Gender and tuberculosis control Perspectives on health seeking behaviour among men and women in Vietnam

被引:125
作者
Johansson, E [1 ]
Long, NH
Diwan, VK
Winkvist, A
机构
[1] Karolinska Inst, Dept Publ Hlth Sci, Div Int Hlth, IHCAR, S-17176 Stockholm, Sweden
[2] Natl Inst TB & Resp Dis, Hanoi, Vietnam
[3] Nord Sch Publ Hlth, S-40242 Gothenburg, Sweden
[4] Umea Univ, Dept Publ Hlth & Clin Med, S-90185 Umea, Sweden
关键词
Vietnam; tuberculosis; health seeking behaviour; gender; stigma; focus group discussion;
D O I
10.1016/S0168-8510(00)00062-2
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
This study explores the perspectives of tuberculosis patients on which factors influenced their health seeking behaviour, with special reference to gender differentials in terms of delays in health seeking. In 1996, a multi-disciplinary research team carried out 16 focus group discussions. The study was done in four districts in Vietnam, both in the south and north of the country and in urban and rural areas. Qualitative analysis of data was performed following general principles of modified grounded theory technique. Participants in the focus groups described three main factors as contributing to delay in health seeking. These were fear of social isolation, economic constraints and inadequate staff attitudes and poor quality of health services. A model illustrating different factors influencing health seeking was elaborated acid served as a basis for discussion of the findings. The main factor contributing to delay among women was described as fear of social isolation from the family or the community. Stigma was described as closely related to contextual factors such as gender-roles, socio-economic status and level of education and seemed to be mediated via denial and concealment of tuberculosis diagnosis and disease, thus causing delay. The main factor contributing to delay among men was described as fear of individual costs of diagnosis and treatment. Staff attitudes and quality of health service facilities were described as not always corresponding to people's expectations of appropriate health services. Women saw themselves and were seen by others as being more sensitive than men to poor service conditions and staff attitudes. A typical feature of the described health seeking behaviour of men was that they neglected symptoms until the disease reached a serious stage, by which rime they tended to go directly to public health services without first visiting private health practitioners. Women. on the other hand, were described as having a tendency to seek out private services and practice self-medication before seeking care at public services. In conclusion. there is a need for better understanding of behavioural factors and for developing strategies, that take these into account. Health workers need to better understand gender and social aspects of tuberculosis control. particularly aspects that influence the likelihood for achieving equity in diagnosis and cure. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.
引用
收藏
页码:33 / 51
页数:19
相关论文
共 34 条
[1]  
BONILLA E, 1991, SALUD DESAROLLO ASPE
[2]  
CHUC VK, 1995, EUROPEAN J CLIN PHAR, V55, P325
[3]  
DOLIN PJ, 1994, B WORLD HEALTH ORGAN, V72, P213
[4]  
Donabedian A, 1989, Qual Assur Health Care, V1, P3
[5]   EVALUATION OF MALARIA CLINICS IN MAESOT, THAILAND - USE OF SEROLOGY TO ASSESS COVERAGE [J].
ETTLING, MB ;
THIMASARN, K ;
KRACHAIKLIN, S ;
BUALOMBAI, P .
TRANSACTIONS OF THE ROYAL SOCIETY OF TROPICAL MEDICINE AND HYGIENE, 1989, 83 (03) :325-331
[6]  
Glaser B.G., 1968, Time for dying
[7]  
Goffman E., 1963, STIGMA NOTES MANAGEM
[8]  
HOLMES BH, 1995, ROLE SEX EPIDEMIOLOG
[9]  
JOHANSSON A, 1998, THESIS KAROLINAKS I
[10]   Staff and patient attitudes to tuberculosis and compliance with treatment: An exploratory study in a district in Vietnam [J].
Johansson, E ;
Diwan, VK ;
Huong, ND ;
Ahlberg, BM .
TUBERCLE AND LUNG DISEASE, 1996, 77 (02) :178-183