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The objectives of the current interim report are to measure the extent of the access to care problem, identify and compare the types of patient- and system-based barriers experienced by Vietnam veterans at risk for suicide when seeking care for physical, psychiatric, and substance abuse conditions, analyze patient-perceived quality of care for individuals who obtained access to care, and identify how the care-seeking experience effected future care seeking. This study is based on a longitudinal sample of 494 Vietnam veterans discharged from military service in September 1971 and subsequently identified as at risk for suicide (306 low risk; 188 high risk). Seventy-one percent (350) of 494 participants completed an extensive qualitative and quantitative interview covering, among other topics, physical conditions, psychiatric conditions, substance use, barriers to care, facilitators of care, and quality of care. Barriers, satisfaction, and effect of the experience were compared by type of condition and suicidal risk category using χ2 analysis and Fisher's as appropriate. The analysis is based on 257 interviews (73 percent) with qualitative data transcribed thus far. Results: Of the 195 patients with self-reported health conditions, 76 (39.0 percent) and 45 (23.1 percent) expressed system-based barriers to care, respectively. The group at higher risk of suicide was significantly more likely (p<0.01) to report patient-based barriers to care and system-based barriers to care (p<0.05), and more likely (p<0.05) to experience negative effects of the care-seeking experience. Both self-perceived and system-based barriers to care pose obstacles for patients at high risk of suicide. Targeted interventions are required to reach out to these patients to address needs for care currently unmet by the health care system and to reduce negative effects of the health care experience.

South Sudanese people form the largest number of resettled refugees in Australia between 2003 and 2004. This study aims to explore how this community understands and responds to health and illness. No study has specifically examined the concept of health and illness in the broader socio-cultural context of the South Sudanese people in Australia.

The design was a qualitative study using interviews and focus group discussions with 33 South Sudanese people in Adelaide, South Australia. Participants were asked to reflect on their understanding of health and illness and influences on their access and use of health and other services. Data were electronically audio-recorded, transcribed verbatim and analysed thematically.

Three main themes emerged from the analysis demonstrating complex and multifaceted views on health and illness. Participants described health as both a lack of disease and wider issues involving social belonging and participation, cultural well-being, living conditions and harmony in the society. They revealed that illnesses are predetermined by God or caused by a curse, breaking a cultural taboo, disharmony with the environment, community and ancestral spirits. Participants deeply tied their beliefs about illness causation and treatment to their historical, social and cultural lived realities, shaping their responses and health-care-seeking decisions.

The current study revealed a complex understanding of health and health-care-seeking practices amongst South Sudanese Australians. The multifaceted views of health and health-care-seeking practices underscore the importance of person-centred care for culturally and linguistically diverse people.

Education programs seek to increase the public’s mental health literacy so they are better able to, among other things, help others engage in care when in need. This task may be diminished when such programs overwhelm participants with too much information. In addition, participants might arrive to the program with information overload related to the covered health topic. Information overload about health topics has been shown to influence attitudes and behavioral intentions. The overall purpose of the current study was to examine the relationship between mental health information overload, topic interest, and care seeking recommendations.

The current study tested a path suggesting high mental health information overload diminishes interest in learning about mental health, which in turn reduces recommendations to others to seek appropriate help when in need. Participants completed online measures of mental health information overload, topic interest and recommendations for care seeking. The data set analyzed represents valid responses from 221 participants. Structural equation modeling was completed to confirm the path model hypothesized for this study.

Structural equation modeling showed satisfactory fit and significant betas for the hypothesized path.

This study adds to the emerging literature on the impact of health information overload and is the first to the best of the authors’ knowledge to measure mental health information overload. Program developers should consider information overload in the ongoing development of public mental health education programs.

This study aims to investigate the health-care-seeking behaviour and practices of West African migrants who reside and operate in Wa, Ghana, as itinerant retailers.

The study was cross-sectional and used the quantitative research approach. The analysis was done on a target population comprising 122 itinerant immigrant retail traders in Wa, Ghana. Fisher’s exact test and logistic regression were used to analyse the data.

