Gender and tuberculosis control Perspectives on health seeking behaviour among men and women in Vietnam

This study explores the perspectives of tuberculosis patients on which fact ors influenced their health seeking behaviour, with special reference to ge nder differentials in terms of delays in health seeking. In 1996, a multi-d isciplinary research team carried out 16 focus group discussions. The study was done in four districts in Vietnam, both in the south and north of the country and in urban and rural areas. Qualitative analysis of data was perf ormed following general principles of modified grounded theory technique. P articipants in the focus groups described three main factors as contributin g to delay in health seeking. These were fear of social isolation, economic constraints and inadequate staff attitudes and poor quality of health serv ices. A model illustrating different factors influencing health seeking was elaborated acid served as a basis for discussion of the findings. The main factor contributing to delay among women was described as fear of social i solation from the family or the community. Stigma was described as closely related to contextual factors such as gender-roles, socio-economic status a nd level of education and seemed to be mediated via denial and concealment of tuberculosis diagnosis and disease, thus causing delay. The main factor contributing to delay among men was described as fear of individual costs o f diagnosis and treatment. Staff attitudes and quality of health service fa cilities were described as not always corresponding to people's expectation s of appropriate health services. Women saw themselves and were seen by oth ers as being more sensitive than men to poor service conditions and staff a ttitudes. A typical feature of the described health seeking behaviour of me n was that they neglected symptoms until the disease reached a serious stag e, by which rime they tended to go directly to public health services witho ut first visiting private health practitioners. Women. on the other hand, w ere described as having a tendency to seek out private services and practic e self-medication before seeking care at public services. In conclusion. th ere is a need for better understanding of behavioural factors and for devel oping strategies, that take these into account. Health workers need to bett er understand gender and social aspects of tuberculosis control. particular ly aspects that influence the likelihood for achieving equity in diagnosis and cure. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.