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Indian Journal of Community Medicine

Socio-demographic Determinants of Treatment-Seeking Behavior among Chest Symptomatics

Author(s): A Grover, R Kumar, S K Jindal,

Vol. 31, No. 3 (2006-07 - 2006-09)

A Grover1, R Kumar1, S K Jindal2

Abstract

Objectives: To study the effect of different socio-demographic factors on different aspects of treatment seeking behavior among chest symptomatics. Methods: In depth interviews were conducted with 200 chest symptomatics (50 each from two urban and two rural areas) who were registered from a cross-sectional survey of 433 households. Results: Sixty to percent of chest symptomatic perceived themselves of having a chest disease. Multivariate analysis revealed significantly more urban (93%) respondents resorted to self-treatment for relieving the symptoms as compared to rural area (80.6%). Treatment seeking from a health care agency was significantly more common among 46-65 year olds (72.7%) compared to 15-30 and 31-45 years age groups (55.8%, 65.5% respectively), and rural locality and lower socioeconomic status were significantly associated with delay in contracting a health agency. Health education efforts must be directed to these groups for improving treatment-seeking behavior.

Keywords: Symptomatic, Treatment-seeking, Behavior, Rural, Socio-economic Status.

Introduction

Health care seeking is a central issue in all kinds of morbidity, since the duration of symptoms increases the probability of severe morbidity and harmful sequelae. Illness or deviation from state of health is mostly a subjective awareness of an individual the relief of which may be sought within or outside of medical and health facilities1. Illness behavior refers to the activities undertaken by individuals in response to symptom experience. It typically includes mental debate about the significance and seriousness of these symptoms, lay consultation, decisions about action including self-medication, and constant with health professionals2.

A substantial proportion of people experience symptoms at any given point of time. Symptom perception has a wellrecognized social and even ethnic dimension2. Perception of illness has been found to vary with cultural, ethnic and socioeconomic difference1.

Care seeking has been viewed as an interval requiring time for problem “appraisal” (assessment of the nature of the problem and the need for clinical care), as well as time to act on the decision to seek care, has been labeled as the “procrastination” interval, although some factors that may contribute to delay are not within a patient’s control. Socio-economic status, whether measured by education, income or other indices of social class, has long been known to be associated with attitudes and health care practices4. The impact of socio-economic status on symptoms, respiratory morbidity and mortality is important because it may influence behaviors towards health seeking also5.

Patient compliance depends on many psychological and sociological factors and the interaction of patient’s own ideas with the disease. Among behavioral aspect, most of the investigators have studied variables like where symptomatics go to seek help and who continue with the treatment and who are the defaulters? There has been hardly any attempt to study the personal variable like perception about the disease and what primary actions are taken to get relief. There are host of personal variables on which treatment-seeking behavior is likely to be dependent. Present study has been done with the objective to find out the influence of socio-demographic factors on different aspects of treatment-seeking actions among adult chest symptomatics.

Material and Methods

This study was a part of cross-sectional survey conducted in Northern India, almost 200 kms north of Delhi, in two villages (Bhurewala & Shahjahnpur). of Haryana State and two urban sectors (sector 19 & 30) of Chandigarh City. Villages and city sectors were chosen randomly. Considering the prevalence of chest symptoms as 10% and absolute allowable error of 6% on either side, and design effect of 2, the approximate sample size was found to be 192 and to account for non responding we decided to interview a total of 200 subjects.

It was decided to interview 50 subjects from each locality. Systematic random sampling technique was used to select households in various study locations. Sampling interval was calculated taking into account the total population of the area, sample size and size of the family for each area separately. All individuals aged 15-65 years were interviewed from 433 selected households to find out whether they have symptoms of cough/expectoration, dyspnoea, haemoptysis, wheezing of pain in the chest for more than one month duration at the time of interview. To ascertain their treatment-seeking pattern, subjects were interviewed using a semi-structured interviews schedule. In 192 subjects the treatment-seeking pattern was studied, and the response rate was 99% for urban and 93% for rural giving a total response rate of 96%.

The Socio-economic score was computed by combining scores for education (Illiterate – 1, Up to Secondary -2, Up to graduate -3, Up to post graduate -4), occupation (Students and housewives -1, Laborers -2, Agriculturist, Service class, Up to 1000-1, Up to 5000 -2, Up to 10000 -3 more 10000 -4). The socio-economic score was divided into three equal categories (tertile transformation), which ranged from 3 to 12. The data were coded and analysed using SPSS. Chi-square was used for testing statistical significance for categorical variables. Multivariate regression analysis was done to find out independent effect of socio-demographic variables (sex, age, income, socioeconomic status) on perception of illness, self-treatment, actions for treatment from health agency and the delay in seeking care from health agency.

