Determinants and Experiences of Care‐Seeking for Childhood Pneumonia in a Rural Indian Setting: A Mixed‐Methods Study.
Introduction: Pneumonia is a leading cause of under‐five mortality, with 30 million annual cases in India. Despite national guidelines, significant barriers to timely and appropriate care‐seeking persist. Caregivers often face financial constraints, lack of awareness, mistrust in government faciliti...
| Publicado en: | Health Expectations Vol. 28; no. 2; pp. 1 - 14 |
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| Autores principales: | , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Apr2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=184679898&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 184679898 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 13696513 EVY jtl: Health Expectations issn: 13696513 maglogo: Y pubinfo: dt: Apr2025 vid: 28 iid: 2 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 184679898 184679898 184679898 10.1111/hex.70263 184679898 ppf: 1 ppct: 13 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Determinants and Experiences of Care‐Seeking for Childhood Pneumonia in a Rural Indian Setting: A Mixed‐Methods Study. aug: au: Gadapani Pathak, Barsha Mazumder, Sarmila Bin Nisar, Yasir Bhatt, Aditya Singh, Mandeep Madhur, Tarun Sandøy, Ingvild Fossgard affil: Society for Applied Studies, New Delhi, India sug: subj: Sociodemographic Factors Socioeconomic Factors Pneumonia Therapy Help Seeking Behavior Evaluation Rural Health Services India Health Services Accessibility Evaluation Human Funding Source India Multimethod Studies Cross Sectional Studies Surveys Insurance, Health Caregiver Attitudes Thematic Analysis Logistic Regression Confidence Intervals Descriptive Statistics Data Analysis Software Male Female Infant, Newborn Infant Child, Preschool Infant, Newborn: birth-1 month Infant: 1-23 months Child, Preschool: 2-5 years Male Female ab: Introduction: Pneumonia is a leading cause of under‐five mortality, with 30 million annual cases in India. Despite national guidelines, significant barriers to timely and appropriate care‐seeking persist. Caregivers often face financial constraints, lack of awareness, mistrust in government facilities and a preference for non‐registered medical practitioners (non‐RMPs), delaying effective treatment. This study explores care‐seeking behaviours, associated socio‐demographic factors and barriers to access to appropriate healthcare for childhood pneumonia in rural India. Methods: This study is part of a broader implementation research (IR) initiative and represents its formative phase. This mixed‐methods study was conducted in Palwal district, Haryana, covering 42 villages (population: 107,440). A cross‐sectional survey identified suspected pneumonia cases among 9593 under‐five children through house‐to‐house visits using a structured checklist. Data on socio‐demographic characteristics, health insurance, care‐seeking patterns and provider preferences were collected. Directed acyclic graphs (DAGs) identified potential confounders in the association between care‐seeking behaviour and key exposure variables. Additionally, qualitative in‐depth interviews explored caregivers' perceptions, decision‐making and healthcare barriers to pneumonia management. Quantitative data were analysed using logistic regression, while qualitative data were thematically analysed using the Three Delays Model. Suspected under‐five pneumonia cases' caregivers and families were actively engaged in this formative phase to inform Phase II implementation strategies of broader IR, ensuring community‐driven and contextually relevant strategies. Results: Among 231 suspected pneumonia cases, 97% of caregivers sought medical care, but 71% consulted non‐RMPs, and only 3.6% visited government facilities. Seeking appropriate care was associated with higher maternal education (AOR 6.5, 95% CI: 2.7–9.7) and higher wealth index (AOR 1.7, 95% CI: 1.0–2.6). Thematic analysis revealed delays due to symptom misinterpretation, reliance on home remedies, financial constraints, gender biases, mistrust in public healthcare services and logistical barriers. Conclusion: Despite high care‐seeking rates, provider preferences, socio‐cultural factors and systemic barriers delay appropriate pneumonia treatment. Addressing these challenges requires improving awareness, enhancing public healthcare trust and strengthening frontline healthworker engagement. This study underscores the role of structured beneficiary involvement in refining pneumonia management strategies to ensure sustainable, community‐driven interventions. Patient or Public Contribution: This study is part of an ongoing implementation research (IR) aimed at improving the effective coverage of childhood pneumonia management in a low‐resource setting. A structured engagement with primary caregivers of under‐five children, mothers, fathers, family members, community members and local community stakeholders/representatives, for example, local leaders, village heads and so forth, has been integrated at multiple stages to ensure the relevance and applicability of its findings. The current study is part of Phase I (formative research) of the IR, where primary caregivers and family members participated in a needs assessment, providing critical insights into the barriers and facilitators influencing care‐seeking for childhood pneumonia in a rural low‐to‐middle socio‐economic setting. Their inputs have informed the refinement of study tools and the development of mitigation strategies for the logic and implementation model. As the research progresses into Phase II (model development and implementation), the community continues to play an integral role in providing feedback on the feasibility and appropriateness of proposed strategies. This ongoing feedback loop assesses how effectively these strategies strengthen linkages between the healthcare system and the community, foster an active local needs assessment mechanism among healthcare providers and enhance demand generation for appropriate pneumonia care‐seeking. These iterative refinements ensure that the implementation strategies remain responsive to the evolving needs of the community. In the forthcoming Phase III, which will focus on scaling up the finalised implementation model, strategies will be adapted to further improve care‐seeking for under‐five children. Continuous engagement with caregivers and local community representatives, including Panchayati Raj Institution (PRI) members, will be central to refining these strategies. Additionally, during the dissemination phase, key findings will be shared with caregivers, community members and PRI representatives, facilitating discussions on study implications and informing future policy and programmatic decisions. Their ongoing involvement will help contextualise findings and enhance the long‐term sustainability of strategies aimed at improving pneumonia care‐seeking behaviours and effective management in rural India. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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