The agriculture industry has high rates of injury and illness. Furthermore, the average age of US farmers is 58 years old. Chronic conditions are more common among older populations and often require management by a health professional. Farmers face barriers when seeking healthcare. These barriers include limited free time, shortage of providers in rural areas, limited funds, and poor health insurance. In addition, lack of quality health insurance and concerns about paying for healthcare are identified as barriers to healthcare-seeking behavior among farmers. More research is needed to examine the impact of type of health insurance on utilization of specific types of healthcare services among this high-risk population. The goal of this study was to examine the association between a farmer’s type of health insurance and their healthcare-seeking behaviors. A brief, in-person, self-administered survey was used to identify the types of health insurance Midwest farmers were using and how this affected what type of healthcare services they utilized, specifically looking at preventive healthcare services. A second survey, administered online, was used to identify pre-existing conditions farmers had and the specific healthcare preventive healthcare services they utilized. The online survey found that type of health insurance was significantly associated with usage of preventive services. Other associations were found in the in-person survey between type of health insurance and stress over health insurance as well as stress over injury on the farm. These results can be used to inform future health and safety programs about the impact of health insurance on farmer’s healthcare-seeking behavior. However, additional research should be done with a larger sample.

Summary: Low back pain is the most common reason for referral to musculoskeletal care in the Canadian military. With healthcare seeking for musculoskeletal care rising over the past five years, and healthcare easily accessible for all military personnel, it is important to investigate factors that may contribute to high usage of the military healthcare system. Objective: To explore the association between LBP prognostic factors and musculoskeletal healthcare seeking for LBP in Canadian military population Methods: Historical cohort study, using data linkage. Results: In our exploratory analysis, fear of movement/(re)injury, Veterans Affairs compensation status, post-traumatic stress disorder, previous high use of musculoskeletal services, history of LBP, and military duty status were associated with healthcare seeking. For our confirmatory analysis, pain-related fear had an independent association with healthcare seeking in this population. Conclusion: Psychological and social factors are associated with the rate of musculoskeletal healthcare seeking in this military population.

Problem Statement: Many developing countries are still grappling with poor health as a result of strained healthcare systems. Top among health inequalities is maternal care with maternal mortality rates being almost 19 times higher in developing countries than in their developed counterparts. mHealth presents the potential for developing countries to overcome some of the traditional healthcare challenges. However, despite the compelling evidence for the potential of maternal mHealth from the plethora of effectiveness studies, why when and how interventions work/do not work in different contexts are not fully understood. Socio-cultural factors are one of the most cited reasons for variance in uptake and utilisation of such technologies. To date, research explaining how socio-cultural factors shape mHealth utilisation is sparse. Purpose of the study: The main objective of the study was to explain how mHealth utilisation behaviour emerges within the healthcare-seeking socio-cultural context. To achieve the objective, the study identified the socio-cultural characteristics of the maternal healthcareseeking context and analysed the user-technology interaction within this context. Research methodology: Building on the foundation that human experiences are best understood in situ, the study adopted explanatory methods guided by an interpretivist paradigm. The study drew upon Activity Theory as a lens to understand the maternal mHealth utilisation phenomenon. Hence, we theorised healthcare-seeking as an activity whose cultural aspects were further understood using Hofstede typology of culture. The study used a Kenyan maternal mHealth intervention to elucidate the phenomenon. We employed semi-structured interviews, focus group discussions, observations, informal discussions, and document review to gather data. The sample was purposively selected and comprised various maternal health stakeholders: maternal health clients, their partners, project implementers and healthcare professionals. Key findings: The results of the study show that the healthcare-seeking socio-cultural context which is characterised by socio-cultural attributes such as high-power distance, high uncertainty avoidance, gendered relations, and collectivism shapes mHealth utilisation behaviour in a dialectical process. This process takes place as maternal health clients shape and are shaped by mHealth within their healthcare-seeking socio-cultural context through a process of internalisation and externalisation. From an internalisation perspective, uncertainties and risks in the maternal healthcare-seeking context resulted in hesitated adoption. Contextual perceptions of usefulness