European Journal of Social Sciences Studies
ISSN: 2501-8590
ISSN-L: 2501-8590
Available on-line at: www.oapub.org/soc
Volume 2 │ Issue 2 │ 2017
doi: 10.5281/zenodo.400695
FACTORS AFFECTING HEALTH SEEKING BEHAVIOUR AMONG
RURAL DWELLERS IN NIGERIA AND ITS IMPLICATION ON
RURAL LIVELIHOOD
Edward Omeire Uchei
Directorate of General Studies
Federal University of Technology Owerri
Owerri, Imo State, Nigeria
Abstract:
Majority of the Nigerian population lives in rural area, where agriculture is the
mainstay. Nigerian rural areas are the most neglected and its people, the most deprived
with regard to the provision of modern health care services. Besides, they lack other
basic infrastructural necessary for the maintenance and promotion of good health. The
implication is that rural dwellers are subjected to high incidence of morbidity and
mortality resulting from the incidence of preventable and infectious disease.
Knowledge about health care seeking behavior is very crucial in health care policies
formulation, early diagnosis, effective treatment and implementation of appropriate
interventions in the rural areas where productive tasks are labor-intensive. In order to
build a responsive health system in the rural areas, there is need to understand the
health seeking behaviours on the demand side and that is the only way to expect
improved health outcomes. This paper explores the factors influencing health-seeking
behaviour of rural areas in Nigeria and its implication on rural livelihood.
Keywords: health seeking behaviour, rural dwellers, Nigeria, rural livelihood
1. Introduction
Majority of the Nigerian population lives in rural area, where agriculture is the
mainstay. In Nigeria, the rural areas are the most neglected, most disadvantaged and
most deprived with regard to modern health care services. In addition, they lack other
basic infrastructural facilities and information necessary for the promotion of good
Copyright © The Author(s). All Rights Reserved.
© 2015 – 2017 Open Access Publishing Group
74
Edward Omeire Uche
FACTORS AFFECTING HEALTH SEEKING BEHAVIOUR AMONG RURAL DWELLERS IN NIGERIA
AND ITS IMPLICATION ON RURAL LIVELIHOOD
health. The implication of these limitations is evidenced in the high incidence of
morbidity and mortality due to high incidence of preventable disease. In nearly all the
rural areas of Nigeria today, only few people have access to better medical treatment,
majority patronizes quacks and traditional healers.
According to the Federal Ministry of Health (2008), in 2004 the total number of
public owned health facilities in Nigeria was put at 14,607 while the private sector
accounted for 9,029. The share of rural areas in this figure is very infinitesimal. For
years, rural areas were neglected in the planning and distribution of health care
facilities in Nigeria. Health care facilities are sparsely provided in many rural areas
within the country. Many rural areas do not have clinics and where clinics exists, they
often lack adequate equipment or trained health personnel. Again, the absence of any
form of health insurance in rural Nigeria added to the problem of distance (location of
clinics) service and transportation cost, exacerbates their situation.
Health seeking behaviour and utilization are of great interest to rural sociologist,
development planners and public health practitioners, because they are critical
elements of wellbeing and essential ingredient for rural development. Again,
knowledge about health care seeking behavior is very crucial in health care policies
formulation, early diagnosis, effective treatment and implementation of appropriate
interventions in the rural areas where productive tasks are labor-intensive. In order to
build a responsive health system in the rural areas, there is need to understand the
health seeking behaviours on the demand side and that is the only way to expect
improved health outcomes. This paper explores the factors influencing health-seeking
behaviour of rural areas in Nigeria and its implication on rural livelihood.
2. Defining Health Seeking Behaviour
Health seeking behaviour, on the other hand, is defined as a
series of corrective
measures which individuals undertake to resolve perceived ill-health (MacKian, 2003).
Broadly speaking, health seeking behaviour includes all the behaviours connected with
establishing and maintaining a healthy physical and mental state, which, in other
words, is referred to as primary prevention. It also entails behaviours which deal with
any deviation from the healthy state, such as the control (secondary prevention), and
reduction of impacts and progression of an illness (tertiary prevention).
It is pertinent to note that health seeking behaviour is so intricate, and as such a
single method may not be applied to the establishment and explanation of the patterns.
It is thus, a reflection of the existing conditions which interact in synergism to produce a
pattern of care seeking, but remains flexible and open to change (Olenja, 2003). As a
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Edward Omeire Uche
FACTORS AFFECTING HEALTH SEEKING BEHAVIOUR AMONG RURAL DWELLERS IN NIGERIA
AND ITS IMPLICATION ON RURAL LIVELIHOOD
dynamic process, health seeking can entail many aspects of medical units at the same
time.
