Women Delay Seeking Research Articles

Understanding the Non-Surgical Treatment Experience of Female Patients with Carpal Tunnel Syndrome: A Qualitative Study.

Carpal tunnel syndrome (CTS) is a peripheral neuropathy of the upper extremity, characterized by pain, loss of strength, and decreased fine motor function. This study describes the experiences of women with CTS who received non-surgical treatments. A qualitative phenomenological study was undertaken. Purposive sampling was used. Women with clinical and electromyographic diagnoses of CTS were included. Eighteen in-depth interviews were conducted among women with CTS, and field notes were kept. The Giorgi’s approach was used for qualitative analysis of the data collected. Five themes emerged: (a) Seeking help and waiting for a diagnosis, (b) trying non-surgical therapeutic options, (c) avoiding invasive options, (d) treatment expectations, and (e) relationships with clinicians. The women described how diagnoses were delayed because women delay seeking help and referrals to medical specialists. Women avoid surgical options and prefer to opt for more conservative approaches, such as splinting or physical therapy. The main reason for avoiding surgical treatment is the fear of limitations and that surgery will not fully eliminate the symptoms. Conflicts may arise in the relationship with the clinician, and they demand to be able to participate in the decision-making process.

Narratives on why pregnant women delay seeking maternal health care during delivery and obstetric complications in rural Ghana

BackgroundDespite the many maternal healthcare policy programmes in Ghana such as free the antenatal care (ANC) and the fee-exemption policy under the National Health Insurance Scheme, among others, the country has yet to make substantial improvements in addressing low skilled care utilisation in pregnancy and delivery. From previous studies, maternal mortality has been linked to women’s healthcare decision-making power at the household level in many low and middle-income countries. Thus, a pregnant women’s ability to choose a healthcare provider, act on her preferences, and to be sufficiently financially empowered to take the lead in deciding on reproductive and pregnancy care has significant effects on service utilisation outcomes. Therefore, we explored rural community-level barriers to seeking care related to obstetric complications and delivery from the perspectives of mothers, youth, opinion leaders and healthcare providers in Nadowli-Kaleo and Daffiama-Bussie-Issa districts in the Upper West Region of Ghana.MethodsThis exploratory qualitative study was based on the narratives of women, health providers and community stakeholders regarding the expectant women’s autonomy to decide and utilise maternal care. To achieve maximal diversity of responses, purposive sampling procedures were followed in selecting 16 health professionals, three traditional birth attendants and 240 community members (opinion leaders, youth and non-pregnant women) who participated in individual depth interviews and focus group discussions.ResultsWomen’s lack of autonomy to seek care without prior permission, perceived quality care of traditional birth attendants, stigmatisation of unplanned pregnancies and cultural beliefs associated with late disclosure of childbirth labour all delayed mothers timely use of skilled care in the study communities. These barriers compounded problems arising from communities that are geographically isolated from hospital care.ConclusionsDecisions about seeking maternal care were usually made by the expectant woman’s husband and family without providing adequate support to pregnant women during the latter stages of pregnancy and delivery. We conclude that this is primarily a cultural issue. The study recommends a change in the approach to community-level health education campaigns for maximum impacts through the increased involvement of men and families in health service delivery and utilisation.

Health seeking behaviour of menopausal women with urinary incontinence in North east Malaysia

ABSTRACT Urinary incontinence (UI) is common in women in postmenopausal age, but many women delay seeking treatment. The objective of this study is to determine health-seeking behavior of postmenopausal women with UI and its associated factors. This is a cross-sectional study involving 348 postmenopausal women from the outpatient clinic using personal data forms and a validated UI questionnaire. A total of 348 menopausal women were involved in the study. Only 13.17% of patients with UI sought treatment. Factors associated with seeking treatment were age of menopause and severity of UI. More health education needs to be done among these patients.

Factors enabling women with pelvic organ prolapse to seek surgery at mobile surgical camps in two remote districts in Nepal: a qualitative study.

