Seeking Health Care Research Articles

Healthcare seeking behavior for acute illnesses among adult Aborigine communities (Orang Asli) in Cameron Highlands, Malaysia: a house-to-house survey

Indigenous people often have poor health due to a lack of access to health care. We studied healthcare-seeking behaviors and associated factors of Orang Asli populations living in remote hilly areas of Peninsular Malaysia. A house-to-house survey was done in 11 of 28 randomly selected villages. A sample of 225 Adults aged 18 years and above were interviewed about healthcare-seeking behavior for an episode of illness 30 days before the survey date. Factors associated with appropriate healthcare-seeking behavior as determined by binary logistic regression analyses. More than a third of the Orang Asli adults (88/225) did not consult any healthcare provider (39%) for which ‘illness does not need treatment’ or ‘not sick enough’ (22%) and no transportation (12%) were the main reasons. Being of older age (aOR 0.95, 95%CI 0.9, 0.98), income higher than 500 Malaysian Ringgits per month (aOR 2.35, 95%CI 1.04, 5.39), perception of illness as ‘severe’(aOR 54.79 95% CI 12.61, 239.9), and closer distance of health facility (aOR 0.86 95% CI 0.81, 0.93) were associated with appropriate healthcare-seeking behavior. Health promotion campaigns are needed to improve awareness about common illnesses and improve care-seeking behavior.

The psychosocial burden of cutaneous leishmaniasis in rural Sri Lanka: A multi-method qualitative study.

Leishmaniasis is a tropical infectious disease affecting some of the world's most economically disadvantaged and resource-poor regions. Cutaneous leishmaniasis (CL) is the most common out of the three clinical types of Leishmaniasis. Since 1904 this disease has been endemic in Sri Lanka. CL is considered a disfiguring stigmatising disease with a higher psychosocial burden. However, there needs to be a more in-depth, holistic understanding of the psychosocial burden of this disease, both locally and internationally. An in-depth understanding of the disease burden beyond morbidity and mortality is required to provide people-centred care. We explored the psychosocial burden of CL in rural Sri Lanka using a complex multimethod qualitative approach with community engagement and involvement. Data collection included participant observation, an auto-ethnographic diary study by community researchers with post-diary interviews, and a Participant Experience Reflection Journal (PERJ) study with post-PERJ interviews with community members with CL. The thematic analysis revealed three major burden-related themes on perceptions and reflections on the disease: wound, treatment, and illness-experience related burden. Fear, disgust, body image concerns, and being subjected to negative societal reactions were wound-related. Treatment interfering with day-to-day life, pain, the time-consuming nature of the treatment, problems due to the ineffectiveness of the treatment, and the burden of attending a government hospital clinic were the treatment-related burdens. Anxiety/worry due to wrongly perceived disease severity and negative emotions due to the nature of the disease made the illness experience more burdensome. Addressing the multifaceted psychosocial burden is paramount to ensure healthcare seeking, treatment compliance, and disease control and prevention. We propose a people-centred healthcare model to understand the contextual nature of the disease and improve patient outcomes.

Sociocultural understanding of Tuberculosis and implications for care-seeking among adults in the province of Zambezia, Mozambique: Qualitative research.

Mozambique has a high burden of Tuberculosis (TB) with an incidence of 368 per 100,000 population in 2020, coupled with a low all-form TB detection rate. The COVID-19 pandemic has exacerbated delays in timely diagnosis and treatment of new TB cases. Promoting active TB case finding is a national priority in Mozambique. We conducted qualitative research to explore factors influencing TB testing in Zambezia province in Mozambique. One-to-one, semi-structured, audio-recorded telephone interviews were conducted to explore TB-related knowledge, and barriers and facilitators to TB testing. A sample of two TB Program staff, two community providers of TB services, and 19 community members (10 women and 9 men) was recruited, with support from provincial government TB staff, from four districts in Zambezia with a high TB burden. Interviews were transcribed verbatim, and thematic analysis was conducted. The Mozambican National Bioethics Committee for Health approved the study protocol. Our study highlights that knowledge about TB symptoms and its causes is low, which could delay timely TB testing. Sociocultural beliefs often implicate certain types of sexual activity and women as causes of TB symptoms; for example, having sex with a widow who has not been traditionally purified, or with a woman who has had an abortion. Therefore, people usually tend to first seek care from traditional healers instead of going to a health facility. Additionally, stigma associated with HIV and TB also delays care seeking. Gender-related disparities in TB care seeking were also evident. This study provides valuable insights into how healthcare seeking for TB is influenced by sociocultural understanding of symptoms and gender dynamics. Therefore, interventions to promote timely and appropriate care seeking for TB should be contextually tailored, culturally appropriate, and gender sensitive.

