‘Working to stay healthy’, health-seeking behaviour in Bangladesh’s urban slums: a qualitative study

BMC Public Health

Nell Gray¹  Beverly Stringer¹  Sadika Akhter²  Aminur Rahman²  Animesh Biswas³  Martins Dada⁴  Jeroen van der Heijden⁴  Stobdan Kalon⁴ 

[1] 0000 0004 0439 3876, grid.452573.2, Manson Unit, Médecins Sans Frontières, Chancery Exchange, 10 Furnival St, EC4A 1AB, London, UK;0000 0004 0600 7174, grid.414142.6, International Centre for Diarrhoeal Disease Research, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, 1212, Dhaka, Bangladesh;Centre for Injury Prevention and Research Bangladesh (CIPRB), House B 162, Road 23, New DOHS, Mohakhali, 1206, Dhaka, Bangladesh;grid.452780.c, Médecins Sans Frontières OCA, Plantage Middenlaan 14, 1018 DD, Amsterdam, Netherlands;

关键词: Slum;    Urban;    Health;    Worker;    Sexual and reproductive health;    Health-seeking behaviour;   

DOI  :  10.1186/s12889-019-6750-0

来源: publisher

【 摘 要 】

BackgroundKamrangirchar and Hazaribagh are the largest slum areas in Dhaka, Bangladesh. In 2013, Médecins Sans Frontières initiated an urban healthcare programme in these areas providing services for factory workers and responding to the sexual and reproductive health needs of young women. Little in-depth information is available on perceptions of health and health seeking behaviour in this population. We aimed to provide a better understanding of community perceptions toward health and health care in order to inform programme strategies.MethodsIn-depth interviews were conducted with women (n = 13); factory workers (n = 14); and key informants (n = 13). Participants were selected using purposive maximum variation sampling and voluntarily consented to take part. Topic guides steered participant-led interviews, which were audio-recorded, translated and transcribed from Bangla into English. By comparing cases, we identified emerging themes, patterns and relationships in the data. NVivo11© was used to sort and code the data.ResultsEmerging themes indicated that in Kamrangirchar and Hazaribagh, health is seen as an asset necessary for work and, thus, for survival. Residents navigate a highly fragmented health system looking for ‘quick fixes’ to avoid time off work, with the local pharmacy deemed ‘good enough’ for ‘common’ health issues. Health care seeking for ‘serious’ conditions is characterised by uncertainty, confusion, and unsatisfactory results. Decisions are made communally and shaped by collective perceptions of quality care. People with limited socio-economic capital have few options for care. ‘Quality care’ is perceived as comprehensive care ‘under one roof,’ including predictive biomedical diagnostics and effective medication, delivered through a trusting relationship with the care provider.ConclusionsHealth seeking behaviour of slum dwellers of Kamrangirchar and Hazaribagh is based on competing priorities, where quick and effective care is key, focussed on the ability to work and generate income. This takes place in a fragmented healthcare system characterised by mistrust of providers, and where navigation is informed by word-of-mouth experiences of peers. Improving health in this context demands a comprehensive and integrated approach to health care delivery, with an emphasis on rapid diagnosis, effective treatment and referral, and improved trust in care providers. Health education must be developed in collaboration with the community to identify knowledge gaps, support decision-making, and be channelled through existing networks. Further research should consider the effectiveness of interventions aiming to improve the practice of pharmacists.

【 授权许可】

CC BY