Search

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. Electronic supplementary material The online version of this article (10.1007/s10865-020-00147-0) contains supplementary material, which is available to authorized users.

BackgroundFemale 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.MethodsWe 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.ResultsBarriers 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.ConclusionStructural, 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.

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.

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 aim of this study was to estimate the prevalence and incidence of hypertension in women, and describe their self-care and health-seeking behaviours. This research was conducted as part of the Australian Longitudinal Study on Women's Health, a study comprising a nationally representative sample of Australian women in three age groups. The focus of this research is 14 099 women born in 1946-1951, who have been surveyed six times (1996-2010). Student t-tests were used to compare women who did or did not have hypertension by their health-care utilization. Longitudinal analyses were conducted using a Poisson generalized estimating equation model. The incidence of hypertension among this cohort during 1996 to 2010 ranged from 400 to 597 participants per survey, resulting in an increase in prevalence of hypertension from 20.9% in 1996 to 41.3% in 2010. For all survey periods, women with hypertension had a significantly higher average number of visits to doctors and allied health practitioners compared with women without hypertension (P0.005). The use of complementary medicine (practitioners and self-prescribed treatments) by women with hypertension was significantly lower compared to women without hypertension (P0.005). Over time, conventional health-care utilization was higher for women with hypertension compared with women without hypertension (adjusted RR=1.18; 95% CI: 1.14, 1.22; P0.0001). Our findings show that women with hypertension are using a range of conventional and complementary and alternative medicine: with hypertensive women using more conventional medicine and less complementary and alternative medicine than non-hypertensive women. As such, health-care providers should communicate with their patients regarding their use of complementary and alternative medicine in their efforts to provide safe, effective and coordinate care.

Background The first month of life is the period with the highest risk of dying. Despite knowledge of effective interventions, newborn mortality is high and utilization of health care services remains low in Ethiopia. In settings without universal health coverage, the economy of a household is vulnerable to illness, and out-of-pocket payments may limit families’ opportunities to seek health care for newborns. In this paper we explore intra-household resource allocation, focusing on how families prioritize newborn health versus other household needs and their coping strategies for managing these priorities. Methods A qualitative study was conducted in 2015 in Butajira, Ethiopia, comprising observation, semi-structured interviews, and focus group discussions with household members, health workers, and community members. Household members with hospitalized newborns or who had experienced neonatal death were primary informants. Results In this predominantly rural and poor district, households struggled to pay out-of-pocket for services such as admission, diagnostics, drugs, and transportation. When newborns fell ill, families made hard choices balancing concerns for newborn health and other household needs. The ability to seek care, obtain services, and follow medical advice depended on the social and economic assets of the household. It was common to borrow money from friends and family, or even to sell a sheep or the harvest, if necessary. In managing household priorities and high costs, families waited before seeking health care, or used cheaper traditional medicines. For poor families with no money or opportunity to borrow, it became impossible to follow medical advice or even seek care in the first place. This had fatal health consequences for the sick newborns. Conclusions While improving neonatal health is prioritized at policy level in Ethiopia, poor households with sick neonates may prioritize differently. With limited money at hand and high direct health care costs, families balanced conflicting concerns to newborn health and family welfare. We argue that families should not be left in situations where they have to choose between survival of the newborn and economic ruin. Protection against out-of-pocket spending is key as Ethiopia moves towards universal health coverage. A necessary step is to provide prioritized newborn health care services free of charge. Electronic supplementary material The online version of this article (10.1186/s12913-018-2943-y) contains supplementary material, which is available to authorized users.

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 5km (p-value

To evaluate the prevalence of nocturia/nocturnal voiding frequency and its impact on overall physical and mental health status in German community-dwelling men and determine which lower urinary tract symptom (LUTS) is responsible for medical consultations in the 2-year follow-up period.A sample of German men aged 50-80 years from a community-dwelling study was chosen for re-evaluation 2 years after initial assessment. Men were clinically investigated and completed the International Prostate Symptom Score, American Urology Association-Symptom Problem Index (AUA-SPI), and the Short-Form Health Survey (SF-12).In total, 1,562 men were eligible for analysis. Mean nocturnal voiding frequency was 2.3 for all men and increased with ageing. SF-12 data indicated that physical but not mental health status was lower than in the average population. LUTS severity reduced both physical and mental health status (p0.001). Clinically relevant nocturia (≥ 2 voids/night) was present in 43 % of men and reduced both physical and mental health status (p0.001), whereas both HRQoL scales were not significantly reduced in men without or only one nocturnal void. In multivariate regression analysis using patient-reported bother (AUA-SPI) from LUTS, only bother from nocturnal voiding was significantly associated with medical consultations in the investigated 2-year follow-up period (odds ratio 2.6; 95 % confidence interval 1.6-4.2; p0.001).Our study confirmed that nocturnal voiding is highly prevalent in community-dwelling men and reduce both physical and mental health status. Bother from nocturnal voiding is the most relevant component of LUTS responsible for medical consultations in German men.

