EVALUATION OF CULTURE ON HEALTH SEEKING BEHAVIOR AMONGST GBARI

PEOPLE IN PAIKORO LOCAL GOVERNMENT AREA OF NIGER STATE, NIGERIA

BY:

ZAKARIYYA MUHAMMAD
PG8/SSC/2020/1061
(B.Sc. UDUS, 2010)

SCHOOL OF POST-GRADUATE STUDIES, FEDERAL UNIVERSITY DUTSIN-MA, KATSINA

STATE, NIGERIA

OCTOBER, 2023
1
EVALUATION OF CULTURE ON HEALTH SEEKING BEHAVIOR AMONGST GBARI
PEOPLE IN PAIKORO LOCAL GOVERNMENT AREA OF NIGER STATE, NIGERIA

BY

ZAKARIYYA MUHAMMAD
PG8/SSC/2020/1061

A DISSERTATION SUBMITTED TO THE SCHOOL OF POST-GRADUATE STUDIES,

FEDERAL UNIVERSITY DUTSIN-MA, IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE AWARD OF MASTER OF SCIENCE (M.Sc.) DEGREE IN
SOCIOLOGY

OCTOBER, 2023
2
 DECLARATION
I, ZAKARIYYA, Muhammad declare that; the work in this dissertation entitled “Evaluation of Culture on
Health Seeking Behavior amongst Gbari people in Paikoro Local Government Area of Niger State, Nigeria”
has been written by me. The information sourced from the literature have been duly acknowledged in text
and list of references provided. No part of this research was previously presented for another Certificate,
Degree or its equivalent at this or any other Institution.

___________________________ ________________
ZAKARIYYA, Muhammad DATE
PG8/SSC/2020/1061

3
 CERTIFICATION.
I certify that this research work titled “Evaluation of Culture on Health Seeking Behavior amongst Gbari
people in Paikoro Local Government Area of Niger State, Nigeria” was conducted by ZAKARIYYA,
Muhammad and has met all the requirements for the award of M.Sc. degree in Sociology in Federal
University, Dutsin-ma, Katsina State, Nigeria.

___________________________ __________________________
Dr. Yar’Zever, S. Ibrahim. Date
Chairman, Supervisory Committee

___________________________ _________________________
Prof. Jacob I. Yecho Date
Member, Supervisory Committee

________________________ __________________________
Dr. Veronica L. Viashima Date
Head of Department

___________________________ __________________________
Prof. Mohammed Umar Sanda Date
Dean, Post-Graduate School, FUDMA

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 DEDICATION

This work is dedicated to my parent: Malama Fatima Binta Mas'ud (mother) and Late W.O. Ya'u Na-Allah

(father) May his soul continue to rest in peace, amin. Also, to my beloved family: Maryam (wife),

Zakariyya (son) and Adama (daughter). I love you all.

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 ACKNOWLEDGEMENTS.

Glory be to almighty Allah for the gift of life, health and resources to go this far. Am saying "Alhamdulillah
rabbil aalamiin".

I will like to acknowledge my supervisors: Dr. Yar'Zever, S. Ibrahim for his fatherly care and tutelage
without any odd & Prof. Yecho, Jacob for his guide in actualizing this work. I am saying, a big thank you
and am forever most indebted to you all Sir. Also, to my former H.O.D. Dr. Zumve, S. who gave me the
right advice to pick up my program in our department, the current H.O.D. Dr. Viashima, L. Veronica, and
PG Coordinator: Dr. Yelwa, Mason Mohammed, To my External Examiner: Professor Femi T. from
Federal University Gusau, my Internal Examiners: Dr. Elijah, Ben Tativ. Dr. Zasha Tersoo Zasha, Dr.
Abdulraheen Anifat among others whom were available to moderate my work despite their schedule and
motivators to my success, am most grateful to you all. I will not forget my friend and adviser: Dr. Wanger,
T. David who always create time to advise me and discuss relevant issues regarding my work. Thank you
sir a million times.

I will like to also, acknowledge traditional heads in my study area who gave me the chance to do my study
and accommodated me with an open door policy in their land most especially Hakimin Paiko (Alhaji
Mansur Baba Mustapha), Hakimin Tutungo/Jedna (Mal. Musa Sarki Abdullahi Paiko), secretary to the
Paikoro traditional council (Dr. Madaki, Mohammed Paiko) among other whose names were not captured
in prints but always present in the golden pen of success as long as this study is concern.

I will not forget about my friends who stood by me in prayers advice and finance to see to the actualization
of this work. Persons like Lt.Col Marafa I. Mohammad, Dr. Jamilu Maipan-uku, Mal. Gideh Bilyaminu,
Muhammad Nura Koko, Ahmad Rufa'I, Ribah Bala, Ibrahim Mashkur, Abel I. Kayit and Muktar Ibrahim
Muhammad. To all my Respondents and Key Informants, am most grateful.

My thanks will never be complete without thanking my parents, brothers, sisters, wife and children who
were my backbone in this course. It’s Allah that will reward you all. I want to sincerely appreciate all that
have helped me one way the other and were not captured in prints to know that, they are capture in success
and may Allah bless us all.

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 TABLE OF CONTENTS.
CONTENT PAGE
Cover page i
Title page ii
Declaration iii
Certification iv
Dedication v
Acknowledgement vi
Table of contents vii
List of Tables xi
List of figures xii
List of Acronyms xiii
Abstract xiv
CHAPTER ONE: INTRODUCTION.
1.1 Background to the Study 1
1.2 Statement of the Problem 2
1.3 Research Questions 5
1.4 Research Objectives 5
1.5 Hypothesis 6
1.6 Scope and limitation of the Study 6
1.7 Significance of the Study 7
1.8 Operational Definition of Terms 8
1.8.1 Culture 8
1.8.2 Health Seeking Behavior 8
1.8.3 Gbari 9
1.8.4 Gbari people 9
1.8.5 Cultural Power 9
1.8.6 Cultural Belief 9
1.8.7 Appropriate health seeking behavior 9
1.8.8 Inappropriate health seeking behavior 9
1.8.9 Cultural knowledge 10
1.8.10 Evaluation 10
1.9 Organization of Work 10
CHAPTER TWO: LITERATURE REVIEW & THEORETICAL FRAMEWORK
2.0 Introduction 12
2.1 Literature review 12
2.1.1 The Concept of culture and health seeking behavior 12
2.1.2 Cultural factors affecting health seeking behavior 14
2.1.2.1 Cultural belief 14
2.1.2.2 Cultural knowledge 15
2.1.2.3 Cultural power 16
2.1.3 Major pathways to health seeking in African societies 16
2.1.3.1 Traditional healthcare system 16
2.1.3.2 Orthodox medical system in Africa 17
2.1.4 Main issues covered from foreign literatures 18
2.1.5 Main issues covered from national literatures 21
2.1.6 Main issues covered from local area literatures regarding the subject under review 24
2.2 Theoretical framework 25
2.2.1 Descriptive model of health seeking behavior by Igun, (1979) 25
2.2.2 Healthcare utilization model by Anderson & Newman, (1973) 34
3.0 CHAPTER THREE: METHODOLOGY
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3.0 Introduction 37
3.1 Research Design 37
3.2 Research setting/study area 37
3.3 Population of study and their characteristics 39
3.4 Sample size determination 39
3.4.1 Determination of sample size for quantitative research 39
3.4.2 Determination of sample size for qualitative research 40
3.5 Sampling procedure 40
3.6 Method of Data Collection 43
3.7 Methods of Data Analysis 44
3.7.1 Quantitative Data Analysis 44
3.7.2 Qualitative Data Analysis 44
3.8 Ethical consideration and certification 45
3.9 Validity and Reliability of the instrument/data generated 45
3.9.1 For quantitative instrument/data generated 45
3.9.2 For qualitative instrument/data generated 46
CHAPTER FOUR: DATA PRESENTATION & ANALYSIS
4.0 Introduction 47
4.1 Respondents’ Socio-demographic attribute 47
4.2 Data presentation and analysis based on research questions of the study 51
4.2.1 Common illnesses in Gbari people 51
4.2.2 Cultural beliefs and knowledge on perceived nature of illnesses amongst Gbari people 53
4.2.3 Nature of health seeking behavior 56
4.2.4 Cultural factors affecting Health Seeking Behavior amongst Gbari people 58
4.2.5 Pathway(s) used in health seeking amongst Gbari people 60
4.3. Data presentation and analysis based on hypothesis testing 61
4.3.1 Data presentation and analysis of hypothesis using chi-square statistical method 62
4.3.2 Data presentation and analysis of hypothesis using correlation statistical method 63
4.4 Discussion of major findings 64
CHAPTER FIVE: SUMMARY, CONCLUTION & RECOMMENDATION
5.0 Introduction 67
5.1 Summary 67
5.2 Conclusion 69
5.3 Recommendation 70
5.4 Suggestion for further research 71
Reference 72
Appendix (A) 77
Appendix (B) 78
Appendix (C) 79
Appendix (D) 80
Appendix (E) 84
Appendix (F) 85
Appendix (G) 86

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 LIST OF TABLE.
TABLE PAGE
Table 3.1 Major districts in Paikoro Local Government and their wards 41
Table 3.2 Clustered districts, sampled wards and their sampled size for quantitative method 41
Table 3.3 Target groups, categories of Respondents, sampled size/tag and percentages for
Qualitative method 43
Table 3.4 Strategies used to enhance research validity and reliability of both quantitative
and qualitative research instrument and data/result generated 46
Table 4.1 Respondents Socio-demographic attributes 48
Table 4.2 Common illnesses found in Gbari people 51
Table 4.3 Cultural beliefs & knowledge on the perceived nature of Illness amongst Gbari people 54
Table 4.4 Nature of health seeking behavior amongst Gbari people 56
Table 4.5 Cultural factors affecting health seeking behavior amongst Gbari people 58
Table 4.6 Pathway(s) used in health seeking amongst Gbari people 60
Table 4.7 Result obtained from chi-square 62
Table 4.8 Result obtained from correlation 63

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 LIST OF FIGURE
FIGURE PAGE
Fig. 2.1: Diagrammatic presentation descriptive health seeking behavior model 28
Fig. 3.1 The map of Niger state showing Paikoro Local government Area and its
Boundary local government 38
Fig.4.1 Common illnesses found amongst Gbari people 53
Fig.4.2 Cultural belief and knowledge on the perceived nature of Illness amongst Gbari people 56
Fig.4.3 Nature of health seeking behavior amongst Gbari people 66
Fig.4.4 Cultural factors affecting Health Seeking Behavior amongst Gbari people 59
Fig.4.5 Pathway(s) used in health seeking amongst Gbari people 61
Fig.4.6 Graphical representation of the weak negative relationship between Culture and
Health Seeking Behavior amongst Gbari people 64

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 LIST OF ABBREVIATION

HIV/AIDS: Human Immuno-deficiency Virus/Acquired Immune Deficiency Syndrome.

HSB: Health Seeking Behavior.
KII: Key Informant Interview.
WHO/ICS-MCU: World Health Organization/ International Collaborative Study of Medical Care
Utilization.

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 ABSTRACT.
Culture and health seeking behavior have of recent a major area to medical sociologist. This cemented the
core trust of this work as it dwells into the evaluation of Gbari culture on Health Seeking Behavior looking
at the higher trends of communicable and noncommunicable illnesses that increases mortality in Nigeria.
The objective of this study is to find out the common illnesses, cultural beliefs and knowledge to perceived
nature of illnesses, cultural factors affecting Health Seeking Behavior (HSB), nature of HSB and pathways
to health seeking amongst the Gbaris. The study employed the services of the Igun’s descriptive model of
health seeking behavior, 1979 & Anderson & Newman’s healthcare utilization model, 1973 to serve as
foundation in explaining relationships between core variables. The research adopted a descriptive survey
design with triangulation (quantitative and qualitative techniques and methods) and total sampled
population of 401 (with quantitative having (384) using Krejcie and Morgan formula, 1972 and qualitative
having 17 using judgmental sampling). Data were analyzed and presented using descriptive and inferential
statistics from SPSS package window version 23. The results generated showed some common illnesses,
cultural beliefs and knowledge on perceived nature of illness episode, cultural factors affecting HSB, the
nature of HSB and major pathways amongst Gbari people. It’s all showed a weak negative relationship of
(-0.34) between Gbari culture and health seeking behavior amongst Gbari people. It has been concluded
that there is an appropriate health seeking behavior amongst Gbari people but also recommend the need
for mass public health education on the need for hygiene. Government should come in by enacting laws
that would synergize both pathways (orthodox and traditional healthcare systems) in the provision of health
services in the health industry.

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 CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Human existence is synonymous to their ways of life (culture). This is evidence as it pre – occupies the

work of early sociologist. Till date, culture has and is still a central theme of study to Sociologists.

Emile Durkheim (1895) who proposed the study of all “Social phenomenon” as the study of “Social facts”

(Laura and Scott, 2015:165 and 185) argued that; these social facts are “Representations” of society in the

minds of people, ways of thinking, feeling and acting that are explicit and external to the person (Stella,

2008). Such facts as portrayed by Durkheim could be viewed to include practices, belief systems, values,

customs and traditions, which are outside the human composition. More so, social facts assume a

consummative power which alienates man from the absolute natural reasoning and subjected man to

external coercive cultural tenets, transmitted from generation to generation.

Durkheim also promoted the study of culture in his work on collective social consciousness and social

solidarity which are core features of culture (Cockerham, 2010). It is on this note that: Taylor and Ashworth

(1987:43) shows the link between “Changing forms of social solidarity and changing perception of health,

(health seeking behavior), diseases and medicine” as having significant relationship.

On the other hand, Max Weber, in his study of protestant ethics and the spirit of capitalism (1904 – 05),

economy and society (Published in English in 1968) highlighted the importance of culture as: “Beliefs and

values co–exist in shaping social action within the micro – cosmos of the individual actor as well as the

level of collectiveness, institutions and the larger society” (Stella, 2010:28). It is on the above submission

that culture could be seen as: humans’ creativity, perfection and cognitive “design for living” (Kluckhohn,

1951:86). He also defines culture as: “Patterned ways of thinking, feeling and reacting, acquired and

transmitted mainly by symbols constituting the distinctive achievement of human groups......traditional

ideas (historically derived and selected) and especially their attached values” (Kluckhohn, 1951:86).

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More so, Malinowski (1944:36) defines culture as: “The integral whole” comprising “Human ideas and

crafts, beliefs and customs partly material, partly human and partly spiritual by which man is able to cope

with the concrete, specific problems that face him.” Culture is partly materials in the sense that; it consists

of physical aspects like tangible objects and artifacts. Partly human has to do with the socio-cultural aspects

like language, norms and interactive meanings assigned to actions and behaviors. Partly spiritual can take

the face of belief and myths which man uses to contain social problems and challenges including ill health

and illnesses.

Social problems like illness (ill health) could be contained through proper behavior which will ensure health

and avert illness. These proper behaviors that will ensure health and avert illness is what could be referred

as health seeking behavior. It is true that: when people exhibit the most appropriate health seeking behavior,

it will improve health, productivity and development. (Edward, 2017; Latunji and Akinyemi, 2018)

MacKian (2003) defined Health Seeking Behavior as a concept situated within the broader aspect of all

“Activities undertaken as well as dealing with any departure from good state of health”. If a behavior

(action/inaction) is geared towards preventing, maintaining and restoring health is seen as health seeking

behavior, then it should be central to Gbari people in Paikoro local government of Niger State as the

wellbeing of its people is one of its key cohesive attributes that binds them together (Shekwo, 1984).

