Health Decision-Making and Care Seeking Among Village Householders in Kibona, Uganda

Purpose:

This study examined health decision-making and care-seeking among village householders in Kibona, Uganda. Primary aims of this study were to:

            1. Understand the role of the key decision-maker concerning health related issues within the family structure

            2. Determine when in the course of illness that care was sought,

            3. Describe the first line of care and help seeking, whether it was use of self-care remedies, traditional healers, or hospital care,

            4. Actively engage students in providing culturally congruent care through collaboration with Kibona community partners.

            A secondary aim of this study was to identify potential health liaisons within the villages who could help provide knowledge for informed decision-making and care-seeking, assess and/or re-direct families for needed care to prevent further complications.

This health decision-making study is significant as families continue to seek out traditional healers for invasive indigenous practices as first line care. These procedures such as ebino (tooth extraction) and tea-tea (cutting) lead to complications, morbidity and mortality. Previous assessment of hospitalized patients indicated that they presented for care in late stages of illness. Written intake histories indicated that patients had prodromal symptoms.

Methods:

University approval was obtained (approval #10086). Ugandan nurses, university nursing faculty and nursing students worked collaboratively in teams to acquire community entre, and interview families. The faculty-researcher reviewed study aims and interview questions with students and community partners in advance. This activity took place in the form of group meetings for translation-backtranslation of the interview questions, and to clarify other questions, concerns, and logistical considerations. Fifty-four head-of-householders were personally interviewed prior to their health examinations.  With faculty-researcher oversight, pairs of students and community partners, who served as translators, conducted the interviews. 

Results:

Study results indicate evolving and fluid conceptions of decision-making and care seeking. In the context of their challenging environment, resources, and present health circumstances, head-of-householders had a continuum of strategies and maintained an openness to information. Limitations of this study were: (a) time constraints which did not allow for follow-up interviews, and (b) head-of-householders who participated in this study may not have been a true representation of Kibona village. In the course of this study, student-participant encounters provided valuable experiences in culturally congruent care.

Conclusion:

Implications for further study include follow-up with community partners and health liaisons, and refinement of models to guide research, education, and evidence based practice.