Problem StatementTo better understand the barriers for seeking primary health-care from Sughavazhvu for patients whohave been diagnosed with CVD chronic disease condition such as Diabetic Mellitus, Hypertension andHyperlipidemia through our community based RRA strategy. The barrier include :(a) Preferred health-care provider – private & public, including those who are currently not seeking care(b) Attitude towards their health condition(c) Behavior(d) Quality of care(e) Affordability(f) Accessibility(g) Awareness about the disease conditionby means of Qualitative interviews (Sample Size 28 individuals) representing all disease categoriesthrough household visits. The duration of the study spanned about one and half months in the entirecatchment of Andipatti RMHC. The final outcome will help develop Home based interventions, andexplore targeted awareness talks/HH visits on medication compliance and diagnostics through secondHEW.
Qualitative InterviewQualitative Interview: We started Qualitative interview with an appropriate greeting and anintroduction about our project and its purpose by means of :a)Unstructured interview – allowed the patient to express themselves freely with minimalcontrol of responses and feel comfortableb)Semi-structured interview – Obtained specific details about our topic with well preparedquestionnaire which helped us to seek maximum informationc)Structured interview – Stimulated the patients by using some probing techniques to gainfurther information which have been missed.
Study design Home Visits (Qualitative interviews are done for 28 individuals through household visits inthe entire catchment of Andipatti RMHC) Geo Commons(Identified location of patients households by using geo commons) Civil dress(We decided to conduct the interviews in civil dress not representing as SV staffin order to help the patients to express themselves freely and feel comfortable) Record of the interview(All the 28 individuals conversation is recorded in order to takenotes of the conversation and to study about their actual barriers in seeking health care) Documentation(Documented the entire interviews which contains detailed informationabout their name,age,diagnosis and personal issues of every individuals) Analysis(From every individuals documentation ,we developed good study about the majorbarriers in seeking health care)
Private / Male/ Female/not old/highincome/independentKey Observations (General) on their preference for Seeking Care in the Private Sector:1. Trust(Good explanation of disease condition, elaborate personalized consultation, close follow-up)2. Loyalty3. Long term Association(Regular Medication for 10yrs to 20yrs from the same Medical Provider; Recommending thesame provider to other members of the family)Key Observations – SughaVazhvu Healthcare Encounters1. Lack of interaction2. Self orientation(Upon consultation within the C. Clinic format, they did not receive good attention about theirdisease condition. They were not very happy with the simple recommendation of following-upthrough an another visit to the RMHC)
Private/Male/Female/Old/High Income/DependentKey Observations(General) – Other than observations on Trust, Loyalty and Long termAssociation the most significant observations was:1. Dependent(For decision making on their spouse/son. The entire family seek care from the same, andrecommend the same for their dependent members as well)
Public/Male/Female/Not old/Low income/IndependentKey Observations(General):1.Cost(Reported existing liability such as House loan and Jewel loans; Insufficient monthly income tomeet their basic needs)2.Travel(Expressed sensitivity towards time (bus etc.; daily wage loss) and expenditure)3.Trust(Elaborate medical infrastructure such as diagnostics, and various specialties available together )4.Long term association(Taking medication regularly for about 15 to 20 years)Key Observations – Sughavazhvu Healthcare Encounters:1.Accessability to RMHC( Don’t have two wheeler, Lack of bus facility, Difficulty to walk upto the RMHC due to distance of4 to 5km from the household)
Public/Female/Not old/Low income/DependentKey Observations (General)1.Cost( Unemployed – not the self earning person hence she is dependentto meet her own needs)2.Dependent ( for decision making and money on their spouse/son)
Public/Male/Female/Old/Low income/DependentKey Observations(General)1.Cost( Unemployed – unable to work due to their age and physical weakness ;familymembers also unable to pay for the old people in their family since they belong to lowincome category)2.Dependent(Some are unable to walk due to old age and will not go for consultation tothe public hospital; any one of their family members will go to Public and get theirmedication regularly; Some are able to walk and they travel by bus and get theirmedication regularly)
