Using Qualitative Methods to Explore Lay Explanatory Models, Health-Seeking Behaviours and Self-Care Practices of Podoconiosis Patients in North-West Ethiopia
Identifieur interne : 004292 ( Pmc/Curation ); précédent : 004291; suivant : 004293Using Qualitative Methods to Explore Lay Explanatory Models, Health-Seeking Behaviours and Self-Care Practices of Podoconiosis Patients in North-West Ethiopia
Auteurs : Harrison S. Banks [Royaume-Uni] ; Girmay Tsegay [Éthiopie] ; Moges Wubie [Éthiopie] ; Abreham Tamiru [Éthiopie] ; Gail Davey [Royaume-Uni] ; Max Cooper [Royaume-Uni]Source :
- PLoS Neglected Tropical Diseases [ 1935-2727 ] ; 2016.
Abstract
Podoconiosis (endemic non-filarial elephantiasis) is a chronic, non-infectious disease resulting from exposure of bare feet to red-clay soil in tropical highlands. This study examined lay beliefs about three under-researched aspects of podoconiosis patients’ care: explanatory models, health-seeking behaviours and self-care.
In-depth interviews and focus group discussions were undertaken with 34 participants (19 male, 15 female) between April-May 2015 at podoconiosis treatment centres across East and West Gojjam regions in north-west Ethiopia.
Explanatory models for podoconiosis included contamination from blood, magic, soil or affected individuals. Belief in heredity or divine punishment often delayed clinic attendance. All participants had tried holy water treatment and some, holy soil. Herbal treatments were considered ineffectual, costly and appeared to promote fluid escape. Motivators for clinic attendance were failure of traditional treatments and severe or disabling symptoms. Patients did not report self-treatment with antibiotics. Self-care was hindered by water being unavailable or expensive and patient fatigue.
A pluralistic approach to podoconiosis self-treatment was discovered. Holy water is widely valued, though some patients prefer holy soil. Priests and traditional healers could help promote self-care and “signpost” patients to clinics. Change in behaviour and improving water access is key to self-care.
Url:
DOI: 10.1371/journal.pntd.0004878
PubMed: 27536772
PubMed Central: 4990189
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Banks</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Brighton and Sussex Medical School, Brighton, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Brighton and Sussex Medical School, Brighton</wicri:regionArea></affiliation></author><author><name sortKey="Tsegay, Girmay" sort="Tsegay, Girmay" uniqKey="Tsegay G" first="Girmay" last="Tsegay">Girmay Tsegay</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Debre Markos University, Debre Markos, Ethiopia</addr-line></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea>Debre Markos University, Debre Markos</wicri:regionArea></affiliation></author><author><name sortKey="Wubie, Moges" sort="Wubie, Moges" uniqKey="Wubie M" first="Moges" last="Wubie">Moges Wubie</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Debre Markos University, Debre Markos, Ethiopia</addr-line></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea>Debre Markos University, Debre Markos</wicri:regionArea></affiliation></author><author><name sortKey="Tamiru, Abreham" sort="Tamiru, Abreham" uniqKey="Tamiru A" first="Abreham" last="Tamiru">Abreham Tamiru</name><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>IOCC Podoconiosis Project, Debre Markos, Ethiopia</addr-line></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea>IOCC Podoconiosis Project, Debre Markos</wicri:regionArea></affiliation></author><author><name sortKey="Davey, Gail" sort="Davey, Gail" uniqKey="Davey G" first="Gail" last="Davey">Gail Davey</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Brighton and Sussex Medical School, Brighton, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Brighton and Sussex Medical School, Brighton</wicri:regionArea></affiliation></author><author><name sortKey="Cooper, Max" sort="Cooper, Max" uniqKey="Cooper M" first="Max" last="Cooper">Max Cooper</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Brighton and Sussex Medical School, Brighton, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Brighton and Sussex Medical School, Brighton</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27536772</idno><idno type="pmc">4990189</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4990189</idno><idno type="RBID">PMC:4990189</idno><idno type="doi">10.1371/journal.pntd.0004878</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">004293</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">004293</idno><idno type="wicri:Area/Pmc/Curation">004292</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">004292</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Using Qualitative Methods to Explore Lay Explanatory Models, Health-Seeking