Perceived ill-health and health seeking behavior in two communities in the nam theun 2 hydroelectric project area in Lao Peoples Democratic Republic

Objective:To compare perceived ill-health and health seeking behavior between two communities affected by the large Nam Theun 2 hydroelectric project in central Lao People’s Democratic Republic(PDR).Methods: Two different affected areas;Nakai plateaubeing remote,sparcely populated and mountainous,and Xe Bang Fai lowland plains,more densely populated and comparatively affluent were included.Data were obtained from two cross-sectional household-based health and socio-economic surveys.Results:We found pronounced differences in the frequency of self-reported fever,cough,headache and myalgia according to location.On the Nakai plateau,45.1%of the individuals with ill-health report(recall period;2 weeks) went to a local health volunteer compared to only 7.2%in the Xe Bang Fai area(P 【 0.001 ).In Nakai,there were disproportionately more illiterates seeking help from local health volunteers when compared to those who attended at least primary schooling(49.2%versus 17.5%,P 【0.01 ).Self-medication with antimalarials was more common in Xe Bang Fai than on Nakai(32.3%versus 7.0%,P 【 0.001).The mean amount of money spent per health consultation was US $ 1.7 in Nakai and US $ 7.2 in Xe Bang Fai.Conclusion:The observed differences in self-reported ill-health and health seeking behavior among these two Lao communities need to be considered when implementing setting-specific mitigation measures as part of the public health action plan of the Nam Theun 2 hydroelectric project.

Seeking Health Information Online:The Moderating Effects of Problematic Situations on User Intention

Purpose： This study investigates how online user intention in searching health information is affected by problematic situations.Design/methodology/approach： Based on the Theory of Reasoned Action, the Technology Acceptance Model, and Sense-making theory, we propose two dimensions of problematic situations： urgency and severity of health issues being searched online. Data were collected through a questionnaire survey among 214 Wuhan University students and analyzed using hierarchical regression analysis.Findings： Perceived usefulness, perceived ease of use, and subjective norm can influence user intention to seek health information online. The urgency of problematic situations has a negative moderating effect on the relationship between perceived ease of use and user intention and the relationship between subjective norm and user intention. The severity of problematic situations has a negative moderating effect on the relationship between subjective norm and user intention.Research limitations： The respondents of the survey are limited to students in one Chinese university, so whether this study＇s results can be applied to another population or not remains to be verified. In addition, only two dimensions of problematic situations are considered in this study. Practical implications： The paper puts forward the moderating effect of problematic situations and verifies it, which is the compensation for online health information-seeking behavior research. Besides, our analyses have implications for professional design of health care systems and related consumer information searches, and improve their performance. Originality/value： Previous work has reported the effects of problematic situation on user intention to seek health information online, ignoring its influence on other factors. This empirical study extends that work to identify the influence of problematic situation when seeking intention-behavior data in two dimensions, urgency and severity.

Research on the Model of Consumer Health Information Seeking Behavior via Social Media

Purpose: We aim to create a model of consumer health information seeking behavior via social media, then to have a better understand of it. After that further efforts should be made to provide targeted recommendations for media managers to promote health communication via social media. Methods: Our custom model was derived from literature review, empirical research was tested by the use of questionnaire investigation, and then the collected data were analyzed by structural equation model tool SmartPLS. Finally, the custom model was modified according to the experimental results of SmartPLS. Results: A total of 239 (66.39%) of the respondents were female and 121 (33.61%) were male. The maximum of two stages of age were 18 - 29 (70.56%), 30 - 39 (13.89%). Wechat (60.28%), QQ Zone (55.22%), Micro-blog (48.89%) were the most commonly used social media to obtain health information. About 44.72% of respondents used social media to obtain health information multiple times a day. The whole numerical values of AVE, cronbach’s alpha, CR and square roots of AVE were above the benchmarks of themselves and showed great reliability and validity. All the 11 hypotheses had obvious statistical significance, the P-value of eight path coefficients exhibited <0.001, one path coefficient exhibited <0.01 and two path coefficients exhibited <0.05. Conclusions: A suitable model of consumer health information seeking behavior via social media was created and some inner relationships were found. Namely, gratification of health information and its platform had a positive effect on attitudes toward health information seeking behavior. Health information literacy and health status were proved to have a significant influence on attitudes toward health information seeking behavior, subject norms and perceived behavioral control respectively. In addition, attitudes toward the health information seeking behavior, subject norms and perceived behavioral control were proved to positively associate with health information seeking behavior intention.