Quality of health service in the local government authorities in Tanzania: a perspective of the healthcare seekers from Dodoma City and Bahi District councils.

Improvement and access to quality healthcare are a global agenda. Sustainable Development Goal (SDG-3) is committed to ensuring good health and well-being of the people by 2030. However, this commitment heavily depends on joint efforts by local authorities and the immediate service providers to communities. This paper is set to inform the status of health service provision in local authorities in Tanzania using the determinants for quality health services in Dodoma City and Bahi District. A cross-sectional research design was employed to collect data from 400 households in the Local Government Authorities. The five-service quality (SERVQUAL) dimensions of Parasuraman were adopted to gauge the quality of service in public healthcare facilities. Descriptive statistics were used to compute the frequency and mean of the demographic information and the quality of health services, respectively. A binary logistic regression model was used to establish the influence of the demographic dimensions on the quality of health services. The findings revealed that quality health services have not been realised for healthcare seekers. Further, the area of residence, education, and occupation are significantly associated with the perceived quality of health service delivery in the Local Government Authorities. The healthcare facilities under the LGAs offer services whose quality is below the healthcare seekers' expectations. The study recommends that the Local Government Authorities in Tanzania strengthen the monitoring and evaluation of health service delivery in public healthcare facilities.

Understanding the Pattern of Health Seeking Behaviour of Indigenous Communities: A Discussion on Rajbanshis of Koch Bihar

Individual or community Health care seeking is always linked to a decision-making process that is influenced by a variety of variables, including household habits, social norms, health beliefs and disease perceptions, as well as the accessibility and availability of medical facilities. Thus, care seeking is diverse in nature. Indigenous communities define medical care, illness etiology, and treatment within social contexts. Their recent embrace of contemporary medications and medical facilities has changed the nature of care seeking behaviour. The current study is based on a primary field study that was carried out among the Rajbanshis of Koch Bihar and demonstrates the type and degree of indigenous peoples' acceptance of both traditional and modern health care systems.

Parent Perceptions of Telemedicine for Acute Pediatric Respiratory Tract Infections: Sequential Mixed Methods Study.

Since 2020, parents have had increasing opportunities to use telemedicine for their children, but how parents decide whether to use telemedicine for acute pediatric care relative to alternative sites of care is not clear. One of the most common reasons parents seek acute care for their children is for acute respiratory tract infections (ARTIs). This study aims to examine parental expectations of care via telemedicine for pediatric ARTIs, contrasting expectations of care delivered via primary care telemedicine and direct-to-consumer (DTC) telemedicine. We performed a sequential mixed methods analysis to examine how parents assess telemedicine for their children's acute care. We used ARTIs as a case study for examining parent perceptions of telemedicine. First, we analyzed semistructured interviews focused on parent responses about the use of telemedicine. Each factor discussed by parents was coded to reflect whether parents indicated it incentivized or disincentivized their preferences for telemedicine versus in-person care. Results were organized by a 7-dimension framework of parental health care seeking that was generated previously, which included dimensions related to care sites (expected access, affordability, clinical quality, and site quality) and dimensions related to child or family factors (perceived illness severity, perceived child susceptibility, and parent self-efficacy). Second, we analyzed responses to a national survey, which inquired about parental expectations of primary care telemedicine, commercial DTC telemedicine, and 3 in-person sites of care (primary care, urgent care, and emergency department) across 21 factors identified through prior qualitative work. To assess whether parents had different expectations of different telemedicine models, we compared survey responses for primary care telemedicine and commercial DTC telemedicine using weighted logistic regression. Interview participants (n=40) described factors affecting their perceptions of telemedicine as a care modality for pediatric ARTIs. Generally, factors aligned with access and affordability (eg, decreased wait time and lower out-of-pocket cost) were discussed as potential incentives for telemedicine use, while factors aligned with perceived illness severity, child susceptibility, and clinician quality (eg, trustworthiness) were discussed as potential disincentives for telemedicine use. In survey responses (n=1206), primary care and commercial DTC telemedicine were rated similarly on items related to expected accessibility and affordability. In contrast, on items related to expected quality of care, primary care telemedicine was viewed similarly to in-person primary care, while commercial DTC telemedicine was rated lower. For example, 69.7% (weighted; 842/1197) of respondents anticipated their children would be comfortable and cooperative with primary care telemedicine versus 49.7% (weighted; 584/1193) with commercial DTC telemedicine (P<.001). In a mixed methods analysis focused on telemedicine for ARTIs, parents expressed more concerns about telemedicine quality in commercial DTC models compared with primary care-based telemedicine. These results could help health systems better design telemedicine initiatives to support family-centered care.