Results

As shown in table I, more males (68.1%) had perceived having chest disease compared to females. Those in lower socio-economic status had better perception (63.4%) than those in higher socioeconomic status group (P = 0.05). Similary more often people m 46-65 year group and those living in rural area had perceived their symptoms as some form of chest disease than those in younger age group and residing in urban area, though the differences were not statistically significant. After logistic regression the p-value for sex came to be near to significant level i.e 0.06.

For seeking relief from symptoms, the first self initiated action varies by different socio-demographic factors. Eighty seven percent of the chest symptomatics had taken some self initiated action for getting relief. Significantly more (93.9%) urban people as compared to rural subjects had started taking home remedies and self medication (P<0.05). More often males, those in higher socioeconomic status and in higher age group (46-65 years) started taking self treatment but these differences were not statistically significant. In logistic regression analysis also, association of locality (urban vs. rural) with self initiated action was found to be statistically significant (p<0.01).

Chest symptomatics keep on trying home remedies and self medication for sometime before switching over to a health agency. Sixty six percent of chest symptomatic had contacted any health agency for seeking relief. As the age advances, more people contact a health agency to seek relief from symptoms. Among other sociodemographic factors, males (69.0%), those residing in urban area (70.7%) and people with higher socioeconomic status (67.8%) were more likely to seek care from a health agency, but these differences were statistically not significant (Table-II)

Of those respondents who sought help from any health care providing agency, 34.4% had gone to the private allopathic practitioners and 33% had attended government health agencies. Significantly more rural people sought services from government health agency (43.1%). Similar pattern emerged between lower and higher socioeconomic status (p<0.05). A higher proportion of males (41%) had attended the private allopathic practitioners than their female counterparts who had attended the government health agencies in higher proportion (44%), and those in 46-65 years age group utilized the services of government facilities more often (35.9%) compared to younger people, however, these differences failed to reach significance at the 0.05 level (Table II).

The delays before seeking the consultation ranged from one day to 10 years depending upon the severity and chronicity of symptoms. Many a times someone else in their surroundings persuaded them for seeking consultation. Significantly more rural and lower socio-economic status people tolerated the symptoms for longer duration. People in age group of 46-65 years had taken more time in contacting any health rural area median delay was 120 days compared to 15 days in urban area (p<0.05). As compared to a delay of 22 days in higher socioeconomic status persons, the delay was 120 days among lower socioeconomic status people (p<0.01). Persons in age group of 46-65 years had median delay of 90 days compared to 30 days in other age group (Table-III) In multivariate analysis also locality and socio economic status were significantly associated with delay in seeking treatment.

Table I: Association of Socio-Demographic Factors with Perception of Symptoms and Self-Actions Among Chest Symptomatics

Socio-demographic Factors Perception of having chest disease Self action (home remedy/self medication)
N Univariate Logistic Regression Univeriate Logistic Regression
% OR 95%
CI
P % OR 95% C.I. P
Sex
Male 113 68.1* 1.0   88.5 1.0      
Female 79 54.4 1.7 1.0-3.2 0.06 86.1 1.5 0.6-37 0.4
Age (years)
15-30 43 62.8 1.0   83.7 1.0      
31-45 61 55.7 1.2 0.5-2.7 0.7 88.5 0.5 0.1-1.6 0.2
46-66 88 67.0 0.8 0.4-1.8 0.6 88.6 0.4 0.1-1.2 0.1
Locality
Urban 99 60.6 1.0 0.5-2.6 0.9 93.9 1.0    
Rural 93 64.5 0.9 0.5-2.6 0.9 80.6 3.5 1.0-11.7 0.03*
Socioeconomic Score
3-5 71 63.4 1.0 0.4-2.0 0.9 81.7 1.0    
6-8 65 64.6 0.9 0.4-2.9 0.9 89.2 0.6 0.2-1.8 0.3
9-12 56 58.9 1.1 0.4-3.0 0.8 92.0 0.6 0.1-2.9 0.5
Total 192 62.5     87.5        

P < 0.05

Table – II: Association of Socio-Demographic Factors with Care Seeking from Health Agency Among Chest Symptomatics

