Whether and how people reach care.
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726 to 750 of 2,047Praying until death: revisiting three delays model to contextualize the socio-cultural factors associated with maternal deaths in a region with high prevalence of eclampsia in India.
Background: A disproportionately high proportion of maternal deaths (99 percent) in the world occur in low and middle income countries, of which 90 percent is contributed by Sub-Saharan Africa and South Asia. This study uses the effective "Three Delays" model to assess the socio-cultural barriers associated with maternal mortality in West Bengal, India.
Methods: It was a retrospective mixed methods study, which used facility-based as well as community-based approaches to explore factors associated with maternal deaths. We reviewed 317 maternal death cases wherein a verbal autopsy technique was applied on 40 cases. The Chi-square test (χ2) and multivariable logistic regression model were employed to accomplish the study objectives.
Results: The delay in seeking care (Type 1 delay) was the most significant contributor to maternal deaths (48.6 percent, 154/317). The second major impacting c…
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Ebeigbe JA (2018)MEDLINE-indexed journal, not yet read by usClinical & experimental optometry29 citations Factors influencing eye-care seeking behaviour of parents for their children in Nigeria.
Background: The eye-care seeking behaviour of parents for their children has a role to play in increasing or reducing the prevalence of childhood blindness. In Nigeria, little or no work has been done in this area. Hence, this study was carried out with a view to assisting eye-care professionals plan better program regimens and also to help them identify various elements that either facilitate or hinder eye-care seeking behaviour of parents for their school age children.
Methods: This was a qualitative narrative study. Data were collected using in-depth interviews (IDIs) and focus group discussions (FGDs). Thirty-five parents and 10 eye-care practitioners were selected by random sampling and homogenous sampling methods, respectively. Parents were selected, based on those who sought care and those who did not seek care for their children after a school screening exercise. Collected data w…
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Predictors of women's utilization of primary health care for skilled pregnancy care in rural Nigeria.
Background: Although Primary Health Care (PHC) was designed to provide universal access to skilled pregnancy care for the prevention of maternal deaths, very little is known of the factors that predict the use of PHC for skilled maternity care in rural parts of Nigeria - where its use is likely to have a greater positive impact on maternal health care. The objective of this study was to identify the factors that lead pregnant women to use or not use existing primary health care facilities for antenatal and delivery care.
Methods: The study was a cross-sectional community-based study conducted in Esan South East and Etsako East LGAs of Edo State, Nigeria. A total of 1408 randomly selected women of reproductive age were interviewed in their households using a pre-tested structured questionnaire. The data were analyzed with descriptive and multivariate statistical methods.
Results: The resu…
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Understanding intersections of social determinants of maternal healthcare utilization in Uttar Pradesh, India.
Objective: To explore intersections of social determinants of maternal healthcare utilization using the Classification and Regression Trees (CART) algorithm which is a machine-learning method used to construct prediction models.
Methods: Institutional review board approval for this study was granted from Public Health Service-Ethical Review Board (PHS-ERB) and from the Health Ministry Screening Committee (HMSC) facilitated by Indian Council for Medical Research (ICMR). IRB review and approval for the current analyses was obtained from University of California, San Diego. Cross-sectional data were collected from women with children aged 0-11 months (n = 5,565) from rural households in 25 districts of Uttar Pradesh, India. Participants were surveyed on maternal healthcare utilization including registration of pregnancy (model-1), receipt of antenatal care (ANC) during pregnancy (model-2), …
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Akeju DO, Oladapo OT, Vidler M, Akinmade AA, Sawchuck D, Qureshi R, Solarin M, Adetoro OO, von Dadelszen P, CLIP Nigeria Feasibility Working Group (2016)MEDLINE-indexed journal, not yet read by usReproductive health47 citations Determinants of health care seeking behaviour during pregnancy in Ogun State, Nigeria.
Background: In Nigeria, women too often suffer the consequences of serious obstetric complications that may lead to death. Delay in seeking care (phase I delay) is a recognized contributor to adverse pregnancy outcomes. This qualitative study aimed to describe the health care seeking practices in pregnancy, as well as the socio-cultural factors that influence these actions.
