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This study aimed to develop a measurement scale with good reliability and validity to assess the reasonableness of resident healthcare-seeking culture. Methods: This investigation utilized a cross-sectional research design, employing a multi-stage random sampling technique to select adult inhabitants aged eighteen and above who possess fundamental literacy abilities. An online survey was conducted from March to April 2021 across 27 provinces in China, encompassing 911 questionnaires for scale development. This study primarily applied discriminant coefficients and exploratory factor analysis to refine the scale items. Scale reliability was assessed using Cronbach's alpha, and split-half reliability. Scale validity was determined through content validity and structural validity. Data analysis was performed using SPSS 21.0, and structural equation modeling was executed with AMOS 23.0 software. Statistical significance was defined at P< 0.05. Results: The Resident Healthcare-seeking Culture Scale (RHCS) ultimately comprised 5 dimensions and 20 items. The cumulative explained variance of the five common factors within this scale amounts to 55.24%, satisfactorily adhering to the established criterion of social science research that the extracted factors should explain between 50% and 60% of the total variance. The Cronbach's alpha coefficient for the total scale was 0.83. Split-half reliability was 0.87. The Pearson correlation coefficients associating the scores from the five dimensions with the overall scale score were 0.78, 0.65, 0.65, 0.64, and 0.42, respectively, all statistically significant with P-values less than 0.001. The results of confirmatory factor analysis suggested that RMR=0.045, GFI=0.952, AGFI=0.936, PGFI=0.712, NFI=0.917, IFI=0.944, TLI=0.931, CFI = 0.943, and RMSEA = 0.046. Conclusion: The measurement scale for healthcare-seeking culture among Chinese residents exhibits superior reliability and validity, serving as an effective instrument for hospital administrators to evaluate the reasonableness of demand-side healthcare culture. Plain Language Summary: Known information: Healthcare culture encompasses both the facets of supply and demand. Existing research predominantly attends to the supply aspect, delving into the organizational culture within healthcare settings and crafting numerous evaluative instruments, including the Hospital and Safety Culture scales. Conversely, the realm of demand, specifically the healthcare-seeking culture among residents, remains underexplored, with a notable absence of tools to assess the reasonableness of this culture. Contribution of this study: This research quantitatively explores the resident healthcare-seeking culture for the first time, introducing a new theoretical framework to the domain of healthcare culture studies. By developing a scale with robust reliability and validity, this research offers a scientific instrument to evaluate the reasonableness of resident healthcare-seeking culture. Furthermore, this study addresses a previously unexplored void in the investigation of healthcare-seeking culture among residents. Implications of this study: By employing this scale, healthcare providers can gain a deeper insight into the characteristics of resident healthcare-seeking culture among residents across various demographic settings. This understanding enables them to tailor their services more closely to align with the cultural practices surrounding patients' access to healthcare, thereby enhancing patient satisfaction and collaboration in treatment. Moreover, this scale furnishes valuable data to health policymakers, facilitating the incorporation of patients' healthcare-seeking cultural traits into the formulation of health policies and the design of more effective and culturally resonant policy initiatives. [ABSTRACT FROM AUTHOR]

[Display omitted] Urinary incontinence (UI) is a disease that quietly yet seriously impacts women's health and represents a global health burden that is often neglected. This study aims to systematically assess the prevalence and dynamics of female UI in China, and can inform further policies and have international implications. This study used three nationwide investigations: A national cross-sectional survey in 2021; another nationwide cross-sectional survey in 2006; and data regarding the institutions and physicians providing pelvic floor rehabilitation services from 2005 to 2019. The weighted prevalence of female UI and its subtypes, including stress UI (SUI), urgency UI (UUI), and mixed UI (MUI), were estimated as primary outcomes. Knowledge, attitude and care-seeking behaviors of UI were evaluated. It was found that the weighted prevalence of female UI was 16.0 % (95% CI, 13.3 %–19.1%) with SUI remaining the predominant subtype (7.0%) in 2021, followed by MUI (6.5%) and UUI (1.9%). The estimated absolute number of Chinese adult women with UI was 85.8 million in 2021. 52.7% (95% CI, 45.9%–59.4 %) of women were aware that UI was a medical condition, and only 10.1% of women with UI sought health care. After 15 years of development, there were 8400 pelvic floor rehabilitation institutions and nearly 10,000 relevant physicians in China—they were found to be associated with UI prevalence. The UI prevalence in China was significantly lower in 2021 compared to that in 2006. Despite the achievement, UI remains a public health problem, especially given China's fast aging and three-child policy. More innovations, especially those that can facilitate care seeking, are needed to address this prevalent yet treatable condition. [ABSTRACT FROM AUTHOR]

Background: Pelvic organ prolapse (POP) is a major reproductive health problem that severely affects women's quality of life in several ways. Women who suffer from POP silently wait to heal from their problem without seeking care until the disease progressively worsens. Objective: The aim of this study was to assess factors associated with delay in seeking treatment among women with POP at public hospitals in Bale Zone, Southeast Ethiopia. Design: Facility-based cross-sectional study. Methods: A total of 344 study participants were enrolled at public hospitals in Bale Zone, Southeast Ethiopia, from 20 February to 20 May 2023. A consecutive sampling method was used to select the respondents. Data were collected using a pretested interviewer-administered structured questionnaire. Both bivariable and multivariable logistic regressions were used to identify the predictors of the outcome variable. Both the crude odds ratio (COR) and adjusted odds ratio (AOR) along with a 95% confidence interval (CI) were used to estimate the strength of the association between predictors and the response variable. Results: This study revealed that out of 333 participants, 76.9% (95% CI: 72.1, 81.4) were delayed in the treatment of POP. The median time of delay for POP treatments was 36 [interquartile range (IQR): 24–96] months. Being a rural resident [adjusted odds ratio (AOR) = 2.02, 95% CI: 1.23, 4.00], autonomous decision-making (AOR = 5.46, 95% CI: 2.30, 10.85), lack of support (AOR = 3.94, 95% CI: 1.64, 9.48), an embarrassment to see male health care providers (AOR = 2.04, 95% CI: 1.09, 3.81), and a lack of knowledge about successful POP treatment (AOR = 2.29, 95% CI: 1.27, 4.14) were significantly associated with delay of treatment for POP. Conclusion: A large number of women with POP did not seek health care in this study: Being in rural, autonomous decision-making, a lack of support, an embarrassment to see male health care providers, and a lack of knowledge on successful treatment were associated with treatment delay. Educating women and the community to make them aware that it is a treatable condition and encourage women's independence in decision-making on health care services in the family will improve their quality of life. [ABSTRACT FROM AUTHOR]

The estimated prevalence of irritable bowel syndrome (IBS) using Rome IV criteria in the United States (US) ranges from 4.7% to 5.3%, although these estimates arise from studies with relatively small sample sizes. This study assessed the prevalence of IBS and its associated burden of illness using a nationally representative data set with nearly 89,000 people in the US. From May 3 to June 24, 2020, we performed an online survey described to participating adults aged ≥18 years old as a "national health survey." We recruited a representative sample of people in the US to complete the survey, which included the Rome IV IBS questionnaire, National Institutes of Health Patient-Reported Outcome Measurement Information System (PROMIS) gastrointestinal scales, and questions on health care-seeking behavior. Overall, 88,607 people completed the survey, of whom 5414 (6.1%) met Rome IV IBS criteria: mixed IBS (n = 1838 [33.9%]), constipation-predominant IBS (n = 1819 [33.6%]), diarrhea-predominant IBS (n = 1521 [28.1%]), and unsubtyped IBS (n = 236 [4.4%]). Women had higher odds for IBS compared with men, whereas racial/ethnic minorities had lower odds for IBS vs non-Hispanic Whites. Across the 3 main subtypes, 68.2% to 73.2% of people reported ever seeking care for their IBS symptoms, whereas 53.8% to 58.9% did so in the past 12 months. In this nationwide US survey, we found that Rome IV IBS is slightly more prevalent (6.1%) vs prior estimates (4.7%–5.3%). Additional research is needed to determine whether this higher prevalence is in part due to the coronavirus disease 2019 pandemic during which this study was conducted. In a nationwide survey of nearly 89,000 people in the United States, 6.1% of people met Rome IV criteria for irritable bowel syndrome. Women had higher odds for irritable bowel syndrome compared with men, and racial/ethnic minorities had lower odds for irritable bowel syndrome compared with non-Hispanic Whites. [ABSTRACT FROM AUTHOR]

Abstract Background According to the minority stress theory, stigma affects the health of marginalized populations. Previous stigma research has focused on the health effects of individual and interpersonal stigma, paying less attention to structural factors. Laws on legal gender recognition affect the lives of transgender individuals in unique ways. The fact that these laws and population attitudes vary greatly between European countries, offer a unique opportunity to study the role of structural stigma in the lives of transgender individuals. Little is known about how transgender specific structural stigma relates to individual health determinants. Consequently, the aim of this study was to explore the association between structural stigma and access to gender affirming care, gender identity disclosure in health care, and experiences of discrimination in health care across 28 European countries. Methods By using multilevel regression, we combined data on health seeking behavior, transgender identity disclosure to health care providers, and experiences of discrimination in health care from 6,771 transgender individuals participating in the 2012 European Union Lesbian, Gay, Bisexual and Transgender survey with a structural stigma measure, consisting of population attitudes towards transgender individuals as well as national legislation on gender recognition. Reasons to refrain from seeking care and discrimination in health care were assessed by categorizing countries as low or high in structural stigma and using Chi-square statistics. Results Country-level structural stigma was negatively associated experiences of seeking gender affirming care and positively associated with concealment of being transgender to health care providers. Identity concealment was associated with a lower likelihood of exposure to discrimination in the health care setting across countries regardless of their level of structural stigma. The most prevalent reasons to forgo gender affirming care were shared between low and high structural stigma country groups and centered around fear. Conclusion The results highlight the importance of changing stigmatizing legislation and population attitudes to promote access to gender affirming care as well as openness of being transgender towards providers. Measures to decrease discrimination in the health care setting are warranted in high as well as in low structural stigma countries.