The objective of the study was to estimate prevalence of urinary incontinence (UI) health care utilization in women from the population up to specialty care.The General Longitudinal Overactive Bladder Evaluation-UI (GLOBE-UI) is a population-based study on the natural history of UI in women ≥ 40 years of age. Prevalence of UI was estimated by using the Bladder Health Survey (BHS). Survey data were linked with electronic health records to build the different steps of the iceberg of disease. Descriptive statistics were used to estimate the prevalence estimates at all levels of the iceberg.A total sample of 7,059 women received the BHS. Of those, 3,316 (47 %) responded. Prevalence of UI was 1,366 (41 %). Women with or without UI did not differ by age or marital status. However, women with versus without UI were more parous (91 vs 87 %), significantly more overweight or obese (74 vs 61 %), and more likely to have a college education or higher (54 vs 46 %), P0.01. Nine hundred fifty-eight (73 %) women with UI reported duration of more than 2 years and 72 % reported moderate to severe UI symptoms. Of all 1,366 women with BHS UI diagnosis, only 339 (25 %) sought care, 313 (23 %) received some care, and 164 (12 %) received subspecialty care.UI is a highly prevalent disease. Only a minority with UI appears to seek care and a fraction sees a pelvic floor specialist. It is important not only to educate women, but also primary care providers about this highly prevalent yet treatable condition.

To know mothers' knowledge and explore their perceptions about newborn danger signs and health care seeking behaviors.A cross-sectional study was undertaken in three of the 27 primary health centres of Wardha district with a population of 88187. Out of 1675 expected mothers, 1160 mothers in the area were interviewed by house-to-house visits. Data was entered and analyzed in SPSS 12.0.1. In order to explore mothers' perception of danger signs and actions taken, a triangulation of formative research methods like chapatti diagram and Focus Group Discussion (FGD) was undertaken. The analysis of free list and pile sort data obtained was undertaken using Anthropac 4.98.1/X software.About 67.2 % mothers knew at least one newborn danger sign. Majority of mothers (87.4%) responded that the sick child should be immediately taken to the doctor but only 41.8% of such sick newborns got treatment either from government hospital (21.8%) or from private hospital (20%) and 46.1% of sick babies received no treatment. As told by mothers, the reasons for not taking actions even in presence of danger signs/symptoms were ignorance of parents, lack of money, faith in supernatural causes, non availability of transport, home remedy, non availability of doctor and absence of responsible person at home. For almost all the danger signs/symptoms supernatural causes were suspected and remedy was sought from traditional faith healer (vaidu) followed by doctor of primary health centre and private doctor.The present study found gap between mothers' knowledge and their health seeking behavior for sick newborn and explored their deep perceptions, constraints and various traditional treatments. Comprehensive intervention strategies are required to change behavior of caregivers along with improvement in capacity of Government health care services and National Health Programs to ensure newborn survival in rural area.

In a population-based study of 207 subjects with irritable bowel syndrome (IBS) or functional dyspepsia (FD) and controls (n = 100), we aimed to determine whether dimensions of abnormal illness behavior from the Abnormal Illness Behaviour Questionnaire and aspects of social learning of illness behavior from the Social Learning of Illness Behaviour scale were independent predictors of health care seeking for IBS and FD. Results showed that dimensions of abnormal illness behavior and aspects of social learning of illness behavior (encouragement, reinforcement, and modeling) did not significantly differentiate between consulters and nonconsulters with IBS and/or FD. The Disease Conviction scale (OR = 1.55; 95% CI, 1.15-2.09) of the Abnormal Illness Behaviour Questionnaire was an independent predictor of having a diagnosis of IBS and/or FD, independent of age and gender, psychiatric diagnoses, and symptom severity. We conclude that a belief in the presence of serious pathology characterizes community subjects with IBS and FD, but not health care seeking.