Methods: The study was conducted in Ogun State, in south-western Nigeria. Data were collected through focus group discussions with pregnant women, recently pregnant mothers, male decision-makers, opinion leaders, traditional birth attendants, health workers, and health administrators. A thematic analysis approach was used with QSR NVivo version 10.
Results: Findings show that women utilized multiple care givers during pregnancy, with a preference for traditional providers. There was a strong sense of trust in traditio…
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Kohler PK, Ondenge K, Mills LA, Okanda J, Kinuthia J, Olilo G, Odhiambo F, Laserson KF, Zierler B, Voss J, John-Stewart G (2014)MEDLINE-indexed journal, not yet read by usAIDS patient care and STDs45 citations Shame, guilt, and stress: Community perceptions of barriers to engaging in prevention of mother to child transmission (PMTCT) programs in western Kenya.
While global scale-up of prevention of mother-to-child transmission of HIV (PMTCT) services has been expansive, only half of HIV-infected pregnant women receive antiretroviral regimens for PMTCT in sub-Saharan Africa. To evaluate social factors influencing uptake of PMTCT in rural Kenya, we conducted a community-based, cross-sectional survey of mothers residing in the KEMRI/CDC Health and Demographic Surveillance System (HDSS) area. Factors included referrals and acceptability, HIV-related stigma, observed discrimination, and knowledge of violence. Chi-squared tests and multivariate regression analyses were used to detect stigma domains associated with uptake of PMTCT services. Most HIV-positive women (89%) reported blame or judgment of people with HIV, and 46% reported they would feel shame if they were associated with someone with HIV. In multivariate analyses, shame was significantly …
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Determinants of negative pathways to care and their impact on service disengagement in first-episode psychosis.
Purpose: Although there have been numerous studies on pathways to care in first-episode psychosis (FEP), few have examined the determinants of the pathway to care and its impact on subsequent engagement with mental health services.
Methods: Using a sample of 324 FEP patients from a catchment area-based early intervention (EI) program in Montréal, we estimated the association of several socio-demographic, clinical, and service-level factors with negative pathways to care and treatment delay. We also assessed the impact of the pathway to care on time to disengagement from EI services.
Results: Few socio-demographic or clinical factors were predictive of negative pathways to care. Rather, service-level factors, such as contact with primary care providers, have a stronger impact on patterns of health service use across multiple indicators. Patients who were in contact with primary care had a…
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Primary care utilization and mental health diagnoses among adult patients requiring interpreters: a retrospective cohort study.
Background: Patients requiring interpreters may utilize the health care system differently or more frequently than patients not requiring interpreters; those with mental health issues may be particularly difficult to diagnose.
Objective: To determine whether adult patients requiring interpreters exhibit different health care utilization patterns and rates of mental health diagnoses than their counterparts.
Design: Retrospective cohort study examining patient visits to primary care (PC), express care (EC), or the emergency department (ED) of a large group practice within 1 year.
Patients: Adult outpatients (n = 63,525) with at least one visit within the study interval and information regarding interpreter need.
Main measures: Mean visit counts, counts of mental disorders, and somatic symptom diagnoses between patients requiring interpreters (IS patients) and not requiring interpreters (no…
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Self-reported barriers to professional help seeking among college students at elevated risk for suicide.
Objectives: This study sought to describe self-reported barriers to professional help seeking among college students who are at elevated suicide risk and determine if these barriers vary by demographic and clinical characteristics.
Participants: Participants were 165 non-treatment seekers recruited as part of a Web-based treatment linkage intervention for college students at elevated suicide risk (from September 2010 through December 2011).
Methods: Data were collected using Web-based questionnaires. Two coders coded students' responses to an open-ended question about reasons for not seeking professional help.
Results: The most commonly reported barriers included perception that treatment is not needed (66%), lack of time (26.8%), and preference for self-management (18%). Stigma was mentioned by only 12% of students. There were notable differences based on gender, race, and severity of d…
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Miedema B, Easley J (2012)MEDLINE-indexed journal, not yet read by usSupportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer38 citations Barriers to rehabilitative care for young breast cancer survivors: a qualitative understanding.