Although abdominal bloating is a common symptom, comparatively little is known about its prevalence in the community. This study aimed to examine the prevalence of bloating and assess related health care seeking using survey data from a nationally representative sample of nearly 89,000 Americans. Participants completed the National Gastrointestinal (GI) Survey II to measure the presence and severity of GI symptoms including bloating. We assessed the prevalence of bloating in the past 7 days, as well as severity and health care seeking for bloating. Multivariable regression was performed to identify associations between the outcomes and covariates. Of 88,795 survey completers, 12,324 (13.9%) reported bloating in the past 7 days. Women and those with comorbidities (eg, irritable bowel syndrome, chronic constipation, ulcerative colitis) and concomitant GI symptoms (eg, abdominal pain, excess gas) had higher odds for bloating (all P <.001). These factors were also associated with more severe bloating (all P <.001). Among those who reported recent bloating, 58.5% never sought care for bloating—29% of whom were self-managing symptoms or were uncomfortable discussing symptoms with their providers. Bloating is common in the community because nearly 1 in 7 Americans have experienced this symptom in the past week. Women and those with certain comorbidities and concomitant GI symptoms are more likely to experience bloating and have more severe symptoms. Nearly one third of sufferers who have not sought care are managing symptoms on their own or are uncomfortable discussing it with their providers, emphasizing that efforts should be made to proactively inquire about bloating. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: According to the minority stress theory, stigma affects the health of marginalized populations. Previous stigma research has focused on the health effects of individual and interpersonal stigma, paying less attention to structural factors. Laws on legal gender recognition affect the lives of transgender individuals in unique ways. The fact that these laws and population attitudes vary greatly between European countries, offer a unique opportunity to study the role of structural stigma in the lives of transgender individuals. Little is known about how transgender specific structural stigma relates to individual health determinants. Consequently, the aim of this study was to explore the association between structural stigma and access to gender affirming care, gender identity disclosure in health care, and experiences of discrimination in health care across 28 European countries. Methods: By using multilevel regression, we combined data on health seeking behavior, transgender identity disclosure to health care providers, and experiences of discrimination in health care from 6,771 transgender individuals participating in the 2012 European Union Lesbian, Gay, Bisexual and Transgender survey with a structural stigma measure, consisting of population attitudes towards transgender individuals as well as national legislation on gender recognition. Reasons to refrain from seeking care and discrimination in health care were assessed by categorizing countries as low or high in structural stigma and using Chi-square statistics. Results: Country-level structural stigma was negatively associated experiences of seeking gender affirming care and positively associated with concealment of being transgender to health care providers. Identity concealment was associated with a lower likelihood of exposure to discrimination in the health care setting across countries regardless of their level of structural stigma. The most prevalent reasons to forgo gender affirming care were shared between low and high structural stigma country groups and centered around fear. Conclusion: The results highlight the importance of changing stigmatizing legislation and population attitudes to promote access to gender affirming care as well as openness of being transgender towards providers. Measures to decrease discrimination in the health care setting are warranted in high as well as in low structural stigma countries. [ABSTRACT FROM AUTHOR]

Introduction: in Ethiopia, increasing access to basic antenatal and neonatal health services may improve maternal and newborn survival. This study examined perceptions regarding antenatal health seeking behaviors from pregnant women, their families, community members, and health care providers in rural Amhara, Ethiopia. Methods: the study was conducted in four rural districts of the Amhara region of Ethiopia. A total of forty participants who were living and working within the catchment areas of the selected health centres were interviewed from October 3rd through October 14th, 2018. A phenomenological qualitative study design was used to understand participants' perceptions and experiences about pregnant women's health care seeking behaviors. Results: early disclosure of pregnancy status was not common in the study area. However, the data from the present study further provided new information, suggesting that some women did disclose their pregnancy status early but preferentially only to their partners and close relatives. Most women did not seek care unless sick or experienced new discomfort or pain. Some reasons for the low utilization of available antenatal services include long distance to health facilities, lack of transportation, difficult topography, and discomfort with male providers. Conclusion: despite the rapid expansion of health posts and deployment of health extension workers since 2003, there are still critical barriers to accessing facility-based care that limit women's health care seeking practices. [ABSTRACT FROM AUTHOR]

Abstract Background Cardiovascular diseases (CVD) are emerging as the leading contributor to death globally. The usual source of care (USC) has been proven to generate significant benefits for the elderly with CVD. Understanding the choice of USC would generate important knowledge to guide the ongoing primary care-based integrated health system building in China. This study aimed to analyze the individual-level determinants of USC choices among the Chinese elderly with CVD and to generate two exemplary patient profiles: one who is most likely to choose a public hospital as the USC, the other one who is most likely to choose a public primary care facility as the USC. Methods This study was a secondary analysis using data from the World Health Organization’s Study on Global AGEing and Adult Health (SAGE) Wave 1 in China. 3,309 individuals aged 50 years old and over living with CVD were included in our final analysis. Multivariable logistic regression was built to analyze the determinants of USC choice. Nomogram was used to predict the probability of patients’ choice of USC. Results Most of the elderly suffering from CVD had a preference for public hospitals as their USC compared with primary care facilities. The elderly with CVD aged 50 years old, being illiterate, residing in rural areas, within the poorest income quintile, having functional deficiencies in instrumental activities of daily living and suffering one chronic condition were found to be more likely to choose primary care facilities as their USC with the probability of 0.85. Among those choosing primary care facilities as their USC, older CVD patients with the following characteristics had the highest probability of choosing public primary care facilities as their USC, with the probability of 0.77: aged 95 years old, being married, residing in urban areas, being in the richest income quintile, being insured, having a high school or above level of education, and being able to manage activities living. Conclusions Whilst public primary care facilities are the optimal USC for the elderly with CVD in China, most of them preferred to receive health care in public hospitals. This study suggests that the choice of USC for the elderly living with CVD was determined by different individual characteristics. It provides evidence regarding the choice of USC among older Chinese patients living with CVD.

Abstract Background The scarce knowledge about the drivers of demand for respiratory health care in the Brazilian Amazon, where the gap of human and physical health care resources is wide, is expanded with two surveys conducted in the west of the region, in Acre state. Potential drivers, informed by a review of twelve recent papers, were classified into seven categories capturing the individual, household, community and macroeconomic dimensions. Methods Quantitative field surveys were conducted in 2017 and 2019 based on coupled conglomerate-quota randomization sampling. Adults responded about their own health or their children’s health. The probability of seeking physician care for the latest episode of respiratory illness or dry cough was analysed with multiple nonlinear regressions, having as covariates the potential predictors informed by the literature. Results The propensity to seek health care and to purchase medication was larger for children. Influenza-like illness (Despite the exact diagnostic stated by respondents being “influenza”, a virus detection test (such as the PCR test) is not commonly applied, as informed by the Acre state public health service. In consistency, the term “influenza-like illness” is used.) was the most frequently diagnosed disease, followed by pneumonia, suggesting that a health care-seeking rate below 40% may perpetuate health impairment and local contagion. Illnesses’ severity, including the pain experienced, was the main predictor, revealing that subjective perception was more influential than objective individual and household characteristics. Conclusions The results suggest that subjective underestimation of respiratory illnesses’ consequences for oneself and for local society could prevent health care from being sought. This is in line with some previous studies but departs from those emphasizing the role of objective factors. Social consequences, of, for instance, a macroeconomic nature, need to be highlighted based on studies detecting long-run relationships among health care demand, health and economic performance at the national level. Depending on the intensity of the trade-off between the costs imposed on the health system by increased demand and on the economy by the reduced productivity of the ill, policy could be adopted to change subjective perceptions of illnesses with nudges and educational and informational interventions.

