Exploring factors affecting health seeking behavior of people ( Institutional delivery, Routine child immunization and COVID-19 vaccination) in Nepal



Ongoing (April 2022)


6 Months ( September 2022)


84421.2 USD




Helen Ward et al define health-seeking behavior (HSB) as “any activity undertaken by individuals who perceive themselves to have a health problem or to be ill for the purpose of finding an appropriate remedy.”[1] The concept of studying health seeking behaviors has evolved with time. Today, it has become a tool for understanding how people engage with the health care systems in their respective socio-cultural, economic and demographic circumstances.[2]Understanding health-seeking behavior has become a vital component of health management and system developments as it reduce delay to diagnosis, improve treatment compliance and improve health promotion strategies in a variety of contexts.

There are two approaches of HSB, which roughly correspond with a division identified by Tipping and Segall (1995).[3]Firstly there are studies, which emphasize the ‘end point’ (utilization of the formal system, or health care seeking behavior); secondly, there are those, which emphasize the ‘process’ (illness response, or health seeking behavior).[4]Health care seeking behaviors demonstrate how the decision to engage with a particular medical channel is influenced by a variety of socio-economic variables, sex, age, the social status of women, the type of illness, access to services and perceived quality of the service (Tipping and Segall, 1995) and they fall under the divisions of geographical, social, economic, cultural and organizational factors. HSB approach offers an opportunity to identify key junctions where there may be a delay in seeking competent care, and is therefore of potential practical relevance for policy development.4 The analysis of NDHS survey (2011 and 2016) on Maternal Health Care in Nepal: Trends and Determinants showed that women marginalized by geography, wealth, and education are less likely to access maternal health care. The study recommended for more focused interventions, targeting the underserved and most marginalized population.[1] A study conducted on Maternal health care-seeking behaviour of married adolescent girls: A prospective qualitative study in Banke District, Nepal showed that several factors influenced maternal health care-seeking behaviour of adolescents. At the individual level, girls’ perceptions, their lack of knowledge about maternal and reproductive health, certain traditional practices, their sole dependency on their husbands and mothers-in-laws and their low decision-making autonomy towards their own health care negatively influenced their utilization of skilled maternal health services. Mothers-in-law and other family members played a critical role in either encouraging or discouraging the use of skilled maternal health services. At the health systems level, lack of adolescent-friendly maternal health services, difficulties in accessing quality maternal health services, and the fixed operating hours of public health facilities restricted their ability to obtain services. The existence of the Safe Motherhood Programme, knowledge sharing platforms such as “women’s groups” and the active role of Female Community Health Volunteers (FCHVs) positively influenced utilization of skilled maternal health services among these girls.[2]

Similarly, a study on health care seeking behaviour of the mothers during childhood illness showed that the mothers were more likely to seek care when they perceived the illness as ‘serious’. Poor maternal knowledge of danger signs of childhood illness warrants the need for a complementary introduction of community-based Integrated Management of Childhood Illness programmes to improve family’s care seeking behaviour and their ability to recognize danger signs of childhood illness. Socioeconomic development of the urban poor may overcome their financial constraints to seek ‘appropriate’ and ‘prompt’ care during the childhood illness. Furthermore, a study on Perspectives on adolescent girls’ health-seeking behaviour in relation to sexual and reproductive health in Nepal reflected that lack of knowledge among adolescent girls and unmet needs of adolescent-friendly facilities affect their access to sexual and reproductive health care in Nepal. Lack of knowledge could be seen as a barrier, and as a reason why adolescent girls do not seek sexual and reproductive health care.[1] Improving the quality or coverage of health products and services is not, in many cases, sufficient to improve health outcomes. It also requires changing the health-seeking behaviors of individuals and communities, as well as the norms that underpin those behaviors. Interventions that seek to change behaviors by addressing factors such as knowledge, attitudes, and norms, known collectively as social and behavior change (SBC) interventions, complement and enhance the role played by health services. SBC interventions are critical to ensuring that people who are most in need can access available health care.[2]

Therefore, the prospect of this study will be to understand the health seeking behavior of Nepalese population on priority areas of health: maternal and child health, and COVID-19 vaccination. The enablers and barriers of HSB will be explored in detail from both supply and demand sides’ perspectives.

 


OBJECTIVE (S)

 

General Objectives

To explore factors influencing health seeking behaviors of people in Nepal.

Specific objectives

  • To explore underlying causes of health seeking behaviors for maternal and child health, and COVID-19 vaccination among people in Nepal.
  • To explore perception of health care professionals on health seeking behaviors of people.
  • To validate findings of desk review with qualitative studies on health seeking behaviors of people in Nepal.

Identification of the factors that influences Health Seeking Behavior of the people of Nepal in regard to maternal health (Institution Delivery), child health (Routine Child Immunization)  and COVID-19 vaccination. The study will also help triangulate the findings aforementioned indicators with the nationally available data. Also perception of the service provider of health in regards to health seeking behavior of people will also be identified.