were ill for ≥7 days, suggesting the influence of a period of confinement on health seeking. More than half, 94 (61.4%), of the facilities visited referred patients to destination hospitals without giving any treatment. Delayed care-seeking was associated with a low birth weight, using home remedies, and a maternal age of ≥30 years. Altogether, 12 neonates (7.8%) died, consisting of three males and nine females (p = 0.018). Socio-cultural factors strongly influence health seeking behavior and the health outcome of neonates in this setting. There appeared to be a limited repertoire of interventions for treating neonatal disease in primary care.

Health seeking behaviour for Buruli Ulcer disease in the Obom sub-district of the Ga south Municipality of Ghana

The current biomedical Buruli ulcer case management strategies emphasise the importance of early reporting and appropriate medical treatment of nodules before they ulcerate and give rise to deformities and disabilities. However, there are a wide range of factors that influence health seeking behaviour for Buruli ulcer case management. The purpose of the study was to determine health seeking behaviour for Buruli ulcer by affected persons and their families. This was a descriptive study involving both qualitative and quantitative data collection. Thirty (30) in-depth interviews were conducted for Buruli ulcer patients and their corresponding caregivers on barriers and facilitators to health seeking. Three (3) Focus Group Discussions (FGDs) were also conducted among elderly community members. Survey questionnaire interviews were conducted with 300 community respondents in Ga, Akan and Ewe languages in the study area. Systematic sampling was used to select 300 respondents for the survey. The study revealed that most respondents (41.0%) would resort to self-medication as their first treatment option when infected with Buruli ulcer. However, the health seeking of self-medication before seeking biomedical treatment was alarming since it leads to delays in reporting. This is a serious public health concern since delay in reporting could lead to category three lesions.

Health System Factors That Influence Health Seeking Behavior Associated With Prostatism among Men above 40 Years in Nyamira County

Background: Prostatism refers to obstruction of the bladder neck due to an enlargement of the prostate as men ages leading to urinary difficulties. Prostatism symptoms are majorly irritative and obstructive. The obstructive ones include hesitancy, the need to initiate micturition and a weakened urinary stream while the Irritative ones which are usually more troublesome to patients includes urgency, frequency as well as nocturia. This study was cross sectional study which was conducted at Nyamira County. Objective: The study sought to establish Health system factors that influence health seeking behavior associated with Prostatism among men above 40 years in Nyamira County. Materials and methods: The study adopted a descriptive cross-sectional community study design. The study utilized qualitative and quantitative research methods in order to obtain the required information from respondents. Quantitative data collection was done by use of open and closed ended questionnaires while qualitative data was collected through focused group discussions with adult Men. Confidentiality of information collected was observed and consent was sought from the respondents before collecting any form of information from them. A total of 387 respondents from 18 villages representing 3 villages from six sub locations of Nyamira south and Masaba wards that were randomly selected, were interviewed representing 91.7% response rate. The tools that the researcher used included questionnaire, interview schedule, pens and pencils. Descriptive data was analyzed with the aid of the Statistical Package for Social Sciences (SPSS) version 20.0 with the help of Microsoft Excel programme to generate frequency tables, graphs and pie-charts. Inferential statistics was calculated using Chi-Square tests (p=0.005) done at 95% confidence level to determine the linkage between the Variables. Results: The study found that the overall uptake level of Prostatism services was 12.1%. Chi-square analysis revealed significant relationship between cost of screening (0.001), having medical insurance (0.001), reception and quality of care (0.01), distance to health facility (0.001) and uptake of Prostatism services. Conclusion: The study findings revealed a low uptake of prostatism services. The findings of this study will help policy makers, facility administrators and care providers to shape comprehensive healthcare policies and programs targeting Prostatism services. This will help come up with a policy specifically addressing health system factors that affect uptake of prostatism services.