Introduction: mortality in under-five children remains a significant challenge in developing countries, including Zambia, where pneumonia and malaria account for twenty percent of under-five deaths. Poor health care seeking is one of the contributors to the high mortality rates. This study examined the predictors of health care seeking for acute respiratory infection (ARI) and fever among under-five children in Zambia. Methods: the study used a population based cross-sectional survey program evaluation dataset with sample size of 12,507 households from 28 districts. Binary logistic regression was used to examine the determinants of appropriate care seeking for ARI or fever, ARI, and fever. Results: the prevalence of fever or ARI in children under five was 22.9%, ARI 12.9%, and fever 13.4%. Educational status and nonparticipation in positive deviance hearth (PDH) were significant predictors in those with fever or ARI. Children whose household head had secondary education or higher were 4.5 times more likely to seek care than those whose household head did not have any education. Among those with ARI, educational status, women empowerment in decision-making and growth monitoring and promotion (GMP) were significant predictors while for fever only GMP was a significant predictor. Conclusion: over two thirds of caregivers sought care appropriately for fever or ARI. Only educational status and GMP were associated with more than one appropriate care seeking outcome. Through GMP services, policymakers can improve healthcare seeking behavior in children under five. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases (CVD) are emerging as the leading contributor to death globally. The usual source of care (USC) has been proven to generate significant benefits for the elderly with CVD. Understanding the choice of USC would generate important knowledge to guide the ongoing primary care-based integrated health system building in China. This study aimed to analyze the individual-level determinants of USC choices among the Chinese elderly with CVD and to generate two exemplary patient profiles: one who is most likely to choose a public hospital as the USC, the other one who is most likely to choose a public primary care facility as the USC.Methods: This study was a secondary analysis using data from the World Health Organization's Study on Global AGEing and Adult Health (SAGE) Wave 1 in China. 3,309 individuals aged 50 years old and over living with CVD were included in our final analysis. Multivariable logistic regression was built to analyze the determinants of USC choice. Nomogram was used to predict the probability of patients' choice of USC.Results: Most of the elderly suffering from CVD had a preference for public hospitals as their USC compared with primary care facilities. The elderly with CVD aged 50 years old, being illiterate, residing in rural areas, within the poorest income quintile, having functional deficiencies in instrumental activities of daily living and suffering one chronic condition were found to be more likely to choose primary care facilities as their USC with the probability of 0.85. Among those choosing primary care facilities as their USC, older CVD patients with the following characteristics had the highest probability of choosing public primary care facilities as their USC, with the probability of 0.77: aged 95 years old, being married, residing in urban areas, being in the richest income quintile, being insured, having a high school or above level of education, and being able to manage activities living.Conclusions: Whilst public primary care facilities are the optimal USC for the elderly with CVD in China, most of them preferred to receive health care in public hospitals. This study suggests that the choice of USC for the elderly living with CVD was determined by different individual characteristics. It provides evidence regarding the choice of USC among older Chinese patients living with CVD. [ABSTRACT FROM AUTHOR]

Background: The scarce knowledge about the drivers of demand for respiratory health care in the Brazilian Amazon, where the gap of human and physical health care resources is wide, is expanded with two surveys conducted in the west of the region, in Acre state. Potential drivers, informed by a review of twelve recent papers, were classified into seven categories capturing the individual, household, community and macroeconomic dimensions.Methods: Quantitative field surveys were conducted in 2017 and 2019 based on coupled conglomerate-quota randomization sampling. Adults responded about their own health or their children's health. The probability of seeking physician care for the latest episode of respiratory illness or dry cough was analysed with multiple nonlinear regressions, having as covariates the potential predictors informed by the literature.Results: The propensity to seek health care and to purchase medication was larger for children. Influenza-like illness (Despite the exact diagnostic stated by respondents being "influenza", a virus detection test (such as the PCR test) is not commonly applied, as informed by the Acre state public health service. In consistency, the term "influenza-like illness" is used.) was the most frequently diagnosed disease, followed by pneumonia, suggesting that a health care-seeking rate below 40% may perpetuate health impairment and local contagion. Illnesses' severity, including the pain experienced, was the main predictor, revealing that subjective perception was more influential than objective individual and household characteristics.Conclusions: The results suggest that subjective underestimation of respiratory illnesses' consequences for oneself and for local society could prevent health care from being sought. This is in line with some previous studies but departs from those emphasizing the role of objective factors. Social consequences, of, for instance, a macroeconomic nature, need to be highlighted based on studies detecting long-run relationships among health care demand, health and economic performance at the national level. Depending on the intensity of the trade-off between the costs imposed on the health system by increased demand and on the economy by the reduced productivity of the ill, policy could be adopted to change subjective perceptions of illnesses with nudges and educational and informational interventions. [ABSTRACT FROM AUTHOR]

Objectives: Preconception care (PCC) is a recognised strategy for optimising maternal health and improving maternal and neonatal outcomes. PCC services are minimally available and not fully integrated into maternal health services in Nigeria. This study explored perceptions about PCC services among health care providers in Ibadan, Nigeria. Methods: Using a qualitative case study design the perspectives of 26 health care providers—16 specialist physicians and nine nurses covering 10 specialties at the primary, secondary and tertiary health care levels was explored. In-depth interviews were digitally recorded, transcribed verbatim and analysed on MAXQDA using thematic analysis. Results: Almost all participants stated that PCC services should be offered at all three levels of health care with referral when needed between lower and higher levels. Participants stated that although all people of reproductive age would benefit from PCC, those who had medical problems like hypertension, sickle cell disease, diabetes and infertility would benefit more. Participants opined that delayed health care seeking observed in the community may influence acceptability of PCC especially for people without known pre-existing conditions. All specialist physicians identified the relevance of PCC to their practice. They identified potential benefits of PCC including opportunity to prepare for pregnancy to ensure positive pregnancy outcomes. Conclusions for Practice: Preconception care is perceived as important for promoting positive pregnancy outcomes in people with known medical problems and is relevant to different specialities of medical practice. Provision of the service will require establishment of guidelines and uptake will depend on acceptability to community members who will benefit from the service. [ABSTRACT FROM AUTHOR]

Objective: To determine the health care seeking behaviour and its association with socio-demographic factors among newly diagnosed Human Immunodeficiency virus infection patients. Study Design: Cross sectional analytical study. Place and Duration of Study: The study was conducted in a regional blood centre and an Institute of Pathology affiliated with National University of Medical Sciences (NUMS) in Rawalpindi, from Feb 2019 to Oct 2019. Methodology: A pretested structured questionnaire was used to collect data from thirty newly diagnosed (within last one year) Human Immunodeficiency Virus Infection (HIV) patients, using consecutive sampling. Age, education, socioeconomic score (SES), family size, income and months living with HIV were divided into groups for analysis. Chi square test was applied to determine association between these variables and health care seeking behaviour. Data was analysed using SPSS version 22. A p-value of 0.05) was found between these independent variables and overall health care seeking behaviour. Conclusions: Health care seeking behaviour of newly diagnosed Human Immunodeficiency Virus infected patients was moderately appropriate and no significant association was found between sociodemographic variables and health care seeking behaviour.

Patients' delay in seeking health care is a major problem in the control of tuberculosis (TB) and increases the risk of TB transmission. This study determined health-seeking practices and delays that occurred from the onset of TB symptoms until diagnosis and assessed the patients' TB-related knowledge. This was a cross-sectional study involving 391 new TB patients recruited from health facilities at an urban sub-district in South Africa from December 2016 to March 2017. Descriptive statistics and logistic regression analyses were performed using Stata 14. Over half (56.3%) of the patients delayed seeking health care for more than 30 days after the onset of their symptoms, 32% sought treatment from informal providers, and 13.3% self-medicated. Lack of suspicion of a TB diagnosis, which was prevalent in 45% of respondents, was statistically associated with delay in seeking healthcare (AOR = 0.53, CI: 0.32-1.87). Overall TB knowledge was high, correct knowledge about TB transmission was 92.6%. TB knowledge was significantly associated with educational status (AOR = 3.96, CI: 1.69-9.28) and seeking treatment from informal sectors (AOR = 0.17, CI: 0.03-0.95). High overall TB knowledge was not statistically associated with seeking health care for TB diagnosis and treatment. We found a substantial delay between the onset of TB symptoms and seeking healthcare from a public health facility providing TB screening services. Promoting early screening and diagnosis through increasing awareness of TB is key in the elimination of TB in communities with a high TB burden [ABSTRACT FROM AUTHOR]

Abstract Background Malaria is one of the top-five contributors to under-5 deaths in Myanmar. Use of insecticide-treated nets (ITN) and receiving early appropriate care in case of fever are the core interventions to prevent malaria and its complications and thereby deaths. This study aimed to assess among the under-five children, (a) utilization of ITNs and its associated factors, (b) care-seeking behaviour among their caregivers and its associated factors and uptake of malaria testing among those with fever in the last 2 weeks. Methods This was a cross sectional study using secondary analysis of Myanmar Demographic and Health Survey (MDHS) conducted in 2015–2016. Multivariable logistic regression was used to explore the factors associated with non-utilization of ITNs and not seeking care for fever. Effect sizes have been presented using odds ratios with 95% confidence intervals. Data analysis was done using svyset command in STATA to account for the multi-stage sampling design of the survey. Results Of 4597 alive under-five children, 80.5% did not sleep under an ITN last night. The factors significantly associated with non-utilization of ITNs were residing in malaria elimination regions (aOR = 2.0, 1.3–3.2), urban residence (aOR = 1.8, 1.2–2.9), staying in delta region (aOR = 8.7, 4.7–12.2), hilly region (aOR = 3.0, 2.0–4.6, and having highest wealth quintile (aOR = 1.8, 1.1–3.0). Around 16% had fever in the last 2 weeks, of whom 66.7% sought care for fever and 3% got tested for malaria. Nearly half (50.9%) of the caregivers sought care from a government health facility, followed by private hospital/doctor (27.8%), shop (8.0%), village health worker (4.4%) and pharmacy (3.1%). The factors associated with not seeking care for fever were residing in specific geographical locations (hilly, delta and central plains compared to coastal region) and having lowest wealth quintile (aOR = 2.3, 1.1–5.7). Conclusions This study highlighted that ownership and utilization of ITNs was very poor among under-5children. Care-seeking behaviour of the caregivers of under-5 children in case of fever was dismal with two-thirds not seeking care. The programme should seriously consider addressing these barriers if Myanmar is to achieve zero malaria deaths by 2030.

