In the past, medical industry is a highly exclusive field, people would overcome a great amount of restriction and obstacle while seeking for medical advice. However, the financial obstacle was much reduced after the National Health Insurance program began in March of 1995. It is now easier and more convenient for people to seeking for medical assistance. By learning more about the key point of what people think before seeking for medical assistance, hospital can make more effective marketing programs. The purpose of this research is to understand the situation of medical care seeking behavior of the public. The structrued survey study sampled 334 patients by quota sampling. Information collected in the questionnaire includes situation of the medical care seeking behavior and medical services utilization. A multiple regression was also performed to examine the factors that influenced the medical care seeking behavior. Some managerial implications were also proposed according to the results.

Postpartum depression is recognized as an important maternal and child health issue. Postpartum depression is the most common perinatal psychiatric disorder and one of the most common complications of childbirth. Studies show prevalence rates in women ranging from 10% to 25%. Postpartum depression affects the emotional wellbeing of mothers, infant behavior, mother-infant bonding, and marital relationships. However, the majority of women who experience postpartum depression do not seek care. The purpose of this analysis is to examine the demographic differences between women in Georgia who report symptoms of postpartum depression but do not seek care, versus women who report postpartum depression symptoms and seek care. Approximately 15% of respondents in this study reported postpartum depression. Of these women, approximately 80% did not seek care for their symptoms. This analysis found that women with the following characteristics were more likely to not seek care for depression: non-White and Hispanic women; women that were uninsured before their pregnancy; women that had their prenatal care paid for by Medicaid or the Military; and women who did not seek care for depression during their pregnancy. The results of this study may help to guide the implementation of public health interventions among postpartum women in Georgia.

Postpartum depression is recognized as an important maternal and child health issue. Postpartum depression is the most common perinatal psychiatric disorder and one of the most common complications of childbirth. Studies show prevalence rates in women ranging from 10% to 25%. Postpartum depression affects the emotional wellbeing of mothers, infant behavior, mother-infant bonding, and marital relationships. However, the majority of women who experience postpartum depression do not seek care. The purpose of this analysis is to examine the demographic differences between women in Georgia who report symptoms of postpartum depression but do not seek care, versus women who report postpartum depression symptoms and seek care. Approximately 15% of respondents in this study reported postpartum depression. Of these women, approximately 80% did not seek care for their symptoms. This analysis found that women with the following characteristics were more likely to not seek care for depression: non-White and Hispanic women; women that were uninsured before their pregnancy; women that had their prenatal care paid for by Medicaid or the Military; and women who did not seek care for depression during their pregnancy. The results of this study may help to guide the implementation of public health interventions among postpartum women in Georgia.

This thesis aimed to study the actual and perceived quality of midwifery practices during childbirth at peripheral and central health care levels in two low-income countries, Angola (I-III) and Mozambique (IV-V). Theoretical models interpreting women's and midwives' views have been developed. Objectives: Study I evaluates midwives' use of an adapted model of the World Health Organization's partograph, a tool used to monitor the progress of labour. Study II describes midwives experiences of working without immediate medical assistance. Study III explores women's perceptions of care-seeking behaviour during childbirth. Study IV observes perinatal midwifery care routines and examine partograph documentation. Study V explores and develops a theoretical understanding of factors perceived to obstruct or facilitate midwives ability to provide quality of perinatal care. Methods: Study I: A one-group pre-and post-test interventional evaluation of 100 partographs from one peripheral delivery unit. Study II: Semi structured interviews with eleven midwives, analysed in a qualitative process comprising six steps. Study III. Ten focus group discussions with pregnant and non-pregnant women, analysed using the grounded theory technique. Study IV. Pre-and post intervention observation of midwifery care of 702 vs. 616 women during delivery and examination of the partographs. Study V: In-depth interviews with 16 midwives, analysed using grounded theory technique. Educational interventions were designed and applied in study II and IV. Results: Study I. Significant improvement of documenting was found in seven of the ten variables and more partographs were correctly documented in sample II compared to sample I. Missed transfers increased, however, in sample II. Study II: The midwives experiences were sorted under four main areas: (1) Society/culture (2) Significant Others (3) Personal Self (4) Professional Self. Confidence was felt in the role as autonomous midwives but dependency on various factors such as the partograph, a functional referral system, peer support, community trust and continuous supervision was emphasised. Socio-economic hardships were identified as major stress factors for themselves and the women. Study III: Women seemed compelled to "mould" their care seeking behaviour and four patterns, two 'avoiding' and two 'approaching' institutional care were identified. The salient features of each pattern were found to be "personal courage", [B1]"disempowerment", "discarding traditional practices" and "awareness and emancipation". Study IV. No improvements were found in quality of care following the intervention. Common problems proved to be hypothermia and rare initiation of the graphic part of the partograph, which monitors progress of labour. Study V. A process labelled "changing perinatal care management" emerged, which comprised four dimensions addressing aspects related to i) existing environment ii) midwives' interaction with women in labour, iii) midwifery profession and iv) caring technology in order to improve quality of care. Communication and collaboration were identified as change agents. Conclusions: The findings in this thesis indicate that midwives' ability to provide quality of maternal and perinatal care in lowincome and post-war affected countries is restricted by organizational, structural, educational as well as attitudinal aspects. Women in need of assistance during childbirth are negatively affected as a consequence of midwives reaction to the various constraints, which at times (Luanda) seems to oblige adverse care seeking behaviour. Midwives recognises the need for change, but change is found to be a slow and complex process, which requires engagement by all levels of the care chain. A model suggesting how to achieve quality of maternal and perinatal care in Safe Motherhood context is presented.