An individual’s approach to health seeking behaviour can be referred to as a
pattern of resort , and as documented in the Encyclopedia of Medical “nthropology
(2004), people usually opt for the simplest form of treatment, which they deem more
often than not, as the cheapest and most effective. It is only when these simplest forms
of treatment are adjudged as unsuccessful, that the higher, more expensive and
unconventional treatments are sought for.
An adequate understanding of the different determinants of health seeking
behaviour of various communities and population groups is vital if any headway is to
be made in the fight against illnesses and diseases within the rural areas. This is because
for there to be an appropriate management of sick people within households and
communities, health seeking ought to be prompt.
3. Models of Health Seeking Behaviour
3.1 Determinants Model
This particular model is based on a more biomedical and quantitative approach. Rather
than concentrating on the steps one could take to preserve or improve health, this
model tends to focus on highlighting a set of determinants which are linked with the
choice of various types of health service (Rebhan, 2009). Different models have been
applied to explain the various different determinants of health seeking behaviours.
Andersen grouped these factors into three major categories namely the
population characteristics, the external environment, and the health care systems
“ndersen, 995 . “nother model focuses on one’s health behaviour and adoption of
sick role, and so does not take cognizance of the consequence of social network on the
decision making (Parson, 1951).
3.2 Pathway Model
This model was used by Suchman to describe the steps of the process from the detection
of symptoms to the use of particular health care facilities. This model seeks to identify a
logical sequence of steps, as well as analyze how cultural and social factors affect this
sequence. In other words, it is described as an anthropological approach which uses
qualitative methods of investigation (Suchman, 1965).
Another theoretical model of illness behaviour focuses on the information one
might be expected to process during the course of an illness. This approach is
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AND ITS IMPLICATION ON RURAL LIVELIHOOD
dependent on economics and elementary theory, and the action evaluated with the costbenefit principle (Rebhan, 2009).
4. Factors Affecting Health Seeking Behaviour
Several factors or determinants have been implicated in the health seeking behaviour of
individuals, communities or groups and the interplay of these factors are vital in the
final choice of a care seeking option. These factors have been broadly categorized into
demographic, socio-economic, cultural, religious, and organizational among others.
4.1 Type and Severity of Ailments/Diseases
Most often, people seek out for different forms of treatments which are particular for
the type of disease they are diagnosed with. The severity of the ailment is another
determining factor when the choice of a treatment option is being made. In rural areas,
when people perceive that their sickness is mild, they tend to avoid healthcare facilities,
and thereby engage in self-medication or patronage of patent medical stores. At other
times, they may resort to the use of herbal medications which most times are nonpatented. For instance, where fever which is mostly considered by rural dwellers as
non-serious is the issue, many may resort to the use of home remedies, but where the
symptoms become more complicated or the illness takes a chronic nature, they may be
pushed to seek for health at more specialized health facilities.
Thus, the nature of the illness cum the length of time it takes to resolve it, exert
an influence on the choice of a care provider.
4.2 Economic Factors
The gap created based on economic difference within the society together with the
nonexistence of social security intensifies the vulnerability of the poor in terms of
affordability and choice of health care provider (Nyamongo, 2002). In fact, health
seeking behaviour has been adjudged as one of the direct pathways through which
socioeconomic status can exert an influence on health outcomes (Stowasser, Heiss,
McFadden, and Winter, 2011). According to the study carried out by Ahmed, Tomson,
Petzold, and Kabir (2005), socioeconomic indices were the single most inclusive
determinant of health seeking behaviour among the study population with an
overriding influence over age and gender.
Economic ability undeniably is a major encumbrance in the quest for prompt and
appropriate healthcare,. This is with reference to, consultation fees, cost of purchasing
medicines, transportation cost to the appropriate health facilities among others. Thus, it
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AND ITS IMPLICATION ON RURAL LIVELIHOOD
could be construed that household economics perpetually hinders the prospect and
option of health seeking.
.
4.3 Religious Beliefs
Of note is the fact that religion is a significant aspect of an individual’s social life. It is
believed, most especially in the rural areas, that there is usually a spiritual undertone to
every serious illness, the implication being that once a disharmony exists between a
man and the gods or ancestors , sickness is bound to occur, and when this happens,
seeking healthcare from professional health care providers will amount to a waste of
time and resources. Thus, those who belong to this category of health seekers look the
way of traditional healers/herbalists who they believe will hear accurately from the
gods or ancestors and solve their health needs. Some religious sects do not consent to
their women being attended to by male doctors and vice versa. This undeniably
influences their health seeking behaviour.
Furthermore, one could relate to the Jehovah Witnesses who do not opt for
blood transfusion and those who belong to the Faith Tabernacle who do not subscribe
to the administration of orthodox medications because of their religious inclinations.