This idea, necessitated the researcher to develop a search into Gbari people Health Seeking Behavior and

view it from a cultural milieu. How it is and how it could be improved (appropriate health seeking behavior)

as the essence of every human society is survival, continuity and development which could be ensured by

having healthy population who would pilot the affairs of such domain from generation to generation.

1.2 Statement of the Problem

Health is one of the important ingredient for the survival of any given community, nation or society. This

is the reason why government of different countries sees health sector as a duty to provide for its citizenry.

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The best way to promote any meaningful development in a place is to ensure its inhabitants are healthy so

as to be productive and creative.

Nigeria as a nation is not left behind in ensuring the health of its timing population. As a developing country,

it is faced with numerous challenges including health problems. This is evidenced in its life expectancy rate

graded by the world health organization (2019) in collaboration with World Bank, estimated for male and

female life expectancy to be 54.7yrs and 55.7yrs respectively. This has raised serious concern to

government and a lot of attention is placed on health sectors and how to improve the nation’s health. The

best way life can be improved is through appropriate Health Seeking Behavior in maintaining good health,

preventing and curing diseases.

Most researches conducted on Health Seeking Behavior are targeted towards gender, socio – economic

variables, psychological and behavioral determinants (Stowasser et al., 2011; Suchman, 1965; Thuan et al.,

2008; Anderson, 1995; Orisaremi, 2019; Ahmed et al., 2000; 2005), access to health facilities, proximity

and utilization of health facilities (Shaikbh and Hatcher, 2005; 2007; Fatimi and Avan, 2002; Iyalombe and

Iyalombe, 2012; Latunji and Akinyemi, 2018). These, has made government of different countries to

concentrate in reducing the cost of medication and providing interventions to subsidize the effects of socio

– economic determinant and enhance effective utilization of health services.

Nigeria is not also left out in bringing interventions in terms of health insurance schemes to its citizenry

(although government personnel), disaster and disease interventions/ policies to improve health of

Nigerians. With all these interventions among others by the Nigerian government in improving the health

of Nigerians, we are still battling with acute communicable diseases like malaria which continues to show

on our populace health negatively. Malaria is described by Amzat and Oliver (2014:67) as: “A disease of

poverty or underdevelopment usually breaded in poorly planned neighborhood, poor housing facilities and

poor sanitation systems” which are attributes of an underdeveloped nation. This disease of poverty (malaria)

among others are most prevalent in local communities than in urban centers in Nigeria. This could be

attributed to the nature of rural areas in Nigeria where they lack basic health facilities and prompt
15
intervention as well as strict adherence to cultural beliefs, practices and knowledge that are widely shared

in these rural areas (including Gbari people of Paikoro in Niger state).

The "Gbari” people are one of the minority groups in Nigeria that has a very strong affiliation to its cultural

beliefs and practices (Madaki, 2019:1). These beliefs and practices greatly influence all aspects of life

including how illnesses are defined, understood and how it should be remedied or cured (health seeking

behavior).

A general cultural beliefs and practice called "Kushi" (invocation of the spirits of the dead ones) is one of

many cultural practices performed by the Gbari in Paikoro (Galadima, 2000). This cultural practice is done

to correct anomalies or caution deviant behavior. For example, in the advent of yam stealing in the farm,

the "Kushi" is consulted to punished the unknown thief by inflicting upon him/her (the thief) illness that

could only be cured using the same "Kushi" system.

Male genital circumcision is also prominent amongst the Gbari in Paikoro. Children between the ages of 5-

7 years in a group of ten or more at the same time would be circumcised using local equipment (Galadima,

2000). This local equipment used are not properly sterilized and treated. No anesthesia used in the

circumcision. This could aid in transmitting communicable diseases to other children since the practice

(circumcision) is done in group and thus, may affects the health of the children.

These problems resulting from the cultural practices that induced illnesses as buttressed above drew the

attention of the researcher to look inward into the ways of life (culture) as it has its varied ways of defining

and responding to health and illnesses. Why are we still battling with acute communicable illnesses that

most advanced nations had passed through? Could it mean that: the problem of inappropriate Health

Seeking Behavior as estimated to be “71% in rural and 53% in urban centers” in Nigeria (Onwujekwe et

al., 2011:50) might not associated to socio – economic, behavioral and poor utilization of healthcare

facilities alone but also, with the general cultural description, understanding of the concept of health and

illnesses' definitions, its nature and modes of curing illnesses amongst Gbari people in Niger state, Nigeria.

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The way the culture of a people perceives and defines illnesses should be focused upon as the problem of

development can only be controlled with a sound, healthy and viable populace. The researcher sees limited

finding as regards to minority groups in local communities in Nigeria looking at the ways of life (culture)

and the cultural description of health seeking in other to understand the major illnesses, cultural belief and

knowledge (understanding) on the nature of the illnesses as perceived by the Gbaris, cultural factors

affecting health seeking behavior, nature of health seeking and the pathway(s) to health seeking amongst

Gbari people which will compliment on existing researches in this area.

1.3 Research Questions

The research questions are:

i. What are the common illnesses reported in Gbari people?

ii. What are the cultural beliefs and knowledge on the nature of the illnesses as perceived by Gbari

people?

iii. What is the nature of Health Seeking Behavior amongst Gbari people?

iv. What are the cultural factors affecting Health Seeking Behavior amongst Gbari people?

v. What are the pathway(s) to health seeking amongst Gbari people?

1.4 Research Objectives

The main objective of this study is to Evaluate Gbari Culture on Health Seeking Behavior of Gbari People

in Paikoro Local Government Area of Niger State, Nigeria. Notwithstanding, the specific objectives of this

research are:

i. To investigate the common illnesses in Gbari people.

ii. To assess the cultural beliefs and knowledge (understanding) on the nature of illnesses as

perceived by Gbari people.

iii. To describe the nature of Health Seeking Behavior amongst Gbari people.

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 iv. To examine the cultural factors that affects Health Seeking Behavior amongst Gbari people.

v. To discover the pathway(s) used for health seeking amongst Gbari people.

1.5 Hypothesis

This study seeks to test the hypothesis stated below:

Ho: There is no relationship between culture and Health Seeking Behavior amongst Gbari people.

H1: There is relationship between culture and Health Seeking Behavior amongst Gbari people.

1.6 Scope and limitation of the Study

The scope of the study is based on three major fronts: Issues covered, Periodization and Geographical

spread.

On the issues covered, the work was able to uncover the common illnesses affecting the Gbari people

(ranging from candidiasis, pile, fever, diabetes among others), the cultural beliefs and knowledge

(understanding) on the nature of the illnesses as perceived by Gbari people (which includes spiritual, natural

man made, accidental and those that are belief to be foreign and unknown to the Gbaris), the cultural factors

that affects Health Seeking Behavior amongst Gbari people (like cultural beliefs, cultural

knowledge/understanding and cultural power), the nature of Health Seeking Behavior amongst Gbari

people (which is both appropriate and inappropriate) and the pathways used for health seeking amongst

Gbari people (which the work confirmed the orthodox and traditional with a higher practice of healthcare

dualism).

On the periodization of this research, it covered the period of ten (10) years and beyond. Its involved Gbaris

who have stayed or are still staying for the past ten (10) years and beyond. It covered the periods of 2010-

2023. This becomes necessary to checkmate the influence of acculturation over time by the researcher and

more so, gain data from people that are acultured and original Gbaris (cultural in practice).

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The geographic coverage is Gbari people in Paikoro Local Government of Niger State with 11 wards and

a total population estimated at 271,300 (National Population Commission, 2022) consisting mainly

agrarians (65%) and (35%) others which include, public servants, businessmen and women, skilled and

unskilled laborers and craftsmanship. (Paikoro Local Government Evaluation Report, 2019).

Although the Gbari people covers about (5) states and the F.C.T. in the central region (middle belt) of

Nigeria spreading from southern Kaduna, Niger, Kwara, Kogi and Nasarawa states (Adebayo and Sanda,

2011) with a total population of about “(15) fifteen million” (Agbaoola and Abah, 2020:13). This research

is limited to Niger state and Gbari people in Paikoro as a case study due to the time frame allocated to the

program. The population estimate characteristics include all Gbari adults: both males and females ranging

from 20years to 80years of age living in Paikoro. The research is limited to only Gbari people in Niger

State with case study of Paikoro local government. The major reason for this delimitation is due to time

constrain and resources available.

1.7 Significance of the Study

The research is significant in the following ways:

First, the study evaluated the Gbari culture and how it affects the Health Seeking Behavior of its inhabitants.

More so, how to minimize and help in proffering ways of reducing acute and chronic illnesses like

candidiasis, pile, malaria/typhoid fever, diarrhea, diabetes, ulcer among others by suggesting appropriate

Health Seeking Behavior to policy makers and the people (Gbari people).

Second, it addressed the most sensitive aspect of social life (health seeking) and to add to existing literature

by filling the gabs from reviewed works on the field of health seeking behavior.

Third, the study was able to add to apply some theoretical explanation (Igun's descriptive model of health

seeking behavior, 1979 & Anderson & Newman's healthcare utilization model, 1973) regarding culture and

Health Seeking Behavior as it affects our local setting (Gbari people in Niger State).

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Fourth, the research gave more information on how culture play a vital role in reducing illnesses by

improving appropriate health seeking behavior.

Fifth, the research came out with common illnesses affecting Gbari people, their cultural beliefs and

knowledge (understanding) on the nature of illnesses as perceived, the nature of health seeking behavior,

cultural factors affecting Health Seeking Behavior and the various pathways used for health seeking

amongst Gbari people.

Finally, the research serve as recommendation guide to the Gbari people, health administrators and policy

makers as together, we fight to eradicate infectious illnesses in Nigeria.

1.8 Operational Definition of Terms

This subsection will provide definition and conceptual clarification of the following terms as there will be

viewed and understood in the case of this study. These terms include: Culture, Health seeking behavior,

Gbari, Gbari people, cultural power, cultural belief, appropriate health seeking behavior, inappropriate

health seeking behavior, cultural knowledge and evaluation.

1.8.1 Culture

Culture as used in the context of this research should be seen as: the perceived and shared beliefs,

knowledge, norms, values, power and other capabilities held by a group who sees each other as sharing

similar language, heritage and lineage occupying a defined territory or area.

1.8.2 Health Seeking Behavior

Health Seeking Behavior (HBS) refers to the process where a person who is believed to be ill, undertakes

an action, inaction or activity in other to find appropriate remedy to the illness and regain health.

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1.8.3 Gbari

Gbari is referred to a group of people joined together by affinity, speaking the language known as

Gbagyi/Gbari/Gbali inhabiting the North Central geo-political zone of Nigeria or as found sparsely located

in other parts of Nigeria. Gbaris is referred to as its plural.

1.8.4 Gbari people

Gbari people refers to the ethnic group who are indigenous origin and speaks the Gbagyi/Gbari/Gbali

language inhabiting parts of the North Central geo-political zone of Nigeria.

1.8.5 Cultural Power

Cultural power is refers to as: the ability for an individual or group to dictate choice to health and health

seeking either been ascribed by traditional authority or as culturally assigned by its cultural system.

1.8.6 Cultural Belief

Cultural belief should be understood as: generalized shared conceptions held by a group of people in

relation to their total ways of life.

1.8.7 Appropriate health seeking behavior

This entails: seeking health care from a certified practitioner (be it orthodox or traditional) within the first

three days of symptoms manifestation.

1.8.8 Inappropriate health seeking behavior

Inappropriate Health Seeking Behavior is seeking health care from a certified practitioner (be it orthodox

or traditional) after the first three days of symptoms manifestation.

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1.8.9 Cultural knowledge

This refers to all understanding and conception regarding a particular health and illness episode as

generally perceived by the culture of a people.

1.8.10 Evaluation

Evaluation is seen as: the act of assessing culture and Health Seeking Behavior based on its relationship of

being appropriate or inappropriate in removing pain and curing illnesses amongst Gbari people with the

aim of drawing inferences on what is obtainable and how it can be enhanced.

1.9 Organization of Work

This section describes the entire research which is organized into (5) five major chapters.

The first chapter consisted of the Introduction, Background to the Study, Statement of the Problem,

Research Questions, Research Objectives, Hypothesis, Scope of the Study, Significance of the Study,

Definition of Terms and Finally, Organization of Work.

Chapter two comprised of: conceptual framework of this study, main concern on the issues to be studied,

main issues covered from international, national and local literatures reviewed and theoretical framework.

The literatures are reviewed thematically drawing inferences from secondary data.

Chapter three (Research Methodology) consisting Research Design, Research Setting/Study Area,

Population of the Study and their Characteristics, Sample Size Determination, Sampling Procedure, Method

of Data Collection, Method of Data Analysis, Ethical Consideration/ Certification, Validity and Reliability

of the Instrument/Data generated.

Chapter four (data presentation and analysis) comprised of Presentation of Data, Its Interpretation, Analysis

Based on Research Questions and Summary of Major Findings.

Finally, Chapter five (summary, conclusion and recommendation) discussed The Summary Based on the

Research Objectives, Conclusion, Proffering Recommendation and Suggestions for Future Research.
22
 CHAPTER TWO

LITERATURE REVIEW AND THEORETICAL FRAMEWORK

2.0 Introduction

This chapter is focused on literature reviews and theoretical framework explaining the key phenomenon

under study.

2.1 Literature review:

This sub-chapter will throw insight on issues like: The concept of culture and health seeking behavior,

cultural factors affecting health seeking behavior, major pathways of health seeking in African societies.

2.1.1 The Concept of culture and health seeking behavior.

The concept of culture before now has been a central focus for anthropologist but of recent, it has been a

point of discussion amongst sociologist most especially medical sociologist in Africa (Amzat & Oliver,

2014). This concept has been defined by different scholars and researchers.

According to Kathy (2005:41) “Culture is made up of all of the ideas, beliefs, behaviors and products

common to and defining a group’s way of life. Literally, culture in tells all perceptions, conception, attitudes

and value system that is unique to a groups' ways of living. Indeed culture is an integral part of a social

world. Also, Kagawa-singer (2011:90) sees culture as:

“The core, fundamental, dynamic, responsive, adaptive and relative coherent

organizing system of life designed to: (1) ensure the survival and wellbeing of its members
and (2) Provide common ways to find meaning and purpose throughout life and to
communicate caring. This system is composed of beliefs, values and lifestyle to successfully
adapt within a biotic and abiotic geographical niche using available technology and economic
resources”.

In the above definition, culture is seen as the total functional structure that serves the people with the recipes

of continuity, growth and development of the social world across different times. More so, culture is
23
described as: the way of life including knowledge, customs, norms, laws, and beliefs which characterizes a

particular society or social group (Giddens and Sutton, 2014:269). Here, culture is seen as patterned

behavior that is distinctive of any human group.

All these definitions are pointing towards a conceptual clarification that culture simply takes two major

dimensions. First, a total human system with the mandate to ensure dynamism, progress and equilibrium.

