Unravelling the Contextual Factors Mediating Illness Response Using Mixed Methodology

Abstract

The re-emergence of infectious diseases has been a rampant public health challenge in the state of Kerala over the past one decade with high rates of mortality and morbidity. In an exploration of the contextual factors determining illness response associated with these diseases, this study employed a mixed methodology including a cross sectional survey of 430 respondents and 30 in-depth interviews. Individuals having one or more cases of selected re-emerging infectious diseases (Chikungunya, Dengue, Malaria and Leptospirosis) from various socio-spatial locations were included in the study to understand the patterns and determinants of illness response across different categories. The findings demonstrated that respondents’ response to illness is jointly determined by individual and household level factors such as gender, parenthood, illness context and spatiality. The article explains the ways in which these factors have interacted and intersected at varying points to create and reinforce multiple layers of vulnerability. Results are pertinent in understanding the pathways and mechanisms through which health inequities are created and sustained among different categories in the population. The findings demonstrate that only interventions concomitantly dealing with these factors and their interactions will produce more equitable results in improving access to health services and management of morbidity associated with re-emerging infectious diseases.

Factors influencing healthcare seeking in patients with dengue: Systematic review

“…Resource availability (5 of 20 studies) was the second most reported individual factor influencing healthcare seeking in dengue. Three quantitative studies reported this factor as significant [33][34][35], while four reported non-significant [12,14,27,35]. 'Low income' and 'too busy' were the primary individual factors that prevent people from seeking healthcare when having dengue [33][34][35][36][37].…”

“…Three quantitative studies reported this factor as significant [33][34][35], while four reported non-significant [12,14,27,35]. 'Low income' and 'too busy' were the primary individual factors that prevent people from seeking healthcare when having dengue [33][34][35][36][37]. One study reported 'multiple communicable infections present in the family' as a barrier to health seeking, which was explained by the lack of income to cover the healthcare cost for many infected family members, hence not seeking help [35].…”

“…Multiple communicable infections present in the family -cannot afford the cost [35] Low income [33][34][35][36][37] Too busy (work) [37] Single communicable infection presents in the family -can afford the cost [35] High income [33,34] 5…”

“…Inconvenient operating hours of health facilities [13,37] Long travelling distance and time to the health facility [35,36,42] The assigned hospital is not the closest point of care (healthcare) [41] Long waiting time for healthcare services [35,36,42] Lack of attention and resources allocation on healthcare facilities [35,36,42] Oversaturated emergency services [35,36,41,42] Convenient operating hours of health facilities [39] Shorter travelling distance and time to the health facility [42] Health centre is located in close proximity [37,39] Health centre offers patients home visits [37] 7…”

“…Health facilities requiring upfront payment [35] Expensive healthcare cost [37] Health facilities offer flexible payment methods [37] 2…”