Health-seeking behaviour and student perception of health care services in a university community in Nigeria

Objectives: Examining consumers’ healthcare behavior can help in the design of ways to ensure better access to health and the quality of care. Health-seeking behavior is viewed as the varied response of individuals to states of ill-health, depending on their knowledge and perceptions of health, socioeconomic constraints, adequacy of available health services and attitude of healthcare providers. This study examines health-seeking behavior of university students, their use of healthcare services in the community and barriers to seeking help at the university health centre. Method: Structured questionnaires were validated and administered on a random sample of university students spread over different academic disciplines in a large institution. The sample consisted of 1608 undergraduate students attending the public university in southwesternNigeria. The demographic profile reflects the national university student population. Relevant information was collected on preferred health services consulted by the undergraduates such as barriers to seeking adequate medical attention and their experiences with salient aspects of service delivery. Responses were weighted and the average was taken to be representative. Results: Students consulted their peers (37.5%) in health related academic disciplines rather than seek treatment at the university health centre. Some students (24.7%) preferred community pharmacies while others took personal responsibilities for their health or abstained from medical care for religious reasons (16.8%). Significant barriers to seeking medical attention at the health centre were cost of care, protracted waiting time, inadequate health information, unfriendly attitude of healthcare workers and drug shortage. Conclusions: Students sought help from community pharmacies (ease of access) and from peers in health related academic programmes rather than from physicians at the health centre. Health-seeking behavior of the students was influenced, essentially, by the nature of ailment, waiting time in the health facility and attitude of healthcare professionals. Implications for policy, practice or delivery: The findings of this research identified the relative use of available health services within the university. Initiatives to improve student access to the university health centre should address significant barriers of patient delays, the need for attitudinal change and continuing professional development of relevant workers in the health facility. Promotional activities may be necessary to inform and educate students on rational use of medicines and access to treatment at the health centre.

Health Care Seeking Behaviour and Predictors of Combined Orthodox and Traditional Health Care Utilization among Households in Communities in Owerri, Imo State, Nigeria

Background: Health care seeking behaviour is a complex, dynamic and multidimensional process that involves a sequence of remedial actions that are influenced by the interaction between the individual, household and community with the intention of addressing perceived ill health. Objective: To determine health care seeking attitude and behaviour and the predictors of combined orthodox and traditional health care use among households in communities in Owerri, Imo State. Nigeria. Methods: A cross sectional design that used a multistage random sampling technique to select 500 participants from households in two communities in Owerri, Imo State. Data was collected using a pretested, semi structured questionnaire. Descriptive analyses were done with frequencies and summary statistics. Chi square statistics were computed to determine significant relationships and binary logistic regression was used to determine predictors of combined use. P was set at 0.05 significance level. Results: The results revealed that, while just more than half of the respondents (56.4%) had a moderate to good level of overall knowledge of health care, almost all of the respondents (96.2%) also had a moderate to good level of overall positive attitude towards seeking health care;with less than one third (29.4%) using combined orthodox and traditional health care treatments. It further revealed that, respondents who were female, traders and from households of polygamous families were significantly more likely to use combined orthodox and traditional health care treatments (p < 0.05) while those with a tertiary level of education, from households with a professional as head, having private water closet toilets and earning a monthly income of more than 50,000 Naira ($140) were significantly less likely to use combined orthodox and traditional health care treatments (p < 0.05). Conclusion: There is a need to be more sensitive to the realities of the combined use of orthodox and traditional treatments, as its use will be difficult to prevent because this behaviour is rooted in the traditional and cultural belief system of our societies.

Knowledge and health seeking behavior for malaria among the local inhabitants in an endemic area of Ethiopia: implications for control

This cross-sectional study was conducted to assess the knowledge and health seeking behavior for malaria among the local inhabitants in an endemic area of Ethiopia: Implications for control. 98.6% and 80.7% of respondents had awareness about malaria and the cause (‘mosquito bite’) of malaria, respectively. 186 (81.6%) respondents seek treatment for a febrile disease from health care facilities. Chi-square analysis revealed a strong association between the edu- cational status of respondents and the measures they take to prevent malaria (Х2 = 58.7;df = 16;p < 0.001). The findings clearly suggest that the majority of the respondents had adequate knowledge and enviable health seeking behaviour. However, still a sizable faction had misconception and undesirable health seeking behaviour. It’s a major barrier to implement effective malaria control strategies in the resource- limited settings particularly in country like Ethiopia. In this context, appropriate communication strategies apparently inevitable. Therefore, appropriate communication strategies should be designed to promote the knowledge and health seeking behaviour of vulnerable section of the society in this vicinity.