Second, a structure that is saddled with the responsibility of programming consciously or unconsciously, a

human social organization. The major borne of contention in all definitions of culture is that: Is it (the

culture) being consumed by the social being (seen as a "social fact") or it’s the social being that consume

the culture (a product of human endeavor: "social action"). Many scholars do see culture as a universal fact

that shapes the human society while others are of the opinion that it is a product of human endeavor that is

designed over time, generations over generations, to uniquely define a particular individual as "in-group"

and others as "out-group". Whenever the concept of culture is viewed, it will always carry the centre of

social activity that is characterized by human society.

Culture to the Gbari world is seen as “Knunu” in general term. However, scholars like Ayuba (2016) see

the word “Knunu” beyond culture when looked at it in a broader sense as it connotes "the totality of the

Gbari way of life, worldview, identity and how they relate to their environment. It further captures cultural

rites, rituals, religion, and a single way of describing the entire personality of Gbari". This shows that;

culture to the Gbari, signifies everything that has to do with the origin, nature and personality of individuals

who interrelates with each other under a unified and distinct structural system that do not only influence

but become a fact that is unalienable to such individuals/group.

In the other hand, Health Seeking Behavior is seen by Tipping and Sengall (1995) under two (2) major

branches: first, the emphasis on the end point (utilization of healthcare system) and second, the processes

(illness behavior). Although, Amzat and Oliver (2014) shows that illness behaviors is synonymous to health

seeking behavior. The current research will be looking at both: the processes of becoming ill and ways of

getting rid of illness and getting well again.

24
It is on this note that; The Bio-cultural model by Pang et al., (2003) as cited by Chika (2017:26) defined

Health Seeking Behavior as: “Those actions that address health related symptoms including seeking health

from healthcare facilities and using alternative resources to abate symptoms of an ailment”. This definition

clearly portrays the intention of the research showing that Health Seeking Behavior involved all actions or

inactions targeted towards regaining health.

Also, Health Seeking Behavior is seen as: “Sequence of remedial actions that individuals undertake to

rectify perceived ill-health” (Bunya, 2009:69). An individual will not seek to perform a desired behavior

until he sees the need and benefit of doing such action. The sick always find the state of ill health as

undesirable, looking for all processes that will make life desirable and pleasant hence, seek for health care

to cure ill health.

More so, Health Seeking Behavior has been defined as: “any action or inaction undertaken by individuals

who perceived them to have health problem or to be ill for the purpose of finding an appropriate remedy”.

(Olenja, 2003:61-62). This scholar places more emphasis on the process of regaining health.

To the Gbari, Health is one of the most important aspects of their endeavor. They are culturally hardworking

which majorly, preoccupied with farming and hunting. During the research (ethnographic observations),

the researcher has come to understand that; the elders in every Gbari clan has the duty to take care, closely

monitor and observe their descendants. This makes it easy to observe and know the routine health behavior

of all members in the family as farming is done in group. When a member is sick, they can easily dictate it

even before such member develops symptomatic characteristics. More so, due to the preference giving to

health and farming, every clan has its most elderly (in most situations) who is a specialists in herbal

medicine called "Ashigbe". The "Ashigbe" takes the social function of restoring health of a seek member.

In a nutshell, health seeking is very familiar to the Gbari traditions from time immemorial.

25
2.1.2 Cultural factors affecting health seeking behavior.

There are many cultural factors affecting Health Seeking Behavior but for the purpose of this study, the

researcher is concentrating on three (3) major factors such as: cultural belief. Cultural knowledge and

cultural power.

2.1.2.1 Cultural belief.

Belief system is as old as the origin of man. Rationally, human beings through the gift of the human brain,

always weigh things that best portrays their self-interest. These interests in what ones feels and agree upon

could be termed as belief.

Culturally, belief is seen in a layman's understanding as those notions that are built collectively by an ethnic

group to be true and guides the activities which the violation of it, is seen as a taboo. This lay understanding

is gathered from the researcher’s ethnographic observation among the Gbari.

Cultural belief is the “Shared tenets or conviction that people hold to be true” regarding their culture. (Little

and McGivern, 2013:84). The scholar clearly shows that cultural belief has to be a universal trait, accepted

by all as the truth in relation to the peoples' ways of life.

More so, Cultural belief is defined as: “A set of behavioral patterns related to thoughts, manners and actions

which members of society have shared and passed on to succeeding generation”. (Hatah et al., 2015:589).

Among the Gbari, cultural beliefs are highly held and it serves as the strongest hold in "Knunu" as a

general ways of life of the Gbari. This is evidence in their annual cultural festival, marriage rites and even

in medicine. The “Zoku” (divination) is highly practice most especially if the sickness is not exhibiting a

desired cultural knowledge held on a particular illness episode. Base on the researchers ethnographic

observation, he was made to understand that, due to their strong cultural belief attachment, there are some

cultural medications that are only made for pure Gbari people as such medication will not work on a person

26
that is not Gbari descendant. This shows the length at which cultural belief affects how the people

understudy (Gbari) could perceived illness, its causes, treatments and pathways in regaining health again.

2.1.2.2 Cultural knowledge

Every human society experience life in accordance to its immediate environment, the challenges it provides

and the resources it was able to culturally maximize. Knowledge as defined by Cambridge dictionary is the

"awareness, understanding or information that has been obtained by experience or study and that is either

in a person's mind or possessed by a group.

Cultural knowledge could be seen as the totality of psychological and physical processes which include

cultural signs, artifacts, values, belief and general worldview held, shared and institutionalized to be unique

within a particular cultural milieu or group. This cultural knowledge gathered over time and influenced by

the belief system, shapes what is illness, causes of illness and medication as in the context of this study.

This routine is almost natural with all human setting. There are scholars that view the orthodox medical

system as a practice incorporating culture of the west (Amzat & Oliver, 2014).

To the Gbari, cultural knowledge is one of the most distinctive features that make them somehow static to

immediate western and religious influence not until of recent. In diagnosis and administration of herbal

mixture for treatment, the knowledge gained from the perceived conception attached with the explanation

gotten from the sick/lay referrals serves the bases for treatment. Although, in the absence of such

explanation (most especially when the sick is unconscious and none knows the problem), the "Ashigbe"

consult the spirits: "A’nangozhi" through "Zoku" (divination) to interpret eventualities and in some cases,

aid in the treatment of those illnesses that are perceived to by spiritual and supernatural. This shows the

high impetus placed on the issue of cultural knowledge as it has to do with the general wellbeing of the

Gbari.

27
2.1.2.3 Cultural power

In every organized human setting, there are groups of individuals or an individual that makes the final

decision. Power is "An enabling capacity that allows individuals to choose ends towards actions

commanding the necessary means towards the pursuit of those ends”. (Zygmunt and Tim, 2001:62). This

means power that is legitimate and for the betterment of all. This should not be seen as coarse but gaining

compliance as a norm in a given society. Power when used legitimately should promote solidarity and

compliance.

This could be witnessed (during ethnographic observation by the researcher) among the Gbari as patrilineal

family system is in practice. The Gbari usually lives in clans where the head of that family/clan makes

decision as to seek for healthcare. In most cases, the oldest is the "Ashigbe" (medicine man) within the

family. Since health is taken with most importance to the Gbari, a well institution of healthcare is culturally

designed to take care of the sick except in extreme cases where the sick is taking to a higher "Ashigbe".

2.1.3 Major pathways to health seeking in African societies

Pathways simply means those channels used to regain health. These channels are generally divided into

two (2) broad systems (Amzat & Oliver, 2014): the traditional healthcare system and orthodox medical

system.

2.1.3.1 Traditional healthcare system

Another name for traditional healthcare system is indigenous ethno-medicine or folk medicine (Amzat &

Oliver, 2014). Traditional medicine can be traced to the origin of man. Traditional medicine is best defined

by the World Health Organization (WHO 2000:1) as:

"the sum total of the knowledge, skills and practices based on the theories, beliefs
and experience (cultural knowledge) indigenous to the different cultures, whether
explicable or not, used in the maintenance of health as well as in the prevention,
diagnosis, improvement or treatment of physical and mental illness" which could be
inherited and transmitted from one generation to another, in written or oral forms”.

28
From the above definition, traditional medicine has the following characteristics:

First, it has to do with cultural belief, knowledge and practices. By implication, traditional medicine relies

heavenly on indigenous culture. Its components used for medication are readily available and culturally

biased, known and familiar to the people.

Second, traditional medicine is localized. This means it is distinct and unique to a place. There is the

possibility of not having a uniform mode/method of operation. Also, medication could be culturally relative

and sensitive to ecology and culture. So, medication in one cultural habitat for a particular illness episode

could be entirely not similar to the same illness episode in another cultural setting.

Third, traditional medicine used for medication and diagnosis could be transmitted and inherited. It has in

its special ways, diagnose patient and administer treatment necessary for recovery. These processes and

techniques can be nurtured to future generations and even in some cases inherited as cultural wealth from

generations to generations.

Finally, the processes of medication and medicine could be oblique, vague and inexplicit to the general

people (not clear, understandable and comprehensible to the public). This shows clearly that; traditional

healthcare and medicines combines both physical and nonphysical practices and knowledge that cannot be

empirically proven and alien to those that are not the traditional practitioners.

The above could be said to be the basic features of traditional medicines in Africa as deduced from WHO

(2000) definition.

2.1.3.2 Orthodox medical system in Africa

Another name for orthodox Medical system is hospital treatment or the professional medical care. The

origin of orthodox medicine in Africa can be traced to colonialism. This started with the Berlin conference

of 1883-84 in Germany where Africa was partitioned among European powers at that time. The act of

colonialism most especially in English colonies allows some percentage of Europeans domicile in Africa.

29
Without good and full prior knowledge of the diseases in Africa made them to be vulnerable and thus, the

introduction of their medical systems vis-a-vis Christian missionary evangelism (Amzat & Oliver, 2014).

Orthodox medicine derives its roots from the germ theory of disease causation. This makes the practices in

hospitals systematic as illness is believed to be caused by germs (pathogens) that invaded the body to cause

malfunctioning. Medication in the clinical setting is always presumed by diagnosis to dictate the causal

agent in other to administer drugs suitable to such ailment. One of the main distinctive difference between

orthodox and traditional medicines is; while the former depend on getting the root cause via running clinical

test and observation to ascertain the fact, the latter rely heavily on oral/spiritual diagnosis and empathy to

diagnose ill health which shows a higher level of predictability and precision of the traditional healer.

Generally, researchers have recorded that; in Africa, there are always the mixture of both pathways (medical

pluralism) in regaining health.

2.1.4 Main issues covered from foreign literature.

This sub-chapter presents reviewed literature from the international realm of scholastic endeavors regarding

major areas concerning this study.

In the works of Julie, et-al (2020) titled Cultural beliefs and health seeking practices: Rural Zambian view

on maternal newborn care pointed out the relationship between cultural beliefs and health seeking practices

on maternal newborn among Zambian rural communities. The relationship is positive showing there is a

very high sense of cultural belief and practices that are strongly attached to Zambian rural communities as

it relates to child delivery and post-natal care. These evidence was presented in their study in practices like

traditional newborn protective rituals, early introduction of traditional herbal mixture inform of porridge

after the first year of birth with the cultural belief of protecting the infant from killer diseases and others.

More so, the issue of cultural power was found in the study as the husbands holds the decision and choice

to health seeking where wives are expected to follow "the wishes of their husbands" (husbands directive)

30
on when and where to go for healthcare. The issue of medical plurality is recorded among the Zambians

with a very high cultural knowledge on maternal health.

The above work was able to look into Health Seeking Behavior and the effect of culture on rural community

which is central to this research. However, it did not take note of other categories of people as it was

centered on maternal and post-natal care ignoring the majority of the Zambian population that are above (5)

years which this research is geared to take note of. The work also sees Health Seeking Behavior as

preventive neglecting the central aspect of healthcare which is to restore health by averting illness. The

current research will look at Health Seeking Behavior as illness behavior because, human beings by their

nature do not engage in maintaining anything except, when there is a problem with that thing.

Ankur & Sharma (2002) were able to discuss the concept of health, illness and Health Seeking Behavior to

avert diseases and restore health. These are all contained in their work: Health, Culture and Health Seeking

Behavior among semi-nomadic Lohar-Gadiyas of Malthon town of Sagar district in Madhya Pradesh, India.

Health in their study is seen as a situation where a person does not have any disease which is utopia. Illness

on the other hand is the presence of disease in an individual. They took the biomedical domain of health

and illness. The major causes of illness according to the semi-nomadic Lohar-Gadiyas of Malthon town are

natural, mercies of the gods and witchery which signifies the significance of their cultural belief and

knowledge in the definition of illnesses and its etiology. Major illnesses found in the area include: fever,

cold, headache, body ache, smallpox, snakebites among others. Health Seeking Behavior is dual as those

illnesses whose culturally are believed to be by the mercies of the gods/witchery are channeled to a

spiritualist who offer prayers and water from the goddess "Durga" while others that are seen as natural

patronized the orthodox medical care. There are very few results in their findings that show the presence of

ethno-medicine (indigenous traditional medicines). It could be concluded that there are multiple pathways

in averting illnesses recorded in India.

31
Despite the work been able to duel on areas like cultural belief, knowledge and Health Seeking Behavior

which are central to this study, it fails to look at other aspects like cultural power, socio-economic variables

which influence the pathways to healthcare system that this research will concentrate upon among others

to see if the results obtained could be achieved here in our local community in Nigeria.

Wei-Chen (2010) studied the Asian-American population in the United States. He based his work on a

cultural doctrine called Confucianism. This cultural doctrine is the major factor that dictates Health Seeking

Behavior amongst Asian-American population when they are ill.

The work was able to show the link between cultural belief and sex roles in making decisions for healthcare

among Asian-Americans. He also shows the cultural power domicile with the paternal head in the family.

In spite of these contributions mentioned in Tung's work, he has been unable to relate the cultural

understanding in determining why people should belief in certain kind of healthcare against others. He also

concentrated on a single data collection method (qualitative) which is subjective and could be prone to bias

which are very difficult to generalize to form group behavior of a community.

This current study will correct these limitation mentioned above by engaging socio-economic, cultural,

natural, situational and demographic factors in studying Health Seeking Behavior amongst Gbari people in

Niger state, Nigeria. More so, triangulation in data, methods and theories would help this current research

to gain a wider holistic approach to the study of culture and Health Seeking Behavior in local communities

which could be generalized and have a more precedence to group behavior.

In the works of Stuart, Pauline, Faafetai & Wale, (2009) titled: "Relationship between health and culture-

A review" gives a clearer understanding of the influence of culture (in Polynesia region) and how it

affects/shapes the use of both traditional and orthodox health care. This shows that; there are some cultural

conception (belief) regarding the etiology of illness and how they should be treated in the region. The belief

system on what is supernormal and normal makes the distinction between various pathways to health

seeking behavior. It also recorded the use of healthcare plurality in treating illnesses. They noted as well, a
32
distinction between some illnesses that are culturally termed to be local who is best treated by traditional

practitioners and those termed as alien are best treated in the hospital.

The work was able to shade light on major issues related to this research like cultural belief, knowledge,

decision in health seeking and pathways to healthcare, it has failed to look into the power interplay involves

in lay referral permission to seek for care. They also based their entire study on secondary data which is not

sufficient in explaining human behavior in a macro context. The work also fails to consider the influence

of place and other socio-economic variables that could moderates the relationship between culture and

health seeking behavior. In a nutshell, this research will work to correct these shortcomings by considering

them in this study. The need for this current study to employ triangulation as a method in data collection

and analysis will give the study a stronger base in empirical evidence, authenticity and its ability to be

generalized so as to stand the test of being scientific by minimizing subjectivity and bias.