Urininkontinens är inte en sjukdom i sig utan ett symtom på bakomliggande orsaker. Att bli inkontinent kan ha flera olika förklaringar, men ofta är behandlingsmöjligheterna goda. Att vara urininkontinent kan bland annat innebära en stor negativ påverkan på livskvaliteten, utgöra en form av begränsning, vara en stor skam samt innebära att inte ha kontroll över sin kropp. Urininkontinensen är ett vanligt problem där många personer förblir obehandlade. Vi söker en bättre förståelse för bakomliggande hinder som påverkar personers val att söka vård. Med bättre förståelse för varför dessa personer inte söker hjälp kan sjuksköterskan bättre nå ut och möta deras behov. Detta arbete skall belysa hinder till att personer väljer att inte söka vård vid urininkontinens och bygger på den forskningsmodell som kallas att bidra till evidensbaserad omvårdnad med grund i analys av kvalitativ forskning. Till denna modell valdes en kvalitativ analysmetod, där analysmaterialet utgjordes av åtta artiklar.Ur analysen framkom sex teman som utgör hinder för personer att söka vård; ”Attityder till urininkontinens”, ”Skam och genans”, ”Ej vara till besvär”, ”Rädsla för behandling/undersökning”, ”Kommunikationsbrister” samt ”Kulturkrock”. Vissa teman byggs upp av subteman. Diskussionen utgörs av reflektioner kring personers attityder till sin kropp med stigande ålder, personers upplevelser av skam som hinder, kunskapsbrister som hinder samt att ej vara till besvär. / Program: Sjuksköterskeutbildning

This dissertation research utilizes anthropological methods to determine the degree to which the signs and symptoms female caregivers identify as causes of acute respiratory infections (ARIs) in under-fives in rural Ecuador correspond with Western biomedical categories. By employing both a semi-structured medical history questionnaire and more open-ended ethnographic methods such as in-depth informant interviews and focus group research, the researcher identifies the factors which determine timely health care-seeking behaviors of female caregivers in this case study. Economic factors such as the cost of medications and lost work hours were determined to be the primary financial obstacles for timely health care-seeking. Other barriers included limited and inconsistent hours at the health centers and transportation issues. Families of lower socioeconomic status were also more likely to have children suffering particular respiratory ailments. Childhood respiratory illness was identified as an outcome of poverty, which had the potential to reproduce itself through the negative effect of illness on household income. However, the research determined that there was an overall lack of recognition of the biomedical signs and symptoms of serious lower respiratory infections regardless of socioeconomic status. The model of ethnomedicine supports the finding that compliance with timely health care-seeking is limited without collaboration between healthcare professionals and communities to work towards beneficial and achievable goals that are joined by a common purpose. By understanding local cultural beliefs towards ARIs, healthcare professionals are in a better position to: (1) assess the accuracy or inaccuracy of ethnomedical beliefs and determine if there is a conflict in symptom recognition and care-seeking behavior with the biomedical model; (2) determine culturally-appropriate interventions or recommendations to address the health problems of the commu nity and identify barriers; and (3) work with existing community resources in order to foster effective health communication. This research finds that public health messages regarding ARIs be informed by ethnomedical knowledge of home treatments and beliefs. Moreover, health centers need to adhere to regular hours of operation and increase staff capacity to better meet the needs of their clients.