Identifying Treatment and Healthcare Seeking Behavior as a Means of Early HIV/AIDS Intervention in Africa

Background: Late diagnosis of Human Immunodeficiency Virus (HIV) infection and delayed commencement of antiretroviral therapy (ART) in sub-Saharan Africa is known to contribute to high morbidity and mortality. It is therefore, prudent to develop innovative approaches to ensure early HIV diagnosis because patients with low immunity will usually develop opportunistic infections and seek some remedial action. A treatment and health care seeking behavior survey was carried out in semi-urban communities in Malaba and Busia in Kenya and Uganda to evaluate the treatment and healthcare seeking behavior among patients visiting randomly selected drugstores. Methodology: Random sampling was applied and questionnaires were used to collect information from 165 interviewees who visited drugstores seeking health information, treatment and other health related services. Results: The results indicated that among this group of people, 67% visited drugstores before any other health facility. 72.2% sought treatment for various illnesses and services ranging from headaches, body fever, gastro-intestinal disturbances, family planning pills, sexually transmitted infections and chronic medications. Among the patients interviewed, there were a number of factors that affected treatment choice. These included the distance to the facility as well as the absence of a consultation fee or fee for service. Conclusion: With proper support, drugstores can play a major role in the implementation of health interventions that seek to promote early diagnosis and treatment as well as play a pivotal role in educating the population on disease prevention and management. In Sub-Saharan Africa, drugstores can play a major role in HIV and AIDS interventions where most patients seek medical intervention for opportunistic infection.

Determinants of Health Care Seeking Behaviors in Puerperal Sepsis in Rural Sindh, Pakistan: A Qualitative Study

Background: Puerperal sepsis (PS) is one of the major causes of maternal death, contributing to 26,000 deaths per year in developing countries. Early recognition and treatment are essential to managing PS, but numerous social, cultural and technical barriers prevent or delay access to care and necessary medical attention. Through this qualitative study, we identified barriers to care seeking for puerperal sepsis among recently delivered women in Matiari, Pakistan. Methods: We conducted 20 in-depth interviews among recently delivered women with and without sepsis and their family members in September 2012. Key informant interviews were conducted with 14 healthcare providers and traditional birth attendants. The themes used for content analysis were knowledge of danger signs, factors affecting care seeking and local treatment practices for postpartum sepsis. Results: A total of 34 interviews were conducted. Recently delivered women, their family members and traditional birth attendants were unaware of the word PS or the local translated term for PS. However, they were familiar with most of the individual symptoms associated with PS. Healthcare providers were aware of the condition and the associated symptoms. The healthcare providers’ understanding of the seriousness of PS was directly proportional their age and clinical experience. The most common barriers to care seeking was the division of labor within the household, obtaining permission from the primary decision maker, access to transportation, lack of financial resources and support from family members. Conclusion: To improve maternal care seeking behaviors for PS, interventions focusing on increasing knowledge of PS, addressing gender inequality, implementing an affordable community transport service and enhancing TBA’s knowledge and skills to manage PS need to be implemented.

Awareness and Practice of Proper Health Seeking Behaviour and Determinant of Self-Medication among Physicians and Nurses in a Tertiary Hospital in Southwest Nigeria