2.1.5 Main issues covered from national literature.

This sub-chapter seeks to review some study conducted within Nigeria as it relates to the current issues to

be covered by this research.

In the works of Segun & Tajuddeen (2019) on the topic: Cultural influence on health information seeking

behavior among rural dwellers in Atakumosa West Local Government Area of Osun state pointed out that;

there is a relationship between culture and health information seeking behavior in Osun state. They showed

health behavior like good dietary, community cleanliness, breastfeeding, sexual abstinence during lactation

and wrestling as practices that promote health. Also, food taboo, traditional circumcision, scarification,

early marriage among others are practices that negatively affects health in the local area. Cultural belief,

alternative medicine, wrong perception of illnesses, rigid to change, and ethnic diversities are the major

factors affecting health information seeking behavior within the state.

The above work has been able to tell the factors affecting health information seeking behavior which is

different to the central trust of this research. However, it has pointed out some key issues like cultural belief,
33
pathways to health and cultural knowledge in its findings. The study is faulted on the grounds of over

relying on literatures (secondary data) rather than getting firsthand information which this current study

seeks to redress. Using of secondary data alone has made the research less scientific which this current

research is not going to make such mistake. The paper dwells only on health information seeking behavior

which this research will look into Health Seeking Behavior proper and try to do justice to it.

In another study conducted by Latunji & Akinyemi (2018) on the topic: Factors influencing Health Seeking

Behavior among civil servants in Ibadan, Nigeria tend to differentiate between appropriate and

inappropriate health seeking behavior. They termed appropriate Health Seeking Behavior as the act of

getting prompt medical attention while inappropriate is the inabilities to look for prompt medical attention

whenever a civil servant is faced with illness. They gave reasons for varied choices in health seeking which

include: proximity of care, quality care, levels of education, affordability and availability of healthcare.

Also, medical pluralism is recorded in their work as a normal routine among civil servants in Ibadan despite

their level of western educational exposure.

This study has been able to bring up major issues like medical pluralism, major factors affecting health

seeking behavior, appropriate and inappropriate Health Seeking Behavior which are key issues to this study

but has been limited to only a class of workers that makes the study too narrow-minded which this study

tends to correct. The study also, has the limitation of not taking into cognizant, the various cultural

variations among civil servants in Ibadan labeling them as homogeneous. It also, fails to look into cultural

attributes that could shape their lives as they seek for healthcare which this current study will cover.

Factors’ affecting Health Seeking Behavior among rural dwellers in Nigeria and its implication on rural

livelihood is one of the works of Edward (2017). He was able to show the different factors affecting Health

Seeking Behavior like culture, nature of the illness, economic factors, religious beliefs, education status,

availability and accessibility of appropriate care, age, occupation and gender. He was also able to point out

some impact of Health Seeking Behavior on rural livelihood such as: effects on growth and development,

34
mode of prevention and control of illnesses, increase in mortality and morbidity rates in our rural

communities.

The researcher concentrated on literatures alone which has been falsified of having the empirical evidence

to generalized findings to the entire country. This current study will seek to implores the services of a mixed

method of data collection in other to correct the problem of bias generalization centered on secondary data

alone. More so, the case study of an entire country made the work to lose focus and vague which the current

research is addressing by looking at the Gbari people in Niger state, Nigeria.

A Study conducted by Omotoso, (2010) on Health Seeking Behavior among rural dwellers in Ekiti state,

Nigeria showing major factors why rural inhabitants patronize hospital treatment to include: nature of

illness, availability of resources at the period of the illness, age, religious affiliation, education status and

the position of the sick person within the family. Other factors that generally influence Health Seeking

Behavior in Ekiti state are; availability of healthcare, staff behavior towards patients, neatness of the

healthcare environment and closeness of healthcare system to the sick person.

Some common illnesses found in Ekiti as stated by Omotoso (2010) include: yellow fever, malaria fever,

typhoid, diarrhea, guinea worm, cough, stomach ache, headache and wounds. He proffers ways of

improving Health Seeking Behavior in orthodox medicines to include; increase personnel, adequate

provision of medical facilities, good attitudes to work by health practitioners and good roads.

The writer was able to look at Health Seeking Behavior from the point of orthodox medicines neglecting

the indigenous healthcare system which this study will duel. Secondly, he concentrated on Health Seeking

Behavior alone which this research will look into the culture and Health Seeking Behavior among local

community.

In Chukwuneke, et al (2012) titled: Culture and Biomedical care in Africa: The influence of culture on

biomedical care in a traditional African society, Nigeria, West Africa shows the link between culture and

35
religion on Health Seeking Behavior in Nigeria. They listed causes of disease to include supernatural,

handwork of the wicked and a reparation of a wrongful doing to the gods by an individual or family.

Due to the cultural belief on some illness to be culturally originated, serves as a major reason for traditional

medicine preference. They also found out that; just like orthodox practitioners that undergo training, the

traditional herbalist also undergo training peculiar to their practices that made them acceptable most

especially in rural areas.

The work was able to bring out major issues like cultural belief in the causes, means of healthcare and the

presence of medical pluralism as pathways to health seeking. It do not focus on the cultural knowledge and

power involves in health seeking behavior, how the cultural belief shapes healthcare seeking which the

current research will focus on.

2.1.6 Main issues covered from local area literature regarding the subject under review.

It is pertinent to note that; not many studies have been conducted in the local area (Gbari people) regarding

culture and health related fields. Notwithstanding, the work of Adeola & Ayuba (2011) tilled: Mystical

powers of witchcraft amongst the Gbari gave an insight on specifically, three (3) major concepts:

"Agunzheyin" (witchcraft), "Zoku" (divination) and "Ashigbe" (medicine man) which could be

good/evil to the Gbari and by extension, could affects the health/Health Seeking Behavior of the people.

The concept that relates to this current work is the "Ashigbe" (medicine man). To Gbari, health is very

essential. "Ashigbe" is generally referred to the medicine man. He/she is the one vested by the tradition to

possess the necessary skills and knowledge to cure/ward off evils or illnesses even before the advent of

orthodox medicine. This stems from the cultural belief in the availability of evildoers who could affects

individuals with a curse (illness). The writers also pointed out that some of these "Ashigbe" have developed

to be evil and uses their powers of healing negatively either to the choice of their masters or self-interest.

36
The above study was able to show the presence of cultural belief, cultural causes of illnesses amongst the

Gbari but has not fully concentrated on Health Seeking Behavior among the Gbari people. The above work

also, is majorly concerned about the mystical powers in Gbari while this current research is centered on

Gbari culture and health seeking behavior.

In a related vain, Kelly, et-al (2015) titled: Ethnomycology: edible and medicinal mushrooms of the

indigenous Gbari people of Nigeria conducted a study that shows the efficacy of some medicinal

mushrooms used by the Gbari in curing illnesses. To them, Gbari people are known for their cultural act of

preparing key mushrooms in powdery, fresh or dried forms for medicinal recipes. These mushrooms are

sometimes combined with some herbs to cure common illnesses. These common illnesses include: pile, eye

problems, ulcers, cancer, fever, tumors, stomach aches, pregnancy related ailments, management of

HIV/AIDS patients and other immune system booster.

The above work was able to show some issues related to the current study like traditional medicinal

practices, some common illnesses in Gbari land and cultural belief in the treatment of illness. The study

was not able to show the link between culture and health seeking which the current study will be interested

to accomplish.

2.2 Theoretical framework

A descriptive model in explaining Health Seeking Behavior propounded by U.A. Igun, 1979 is the theory

used in this research. Although, some borrowed concepts will be needed in another theory (healthcare

utilization model by Anderson & Newman, 1973) to explain some intervening variables.

2.2.1 Descriptive model of Health Seeking Behavior by Igun, (1979).

This model is able to give explanation on the interpersonal, social, cultural and effects of lay referrals to

health seeking behavior. The major strength of this model is that: it has provided the possibility of assessing

the efficacy of treatment making a viable tool not only in explaining acute but also, chronic illnesses, choice

37
of remedy, actions, behavior of the illness processes and the sick in regaining health (health seeking

behavior).

More so, the model was drafted from Nigeria satisfying both the epidemiological and ecological context of

the study where this research is being conducted not necessarily making strict adjustment that might affect

its credibility and originality. The model explains reasons for medical pluralism in the quest to regain health

(health seeking behavior). It also, explain the effects of cultural beliefs, knowledge and power (which are

central thesis to these research) in making decisions on how, when and where to seek for healthcare (health

seeking behavior) whenever one is ill.

The model is built within these six (6) major assumptions:

1. Illness is unwanted (undesirable) in the society.

2. Illnesses are understood (comprehended) by modes of unique language (taxonomy) which are related to

lay culture and changes from one social ecology to another.

3. Illnesses have both micro (personal) and macro (social) functions and dysfunction.

4. The conception for healthcare is subjective (personal) rather than objective (scientific).

5. Sick people have cultural knowledge and understanding about the etiology which might not be in

consonant with those held by professional health practitioners (be it traditional or orthodox).

6. Patients are rational beings who could evaluate the nature, causes, conceived perception of the illness

and the efficacy of treatment via its frequency and reoccurrence using utility considerations to reach

decisions (to seek for healthcare) in respect to previous experience, knowledge, understanding, beliefs and

other available data/capacities (including normal or supernormal means) regarding the best actions which

will avert the illness (Igun, 1979 & 1988).

38
Based on the aforementioned assumptions, the descriptive model is developed into having eleven (11)

stages namely:

1. Symptoms experience stage.

2. Self-medication/ treatment stage.

3. Communication to significant others stage.

4. Assessment of symptoms stage.

5. Assumption of the sick role stage.

6. Expression of concern (by kin, close friends and neighbors) stage.

7. Assessment of probable efficacy or appropriate of sources of treatment stage.

8. Selection of treatment plan stage.

9. Treatment stage.

10. Evaluation of the effects of the treatment stage.

11. Recovery and rehabilitation stage. Igun, (1979)

39
Fig.2.1: Diagrammatic presentation of the stages of descriptive Health Seeking Behavior model.

Source: Igun, 1979:448.

Stage 1: Symptoms experience.

This is the first stage of Health Seeking Behavior (to regain health from a state of ill health). It is the stage

that the individual starts feeling some unusual signs of body malfunction. This stage is anchored by four

analytical phases. These phases are:

First, physical experience phase. Here, the individual ill start to see some physical weakness in the way

they does their daily social roles. These social roles may not be easily performed with ease as usual due to

an unusual defunct that is new which is different from being tired or fatigued. This situation may not

necessarily show a symptom as at the earlier stage. The observation of physical weakness is easily perceived

due to the subjective cultural knowledge such individual has related to a particular behavior to be culturally

defined as a problem (illness) and what the culture of such community define as health or illness symptoms

and behavior.
40
Second, the cue process phase. This is the phase of the gradual deterioration in daily social roles/functions

as a result of the physical dysfunction in the body system as experienced. The individual as time goes on

(may be as hours goes on into the second day of the distressing position of the body), experience a more

dysfunction in his normal role performance. This second phase goes simultaneously with the first phase of

physical experience. The greater the physical experience, the severe the cue process.

Third, the cognitive phase. This has to do with the cultural meaning labeled on individual feelings of such

symptoms category. These meanings also have to be conceived by the individual as a symptom of ill health

and subjectively tagged as a problem. The ability of the individual to perceived and conceived the bodily

dysfunction as a problem generates the anxiety for a solution as humans naturally wants to avoid pain and

enjoy pleasures. This leads to the last phase of the symptoms experience stage.

Finally, the emotional response phase. This is the fear generating phase. Here, anxiety/fear will make the

individual to seek for any of the two major stages which will be based on their conclusion. This conclusion

is possibly made through their impositions of the cultural definition, belief and knowledge of the symptoms

they are experiencing and on the symptoms categories. If the individuals are able to understand and feel

that these symptoms they are experiencing is known to them under their cultural definition, belief and

knowledge accrued to such symptoms category and which can be treated by self-medication, the individual

moves to the stage two (2). Then, if the individual is unable to understand the symptoms based on the

available resources (cultural meaning, belief and knowledge attributed to such symptoms category), the

individual skips the stage two (2) and move into the stage three (3) of the descriptive model in health

seeking behavior.

Stage 2: Self-medication/ treatment.

This stage starts immediately when the individual has successfully labeled a symptom experience as a minor

health problem which could be addressed via self-treatment. This labeling is done using the cultural

knowledge attached to such set of symptoms manifestation category available to the individual from either

41
lay experience and or cultural definition of such symptoms. The individual goes into self-medication simply

because, they hasn't concluded to be sick but knows that there is a minor health problem that needs to be

addressed. Here, the symptoms experience is within the individual alone. The dysfunction in their social

role has not attracted popular interest as they may be facing such difficulty without necessarily informing

anyone. This stage continues until when the individual perceives that: either the treatment is not effecting

the needed result on the symptoms or the symptoms are increasing reaching a stage where they could have

labeled it as severe defying all existing cultural knowledge and lay experience they have related to the

symptoms category. This leads to more consultation from close relative and friends which leads to the next

stage.

Stage 3: communication to significant others.

The communication could be verbal and non-verbal, voluntary or involuntary as the individual close

relatives and friend started sensing a problem with the individual's social role dysfunction. This is where

the problem of the individual will be brought into the wider look of the family and other close friends. The

individual with the symptoms experience will want to have a clear understanding of the illness and listen

to varied explanations from significant others. Also, other lay referral options of self-medication could be

offered if the individual hasn't put it into test. As symptoms persist, the family discussed how the individual

is responding to home treatment which leads to the next stage.

Stage 4: Assessment of symptoms.

The assessment of symptoms would be made by the individual's significant others (family and close friends).

During the assessment, two major conclusions are reached. First, whether the individual should legitimately

assume the sick status. Second, a tentative diagnosis of the symptoms would be made. This is where the

issue of cultural power (ability to decide the choice of treatment) comes to play. In Gbari people, the

decision rest on the shoulders of the father as the head of the family (see table 4.14 & fig. 4.14 respectively).

He decides on the best possible choice of treatment based on the available resources (cultural belief,

42
knowledge and definition of such symptoms category). When the symptoms have been finally diagnosed

(subjectively) by significant others as constituting an illness episode, the illness will gain social recognition.

In most cases, this stage goes simultaneously with the previous stage (communication to significant others).

The individual after the tentative diagnosis is certified as been socially sick, can assume the sick status.

This moves the individual to the next stage.

Stage 5: Assumption of the sick role.

The individual after tentatively diagnosed and confirmed to be sick will now enjoy all rights, privileges and

expected duties of the sick role in such community such as social role exemption that couldn't be effectively

performed, cooperating with health givers among others base on the nature of the disease. The higher the

severity of the illness, the greater the social role exemption of the sick person and vice versa. This

exemption from social roles was not only prompted by the assessment alone but also, by the cultural belief,

knowledge and definition labeled upon such symptoms category. This exemption will normally cause

disturbance and social misbalance as other family members, friends, colleagues or even the community at

large could be saddled with the responsibility of performing the role left by the sick individual depending

on his/her significant to the family, friends and the community at large. This will eventually lead to the next

stage.

Stage 6: Expression of concern (by kin, friends and close neighbors).