Pelvic organ prolapse (POP) is a major reproductive health problem in Nepal, though many women delay seeking treatment. To address this, the Nepalese government has been providing free vaginal hysterectomies with pelvic floor repair to women in mobile surgical camps. Studies exploring factors that enable women to attend these camp settings are limited. This study aimed to identify factors that affected women seeking surgical treatment for POP at mobile surgical camps. The study used a qualitative approach. Twenty-one women with POP were recruited in two week-long mobile surgical camps held in two remote districts in Nepal during April and May 2013. Data were collected from individual face-to-face interviews and were analysed thematically. Three themes and six subthemes emerged from the analysis. The first theme, "health-system factors", suggests that accessibility and affordability of the treatment, and the supportive role of female community health volunteers facilitate women to seek treatment in the camp. The second theme, "factors related to sociocultural norms", reveals that reaching the end of reproductive years and approval by relevant influential family members empowers women to take up surgical treatment in the mobile surgical camp. Similarly, the third theme, "individual-level factors", includes women's experience of POP, such as worsening symptoms and fear of development of cancer, as factors enabling women to seek treatment. Enablers to seeking treatment at mobile surgical camps for women are related to the Nepalese health system, sociocultural norms and individual experiences of women. Each of these factors should be considered when conducting mobile surgical camps, if women's uptake of treatment is to be enhanced.

Gender comparisons in non-acute cardiac symptom recognition and subsequent help-seeking decisions: a mixed methods study protocol

IntroductionCoronary heart disease (CHD) is one of the leading causes of death in both men and women worldwide. Despite the common misconception that CHD is a ‘man's disease’, it is...

Breast cancer in Sub-Saharan Africa: opportunities for prevention

Although breast cancer is a growing health problem in sub-Saharan Africa, reasons for its increased occurrence remain unclear. We reviewed the published literature to determine the magnitude of the increase in breast cancer, associated risk factors (including for breast cancer subtypes), and ways to reduce incidence and mortality. Some of the increased breast cancer occurrence likely reflects that women are living longer and adopting lifestyles that favor higher incidence rates. However, a greater proportion of breast cancers occur among premenopausal women as compared to elsewhere, which may reflect unique risk factors. Breast cancers diagnosed among African women reportedly include a disproportionate number of poor prognosis tumors, including hormone receptor negative, triple negative, and core basal phenotype tumors. However, it is unclear how lack of standardized methods for tissue collection, fixation, and classification contribute to these rates. Given appropriate classifications, it will be of interest to compare rates with other populations and to identify risk factors that relate to specific tumor subtypes. This includes not only risk factors that have been recognized in other populations but also some that may play unique roles among African women, such as genetic factors, microbiomata, xenoestrogens, hair relaxers, and skin lighteners. With limited opportunities for effective treatment, a focus is needed on identifying etiologic factors that may be amenable to intervention. It will also be essential to understand reasons why women delay seeking care after the onset of symptoms and for there to be educational campaigns about the importance of early detection.

Living With Advanced Breast Cancer

Pakistan has the highest rate of breast cancer in Asia. Many women delay seeking heath advice and treatment for breast cancer, and between 50% and 70% of women will present when the disease in is in an advanced, aggressive form, particularly young women. The psychological impact of breast cancer is challenged by the negative public perception of cancer. This qualitative study explored the psychological impact of advanced breast cancer in women receiving follow-up care in an oncology hospital in Pakistan. This qualitative study used semistructured interviews to explore women's experiences of living with advanced breast cancer and the impact that this had on their lives as women, mothers, and wives. Twenty-one women were interviewed. Data were analyzed using thematic analysis. The majority of 21 women interviewed were diagnosed between 1 and 11 years, and 15 women had a history of metastases. Four themes emerged from the data. These were reaction to the diagnosis, change in outlook, living life positively, and motivating factors. Women acknowledged the significance of their illness on their health and longevity. Their individual cancer journey was multilayered and imbued with the hope of cure, remission, and an emotional catalog of feelings. All married women wished for sufficient time to visualize their children reach adulthood and marry. Single women wished to care for their mothers and families. Through education and support, nurses can provide women with advanced breast cancer and their families educational, spiritual, and psychological care.

"It's not easy to acknowledge that I'm ill": a qualitative investigation into the health seeking behavior of rural Palestinian women.