Reproductive health service access and utilisation among migrant women in Dhaka’s urban slums: a qualitative study

This study explores the impact of migration on the access and utilisation of sexual and reproductive health services by women living in an informal settlement in Dhaka, Bangladesh. A total of 16 in-depth interviews were conducted in March and April of 2019 with women (18–49 years old) who had migrated from rural areas to Dhaka. They reported continued economic insecurity while receiving minimal support from the state. All women reported financial and infrastructural barriers to accessing formal sexual and reproductive health services and tended to seek resources and support through social networks within the slum and from informal health services. Compared with more recent migrants, women who had migrated and resided in the slums for longer found it easier to utilise social networks and resources for sexual and reproductive health. Women had more agency in experimenting with contraceptives but had less power in making decisions during pregnancy and when seeking health care. Menstrual health was a neglected aspect of public health. The study indicates that public health policy targeting the urban poor needs to address the unique challenges faced by migrant women in informal settlements to rectify inequities in health services that leave significant portions of the urban poor population behind.

Abnormal uterine bleeding diagnoses and care following COVID-19 vaccination

BackgroundThere is evidence suggesting that COVID-19 vaccination may be associated with small, transitory effects on uterine bleeding, possibly including menstrual timing, flow, and duration, in some individuals. However, changes in health care seeking, diagnosis, and workup for abnormal uterine bleeding in the COVID-19 vaccine era are less clear. ObjectivesTo assess the impact of COVID-19 vaccination on incident abnormal uterine bleeding diagnosis and diagnostic evaluation in a large integrated health system. Study DesignUsing segmented regression, we assessed whether the availability of COVID-19 vaccines was associated with changes in monthly, population-based rates of incident abnormal uterine bleeding diagnoses compared to the pre-pandemic period in health system members ages 16-44 years who were not menopausal. We also compared clinical and demographic characteristics of patients diagnosed with incident abnormal uterine bleeding between December 2020 through October 13, 2021 by vaccination status (never vaccinated, vaccinated in the 60 days prior to diagnosis, vaccinated more than 60 days prior to diagnosis) and conducted detailed chart review of patients diagnosed with abnormal uterine bleeding within 1-60 days of COVID-19 vaccination in the same time period. ResultsIn monthly populations ranging from 79,000 to 85,000 female health system members, incidence of abnormal uterine bleeding diagnosis per 100,000 person-days ranged from 8.97 to 19.19. There was no significant change in the level or trend in the incidence of abnormal uterine bleeding diagnoses between the pre-pandemic (January 2019-January 2020) and post-COVID-19 vaccine (December 2020-December 2021) periods. A comparison of clinical characteristics of 2,717 abnormal uterine bleeding cases by vaccination status suggested that abnormal bleeding among recently vaccinated patients was similar or less severe than abnormal bleeding among patients who had never been vaccinated patients or those vaccinated more than 60 days prior. There were also significant differences in age and race of patients with incident abnormal uterine bleeding diagnoses by vaccination status: never vaccinated patients were the youngest and those vaccinated more than 60 days prior were the oldest; the proportion of patients who were Black/African American was highest among never vaccinated patients, and the proportion of Asian patients was higher among vaccinated patients. Chart review of 114 confirmed post-vaccination abnormal uterine bleeding cases diagnosed from December 2020 through October 13, 2021 found that the most common symptoms reported were changes in timing, duration, and volume of bleeding. Approximately one-third of cases received no diagnostic workup; 57% had no etiology for the bleeding documented in the electronic health record. In 12% of cases, the patient mentioned or asked about a possible link between their bleeding and their recent COVID-19 vaccine. ConclusionsThe availability of COVID-19 vaccination was not associated with a change in incidence of medically attended abnormal uterine bleeding in our population of over 79,000 female patients of reproductive age. Additionally, among 2,717 patients with abnormal uterine bleeding diagnoses in the period following COVID-19 vaccine availability, receipt of the vaccine was not associated with greater bleeding severity.