Background: There is generally a lack of good health-seeking practices among health professionals due to a variety of factors, including the intensity of the medical practice itself. Doctors and nurses are perceived to have a good knowledge of ideal health-seeking behaviors and as such, it is important to determine the level of their awareness and estimate whether this knowledge is put into practice. This study, therefore, aimed to determine the level of awareness and practices of proper health-seeking behavior and to identify the factors responsible for self-medication among doctors and nurses in a tertiary hospital in Nigeria. Methodology: A cross-sectional descriptive study was conducted between April and may 2018 among 106 doctors and 164 nurses in a tertiary health facility in Ido-Ekiti, Ekiti State, Southwestern Nigeria. A simple random sampling technique by balloting was performed from the list of doctors and nurses in the hospital to select doctors and nurses that participated in the study. A pretested semi-structured self-administered questionnaire was designed and used to collect data. The data were entered into the computer software and analyzed using SPSS version 20. P ≤ 0.05 was taken as significant. Result: Out of 106 doctors and 164 nurses recruited, only 102 doctors and 143 nurses filled the questionnaire completely and returned for analysis. One hundred and four respondents (42.4%) fall within the ages of 31 - 40 years with a male to female ratio of 1:1.23. Awareness of proper health seeking behavior among both doctors and nurses was high among the two groups with no statistically significant difference between them. Twenty-nine (28.0%) doctors compared with thirty-four (23.8%) nurses go for a regular medical check-up with no statistically significant difference between the two groups (p = 0.411). Out of these, 5 (17.2%) doctors and 7 (23.8%) nurses visit at an interval of less than 6 month (p = 0.736). There is a statistically significant difference in the number of doctors (60.8%) compared with nurses (41.3%) that have consulted a doctor in the last one year (p = 0.003). More than half (51.6%) of this consultation among doctors was over the phone whereas 64.4% of such among nurses were via clinic appointment (p = 0.008). More doctors (90.2%) comply with their treatment prescription from physicians compared with nurses (77.6%) (p = 0.010). More nurses compared with doctors self-medicate when ill [Doctor 61.8% (63), Nurses 78.3% (112)] (p = 0.005) and had also self-medicated in the last one year [Doctor 34.3% (35), Nurses 42.7% (61)] (p = 0.187). Decreasing age, decreasing years of experience, increasing working hours, lack of health insurance, fear of confidentiality and lack of satisfaction with health services are factors that significantly increased the likelihood of self-medication among doctors and nurses within the last one year. Conclusion: Awareness of proper health seeking behavior was high but this did not translate into proper health-seeking practices among doctors and nurses. There is apathy for regular medical check-up and self-medication was also high among this group of health workers. Decreasing age and years of experience, increasing working hours, lack of health insurance, fear of confidentiality and lack of satisfaction with health services were factors were identified to significantly increase the likelihood of self-medication.

Healthcare seeking trends in acute respiratory infections among children of Pakistan

AIM To assess healthcare seeking trends among Pakistani children with acute respiratory infections through comparative analysis between demographic health surveys(DHS) 2006-2007 and 2012-2013. METHODS Data of the last born children 0-24 mo of age of the sampled households from both the DHS was analyzedafter seeking permission from the DHS open access website. These were children who had suffered from cough and/or breathing difficulty in the past two weeks and sought health care thereafter. The trends of health care seeking were determined separately for the individual, household and community level according to the study parameters. χ2 test was applied to compare these trends. A P-value of < 0.05 was considered significant. RESULTS Out of 2508 children in 2006-2007 there were 1590 with acute respiratory infections(ARI) according to case definition along with 2142 out of 3419 children in 2012-2013 DHS, whose data was analyzed. During 2006-2007, 69% cases sought healthcare for ARI which improved to 79% in 2012-2013. Additionally, it was revealed that when compared between 2006-2007 and 2012-2013, improvement in care seeking practices was observed among illiterate mothers(64% vs 77%) although there was minimal change in those literate. Similarly, those women working also showed an increase in healthcare seeking from 67% to 79%. Additionally, those belonging to low and middle socioeconomic class showed a marked increase as compared to those in the higher class where there was no significant change. Whereas those living in rural communities also showed an increase from 66% to 78%.CONCLUSION Increasing health budget, improving maternal education and strengthening multi-sectoral coordination are among the effective strategies to improve outcomes associated with healthcare seeking in ARI.

Knowledge of Health Communications Management and Treatment Seeking-Behavior Regarding Malaria in Uganda

In Uganda, there is still insufficient comprehension of malaria as a lethal disease especially in rural areas despite universal bed-net distribution coverage and effective anti-malarial treatment. Aim: To get evidence-based knowledge to establish the contribution of an individuals’ knowledge from various health communications that could increase their active involvement in health care especially seeking timely appropriate treatment for malaria or suspected malaria. Method: A cross-sectional survey using a correlational design was employed on a clustered sample of 380 rural households in 05 sub-counties of Kanungu district. Data were corrected between October 2016-January 2017 using researcher-administered questionnaires, key-informant interviews and focus group discussions. Correlation analysis was done. Result: There is a significant positive relationship between knowledge of health communications and treatment-seeking behavior (r = 0.312;p ≤ 0.01). Conclusion: Exposure to consistent Behavioral Change Communications messages influences treatment-seeking behaviour. Thus, in malaria-prone communities, it appears that other factors including sufficient targeted persuasive health communication are lacking in influencing personal orientations towards treatment-seeking behaviour. Therefore, proper Health Communications management supplements efforts from other disciplines and players, against malaria in Uganda.