This stage represents the formal beginning of the illness episode. This sick person will attract visitation

from close relations to show care to the sick. For example, among the Gbagyis, the sick person is being

provided with food and other necessities which cannot be performed by him/her as a result of being sick

and socially unfit to perform roles. This expression of concern goes on till the individual is fully recovered

and reintegrated. This is so because; the knowledge of the illness has gotten to others outside the individual's

immediate family. This visitation is to show empathy and moral encouragement. Sometimes during such

43
visits, lay referrals are suggested to families of the sick as discussion of the illness is being passed in the

course of the visitation. This will lead to the next stage.

Stage 7: Assessment of probable efficacy of or appropriateness of sources of treatment.

Every culture has a distinctive language and meaning (taxonomy) assigned to every illness episode. These

illnesses contain various appropriate treatment regimen based on its cultural belief, knowledge and

definition of such illnesses. In every typical African society which Gbari people is inclusive, there is the

notion of medical pluralism (Amzat and Oliver, 2014) where some illnesses are believed to be spiritual,

should be directed to the traditional practitioner while others are seen as normal, which could be attended

by the orthodox (medical doctor). In this stage, the close relatives (significant others) of the sick, assesses

the impact of all treatment options and the appropriateness of the sources of the treatment as it suits the

preconceived cultural knowledge which could be further influenced by the available resources at their

disposal. When the assessment is finally done, some varied options of treatment plan related to the

symptoms manifestation is presented. This leads to the next stage.

Stage 8: Selection of treatment plan.

In this stage, from the varied options available, the best option will be selected. This selection is done

considering the cost and benefits of an appropriate treatment source based on the available resources. In

Gbari people, the selection would run across available traditional practitioners, orthodontist, its proximity,

nature of the disease (whether termed as spiritual or normal definition of the illness) and how urgent is the

case of the illness (severity of the disease). At the end, a treatment plan is selected and this leads to the next

stage.

Stage 9: Treatment.

This is the phase where the agreed selected treatment plan is implemented and followed by both the care

givers and the sick person. The sick person is therefore expected to comply with the treatment regimen

44
selected in other to regain health. During this stage, one of these two things are bound to happen: first, the

sick person may eventually die and it ends the health seeking process or second, the treatment goes as

schedule where the significant others (families and close friends) evaluates the efficacy of the treatment on

the symptoms which leads to the next stage.

Stage 10: Assessment of the effects of treatment on symptoms.

This stage always goes with the treatment stage simultaneously. As treatment proceeds, the sick person's

relatives monitor the treatment to see whether it is having the expected desired effect on the symptoms

experienced. If the treatment plan selected has a positive effect in eliminating the symptoms, the sick

individual moves to the next stage of recovery and rehabilitation. When the desired expected outcome is

not forthcoming, the treatment process is evaluated and returned back to stage (7): assessment of probable

efficacy and/ appropriateness of the best source of treatment as it has defied the one earlier selected. This

mostly happens in the case of chronic diseases as new label will be made after subjective re-assessment of

the efficacy and source of treatment plan where another treatment plan is selected and goes through the

treatment phase again. Any new challenge always comes with new lay experience and cultural definition

related to the symptom category which further reaffirm or disaffirm the existing cultural knowledge and

belief regarding such illness episode. By this juncture, two major possibilities could be presented. First is

the situation where the expected impact is not attained, the health seeking circle may be reversed to the

assessment of the (present) symptoms stage or the assessment of the effectiveness of the method of care

used to see if another option could be available for use. Second is, when the treatment plan selected is

showing the desired outcome, the individual moves to the final stage of the descriptive health seeking model.

Stage 11: Recovery and Rehabilitation.

Here, the impact of the treatment is felt positively. Generally, the sick individual will start to feel signs of

recovery from the ailment. The sick individual fully recovers, not feeling any signs and symptoms of the

45
illness. Finally, he/she returns to his/her social roles performance as usual. This complete the cycle of the

descriptive Health Seeking Behavior model by A.U. Igun (1979) for a particular illness episode.

This is to further buttress that: not all illness episode has to follow all the stages chronologically. Some ends

in self-treatment stage while others may end at the expression of concern stage. In most chronic illness, a

reversal to some stages at a particular point of the illness episode is inevitable until treatment or corrective

measures that are satisfying are reached.

In conclusion, the major delimitations of this theory is that: it perceived all patients and their significant

other as active and rational (with some level of pre-existing knowledge about an illness episode gained via

cultural belief, knowledge and lay experience) which is not always obtainable in all illnesses most

especially with the advent of newly recognized infections and diseases like the Covid-19 pandemic among

others.

In a nutshell, this model could be used as a heuristic model to test Health Seeking Behavior in an attempt

to give descriptive explanations that are adequately applicable to Gbari people in specific and African

societies in general. Although, in explaining some stages (like the communication with significant others

stage, assessment of symptoms stage, assessment of the probable efficacy or appropriateness of sources of

treatment stage and the selection of treatment stage), the theory made clear some intervening attributes that

was not explicitly noted (was hanging) in the theory which led to the adoption of the major three (3)

constructs: "predisposing, enabling and needs" concepts in health utilization model by Anderson &

Newman, 1973 to further illustrates those mediating variables.

2.2.2 Healthcare utilization model by Anderson & Newman, (1973).

This model was first developed by Anderson in 1963 using the World Health Organization sponsored

International Collaborative Study of Medical Care Utilization tagged WHO/ICS-MCU. It was developed

on the major assumption that: there are natural demographic attributes that helps individuals and groups in

making decisions regarding the choice of healthcare utilization (Igun, 1988).

46
The model was later re-developed by Anderson and Newman (1973) to incorporate socio-cultural variables

to project three (3) major factors responsible in influencing health seeking behavior. These factors are:

"predisposing, enabling" and "needs factors" (Anderson & Newman, 1973).

This study borrowed these terms: "predisposing, enabling" and "needs" (Anderson & Newman, 1973) to

explain the intervening variables which are real and aid in explaining the reasons for a particular Health

Seeking Behavior exhibited by an individual or group. Cultural attributes like cultural belief, knowledge

and power are central in influencing human behavior within a community but, can be moderated by these

variables that the researcher grouped them under these three (3) borrowed terms of Anderson and Newman

(1973).

First, Predisposing attributes: These are characteristics like age, gender, marital status, place of residence

(ecology), income and level of education. These attributes are seen as natural and socio-economic that has

become inherent and inevitable in all human endeavors across all human societies. It will be a great

oversight for a researcher not to put them into considerable because they are unalienable. These inherent

characteristics cannot be easily controlled except when put into consideration.

Second, Enabling attributes: These are variables like proximity to care, lay consultation/referrals, perceived

efficacy of care/healthcare system and cost/benefit exigencies of alternative healthcare. These attributes are

scenario that makes individuals/groups to take healthcare based on the cultural belief, knowledge and power

regarding such illness episode. Healthcare here could starts from self/home remedy to lay medication.

Third, Needs attributes: These attributes are parameters that the sick and "significant other” needed for the

best available and affordable healthcare services decision. These attributes include perceived symptoms of

the illness based on the preconceived cultural knowledge and belief, perceived nature of the illness (whether

natural, supernatural or otherwise), sick role status (mild versus severe) and resources available/needed for

healthcare. These "needs" attributes are considered as final stimulant that will push the sick

47
individual/group to seek for healthcare due to the prevailing issue at hand which might have superseded lay

and self-medication.

These aforementioned attributes are real which directs the kind of healthcare system to be considered in

any given illness episode.

Despite the theory been criticized of over emphasizing on socio-cultural and demographic factors

neglecting economic and situational variables, the researcher has been able to borrow the concepts and

incorporates variables that are natural, situational, socio-economic to complement the descriptive model by

Igun (1979) and helped in explaining some intervening variables considered in the study.

48
 CHAPTER THREE

RESEARCH METHODOLOGY

3.0 Introduction

This section presents the methodology that was used in this research. This chapter consists of research

design, research setting/study area, population of the study and their characteristics, sample size

determination, sampling procedure, method of data collection, method of data analysis, ethical

consideration and certification, validity and reliability of instrument/data generated round up this chapter.

3.1 Research Design

This study is descriptive survey research design. This involves the administration of structured

questionnaire to the selected respondents within the adult ages: both male and female. The justification for

selecting male and female is to have a full representation of the population gender characteristics as its one

of the variables understudy. Key Informants Interview (KII) was conducted after a non-participatory

ethnographic observational study for 6months starting from August, 2022 to January, 2023 in the

community under study. The reason for employing aforementioned ethnographic study is to help the

researcher in getting data as very limited data were available regarding the subject area under investigation.

Results generated from the interview will add better understanding of major cultural properties that the

researcher might not be able to comprehend and was not readily available in literature.

3.2 Research setting/study area

The research setting is Gbari people in Paikoro local government area of Niger state, Nigeria. Paikoro was

first created by Alhaji Shehu Shagari administration in December, 1981. By 1984, the local government

was dissolved by the General Muhammadu Buhari- Idiagbon military government. Later on in September

1991, Paikoro was created again by General Ibrahim Badamasi Babangida regime (Paikoro local

government report, 2019).

49
Fig. 3.1 The map of Niger State showing Paikoro Local government Area and its boundary Local
Governments

Source: Paikoro Local Government evaluation report, 2019

The name: "Paikoro" originated from a prefix and suffix of two major district in its defunct. 'Pai' was gotten

from the prefix in Paiko district and 'Koro' from the suffix Kaffinkoro district making "Paikoro". Before

the creation of Paikoro Local Government, the two (2) defunct districts were having the following wards

as allocated to each: Paiko district has (6)wards namely: Paiko Central, Nukuchi/tungan-mallam, Jere,

Tutungo/Jedna, Gwam and Kwagana wards while Koro district has (5) wards namely: Kaffinkoro, Kwakuti,

Adunu, Chimbi and Ishau wards.

Paikoro is predominately Gbari tribe. It consists of 85℅ of the entire population in the local government

(Paikoro local government report, 2019). Other tribes in the local government include: Koro, Kadara, Hausa,

Fulani, Nupe, Yoruba, Igbo, among other ethnic groups in Nigeria. Paikoro Local Government is one of

the 774 local governments we have in Nigeria and also, one of the 25 local governments in Niger state. The

location of Paikoro on the map coordinate 9° '26°N and 6° '38°E. Paikoro is just 25km from the state capital

Minna, Niger State with the land area of 2,066sqkm which is equivalent to 798sq miles (Yamma, 2015 &

Madaki, 2019).

The local government is bounded by other local governments like Bosso L.G.A from the north west, Shiroro

L.G.A. from the north, Gurara L.G.A. from the south east, Lapai L.G.A. from the south, Katcha L.G.A.

from the west, Agaie L.G.A. from the south west and Munya L.G.A. from the north east.

50
Paikoro consist of 11 political wards namely: Paiko central, Nukuchi/tungan mallam, Jere, Tutungo/Jedna,

Gwam, Kwakuti, Kaffinkoro, Kwagana, Adunu, Chimbi and Ishau wards (Paikoro local government report,

2019).

3.3 Population of study and their characteristics

Paikoro local government inhabiting the Gbari people has a total projected population of 271,300(National

Population Commission, 2022). Gbari people makes up 85℅ (Paikoro local government report, 2019) of

the entire population of 271,300. So, to calculate the total estimated target population of study would be:

85/100 × 271,300= 230,605 people.

Therefore, the population estimate (Gbari people) is 230,605. These people are males and females with age

bracket of 20-80years and must have been in the community for at least 10years and above. The justification

for selecting adults male and female within the ages of 20-80 years is to have people who have satisfied the

basic requirement needed by the research scope of living for up to 10 or beyond. More so, that of 80 years

limit is to control the problem of memory recall and the effects of ageism in the collection of reliable data.

The Gbari people are peace loving and accommodating people who engages in different occupation ranging

from civil service, farming, trading, hunting, craftsmanship, skilled and unskilled labor among others

(Paikoro local government report, 2019).

3.4 Sample size determination

This section is used to determine the sample size for both methods: quantitative and qualitative.

3.4.1 Determination of sample size for quantitative research

For quantitative aspect of the research, Krejcie & Morgan formula (1970) was applied.

Thus, the formula is:

n= x²NP (1-P)
d² (N-1) +x²P (1-P)
Where
51
n= sample size

X² (chi-square table value) = 3.841(at 95℅ confidence level and degree of freedom is 1)

N (population estimate) =230,605 people.

P (Population proportion) = 0.5 (at 50% population proportion)

1 (statistical constant) = 1

d (margin of error) = 0.05 (at 95℅ level of confidence)

Therefore,

n = 3.841×230605×0.5(1-0.5)
0.05²(230605-1) +3.841×0.5(1-0.5)

= 221438.451
577.47025

n. = 383.462959
The sample size is 384 Respondents (approximately).

(Note: The sample size characteristics include males and females of 20-80years that are Gbari by tribe).

3.4.2 Determination of sample size for qualitative research

The researcher employs a convenient and purposive sampling technique to select (17) respondents who are

seen as subjects that have key information regarding the study (the KII section).

In total, the sampled size for both the quantitative and qualitative aspects of the research is 401 respondents.

3.5 Sampling procedure

The grand total sample size of four Hundred and One (401) respondents were used for this study. The

respondents for this study were divided into quantitative and qualitative sampling techniques.

For the quantitative sampling technique, a multi stage sampling techniques was used to select (384)

respondents for quantitative data using the Krejcie & Morgan formula (1970). The quantitative method

involves the use of questionnaire with both open and closed ended multiple options that were self-designed

and administered by the researcher. Multi-stage cluster was used to select the respondents for the

52
quantitative aspect because, the study population is dispersed in several wards and equal opportunities were

given to all sample size selected.

At the initial stage, cluster sampling was used to divide the community into: Paiko and Koro districts

(Paikoro L.G Report, 2019).

Table 3.1 showing the (2) major districts in Paikoro Local Government and the wards under each district.
Paiko district Koro district
Paiko Central, Nukuchi/tungan-mallam, Jere, Kaffinkoro, Kwakuti, Adunu, Chimbi and Ishau
Tutungo/Jedna, Gwam and Kwagana wards wards.
Source: Paikoro Local Government Council, 2019

Paiko district which consist of 6major wards such as: Paiko Central, Nukuchi/tungan mallam, Jere,

Tutungo/Jedna, Gwam and Kwagana wards and Koro district with Kaffinkoro, Kwakuti, Adunu, Chimbi

and Ishau wards.

At Second stage, Simple Random Sample, a probability sampling technique (SRS) via Simple Lottery

Method (SLM) was used to select (4)wards from the two (2) major clustered district. One third (1/3) of the

total wards in each district was selected. This makes an approximately two (2) wards from each district.

This is to ensure equal representation of both districts. To do that, names of the wards were written on a

piece of paper, squeezed properly and dropped into a bowl where the wards were picked at random in equal

ratio of 2:2. After the simple lottery method was completed, the following districts have the following

wards: Paiko district cluster have Paiko central and Tutungo/Jedna wards while Koro district cluster have

Kwakuti and Chimbi wards.