BackgroundThis qualitative study sets to fill a gap in knowledge by exploring the health seeking behaviour of rural women living in the occupied Palestinian territories (oPt). The existing literature on the oPt has so far focused on unravelling the country’s epidemiological and health system profile, but has largely neglected the assessment of factors shaping people’s decisions on health care use.MethodsBased on a conceptual framework rooted in the Anderson behavioural model, we conducted 30 semi-structured interviews with purposely selected women and seven key informant interviews in three purposely selected villages in Ramallah district.ResultsOur findings indicate that women delay seeking professional care, use self-prescribed medications and home treatment, and do not use preventive and educational health services. Their health seeking behaviour is the result of the interplay of several factors: their gendered socio-cultural role; their health beliefs; financial affordability and geographical accessibility; their perceptions of the quality of care; and their perceived health needs.ConclusionsFindings are discussed in the light of their policy implications, suggesting that adequate health policy planning ought to take into considerations socio-cultural dimensions beyond those directly pertinent to the health care system.

Shedding light on women's help seeking behaviour for self discovered breast symptoms

PurposeTo describe women's help seeking behaviour (HSB) and the associated influencing factors on self-discovery of a breast symptom. MethodsA descriptive, correlational survey design was used. Following ethical approval, survey data were collected from women (n = 449) attending the breast clinics of two large urban hospitals within the Republic of Ireland. ResultsThe majority of women (69.9%; n = 314) sought help (by visiting their General practitioner, GP) within one month, 30.1% (n = 135) delayed help seeking for more than one month following symptom discovery and 16.7% (n = 75) delayed for three months or more. The factors most significantly associated with delayed HSB were knowledge around symptom identity (Odds Ratio (OR) = 4.80, p = 0.005); ignoring the symptom and hoping it would go away (OR = 10.72, p < 0.001) and women's belief that the symptom would persist for a long time (OR = 1.18, p = 0.023). Being afraid on symptom discovery (OR = 0.37, p = 0.005) was associated with reduced risk of delayed HSB. ConclusionsIt is encouraging to see that the majority of women who find a breast symptom seek help promptly. However, a small cohort of women delay seeking help from their GP. HSB is influenced by multiple factors which can impact on patient outcomes. Findings are important for oncology nurses who have a key role to play in promoting breast awareness, prompt help seeking and early detection and treatment of breast cancer, amongst women.

Travelling on parallel tracks: Patient and physician perspectives on why women delay seeking care for breast cancer symptoms

In the breast cancer literature, "delayed presentation" is defined as a delay of > 3 months from the self-detection of a new breast cancer symptom until presentation to a health care provider. It has been established that early detection of breast cancer is associated with better health outcomes. The purpose of this qualitative study was to explore reasons why women delay seeking care for their breast cancer symptoms by asking both women and family physicians for their perspectives. Narrative analysis was used to reveal the ways in which people make sense of their experiences and which parts of their stories are most important to them. We found differences in the explanatory narratives of women versus those of family physicians when it came to understanding delay. Suggestions to promote earlier presentation include improving physician-patient communication and encouraging physician and health care professional neutrality in making attributions about women's delay.

The burden of uterine fibroids in five European countries

Objective To quantify the burden of uterine fibroids (UF) on health-related quality of life (HRQOL) and work productivity in a general population of women. Study design Women diagnosed with or experiencing UF-related symptoms living in five Western European countries (France, Germany, Italy, Spain, and the United Kingdom) were identified through a cross-sectional Internet-based survey. The following parameters and outcomes of interest were captured and analysed: patient history and demographics, treatment and diagnosis patterns, symptom severity and HRQOL, work productivity and activity impairment, and disease or symptom-related health care resource use for the past year (e.g., provider visits, hospitalisation). Results This analysis included 1756 women (France, 358; Germany, 345; Italy, 351; Spain, 352; United Kingdom, 350). Prevalence of a diagnosis of UF ranged from 11.7% to 23.6%, and that of undiagnosed bleeding symptoms from 14.7% to 24.6% across the five countries. Between 9.0% and 32.5% of women waited ≥5 years before seeking treatment for UF. Mean UFS-QOL symptom severity scores ranged from 24.7 (95% confidence interval [CI], 21.1–28.3) to 37.6 (95% CI, 32.2–43.0; P < 0.001), suggesting mild to moderate severity. Mean UFS-QOL scores ranged from 59.2 (95% CI, 54.2–64.2) to 69.7 (95% CI, 66.5–73.0; P = 0.002), suggesting moderate impairment. In pooled analyses, absenteeism was reported by 32.7% of employed women with a diagnosis of UF. Overall worker productivity was reduced by 36.1% and general activity was impaired by 37.9%. Conclusions UF are common in women residing in Western Europe. They are associated with impairment of HRQOL and productivity. A substantial number of women delay seeking medical help. Encouraging symptomatic women to seek help and treatment earlier may benefit women by improving their HRQOL and may also benefit society through enhanced worker productivity.