Public/Male/Female/Old/High income/DependentKey Observations(General):1.Dependent ( for money and decision making on their son; They are depressed andfeel alone in their household; Their family not ready to pay for the old people in theirhousehold though belonged to high income category)
Public/Male/Old/High income/IndependentKey Observations(General):1.Long term of association( Take medication regularly for about 7 years and they feelcomfort with the diagnostics offered on regular basis by the public hospital)Key Observations – Sughavazhvu Healthcare Encounters1. Willing to seek care from SV( He feel like giddiness and exhausted whiletravel by bus to the public hospital due to the distance of 25 to 30 kmfrom the house.Hence willing to seek care from SV)Recommendations1.Regular follow up with phone call and Home visits( Since patient willingto shift to SV due to travel issue , we should follow up the patient regularlyand build trust by making phone calls &home visits to provide diagnosticsand medication regularly by the doctor) )
Not seeking care/Male/Not old/Highincome/IndependentKey Observations(General):1.Procrastination (They give priority to work and very busy in their daily activities;Some are alcoholic dependent and they drink everyday; They will not listen to thewords of their family)Awareness(Lack of awareness about their disease condition )Key Observations – Sughavazhvu Healthcare Encounters:1.Trust (When he visited to the CVD report clinic in SV, he doesn’tget clarified about his diagnosis; Hence willing to double checkwith other provider in order to confirm the diagnosis once againand undergo medication regularly )Recommendations:1.Home visit(Building trust from SV part and to create awareness by clearcut explanation about his diagnosis and its symptoms)2.Home based care model( Household visits by the doctor for medicationand diagnostics regularly )
Not seeking care/Female/Not old/Highincome/DependentKey Observations(General):1.Awareness(Lack of awareness about her disease condition)2.Dependent(for money and decision making on her spouse/son)3.Travel(Unable to walk to SV due to the distance of 5 to 6km from thehousehold)Key Observations – Sughavazhvu Healthcare Encounters:1.Self orientation(She doesn’t feel happy with the consultation provide by the doctor .She hastaken medication from SV for first 15 days; When she went to the CVD blood reportdistribution clinc for second time to continue the medication, She was told that prescriptioncan be delivered only after gone through the laptop present in the RMHC ;Hence felt that thedoctor is self oriented)Recommendations:1.Awareness( Awareness about the disease condition should be provided to both thepatient and her spouse/son who is the decision maker)2.Home based model(Since the patient feel travel as an issue to SV, we can prefer homebased care model for medication and diagnostics)3.Home visit and phone calls(Trust building from SV part)
Not seeking care/Male/Female/Old/Lowincome/DependentKey Observations(General):1.Cost(Some people work on the field rarely and earn which is not sufficient to meet theirbasic needs and some are unable to work )2.Awareness(Lack of awareness about their disease condition)3.Travel( Unable to walk anywhere due to old age and physical weakness)4.Procrastination( Lack of interest in seeking care due to old age)Key Observations- Sughavazhvu Healthcare Encounters:1.Irregular medication(50% of people taken medication for first 15 days from SV and thendropped. The reason behind that they paid since they earn occasionally on the field andremaining 50% of people have not taken any medication for the mentioned diseasecategory since they procrastinate due to lack of interest and awareness. Specifically oneperson shifted to out of catchment for self earning work)
Not seeking care/Male/Not old/Lowincome/IndependentKey Observations(General):1.Cost( Insufficient monthly income to meet their basic needs, spending for theirson/daughter higher study)2.Procrastination( They give priority to work, very busy in their work schedule)Key Observations – Sughavazhvu Healthcare Encounters1.Cost deduction( Expecting cost deduction from SV. Able to spend aroundRs 150 – 200 per month for medication)Recommendations:1.Awareness (About disease condition and explaining the importance ofhealth )
Main Learnings and RecommendationsTrustAwarenessAccessibilityCostProcrastinationMental depressionDependentLearnings:Recommendations:Good explanation of disease conditionElaborate personalized consultationClose follow upAwarenessHome based SV modelHome visit and Phone callsCounseling
FeedbackShare your general views about this Qualitative interviews?Do you think this analysis will be more effective on better understanding of ourcommunity?What kind of interventions can be implemented to meet all those barriers?What are all the challenges you may face to meet all these barriers as a Physician?Based on this presentation ,What would you like to share about the community asa HEW?