Black and Asian American perceptions and experiences of racism in healthcare contexts: Consequences and solutions from qualitative data

ABSTRACT Race is a consequential sociocultural cue in healthcare contexts. Racism is associated with health disparities. Extant research shows significant health inequities between White and Black people. However, little is known about health gaps between or among other racial groups. This study investigated how Blacks and Asian Americans perceive and experience racism in seeking healthcare, effects of such perceptions and experiences on health outcomes, and ways to reduce racism in healthcare contexts. Findings from 40 interviews suggest strong similarities and subtle differences between the two racial groups.

Healthcare-seeking behaviours among mother's having under-five children with severe wasting in Dodoma and Mbeya regions of Tanzania-A qualitative study.

Maternal healthcare-seeking behaviour affects the health and well-being of under-five children. Drawing from the concepts of the health belief model, this study seeks to understand the determinants of health-seeking behaviours among mothers or caregivers of under-five-year-old children having severe wasting in Tanzania. A qualitative study employing the ethnography method conducted 32 semi-structured and narrative interviews with healthcare workers, community health workers, traditional healers, religious and village leaders, and mothers or caregivers of children who had acute malnutrition. The analysis of transcripts was done by qualitative content analysis. Further, the thematic analysis was carried out by assigning data into relevant codes to generate categories based on study objectives. Severe wasting among under-five-year-old children was not observed as a serious disease by the majority of mothers or caregivers. The study established that the health systems parameters such as the availability of the community health workers or healthcare providers and the availability of medicines and supplies to the health facility impact on mothers' or caregivers' healthcare-seeking behaviours. The findings also show that long distances to the health facility, behavioural parameters such as lack of awareness, negative perception of the management of severe wasting at the health facility, superstitious beliefs, women's workload, household food insecurity, and gender issues have a significant role in seeking healthcare. The results reaffirm how a programme on integrated management of severe wasting in Tanzania should encompass sociocultural factors that negatively influence mothers or caregivers of children with acute malnutrition. The programme should focus on engaging community structures including traditional healers, religious and village leaders to address prevailing local beliefs and sociocultural factors.

Using intersectional gender analysis to identify challenges in tuberculosis care at four health care facilities in Uganda

BackgroundTuberculosis (TB) care could be considered as a continuum from symptom recognition, decision to seek care, diagnosis, treatment initiation and treatment completion, with care along the continuum influenced by several factors. Gender dimensions could influence TB care, and indeed, more men than women are diagnosed with TB each year. The study was done to identify social stratifiers that intersect with gender to influence TB care.MethodsA cross-sectional qualitative study was done at four health facilities in 3 districts in central Uganda between October 2020 and December 2020. Data was collected from patients seeking a diagnosis or on TB treatment through focus group discussions and key informant interviews. Key themes around gender guided by a gender and intersectionality lens were developed and thereafter thematic content analysis was done.ResultsWomen have increased vulnerability to TB due to bio mass exposure through roles like cooking. Women have increased access to health care services as they interface with the health care system frequently given their role as child bearers and child care givers. Men have a duty to provide for their families and this most often is prioritised over healthcare seeking, and together with belief that they are powerful beings leads to poor healthcare seeking habits and delays in healthcare seeking. Decisions on when and where to seek care were not straightforward for women, who most often rely on their husbands/partners to make decisions.ConclusionsMen and women experience challenges to TB care, and that these challenges are deeply rooted in roles assigned to them and further compounded by masculinity. These challenges need to be addressed through intersectional gender responsive interventions if TB control is to be improved.Graphical