24 Stroke Risk Factors, Aetiology, and Outcomes in a Multi-ethnic Irish Stroke Population

Abstract Background Stroke aetiology, risk factors and outcomes vary among ethnic groups. The profile of patients presenting to hospital with stroke in Ireland is changing as immigration increases. We aim to describe differences that exist between a multi-ethnic immigrant population and native Irish residents. Methods Using our hospital's stroke registry we identified all non-Irish (NI) patients admitted to the stroke unit over a two year period through surname recognition (N=44). Country of birth was confirmed by a chart review. The Irish patients admitted over the same time frame were used as a comparison group (N=437). Data was collected on stroke subtype and outcomes, comorbidities, and socioeconomic factors. Patients were grouped based on ethnicity and stroke subtype. Chi squared test was used to analyze the relationship between groups. Results NI patients made up 9.1% of all stroke unit admissions. NI patients were younger than Irish patients (average age 57.5 vs 69.6 years, p &lt;0.01) and there was a higher prevalence of ICH in the NI group (34.1% vs 11.7%, p &lt;0.01). Hypertension was the most common vascular risk factor in both groups (72.7% vs 68.2%, p = 0.54). Mortality and morbidity was lower in the NI group, with more patients being discharged to home. Conclusion Our study demonstrates that NI stroke patients have a different risk factor and stroke sub-type profile compared to Irish patients. NI patients are more likely to be young, hypertensive, male, and have higher rates of ICH. Cultural and linguistic barriers may adversely influence health seeking behaviour in this group. These findings underscore the need to identify the root causes of these ethnic differences so targeted primary prevention campaigns can be established.

Prevalence and predictors of complementary and alternative medicine modalities in patients with chronic hepatitis B.

The use of complementary and alternative medicine (CAM) in patients with chronic hepatitis B (CHB) can interact with antiviral treatment or influence health-seeking behaviour. We aimed to study the use of individual CAM modalities in CHB and explore determinants of use, particularly migration-related, socio-economic and clinical factors. A total of 436 CHB outpatients who attended the Toronto Centre for Liver Disease in 2015-2016 were included in this cross-sectional study. Using the comprehensive I-CAM questionnaire and health records, data were collected on socio-demographic and clinical variables and on usage of 16 CAM modalities in the last year. Sixty percent of patients were male, 74% were Asian and 46% were using antiviral treatment. Three-hundred and nine (71%) patients used CAM. Vitamin/mineral preparations (45% of patients) were most commonly used. Overall CAM use and the specific use of potentially injurious CAM, such as green tea extract (9.2%) and St. John's wort (0.2%), were not associated with liver disease severity. Female sex, family history of CHB, lower serum HBV DNA, and higher socio-economic status were independently associated with bio-holistic CAM use, the clinically most-relevant CAM group (P<0.05); ethnicity, antiviral therapy use and liver disease severity were not. CAM use among CHB patients was extensive, especially use of vitamin and mineral preparations, but without direct influence on liver disease severity. Bio-holistic CAM use appeared to be associated with socio-economic status rather than with ethnicity or liver disease severity. Despite the rare use of hepatotoxins, physicians should actively inquire about it.

P221 A survey examining health seeking behaviours of those accessing sexual health services in London

Background/introduction Open access to sexual health services reduces STI’s and onwards transmission. Given cuts to Public Health budgets, a better understanding of how patients access care is vital to rationalise services. Aim(s)/objectives Assessing demographics and health behaviours of sexual health clinic attendees to improve service delivery. Methods Patient-directed questionnaires were completed on registration in a London Trust. Information including demographics, travel times and whether patients sought help before attending were collected. Results 231 surveys were returned with respondents 48% white, 23% black and 13% Asian. 62% of patients walked-in, 34% booked online. 52/217 (24%) sought advice from elsewhere before attending (primarily GP - 26/52, 50%) with 50% finding it useful. Of 107 responses, 41 (38%) tried self-treating before attendance. Symptomatic patients were more likely then asymptomatic patients to seek help elsewhere (40/113 versus 12/99, p Discussion/conclusion Our data demonstrates the clinics surveyed serving a very local population. However a significant proportion of patients, particularly those with symptoms, seek help elsewhere before attending, with only 50% finding this useful. This highlights the importance of specialist services addressing local patients’ health needs. Overall socio-demographic factors did not appear to influence health seeking behaviour, although those with a lower education status appeared to access services more directly.