Malaria was the commonest disease among them. Five in ten of the migrants preferred to report malaria episodes to a private health facility than to a government facility. Significant associations were identified between four dimensions (health facility, self-medication, home remedy and consult others) of health-seeking behaviour, and some background characteristics. The main reason why migrants prefer government health facilities was because of their better health personnel. They self-medicated because of easy accessibility of over-the-counter medicine shops. Also, when ill, the migrants usually consulted family members who would be in a position to take them home when their ailment worsens.

Snowball sampling was used to select the respondents which could potentially lead to a sample that is not fully representative of the population in general.

Studies concerning migration and health in Ghana have been focused on internal migrants. Yet, minority immigrant traders equally encounter adverse health conditions but limited studies have been conducted to espouse their health-seeking behaviour. This study imperatively contributes to the subject matter that has limited literature in the country.

Around three million infants die within the first four weeks of life each year – nearly all (98%) of these deaths occur in developing countries. Approximately one million newborns die each year in India. Therefore, this study aims to determine the patterns of reported neonatal morbidity and care-seeking behavior and identify factors associated with it.

A cross-sectional study was conducted during November 2016. A systematic random sampling technique was used to select the sample. Statistical techniques like Binary Logistic regression and chi-square test were used.

The results of the study showed that around 31% mothers of neonates reported that their neonates suffered from some kind of morbidity. Fever, jaundice, cough and cold, the low birth-weight and difficulty in breathing were the most common dangers signs reported. Birth order and mother’s knowledge of neonatal danger signs were found to be significantly associated with reporting of neonatal morbidity. In all 95% of the mothers sought care for their newborns. Among those who had problems, 59% consulted private hospitals/clinics, 30% visited District Hospital/Taluka Hospital or higher facilities and another 9% to Primary Health Centers/Community Health Centers. Further, findings show that nearly half of the neonates taken to government facilities have got free treatment, whereas an average cost of 7,156 INR were recorded for treatment, 935 INR for outpatient department and 13,774 INR for inpatient department cases.

There is an urgent need to implement intervention modalities that focus on increasing the level of parental education and access to treatment, and advocating the message regarding newborn danger signs during pregnancy is pinpointed.

Objective – Nepal's Safe Delivery Incentive Programme (SDIP) was introduced nationwide in 2005 with the aim of encouraging greater use of professional care at childbirth. It provided cash to women giving birth in a public health facility and an incentive to the health provider for each delivery attended, either at home or in the facility. We aimed to assess the impact of the programme on neonatal mortality and health care seeking behaviour at childbirth in one district of Nepal.

Methods – Impacts were identified using an interrupted time series approach, applied to household data. We estimated a model linking the level of each outcome at a point in time to the start of the programme, demographic controls, a vector of time variables and community-level fixed effects.

Findings – The recipients of the cash transfer in the programme's first two years were disproportionately wealthier households, reflecting existing inequality in the use of government maternity services. In places with women's groups – where information about the policy was widely disseminated – the SDIP substantially increased skilled birth attendance, but failed to impact on either neonatal mortality or the caesarean section rate. In places with no women's groups, the SDIP had no impact on utilisation outcomes or neonatal mortality.

Implications for policy – The lack of any impact on neonatal mortality suggests that greater increases in utilisation or better quality of care are needed to improve health outcomes. The SDIP changed health care seeking behaviour only in those areas with women's groups highlighting the importance of effective communication of the policy to the wider public.

A plethora of studies have documented evidence on morbidity patterns and treatment-seeking behaviour among older persons in India. However, so far no attempt has been made to understand differences in the morbidity prevalence rates and utilization of health care services among older adults between religion groups in India. The purpose of this paper is to make an effort in this direction.

Multivariate logistic regression models were fitted to examine the association between socio-demographic conditions and morbidity prevalence and health care-seeking behaviours among the two religion groups: Hindu and Muslim. Data from the 60th round of the National Sample Survey in 2004 were used.

This study provided interesting evidence that, overall, the morbidity prevalence rate was higher among Muslim older persons than their Hindu counterparts by seven percentage points and Hindu scheduled caste (SC) and scheduled tribe (ST) counterpart population (compared to SCs eight percentage points, and STs 20 percentage points); income had no association with the burden of disease among Muslim older population – an older person belonging to the first income quintile was equally likely to report ill-health as an older person of the fifth income quintile. However, despite the low socio-economic status, Muslim older persons were more likely to seek treatment for ill-health compared to Hindu older persons but spent less money for treatment. Also, loss of household income due to sickness was greater among Muslim compared to Hindu older adults.