Abstract Background Female genital mutilation/cutting (FGM/C) is a cultural practice associated with health consequences, women rights and deprivation of dignity. Despite FGM/C-related health consequences, circumcised women may encounter additional challenges while seeking interventions for reproductive health problems. Experiences of women/girls while accessing health services for reproductive health problems including FGM/C-related complications in poor, remote and hard to reach areas is poorly understood. We sought to explore barriers to care seeking among Somali women with complications related to FGM/C in public health facilities in Kenya. Methods We drew on qualitative data collected from purposively selected women aged 15–49 years living with FGM/C, their partners, community leaders, and health providers in Nairobi and Garissa Counties. Data were collected using in-depth interviews (n = 10), key informant interviews (n = 23) and 20 focus group discussions. Data were transcribed and analyzed thematically using NVivo version 12. Results Barriers were grouped into four thematic categories. Structural barriers to care-seeking, notably high cost of care, distance from health facilities, and lack of a referral system. Concerns regarding perceived quality of care also presented a barrier. Women questioned health professionals’ and health facilities’ capacity to offer culturally-sensitive FGM/C-specific care, plus ensuring confidentiality and privacy. Women faced socio-cultural barriers while seeking care particularly cultural taboos against discussing matters related to sexual health with male clinicians. Additionally, fear of legal sanctions given the anti-FGM/C law deterred women with FGM/C-related complications from seeking healthcare. Conclusion Structural, socio-cultural, quality of service, and legal factors limit health seeking for reproductive health problems including FGM/C-related complications. Strengthening health system should consider integration of FGM/C-related interventions with existing maternal child health services for cost effectiveness, efficiency and quality care. The interventions should address health-related financial, physical and communication barriers, while ensuring culturally-sensitive and confidential care.

Abstract Background Tuberculosis (TB) is a major public health problem and it is among the top 10 causes of death worldwide. One of the challenges against attaining an effective TB control program is delay in seeking health care to diagnosis and treatment of TB patients. The aim of this study was to assess health care-seeking delay among pulmonary TB patients. Methods An institutional based cross-sectional study was conducted among new pulmonary tuberculosis (PTB) patients > 15 years of age who were enrolled in the intensive phase TB treatment from November 1, 2015 – January 30, 2016. Data were collected by an interviewer administered technique using a structured questionnaire. Health care seeking delay was categorized by using a median cutoff point of > 30 days as a prolonged health care seeking delay. Logistic regression analyses were employed to determine factors independently associated with the delays in health care seeking. Results A total of 422 PTB patients were included in this study. The median age of respondents was 37 years (interquartile range (IQR) =35–44). The median time of health care seeking delay was 30 days (IQR) = 21-60). Respondents occupation, knowledge about pulmonary tuberculosis, health facility visited first, seeking treatment from traditional or religious healers before visiting health facilities, reason for not seeking treatment early from health facilities, and reason for first consultation were found to be significantly associated with health care seeking delay. Conclusion The study showed the magnitude of health care seeking delay among pulmonary tuberculosis patient was very long and the factors associated with health care seeking delay were: occupation, knowledge status, health facility visited first and seeking treatment from religious or traditional healer before health facilities. To overcome delay of health care seeking among tuberculosis patients, efforts should required availing tuberculosis diagnostic and treatment services at the primary health care level.

The health care needs and service experiences of higher education students require more research attention, given the increase in students who have a long-term illness, medical condition, or disability ("condition"). It is also important to consider the experiences of rising numbers of international students. This exploratory qualitative study used face-to-face interviews and the common-sense model of self-regulation to investigate students' perceptions and coping behaviours, in a higher education institution in the UK. Thematic analysis was used to analyse the data. Twenty students who self-identified as having a condition were interviewed. This study adds depth to the understanding of the connections between students' health-related experiences and their personal, academic, and post-graduation aspirations and the support needs of students, including international students. To optimise institutional support, innovations in partnerships with local care organisations and within the university, staff training about conditions, peer mentorship, and information outreach especially to international students, should be considered. [ABSTRACT FROM AUTHOR]

Objective: To describe patterns of conventional health care (CH) and complementary and alternative medicine (CAM) use among U.S. adults reporting recent joint symptoms in a nationally representative sample. Design: This study uses the adult alternative medicine supplement from the 2012 National Health Interview Survey (NHIS). Location: United States. Subjects: Nationally representative cross-sectional sample of non-institutionalized U.S. residents. Of 34,525 respondents who answered the alternative medicine supplement, approximately 30% (n = 10,964) reported recent pain symptoms (pain, aching, stiffness). Outcome measures: Among adults reporting joint symptoms, we examine reported use of CH, CAM, both CH and CAM, or neither specifically for joint symptoms or joint condition. Results: Among adults reporting joint symptoms in the past 30 days, 64% reported using only CH for their joint pain, whereas ∼10% reported using CAM. Among those using CAM for their joint symptoms, 83% also sought help from a CH practitioner. CAM-only users comprised only 1.6% of the sample of joint pain sufferers. Those who reported using both CH and CAM for joint pain were more likely to report a diagnosis of a joint condition compared with CAM-only users, but also reported higher comorbidities and worse self-reported health. Conclusion: Most U.S. adults reporting recent joint pain seek care only from a CH practitioner, although among the 10% who report CAM use for joint conditions, a strong majority also report seeking care from a CH practitioner. CH and CAM providers should consistently inquire about other forms of treatment their patients are using for specific symptoms to provide effective integrative health care management. [ABSTRACT FROM AUTHOR]

Objective: To determine the health care seeking behaviour and its association with socio-demographic factors among newly diagnosed Human Immunodeficiency virus infection patients. Study Design: Cross sectional analytical study. Place and Duration of Study: The study was conducted in a regional blood centre and an Institute of Pathology affiliated with National University of Medical Sciences (NUMS) in Rawalpindi, from Feb 2019 to Oct 2019. Methodology: A pretested structured questionnaire was used to collect data from thirty newly diagnosed (within last one year) Human Immunodeficiency Virus Infection (HIV) patients, using consecutive sampling. Age, education, socioeconomic score (SES), family size, income and months living with HIV were divided into groups for analysis. Chi square test was applied to determine association between these variables and health care seeking behaviour. Data was analysed using SPSS version 22. A p-value of <0.05 was taken as significant. Results: The participants were divided into three groups depending on their total questionnaire score value based on cut-off score value of 60%. Out of total 30 patients, 7 (23.3%) had inappropriate behaviour, 18 (60%) moderately appropriate and 5 (16.7%) appropriate behaviour respectively. No statistically significant association (p-value >0.05) was found between these independent variables and overall health care seeking behaviour. Conclusions: Health care seeking behaviour of newly diagnosed Human Immunodeficiency Virus infected patients was moderately appropriate and no significant association was found between sociodemographic variables and health care seeking behaviour. [ABSTRACT FROM AUTHOR]

The economic, social, and health costs of mental distress are increasingly burdening individuals and societies in Europe. Yet, overmedicalization of mild symptoms is also well documented. This accumulates in more pressures and demands on health care systems. In this article, I explore how the process of help seeking in mental distress might be shaped by health system design and functioning in one of the South European societies—Spain. Employing Bourdieu's theoretical lens, in-depth interviews with health care providers and users of services are analyzed. I reveal how the logic of the mental health care field, which is reinforced by the market, the state, and the media, may result in medicalization of mild distress while severe mental illness remains undertreated. I also show how mental help-seeking practices could gradually influence the functioning of the treatment system. Nevertheless, points of resistance to medicalization can also be identified. [ABSTRACT FROM AUTHOR]

Background: Pelvic floor disorders (PFDs), include urinary incontinence, overactive bladder, anal incontinence, and pelvic organ prolapse negatively affect physical, psychosocial, and economic wellbeing of women. In developing countries, less than a quarter of women with PFDs seek health care for their problem. Health care seeking for PFDs, and its associated factors, is little known in Ethiopia. This study aimed to assess health care seeking for PFDs, associated factors, and deterrents for seeking care. Methods: From a community based cross sectional study conducted form August 10 to September 4, 2016 to assess pelvic floor disorders, seven hundred four participants with PFDs drawn for health care seeking behavior analysis. Data were collected through interviewed administered questionnaire. Poisson regression model with robust variance was used to investigate the association of the independent variable with health care seeking behaviors. The results are reported in crude and adjusted prevalence ratio with 95% confidence intervals. Result: Two hundred twenty five (32%; CI: 26.8–35.5) women sought care for their PFDs. Majority 160 (71%) of them seek care from government health facilities. Middle wealth index Adjusted Prevalence Ratio (APR) = 1.4, CI: 1.1, 1.8), autonomous decision making on own health (APR = 1.3, CI: 1.1, 1.7), and sever impact of PFDs on quality of life (APR = 1.4, CI:1.1, 1.9) were identified as associated factors for health care seeking. Conclusion: A large number of women with pelvic floor disorder did not seek health care: this calls for urgent and tailored intervention to enhance health care seeking behaviors of women with PFD. [ABSTRACT FROM AUTHOR]