Purpose: The goal of this study was to assess the rehabilitation needs of young women breast cancer survivors under the age of 50 and to identify factors that may impact or prevent cancer rehabilitation utilization.
Methods: Utilizing a grounded theory methodology, 35 young breast cancer survivors were interviewed twice in four Atlantic Canadian provinces.
Results: A considerable number of barriers exist to receiving rehabilitative care post-treatment for young breast cancer survivors. The systemic barriers include the lack of availability of services, travel issues, cost of services, and the lack of support to address the unique needs for this age group. However, the most complicated barriers to accessing rehabilitative care were personal barriers which related more to choice and circumstances, such as the lack of time due to family responsibilities and appointment fatigue. Many of thes…
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Health seeking behavior for cervical cancer in Ethiopia: a qualitative study.
Background: Although cervical cancer is a leading cause of cancer related morbidity and mortality among women in Ethiopia, there is lack of information regarding the perception of the community about the disease.
Methods: Focus group discussions were conducted with men, women, and community leaders in the rural settings of Jimma Zone southwest Ethiopia and in the capital city, Addis Ababa. Data were captured using voice recorders, and field notes were transcribed verbatim from the local languages into English language. Key categories and thematic frameworks were identified using the health belief model as a framework, and presented in narratives using the respondents own words as an illustration.
Results: Participants had very low awareness of cervical cancer. However, once the symptoms were explained, participants had a high perception of the severity of the disease. The etiology of cer…
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Attitudes and decision making among women seeking abortions at one U.S. clinic.
Context: Various restrictions on abortion have been imposed under the pretense that women may be uninformed, undecided or coerced in regard to their decision to terminate a pregnancy. Understanding whether certain women are at risk of low confidence in their abortion decision is useful for providing client-centered care and allocating counseling time to women with the greatest needs.
Methods: Data were abstracted from the precounseling needs assessment form and clinical intake form of 5,109 women who sought 5,387 abortions at one U.S. clinic in 2008. Multivariate logistic regression was used to analyze variables associated with women's high confidence in their abortion decision.
Results: For 87% of the abortions sought, women had high confidence in their decision before receiving counseling. Certain variables were negatively associated with abortions' being sought by women with high conf…
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Treatment choices for fevers in children under-five years in a rural Ghanaian district.
Background: Health care demand studies help to examine the behaviour of individuals and households during illnesses. Few of existing health care demand studies examine the choice of treatment services for childhood illnesses. Besides, in their analyses, many of the existing studies compare alternative treatment options to a single option, usually self-medication. This study aims at examining the factors that influence the choices that caregivers of children under-five years make regarding treatment of fevers due to malaria and pneumonia in a rural setting. The study also examines how the choice of alternative treatment options compare with each other.
Methods: The study uses data from a 2006 household socio-economic survey and health and demographic surveillance covering caregivers of 529 children under-five years of age in the Dangme West District and applies a multinomial probit techni…
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A clinical framework for improving the advance care planning process: start with patients' self-identified barriers.
Objectives: To explore barriers to multiple advance care planning (ACP) steps and identify common barrier themes that impede older adults from engaging in the process as a whole.
Design: Descriptive study.
Setting: General medicine clinic. San Francisco County.
Participants: One hundred forty-three English and Spanish speakers aged 50 and older (mean 61) enrolled in an advance directive preference study.
Measurement: Six months after reviewing two advance directives, self-reported ACP engagement and barriers to each ACP step were measured with open- and closedended questions using quantitative and qualitative (thematic content) analyses.
Results: Forty percent of participants did not contemplate ACP, 46% did not discuss with family or friends, 80% did not discuss with their doctor, and 90% did not document ACP wishes. Six barrier themes emerged: perceiving ACP as irrelevant (84%), person…
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Changes in health and primary health care use of Moroccan and Turkish migrants between 2001 and 2005: a longitudinal study.
Background: Social environment and health status are related, and changes affecting social relations may also affect the general health state of a group. During the past few years, several events have affected the relationships between Muslim immigrants and the non-immigrant population in many countries. This study investigates whether the health status of the Moroccan and Turkish immigrants in the Netherlands has changed in four years, whether changes in health status have had any influence on primary health care use, and which socio-demographic factors might explain this relationship.