At Third stage, the sample size of three hundred and eighty-four (384) were shared into four (4) to

accommodate the four (4) wards sampled making the following:

Table 3.2 Clustered districts, sampled wards, size & percentages for quantitative method.
Clustered District Sampled wards sampled population size Percentage (%)
Paiko Paiko central 96 25
Tutungo/Jedna 96 25
Koro Kwakuti 96 25
Chimbi 96 25
Total 4 384 100
Source: Author’s field work, 2023

53
It is important to note that; there was no disparity in the distribution of respondents into the (4) wards. This

is because, the sample size for the quantitative aspect as determined by the formula used makes it possible

to divide it into four (4) equally.

To draw up the final sampled respondents, a systematic simple random sampling method was used to arrive

at each sampled respondent. To achieve that, an nth number (the 1st household) was chosen across every

ten grouped houses in each ward until the desired number is attained in each ward. Being systematic was

that, in each nth numbered household randomly selected, a respondent was picked who had the following

criteria: must be Gbari, within 20 years old to 80 years of age and must have resided/still residing for up to

10 years or beyond.

For the qualitative sampling technique, a naturalistic non-participatory ethnographic method was used to

gather qualitative data. Apart from direct observation by the researcher, inferring was mated on some

occasions for clarity. More so, Key Informant Interview (KII) was conducted after the ethnography which

was targeted to gain an in-depth clarification on data generated during both the questionnaire and

ethnography as compliment to both quantitative (questionnaire) and qualitative (ethnography) data. The

interview questions were formulated by self in line with the research objective, questions and purpose of

the study. The interview questions were typed in English. After the interview questions are set, purposive

sampling was used for selecting respondents for the qualitative data that were generated via Key Informant

Interview (KII) of seventeen (17) respondents partitioned into three (3) major target groups as follow: first

target group is the traditional leaders. Five (5) traditional heads who are the custodian of the Gbari culture

and people were selected from each of the four sampled Wards and the central head of all traditional leaders

in Paikoro made the fifth respondent (tagged A-E). The second target group is the healthcare practitioners.

They are made up of both the orthodox and traditional healers. Four (4) traditional certified practitioners,

one from each of the sampled ward (tagged F-I), four (4) medical practitioners (one from each of the

sampled ward) would be picked judgmentally to make up this target group (tagged J-M). The third and final

target group is the sick patients. Four (4) patients in total were selected (one from each of the sampled ward).

These patients were drawn from both the orthodox and traditional healthcare. Two (2) sick patients under
54
treatment with the traditional (tagged N & O) and two (2) sick patients under treatment with the orthodox

care (tagged P & Q).

Table 3.3 Target groups, Categories of Respondents, sampled size/tags and percentage for selected
qualitative aspect
Target groups Categories of respondents Sampled size/tags. Percentage (%)
Traditional leaders Traditional heads 5 (tagged A-E) 29.40
healthcare practitioners Traditional healers 4 (tagged F-I) 23.53
Orthodox 4 (tagged J-M) 23.53
Sick patients Patients under traditional 2 (tagged N & O) 11.77
care
Patients under orthodox 2 (tagged P & Q) 11.77
care
Total 5 17 100
Source: Author’s field work, 2023

The justification for selecting these categories of respondents for Key Informants Interview (KII) is that,

the categories deemed to be self-evident, custodian of the culture and people, considered to be convenient

to provide an insightful, reliable and firsthand information on the case study at hand (culture and health

seeking behavior).Two (2) research assistants were recruited and trained by the researcher to assist in areas

of interpretation to local language in case where respondent(s) don't understand English.

3.6 Method of Data Collection

Mixed method (data triangulation) was adopted for this study. This consists of the structured questionnaire

guide and Key Informant Interview to be generated after the ethnographic observation for complementary.

The questionnaire guide was used to generate the quantitative data while, the ethnographic observation and

Key Informant Interview were used for qualitative data generation.

For the quantitative data, questionnaire was administered to the respondents whom were Gbari only. The

questionnaire drafted in English language contains both closed and opened ended questions with multiple

options to be selected. Thus, options were provided in the questionnaire where the respondent chooses the

best/appropriate answer to his/her interest by ticking in the blank box or as otherwise provided (spaces) in

open ended questions. Demographic variables related to the research such as age, gender, educational status

and place of residence among others were assessed.

55
For the qualitative method, data were generated via ethnographic observation and Key Informant Interview

(KII). However, the interviews (KII) contain some probable questions to further elaborate on issues

concerning the study which will gives a more insight and firsthand information on the research. The

respondents were interviewed individually at places and time of their convenience. To do this, two research

assistants were trained and employed. Their duties are to help explain the questionnaire/interview question

in the local dialect clearly to the respondents who cannot read and write or those who may find it difficult

to understand some aspects of the questionnaire and interview schedule. The interviews was orally

administered while responses were recorded with the consent of the interviewee and later transcribed by

the researcher according to the demands of this study.

3.7 Methods of Data Analysis

A mixed method (triangulation) of data analysis was used for this study. The quantitative data serves as the

numerical data analyzed while the input from qualitative analysis compliments findings.

3.7.1 Quantitative Data Analysis

Statistical Packages for Social Sciences (version: 25) was used to analyze the quantitative data that was

collected via questionnaire to generate the descriptive aspects of data analysis. The numerical data presented

in the Tables are followed by a manual logical descriptive interpretation in words during the analysis. This

helped in the clarity and easy understanding of raw data. For inferential aspect, Chi-Square test was used

to test the relationship between core variables in the stated hypotheses.

3.7.2 Qualitative Data Analysis

Analysis of qualitative data that were generated through ethnography and Key Informant Interview (KII)

were manually coded, interpreted and analyzed by the researcher as complimentary tonic to the quantitative

analysis. Although, some description of what were recorded during interview sessions with the respondents

are directly or indirectly quoted as further proof during analysis or as the case may be. In going through the

56
transcriptions, verbatim phrases with special connotations were used to protect the respondents' identity,

ensures confidentiality and anonymity as major ethics in research.

Finally, discussions of findings, recommendations and limitations of the study cap-up the final aspect of

data analysis of this study.

3.8 Ethical consideration and certification

Ethical concerns are of most imperative when conducting a life event, history and narrative study (Clarke,

2008:14) which is core to this research. This become necessary for the researcher to request for it.

The researcher requested for permission from both the institution (Department of Sociology, Faculty of

Social Sciences, Federal University Dutsinma, Katsina State, Nigeria) And the Host Community (Gbari

people in Paikoro Local Government Area of Niger State, Nigeria). These requests were granted as it

enabled the researcher to conduct the study successfully.

The researcher in his stay in the study area( as part of the ethnographic study) built confidence, trust, truthful

reportage (via respondent/key informant review of both written and recorded response) and anonymity of

respondents as stressed out by Hatch & Wisniewski (1995), Karlsson (2009) as key to research ethics,

validity and reliability.

Consent letters where served to key informant (KI) as time, date and venue for the interview were

conveniently suggested by them individually. Response was consciously recorded on permit and played

afterwards to the certification of the Key informant for originality, authentication and contribution where

necessary.

3.9 Validity and Reliability of the instrument/data generated

This subsection tend to explain the strategies used in ensuring the research validity and reliability.

3.9.1 for quantitative instrument/data generated

The quantitative instrument used for data collection in this study is the questionnaire. This instrument was

validated via construct validity carried out by both the researcher and his supervisors. The questionnaire

was designed to certify the construct indicators (concepts) that where adequately invented and

operationalized to show it relatedness to theoretical and schematic conceptual frameworks.

57
After data were collected from the field, IBM SPSS (version 23) was used to check the crochbach reliability

test (which was estimated at 0.7) showing a strong reliability on the data and result presented (see appendix

E4).

3.9.2 for qualitative instrument/data generated

The qualitative instrument used for this research is the Key Informant Interview (KII). Content validity was

used to evaluate and ensure the interview questions certify the standard needed to gain insightful and

firsthand information that are relevant to the study. The content analysis was conducted by the researcher's

supervisors and necessary corrections where effected before the interview with key informants.

During the Key Informant Interview, electronically recoding instrument (phone recorder) was used (with

key informant's permission) to record responses and was played to the listening of the key informant for

authentication, accuracy and further contribution where necessary. After documentation of responses, a

second visit to the key informant to have a clear representation of responses and avoid (to its barest

minimum) the problem of subjective bias and misinterpretation due to the problem of memory recall, time

or circumstance. Below is the summary of the validity and reliability schedule for the research.

Table 3.4 Strategies used to enhance research validity and reliability of both quantitative and
qualitative research instrument and data/result generated
QUANTITATIVE QUALITATIVE
1. The use of Construct validity on the questionnaire Content analysis was used to validate the interview
by the researcher and co-supervisors. questions by the researcher and his co-supervisors.
2. Triangulation with qualitative data. Triangulation with quantitative data.

3. Self-administration of questionnaire by the Self-administration of interview (K.I.I.) by the

researcher. researcher.
4. Adequate coding categories and codes with multi- Key informant review of recorded responses for
inferential statistical analysis to show validity of authenticity, originality and evaluation.
data.
5. The use of IBM SPSS version 23(windows app.) to Key informant checking to ensure accuracy in data
test Cronbach’s alpha reliability test of (0.7) collected and representation after documentation.
which show a high reliability on the data
generated.
Source: Author’s field work, 2023

58
 CHAPTER FOUR

DATA ANALYSIS AND PRESENTATION

4.0 Introduction

This chapter expressed both the quantitative and qualitative data gathered during the field work. The

quantitative data was analyzed using the SPSS package and interpretation was done manually to portray

the exact trust and objective presentation of the data into information. The qualitative data were used to

support and make clearer explanations (complementary) on the data generated by the quantitative aspect.

The data was presented starting with the socio-demographic characteristics of respondents after which,

presentation were made to analyze and interprets answers to research questions. This chapter is divided into

(3) sections. Section (1) presented by 4.1 (data on Respondents’ Socio-demographic attribute), section (2)

presented by 4.2 (the Data analysis based on research questions and hypotheses of this study) while section

(3) presented by 4.3 (discussion of major findings).

4.1 Respondents’ Socio-demographic attribute

This section presented respondents socio-demographic characteristics of the sampled study population.

These attributes includes: age, gender, marital status, major source of income, place of residence and level

of education.

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Table 4.1 Respondents’ Socio-demographic attribute
Age Frequency Percentage (%)
21-40 111 28.9
41-60 257 66.9
61-80 16 4.2
Total 384 100.0
Sex Frequency Percentage (%)
female 182 47.4
male 202 52.6
Total 384 100.0
Marital Status Frequency Percentage (%)
never married 334 87.0
ever married 50 13.0
Total 384 100.0
Major source of income Frequency Percentage (%)
government 118 30.8
farming 218 56.7
others 48 12.5
Total 384 100.0
Place of residence Frequency Percentage (%)
town 95 24.8
village 289 75.2
Total 384 100.0
Level of formal education Frequency Percentage (%)
None education 25 6.5
primary 59 15.4
secondary 90 23.5
tertiary 210 54.6
Total 384 100.0
Source: Author’s field work, 2023

The age distribution of the respondents are presented in interval scale of (20) twenty each. These intervals

ranges from 21-40 years, 41-60 years and 61-80 years. The total sampled respondents for the quantitative

aspect of this research is (384) three hundred and eighty-four.

The age interval of 21-40 years showed the total frequency of (111) one hundred and eleven respondents

making 28.9% out of the entire sampled size. The age interval of 41-60 years have (257) two hundred and

fifty-seven respondents making 66.9% of the entire sampled size. The last age interval of 61-80 years

occupied (16) sixteen respondents making 4.2% out of the entire sampled size of 384 Respondents.

This signified that the majority of the study population are within the age bracket of 41-60. The implication

of the data showed that the sampled population were effectively represented as most of it (within 20-60years)

are within the ages that are not faced with the problem of ageism and as such, might not have the problem

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of recall amongst other aged-like syndrome that might affects the validity and reliability of the data

collected.

Next is the Sex of respondents which is categorical. It was basically divided into two (2) namely: female

and male.

The female occupied one hundred and eighty-two (182) respondents making 47.4% out of the total sampled

size. The Male category occupied two hundred and one (202) respondents making 52.6% out of the entire

sampled size of three hundred and eighty-four (384) used. Below, the gender characteristics of respondents

are graphically presented showing its frequency and percentages it occupied in the sampled size.

The implication of the above data collected has shown that; the data collected has effectively covered both

gender in the population. The effectiveness to cover both gender makes the data to have responses that are

gender sensitive and hence, can be generalized.

The marital status of respondents the third socio-demographic construct in table 4.1 which is categorical. It

was basically divided into two (2) namely: never married the ever married categories.

For the ever married category, it consist of three hundred and thirty-four (334) respondents making 86.98%

while the never married category made 13.02% equivalent to fifty (50) respondents out of the total sampled

population of three hundred and eighty-four (384).

This implied that, most of the study area (adults) have ever married and by extension, within the family

which could have experienced the stages of Health Seeking Behavior as proposed by the theory (descriptive

model of health seeking behavior) used for this research.

Fourth is the major source of income of respondents which is also categorical. It was basically divided into

three (3) namely: Government job, farming and others.

Government jobs as a major source of income contributes one hundred and eighteen (118) respondents

making 30.7% of the sampled population. Farming as a major source of income made two hundred and

eighteen (218) respondents equivalent to 56.8% of the total sampled population. Others as major sources

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of income include jobs like craftsmanship, private businesses and mining that made fourth-eight (48)

respondents and 12.5% out of the sampled population.

By implication, this data was able to justified the notion that, faming as seen in the data above is not only

seen as agrarian society that uses faming for both subsistence and cash purposes but also confirmed that

it’s a way of life as those who reported other sources as their main source of income, engages in faming as

well.

Next is; Respondents distribution by their place of residence into two (2) major categories: town and village.

For town (respondents living in the core of the Local Government), it have the total respondents of ninety-

five (95) making 24.7% out of the aggregate of 384 respondents.

For village (respondents living at the hinterland from the center of the Local Government), it made two

hundred and eighty-eight (289) respondents making 75.3% of the entire sampled population of 384

respondents.

The above data presented implies that, majority of the study population lived in villages that enabled

farming and hence, the Gbari identity.

Respondents’ distribution by level of formal education is categorical. It is categorized into four (4) major

categories: No Formal Education, Primary, Secondary and Tertiary.

The No Formal Education consist of (25) twenty-five respondents which is equivalent to 6.5% out of the

total sampled size (384) for the study. The next category is the Primary Level of Education. It accounted

for Fifty-nine (59) respondents making 15.4% out of the sampled population of 384. Those with the

Secondary certificate made the third level with ninety (90) respondents making 23.4% of the sampled

population (384). The final level of education are those respondents with Tertiary education. This category

bagged the highest respondents of two hundred and ten (210) and 54.7% out of the entire sampled size of

384 used for the quantitative research.

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 This implied that, the majority of the study area are having some level of western education. This made the

study population to have the rationale making decisions in seeking for appropriate healthcare as proposed

by the theory used for this study

4.2 Data presentation and analysis based on research questions of the study

This section provided answers based on available data to research questions raised as the foundation of this

study using descriptive statistical analysis of frequencies and percentage. The final aspect of this sub-

section will present inferential statistics which will be used to test the hypothesis of this research.

4.2.1 Common Illnesses in Gbari people

This Sub-section tries to present the common illnesses generated from the field when collecting data

amongst the study area.