The findings of this study are important to support the policy makers and health care providers in identifying individuals “at risk” and could be integrated into the current programs of social, economic and health security for the older persons.

A shared set of moral standards, ethical principles and behavioral norms of social structure can be referred to as culture. Many health problems are strongly influenced by one’s cultural background. The purpose of the paper is to examine the scientific explanation of indigenous norms and practice of health healing.

This qualitative study considered in-person interviews to know the Tribals’ indigenous healing practice in Bangladesh. A focus group discussion with five tribal students was conducted to form a baseline on Tribals’ norms, rituals and information-sharing behavior. Around 35 tribal students were interviewed to find out their healing practices, norms and rituals on health issues. All these practicing indigenous knowledge were documented instantly. Peer-reviewed scientific papers from renowned databases were searched to have scientific evidence on each case. All the studies having negative or positive evidence were mentioned with each case.

The findings showed more indigenous knowledge with scientific disagreements on health aspects among the Tribals’ health practice in Bangladesh. However, the positive impact of such knowledge is not negligible. Therefore, showcasing the scientific tribals’ indigenous knowledge to a global audience is a strong recommendation.

Health and health care-seeking behavior among the tribal population in Bangladesh is not a new area of research, few studies have focused on the context, reasons and choices in patterns of health care-seeking behavior; obstacles and challenges faced in accessing health-care provision in the tribal areas in the country. However, research attempts to show the relationship between ecological knowledge and scientific indication is new in nature.

This paper addresses access to formal health care among Cape Verdean immigrants in the Netherlands, and their transnational health‐seeking process in other European countries. Three barriers hindering Cape Verdeans' access to care have been identified: lack of information about the health services available, problems in the relationship with health providers and difficulties in dealing with the conditionality of help. These problems are deeply intertwined, and relate to two sets of factors. At the macro‐level these include the organisational and structural characteristics of the Dutch health care system. At the micro‐level, the problems concern the mismatch between users' and providers' expectations of health care provision.Despite the barriers encountered, Cape Verdeans strive to benefit from good health. The informants in this study employ two sorts of strategy to access good health care. On the one hand, they try to adapt their help‐seeking behaviour to the model prevalent in the Netherlands. On the other, they resort to transnational health care use in other European countries, including Portugal and France. These strategies prove Cape Verdeans' resilience in finding the care that is most appropriate to their needs.

Access to health-care services for refugees are always impacted by many factors and strongly associated with population profile, nature of crisis and capacities of hosing countries. Throughout refugee’s crisis, the Jordanian Government has adopted several healthcare access policies to meet the health needs of Syrian refugees while maintaining the stability of the health-care system. The adopted health-care provision policies ranged from enabling to restricting and from affordable to unaffordable. The purpose of this paper is to identify the influence of restricted level of access to essential health services among Syrian refugees in Jordan.

This paper used findings of a cross-sectional surveys conducted over urban Syrian refugees in Jordan in 2017 and 2018 over two different health-care access policies. The first were inclusive and affordable, whereas the other considered very restricting policy owing to high inflation in health-care cost. Access indicators from four main thematic areas were selected including maternal health, family planning, child health and monthly access of household. A comparison between both years’ access indicators was conducted to understand access barriers and its impact.

The comparison between findings of both surveys shows a sudden shift in health-care access and utilization behaviors with increased barriers level thus increased health vulnerabilities. Additionally, the finding during implementation of restricted access policy proves the tendency among some refugees groups to adopt negative adaptation strategies to reduce health-care cost. The participants shifted to use a fragmented health-care, reduced or delayed care seeking and use drugs irrationally weather by self-medication or reduce drug intake.

Understanding access barriers to health services and its negative short-term and long-term impact on refugees’ health status as well as the extended risks to the host communities will help states that hosting refugees building rational access policy to protect whole community and save public health gains during and post crisis. Additionally, it will support donors to better mobilize resources according to the needs while the humanitarian actors and service providers will better contribute to the public health stability during refugee’s crisis.