Background: In low- and middle-income countries, a large number of maternal and newborn deaths occur due to delays in health care seeking. These delays occur at three levels i.e. delay in making decision to seek care, delay in access to care, and delay in receiving care. Factors that cause delays are therefore need to be understand to prevent and avoid these delays to improve health and survival of mothers and babies. Methods: A systematic review of observational and qualitative studies to identify factors and barriers associated with delays in health care seeking. Results: A total of 159 observational and qualitative studies met the inclusion criteria. The review of observational and qualitative studies identified social, cultural and health services factors that contribute to delays in health care seeking, and influence decisions to seek care. Timely recognition of danger signs, availability of finances to arrange for transport and affordability of health care cost, and accessibility to a health facility were some of these factors. Conclusions: Effective dealing of factors that contribute to delays in health care seeking would lead to significant improvements in mortality, morbidity and care seeking outcomes, particularly in countries that share a major brunt of maternal and newborn morbidity and mortality. Registration: PROSPERO CRD42012003236.

Abstract Background In remote rural areas of Pakistan, access to the maternal, newborn and child health (MNCH) care provided by a skilled health provider is quite difficult. There are many reasons such as women’s restricted social mobility, lack of education, disenfranchised in decision making and poverty. To overcome these barriers and impediments in district Chitral, which is the largest territory in terms of geography in province Khyber Pakhtunkhwa, local women of reproductive age, were mobilized to form the Community Based Saving Groups (CBSGs) at the village level. In these CBSGs, they pool-in their money, and then provide soft loans to the expecting mothers to meet the expenses of delivery. Simultaneously, young literate women were identified from the local communities; they were trained as Community Midwives (CMWs), using national MNCH curriculum, and later deployed in their respective villages within the district. This study captured their perceptions about the formation of CBSGs to overcome the financial and social barriers, and subsequent use of CMW services. Methods A qualitative enquiry was conducted with the delivered mothers and their husbands through gender specific separate focus group discussions, with CBSG members and with non-members in four different sites of District Chitral. Results CBSG member women were far more aware on health issues. Information sought from these forums brought a noticeable change in the health seeking practices. Seeking care from a trained birth attendant in the community became easier. Women associated with the CBSGs as members, expressed an increased access to money for utilizing the CMW services, better awareness on MNCH issues, and empowerment to decide for seeking care. CBSG have been an instrumental platform for social networking, helping each other in other household matters. Conclusion Women have started using the services of CMW and the CBSGs have actually helped them overcome the financial barriers in health care seeking. Moreover, the CBSGs became a medium to improve the awareness of service availability, understanding the MNCH issues, and timely utilization of MNCH services.

Fahmida Chowdhury,1 Katharine Sturm-Ramirez,1,2 Abdullah Al Mamun,1 A Danielle Iuliano,2 Mejbah Uddin Bhuiyan,1 Mohammod Jobayer Chisti,1 Makhdum Ahmed,1 Sabbir Haider,3 Mahmudur Rahman,3 Eduardo Azziz-Baumgartner2 1Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; 2Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; 3Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh Background: Pharmacies in Bangladesh serve as an important source of health service. A survey in Dhaka reported that 48% of respondents with symptoms of acute respiratory illness (ARI) identified local pharmacies as their first point of care. This study explores the factors driving urban customers to seek health care from pharmacies for ARI, their treatment adherence, and outcome.Methods: A cross-sectional study was conducted among 100 selected pharmacies within Dhaka from June to December 2012. Study participants were patients or patients’ relatives aged >18 years seeking care for ARI from pharmacies without prescription. Structured interviews were conducted with customers after they sought health service from drug sellers and again over phone 5 days postinterview to discuss treatment adherence and outcome.Results: We interviewed 302 customers patronizing 76 pharmacies; 186 (62%) sought care for themselves and 116 (38%) sought care for a sick relative. Most customers (215; 71%) were males. The majority (90%) of customers sought care from the study pharmacy as their first point of care, while 18 (6%) had previously sought care from another pharmacy and 11 (4%) from a physician for their illness episodes. The most frequently reported reasons for seeking care from pharmacies were ease of access to pharmacies (86%), lower cost (46%), availability of medicine (33%), knowing the drug seller (20%), and convenient hours of operation (19%). The most commonly recommended drugs were acetaminophen dispensed in 76% (228) of visits, antihistamine in 69% (208), and antibiotics in 42% (126). On follow-up, most (86%) of the customers had recovered and 12% had sought further treatment.Conclusion: People with ARI preferred to seek care at pharmacies rather than clinics because these pharmacies were more accessible and provided prompt treatment and medicine with no service charge. We recommend raising awareness among drug sellers on proper dispensing practices and enforcement of laws and regulations for drug sales. Keywords: drug sellers, pharmacy, acute respiratory illness, dispensing practice, health care seeking, customers

Given the targeted 4–5% annual reduction of tuberculosis (TB) cure cases to reach the “End TB Strategy” by 2020 milestone globally set by WHO, exploration of TB health seeking behavior is warranted for insightful understanding. This qualitative study aims to provide an account of the social, cultural, and socioeconomic breadth of TB cases in Bangladesh. We carried out a total of 32 In-depth Interviews (IDIs) and 16 Key Informant Interviews (KIIs) in both rural and urban areas of Bangladesh. We covered both BRAC [a multinational Non-governmental Organization (NGO)] and non-BRAC (other NGOs) TB program coverage areas to get an insight. We used purposive sampling strategy and initially followed “snowball sampling technique” to identify TB patients. Neuman’s three-phase coding system was adopted to analyze the qualitative data. Underestimation of TB knowledge and lack of awareness among the TB patients along with the opinions from their family members played key roles on their TB health seeking behavior. Quick decision on the treatment issue was observed once the diagnosis was confirmed; however, difficulties were in accepting the diseases. Nevertheless, individual beliefs, intrinsic ideologies, financial abilities, and cultural and social beliefs on TB were closely inter-connected with the “social perception” of TB that eventually influenced the care seeking pathways of TB patients in various ways. Individual and community level public health interventions could increase early diagnosis; therefore, reduce recurrent TB.

Background: Female genital mutilation/cutting (FGM/C) is a cultural practice associated with health consequences, women rights and deprivation of dignity. Despite FGM/C-related health consequences, circumcised women may encounter additional challenges while seeking interventions for reproductive health problems. Experiences of women/girls while accessing health services for reproductive health problems including FGM/C-related complications in poor, remote and hard to reach areas is poorly understood. We sought to explore barriers to care seeking among Somali women with complications related to FGM/C in public health facilities in Kenya. Methods: We drew on qualitative data collected from purposively selected women aged 15–49 years living with FGM/C, their partners, community leaders, and health providers in Nairobi and Garissa Counties. Data were collected using in-depth interviews (n = 10), key informant interviews (n = 23) and 20 focus group discussions. Data were transcribed and analyzed thematically using NVivo version 12. Results: Barriers were grouped into four thematic categories. Structural barriers to care-seeking, notably high cost of care, distance from health facilities, and lack of a referral system. Concerns regarding perceived quality of care also presented a barrier. Women questioned health professionals' and health facilities' capacity to offer culturally-sensitive FGM/C-specific care, plus ensuring confidentiality and privacy. Women faced socio-cultural barriers while seeking care particularly cultural taboos against discussing matters related to sexual health with male clinicians. Additionally, fear of legal sanctions given the anti-FGM/C law deterred women with FGM/C-related complications from seeking healthcare. Conclusion: Structural, socio-cultural, quality of service, and legal factors limit health seeking for reproductive health problems including FGM/C-related complications. Strengthening health system should consider integration of FGM/C-related interventions with existing maternal child health services for cost effectiveness, efficiency and quality care. The interventions should address health-related financial, physical and communication barriers, while ensuring culturally-sensitive and confidential care. [ABSTRACT FROM AUTHOR]