Table 4.2 Common illnesses amongst Gbari people

Construct Frequency Percent Local names
Feve Fever 72 18.8 Shaura
Ulcer 21 5.5 Nubosnasna
Spirit infestation in human body 70 18.3 Bori
Cancer 18 4.7 Phitankpa/Daji
Masquerade/witchcraft sickness 18 4.7 Kushi guma/Agusheyi
Measles 12 3.1 Gbasheyi
Guinea worm 10 2.6 Sombya
Chickenpox 14 3.7 Buzhara
Meningitis 11 2.9 Sheshenga
Appendix 10 2.6 Garaiy
Candidiasis 81 20.9 Munu
Pile 21 5.5 Enyi/Enyi guma
Cough/whooping cough 12 3.1 Aishi/Fuka
Others 14 3.7
Total 384 100.0
Source: Author’s field work, 2023

The above table 4.7 seeks to provide data that will answer the second research question which reads: What

are the common illnesses found amongst Gbari people.

From the table, responses where gathered and presented the numerous illnesses affecting the study area.

The most with the highest response is candidiasis called "Munu" in the local dialect. It consisted of eighty-

one (81) responses equivalent to 20.9% of the total responses of three hundred and eight-four (384). Next
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is fever (Shaura) with seventy-two (72) responses and 18.8%. The third most recorded illness is spirit

infestation of the human body/possession (Bori) with seventy (70) responses and 18.3%. The fourth are

pile (Enyi) and ulcer (Nubosnasna) having twenty-one (21) responses and 5.5% respectively. The fifth are

cancer (Phitankpa/Daji) and masquerade/witches induced illnesses (kushi guma/Agusheyi) have eighteen

(18) responses making 4.7% for each. The sixth are chickenpox (Buzhara) and others with fourteen (14)

responses making 3.7%. The others consist of thirteen (14) different illnesses like: snake bite (wasa guma),

excessive Head pain/headache (Pmachigo/cigosnasna), skin infection/eczema (danbbai/fugobuiy), back

pain (Ashi guma), stomach pain (Nubosnasna), pneumonia/rib pain (Egba/Bagu), catarrh (shiiguma),

epilepsy (Kumbo), obesity (Gbamubpe guma), diabetes (Yakagukpa), Leprosy (chekuru guma ),

Madness (nyeche guma), Convulsion (Eluguma) and Blindness (Yebuiy). The seventh illnesses are

measles (Gbasheyi) and cough/whooping cough (Aishi/Fuka) which had twelve (12) responses and 3.1%

respectively. The ninth type of common illnesses is meningitis (Sheshenga guma) making 2.9%. Finally,

appendix and guinea worm made the least responses of ten (ten) and 2.6% for each.

Data from the Key Informant Interview also confirmed and corroborated the quantitative data discussed

above. For example, an interviewee reported (traditional medicine practitioner: Mr. I) and confirmed that:

“ The common illnesses amongst our people (Gbari) are pile, ‘Munu’ (candidiasis), head pain, fever, convulsion
in children, snake bite, stroke and hypertension” (traditional healer Mr. I. KII, 2023).

Also so, a medical doctor (Mr. J) also confirmed most common illnesses captured in Paikoro include:

“Diarrhea, cholera, malaria and typhoid fever, dysentery, hyena, cuts and wounds”
(Medical practitioner: Mr. J. KII, 2023).

More so, a sick patient (Ms. Q) in the hospital was interviewed and this is what she said is disturbing her:

“When we came to the hospital yesterday, it was reported that it is typhoid that is disturbing me and I also have
ulcer. That’s what the doctor told my mother” (sick patient: Ms. Q. KII, 2023).

A mother to the patient (Mr. N) taking the traditional care reveled to the researcher during the KII that:

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“My son went to farm today and on his way coming, a snake ‘wasa’ bite my son and here we are for treatment”
(sick patient: Mr. N. KII, 2023).

The above interview conducted justified the examples given by the sampled respondents as common

illnesses found amongst Gbari people. Below is a graphical representation of the major common illnesses

as generated from quantitative research.

Fig.4.1 Common illnesses amongst Gbari people

Source: Author’s field work, 2023

The above Fig. 4.1, the mean (which is peak of the plot) lied within 6.33 (measles) out of the aggregates of

14.00. The implication of the above data (after showing many common illnesses amongst Gbaris) was able

to have shown that: the three major illnesses above the histogram plot (candidiasis, fever and spirit

infestation in human body) are the most prevalent illnesses as is affecting more than halve (58%) of the

population under study.

4.2.2 Cultural beliefs and knowledge (understanding) on perceived nature of illnesses amongst Gbari

people

This sub-chapter seeks to provide data collected from the field in relation to the research question that reads:

what are the cultural belief and knowledge (understanding) on perceived nature of illnesses amongst Gbari

people.

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Table 4.3 Cultural belief and knowledge on the perceived nature of illness amongst Gbari people
construct Frequency Percentage (%)
natural 101 26.4
spiritual 193 50.1
manmade 55 14.4
others 35 9.1
Total 384 100.0
Source: Author’s field work, 2023

From the above descriptive data, the cultural belief and knowledge on the perceived nature of illness

amongst Gbari people are categorized into four (4) major constructs: natural, supernatural, man-made and

others categories.

The spiritual construct occupied one hundred and ninety-three (193) responses making 50.1% out of the

aggregate responses generated from the field. It carries the highest percentage of the population sampled

responses. This is also justified by the interview from a traditional head (Mr. A) where he said:

"The superstitious belief and the way we (Gbari people) perceived our sickness (illness) grows out of our culture"
(traditional leader: Mr. A. KII, 2023).

Another key informant (traditional leader: Mr. B) reported that:

“......as long as we are Gbaris, you can't take away from us our conception of supernatural which is highly placed
on our cultural belief in evil and evil doers that do causes illnesses and other life problems amongst our people"
(traditional leader: Mr. B. KII, 2023).

These amongst many shows a very strong attachment of the Gbari people to their cultural belief in

divination (Knunu) which embodied all aspects of life including wellness and illness. This could serve as

the basic reasons why the spiritual perception of the nature of illness is high amongst people in the study

area.

The natural construct made the second position with one hundred and one (101) responses and 26.4% out

of the total sampled responses of 384. Despite their (Gbari) belief in supernatural nature of illness, there

those illnesses that are perceived as natural due to environmental issues and vectors. This is supported by a

Key Informant (medical practitioner: Mrs. K) where she said:

66
“yes, most illnesses that are brought to us in the hospital are naturally perceived due to our environment, poor
hygiene, sanitation and some insects like mosquitoes that causes them except in some very few exceptional cases
that we couldn’t certify any clinical test regarding such illness” (medical practitioner: Mrs. K. KII, 2023).

Manmade construct made the third (3rd) ranking as it had fifty-five (55) responses and 14.4% out of the

total sampled responses of 384. Majorly, illnesses that are manmade are induced by people, witchcraft and

evil doers who will want to protect their produce on the farms, prevent one from prospering (punishment)

and inflict pain and suffering respectively. These were observed by the researcher during his ethnographic

observation. It is also supported by a traditional practitioner (Mr. G) where he said:

“Some people in our locality are witches. They do their evil work sometimes to cause pain and other times put fear
by putting in them (their victims) sickness (illness) that the ordinary eye will see it as normal (natural illness) but
it’s the activities of the wicked. This (perceived natural illness) will make the people to be suffering by going to
hospital. When they come back to us (traditional health practitioners), the person may not even be alive (may not
made it alive)" (traditional practitioner: Mr. G. KII, 2023).

Another traditional leader (Mr. C) also added to this (manmade construct) where he said:

"People invoke illness to self... (How?), very good. When someone stole farm produce from a farm that is not his
and the complaint comes to us (traditional head), we will go to our shrine and consult "kushi" who will punish
the unknown thief. So by this example, the thief has brought illness to himself and only through the same way
(kushi system) that they will be cured. Although, this practice is not too common nowadays due to religion"
(traditional leader: Mr. C. KII, 2023).

Others form the final construct. This category (others) includes: unknown nature and accidental. The Gbari

people also believed that some illnesses are unknown which they termed "not indigenous", accidental and

nature of job. An example of such illnesses termed at foreign is the Covid-19 pandemic. These contributions

were made by most traditional practitioners during the ethnographic observation and presented by the

researcher as thus:

They (Gbari people) don't know or have any knowledge about the illness (Covid-19) but they used the herbs from
their locality to treat some of them who showed up with the signs of cough illness (Aishi guma) perfectly.
(Traditional practitioners Mr. G, H, J, & Mrs. F. KII, 2023).

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The other construct has the total of thirty-five (35) responses and 9.1% out of the entire sampled responses

of 384. Below is the graphical representation of the cultural belief and knowledge/understanding on the

perceived nature of illness amongst Gbari people.

Fig.4.2 Cultural belief and knowledge on the perceived nature of illness amongst Gbaris

Source: Author’s field work, 2023

The above fig.4.2 showed that the mean (2.06) which is the peak of the plot out of the aggregate of 5.0 fell

within the spiritual construct. By implication, the data above showed that: the majority of the study

population cultural beliefs and knowledge (understanding) on the perceived nature of illnesses is spiritual.

This justified the definition of illnesses as highly subjective as proposed by the descriptive model on Health

Seeking Behavior used in this study.

4.2.3 Nature of Health Seeking Behavior amongst Gbari people.

The nature of Health Seeking Behavior is divided into two: appropriate and inappropriate health seeking

behavior. The following responses were collected from the study area to measure the nature of Health

Seeking Behavior amongst the Gbaris.

Table 4.4 Nature of Health Seeking Behavior amongst Gbari people.

Nature Frequency Percent
appropriate 242 62.9
inappropriate 142 37.1
Total 384 100.0
Source: Author’s field work, 2023

From the above table 4.4, two hundred and fourth-two (242) responses were gathered from the sampled

population whose visit (seek for healthcare) any of the pathways (orthodox/traditional healthcare system)

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within the first three (3) days of illness manifestation making it appropriate health seeking behavior. This

made 62.9% of the entire responses collected. When a sick patient (Mr. P) receiving treatment from the

orthodox was asked and she said:

“My parents brought me here the first day I started feeling unwell”. (Sick patient: Mr. P. KII, 2023).

The other patient (Ms. O) from the traditional healthcare also confirmed to the researcher that:

“She was brought here for spiritual healing immediately when she fell unconscious due to the ‘Bori’ attack”.
(Sick patient: Ms. O. KII, 2023).

One hundred and fourth-two (142) responses were gathered whose response showed that; they visited

(seek for healthcare) any of the pathways (orthodox/traditional healthcare system) after three (3) days of

illness manifestation making it inappropriate health seeking behavior. This made 37.1% out of the

sampled population. A respondent (patient: Mr. N, receiving treatment with the traditional healer) said:

“I was taken to the clinic at first by my mother as my father don’t work here. After three (3) days without
getting better, my mother informed my father and I even spoke to him telling him what I use to fill. My
father then instruct my mother to bring me here. We have spent five (5) days now and am about to be
discharged to go home tomorrow as the traditional herbalist said am relieved”. (Sick patient: Mr. N. KII,
2023).
Below is the graphical representation of the above description

Fig.4.3 Nature of Health Seeking Behavior amongst Gbari people.

Source: Author’s field work, 2023

From the above fig.4.3 showed the mean (1.37) which is the peak of the plot fell within the appropriate

Health Seeking Behavior amongst Gbari people. The Gbari people could be concluded to be having

appropriate health seeking behavior. By implication, the above data confirmed that: despite the stronger

attachment to culture by the Gbaris in their subjective experience and knowledge of illnesses, they still
69
maintained an appropriate health seeking behavior. Although, a good record of inappropriateness in health

seeking is still reported (37.1%) which could still explain the need for a more control to reduce illnesses'

occurrence.

4.2.4 Cultural factors affecting Health Seeking Behavior amongst Gbari people.

Below is a table showing the cultural factors in (3) constructs, their frequencies and percentages as gathered

from the study area.

Table 4.5 Cultural factors affecting Health Seeking Behavior amongst Gbaris
Construct Frequency Percentage (%)
cultural belief 313 81.5
cultural knowledge 51 13.3
Cultural power 20 5.2
Total 384 100.0
Source: Author’s field work, 2023

In above table 4.5, the cultural factors affecting Health Seeking Behavior amongst Gbari people are cultural

belief, cultural knowledge and cultural power.

From the responses gathered from the study population via its sampled size shows that: Cultural belief has

the highest affect towards Health Seeking Behavior with three hundred and twelve responses making 81.5%

out of the aggregate responses of three hundred of eighty-four (384). This implies that; the cultural belief

of the people of Gbari plays the most effect on where, when and how to seek for health whenever they

(Gbaris) are sick. Cultural knowledge/understanding made the second with fifty-one (51) responses making

13.5% out of the sampled population of 384 respondents. This shows that; cultural

knowledge/understanding of the illness episode accounts for about 14% predictability of where, when and

how to seek for health Care whenever Gbaris are ill. This goes in line with the summation of a traditional

leader (Mr. D) during one of the interviews that said:

"You cannot separate a typical Gbari native from his/her cultural belief" (traditional leader: Mr. D. KII, 2023).

Another key informant (traditional healthcare practitioner: Mr. H) also said:

“The way we see illnesses are highly guided by our superstitious cultural belief and what we know (cultural
knowledge) that can caused it". (Traditional practitioner: Mr. H. KII, 2023).

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More so, another traditional healer (Mrs. F) explained that:
“No matter where we (Gbaris) may be, we are strongly attached to our culture which guides everything we do as
in regards to illness and medicine". (Traditional leader: Mrs. F. KII, 2023).

The final factor is the cultural power (other) which made the least effect with twenty (20) responses

equivalent to 5.2% of the entire sampled population of 384 responses.

Below is the graphical representation of the above illustration.

Fig.4.4 Cultural factors affecting Health Seeking Behavior amongst Gbari people

Source: Author’s field work, 2023

The peak of the plot as represented by the mean (1.24) above fell within the cultural belief which showed

the importance of their belief system in health seeking, understanding of illness episode and labelling of

the sick (sick role). The implication of the above data as presented is: the cultural beliefs construct occupied

the summit and as core in dictating how other cultural constructs are shaped and moderated as it affects

Health Seeking Behavior amongst the Gbaris. Although, other cultural factors that moderates Health

Seeking Behavior include: cultural knowledge and power as presented in the data above.

4.2.5 Pathway(s) used in health seeking amongst Gbari people.

The table below show the various pathways used in health seeking amongst Gbari people.

Table 4.6 showing the pathway(s) used in health seeking amongst Gbari people.
construct Frequency Percentage
orthodox 76 19.8
traditional 122 31.9
dual 186 48.3
Total 384 100.0
Source: Author’s field work, 2023

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From the above table 4.6 showed that there are two (2) major pathways but most respondents combined

both (dual/pluralism) concurrently or simultaneously.

First, the Orthodox pathway which have the total of seventy-six (76) responses and 19.8%. When asked by

the researcher (during ethnographic observation), a key informant (medical practitioner: Mrs. M) and said:

“Most of the people living in the core towns of paikoro local government do patronize hospital care to traditional
care. This may be because there are educated and we (hospitals) are available to them unlike those in the
hinterland” (medical practitioner: Mrs. M. KII, 2023).

While the second, traditional pathway have one hundred and twenty-two (122) responses making 31.9%.

When asked by the researcher (during ethnographic observation), a key informant (traditional leader: Mr.