Self-treatment of Uncomplicated Malaria at Community Level in Masala Township, Ndola District, Zambia: Prevalence, Knowledge and Factors Influencing Self-treatment

Background: Malaria is the commonest cause of fever, morbidity and mortality in the tropics. A good number of people are able to recognize the symptoms and initiate treatment. However lack of clinical evaluation of the patients by trained health professionals, may delay appropriate treatment and promote drug resistant. Objective: To determine the prevalence of self-treatment of malaria among the people with regard to knowledge and factors that may influence health seeking behavior. Method: Community based cross section descriptive study carried among 365patients buying medicines from local drugstores. A structured questionnaire was used to gather data entered in Epi Data 3.1 and analysis done using SPSS version 16.0. To ascertain association between dependent and independent variables, binary logistic regression and variables with p-value of less than or equal to 0.05 were entered into multivariate regression analysis. Results: Among the 365 patients interviewed 150 bought antimalarials 150/365 (41.1%). The overall knowledge was 44.7% and significantly associated with income, education and occupation. Compared to respondents with income > K1000, respondents with income < K500 were 94% (AOR=0.06; 95% CI [0.01, 0.21]) less likely to be knowledgeable. Respondents with tertially education were 2.73 (95% CI [1.50, 4.89]) times more likely to be knowledgeable compared to respondents with primary education. Compared to respondents with othersa occupations, professionals were 5.97 (95% CI [2.27, 15.7]) times more likely to be knowledgeable. Sulfadoxine-pyrimethamine (fansidar) is by far the antimalaria drug that was used 51.3%. About 66.7% attributed to overcrowding and 72.7% to not being attended to in less than 2 hours upon arrival at health facility as reasons for not seeking treatment at government facilities. Conclusion: Prevalence of self-medication was high 41.1% and most people lacked adequate knowledge on malaria. The individual’s level of formal education, income and occupation were determinants knowledge.

Health Seeking Behavior for HIV/AIDS among Public College Community, Ethiopia; A Qualitative Study Using Behavioral Models

Background: Producing quality data for decision at all levels of the health communication is a global imperative. Following that, recently, many organizations are evaluating various prevention communications; however, adequate data has not been obtained. This study is aimed to explore factors that have impact on health seeking behavior for HIV/AIDS among public college community. Methods: Focus group discussions and in-depth interviews were conducted from March 1-30, 2012 with students, teachers and HIV mainstreaming heads in the three colleges of Hadiya Zone, Ethiopia. Data was captured using voice recorders, and field notes were transcribed verbatim from the local language into English. Key constructs and thematic frameworks were developed using the Extended Parallel Process Model (EPPM) and health belief model (HBM), and presented in narratives using the respondents own words. Results: Participants had very low self-susceptibility to HIV/AIDS but they claimed others as highly susceptible. Self-efficacy (confidence in performing the behaviour), and response efficacy (the belief of efficacious of the message) regarding acceptance of recommended preventive message were the most important correlates of the perception. Conclusion: Lack of awareness of self-susceptibility is a critical problem for adaptation of behavior. All the participants’ agree seriousness of the problem which is not attached with using recommended methods. Selecting one recommended response hampered the others prevalence. For instance, low self-efficacy and response efficacy were the critical problems in condom use. Accesses to services for social marketing were poor for a variety of psycho-social and cultural reasons. Prior to the promotion of prevention programs, health service related factors that influence health seeking behaviour must be addressed through appropriate behaviour change communications.

