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OBJECTIVES: To explore the health-seeking behaviour of Ethiopian caregivers when infants are unwell. DESIGN: A qualitative descriptive approach was employed using in-depth interviews and focus group discussions. Data were collected using semistructured interview guides. SETTING: The study was conducted in East Gojjam zone, Amhara region, northwest Ethiopia. PARTICIPANTS: Participants were selected using a maximum variation purposive sampling technique across the different study groups: caregivers, community members and healthcare providers. A total of 35 respondents, 27 individuals in the focus group discussions and 8 individuals in the in-depth interviews participated in the study. METHOD: In this study, a qualitative descriptive approach was employed to explore the health-seeking behaviour of caregivers. The data were collected from July to September 2019 and conventional content analysis was applied. RESULTS: The decision to take a sick child to healthcare facilities is part of a complex care-seeking process that involves many people. Some of the critical steps in the process are caregivers recognising that the child is ill, recognising the severity of the illness and deciding to take the child to a health institution based on the recognised symptoms and illness. In Ethiopia, a significant proportion of caregivers do not seek healthcare for childhood illness, and most caregivers do not know where and when to seek care for their child. This study points out that the health-seeking behaviour of caregivers can be influenced by different contextual factors such as caregivers’ disease understanding, access to health services and family pressures to seek care. CONCLUSIONS: Healthcare-seeking practice plays an important role in reducing the impact of childhood illnesses and mortality. In Ethiopia, home-based treatment practice and traditional healing methods are widely accepted. Therefore, contextual understanding of the caregivers’ health-seeking is important to design contextual healthcare interventions in the study area.
The study was conducted in the East Gojjam zone, in the Amhara region of Ethiopia, from July to September 2019. The zone is located in the east part of Amhara, which is in the north-western part of Ethiopia and has a land area estimated at 170 000 km2, with a population density of 110/km2. According to a 2007 Central Statistics Agency report, East Gojjam zone has an estimated population of 2 153 937 and an area of 14 000 km2, giving a population density of 153.80/km2.22 Nearly 84% of the people living in rural areas are engaged in agricultural activities, mostly comprising subsistence farming.23 According to the 2015–2016 Amhara regional report, the level of poverty in the region was higher than in the nation: 26.1% of the region’s population lived in poverty, compared with 23.5% of the entire country’s population.23 Regarding access to health services, the region had a poor health status compared with other regions in Ethiopia.23 The rate of child mortality in the region was among the highest in the country, 85 deaths per 1000 live births;24 it also had the highest stunting rate compared with other regions in the country, 46% of the under 5 children were stunting in 2016.23 24 A qualitative study was used to explore caregivers’ and healthcare providers’ experiences of health-seeking behaviours when infants were unwell. Qualitative descriptive is a method for research that seeks to present the voice of the particular population under study. Qualitative description approaches help the researcher remain closer to the words and meanings offered by informants and can offer a comprehensive summary of a phenomenon in simple terms.25 26 Naturalistic inquiry involves studying something in its natural state such that variables are neither predetermined nor manipulated, and no a priori commitment is made to any particular theoretical viewpoint.25 Researchers conducting qualitative descriptive studies stay closer to their data and to the surface of words and events than researchers conducting grounded theoretic, phenomenological, ethnographic or narrative studies.25 A maximum variation purposive sampling technique was used across the different groups of participants (caregivers, communities and healthcare providers). In-depth interviews and focus group discussions were conducted with healthcare providers and caregivers, respectively. The number of focus group discussions was determined by data saturation and a total of five focus group discussions were conducted: two were conducted with primary caregivers at health centres and health posts during child vaccinations and another three were conducted with community members (fathers, grandmothers and community leaders). The focus group discussion with caregivers was held at a separate location away from the health centre and health post. Focus group discussions with community members were conducted at a central place within the village. An investment of time is required of participants, so they received remuneration of $A10.00 (the average daily wage for a labourer in Ethiopia) and per diem for health workers. The payment was made at the end of the interview and focus group discussion. Additionally, eight key informant interviews were conducted: four with healthcare providers working in maternal and child health units (two with health extension workers and two with nurses) and another four with community leaders. The lead researcher and data collectors who were native speakers of the local language, Amharic, conducted the focus group discussions and interviews. Two healthcare providers from a local university who had previous experience in interviews and moderating focus group discussions and who had work experience in the area for more than a year were recruited as data collectors. The data collectors undertook appropriate training to understand the cultural context, values and norms of the community prior to conducting the interviews. Male focus group discussion was moderated by male and female focus group discussion was moderated by female. The interviews were conducted at a private room in the health post and health centre. Audio was recorded with prior consent of the informants, and the recordings were transcribed verbatim. In addition, field notes were used and transcribed. The focus group discussion takes around 2 hours. Data analysis began immediately following data collection and continued throughout the research process. We applied conventional content analysis, which allowed for the continuing data collection to inform and be informed by emerging analyses. Content analysis is a procedure for the categorisation of verbal or behavioural data for the purpose of classification, summarisation and tabulation. It is generally used to describe a phenomenon: in this case, caregivers’ health-seeking behaviours for infant and newborn health services. Conventional content analysis involves the identification, coding and categorisation of primary patterns in the data to ultimately draw meaningful relationships for study.27 It allows for researchers’ immersion in the data to allow new insights to emerge.27 First, audio recordings of focus group discussions and key informant interviews were transcribed to the local language, Amharic, by the data collectors. The transcribed data were then translated into English. After repeated reading of focus group discussion and key informant interview transcripts, coding frames were generated. We used NVivo V.1228 to assign codes to text and to assign strict defining parameters to the codes, thereby maximising consistency in the coding process. The interviews with healthcare workers and focus group discussions were coded separately and three data coders coded the data. Once all the interviews and group discussions were coded, the codes were categorised into larger themes that directly corresponded to the primary research questions. Within each of the broad themes, data were sorted into more narrow constructs, concepts and categories to allow for data interpretation.27 No patient was involved in the development of the research questions and outcome measures, study design or recruitment, and in the conduct of this study.