Health care seeking behaviour towards cervical cancer screening among women aged 30–49 years in Arbaminch town, Southern Ethiopia, 2023

BackgroundCervical cancer is a preventable disease. However, it remains the commonest and deadly cancer in women worldwide. Health care seeking behaviour is not well studied in Ethiopia even though it is crucial in averting cervical cancer by maximizing cervical cancer screening utilization. Therefore, this study amid to assess health care seeking behaviour towards cervical cancer screening and its associated factors among women aged 30–49 years in Arba Minch town, Southern Ethiopia, 2023.MethodsA community-based cross-sectional study design was conducted on 414 women who are in the age range of 30–49 in Arba Minch town from January 2-February20, 2023. Study participants were selected by a simple random sampling technique from all kebeles and data were collected using pretested interviewer administered questionnaires. SPSS version 27 was used to conduct binary and multivariable logistic regression analysis. Socio-demographic characteristics of the respondents were described using descriptive statistics. Furthermore, binary and multivariable logistic regression analyses were made to find the factors associated with health care seeking behaviour. Variables with a p-value less than 0.25 on binary logistic regression were selected for multivariable logistic regression. Variables with a p-value < 0.05 were considered statistically significant. The reliability and internal consistency of the constructs of health belief model were calculated independently using Cronbach’s alpha.ResultThe prevalence of health care seeking behaviour towards cervical cancer screening was 197(47.6%) [95%CI: 42.7-52.5%]. Respondents’ good knowledge [AOR = 1.55, 95%CI: 1.01–2.39], positive perceived susceptibility [AOR = 3.63, 95%CI: 2.06–6.42], positive perceived severity [AOR = 2.65, 95%CI: 1.71–4.09], positive perceived benefits [AOR = 4.85, 95%CI: 2.92–7.87] were significantly associated with health seeking behaviour.ConclusionThe prevalence of health care seeking behaviour towards cervical cancer screening is low in this study. To maximize the health care seeking behavior of women, further acting on perceived susceptibility, respondents’ knowledge, perceived severity, and perceived benefit of the woman are crucial.

Magnitude and determinant of healthcare-seeking behavior for childhood acute respiratory tract infections in Ethiopia: a cross-sectional study

BackgroundAcute respiratory infections (ARIs) remain a major public health concern which become the leading cause of mortality and morbidity in children under the age of five. A large percentage of childhood deaths and complications can be avoided by seeking proper medical care. Therefore, this study aimed to assess the magnitude, and individual and community-level determinants of mothers’ healthcare-seeking behavior for their children under the age of five who had ARI symptoms in Ethiopia.MethodA secondary data analysis was conducted using the 2016 Ethiopian Demographic and Health Surveys(EDHS) with a total weighted sample of 643 under-five children who had ARI symptoms within two weeks of the survey. Due to the hierarchical nature of the EDHS data, a multi-level logistic regression model was used to identify the individual and community-level factors influencing mothers’ health care-seeking behavior for their children with ARI symptoms. In the multivariable multilevel analysis, those variables with a p-value < 0.05 were considered to be significant predictors of the outcome variable.ResultsHealthcare-seeking behavior among mothers or caregivers for children with symptoms of ARIs was 32.61% (95% CI: 29.08–36.33%) in Ethiopia. The ICC in the null model indicated that about 55% of the total variability of treatment-seeking behavior was due to differences between clusters. Child aged > 24 months [AOR = 0.35; 0.19–0.63], having primary education [AOR = 3.25; 1.27–8.32], being media exposed [AOR = 2.49; 1.15, 5.38], female household head[AOR = 3.90; 1.35, 11.24], and delivery at health institution[AOR = 2.24; 1.00, 5.01] were significant predictors of health care seeking behavior of mother for their children with ARI symptoms.ConclusionThere is poor treatment-seeking behavior for children with symptoms of ARI in Ethiopia with significant community level variations. The multilevel logistic regression analysis showed that improving mothers’ education, women’s empowerment, facilitating institutional delivery and media accessibility are critical to promoting health-seeking behaviors among mothers or caregivers of under-five children with ARI symptoms. Hence, concerned bodies should design targeted interventions that increase mothers’ or caregivers’ treatment-seeking behavior for childhood ARI to reduce child morbidity and mortality.