of the intervention resulted in the use of mHealth to substitute other healthcare structures while having different perceptions of the role of mHealth created dissonance among the maternal health clients. With regards to externalisation, maternal health clients adopted legitimisation strategies to reduce uncertainties and to develop trust required for initial and continued use of the intervention. They legitimised both the intervention artifact, and the information. Since the mHealth intervention presented appropriate social cues, being accompanied by the expected health provider's persona, maternal health clients readily humanised the intervention. The contextual social norms around pregnancy also presented a need for the maternal health clients to make their mHealth use an ‘appropriate behaviour' by negotiating use with relevant stakeholders in the context. Finally, in response to mHealth technology paradoxes that challenged the very motive of healthcare-seeking, maternal health clients coped by abandoning mHealth, or otherwise accommodating it. Originality/contribution: This study contributed to knowledge, theory, and practice. First, the study suggests theoretical propositions that explain how mHealth utilisation behaviour emerges. These findings may be useful to similar developing-country contexts. A further contribution to theory emerges from the use of Activity Theory to understand the phenomenon. The study helps to operationalise Activity Theory concepts in Information Systems research. Second, the study provides recommendations to practise with regard to the design and implementation of mHealth interventions. These insights may be useful to mHealth designers and implementers in designing mHealth solutions that are contextually relevant. Here, we propose the consideration of mHealth intervention characteristics that will aid utilisation, involving healthcare professionals and other community stakeholders in mHealth implementation and integrating mHealth into existing healthcare structures.

Thesis (MPH.) -- University of Limpopo, 2020 / Background Health status and access to adequate healthcare are vulnerabilities that undocumented migrants face in the receiving country. The purpose of the study was to explore the experiences of undocumented Zimbabwean migrants on accessing public healthcare services in the Tshwane Metro, South Africa. Methods A qualitative, descriptive and exploratory research was conducted to explore the experiences of undocumented Zimbabwean migrants on accessing public healthcare services in Tshwane Metro, South Africa. A group of undocumented Zimbabwean migrants (n=20) were purposively sampled. Data were analysed using a grounded approach. Results The study has highlighted the challenges undocumented Zimbabwean migrants living in the Tshwane Metro, South Africa face when trying to access public healthcare services. The study also highlighted the alternative health-seeking strategies the migrants were using to access health services. The findings revealed that there were tensions between public health workers and undocumented migrants. These tensions were contrary to international compacts as well as the policy provisions of the South African government. Conclusion A human rights paradigm needs to be central to any dialogue regarding migrants, legal or illegal, as their health status was invariably entwined with that of the citizens of South Africa.

Malaria är ett globalt problem, som framförallt existerar i de tropiska delarna av världen. I Uganda uppskattas 25-40% av patienter som uppsöker statlig vård vara patienter som har relaterade malaria symtom. Eftersom Batwa är en minoritetsgrupp som skiljer sig från övriga Ugandier i sin historiska livsstil, undersöker denna studie hur denna grupp söker vård. Studien är kvalitativ och har använt sig av en etnografisk metod, därav tio intervjuer och en fokusgrupp diskussion för att samla data. Det teoretiska ramverket har varit medicinsk antropologiskt, där en hälsouppsökande modell har använts. Resultatet visar på en mängd olika hälsoalternativ för Batwa att söka vård inom. Dock skiljer sig Batwas hälsouppsökande beteenden från andra gruppers beteenden, enligt tidigare studier, och från det teoretiska ramverkets modell, som använts i uppsatsen. Batwa föredrar offentlig vård i högre grad, eftersom det är ett billigare och ett mer lättillgängligt alternativ att bli frisk på, i jämförelse med många andra alternativ. / Malaria is a global problem that exists mostly in the tropical region of the world. In Uganda approximately 25-40% of the patients who are seeking governmental healthcare are patients with malaria related symptoms. Because Batwa is a minority group who differ from other Ugandans in their historical lifestyle, the present study investigates how this group are seeking healthcare. The study is qualitative and has used an ethnographic method, whereby ten interviews and one focus-group discussion to collect data. The theoretical framework has been medical anthropology, where a healthcare seeking model has been used. The result reveals a varied spectrum of healthcare option for Batwa too seek treatment within. However, Batwa healthcare seeking behaviour differs from other groups of healthcare seeking behaviour, according to earlier studies, and from the model used in the theoretical framework in the present study. Batwa prefer governmental healthcare in a greater extent, because it is cheaper and a more accessible alternative to get treated, compared to many of the other alternatives.