Background: Malaria is one of the top-five contributors to under-5 deaths in Myanmar. Use of insecticide-treated nets (ITN) and receiving early appropriate care in case of fever are the core interventions to prevent malaria and its complications and thereby deaths. This study aimed to assess among the under-five children, (a) utilization of ITNs and its associated factors, (b) care-seeking behaviour among their caregivers and its associated factors and uptake of malaria testing among those with fever in the last 2 weeks. Methods: This was a cross sectional study using secondary analysis of Myanmar Demographic and Health Survey (MDHS) conducted in 2015–2016. Multivariable logistic regression was used to explore the factors associated with non-utilization of ITNs and not seeking care for fever. Effect sizes have been presented using odds ratios with 95% confidence intervals. Data analysis was done using svyset command in STATA to account for the multi-stage sampling design of the survey. Results: Of 4597 alive under-five children, 80.5% did not sleep under an ITN last night. The factors significantly associated with non-utilization of ITNs were residing in malaria elimination regions (aOR = 2.0, 1.3–3.2), urban residence (aOR = 1.8, 1.2–2.9), staying in delta region (aOR = 8.7, 4.7–12.2), hilly region (aOR = 3.0, 2.0–4.6, and having highest wealth quintile (aOR = 1.8, 1.1–3.0). Around 16% had fever in the last 2 weeks, of whom 66.7% sought care for fever and 3% got tested for malaria. Nearly half (50.9%) of the caregivers sought care from a government health facility, followed by private hospital/doctor (27.8%), shop (8.0%), village health worker (4.4%) and pharmacy (3.1%). The factors associated with not seeking care for fever were residing in specific geographical locations (hilly, delta and central plains compared to coastal region) and having lowest wealth quintile (aOR = 2.3, 1.1–5.7). Conclusions: This study highlighted that ownership and utilization of ITNs was very poor among under-5children. Care-seeking behaviour of the caregivers of under-5 children in case of fever was dismal with two-thirds not seeking care. The programme should seriously consider addressing these barriers if Myanmar is to achieve zero malaria deaths by 2030. [ABSTRACT FROM AUTHOR]

Given the targeted 4–5% annual reduction of tuberculosis (TB) cure cases to reach the "End TB Strategy" by 2020 milestone globally set by WHO, exploration of TB health seeking behavior is warranted for insightful understanding. This qualitative study aims to provide an account of the social, cultural, and socioeconomic breadth of TB cases in Bangladesh. We carried out a total of 32 In-depth Interviews (IDIs) and 16 Key Informant Interviews (KIIs) in both rural and urban areas of Bangladesh. We covered both BRAC [a multinational Non-governmental Organization (NGO)] and non-BRAC (other NGOs) TB program coverage areas to get an insight. We used purposive sampling strategy and initially followed "snowball sampling technique" to identify TB patients. Neuman's three-phase coding system was adopted to analyze the qualitative data. Underestimation of TB knowledge and lack of awareness among the TB patients along with the opinions from their family members played key roles on their TB health seeking behavior. Quick decision on the treatment issue was observed once the diagnosis was confirmed; however, difficulties were in accepting the diseases. Nevertheless, individual beliefs, intrinsic ideologies, financial abilities, and cultural and social beliefs on TB were closely inter-connected with the "social perception" of TB that eventually influenced the care seeking pathways of TB patients in various ways. Individual and community level public health interventions could increase early diagnosis; therefore, reduce recurrent TB. [ABSTRACT FROM AUTHOR]

According to the Migration Policy Institute (2019), as of 2017 the USA was home to approximately 44 million immigrants, the largest number of immigrants in the world. Most of these immigrants relocate from Mexico, India, China, the Philippines, El Salvador, Vietnam, Cuba, and the Dominican Republic. Since 2017, there have been increased reports of Immigrations and Customs Enforcement (ICE) interventions toward immigrants, especially at and near previously delineated "safe areas" such as medical facilities, as immigrants sought health care. Currently, health care providers are reporting delays and reductions in health care seeking by immigrants. This increases risks of untreated health problems for the immigrants themselves as well as their communities. To protect the health of immigrants, and the general public, the Society of Behavioral Medicine joins the American College of Physicians (2011) and the American Medical Association (2017) in recommending that Congress impose restrictions on ICE interventions in or around medical facilities. [ABSTRACT FROM AUTHOR]

The reduction of prehospital delay for patients with acute coronary syndrome (ACS) is widely discussed within cardiac research. Medically informed literature generally considers patient hesitancy in seeking treatment a significant barrier to accessing timely treatment. With this starting point, we conducted an interview study with people previously hospitalized for ACS and with the bystanders involved in their decision to contact the health care system. The analysis was conducted in two stages: first, a systematic extraction of key information; second, an in-depth analysis informed by medical anthropology. This led us to understand the prehospital period as an interpretation process where bodily sensations appeared as symptoms. Informants vacillated between sensations, knowledge, interpretations, and emotions as they struggled to preserve everyday ordinariness. They were led to contact the health care system by bodily discomfort rather than a rational decision to reduce risk. The paradigmatic implications from medical anthropology proved an important alternative to the medical paradigm. [ABSTRACT FROM AUTHOR]

Background: Gender differences can be in any stage in the life cycle including before birth (feticide/sex selective abortions) which have been objectively documented. This study tries to identify the gender differentials among the children which is a basic step in cascade process of female discrimination in the society. Objective: To study the gender differentials among children under 6 years in households of rural Ballabgarh, Haryana in terms of nutrition, health care seeking, social aspects and to see whether they differ by socio economic status. Methods: Two hundred households were selected purposively from four villages (50 households each) by multi stage sampling during Mar – June 2010. Pre tested interview schedule was used to assess gender differences in nutrition (breast feeding, 'z' score); in health care seeking and in social aspects (Expenditure on birth related ceremonies and toys and dresses). Differences are measured in means or proportions. Determinants of Gender differentials were identified by logistic regression. Results: Girls were breast fed for five months lesser than boys (P < 0.02). Even though occurrences of common childhood illnesses were equal between the two, expenditures incurred to treat these illnesses were more among the boys (Boys Vs girls: Rs 181.3 Vs Rs 123.9). Proportion of illnesses treated from health facilities located outside the villages was higher among the boys [boys (22.2%), girls (11.4%)]. Expenditures incurred during birth related social ceremonies were higher for boys (Rs 20311 and Rs 2487.5 respectively for boys and girls). Conclusion: In this patriarchal society, socio cultural norms have produced the gender gap which can have adverse impact on health of the female children.

The world has been unable to meet the United Nations Millennium Development Goals (MDGs) of reducing child mortality by 2015. Since 1990, there is an established disparity of under-5 mortality rates among countries across the globe. This disparity is due to high burden of child deaths in several of the low income countries. These high burden countries includes India, Nigeria, Pakistan and Democratic Republic of the Congo (DRoC) (UNICEF-Report-2015). Currently, these four countries carry almost 45% of the global burden of child deaths. If these high burden countries continues to shows such trends of child mortality, then in the next 15 years or so, they will be carrying almost half of the global burden of child mortality (UNIGCME-2015).

Background: Lack of appropriate health care seeking for ill mothers and neonates contributes to high mortality rates. A major challenge is the appropriate mix of strategies for creating demand as well as provision of services. Design: Systematic review and meta-analysis of experimental studies (last search: Jan 2015) to assess the impact of different strategies to improve maternal and neonatal health care seeking in low- and middle-income countries (LMIC). Results: Fifty-eight experimental [randomized controlled trials (RCTs), non-RCTs, and before-after studies] with 310,652 participants met the inclusion criteria. Meta-analyses from 29 RCTs with a range of different interventions (e.g. mobilization, home visitation) indicated significant improvement in health care seeking for neonatal illnesses when compared with standard/no care [risk ratio (RR) 1.40; 95 confidence interval (CI): 1.17–1.68, 9 studies, n=30,572], whereas, no impact was seen on health care seeking for maternal illnesses (RR 1.06; 95% CI: 0.92–1.22, 5 studies, n=15,828). These interventions had a significant impact on reducing stillbirths (RR 0.82; 95% CI: 0.73–0.93, 11 studies, n=176,683), perinatal deaths (RR 0.84; 95% CI: 0.77–0.90, 15 studies, n=279,618), and neonatal mortality (RR 0.80; 95% CI: 0.72–0.89, 20 studies, n=248,848). On GRADE approach, evidence was high quality except for the outcome of maternal health care seeking, which was moderate. Conclusions: Community-based interventions integrating strategies such as home visiting and counseling can help to reduce fetal and neonatal mortality in LMIC.

Background: Inter district variations in health parameters can be conducive for policy making with regards to child health status and healthcare utilization. Aims and Objectives: We carried out this study to understand district-wide variations in child health promotion practices in well performing Dakshina Kannada (DK) and poorly performing Bellary districts of Karnataka state of South India. Materials and Methods: Data was collected by cross sectional door to door community survey carried out among 2203 households of DK district and 2158 households of Bellary district. The Institutional Ethics Committee had approved this study Result: Initiation of breast feeding within 2 hours was seen in 92.2% mothers in DK and 43.2% mothers in Bellary. Higher rates of prelacteal feeds (DK 16% Bellary 68.1 %) and delayed complementary feeding (DK 39.2 % Bellary 64.9%) was observed in Bellary. Home deliveries were negligible in DK but in Bellary almost half of the mothers had delivered at home .Fever was recognized as danger sign in majority, while awareness of all danger signs was seen in 44.4 % in DK and 14.8 % in Bellary. 28 % in Bellary had delayed health seeking. Conclusion: There is inter district variation child health promotional practices and health seeking and need due consideration by health policy makers.