Assessment of Urban Health Extension Package Utilization and Healthcare Seeking Behavior Among Model and Non-model Households in Addis Ababa, Ethiopia: A Comparative Community Based Study

BACKGROUND: Ethiopia has been implementing the Urban Health Extension Program (UHEP) at the community level since 2009. The program was a pro-poor and cost-effective approach that aimed to enhance the utilization of urban health extension program packages and empower community healthcare-seeking behavior. This study was conducted to compare the utilization and healthcare-seeking behaviors of urban health extension program packages and the healthcare-seeking behaviors of model and non-model households. METHODS: A community-based comparative cross-sectional study was conducted among 594 female household heads (297 models and 297 non-models) using a structured face-to-face interview. A bivariate and multivariable logistic regression analysis was employed to identify associated factors. A p-value less than 0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval were carried out to identify significant factors. RESULTS: Urban health extension program package utilization was 78% among model and 64.2% among non-model female households. A total of 75.5% of model and 65.2% of non-model female household heads had appropriate healthcare-seeking behavior. Moreover, having information about UHEPs (AOR = 2.35, 95% CI = 1.08 - 3.42), the frequency of home visits by UHEWs (AOR = 2.12, 95% CI = 1.01 - 3.13), knowledge about UHEPs (AOR = 3.14, 95% CI = 2.43 - 4.47), and household graduation status (AOR = 3.052, 95% CI = 2.024 to 5.113) were significantly associated with urban health extension program package utilization and healthcare-seeking behaviors. CONCLUSION: In terms of utilization, the overall urban health extension package favors model female household heads over the non-model female household heads. As a result, raising awareness, frequent home visits, and focusing more on disease prevention and control packages will boost the adoption of urban health extension packages.

“What if I get sick, where shall I go?”: a qualitative investigation of healthcare engagement among young gay and bisexual men in Nairobi, Kenya

BackgroundGlobally, young gay, bisexual and other men who have sex with men (YMSM) experience a disproportionate burden of disease compared to young heterosexual men and older MSM. However, YMSM experience major inequities in access and use of health services. We sought to gain a detailed understanding of YMSM’s healthcare engagement experiences across public, private, tertiary institution-based and MSM-friendly health facilities in Nairobi, Kenya, to inform development of interventions to improve access and use of health services by YMSM.MethodsIn September 2021, in-person qualitative in-depths interviews were conducted among 22 YMSM purposively sampled from 248 YMSM who had previously participated in a respondent-driven sampling integrated bio-behavioral survey. Interviews were done in English, transcribed verbatim and analyzed descriptively using NVivo version 12.ResultsParticipants were 18–24 years old, all identified as cisgender male, three-quarters as gay and a quarter as bisexual. Themes that were defined from the analysis included: YMSM’s experiences during healthcare seeking in various clinical settings, priority health needs, desired healthcare provider (HCP) characteristics, and the potential role of digital health interventions in improving access and use of health services. Participants relayed experiences of prejudice, stigma and discrimination when seeking services in public and institution-based health facilities, unlike in community pharmacies, private and MSM-friendly health facilities where they felt they were handled with dignity. Health needs prioritized by YMSM centered on prevention and control of HIV, sexually transmitted infections (STIs), depression and substance abuse. Participants desired HCPs who were empathetic, non-judgmental and knowledgeable about their unique health needs such as management of anorectal STIs. Participants highlighted the usefulness of digital media in offering telehealth consultations and health education on subjects such as HIV/STIs prevention.ConclusionDuring engagement with healthcare, YMSM experience various barriers that may cause them to postpone or avoid seeking care hence resulting in poor health outcomes. There is need to equip HCPs with knowledge, skills and cultural competencies to enable them offer equitable services to YMSM. Considerations should also be made for use of digital health interventions that may help YMSM circumvent some of the aforementioned barriers to service access and use.