Problématique : Dans les pays africains où les soins de santé sont encore payants au point de service, la barrière financière est un des obstacles majeurs au recours aux soins. Les indigents, qui sont les plus démunis, en sont les plus affectés. Pour faire face à ce défi, certains pays ont entrepris l’élaboration de programmes de santé ciblant les indigents pour leur permettre d’avoir un meilleur recours aux soins de santé par l’intermédiaire d’une exemption du paiement. Mais il existe un réel défi à identifier les indigents. De plus, peu d’études ont évalué l’impact de programmes d’exemption du paiement sur leur recours aux soins. Les indigents sont en majorité des personnes âgées avec des besoins importants en santé. Les personnes âgées en Afrique consultent très peu les professionnels de santé et les déterminants de leur recours aux soins sont peu connus. Pourtant, leur proportion est en augmentation dans les pays à faibles et moyens revenus. Ils sont en perte d’autonomie, ont de faibles revenus et présentent une prévalence élevée de maladies chroniques et d’incapacités fonctionnelles. Ces affections surviennent de façon précoce surtout chez les femmes. Objectifs : Cette thèse a pour objectifs : i) de déterminer le caractère équitable d’un processus de sélection communautaire des indigents au Burkina Faso qui vise à les faire bénéficier d’une exemption du paiement des soins; ii) de mesurer l’impact de ce programme d’exemption sur le recours aux soins de santé des indigents ; iii) d’analyser les facteurs associés au recours aux soins de santé par les personnes âgées au Nigéria. Méthode : Le cadre conceptuel de cette étude est le modèle d’Andersen et Newman qui regroupe les déterminants de l’utilisation des soins de santé en facteurs prédisposants (âge, sexe, état matrimonial, occupation), en facteurs facilitants (revenu, existence d’un recours à une aide financière, alimentaire ou instrumentale, cohabitation) et en besoins (présence de maladies chroniques et de limites de la vision, de la force musculaire et de la mobilité). Dans un premier temps, pour déterminer le caractère équitable d’une sélection communautaire des indigents, nous avons réalisé une étude transversale en 2010 dans le district de Ouargaye au Burkina Faso. Au cours de cette enquête, 1687 indigents ont été interrogés. La variable dépendante est la possession de la carte d’exemption du paiement des soins. Des analyses bivariées et une régression logistique ont été réalisées. Dans un deuxième temps, à partir d’un devis quasi expérimental pré/post, nous avons évalué les effets de ce programme d’exemption du paiement des soins sur le recours aux soins de santé des personnes en situation d’indigence au Burkina Faso. Au cours de cette recherche, 1224 indigents ont été interrogés en 2010 sur leur recours aux soins de santé. Parmi eux, 540 ont été sélectionnés et ont reçu une carte d’exemption du paiement des soins. Un an plus tard, un suivi a été réalisé avec un taux de rétention de 55,3%. Des analyses bivariées et une régression logistique ont été réalisées. Dans un troisième temps, à partir des données d’une étude transversale nationale, le General Household Survey de 2012-2013 du Nigéria qui couvre toutes les régions du pays, nous avons étudié le recours aux soins de 3587 personnes âgées dont 850 ont déclaré avoir été malades. Nous avons tenté d’identifier les facteurs qui y sont associés. Des analyses pondérées bivariées et une regression de Poisson pondérée ont été effectuées. Résultats : Au Burkina Faso, l’exemption du paiement des soins a été accordée en majorité aux veufs (ves) (OR=1,40 IC 95% [1,10-1,78]), à ceux qui ne bénéficient pas d’aide financière de leur ménage pour recourir aux soins de santé (OR=1,58 IC 95% [1,26-1,97], qui vivent seuls (OR=1,28 IC 95% [1,01-1,63]), qui vivent avec leurs époux/se (OR=2,00 IC 95% [1,35-2,96], qui ont des troubles de la vision (OR=1,45 IC 95% [1,14-1,84]), qui ont une faible force musculaire et une bonne mobilité (OR=1,73 IC 95% [1,28-2,33]). Le processus de sélection communautaire des indigents n’est pas parfaitement équitable, car très restrictif, bien qu’il ait permis de sélectionner les plus démunis. Il existe des différences de genre concernant les déterminants du recours aux soins chez les indigents. Être veufs (OR=0,53 IC 95% [0,33-0,81]) et avoir des troubles de la vision (OR=0,42 IC 95% [0,28-0,63]) freinent le recours aux soins