Socio-demographic Factors N Contact with any health agency   Type of health agencies
Univariate Logistic Regression N UMP PAP AP GH/D
% OR 95%
CI
P % % % %
Sex
Male 113 69.0 1.0     78 23.1 41.0 10.03 25.6
Female 79 63.2 0.7 0.4-1.3 0.2 50 18.0 24.0 14.0 44.0
Age (years)
15-30 43 55.8 1.0     24 16.7 37.5 16.7 29.2
31-45 61 65.5 2.4 1.4-5.4 0.04* 40 17.5 37.5 15.0 30.0
46-66 88 72.7 1.4 0.7-3.1 0.3 64 25.0 31.3 07.8 35.1
Locality
Urban 99 70.7 1.0     70* 5.7 52.9 17.1 24.3
Rural 93 62.3 0.5 0.2-1.1 0.1 58* 39.7 12.1 05.2 43.1
Socioeconomic Score
3-5 71 67.6 1.0     48* 37.5 16.7 02.1 43.8
6-8 65 65 0.8 0.3-2.2 0.7 42* 16.7 33.3 11.9 38.1
9-12 56 56 1.1 0.4-2.3 0.9 38* 5.3 57.9 23.7 13.2
Total 192 66.6       21.1 34.4 11.7 32.8  
UMP = Unqualified medical practitioner, PAP = Private allopathic practitioner, AP = Ayurvedic practitioner, GHD = Government hospital/Dispensary

Table – III: Association of Socio-Demographic Factors Delay in Contacting Health Agency Among Chest Symptomatics

Socio-demographic Factors N Delay in Contacting Health Agency (%)
<30 Days 31-60 Days 61-120 Days >120 Days Median Days
Sex
Male 113 46.9 8.8 15.9 28.3 60
Female 79 45.6 6.3 10.1 38.0 60
Age (years)
15-30 43 58.1 4.7 18.6 18.6 30
31-45 61 50.8 4.9 14.8 29.5 30
46-66 88 37.5 11.4 10.2 40.9 90
Locality
Urban 99 66.7 3.0 7.1 23.2 15
Rural 93 24.7 12.9 20.4 41.9 120
Socioeconomic Score
3-5 71 23.9 14.1 16.9 45.1 120
6-8 65 53.8 4.6 12.3 29.2 30
9-12 56 66.1 3.6 10.7 19.6 22
* p <0.05.

Discussion

To a large extent characteristic features of a particular community determine illness behavior8,9. It has been observed by many working in this area that behavior of ill persons towards seeking help from any outside agency is not unpredictable. It follows a path or course in certain meaningful ways. The pattern of help seeking might vary according to socio-economic and other determinants10. The knowledge about ill understood phenomenon of pathepay to help, case or treatment seeking behavior our understood even partially might be of some help to those who design health services. Many studies has been carried out to understand the problem of treatment seeking and proper utilization of health services11-13. That is why, present study was focussed on understanding the treatment seeking behavior of chest symptomatics so that in spite of their own culture sensitiveness, they can be given proper guidance as far as appropriate health care need is concerned.

Among chest symptomatics, regarding their perception of having any chest diseases, in the present study 62.5% perceive themselves of having some chest disease. Similar findings were reported by Narayan et al14 in 1982. Surprisingly, none of the socio-demographic factors (age, sex locality and socioeconomic score) was found to be associated with diseases perception in the present study.

Of these who are symptomatic but don’t seek a professional consultation, a majority either accommodate to the symptoms or employ self-medication. In our study, significantly more people in urban area take self medication as compared to rural area. Self-treatment varied according to different socioeconomic status also but the differences were not statistically significant. In a survey by Warsworth et al, 488 symptomatic individuals took no action while 562 of the 1000 sample took ‘non-medical’ action15. Before reaching a treatment providing agency chest symptomatic keep on trying self-treatment either by home remedies or by self-medication. Sudha G et al16 have observed similar findings in their study in South India where 33% of urban and 21% of rural chest symptomatics opted for self-medication. Only 4% of rural symptomatics resorted to home remedies and alternate systems of medicine.

Zola described the process of translating symptom to seeking care from physician in an elegant manner. He says that virtually every day we are subject to a vast array of bodily discomforts. Only an infinitesimal amount of these get a physician. Of those who are symptomatic but don’t seek a professional consultation, a majority either accommodate to the symptoms or employ self-treatment17. Most of the chest symptomatics go outside the home and seek some help from health care providing agency after trying self-treatment at home (home remedies and self-medication) for considerable period of time (one day to ten years), Seventy-six percents of the chest symptomatic had sought consultation from a health agency, rest did not. Significant factor associated with help seeking from a healthcare agency was age. More people in 46-65 years age group sought consultation. Different agencies contacted for treatment were unqualified private practitioners, private allopathic practitioners, government health services and ayurvedic practitioners (Table-II).

Socio-demographic factors were not associated significantly with perception of chest disease but were significantly associated with self-action and with seeking consultation from a health agency. After controlling the confounding effects of different socio-demographic factors, it can be concluded that more urban people compared to rural take self-action for relief of symptoms and more often people in 46-65 years age group compared to younger persons decide to seek help from health care providing source.