Behaviours and Self-Care Practices of Podoconiosis Patients in North-West Ethiopia</title><author><name sortKey="Banks, Harrison S" sort="Banks, Harrison S" uniqKey="Banks H" first="Harrison S." last="Banks">Harrison S. Banks</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Brighton and Sussex Medical School, Brighton, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Brighton and Sussex Medical School, Brighton</wicri:regionArea></affiliation></author><author><name sortKey="Tsegay, Girmay" sort="Tsegay, Girmay" uniqKey="Tsegay G" first="Girmay" last="Tsegay">Girmay Tsegay</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Debre Markos University, Debre Markos, Ethiopia</addr-line></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea>Debre Markos University, Debre Markos</wicri:regionArea></affiliation></author><author><name sortKey="Wubie, Moges" sort="Wubie, Moges" uniqKey="Wubie M" first="Moges" last="Wubie">Moges Wubie</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Debre Markos University, Debre Markos, Ethiopia</addr-line></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea>Debre Markos University, Debre Markos</wicri:regionArea></affiliation></author><author><name sortKey="Tamiru, Abreham" sort="Tamiru, Abreham" uniqKey="Tamiru A" first="Abreham" last="Tamiru">Abreham Tamiru</name><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>IOCC Podoconiosis Project, Debre Markos, Ethiopia</addr-line></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea>IOCC Podoconiosis Project, Debre Markos</wicri:regionArea></affiliation></author><author><name sortKey="Davey, Gail" sort="Davey, Gail" uniqKey="Davey G" first="Gail" last="Davey">Gail Davey</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Brighton and Sussex Medical School, Brighton, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Brighton and Sussex Medical School, Brighton</wicri:regionArea></affiliation></author><author><name sortKey="Cooper, Max" sort="Cooper, Max" uniqKey="Cooper M" first="Max" last="Cooper">Max Cooper</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Brighton and Sussex Medical School, Brighton, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Brighton and Sussex Medical School, Brighton</wicri:regionArea></affiliation></author></analytic><series><title level="j">PLoS Neglected Tropical Diseases</title><idno type="ISSN">1935-2727</idno><idno type="eISSN">1935-2735</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Background</title><p>Podoconiosis (endemic non-filarial elephantiasis) is a chronic, non-infectious disease resulting from exposure of bare feet to red-clay soil in tropical highlands. This study examined lay beliefs about three under-researched aspects of podoconiosis patients’ care: explanatory models, health-seeking behaviours and self-care.</p></sec><sec id="sec002"><title>Methods</title><p>In-depth interviews and focus group discussions were undertaken with 34 participants (19 male, 15 female) between April-May 2015 at podoconiosis treatment centres across East and West Gojjam regions in north-west Ethiopia.</p></sec><sec id="sec003"><title>Results</title><p>Explanatory models for podoconiosis included contamination from blood, magic, soil or affected individuals. Belief in heredity or divine punishment often delayed clinic attendance. All participants had tried holy water treatment and some, holy soil. Herbal treatments were considered ineffectual, costly and appeared to promote fluid escape. Motivators for clinic attendance were failure of traditional treatments and severe or disabling symptoms. Patients did not report self-treatment with antibiotics. Self-care was hindered by water being unavailable or expensive and patient fatigue.</p></sec><sec id="sec004"><title>Conclusion</title><p>A pluralistic approach to podoconiosis self-treatment was discovered. Holy water is widely valued, though some patients prefer holy soil. Priests and traditional healers could help promote self-care and “signpost” patients to clinics. Change in behaviour and improving water access is key to self-care.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Davey, G" uniqKey="Davey G">G Davey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Molla, Yb" uniqKey="Molla Y">YB Molla</name></author><author><name sortKey="Wardrop, Na" uniqKey="Wardrop N">NA Wardrop</name></author><author><name sortKey="Le Blond, Js" uniqKey="Le Blond J">JS Le Blond</name></author><author><name sortKey="Baxter, P" uniqKey="Baxter P">P Baxter</name></author><author><name sortKey="Newport, M" uniqKey="Newport M">M Newport</name></author><author><name sortKey="Atkinson, P" uniqKey="Atkinson P">P Atkinson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Davey, G" uniqKey="Davey G">G Davey</name></author><author><name sortKey="Gebrehanna, E" uniqKey="Gebrehanna E">E GebreHanna</name></author><author><name