chez les hommes, mais pas chez les femmes. Les maladies chroniques demeurent un obstacle commun aux hommes (OR=4,05 IC 95% [2,84-5,77]) et aux femmes (OR=2,14 IC 95% [1,54 – 2,97]). Le fait d’être exempté du paiement des soins n’est pas associé à l’augmentation de l’utilisation des services de santé (OR=1,1 IC 95% [0,80-1,51]). Qu’ils aient bénéficié ou pas de l’exemption du paiement des soins, les indigents qui ont un âge supérieur à 69 ans (OR=1,66 IC 95% [1,05-2,64]), qui appartiennent au genre masculin (OR=1,44 IC 95% [0,99-2,08]), qui appartiennent à un ménage à faible revenu (OR=1,71 IC 95% [1,15-2,54]) et ceux qui ont recours à l’aide financière familiale pour accéder aux soins de santé (OR=1,59 IC 95% [1,1-2,28]), sont les plus susceptibles d’augmenter leur utilisation des soins de santé. Au Nigéria, seulement 53% des personnes âgées ont consulté un agent de santé suite à un épisode de maladie. L’absence de scolarisation (PR = 0.73, 95% CI [0.6 0–0.8]), la faiblesse du revenu de ménage (PR = 0.75, 95% CI [0.5–0.9]), et le fait de résider dans les zones du Sud-Sud (PR = 0.59 95% CI [0.4–0.7]) et du Sud-Ouest (PR = 0.60 95% CI [0.4–0.7]), constituent des freins à la consultation d’un agent de santé. Conclusion La sélection communautaire est une des méthodes qui semble avoir permis de sélectionner les indigents avec une prévalence élevée de besoins en santé et d’obstacles économiques au recours aux soins. Cependant, l’exemption du paiement des soins n’est pas suffisante pour améliorer leur recours aux soins. Les déterminants de leur recours aux soins différent selon le genre, mais les maladies chroniques constituent un motif commun. Les personnes âgées et les indigents ont des caractéristiques communes telles que l’âge avancé, mais certains facteurs qui déterminent leurs recours aux soins diffèrent. Le déterminant commun est le facteur financier, soit la capacité contributive de ces personnes dans un contexte où l’utilisateur des services de santé est le payeur. En attendant la couverture universelle de soins, il serait approprié que les interventions pour améliorer le recours aux soins ciblent en premier lieu les populations ayant des besoins importants telles que les indigents et les personnes âgées en ôtant la barrière financière. Pour les indigents par contre, il faudrait y ajouter des mesures additionnelles comme, par exemple l’accompagnement, le transport et les frais d’hébergement. Enfin, les interventions doivent aussi considérer les différences de genre qui existent dans les facteurs qui déterminent leur recours aux soins. / Problem In African countries with point-of-service healthcare user fees, financial barriers are one of the major obstacles to healthcare-seeking behaviour, and the indigent, the poorest members of society, are the most affected. To address this issue, some countries have begun developing health programs targeting indigent people to help them gain better access to healthcare by waiving healthcare fees. Unfortunately, it is a genuine challenge to identify those who are indigent. In addition, few studies have assessed the impact of user fees exemption programs on healthcare-seeking behaviour. The majority of indigent people are older with significant health needs. Older people in Africa do not often consult health professionals. The determinants regarding healthcare-seeking behaviour by older people is little-known, although proportionately, their numbers are increasing in low- and middle- income countries. They are losing their autonomy, have little income and have a high prevalence of chronic diseases and functional disabilities. These problems occur early on, especially among women. Objectives The objectives of this thesis are as follows: (i) to determine the equitable nature of a community-based selection process for indigent people in Burkina Faso that aims to exempt them from paying healthcare user fees; (ii) to measure the impact of this user fees exemption program on healthcare-seeking behaviour among indigent people; (iii) to analyze the factors associated with healthcare-seeking behaviour by older people in Nigeria. Method The conceptual framework of this study is based on the model developed by Andersen and Newman, which groups healthcare use determinants into predisposing factors (age, gender, marital status, occupation), enabling factors (income, means and know-how to access financial, food or instrumental