This religious mindset plays a significant role in their health seeking behaviour.
4.4 Educational Background
It has also been noticed
that low literacy levels exert a significant influence on the
health seeking behaviour of individuals. When people are enlightened, they tend to be
more knowledgeable about different healthcare options and this informs why they
always make a choice for the more conventional orthodox medicine in times of ill
health. It must also be stressed that the formal literacy status of individuals at times
interplays with other factors such as culture and religious beliefs to determine the
choice of a healthcare option.
4.5 Availability and Accessibility of Appropriate Healthcare Facility
A person place of residence to a large extent determines the type of treatment choice the
person will make in the face of ill-health. This is because some forms of treatment
options may be non-existent due to one’s locality. This is particular to rural dwellers.
Generally, treatment options which are not localized within these rural areas may not
be effortlessly available due to factors such as poverty, location of healthcare facilities,
the availability of transport, poor roads, the time taken to reach these facilities, and the
overall cost implications. In fact, among these factors the distance between those in
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need of healthcare and the nearest health facility has been noted as a very serious
barrier to good healthcare choices, especially in the rural areas.
4.6 Age
The critical role of age in the health seeking behaviour of individuals cannot be
exaggerated. The very young and very old who because of their ages cannot take
themselves to places where they can receive healthcare, depend tremendously on the
decision of their caregivers when it comes to health seeking options. These caregivers,
who could be parents, children or other relations as the case may be, determine the time
to take them out for such care, the care provider to visit and virtually everything
concerning their health. Even where one may want to decide when and where to seek
for health, more especially among the very old, the wherewithal to finance the process
becomes a problem, because the caregivers who assume the position of decision-makers
are also most likely to finance the cause.
In many situations, this incapacitation has led to belated health seeking practices
which often are detrimental to the one who is in need of healthcare.
4.7 Gender
There is a remarkable difference between men and women with regards to health
seeking behaviour (Currie and Wiesenberg, 2003; Shaikh and Juanita, 2004). Some
studies have shown that women less frequently seek for health care when compared to
the men. Several reasons have also been proffered for this. According to Rani and Bonu,
(2003), men are the principal decision-makers and thus control the resources in addition
to deciding when and where the women seek for health care.
Furthermore, the women most times are less likely to recognize disease
symptoms, and even when they perceive an existing symptom, they wish it away as not
meaning anything (Currie and Wiesenberg, 2003); and some cultural inclinations also
forbid women from taking decisions with respect to their own health and that of their
children. The effect of this is that these women in these situations cannot visit
healthcare facilities alone, and there are also times of the day which they are not
permitted to visit such facilities. Therefore, they have been harmfully affected in terms
of seeking for health under emergencies (Uchudi, 2001; Fatimi and Avan, 2002).
4.8 Culture
Cultural values and norms play significant roles in influencing the decision-making
process which is inherent in health seeking behaviour. In most cases, these cultural
values make people to place the concerns of others over their own needs, thereby
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AND ITS IMPLICATION ON RURAL LIVELIHOOD
discouraging them from seeking prompt health care when the need arises. This most
times leads to self-medication and consultation with traditional healers who are
domiciled within the communities. In some other cultures, health issues are regarded as
family problems which should kept as a secret not be exposed to outsiders. This cultural
belief makes them think that seeking help from professionals in the healthcare sector is
tantamount to exposing the family at large, and this the family members will not permit
because they perceive such move (seeking help from professionals) as being disgraceful
and injurious to the family name and reputation. In situations such as these, the act of
seeking for proficient health care is invariably delayed or never sought for at all.
4.9 Organizational Factors
Most people in the rural areas are obviously poor and depend very much on the public
owned health facilities which they perceive as being more affordable than the privateowned ones. Lack of good healthcare facilities in the rural areas affects the health
seeking practice of these communities. In addition, the quality of service obtained
previously (patient/client satisfaction), availability, affordability of recommended
medications, confidentiality principally in diseases which attract stigma from the
society, attitude of health care providers, waiting time before consultation, availability
and expertise of staff, and adequate equipment of facilities among others influences the
health seeking behaviour in rural areas (Musoke, Boynton, Butler, and Musoke, 2014).
5. Health Seeking Behaviour and Utilization of Health Care Systems
A health system was defined by the World Health Organization
, as a system
which includes all activities primarily geared towards promoting, restoring and maintaining
health . Three fundamental objectives can therefore be deduced from the above
definition, and these are to improve the health of the people; to respond to their
expectations and to provide financial protection against the costs of ill health for the
poor.