Why women delay seeking assistance for locally advanced breast cancer

Locally advanced breast cancer (LABC) occurs in 10% to 30% of all new primary breast cancer diagnoses. For reasons that are not well-understood, 20% to 30% of women with breast cancer (at all stages) wait eight weeks or more from the time they notice the breast symptom(s) to when they seek assistance from a health care provider. Comprehending the mechanisms that support the health appraisal and health seeking behaviour is paramount and not well understood, particularly for women with LABC. The purpose of this study was to qualitatively explore the cognitive, emotional, and contextual experience of women with locally advanced breast cancer in the time between symptom discovery and seeking health care. In-depth qualitative interviews and a cross-case, content analysis revealed that the participants delayed their search for assistance because they did not perceive themselves to be at risk for developing breast cancer, had a symptom other than a lump, and so misattributed or minimized the gravity of the symptom, had a previous experience with a benign tumour, and/or were experiencing concurrent stressful life events. These participants were motivated to seek attention if they had an already scheduled appointment with a health professional for another matter, felt the symptom worsen over time, or were motivated by a loved one to seek help. Implications for health promotion and for education with women with benign breast disease, as well as the general public, are discussed.

Lack of knowledge about sexually transmitted infections among women in North rural Vietnam

BackgroundThe serious long-term complications of sexually transmitted infections (STI) in women and newborns are well-documented. Particularly, STI imply considerable social consequences for women. Low STI knowledge has been shown to be associated with unsafe sex. In Vietnam, misconceptions regarding STI exist, and rural women delay seeking care for STI. The aim of the study was to investigate knowledge of STI among women aged 15 to 49 years in a rural district of Vietnam and to evaluate possible associations between socioeconomic factors and STI knowledge.MethodsA cross-sectional population-based study using face-to-face interviews was carried out between March and May 2006 in a demographic surveillance site in rural Vietnam. In total, 1805 women aged 15–49 years were randomly selected to participate in the study. The interviews were based on a structured questionnaire including questions on sociodemographic characteristics of the women and their knowledge about STI. Each correct answer was scored 1, incorrect or do not know answer was scored 0. Multivariate analyses were applied to examine associations between socio-economic conditions and STI knowledge. Intra-cluster correlation was calculated to examine similarities of STI knowledge within clusters.ResultsOf the 1,805 respondents, 78% (73% married vs. 93% unmarried, p < 0.001) did not know any symptoms of STI, 50% could not identify any cause of STI, 59% (54% married vs. 76% unmarried, p < 0.001) did not know that STI can be prevented. Only 31% of the respondents (36% married vs. 14% unmarried, p < 0.001) answered that condom use could protect against STI, and 56% considered partner treatment necessary. Of 40 possible correct answers, the mean knowledge score was 6.5 (range 0–26, median 6). Young, unmarried women and women who lived in the highlands or mountainous areas demonstrated very low levels of STI knowledge (regression coefficients -1.3 and -2.5, respectively, p < 0.001). Experience of an induced abortion was significantly associated with a higher level of knowledge.ConclusionThe low levels of STI knowledge found among women of reproductive age in a rural district of Vietnam indicate an urgent need of health education interventions, of which, young and unmarried women should be specifically targeted.