Objective: This study analyzes the relationship between number of paid sick days and reported preventive health care service usage among older US workers. Methods: Using a 2014 cross-section of 3235 US workers age 49 to 57 from the National Longitudinal Survey of Youth, this study is the first to measure paid sick leave as an ordinal variable in an effort to refine our understanding of sick leave, and identify the ideal range of sick days necessary for people to access preventive health care services. Results: We find workers with 10 or more paid sick days have increased odds of reporting five different preventive health care services. Conclusion: To support worker and public health, policy planners may want to consider the number of paid sick days that are needed before changes in preventive service use are observed. [ABSTRACT FROM AUTHOR]

The current study explored factors associated with lesbian disclosure to health care providers (HCPs) and engagement in preventative health behaviors by replicating and extending a Canadian path analysis study with a sample of U.S. lesbians. Both patient (education, feminism, global outness, and internalized homophobia) and HCP-related (lesbian-friendly HCPs and patient comfort) factors were either directly or indirectly associated with disclosure and engagement in preventative health behaviors, including avoidance of health-compromising behaviors (e.g., smoking) and health care seeking. Importantly, findings suggest that HCPs—particularly those who are inclusive of lesbian patients—may play a role in assuaging their patients' experiences of minority stress. Overall, the findings were similar to those originally reported in the Canadian study, with the exception of internalized homophobia playing a more visible role in the current study. [ABSTRACT FROM AUTHOR]

This research was undertaken to explore experiences of xenophobia by refugees from the Democratic Republic of Congo (DRC) with the health care system in Durban, South Africa. The study adopted a qualitative methodology consisting of 31 in-depth interviews with refugees from the DRC. Framework analysis was conducted. The findings revealed that refugees face medical xenophobia during their encounter with health care workers with language barriers and documentation as the first stumbling block in efforts to seek health care services. The pervasiveness of xenophobia is also experienced in prejudice evident in ethnic slurs, unwelcome and insensitive comments and discriminatory practices, including denial of treatment, contributing to inequality in health care delivery. [ABSTRACT FROM AUTHOR]

Background: Eclampsia is one of the leading causes of maternal death worldwide. Maternal catastrophe is made worse in developing countries by the high incidence coupled with delayed presentation of patients and health facility constraints in effective management of eclampsia and its complications.Methods: A prospective study of all 93 eclamptic women admitted to a general hospital in Somali regional state, Ethiopia was conducted between May 1, 2014 and April 30, 2015 using a structured questionnaire which included socio-demographic data, antenatal visit status, distance of nearest maternal health facility, timing of convulsions, questions related to symptoms preceding seizures; health care seeking for the symptoms and time interval from prodromal symptoms to the diagnosis of eclampsia. Descriptive statistics and multivariable logistic regression analyses were conducted. Statistical tests were done at a level of significance of P < 0.05.Results: There were 93 cases of eclampsia among 3500 deliveries with an incidence of 2.7%. The timing of Eclampsia was antepartum in 57 (61.3%); intrapartum in 26 (28.0%) and postpartum in 10 (10.7%). Most (63%) were not having any antenatal care (ANC) follow up. Precedent symptoms were reported in 73 (79.0%) of the mothers with severe head ache in 70 (75.0%); visual disturbance in 44 (47%) and epigastric pain in 17 (18.0%). The frequency of symptoms was not influenced by the timing of eclampsia and degree of hypertension and prodromal symptoms were reported in 80% of the patients with severe hypertension. The mean duration of prodromal symptoms before patients were diagnosed with eclampsia was 5.5 days. Only 19/73 (26.0%) of the patients with prodromal symptoms visited a health facility for their complaints prior to developing eclampsia. The diagnosis of hypertensive disorder of pregnancy was made in 8 (42.0%) of these patients. Independent predictors of failure to seek health care in response to preceding symptoms were: rural residence (p-value < 0.001) and distance of maternal health facility of > 5km (p-value < 0.01).Conclusions: Precedent symptoms were reported in most women. But many patients present late in response to these warning signs of eclampsia. Improving awareness of prodromal symptoms of eclampsia and timely health care seeking; providing ANC advises on danger signs of eclampsia in the socio-cultural context of the community; ensuring access to ANC services for rural mothers, and administration of anticonvulsants for all women with prodromal symptoms are recommended. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal symptoms (GISs) are caused by a combination of biopsychosocial factors and are highly prevalent worldwide. Given their complex nature, coupled with ineffective communication of diagnoses by physicians, patients with intimate GISs often feel stigmatized. This, in turn, can inhibit their ability to express their thoughts and feelings adequately, leading them to over- or underreport their symptoms. Moreover, selective service-seeking for and reporting of GISs have a direct bearing on the stage of disease at presentation and, consequently, on the overall prognosis., Objective: This study aimed to investigate the usefulness of a web-based self-assessment of GISs as a supplementary means to cope with potential over- or underreporting during routine consultations., Methods: GIS data were collected using a novel web-based self-assessment tool (n=475) and from nonparticipative observation of doctor-patient consultations (n=447) and household surveys (n=10,552) in Anhui, China. Data analysis focused primarily on the description of the composition of respondents and the occurrence rates of GISs by sociodemographics, and by symptom solicitation methods and settings. Chi-square power tests were used when necessary to compare differences in the occurrence rates between relevant groups. The level of significance for the 2-sided test was set at α<.05., Results: The average occurrence rates of both upper and lower GISs derived from the web-based self-assessment were higher than those from the observation (upper GISs: n=661, 20.9% vs n=382, 14.2%; P<.001; lower GISs: n=342, 12.9% vs n=250, 10.8%; P=.02). The differences in 6 of the 9 upper GISs and 3 of the 11 lower GISs studied were tested with statistical significance (P<.05); moreover, a higher frequency rate was recorded for symptoms with statistical significance via self-assessment than via observation. For upper GISs, the self-assessed versus observed differences ranged from 17.1% for bloating to 100% for bad mood after a meal, while for lower GISs, the differences ranged from -50.5% for hematochezia or melena to 100% for uncontrollable stool. Stomachache, regurgitation, and dysphagia had higher occurrence rates among participants of the self-assessment group than those of the household survey group (20% vs 12.7%, 14% vs 11%, and 3% vs 2.3%, respectively), while the opposite was observed for constipation (5% vs 10.9%), hematochezia or melena (4% vs 5%), and anorexia (4% vs 5.2%). All differences noted in the self-assessed occurrence rates of specific, persistent GISs between sociodemographic groups were tested for nonsignificance (P>.05), while the occurrence rates of any of the 6 persistent GISs among respondents aged 51-60 years was statistically higher than that among other age groups (P=.03)., Conclusions: The web-based self-assessment tool piloted in this study is useful and acceptable for soliciting more comprehensive GISs, especially symptoms with concerns about stigmatization, privacy, and shame. Further studies are needed to integrate the web-based self-assessment with routine consultations and to evaluate its efficacy., (©Xiaoqin Guan, Qun Xue, Huan Ma, Guocheng Li, Xiuze Xu, Kexin Zhang, Mengsha Tang, Rong Liu, Debin Wang, Xingrong Shen. Originally published in JMIR Formative Research (https://formative.jmir.org), 30.08.2023.)

Background: The COVID-19 pandemic overburdened primary care clinicians. For nurse practitioners (NPs) to alleviate the burden, the public must be willing to see an NP over a physician. Those with poor health tended to continue seeking care during the pandemic, suggesting that they may be willing to see an NP., Objective: The aim of this study is to evaluate the public's willingness to see an NP for primary care and how this may be associated with their beliefs about the local supply of physicians and self-rated health. Two studies were conducted: (1) a survey to identify correlations and (2) an experiment to assess how willingness is dependent on information about the local supply of physicians., Methods: The survey and experiment were conducted digitally in April and December 2020, respectively. Participants were US adults recruited from Amazon's Mechanical Turk platform. The key independent variables were self-rated health, which was a dichotomized 5-point scale (excellent, very good, good vs fair, and poor), and beliefs about local physician supply. The survey measured beliefs about local physician supply, while the experiment manipulated beliefs by altering information the participants read about the local supply of physicians. Willingness to see an NP was assessed in 2 ways. First as an overall preference over a physician and the second as a preference given 2 clinically significant scenarios in which participants imagined they were experiencing either coughing or a headache (presentation order randomized). Multiple regressions and ANOVAs were used to assess how beliefs about the local physician supply and self-rated health were associated with overall willingness to see an NP. Bivariate probits simultaneously estimated willingness to see an NP in the 2 clinically significant scenarios., Results: The survey showed that concerns about physician supply were associated with lower willingness to see an NP among respondents with comparatively better health but a greater willingness among respondents with comparatively worse health. The experiment suggests that only the latter is causal. For the 2 clinically significant scenarios, these patterns appeared for the coughing scenario in the survey and the headache scenario in the experiment., Conclusions: US adults with comparatively worse self-rated health become more willing to see an NP for primary care when they hear information that raises their concerns about the local physician supply. The differences between the survey and experiment results may be useful for interpreting findings from future studies. Findings may aid in managing finite health care resources during public health crises and crafting successful messaging by NP advocacy groups. Efforts to address nursing shortages will also be needed., (©Celeste Campos-Castillo. Originally published in JMIR Formative Research (https://formative.jmir.org), 16.08.2023.)