Health Seeking Behavior among Medical Students in the University of Sharjah

Background： Medical students have different perception of symptoms and illness. Moreover, medical students reportbarriers to seeking help about their health, and are more likely to seek advice informally from friends and/or family. It is important toidentify health seeking behaviors among medical students to be able to modify and interfere accordingly. Objectives： To describe thehealth seeking behavior of medical students in UOS and identify the factors affecting those behaviors. Methods： A cross-sectionalstudy was conducted at the University of Sharjah during the spring semester of the academic year 2012-2013. Self-administeredquestionnaires were distributed to all medical students from all 5 years. Questions were related to physical health seeking behaviorsonly. Data was analyzed using the SPSS21 software. Results： We have found that self-prescription was the most common practicedhealth seeking behavior among 91.8%-96.6% of UOS medical students （CI of 95%） followed by the order ignoring a health problem,seeking immediate care, using the internet, reading more about the problem and self diagnosis ＆ management. All are practiced bymore than 50% of the students. A set of other behaviors was identified as well. Factors affecting these behaviors mainly included：self-care orientation ＆ medical education. Other factors that had a role as well were： gender, stage of studying, having a chronic illnessand lack of knowledge about the health services available. Conclusions： Medical students in the University of Sharjah have a high levelof self-care orientation and accordingly, tend to react to their illness in a variety of ways. The most common of these is self-prescription.Studying medicine is the 2nd major factor that influences their health seeking behaviors. Sufficient guidance about the consequencesassociated with certain behaviors may be required.

Parents’ and caregivers’ attitudes towards malaria, and health care seeking practices for their febrile children in a hospital in north-eastern Nigeria

Despite the very high burden of malaria among children in Borno state, the proportion of those who receive standard treatment has been very low. This study aimed to determine malaria knowledge, attitude towards prevention, and health care seeking behaviours of parents or caregivers of children presenting with fever at the paediatric clinic of a secondary-level hospital in Maiduguri, Borno state, Nigeria. A cross-sectional study design was used to obtain information from the respondents. Data were collected using a structured questionnaire, from the parents or caregivers of children presented to the Paediatric clinic with history of fever, and analysed in SPSS. A total of 331 respondents were finally recruited into the study. The ages of the children ranged from one to fourteen years. Some of them (15.3%) were internally displaced persons (IDPs). As many as 90.7% and 91.9% of the respondents believed that malaria is a life-threatening illness, and ITNs could prevent malaria, respectively. Less than a half of them (42.3%) had immediately brought their children to the hospital once they detected the fever. At the hospital, only 202 (60.7%) of the children had had malaria parasite test done on them, of which 89.1% tested positive. Permanent residents were more likely to promptly take their children to the hospital, one they detected fever, compared to IDPs ( 2=12.401, df =1, p=0.002). There is the need for promoting early presentation of febrile children to health centres, and also promoting routine malaria tests for febrile persons.

Health-seeking behavior of migrant beggars in Ibadan, Southwestern Nigeria

Most studies on beggars in Nigeria have focused exclusively on the social course of indigenous begging activities in Nigerian cities. There exists dearth of knowledge about international migrant beggars and their health-seeking behavior in Ibadan Southwestern Nigeria. A cross sectional survey data were collected through purposive sampling technique among a total of 250 international migrant beggars in six locations in Ibadan. Results showed that 56% of respondents were female, few had formal education, 85.6% were married, and 94.8% were Muslim. Respondents migrated from Niger (83.6%), Chad (11.2%), Mali (4.0%) and Benin (1.2%). None had a legal residence permit. Respondents’ mean residence duration in Nigeria was 8.5 years. Malaria was common to beggars both in their home country and in Nigeria. Treatment was received from patent medicine vendors by 51.2% respondents. Advice for appropriate treatment for illness was received from family members by 44.4% migrant beggars. Sex and country of beggars have a direct relationship with the treatment seeking (P Financial and legal status of migrant beggars dynamically limited their healthcare choices. Routine health education on hygiene practice and appropriate treatment-seeking should be taken to beggars at their different locations by health workers as means of prevention of the spread of diseases.