65. Anxiety and Depression Comorbidity in Primary Care Gout: A Matched Retrospective Cohort Study

Background: Chronic conditions such as diabetes mellitus and cardiovascular disease are common in people with gout and are associated with poorer quality of life and higher mortality. However, our understanding of the role of psychological comorbidity in gout remains unclear. Frequent experience of severe pain, social isolation and strained family relationships may impact negatively on psychological health and influence health-seeking behaviour. This matched retrospective cohort study aimed to examine the association between gout and subsequent consultation for anxiety & depression in a UK primary care population. Methods: The study was undertaken using data from a general practice consultation database (CiPCA), gathered from nine general practices in North Staffordshire. Patients aged 18 years who consulted with gout between 2000 and 2008 were identified by Read code and each matched to 4 controls by age, gender, year of consultation and general practice. A consultation for either anxiety or depression, subsequent to the gout diagnosis, was defined from a relevant Read code gained between 2000 and 2011. Several other gout-related comorbidities (e.g. hypertension) were also recorded by Read code. Cox regression model was used to examine the association between gout and subsequent anxiety & depression consultation (new episodes), adjusting for age, gender, deprivation, year of consultation, general practice and comorbidities. Hazard ratio (HR) and 95% CI were reported for gout cases vs matched controls. Results: 1689 patients with gout were compared with 6,756 control patients. Mean age was 63 years (Standard deviation 16) and 24% were female. Of gout patients, 15.3% & 9.7% had consulted for anxiety & depression respectively, this was in comparison with 14.2% & 9.5% of the controls. Adjusted cox regression analysis found no association between gout and time to consultation for anxiety (HR 1.04, 95% CI 0.9, 1.2) or depression [0.88 (0.7, 1.1)] compared with controls. Across gout patients and matched controls, being younger and female was associated with a propensity to consult for anxiety & depression. With each year from first diagnosis (gout and controls), there was a trend of increasing consultation for anxiety. The presence of hypertension and alcoholism comorbidity was associated with an increased probability of consultation for anxiety & depression. Conclusion: Despite the psychological burden which gout may be expected to impart on patients, time to consultation for anxiety & depression in UK primary care was equivalent to matched controls. This may relate to the prolonged asymptomatic inter-critical period between gout attacks during which psychological burden may ease. However, as under-reporting of both anxiety & depression in primary care is common and the severity & disease characteristics of gout, anxiety & depression could not be established from medical records, further research considering these factors would be of benefit. Disclosure statement: The authors have declared no conflicts of interest.

Health-Seeking Behavior of Rural Dwellers in Southern Nigeria: Implications for Healthcare Professionals

The Nigerian rural people demonstrate undesirable health-seeking behavior because of their cosmological and nosological notions which ascribe etiology of diseases and ill-health to entities far beyond the realm of the stethoscope. The present review is therefore solicited to enhance the health status of rural dwellers by providing potentially useful guidance that will enhance the knowledge of healthcare professionals with respect to the peculiar health-seeking behavior of rural dwellers so as to promote good patient-physician interaction and to provide empirical basis for rational health policy formulation. A manual literature and internet (Google, Medline, Embase, HINARI and Cochrane data bases) search showed that in a pluralistic medical milieu in which the rural dwellers find themselves, the decision to seek healthcare, where to do this and the form of care perceived as appropriate are all influenced by a multiplicity of factors relating to the person, the facility and the socio-cultural environment. Primarily, religious beliefs, use of Traditional African Medicine (TAM) and patients’ perception of reality influence health-seeking behavior. In order to adequately and successfully manage the Nigerian rural patients, the healthcare provider must pay attention to patients’ impression of illness and underpinning health beliefs during consultation, in therapeutics and in handling evolving complications of TAM and ethical dilemmas. Improvement of rural infrastructure and behavioral health promotion campaigns among the rural people together with rational health policy formulation and regulation of TAM practice, are imperative. Review Article