According to Shaikbh and Hatcher (2005), how a community utilizes health
services is determined by their health seeking behaviour, and this in turn influences the
health outcomes of the people. Without a doubt, the utilization of a health care system
may be dependent on educational levels, economic factors, cultural beliefs and practices
among others. More so, the choice of health care providers by patients is influenced by
several factors such as those connected with the potential providers (such as quality of
service and area of expertise) and those that pertain to the patients themselves (such as
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age, education levels, gender, and economic status (Thuan, Lofgren, Lindholm, and
Chuc, 2008).
That is to say that the organization of the health system to a larger extent
determines the health seeking behaviour and health care utilization of a people. The
health system does not just stand for the structures that provide health care but rather,
it encompasses various other elements which include family system, cultural forces,
economic conditions, social support network, political systems and environmental
conditions, among others which invariably affect the health care seeking patterns
(Shaikbh and Hatcher, (2007). Undeniably, there exist a strong correlation between the
health seeking behaviour of a people and their utilization of health care systems seeing
that both of them by some means share the same determinant factors. These factors are
so significant in that they can influence access to health care even when services do exist
in a community,
6. Impacts of Health Seeking Behaviour on Rural Livelihood
Accessing health care in rural areas is strenuous and confounded by problems such as
insufficient health infrastructure, the presence of chronic diseases and disabilities,
socioeconomic and physical barriers (Ricketts, 2009). Wherever the issue of health
seeking behaviour among individuals, households and rural dwellers in particular is
handled dispassionately, there certainly will arise grave implications. It must be
stressed that prompt health seeking is essential if diseases are to be effectively and
efficiently managed no matter how minor they may appear to be.
Early detection and diagnosis make for timely management which in turn
prevents the progression of an illness. The health of the citizens of any community, state
or nation cannot be clearly separated from the economic growth of such community,
state or nation. This is underscoring the fact that the health of a people is fundamental
to the economic development and growth of the society. Little wonder it is said that, a
healthy nation is a wealthy nation . It follows that when a people are healthy, they will be
more productive, and more productivity will ensure a growing economy.
On the other, ill health is inimical to the growth and development of the nation.
The livelihood of people particularly the rural dwellers are adversely affected as their
productivity declines. Most of the agricultural produces enjoyed within the nation are
from these rural settings. Also, when there is an increased rate of morbidity and
mortality, the workforce is reduced and chances of communicable diseases been spread
to the urban settlements are raised as well.
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It has been noticed that Nigerian rural dwellers exhibit inappropriate health seeking
behaviour (Iyalomhe and Iyalomhe, 2012). These could be explained based on the
interaction of the factors previously mentioned.
Most of these rural dwellers do not have access to modern health care services
together with other basic amenities/infrastructure which promote and maintain good
health. Even where these are available, they are inadequate. This unwholesome
condition wherein the rural dwellers have found themselves also make them vulnerable
to fake medications and non-patented herbal mixtures which rather than cure them,
end up destroying their body organs.
With circumstances such as these, the likelihood of expressing poor health
seeking behaviour are increased, and where this is the case, the rural populace and the
entire nation at large are badly affected.
The truth remains that inappropriate health seeking behaviour increases the
morbidity and mortality rates among individuals and this invariably exerts its
unfavourable toll on the economy. But where the reverse is the case, a healthy and
productive workforce is observed.
Therefore, there is need to holistically look at the various factors which tend to
affect the health seeking practice of a given population and address such appropriately
with a view to enhancing proper health seeking behaviour.
7. Conclusion
No country can witness a significant development when the health of the people is
jeopardized. Health seeking behaviour which could either be appropriate or
inappropriate has got a significant influence on the health outcomes of people
particularly the rural dwellers, and as such efforts should be made to encourage
desirable outlook towards the health seeking behavior of the populace. With the
existence of different factors which interplay to determine the health seeking behavior
of people, efforts should be made to provide a synergism between them so that the
outlook of the rural dwellers will be healthy.
8. Recommendations
There should be synchronized efforts to improve the infrastructural status of healthcare
facilities of rural areas, as well as provide adequate number of healthcare providers
who will in turn be properly motivated to render quality services to those who are
challenged by ill health. In communities where community health workers are engaged,
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this workforce should be adequately strengthened. Policy makers should try as much as
possible to have firsthand information on the various determinants of health seeking
behaviour among the different communities as this will enable them enact appropriate
policies that will serve their health needs.
Where the health facilities may not be adequate in number or where the distance
to be covered is quite long, mobile clinic services should be employed. There is also
need for an improved interpersonal relationship between patients who come to seek for
health and the healthcare providers. Health enlightenment programmes should also be
scaled up to educate the people on the need to patronize the conventional orthodox
healthcare facilities and report to the same as soon as symptoms are observed to ensure
prompt case management.
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