The effect of COVID-19 pandemic on healthcare seeking in an urban informal settlement in Nairobi and a rural setting in western Kenya.

The COVID-19 pandemic caused widespread changes and disruptions to healthcare seeking behavior. There are limited studies on the effect of the COVID-19 pandemic on healthcare seeking patterns in low-and middle-income countries (LMICs), especially in settings with inequitable access to healthcare in rural and urban informal settlements. We investigated the effect of the COVID-19 pandemic on reported healthcare seeking at health facilities and chemists using morbidity data from participants in an ongoing population-based infectious disease surveillance platform in Asembo in Siaya County, a rural setting in western Kenya and Kibera, an urban informal settlement in Nairobi County. We described healthcare seeking patterns before (from 1st January 2016 to 12th March 2020) and during the pandemic (from 13th March 2020 to 31st August 2022) by gender and age for any reported illness and select clinical syndromes using frequencies and percentages. We used a generalized estimating equation with an exchangeable correlation structure to assess the effect of the pandemic on healthcare seeking adjusting for gender and age. Overall, there was a 19% (adjusted odds ratio, aOR: 0.81; 95% Confidence Interval, CI: 0.79-0.83) decline in odds of seeking healthcare at health facilities for any illness in Asembo during the pandemic, and a 30% (aOR: 0.70; 95% CI: 0.67-0.73) decline in Kibera. Similarly, there was a decline in seeking healthcare by clinical syndromes, e.g., for ARI, aOR: 0.76; 95% CI:0.73-0.79 in Asembo, and aOR: 0.68; 95% CI:0.64-0.72 in Kibera. The pandemic resulted in increased healthcare seeking at chemists (aOR: 1.23; 95% CI: 1.20-1.27 in Asembo, and aOR: 1.40; 95% CI: 1.35-1.46 in Kibera). This study highlights interruptions to healthcare seeking in resource-limited settings due to the COVID-19 pandemic. The pandemic resulted in a substantial decline in seeking care at health facilities, and an increase of the same at chemists.

Health Literacy and Healthcare Seeking with Lung Cancer Symptoms among Individuals with Different Smoking Statuses: A Population‐Based Study

Objective. To estimate proportions of contacts to the general practitioner (GP) among people with specific and nonspecific lung cancer symptoms, respectively, in the Danish general population and to analyse the associations between health literacy and these contacts based on smoking status. Methods. A total of 67,280 randomly selected individuals aged ≥40 years were invited to a survey concerning symptoms and healthcare seeking. This study included lung cancer symptoms, GP contacts, smoking status, four aspects of health literacy, and socioeconomics. Descriptive statistics and multivariable logistic regression models were applied. Results. Of 22,055 respondents, 23% reported at least one specific lung cancer symptom, while 47% reported at least one nonspecific symptom. GP contacts ranged from 30% (tiredness) to 60% (shortness of breath). Individuals who currently smoke had lower odds of GP contacts. The health literacy aspect “Feeling understood and supported” increased the likelihood of GP contact, while “Having sufficient information” decreased the likelihood. Smoking status did not modify these associations. Conclusion. Efforts targeting individuals at risk of postponing healthcare seeking with lung cancer symptoms are needed. This study highlights aspects of health literacy that may be addressed in interventions increasing both individuals and community‐based health literacy responsiveness and enhanced chances of timely healthcare seeking.