Examining the changing health care seeking behavior in the era of health sector reforms in India:evidences from the National Sample Surveys 2004&2014

Background:Health policy formulations in India have witnessed a shift from a reactive approach to a more proactive approach over the last decade.It is therefore important to understand the effectiveness of recent national health policies(such as the National Rural Health Mission and the National Urban Health Mission)in addressing the varied needs of the heterogeneous population of India.Methods:We use datasets from the National Sample Surveys carried out in 2004 and 2014 to understand the change in the health seeking behavior as a result of these policies.The choice of health care facilities and the associated expenditures are compared through descriptive analyses.A multinomial logistic regression is used to identify the significant parameters which contribute towards the share of health care providers in India.The health status of two economically disparate Indian states(Bihar and Kerala)are also compared through specific metrics of performance.Results:It is seen that due to increased availability of facilities in close proximity,both rural and urban residents prefer to avail of those facilities which will result in minimization of transportation cost.The effectiveness of national health policies is found to vary on a regional scale.Literacy and health status have a strong correlation,thereby reinforcing that Bihar still lags far behind Kerala in terms of access to equitable health care.Conclusion:Therefore,a hierarchical system,incorporating medical pluralism and tailor-made policies targeted at diverse health care demands,needs to be put in place to achieve Goal 3 of the Sustainable Development Goals as decreed by the United Nations,i.e.,“health for all”.

Factors that contribute to delay in seeking cervical cancer diagnosis and treatment among women in Malawi

Cervical cancer is a curable disease if diagnosed early. However, many women in Malawi seek treatment when the disease has reached inoperable stage. This study was conducted to explore factors that contribute to delay in seeking early diagnosis and treatment of cervical cancer among women in Malawi. The study was exploratory and utilized qualitative data collection and analysis method. In-depth interviews were conducted using a semi-structured interview guide on a purposive sample of 24 women who were diagnosed of cervical cancer at the gynaecological wards of Zomba and Queen Elizabeth Central Hospitals in Malawi between July and September, 2011. Thematic content analysis was used to analyze the qualitative data. Two major themes (individual and health facility) emerged from the participants’ narratives as factors that contributed to their delay in seeking early diagnosis and treatment. The individual factors included;limited knowledge on symptoms and signs and limited financial resources. The health facilities factors included;limited accessibility and unavailability of cancer screening facilities in the health centres. Results show that there is a need to strengthen the screening of cervical cancer among women in the country. In addition, there is a need to create community awareness on the signs and symptoms of cervical cancer and the merits of seeking early diagnosis and treatment.

Information seeking and anxiety among colonoscopy-na?ve adults: direct-to-colonoscopy vs traditional consult-first pathways

AIM To investigate the effects of direct to colonoscopy pathways on information seeking behaviors and anxiety among colonoscopy-na?ve patients.METHODS Colonoscopy-na?ve patients at two tertiary care hospitals completed a survey immediately prior to their scheduled outpatient procedure and before receiving sedation.Survey items included clinical pathway(direct or consult),procedure indication(cancer screening or symptom investigation),telephone and written contact from the physician endoscopist office,information sources,and pre-procedure anxiety.Participants reported pre-procedure anxiety using a 10 point scale anchored by "very relaxed"(1) and "very nervous"(10).At least three months following the procedure,patient medical records were reviewed to determine sedative dose,procedure indications and any adverse events.The primary comparison was between the direct and consult pathways.Given the very different implications,a secondary analysis considering the patient-reported indication for the procedure(symptoms or screening).Effects of pathway(direct vs consult) were compared both within and between the screening and symptom subgroups.RESULTS Of 409 patients who completed the survey,34% followed a direct pathway.Indications for colonoscopy were similar in each group.The majority of the participants were women(58%),married(61%),and internet users(81%).The most important information source was family physicians(Direct) and specialist physicians(Consult).Use of other information sources,including the internet(20% vs 18%) and Direct family and friends(64% vs 53%),was similar in the Direct and Consult groups,respectively.Only 31% of the 81% who were internet users accessed internet health information.Most sought fundamental information such as what a colonoscopy is or why it is done.Pre-procedure anxiety did not differ between care pathways.Those undergoing colonoscopy for symptoms reported greater anxiety [mean 5.3,95%CI: 5.0-5.7(10 point Likert scale)] than those for screening colonoscopy(4.3,95%CI: 3.9-4.7).CONCLUSION Procedure indication(cancer screening or symptom investigation) was more closely associated with information seeking behaviors and pre-procedure anxiety than care pathway.