Methods: A cohort of 108 Turkish and 102 Moroccan respondents were interviewed in 2001 and in 2005. The questionnaire included the SF-36 and the GP contact frequency (in the past two months). Interviews were conducted in the language preferred by the respondents. Data were analysed using multivariate line…
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A Prospective Study on Structural and Attitudinal Barriers to Professional Help-Seeking for Currently Untreated Mental Health Problems in the Community.
To date, little is known about the concurrent impact of structural and attitudinal factors on help-seeking behaviour for mental health problems. Therefore, this study investigated a longitudinal German community sample of adults with currently untreated mental health problems (N = 188, mean age = 50.34, 70.7% female) regarding perceived structural (e.g. accessibility) as well as attitudinal barriers (e.g. anticipated self-stigma) to help-seeking intentions and behaviour. Overall, perceived accessibility, spatial and temporal distance from mental health services predicted help-seeking. Among attitudinal factors, treatment efficacy beliefs were strongly connected to help-seeking. In addition, among people who knew where to find a psychologist or psychotherapist, anticipated self-stigma emerged as a significant barrier to help-seeking. Therefore, creating positive treatment expectancies and…
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Do depression literacy, mental illness beliefs and stigma influence mental health help-seeking attitude? A cross-sectional study of secondary school and university students from B40 households in Malaysia.
Background: Mental illness rates among young people is high, yet the frequency of help-seeking is low, especially among those from lower socioeconomic backgrounds. Understanding factors influencing help-seeking, such as mental illness beliefs, stigma and literacy among B40 individuals is important, but past studies are sparse. Hence, we aimed to examine the factors associated with mental help-seeking attitude among students from the B40 income bracket. Differences in beliefs toward mental illness, stigma and help-seeking attitudes among university and secondary school students were also investigated.
Methods: University and secondary school students from low-income households (N = 202) were involved in this cross-sectional study. Participants completed the Depression Literacy Questionnaire (D-Lit), General Help Seeking Questionnaire (GHSQ), Mental Help Seeking Attitudes Scale (MHSAS), Se…
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A Bourdieusian Analysis of U.S. Military Culture Ground in the Mental Help-Seeking Literature.
This theoretical treatise uses the scientific literature concerning help seeking for mental illness among those with a background in the U.S. military to posit a more complex definition of military culture. The help-seeking literature is used to illustrate how hegemonic masculinity, when situated in the military field, informs the decision to seek formal treatment for mental illness among those men with a background in the U.S. military. These analyses advocate for a nuanced, multidimensional, and situated definition of U.S. military culture that emphasizes the way in which institutional structures and social relations of power intersect with individual values, beliefs, and motivations to inform and structure health-related practices.
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Farmer DB, Berman L, Ryan G, Habumugisha L, Basinga P, Nutt C, Kamali F, Ngizwenayo E, St Fleur J, Niyigena P, Ngabo F, Farmer PE, Rich ML (2015)MEDLINE-indexed journal, not yet read by usGlobal health, science and practice60 citations Motivations and Constraints to Family Planning: A Qualitative Study in Rwanda's Southern Kayonza District.
Background: While Rwanda has achieved impressive gains in contraceptive coverage, unmet need for family planning is high, and barriers to accessing quality reproductive health services remain. Few studies in Rwanda have qualitatively investigated factors that contribute to family planning use, barriers to care, and quality of services from the community perspective.
Methods: We undertook a qualitative study of community perceptions of reproductive health and family planning in Rwanda's southern Kayonza district, which has the country's highest total fertility rate. From October 2011 to December 2012, we conducted interviews with randomly selected male and female community members (n = 96), community health workers (n = 48), and health facility nurses (n = 15), representing all 8 health centers' catchment areas in the overall catchment area of the district's Rwinkwavu Hospital. We then ca…
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Elder mistreatment, culture, and help-seeking: a cross-cultural comparison of older Chinese and Korean immigrants.