Over the course of the twentieth century, the quality, quantity and accessibility of health care services in Nicaragua were remarkably altered in accordance with the agendas of stakeholders in the national government and providers of "development aid", many of whose objectives were as much or more political as they were humanitarian. Much of the international health literature has focused on sociocultural factors that impact health care seeking, yet little research has been conducted on the political economic dimensions. This dissertation examines how sociocultural factors, political economy and social relations interacted in health care seeking decision-making among 50 poor and lower-middle-income households in Nicaragua, a country with high rates of poverty, child morbidity and child mortality. Attending to the ways that global and national policies were experienced in a local setting, the study provides an in-depth analysis of health care services in a country that has undergone three major regime changes within the last 25 years. How did the ideology of each regime influence health care, and how did the state influence both health staff and the lay population, especially with regards to people's expectations and understandings of the allocation of responsibility for health?The data indicate that health care services have significantly worsened during the recent years of neoliberal-oriented governance, concordant with an increase in economic insecurity. In conjunction with these macro-level processes, conditions of poverty have undermined people's ability to maintain longstanding reciprocal exchange relations and health care responsibilities. In ideology and praxis, the struggle between an ethos of solidarity and cooperation, versus one of individual competition and self-preservation, was engaged on a daily basis within and across extended households of kin, as well as between and among health care seekers and practitioners. Local level efforts to make up for the gap in government responsibility were limited precisely because the policies implemented by the government and international bodies undermined them. Neither the state nor civil society currently possesses the capacity to meet the basic health needs of the majority of Nicaraguans. For communities to thrive, the state must restore its safety net of health and other basic services.

Objectives:  A qualitative study to explore the perceptions and ideas of women at community level in Uganda, about factors influencing their health care-seeking behaviour when symptoms that could indicate pulmonary tuberculosis. To let the women identify barriers to health care-seeking and to let them present ideas how to overcome barriers. Method:  Focus Group Discussions (72 informants) and In Depth Interviews (19 informants) were conducted in rural Uganda with women of reproductive age. For triangulation purposes discussions and interviews also included health care providers, traditional healers and a few men. Main Results: The data showed a wide range of health care-seeking behaviours including no action at all, self-treatment using traditional herbs or western medicines, consulting traditional healers and consulting various formal or informal healthcare facilities. The data also identified many barriers that could prevent women from getting a proper diagnosis, including lack of financial resources, lack of power, male supremacy in decision-making, lack of knowledge, perceived corruption in healthcare facilities, fear of stigma and this fear heavily boosted by the idea that PTB equates HIV/AIDS. Conclusion: These data support the idea that successfully fighting PTB among Ugandan women and increasing case finding, demands recognition that tuberculosis is a multifaceted disease: economical, social, psychological and medical. Therefore, approaches to eradicating tuberculosis must target different sectors and reach all levels of society / <p>ISBN 978-91-86739-19-5</p>