sortKey="Adebowale, 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS Negl Trop Dis</journal-id><journal-id journal-id-type="iso-abbrev">PLoS Negl Trop Dis</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosntds</journal-id><journal-title-group><journal-title>PLoS Neglected Tropical Diseases</journal-title></journal-title-group><issn pub-type="ppub">1935-2727</issn><issn pub-type="epub">1935-2735</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, CA USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27536772</article-id><article-id pub-id-type="pmc">4990189</article-id><article-id pub-id-type="doi">10.1371/journal.pntd.0004878</article-id><article-id pub-id-type="publisher-id">PNTD-D-16-00430</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Parasitic Diseases</subject><subj-group><subject>Elephantiasis</subject><subj-group><subject>Podoconiosis</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Tropical Diseases</subject><subj-group><subject>Neglected Tropical Diseases</subject><subj-group><subject>Podoconiosis</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Public and Occupational Health</subject><subj-group><subject>Behavioral and Social Aspects of Health</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Musculoskeletal System</subject><subj-group><subject>Limbs (Anatomy)</subject><subj-group><subject>Legs</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Musculoskeletal System</subject><subj-group><subject>Limbs (Anatomy)</subject><subj-group><subject>Legs</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Health Care</subject><subj-group><subject>Patients</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Behavior</subject></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Agriculture</subject><subj-group><subject>Farms</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Health Care</subject><subj-group><subject>Health Services Research</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Organisms</subject><subj-group><subject>Plants</subject><subj-group><subject>Herbs</subject></subj-group></subj-group></subj-group></subj-group></article-categories><title-group><article-title>Using Qualitative Methods to Explore Lay Explanatory Models, Health-Seeking Behaviours and Self-Care Practices of Podoconiosis Patients in North-West Ethiopia</article-title><alt-title alt-title-type="running-head">Lay Explanatory Models, Health-Seeking Behaviours and Self-Care Practices of Podoconiosis Patients</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Banks</surname><given-names>Harrison S.</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="corresp" rid="cor001">*</xref></contrib><contrib contrib-type="author"><name><surname>Tsegay</surname><given-names>Girmay</given-names></name><xref ref-type="aff" rid="aff002"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Wubie</surname><given-names>Moges</given-names></name><xref ref-type="aff" rid="aff002"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Tamiru</surname><given-names>Abreham</given-names></name><xref ref-type="aff" rid="aff003"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Davey</surname><given-names>Gail</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Cooper</surname><given-names>Max</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib></contrib-group><aff id="aff001"><label>1</label><addr-line>Brighton and Sussex Medical School, Brighton, United Kingdom</addr-line></aff><aff id="aff002"><label>2</label><addr-line>Debre Markos University, Debre Markos, Ethiopia</addr-line></aff><aff id="aff003"><label>3</label><addr-line>IOCC Podoconiosis Project, Debre Markos, Ethiopia</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Mackenzie</surname><given-names>Charles D.</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>Michigan State University, UNITED STATES</addr-line></aff><author-notes><fn fn-type="conflict" id="coi001"><p>The authors have declared that no competing interests exist.</p></fn><fn fn-type="con" id="contrib001"><p>Conceived and designed the experiments: HSB GT GD MC. Performed the experiments: HSB GT MW AT. Analyzed the data: HSB GT MC. Wrote the paper: HSB GD MC. Designed study protocol: HSB GT MW AT GD MC. Ran study logistics: AT. Read and approved of final manuscript: HSB GT MW AT GD MC.