To find out awareness of mothers about newborn danger signs and their health care seeking behavior for sick newborns in the peri urban field practice area of Urban Health Centre in Wardha.Triangulated study of quantitative (survey) and qualitative (mapping, pair-wise ranking exercise) methods were undertaken. 72 identified mothers of children (0-11 months) in social mapping exercise were interviewed by trained social workers using pre-designed and pre-tested questionnaire and by paying house to house visits. The structured questionnaire covered information on newborn danger signs, health care seeking and socio-demographic information. The data was analyzed by using Epi_info software package. A pair-wise ranking exercise for assessment of preferred health care facility for sick newborn was undertaken with the group of purposively selected mothers.Out of 72 mothers, 29 (40.3%), 16 (22.2%) and 10 (13.9%) identified difficulty in breathing, poor sucking and lethargy/unconsciousness as newborn danger signs respectively. Only 7(9.7%) and 2 (2.8%) identified convulsion and hypothermia as newborn danger signs respectively. About 27 (37.5%) babies were sick during newborn period. About 11(15.3%) and 8 (11.1%) were reported to have poor sucking and difficulty in breathing respectively. All sick newborns with danger signs were taken to the doctor and only two mothers consulted faith healer for treatment.Considering the poor awareness of mothers regarding newborn danger signs, there is need for raising awareness building which required for early recognition and prompt treatment. Apart from strengthening government health facilities, the capacity of intermediate non government health care providers should be developed for newborn care.

The factors that drive subjects with dyspepsiain the community to seek medical care are uncertain. Weaimed to identify whether psychological factors explainhealth care utilization among subjects with dyspepsia. A sample of residents of westernSydney selected randomly from the electoral rolls wasmailed a validated self-report questionnaire. Dyspepsiawas defined as pain or discomfort centered in the upper abdomen. Potential predictors ofphysician visits tested included gastrointestinalsymptoms, neuroticism (by the Eysenck PersonalityQuestionnaire), psychological morbidity (General HealthQuestionnaire), and sexual, physical, and emotional abuse(based on standardized criteria). Among 730 subjects,13% (95% CI 10.3-15.2%) had dyspepsia and 70% (95% CI59.8-79.5%) had sought medical care. Subjects with dyspepsia had significantly higher neuroticismand psychological morbidity scores and reportedchildhood emotional abuse more often than those withoutdyspepsia (all P < 0.05), but none of these wereindependent predictors. Male gender (OR = 0.58, 95% CI0.37- 0.91), greater pain severity (OR = 2.49, 95% CI2.12-2.91, P < 0.01), and meeting the Rome criteriafor irritable bowel (OR = 2.0, 95% CI 1.06-3.78) wereassociated with dyspepsia subjects seeing a physician oralternative therapist for abdominal pain or discomfort,explaining 32% of the deviance. Pain severity (OR =1.39, 95% CI 1.22-1.58) and symptoms of five or more years duration (OR = 5.73, 95% CI 3.71-8.87)were predictive of dyspepsia subjects ever seeking carefor abdominal pain or discomfort, explaining 15% of thedeviance. Psychological factors were not significant predictors of seeking medical attention indyspepsia. Health care seeking among community subjectswith dyspepsia is explained in part by symptom severityand duration but not by neuroticism, psychological morbidity, or a history of abuse.

Background: Asymptomatic screening and timely presentation to care for symptoms are fundamental to reducing the prevalence of sexually transmitted diseases (STDs) in adolescents. The objective of this study was to clarify provider and clinic characteristics that adolescents consider important to their decisions to seek care for STDs.

This study replicated Kleinman's research on family-based popular health care in Taiwan among the Puyallup Indians of Washington. Standardized interviews were conducted among 80 Puyallup families to determine family health practices and beliefs, and the patterns of referral to professional practitioners. Comparisons are made between the Puyallup and Taiwanese family health care practices and health care seeking processes. The author concludes that the relative absence of folk medicine and the availability of free medical care among the Puyallup are the most important factors causing the variance between the rates of family treatment and the patterns of health care seeking behaviors between the Puyallup and the Taiwanese.