Zemstvo medicine and healthcare seeking in the late 19th – early 20th centuries: evidence from Samara uezd

This article examines the state of zemstvo medicine in Samara uezd in 1886–1913. An important aspect of this analysis is the study of healthcare seeking, which serves both as a statistical parameter of the frequency of medical care seeking and an indicator of very complex sociocultural dynamics within certain society. One’s decision to visit a hospital, and in general one’s perception of his or her own physical body and its deviations and abnormalities in medical terms are influenced by multiple factors that are not limited to the characteristics of the healthcare systems. Similar issues are studied in detail within the framework of medicalization, as well as the methodology of health seeking behavior, which examines the factors behind people’s decisions to follow healthy lifestyles, including visiting hospitals. This research is based on medical and statistical reports of the Samara uezd physicians in the late 19th – early 20th centuries and examines the temporal and spatial dynamics of the healthcare seeking; the main purpose of this study is to measure disparity levels of healthcare seeking practices in different parts of Samara uezd. Firstly, the study reveals that in the infrastructural aspect, healthcare in the Samara uezd was in an active development stage, which reflected in an increase in both the number of medical stations and hospitals, and physicians and paramedics. Secondly, the healthcare seeking rates was also evolved in a positive direction, which is reflected in an increase in both the number of medical services delivered to population. Furthermore, it shows the decrease of heterogeneity level of healthcare seeking rates between medical stations in uezd from 1898 to 1913; however, this level between the volosts remains high even after 15 years.

A qualitative study to assess satisfaction with the Manipal model of telepsychiatry among patients and caregivers.

Telepsychiatry in India is nearly two decades old and is witnessing rapid adaptation in clinical services. This warrants studying the satisfaction with this mode from healthcare seekers' point of view. This study aimed to study the treatment satisfaction among persons with psychiatric disorders and their caregivers receiving telepsychiatry services via the Manipal model. This was a qualitative cross-sectional study conducted in three centers, which were part of the Manipal model of telepsychiatry, namely community healthcare centers at Hebri, community healthcare centers at Byndoor, and primary healthcare center (PHC) at Kandlur of Udupi District. Semi-structured interview schedule and focused group discussions were conducted to assess the treatment satisfaction. Descriptive statistics were used to analyze sociodemographic data, and data generated from focused group discussions were qualitatively analyzed. Collected data were coded, and themes were generated from the codes. A total of 45 persons with psychiatric disorders and 28 of the caregivers receiving telepsychiatry services were recruited into this study. Results revealed high satisfaction among patients and caregivers with telepsychiatry services provided to them. Qualitative results of this study revealed high satisfaction among patients and caregivers with telepsychiatry services in different domains such as time, cost of treatment, convenience, doctor-patient communication, and healthcare quality. This study witnessed that patients and caregivers were highly satisfied with telepsychiatry services provided to them. These findings clearly indicate the importance of telepsychiatry services in the country, where the concept of telepsychiatry and its practice is rising.

Health-seeking behaviour of breast cancer patients receiving care at a tertiary institution in Ghana.

Breast cancer incidence rates are rising in Africa and mortality is highest in West Africa. Reasons for poor survival are multifactorial but delays in seeking appropriate health care result in late presentation which contributes significantly to poor outcomes. Total delays of more than 3 months have been associated with advanced stage at presentation and poorer survival. A cross-sectional design was used to assess delays in health-seeking behaviour in consecutive breast cancer patients receiving treatment at Korle Bu Teaching Hospital (KBTH) from January to December 2022 using a structured, interviewer-administered questionnaire. Data were gathered to assess health-seeking behaviour in relation to delays in a presentation to a health care facility, and factors that may have influenced the delays. Statistical analysis was done using descriptive and inferential analyses. The study involved 636 participants with a mean age and SD of 52.6 ± 12 years. Most participants were diagnosed with Stage 3 or 4 breast cancer (56.5%). Ninety percent of participants had visited at least one health facility prior to seeking care at KBTH. Forty-two percent of the participants sought care at a health facility less than a month after noticing symptoms of breast cancer while 34.4% did so greater than 3 months after noticing symptoms. Delays showed a significant association with age, marital status, educational level, average monthly income and cancer stage (p < 0.05). Common reasons for delays were lack of knowledge of breast cancer signs and/or symptoms (47%), advice from family and friends (15%), financial difficulties (9%), seeking alternate treatments (7%), competing priorities (6%) and indifference (5%). Lack of knowledge about breast cancer was a major cause of delay in seeking health care in this study. Education should specifically target knowledge about breast cancer and the need for appropriate and timely health seeking.