The Rural Household Production of Health Approach: Applying Lessons from Zambia to Rural Cancer Disparities in the U.S.

The recent focus on rural–urban cancer disparities in the United States (U.S.) requires a comprehensive understanding of the processes and relations that influence cancer care seeking and decision making. This is of particular importance for Black, Latino, and Native populations living in rural areas in the U.S., who remain marginalized in health care spaces. In this article, we describe the household production of health approach (HHPH) as a contextually-sensitive approach to examining health care seeking and treatment decisions and actions. The HHPH approach is based on several decades of research and grounded in anthropological theory on the household, gender, and therapy management. This approach directs analytical attention to how time, money, and social resources are secured and allocated within the household, sometimes in highly unequal ways that reflect and refract broader social structures. To demonstrate the benefits of such an approach to the study of cancer in rural populations in the U.S., we take lessons from our extensive HHPH research in Zambia. Using a case study of a rural household, in which household members had to seek care in a distant urban hospital, we map out what we call a rural HHPH approach to bring into focus the relations, negotiations, and interactions that are central to individual and familial health care seeking behaviors and clinical treatment particular to rural regions. Our aim is to show how such an approach might offer alternative interpretations of existing rural cancer research in the U.S. and also present new avenues for questions and for developing interventions that are more sensitive to people’s realities.

The impact of current smoking, regular drinking, and physical inactivity on health care-seeking behavior in China

Background People with lifestyle behaviors, such as current smoking, regular drinking, and physical inactivity, may experience a lack of or delayed health care, leading to severe sickness and higher health care expenditures in the future. Hence, the current study aims to ascertain the effects of current smoking, regular drinking, and physical inactivity on health care-seeking behavior among adults who report physical discomfort in China. Methods The data used in this study were obtained from the China Family Panel Studies (CFPS). The final sample consisted of 44,362 individuals who participated in all five waves of data collection. Logistic regression models were used for the analysis. Results The results of fixed effects logistic regression showed that among those who reported physical discomfort, adults who currently smoked cigarettes were 0.65 times less likely to seek health care than those who formerly smoked. Compared to nondrinkers, adults who regularly drank alcohol had a decreased likelihood of seeking health care. Adults who never engaged in physical exercise had 24% lower odds of seeking health care than those who engaged in physical exercise. Conclusions Current smoking, regular drinking, and physical inactivity decreased the probability of seeking health care among adults who reported physical discomfort. Therefore, screening and brief advice programs should be delivered by primary-level care and should pay more attention to individuals who engage in lifestyle behaviors such as current smoking, regular drinking, and physical inactivity, thus avoiding missed opportunities to treat chronic conditions and detect new diseases early.

Health care seeking behaviour for children with acute childhood illnesses and its relating factors in sub-Saharan Africa: evidence from 24 countries

Background Childhood illnesses and mortality rates have declined over the past years in sub-Saharan African countries; however, under-five mortality is still high in the region. This study investigated the magnitude and factors associated with health care seeking behaviour for children with childhood illnesses in 24 sub-Saharan African countries. Methods We used secondary data from Demographic and Health Surveys (DHSs) conducted between 2013 and 2018 across the 24 sub-Saharan African countries. Binary logistic regression models were applied to identify the factors associated with health care seeking behaviour for children with acute childhood illnesses. The results were presented using adjusted odds ratios (aOR) with 95% confidence intervals (CIs). Results Overall, 45% of children under-5 years with acute childhood illnesses utilized health care facilities. The factors associated with health care seeking behaviour for children with acute illnesses were sex of child, number of living children, education, work status, wealth index, exposure to media and distance to a health facility. Conclusions Over half of mothers did not seek appropriate health care for under-five childhood illnesses. Effective health policy interventions are needed to enhance health care seeking behaviour of mothers for childhood illnesses in sub-Saharan African countries.

Hearing Loss and Health Care Seeking

Hearing loss is common among older adults. Hearing loss is associated with increased health care expenditures, risk of 30-day readmission, and longer length of hospital stay. However, little is known about behaviors and attitudes in seeking care. In this cross-sectional analysis, we examined data from the 2016 Medicare Current Beneficiary Survey (MCBS) datasets. Participants are asked to describe their self-perceived trouble hearing. Health care seeking attitudes were assessed on all study participants in 2016 via self-report avoidance or delay of care, personal health concerns, and sharing health status. Multivariate regression models adjusted for demographic/socioeconomic characteristics and general health determinants were used to explore the association between trouble hearing and outcomes. In the 2016 MCBS, 12,140 Medicare beneficiaries, representing 51 million with survey weights, answered questions on help-seeking attitudes. In the sample, 55.6% reported no trouble hearing, while 38.8% and 5.5% reported a little trouble and a lot of trouble hearing, respectively. Those with a lot of trouble hearing were more likely to report avoiding doctors (Odds Ratio [OR] = 1.35; 95% Confidence Interval [CI] = 1.09 – 1.67) and delaying care (OR = 1.47; 95% CI = 1.19 – 1.82). However, no differences were found in personal health concerns or willingness to share health status with others. Poorer health care seeking behaviors may help explain higher costs associated with hearing loss as avoidance of care can exacerbate health problems. Further work is needed to understand underlying reasons and whether addressing hearing loss modifies the observed association.

Postpartum Health Care Seeking Behaviour among the Rural Women in Bangladesh

Introduction: Pregnancy and childbirth is an important event in the life cycle of women and their health during this period is very much vital for the mother and children. Maternal mortality ratio (MMR) of a country is an important indicator of the overall health status of mother. Objectives: To assess the health care seeking behaviour of postnatal women in rural Bangladesh. Materials and Methods: This cross sectional study was conducted at Chaturia in Dhamrai upazilla of Dhaka district from January 2019 to March 2019 among purposively selected 196 rural women of reproductive age who had at least one living child. Data were collected by face-to-face interview using pretested questionnaire. Results: Among 196 respondents average monthly family income was 12561 Taka with SD of 10462 taka. Majority of them were housewives and about two-third (64.8%) were educated above secondary level. 70.9% respondents had their delivery of last child in a government health care center and 37.8% deliveries were conducted by nurses which was followed by government doctors (36.2%). Majority (62.2%) had their health checkup within 42 days, 59.2% of them had checkup for three or more times and the checkup were done by government doctors (60.2%). 47.1% of the respondents experienced high grade fever as postpartum complication. Statistically significant association (p<0.05) were revealed between age group of the respondents with health personnel conducted deliveries and also between educational level of the respondents with place of delivery of last child. Conclusion: Awareness, motivation and infrastructural development play a vital role in utilizing the government healthcare services by the postnatal women in rural Bangladesh. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 80-83