Perceptions of Health Warning Signs in Seriously Ill Woman of Childbearing Age in Kinshasa

Introduction: For seriously ill women of childbearing age, perceived health warning signs may influence decision of whether or not to seek care. Inaccurate perceptions of patients and those around them may lead to attitudes that delay seeking care. This study analyzes perceptions of danger and related delays to seek care in Kinshasa. Methods: Sixty deceased women who died between March and April 2004 were taken away from two Kinshasa mortuaries. History of disease and deaths were reconstructed through medical records and semi-structured interviews of family members and leaders. The Qualitative Software Research was used to conduct a qualitative analysis. Results: Perceived health warning signs had five manifestations: Specific clinical health warning signs, aggravation of non-specific signs, persistence of signs, indirect danger signs and superstitious signs. The incorrect perception of the signs was an important cause of late awareness of the danger and delayed decision to seek care. Conclusion: Misunderstandings of signs often delayed awareness of danger as well as decisions to seek appropriate care. Educational programs teaching health warning signs should be designed to promote the timely use of facilities.

基于福格行为模型的社区主要不良心脏事件高危者的健康干预

目的探讨基于福格行为模型的健康干预对社区主要不良心脏事件高危者生活方式、用药依从性及院前延迟行为意向的影响。方法将不良心脏事件高危者按照社区分为对照组和干预组各66人。对照组采用常规健康管理,干预组在对照组的基础上依据福格行为模型从动机、能力和提示3个关键要素进行健康干预6个月并随访3个月。在干预前、干预后和随访后对两组健康促进生活方式、院前延迟行为意向、用药依从性进行评价。结果对照组60人、干预组57人完成干预及随访。干预及随访后,干预组健康促进生活方式、用药依从性评分显著高于对照组,院前延迟行为意向评分显著低于对照组(均P<0.05)。结论基于福格行为模型的健康干预有利于提高社区不良心脏事件高危者的健康促进生活方式和用药依从性,降低院前延迟行为意向。

上海市闵行区2型糖尿病患者社区就医轨迹变化与血糖控制水平的研究

目的构建2型糖尿病(type 2 diabetes mellitus,T2DM)患者的社区就医轨迹模型,分析不同轨迹的影响因素,并探讨不同就诊轨迹下的血糖控制水平。方法本研究采用回顾性纵向研究方法,纳入18088例于2006年1月至2009年12月在闵行区各社区卫生服务中心建立居民健康档案并建卡纳入社区随访管理的T2DM患者,在2010年1月1日开始随访,2019年12月31日随访终止,随访信息完整。基于群体的组基轨迹模型(group-based trajectorymodelling,GBTM)来识别、构建糖尿病患者的社区就诊轨迹。利用贝叶斯信息准则(Bayesian information criterion,BIC)、平均验后分组概率(average posterior probability,AvePP)等评价指标选择最佳亚组数的轨迹,比较不同类别轨迹在人口学特征、家族史、居住地、空腹血糖、BMI等方面差异,运用无序多分类Logistic回归模型分析不同就诊轨迹的影响因素。采用Cox比例风险模型分析T2DM不同社区就医轨迹与血糖控制水平的关系。结果运用GBTM分析,构建最优模型Model 4,将社区建卡的18088名T2DM患者分为5个不同轨迹亚组,分别为持续不就诊组(22.29%)、低水平上升组(15.09%)、高水平缓慢下降组(14.18%)、高水平快速下降组(14.90%)、持续规律就诊组(33.54%)。以持续规律就诊组作为对照,性别、年龄、居住地、基线合并高血压、基线空腹血糖水平、BMI对T2DM患者社区就诊轨迹均有影响(P<0.05)。校正了混杂因素后,Cox回归分析结果显示,相对于持续不就诊组,低水平上升组、高水平缓慢下降组和持续规律就诊组血糖控制水平较好,HR分别为0.37(95%CI:0.34~0.39)、0.72(95%CI:0.67~0.78)、0.78(95%CI:0.73~0.84);高水平快速下降组血糖控制水平相当,HR为1.06(95%CI:0.99~1.12)。结论2型糖尿病患者在最优模型下社区就医轨迹呈现不同的动态变化特征;性别、居住地、合并高血压、消瘦影响患者出现不同就医轨迹。定期社区门诊就诊随访可能有助于控制血糖水平。