Approximately 49 million Americans are 65 years and older, 80% of whom have ≥1 chronic condition, while nearly 70% of Medicare beneficiaries have ≥2 such conditions. Moreover, avoidance of medical care is frequently seen among older adults; a national survey reported that over 33% of participants avoided seeking care even when they suspected that they should go to the doctor. Healthcare avoidance, especially by older adults, can result in adverse health and economic outcomes including higher use of emergency department (ED), longer inpatient stays, and poorer health status, alongside emotional burden. Studies have shown that perceived satisfaction of care and the need to seek care as a result of presence of illness are associated with care seeking behaviors. Thus, this study aimed to examine the extent to which these enabling and need factors translate to care seeking behaviors among Medicare beneficiaries. This is a cross-sectional study that includes 13,441 Medicare beneficiaries who responded to the 2018 Medicare Current Beneficiary Survey (MCBS). MCBS provides information on the beneficiaries’ medical conditions including healthcare utilization, healthcare access, and satisfaction with care. Multivariate logistic regression analyses were conducted to test the association between satisfaction of available care by specialists; satisfaction with the quality of medical care received the year before; presence of chronic illness like cardiovascular diseases (CVD), diabetes, arthritis, lung disease (chronic obstructive pulmonary disease (COPD), asthma, etc.) and depression, with care seeking behavior among Medicare beneficiaries. Care seeking behavior, which is the outcome of interest, was defined using three measures: not doing anything to avoid going to the doctor, not keeping sickness to self, and going to the doctor as soon as one feels sick. Of the total respondents, only about 29% showed care seeking behavior. Being male, being Hispanic, and having more than high school education were significantly associated with higher care seeking behavior. Lower likelihood of care seeking behavior was seen among beneficiaries who were dissatisfied with ease getting to doctor from home [adjusted odd’s ratio (aOR)=0.635; p

Bakgrund: Psykisk ohälsa är en utbredd folksjukdom vilken förekommer hos samtliga generationer och kön. Det finns en överrepresentation av patienter med psykisk ohälsa inom psykiatriska- och somatiska verksamheter. Att arbeta inom hälso- och sjukvården och ta emot personer med psykisk ohälsa kan upplevas tids- och resurskrävande. Syfte: Syftet med studien var att sammanställa och beskriva individer med psykisk ohälsas upplevelser av att söka vård inom somatiska vårdinrättningar. Metod: En beskrivande litteraturstudie baserad på tio kvalitativa studier samt en studie med mixad metod. Artiklarna hämtades via databassökningar i databaserna PubMed och Cinahl. Huvudresultat: En majoritet av patienterna upplevde stigmatiserande attityder från personalen, ett bristande förtroende kopplat till dess symtombeskrivning samt kunskapsbrist. Patienterna uppfattade att reell kompetens saknades relaterat till att frångå patientens tidigare hälsohistoria och behandla patienten enligt nuvarande hälsoproblematik. Noterade arroganta attityder gentemot patienterna framhävs, vilka saknade korrelation till patienternas uppförande. Positiva vårdupplevelser framhävs i de fall vårdpersonal skapade en god relation med patienten samt erhöll en genuin känsla av omsorg. Slutsats: Patienterna beskrev att stigmatiserande attityder från personal bidrog till en känsla av utanförskap inom de somatiska vårdinrättningarna. Utanförskapet genererade ett hinder gällande vårdsökande, vilket ansågs begränsa individens livskvalitet. Enligt författarna beräknas studien generera en ökad sjukdomsförståelse hos vård- och omsorgspersonal, vilket kan bromsa samhällsutvecklingen av psykisk ohälsa. / Background: Mental illness is a widespread public illness which occurs in all generations and genders. There is an over-representation of patients with mental illness in psychiatric- and somatic functions. Working in health care and receiving people with mental illness can be experienced as time- and resource-consuming. Aim: The purpose of the studies was to compile and describe the experience of individuals with mental illness seeking care in somatic care facilities. Method: A descriptive literature study based on ten qualitative studies and one study with a mixed method. The articles are retrieved via database searches in the databases PubMed and Cinahl. Main results: A majority of patients experienced stigmatizing attitudes from professionals, a lack of trust linked to its symptom description and a lack of knowledge. The patients perceived that real competence was lacking in relation to departing from the patient's previous health history and treating the patient according to current health problems. Noted arrogant attitudes towards the patients are highlighted, which lacked correlation to the patients' behavior. Positive care experiences are highlighted in cases where care staff created a good relationship with the patient and received a genuine feeling of care. Conclusion: The patients described that stigmatizing attitudes from professionals contributed to a feeling of exclusion within the somatic care facilities. Being outside generated an obstacle regarding seeking care, which was considered to limit the individual's quality of life. According to the authors, the study is expected to generate and increase understanding of the disease among health and social care personnel, which can slow down the social development of mental illness.