Zola has also pointed out that accommodation to symptoms, perhaps after a long delay incorporating lay consultation, can break down and result in a possibly reluctant consultation. He mentions few triggers to the decision to seek medical aid. One among these is that the symptomatic would set external criteria for action- such as ‘if it isn’t better in 3 days, or 1 week, or 7 hours, or 6 months, the I will take care of it’. Zola has labeled this as ‘temporalizing of symptomatology’17. Current study has tried to elicit which factor is mainly responsible that leads to delayed consultation.

Our analysis revealed that rural locality and lower socioeconomic status were significantly associated with delay in contracting the health agency. Needham et al18 has studied the delay in tuberculosis patients. In their study, the median diagnostic delay was 8.6 weeks and it was significantly associated with female sex, lower education, more than six instances of health-seeking encounters, outpatient diagnosis of TB, visiting private or traditional healer.

Health seeking is a dynamic process determined by certain socio-demograhpical and socio-cultural factors19. These factors influence the interpretation of different chest symptoms, formation of concepts and finally decision to take any action or visiting any health care providing agency. The study revealed that a significant proportion of people in higher age group (46-65 years) decide to visit any health care provider irrespective of gender, locality and socio-economic status. Findings of this study suggest that health services should increase awareness about chest symptoms so that chest symptomatic contacts health agency soon after the onset of the chest symptoms. More emphasis needs to be given to younger persons and those belongings to lower socioeconomic status since they are more likely to ignore their symptoms.

References

  1. Rabin D and Schach E. Medicaid, Morbidity and Physician. Medical Care 1975; 13 : 68-73.
  2. Tones K. Health education, behavior change and public health. In Oxford textbook of public health (ed. 3rd), vol 2, New York: Oxford University Press 1997; 787-88.
  3. Fortenberry. Health care seeking behaviors related to sexually transmitted diseases among adolescents. Am J Pub Health 1997; 87 : 417-20.
  4. Marmot M, Feeny A, General explanation for social inequalities in Health. IARC Sci Public 1997; 38 : 207-08.
  5. Prescott E, Vestbo J. Socio economic status and chronic obstructive pulmonary disease. thorax 1999; 5 : 737-41.
  6. Bakke PS, Hanoa R, Culsik A. Educational and obstructive lung diseases, given smoking habits and occupational airborne exposure : A Norweiginan Community study. Am J Epidemiol 1995; 141 : 1080-8.
  7. Grover A, Kumar R, Jindal SK. Treatment seeking behavior of Chest Symptomatics. Ind J Tuberculosis 2003; 50 : 87-94.
  8. Kiev A Magic, Faith and Healing : studies in primitive psychiatry today. New York : Free Press : p xiii, 1964; 121.
  9. Singh VK. Medical practice among an Indian Tribe. Indian J Psychiatry 1973; 15 : 358-62.
  10. Rogler LH, Cortes DE. Help seeking pathways; a unified concept in mental health care. American J Psychiatry 1993; 150 : 554-561.
  11. Briones FD, Peter MD, Heller L, et al. Socio-economic status, ethinicity psychological distress and readiness to utilize a mental health facility. Am J Psychiatry 1990; 147 : 1333-1340.
  12. Giel R, Hardling TW. Psychiatric priorities in developing countries Br J Psychaiatr 1976; 128 : 513-522.
  13. Srinivasmurthy R, Ghosh A, Wig NN. Dropout from psychiatry walk-in clinic. Indian J Psychiatry 1977; 19 : 11-17.
  14. Narayan R, Thomas S, Srikanthramu N, Srikantan K. Illness perception and medical relief in rural communities. Ind J Tuberculosis 1982; 29 : 98-103.
  15. Wadsworth M, Butterfiedl WJH, Blany R. Health and sickness the choice of treatment. Tavistock, London; 1971.
  16. Sudha, G., Nirupa C., Rajasakthivel, M., Sivasusbramanian, S., Sundaram, V., Bhatt, S., Subramaniam, K., Thiruvalluvan, E., Mathew, R., Renu. G & Santha, T. Factors incluencing the care-seeking behavior of chest symptomatics : a community- based study involving rural and urban population in Tamil Nadu, South India. Tropical Medicine & Interntional Health 8 (4), 336-341.
  17. Zola IK, Pathways to the doctor-from person to patient. Social Science and Medicine 1973; 7 : 667-689.
  18. Needham DM, Foster SD, Tomlinson G, Faussett PG. Socio- economic, gender and health services factors affecting diagnostic dealy for tuberculosis patients in Urban Zambia. Trop Med Internal Health 2001; 6 : 256-59.
  19. Madionos MG, Madianou D, Stefanis CN. Help seeking behavior for psychiatric disorder from physicians or psychiatrists in Greece. Soc Psychiatry Psychaiatr Epidemil 1993; 28 : 285-91.

1 Deptt. of Community Medicine,

2 Pulmonary Medicine, Post Graduate Institute of Medical Education
and Research, Chandigarh,
E-mail: [email protected]

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