</p></fn><corresp id="cor001">* E-mail: <email>H.Banks1@uni.bsms.ac.uk</email></corresp></author-notes><pub-date pub-type="epub"><day>18</day><month>8</month><year>2016</year></pub-date><pub-date pub-type="collection"><month>8</month><year>2016</year></pub-date><volume>10</volume><issue>8</issue><elocation-id>e0004878</elocation-id><history><date date-type="received"><day>11</day><month>3</month><year>2016</year></date><date date-type="accepted"><day>5</day><month>7</month><year>2016</year></date></history><permissions><copyright-statement>© 2016 Banks et al</copyright-statement><copyright-year>2016</copyright-year><copyright-holder>Banks et al</copyright-holder><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><self-uri content-type="pdf" xlink:href="pntd.0004878.pdf"></self-uri><abstract><sec id="sec001"><title>Background</title><p>Podoconiosis (endemic non-filarial elephantiasis) is a chronic, non-infectious disease resulting from exposure of bare feet to red-clay soil in tropical highlands. This study examined lay beliefs about three under-researched aspects of podoconiosis patients’ care: explanatory models, health-seeking behaviours and self-care.</p></sec><sec id="sec002"><title>Methods</title><p>In-depth interviews and focus group discussions were undertaken with 34 participants (19 male, 15 female) between April-May 2015 at podoconiosis treatment centres across East and West Gojjam regions in north-west Ethiopia.</p></sec><sec id="sec003"><title>Results</title><p>Explanatory models for podoconiosis included contamination from blood, magic, soil or affected individuals. Belief in heredity or divine punishment often delayed clinic attendance. All participants had tried holy water treatment and some, holy soil. Herbal treatments were considered ineffectual, costly and appeared to promote fluid escape. Motivators for clinic attendance were failure of traditional treatments and severe or disabling symptoms. Patients did not report self-treatment with antibiotics. Self-care was hindered by water being unavailable or expensive and patient fatigue.</p></sec><sec id="sec004"><title>Conclusion</title><p>A pluralistic approach to podoconiosis self-treatment was discovered. Holy water is widely valued, though some patients prefer holy soil. Priests and traditional healers could help promote self-care and “signpost” patients to clinics. Change in behaviour and improving water access is key to self-care.</p></sec></abstract><abstract abstract-type="summary"><title>Author Summary</title><p>Podoconiosis is a disease that is caused by long-term exposure to red clay soil found in tropical highland areas. This causes swelling of the legs, episodes of intense pain and severe disability. Sufferers of the condition experience stigma and exclusion from the community. Previous work has demonstrated a low rate of re-attendance to clinics and that many patients fail to adhere to their treatment regime of improving foot hygiene. The present study explored areas of health-seeking behaviour and self-care practices to discover the reason behind these failures. It was found that explanatory models of disease causation had a significant impact on decisions to seek healthcare and that participants only turned to Western medical clinics after failure of traditional treatments and with particularly severe symptoms. We identified several form of traditional treatment for the disease, and these tended to be based on cleansing, fluid extraction or faith/symbolism. The most important barrier to self-care and adhering to treatment regimens was an inability to collect adequate water. We call for greater integration with traditional healers, improved access to water through collaboration with other NGOs and the government and the use of expert patients to disseminate information and signpost patients to clinics.</p></abstract><funding-group><funding-statement>This work was supported by <ext-link ext-link-type="uri" xlink:href="http://theassociationofphysicians.org.uk/index.php/links-with-developing-countries">http://theassociationofphysicians.org.uk/index.php/links-with-developing-countries</ext-link>. Melanie Newport and Leena Al-Hassan are colleagues of GD working in the same department (Global Health at Brighton and Sussex Medical School). All funding awarded to the department is shared amongst researchers. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</funding-statement></funding-group><counts><fig-count count="1"></fig-count><table-count count="1"></table-count><page-count count="11"></page-count></counts><custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name><meta-value>Data cannot be made publicly available as it may compromise participant privacy. Anonymised data are available from Debbie Miller (<email>d.miller@bsms.ac.uk</email>), Administrator of the Global Health and Infection Department and Brighton and Sussex Medical School.</meta-value></custom-meta></custom-meta-group></article-meta><notes><title>Data Availability</title><p>Data cannot be made publicly available as it may compromise participant privacy. Anonymised data are available from Debbie Miller (<email>d.miller@bsms.ac.uk</email>), Administrator of the Global Health and Infection Department and Brighton and Sussex Medical School.</p></notes></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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