Women’s help-seeking behaviour at the onset of myocardial infarction

Few studies have explored the factors affecting women's decisions to seek medical assistance at the onset of cardiac symptoms. Although some studies have shown that there are gender differences between men and women in terms of how they cope with having a myocardial infarction (MI) and heart disease, few have explored how women actually experience MI and what influences their help-seeking behaviour. Those studies that have, suggest that women often fail to recognize the signs of MI and delay seeking treatment for symptoms of MI longer than men do. This qualitative study explores the female experience of MI, focusing on some of the thought processes and coping strategies used by women when having an MI. Using a grounded theory research approach, 25 post-MI female patients were interviewed about their experiences during acute MI. Through analysing and coding data, a number of categories emerged that provide insight into the health seeking behaviour of women at the onset of MI. Emergent categories were: a delay in seeking help (main category); an engendered perception of heart disease (sub-category); not recognizing symptoms (sub-category); maintaining control through self-medication (sub-category). Analysis of the data suggests that when experiencing an MI, women delay seeking help for a number of reasons, including not recognizing symptoms, perceiving heart disease as a 'male' problem and preferring to self-medicate.

Black, Hispanic, and White Women's Perception of Heart Disease

Understanding why women delay seeking treatment for symptoms suggestive of an acute myocardial infarction remains elusive. Thirty individual semistructured interviews were conducted to determine black (n=10), Hispanic (n=10), and white (n=10) women's perception of heart disease risk and whether differences existed based on participant's race or ethnicity. Narrative descriptions analyzed using the Morse and Field method revealed that women, regardless of race or ethnicity, associated heart disease and heart attacks with men who were obese, stressed, and smokers. Perceptions of heart disease risk were similar between groups, with women generally believing they were at risk for heart disease because of family history, diet, and obesity. Racial and ethnic differences were noted, however, in risk reduction and anticipated treatment-seeking behaviors. Continued efforts are needed to raise women's perception of their cardiac risks and the need for the engagement in health-promoting behaviors.

Patient Privacy and Conflicting Legal and Ethical Obligations in El Salvador: Reporting of Unlawful Abortions

Postabortion care providers who breach patient confidentiality endanger women's health and violate ethics. A 1998 abortion ban in El Salvador likely spurred an increase in the number of women investigated, because many women were reported to legal authorities by health care providers. Having analyzed safeguards of confidentiality in laws and ethical guidelines, we obtained information from legal records on women prosecuted from 1998 to 2003 and identified factors that may lead to reporting through a survey of obstetrician-gynecologists (n=110). Although ethical and human rights standards oblige providers to respect patients' privacy, 80% of obstetrician-gynecologists mistakenly believed reporting was required. Most respondents (86%) knew that women delay seeking care because of fear of prosecution, yet a majority (56%) participated in notification of legal authorities.

Public health information programmes: can partnerships reduce costs?

Despite evidence showing the benefits of early diagnosis of breast cancer many Australian women delay seeking advice when they find a change in their breast. This paper describes the process evaluation of a national programme to encourage women to see their general practitioner within three months of finding a breast change. The programme used a partnership approach involving different sectors of the community to deliver an inexpensive national programme with sustainable community components. The programme included strategies to promote messages through the news media, television commercials, community meetings across Australia and general practitioner based strategies. This paper reports on a process evaluation of the implementation of the programme; outcome measures will be available at a later stage.

Risky shifts or shifting risk: African and African-Caribbean women's narratives on delay in seeking help for breast cancer

Research in USA and the UK has revealed that whilst the incidence of breast cancer is lower in women from black and ethnic minority groups, African and African-American women delay seeking help, have a worse prognosis, and a higher mortality rate. A variety of reasons has been suggested for this: from system delay, to delay by the women arising from educational and socio-economic disadvantage or religious beliefs. Building on this in the UK, from a study conducted in a South London Screening Clinic, a sub-sample of African and African-Caribbean women were interviewed to obtain their narratives of action in delay in seeking help for late-stage breast cancer. The findings suggest that the women were aware of the services offered, were expecting a diagnosis of cancer, but offered a model of fearing extrusion from their community rather than fear of death from the disease, leading to delay in seeking help. The reasons for this are explored and a risk trajectory in biomedicine compared with the African and African-Caribbean women's world is described.