This study explored and compared the salient sociocultural characteristics that influenced elder mistreatment and help-seeking behaviors among older Chinese and Korean immigrants. Results from qualitative, in-depth focus groups with 30 participants revealed that elder mistreatment is a culturally laden construct, and core values of traditional culture and acculturation are significant contextual factors that profoundly affect the perceptions of elder abuse and receptivity of interventions. Older Korean participants, compared to their Chinese counterparts, demonstrated stronger influence of hierarchy and cultural beliefs in exclusive family ties and gender norms, and were less likely to disclose abuse. Implications for culturally based interventions are also discussed.
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Attitudes towards psychiatric treatment and people with mental illness: changes over two decades.
Background: Over the past decades, psychiatry, as a science and a clinical discipline, has witnessed profound changes.
Aims: To examine whether these changes are reflected in changes in the public's conceptualisation of mental disorders, the acceptance of mental health treatment and attitudes towards people with mental illness.
Method: In 1990 and 2011, population surveys were conducted in Germany on public attitudes about schizophrenia, depression and alcohol dependence.
Results: Although the public has become more inclined to endorse a biological causation of schizophrenia, the opposite trend was observed with the other two disorders. The public's readiness to recommend help-seeking from mental health professionals and using psychotherapy and psychotropic medication has increased considerably. Attitudes towards people with schizophrenia worsened, whereas for depression and alcohol depe…
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Disentangling self-stigma: are mental illness and help-seeking self-stigmas different?
Two established but disparate lines of research exist: studies examining the self-stigma associated with mental illness and studies examining the self-stigma associated with seeking psychological help. Whereas some researchers have implicitly treated these 2 constructs as synonymous, others have made the argument that they are theoretically and empirically distinct. To help clarify this debate, we examined in the present investigation the overlap and uniqueness of the self-stigmas associated with mental illness and with seeking psychological help. Data were collected from a sample of college undergraduates experiencing clinical levels of psychological distress (N = 217) and a second sample of community members with a self-reported history of mental illness (N = 324). Confirmatory factor analyses provide strong evidence for the factorial independence of the 2 types of self-stigma. Additio…
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Why don't older adults with subjective memory complaints seek help?
Background: Subjective memory complaints (SMCs) are common among older adults, often causing significant distress and showing strong relationships to future cognitive decline. However, low rates of help-seeking for memory complaints are well documented. Little is known about the reasons behind the decision to seek or not to seek help with memory problems. The common-sense model of illness perception proposes that the beliefs people hold about their health underlie help-seeking behaviour. The present study investigated factors underlying the decision to seek help in people with SMCs within the framework of the common-sense model of illness perception.
Methods: Cognition, illness perceptions, coping styles, depression and anxiety were assessed in 98 adults with SMCs, aged 50 years and above, including 60 attending a memory clinic and 38 non-help-seekers.
Results: Objective cognitive perfor…
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Help-seeking behaviour: a concept analysis.
The concept 'help-seeking behaviour' has gained popularity in recent years as an important vehicle for exploring and understanding patient delay and prompt action across a variety of health conditions. The term is used interchangeably with health seeking and is described as part of both illness behaviour and health behaviour. Concept clarification is required to aid nurses and other health-care professionals understanding of the attributes of help-seeking behaviour and to guide theory development, practice and research. The Walker and Avant method of concept analysis was used to guide the analysis. Help-seeking behaviour was shown to be a complex decision-making process instigated by a problem that challenges personal abilities. According to the literature, the process is characterized by the following attributes: problem focused, intentional action and interpersonal interaction. Help-se…
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The influence of ethnicity on the extent of, and reasons underlying, delay in general practitioner consultation in patients with RA.
Objective: Delay in assessment by rheumatologists of patients with new-onset RA is an important determinant of delay in treatment initiation. The influence of ethnicity on delay in assessment has not been addressed. We studied the extent of delay in patients of South Asian origin compared with other patients and the reasons underlying this delay.
Methods: Data were collected from 272 patients with RA at the time of assessment by a rheumatologist; 43 were of South Asian origin. Delays were recorded at the level of the patient seeking advice from the general practitioner (GP), the GP referring to secondary care and the rheumatologist seeing the patient after the referral had been made. In addition, using qualitative methods, we assessed the reasons underlying delay in help-seeking behaviour in 10 patients of South Asian origin.
Results: Patient delay was significantly longer in patients of…
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