The document summarizes a qualitative analysis of barriers to primary healthcare among patients with cardiovascular diseases in Andipatti, India. Home visits and interviews were conducted with 28 individuals representing different disease categories. Key barriers identified included preference for private providers due to trust and long-term relationships; cost and travel difficulties; lack of awareness; and procrastination. Recommendations focus on improving trust in Sughavazhvu through home visits, counseling, and a home-based care model to increase accessibility and adherence. The analysis could help develop targeted interventions and awareness activities to address identified barriers.

1. Qualitative Analysis – CVD Cohort
Management
Presentation by
Dr.Uma

2. Problem Statement
To better understand the barriers for seeking primary health-care from Sughavazhvu for patients who
have been diagnosed with CVD chronic disease condition such as Diabetic Mellitus, Hypertension and
Hyperlipidemia 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 condition
by means of Qualitative interviews (Sample Size 28 individuals) representing all disease categories
through household visits. The duration of the study spanned about one and half months in the entire
catchment of Andipatti RMHC. The final outcome will help develop Home based interventions, and
explore targeted awareness talks/HH visits on medication compliance and diagnostics through second
HEW.

3. Qualitative Interview
Qualitative Interview: We started Qualitative interview with an appropriate greeting and an
introduction about our project and its purpose by means of :
a)Unstructured interview – allowed the patient to express themselves freely with minimal
control of responses and feel comfortable
b)Semi-structured interview – Obtained specific details about our topic with well prepared
questionnaire which helped us to seek maximum information
c)Structured interview – Stimulated the patients by using some probing techniques to gain
further information which have been missed.

4. Study design
 Home Visits (Qualitative interviews are done for 28 individuals through household visits in
the 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 staff
in 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 take
notes of the conversation and to study about their actual barriers in seeking health care)
 Documentation(Documented the entire interviews which contains detailed information
about their name,age,diagnosis and personal issues of every individuals)
 Analysis(From every individuals documentation ,we developed good study about the major
barriers in seeking health care)

5. Sample Characteristics

6. Sample profiles
1. Private/Male & Female/Not old/High income/Independent
2.Private/Male & Female/Old/High income/Dependent
3.Public/Male & Female/Not old/Low income/Independent
4.Public/Female & Not old/Low income/Dependent
5.Public/Male/Female/Old/Low income/Dependent
6.Public/Male/Female/Old/High income/Dependent
7.Public/Male/Old/High income/Independent
8.Not seeking care/Male/Not old/High income/Independent
9.Not seeking care/Female/Not old/High income/Dependent
10.Not seeking care/Male/Female/Old/Low income/Dependent
11.Not seeking care/Male/Not old/Low income/Independent

7. Private / Male/ Female/not old/high
income/independent
Key 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. Loyalty
3. Long term Association
(Regular Medication for 10yrs to 20yrs from the same Medical Provider; Recommending the
same provider to other members of the family)
Key Observations – SughaVazhvu Healthcare Encounters
1. Lack of interaction
2. Self orientation
(Upon consultation within the C. Clinic format, they did not receive good attention about their
disease condition. They were not very happy with the simple recommendation of following-up
through an another visit to the RMHC)

8. Private/Male/Female/Old/High Income/Dependent
Key Observations(General) – Other than observations on Trust, Loyalty and Long term
Association the most significant observations was:
1. Dependent
(For decision making on their spouse/son. The entire family seek care from the same, and
recommend the same for their dependent members as well)

9. Public/Male/Female/Not old/Low income/Independent
Key Observations(General):
1.Cost
(Reported existing liability such as House loan and Jewel loans; Insufficient monthly income to
meet 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 of
4 to 5km from the household)

10. Public/Female/Not old/Low income/Dependent
Key Observations (General)
1.Cost( Unemployed – not the self earning person hence she is dependent
to meet her own needs)
2.Dependent ( for decision making and money on their spouse/son)

11. Public/Male/Female/Old/Low income/Dependent
Key Observations(General)
1.Cost( Unemployed – unable to work due to their age and physical weakness ;family
members also unable to pay for the old people in their family since they belong to low
income category)
2.Dependent(Some are unable to walk due to old age and will not go for consultation to
the public hospital; any one of their family members will go to Public and get their
medication regularly; Some are able to walk and they travel by bus and get their
medication regularly)

12. Public/Male/Female/Old/High income/Dependent
Key Observations(General):
1.Dependent ( for money and decision making on their son; They are depressed and
feel alone in their household; Their family not ready to pay for the old people in their
household though belonged to high income category)

13. Public/Male/Old/High income/Independent
Key Observations(General):
1.Long term of association( Take medication regularly for about 7 years and they feel
comfort with the diagnostics offered on regular basis by the public hospital)
Key Observations – Sughavazhvu Healthcare Encounters
1. Willing to seek care from SV( He feel like giddiness and exhausted while
travel by bus to the public hospital due to the distance of 25 to 30 km
from the house.Hence willing to seek care from SV)
Recommendations
1.Regular follow up with phone call and Home visits( Since patient willing
to shift to SV due to travel issue , we should follow up the patient regularly
and build trust by making phone calls &home visits to provide diagnostics
and medication regularly by the doctor) )

14. Not seeking care/Male/Not old/High
income/Independent
Key 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 the
words 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’t
get clarified about his diagnosis; Hence willing to double check
with other provider in order to confirm the diagnosis once again
and undergo medication regularly )
Recommendations:
1.Home visit(Building trust from SV part and to create awareness by clear
cut explanation about his diagnosis and its symptoms)
2.Home based care model( Household visits by the doctor for medication
and diagnostics regularly )

15. Not seeking care/Female/Not old/High
income/Dependent
Key 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 the
household)
Key Observations – Sughavazhvu Healthcare Encounters:
1.Self orientation(She doesn’t feel happy with the consultation provide by the doctor .She has
taken medication from SV for first 15 days; When she went to the CVD blood report
distribution clinc for second time to continue the medication, She was told that prescription
can be delivered only after gone through the laptop present in the RMHC ;Hence felt that the
doctor is self oriented)
Recommendations:
1.Awareness( Awareness about the disease condition should be provided to both the
patient 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 home
based care model for medication and diagnostics)
3.Home visit and phone calls(Trust building from SV part)

16. Not seeking care/Male/Female/Old/Low
income/Dependent
Key Observations(General):
1.Cost(Some people work on the field rarely and earn which is not sufficient to meet their
basic 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 then
dropped. The reason behind that they paid since they earn occasionally on the field and
remaining 50% of people have not taken any medication for the mentioned disease
category since they procrastinate due to lack of interest and awareness. Specifically one
person shifted to out of catchment for self earning work)

17. Not seeking care/Male/Not old/Low
income/Independent
Key Observations(General):
1.Cost( Insufficient monthly income to meet their basic needs, spending for their
son/daughter higher study)
2.Procrastination( They give priority to work, very busy in their work schedule)
Key Observations – Sughavazhvu Healthcare Encounters
1.Cost deduction( Expecting cost deduction from SV. Able to spend around
Rs 150 – 200 per month for medication)
Recommendations:
1.Awareness (About disease condition and explaining the importance of
health )

18. Main Learning's and Recommendations
Trust
Awareness
Accessibility
Cost
Procrastination
Mental depression
Dependent
Learning's:
Recommendations:
Good explanation of disease condition
Elaborate personalized consultation
Close follow up
Awareness
Home based SV model
Home visit and Phone calls
Counseling

19. Feedback
Share your general views about this Qualitative interviews?
Do you think this analysis will be more effective on better understanding of our
community?
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 as
a HEW?