assistance, social relationships), and needs (presence of chronic disease and vision, muscle strength and mobility limitations). To determine the equitable nature of a community-based selection of indigent people, we carried out a cross-sectional study in 2010 in the Ouargaye District of Burkina Faso, in which 1687 indigent people were interviewed. The dependent variable was possession of an exemption card. Bivariate analyses and logistic regression were performed. Next, using a quasi-experimental before/after approach, we assessed the effects of this user fees exemption program on healthcare-seeking behaviour by indigent people in Burkina Faso. To that end, 1224 indigent people were interviewed in 2010 about their healthcare-seeking behaviour. Among them, 540 were selected and received an exemption card. One year later, a follow-up was conducted, with a 55.3% retention rate. Bivariate analyses and logistic regression were performed. Finally, using data from a national cross-sectional study, the Nigerian 2012–2013 General Household Survey, which covers all the country’s regions, we studied healthcare-seeking behaviour by 3587 older people, of whom 850 stated that they were ill. We attempted to identify the associated factors. Weighted bivariate analyses and a weighted Poisson regression were performed. Results In Burkina Faso, healthcare payment waivers were mainly granted to widows or widowers (OR=1.40 IC 95% [1.10–1.78]), to those who do not receive financial support from their household for healthcare (OR=1.58 IC 95% [1.26–1.97], or those who live alone (OR=1.28 IC 95% [1.01–1.63]), or with their spouse (OR=2.00 IC 95% [1.35-2.96], who have vision impairment (OR=1.45 IC 95% [1.14–1.84]), who have limited muscle strength and good mobility (OR=1.73 IC 95% [1.28–2.33]). The community-based selection process of indigent people is not completely equitable, although it did enable the most needy to be selected. There are gender differences concerning healthcare-seeking behaviour determinants among indigent people. Being a widower (OR=0.53 IC 95% [0.33–0.81]), and having vision impairment (OR=0.42 IC 95% [0.28–0.63]) were factors limiting healthcare-seeking behaviour among men but not among women. Chronic diseases remain a common obstacle among men (OR=4.05 IC 95% [2.84–5.77]) and women (OR=2.14 IC 95% [1.54–2.97]). User fees exemption is not associated with an increased use of healthcare services (OR=1.1 IC 95% [0.80–1.51]). Whether they received or did not receive exemption cards, indigent people over the age of 69 (OR=1.66 IC 95% [1.05–2.64]), who were male (OR=1.44 IC 95% [0.99–2.08]), who belong to a low-income household (OR=1.71 IC 95% [1.15–2.54]), and those who had financial assistance from family to access healthcare (OR=1.59 IC 95% [1.1–2.28]), are more likely to increase their use of healthcare. In Nigeria, only 53% of older people consulted a health practitioner after an episode of illness. Lack of education (PR = 0.73, 95% CI [0.60–0.8]), low household income (PR = 0.75, 95% CI [0.5–0.9]), and residence in Nigeria’s South South (PR = 0.59 95% CI [0.4–0.7]) and South West zones (PR = 0.60 95% CI [0.4–0.7]) constituted limitations to consulting a health practitioner. Conclusion Community-based selection is one method that appears to have made it possible to select indigent people with a high prevalence of health needs and obstacles to seeking healthcare. Healthcare payment waivers are not sufficient to increase their healthcare-seeking behaviour. Healthcare use determinants differ according to gender, but chronic disease constitutes a common theme. Elderly and indigent people have common characteristics, such as advanced age, but some factors that determine their healthcare-seeking behaviour differ. The common determinant is the financial factor, i.e., the contributory capacity of these people in a context where the user pays. Until there is universal healthcare coverage, it would be appropriate to ensure that activities to improve healthcare-seeking behaviour primarily target populations with significant needs, such as indigent and elderly people, by removing financial barriers. For indigent people, however, additional measures must be included, such as accompaniment, transportation and accommodation expenses. And activities must also take existing gender differences into account among the factors determining their healthcare-seeking behaviour.