Clinics and Churches: lifeworlds and health-seeking practices of older women with noncommunicable disease in rural South Africa

BMC International Health and Human Rights

Stephen M. Tollman¹  Daniel Lopes Ibanez-Gonzalez² 

[1] MRC/Wits Rural Public Health and Health Transitions Research Unit, University of the Witwatersrand, Johannesburg, South Africa;MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa

关键词: Chronic;    Illness and disease;    Health seeking;    Users’ experiences;    Healthcare;    Remote/Rural;    Healthcare;    Access to;    Healthcare;    Theory of communicative action;    Lifeworld;   

Others  :  1207587
DOI  :  10.1186/s12914-015-0051-1

 received in 2014-11-09, accepted in 2015-05-19,  发布年份 2015

【 摘 要 】

Background

In this article we describe a phenomenological lifeworld study based on the theory of communicative action of 13 women with noncommunicable disease (NCDs) in a rural area in South Africa. The purpose of the study was to generate key concepts of health care access and the management of NCDs in a rural South African context.

Methods

The study employed a qualitative methodology with serial semistructured interviews. We used a content analytical approach to analyse key themes and patterns in participants’ narratives of NCDs and health care access.

Results

The findings are reported by theme and include analyses of narrative sequences related to 1) family environment, 2) experiences of NCDs, 3) understandings of the causes of NCDs, 4) accessibility of formal health care services, 5) experiences of formal health care services, 6) treating NCDs, and 7) experiences of informal health care services. The findings suggest that participation in the routines prescribed by formal health care services and reinforced by families and faith-based communities normalises the experience of NCDs to the extent that narratives of NCDs form the background, rather than the focus of broader illness narratives. Such narratives rather tend to focus on significant life events and relationships. The key features of the narratives include connections between social or autobiographical and biological understandings of NCDs, the appropriation of modern concepts of disease in illness narratives, and reflexive commentary on the modern features of NCDs. In the context of such narrative expertise formal health care services have a high level of acceptability in this rural area.

Conclusion

Lifeworld analysis of health care access based on the theory of communicative action places consensual understandings of NCDs and their treatment as central to the health care experience. Our findings suggest that such analyses can facilitate potential feedback processes between health care users and professionals which generate consensus as well as institutional reform within formal health care services.

【 授权许可】

   
2015 Lopes Ibanez-Gonzalez and Tollman; licensee BioMed Central.

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