Background: Regular utilization of maternal health care services reduces maternal morbidity and mortality. This study assessed the maternal health care seeking behavior and associated factors of reproductive age women in rural villages of Haramaya district, East Ethiopia. Methods: Community based cross sectional study supplemented with qualitative data was conducted in Haramaya district from November 15 to Decemeber 30, 2015. A total of 561 women in reproductive age group and who gave birth in the last 2 years were randomly included. Bivariate and multivariate logistic regressions model was used to identify the associated factors. Odds ratios with 95% CI were used to measure the strength of association. Result: Maternal health care service seeking of women was found as; antenatal care 74.3% (95% CI; 72.5, 76.14), attending institutional delivery 28.7% (95% CI; 26.8, 30.6) and postnatal care 22.6% (95% CI; 20.84, 24.36). Knowledge of pregnancy complications, Educational status, and religion of women were found to be significantly associated with antenatal health care, delivery and postnatal health care service seeking behaviours triangulated with individual, institutional and socio-cultural qualitative data. Conclusion: The maternal health care service seeking behavior of women in the study area was low. Educational status of the women, birth order and knowledge about pregnancy complications were the major factors associated with maternal health care service seeking behavior Focused health education with kind and supportive health care provider counseling will improve the maternal health care seeking behaviors of women. [ABSTRACT FROM AUTHOR]

In recent years an extensive social gradient in cancer outcome has attracted much attention, with late diagnosis proposed as one important reason for this. Whereas earlier research has investigated health care seeking among cancer patients, these social differences may be better understood by looking at health care seeking practices among people who are not diagnosed with cancer. Drawing on long-term ethnographic fieldwork among two different social classes in Denmark, our aim in this article is to explore the relevance of class to health care seeking practices and illness concerns. In the higher middle class, we predominantly encountered health care seeking resembling notions of health consumerism, practices sanctioned and encouraged by the health care system. However, among people in the lower working class, health care seeking was often shaped by the inseparability of physical, political, and social dimensions of discomfort, making these practices difficult for the health care system to accommodate. [ABSTRACT FROM AUTHOR]

Objectives Four antenatal visits, delivery in a health facility, and three postnatal visits are the World Health Organization recommendations for women to optimize maternal health outcomes. This study examines maternal compliance with the full recommended maternal health visits in rural Tanzania with the goal of illuminating interventions to reduce inequalities in maternal health. Methods Analysis included 907 women who had given birth within two years preceding a survey of women of reproductive age. Multinomial logistic regression was used to assess the influence of maternal, household, and community-level characteristics on four alternative classes defining relative compliance with optimal configuration of maternal health care seeking behavior. Results Parity, wealth index, timeliness of ANC initiation, nearest health facility type, religion, and district of residence were significant predictors of maternal health care seeking when adjusted for other factors. Multiparous women compared to primiparous were less likely to seek care at the high level [RRR 0.16, 95 % confidence interval (CI) 0.06-0.46], at the mid-level (RRR 0.22, 95 % CI 0.09-0.58), and the mid-low level (RRR 0.27, 95 % CI 0.09-0.80). Women in the highest wealth index compared to those in the poorest group were almost three times more likely to seek the highest two levels of care versus the lowest level (high RRR 2.92, 95 % CI 1.27-6.71, mid-level RRR 2.71, 95 % 1.31-5.62). Conclusion Results suggest that efforts to improve the overall impact of services on the continuum of care in rural Tanzania would derive particular benefit from strategies that improve maternal health coverage among multiparous and low socioeconomic status women. [ABSTRACT FROM AUTHOR]

Background: Low back and neck pain are commonly reported in the general population and represent frequent causes for health care consultations. The main aim of this study was to describe the determinants of health care contact during a 1-year period in a general population with recent onset spinal pain.Methods: From 9056 participants in a general health survey in Norway we identified 219 persons reporting a recent onset (<1 month) of low back or neck pain. Questionnaires were given at 1 (baseline), 2, 3, 6 and 12 months after pain debut. The main outcome was self-reported health care contact due to spinal pain. Associations between health care contact and pain-related factors, other somatic and mental health factors, pain-related work limitations, physical activity and sociodemographic factors were explored.Results: Conventional health care was sought by 93 persons (43 %) at least once throughout the year following the onset of pain. 18 persons (8 %) sought alternative health care only and 108 persons (49 %) sought no kind of health care. Baseline reports of coexisting low back and neck pain of equal intensity, poor self-reported health, symptoms of anxiety or depression, obesity and smoking were all associated with an increased tendency to seek conventional health care. Pain intensity and pain-related work limitations at each occasion were strongly associated with concurrent health care contact throughout the year. Higher education was associated with a reduced tendency to contact health care and no association was found for physical activity.Conclusion: The main finding in this study was that people from the general population who seek health-care for a new incident of neck or low back pain report more symptoms of mental distress, poorer self-reported health and more intense pain with stronger work limitations compared to those who do not. The findings suggest that identification of complementary symptoms is highly relevant in the examination of spinal pain patients, even for those with recent onset of symptoms. [ABSTRACT FROM AUTHOR]

Background: Inter district variations in health parameters can be conducive for policy making with regards to child health status and healthcare utilization. Aims and Objectives: We carried out this study to understand district-wide variations in child health promotion practices in well performing Dakshina Kannada (DK) and poorly performing Bellary districts of Karnataka state of South India. Materials and Methods: Data was collected by cross sectional door to door community survey carried out among 2203 households of DK district and 2158 households of Bellary district. The Institutional Ethics Committee had approved this study. Result: Initiation of breast feeding within 2 hours was seen in 92.2% mothers in DK and 43.2% mothers in Bellary. Higher rates of prelacteal feeds (DK 16% Bellary 68.1 %) and delayed complementary feeding (DK 39.2 % Bellary 64.9%) was observed in Bellary. Home deliveries were negligible in DK but in Bellary almost half of the mothers had delivered at home. Fever was recognized as danger sign in majority, while awareness of all danger signs was seen in 44.4 % in DK and 14.8 % in Bellary. 28 % in Bellary had delayed health seeking. Conclusion: There is inter district variation child health promotional practices and health seeking and need due consideration by health policy makers. [ABSTRACT FROM AUTHOR]

This study was carried out to understand the role social determinants and health seeking behavior among rice farming and pastoral communities in Kilosa District in central Tanzania. The study involved four villages; two with rice farming communities while the other two with pastoral communities. In each village, heads of households or their spouses were interviewed to seek information on livelihoods activities, knowledge and practices on malaria and its preventions. A total of 471 individuals (males = 38.9%; females = 61.1%) were interviewed. Only 23.5% of the respondents had adequate knowledge on malaria. Fifty-six percent of the respondents could not associate any livelihood activity with malaria transmission. Majority (79%) of the respondents believed that most of fevers were due to malaria; this was higher among the pastoral (81.7%) than rice farming communities (76.1%) ( p = 0.038). Cases of fever were significantly higher in households with non-educated (31.2%) than educated respondents (21.5%). Women experienced significantly more episodes of fever than men ( p < 0.001). Of the total of 2606 individuals living in the households, 26.9% were reported to have had fever in the previous three months. Fever was reported more frequently among pastoral than rice farming communities ( p < 0.01). Of those who had fever, 36.6% were clinically diagnosed with malaria and 22.9% were confirmed to be infected with malaria. A combination of fever + convulsions or joint pains + headache was most frequently perceived to be malaria. Treatment seeking frequency differed by the size of the household and between rice farming and pastoral communities ( p = 0.05). In conclusion, education, sex, availability of health care facility and livelihood practices were the major social determinants that influence malaria acquisition and care seeking pattern in central Tanzania. Appropriate public health promotion should be designed to address the links of livelihoods and malaria transmission among rural farming communities in an ecohealth approach. [ABSTRACT FROM AUTHOR]

Background: Long-lasting insecticidal nets (LLIN), indoor residual spraying (IRS) and malaria case treatment with artemisinin-based combination therapy (ACT) have been proven to significantly reduce malaria, but may not necessarily lead to malaria elimination. This study explored factors hindering the acceptability and use of available malaria preventive measures to better inform area specific strategies that can lead to malaria elimination. Methods: Nine focus group discussions (FGD) covering a cross-section of 81 lay community members and local leaders were conducted in Ruhuha, Southern Eastern Rwanda in December 2013 to determine: community perceptions on malaria disease, acceptability of LLIN and IRS, health care-seeking behaviours and other malaria elimination strategies deployed at household and environmental levels. Discussions were recorded in Kinyarwanda, transcribed into English and coded using Nvivo 10 software. Results: Participants ranked malaria as the top among five common diseases in the Ruhuha sector. Participants expressed comprehensive knowledge and understanding of malaria transmission and symptoms. The concept of malaria elimination was acknowledged, but challenges were reported. Sleeping under a bed net was negatively affected by increase of bedbugs (and the associated irritability) as well as discomfortable warmness particularly during the dry season. These two factors were reported as common hindrances of the use of LLIN. Also, widespread use of LLIN in constructing chicken pens or as fences around vegetable gardens was reported. Participants also reported that IRS appeared to lead to an increase in number of mosquitoes and other household bugs rather than kill them. Prompt health centre utilization among participants with presumed malaria was reported to be common particularly among subscribers to the subsidized community-based health insurance (CBHI) scheme. In contrast, the lack of CBHI and/or perceptions that health centre visits were time consuming were common reasons for the use of over-the-counter medicines for malaria management. Conclusion: In this study, identification of behavioural determinants in relation to LLIN use, IRS acceptability and health care seeking is a critical step in the development of effective, targeted interventions aiming to further reduce malaria transmission and elimination in the area. [ABSTRACT FROM AUTHOR]