G) attested to the fact that:

“The origin of the Gbari culture cannot be complete without mentioning our medicine. This make our people
(despite the high level of education and propaganda by western medicine by international organization through
the traditional leaders) to be more attached to our 'Ashigbe' (traditional healers) for medication and some mystical
interpretations" (traditional leader: Mr. G. KII, 2023).

Although, the majority responses of one hundred and eighty-six (186) equivalent to 48.3% practiced

medical pluralism (dual pathways) out of the aggregate of 384 responses gathered from the field. Another

Traditional leader (Mr. E) proclaimed that:

“Due to the tight attachment to our culture and superstitious belief in illness perspective, our people must first of
all consult a traditional healer for interpretation before going to either hospital or taking a traditional care. This
explains why we have a traditional healer in most of our streets and homes” (Traditional leader: Mr. E. KII,
2023).

Below is the graphical representation of the pathway(s) used in health seeking amongst Gbari people.

Fig.4.5 showing the pathway(s) used in health seeking amongst Gbari people.

Source: Author’s field work, 2023

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From the above (Fig.4.5), the mean score of 2.28 out of the aggregate of 3.50 showed the peak of the plot

which fell within traditional pathways. The data above implied that; there is a very high application of

healthcare dualism despite the presence of two major health seeking pathways: orthodox and traditional

pathways. This is explained in their (Gbaris) affection to the perceived cultural beliefs and knowledge in

the nature (spiritual) of illnesses which made them (Gbaris) to seek for spiritual explanation (traditional

pathway) before going for the most appropriate and probable efficacy source of treatment. Hence, a higher

medical pluralism is observed amongst the study population.

4.3. Data presentation and analysis based on hypothesis testing.

The hypothesis of this research was written in both null and alternative statements. The null is represented

by (Ho) and written in a negative form while the alternative is represented by (H1) written in a positive

form. The hypothesis statements are as thus:

Ho: There is no relationship between culture and Health Seeking Behavior amongst Gbari people.

H1: There is a relationship between culture and Health Seeking Behavior amongst Gbari people.

The bases to reject or fail to reject a null hypothesis steams out of the conclusion after test where: if the

calculated value (test value) is less than or equal to the alpha value (0.05), the null hypothesis is rejected

and the alternative hypothesis is failed to be rejected (accepted) but, where the calculated value (test value)

is greater than the alpha value (0.05), the null hypothesis is failed to be rejected (accepted) and the

alternative hypothesis is rejected.

Due to the demands for the use of construct validity of data analysis in this study, the researcher used a

multi-statistical methods (chi-square and correlation) to analyze and test hypothesis and their results were

presented below.

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4.3.1 Data presentation and analysis of hypothesis using chi-square statistical method.

For chi-square, the table below showed the result generated after the analysis to test if there is a relationship

between the core variables (culture and health seeking behavior).

Table 4.7 Chi-square showing relationship between Culture and HSB

Value Approximate Significance (sig)
Interval by Pearson's R -.341 .000c
Interval
Ordinal by Spearman’s R -.365 .000c
Ordinal
N of Valid Cases 384
c. Based on normal approximation.
Source: Author’s field work, 2023

From the above table, the Pearson’s (R) value is –0.341 at a significance (sig) of 0.00. This showed that the

test value (sig) is less than the alpha value of 0.05. Therefore, the null hypothesis is rejected and the

alternative hypothesis is upheld (accepted). Also, the Spearman’s (R) value (–0.365) at a significance (sig)

of 0.00 showed that the test value (sig) is less than the alpha value (0.05). More so, the null hypothesis is

rejected and the alternative hypothesis is retained (accepted).

The strength of the relationship can be expressed by looking at the chi-square value of –0.341 and -0.365

within the chi-square measurement value of 1 ≤ 0 ≤ -1. Where from -0 to -0.3 shows a weak negative

relationship, -0.4 to -0.6 shows a negative moderate relationship while from -0.7 to -1 shows a negative

strong relationship. In this situation (-0.341/ -0.365) showed a weak negative relationship. This implies that;

the higher the independent variable (culture), the lower its corresponding implication (but the corresponding

implication is not proportional that’s why it’s negative) on the dependent variable (health seeking behavior).

Therefore, based on the above facts gathered from the field, the researcher tested the hypothesis and found

out that there is a negative relationship between culture and Health Seeking Behavior amongst Gbari people

in Paikoro local Government Area of Niger state, Nigeria.

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4.3.2 Data presentation and analysis of hypothesis using correlation statistical method.

For Correlation, the table below showed the generated result after the analysis to test if there is a relationship

between the core variables (culture and health seeking behavior).

Table 4.8 Correlation showing relationship between Culture and HSB

culture Health seeking behavior
culture Pearson 1 -.341**
Correlation
Sig. (2-tailed) .000
N 384 384
Health seeking Pearson -.341** 1
behavior Correlation
Sig. (2-tailed) .000
N 384 384
**Correlation is significant at the 0.01 level (2-tailed).
Alpha value is 0.05
Source: Author’s field work, 2023

After using the same data generated from the field to test the relationship between the core variables

(culture and health seeking behavior) using correlation, the above result was achieved. From the result

above, Pearson’s correlation between culture and culture, Health Seeking Behavior and Health Seeking

Behavior is perfect (=1). The Pearson’s correlation between culture and Health Seeking Behavior is -

0.341 (the same value gotten from the chi-square analysis) at a significance (sig) of 0.00 which is below

the alpha value of 0.05 on a (sig 2 tailed) signified that; there is a weak negative relationship between

culture and Health Seeking Behavior amongst Gbari people in paikoro local government area of Niger

state, Nigeria.

This is to say, both statistical methods (chi-square and correlation) gave similar results (-0.341) which

showed a high construct validity of the data analyzed. Finally after observing both results, the researcher

came up with the conclusion that; since the calculated value (sig) of 0.00 is less than the alpha value of 0.05

then, the null hypothesis (Ho) is rejected and the alternative hypothesis (H1) is accepted meaning there is

a (negative weak) relationship between culture and Health Seeking Behavior amongst Gbari people. This

summation is graphically represented below:

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Fig.4.6 showing the graphical representation of the weak negative relationship between culture and
Health Seeking Behavior (HSB) amongst Gbari people.

Cultural belief cultural knowledge cultural power

Source: Author’s field work, 2023

From the above fig 4.6, each construct of the culture shows the negative weak relationship between it

(culture) and Health Seeking Behavior amongst Gbari people.

In the first bars (cultural belief construct), when appropriate Health Seeking Behavior is high (170 count),

a corresponding lesser (140 count) inappropriate Health Seeking Behavior is observed although, not in

the similar proportion (that’s why it’s a weak relationship). Also, the same is applicable to the second

cultural construct (cultural knowledge). When a higher appropriate health seeking (50 count) is recorded

within the influence of the cultural knowledge, the lesser the inappropriate Health Seeking Behavior (0

count) although, not in the same proportion (that’s why it’s a weak relationship). More so, the higher the

cultural power construct (20 count), the lower the inappropriate Health Seeking Behavior (0 count).

4.4 Discussion of major findings.

This study was organized to look into Gbari culture and Health Seeking Behavior with the aim of evaluation.

This research adopted a descriptive survey design that allowed the used of both quantitative and qualitative

techniques (triangulation) in gaining useful results that could be generalized. The sampled population for

both quantitative (384 respondents) and qualitative (17 respondents) equated to the total of 401 respondents.

The socio-demographic characteristics of the sampled respondents ranges from female (182) to male (202)

with age brackets of 20-40years (111), 41-60years (257) and 61-80 years (16) and living in town (95) and

villages (288). Various levels of formal education was recorded such as no formal education (25), primary

76
(59), secondary (90) and tertiary (210) with major source of income as farming(56.7%) followed by

government jobs (30.8%) among others (12.5%). Responses were generated from the study area to satisfy

research questions/objectives which were carefully craved out from the statement of problem are as follows:

The first research questions on the common illnesses amongst Gbari people was as answered where

candidiasis “Mumu” is the most common illness discovered with 20.9% responses. To the Gbaris,

candidiasis is an illness that they see as normal and natural to all birth giving individual amongst them. It

only manifest when a favorable condition is achieved. Other illnesses that are common are fever, ulcer,

cancer, measles, appendix, pile, cough, headache, head pain, pneumonia, diabetes and catarrh. These results

are also detected in the works of Ankur & Sharma (2002), Omotoso (2010), and Kelly et-al (2015). In

contrast to what previous researchers have found out (as reviewed), more other common illnesses recorded

are: Candidiasis, possession of spirits in human body, spiritual sickness, meningitis epilepsy, whooping

cough, back pain, obesity, madness and blindness are common illnesses that previous reviewed researchers

haven’t discovered in their work..

The second research question on the cultural belief and knowledge on the perceived nature of illnesses

generated responses from the study area which showed that the perceived nature of illnesses amongst Gbaris

are natural (culturally believed and perceived to be caused by nature/God), supernatural (culturally

perceived and believed to be caused by evil spirits). This findings are also justified by Ankur &Sharma

(2002), Stuart et-al (2009), Chukwuneke et-al (2012) and Kelly et-al (2015). In contrast, perceived nature

of illnesses like not indigenous, accidental and nature of job like in terms of farming are not reported by

reviewed scholars.

The third results showing the cultural factors affecting Health Seeking Behavior amongst the Gbaris as

cultural belief occupied the summit which 81.5% followed by cultural knowledge with 13.3%. These facts

are also supported in the study of Julie et-al (2020), Ankur &Sharma (2002), Wei-Chan (2010), Stuart et-

al (2009), Segundo & Tajuddeen (2019) Edward (2017), Chukwuneke et-al (2012), Adeola & Ayuba (2011)

and Kelly et-al (2015). In contrast to the above scholars (as reviewed), cultural power with 5.2% was
77
dictated as a very important cultural factor affecting not only the choice to the pathway to health seeking

but Health Seeking Behavior in general. The result above showed the high impetus placed on the cultural

belief, knowledge and power in the definition, nature, causes and remedy of illnesses amongst Gbari people.

The researcher also provided results that showed the various pathways used in Health Seeking Behavior

used in the study area. This result showed that; In Gbari people, there are two major pathways (orthodox

and traditional health Care systems). These pathways found in Gbari people are also seen in the works of

Julie et-al (2020), Ankur &Sharma (2002), Wei-Chan (2010), Stuart et-al (2009), Segun & Tajuddeen

(2019), Latunji & Akinyemi (2018), Chukwuneke et-al (2012) and Kelly et-al (2015). In contrast to

previous findings as reviewed, this study showed that: most of the respondents do combine both pathways

(pluralism) in the quest for health seeking unlike what is seen (in reviewed works) as just supplementary.

In this research, the most common and acceptable method in health seeking is to practice dualism as shown

in the work.

The result gathered showed the Gbari people have more of appropriate Health Seeking Behavior as 62.9%

in contrast to what Omotoso (2010) reported against inappropriate of 37.1%. Appropriateness shows that

they (Gbaris) seek for healthcare immediately or within the first (3) three days of symptom manifestation

while seeking for healthcare after (3) three days of symptom manifestation is tagged inappropriate.

Finally, the test of hypothesis was made and it confirmed that there is a weak negative relationship between

culture and Health Seeking Behavior amongst Gbari people in Paikoro Local Government Area of Niger

State, Nigeria. This result was in contrast to the works of Omotoso (2010), Julie et-al (2020), Kelly et-al

(2015) and Chukwuneke et-al (2012) who all reported a positive relationship between culture and health

seeking behavior. This might be so because, there are some intervening variables that moderates the

outcome variable (health seeking behavior) amongst Gbari people in Paikoro Local Government area of

Niger state, Nigeria.

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 CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATIONS.

5.0 Introduction.

This chapter tend to make a recap of the major aspects of the research (summary), draw generalization

(conclusion) and proffer workable solutions to the problems studied (recommendations).

5.1 Summary.

This study was built on the topic: evaluation of culture on Health Seeking Behavior amongst Gbari people

in Paikoro Local Government Area of Niger State, Nigeria with the aim of assessing the problem and

providing suggestions to the phenomenon under study.

By doing this, the study employed the services of a descriptive survey design where triangulation in method,

data and statistical presentation were used to collect, analyze, present and interpret data to information in

forms of tables, graphics and written description. The sampled size of 401 was used in total where

quantitative aspect had 384 respondents while qualitative aspect have 17 respondents. Questionnaire and

Key Informant Interview (KII) were used for quantitative and qualitative data collection respectively. After

the data were collected, analyzed, presented and interpreted to answer research questions, the following are

the summary of the findings in relation to the research objectives as stated in chapter one of this work.

In relation to the first objective of this study which was to find out the common illness amongst Gbari

people. From the result in chapter four (see table 4.7) showed that: there are many common illnesses

amongst Gbari people ranging from communicable and non-communicable illnesses like Candidiasis with

the highest response, fever, diabetes, meningitis, cough, catarrh and pile are of the high prevalence that are

disturbing the Gbari people. Others with fair prevalence are obesity, blindness, madness, back pain and

epilepsy. This findings showed that: the Gbari people in Paikoro are still suffering from many contagious

and non-contagious illnesses.

79
The second objective of this research is to find out the cultural belief and knowledge on perceived nature

of illnesses amongst the study population. Findings from this study brought out interesting updates that

showed the influence of culture in the nature, etiology and ontology of illnesses. Illnesses are largely belief

and understood to be spiritual even though they look normal. Other cultural belief and understanding on

the nature of illnesses include manmade, natural and the unknown/foreign to the Gbaris.

The third objective was justified with results generated on the cultural factors affecting Health Seeking

Behavior amongst Gbari people. The researcher found out that cultural belief, knowledge and power are

the most fundamental cultural constructs that affects (appropriately or inappropriately) Health Seeking

Behavior in the study area. This speaks volume why the strong attachment to cultural belief system in the

general assessment of the illness episode.

The fourth objective is to find out the nature of Health Seeking Behavior amongst Gbari people. Data

received and presented showed that a higher population of the Gbaris do seek for health care immediately

or within the first (3) three day of symptom manifestation. This showed that there is a higher appropriate

Health Seeking Behavior when compared to those that seek for healthcare after the first (3) three days of

symptom manifestation (inappropriate health seeking behavior). Although, the percentage of the

inappropriate Health Seeking Behavior is above normal as it has more than one-third of the sampled

responses.

The fifth objective of the study is to find out the pathways in health seeking amongst the Gbari people.

Results from this study also showed that: there are two (2) major pathways (orthodox and traditional

healthcare systems) although, most Gbaris combine both as the influence of their belief system and

effectiveness of treatment where given as major reasons for dual treatment.

Finally, hypothesis was tested and the conclusion was reached which showed a weak negative relationship

between Gbari culture and health seeking behavior. This could be attributed to a lot of intervening variables

that moderates the outcome (health seeking behavior) as shown in the study (see fig.2.1). To ascertain to

80
the above insinuation, a further research could be conducted to ascertain the reason why there is a weak

negative relationship between Gbari culture and their Health Seeking Behavior in future as it wasn't the

scope of this study.

5.2 Conclusion.

Based on the result presented in this study, the following conclusion are made.

First, there are many illnesses affecting Gbari people ranging from communicable, non-communicable,

acute, chronic and spiritual based illnesses most notable are candidiasis (Munu) and spirit infestation in

human body (Bori).

Second, Cultural belief and knowledge plays a vital role in the perception and nature of illnesses amongst

the study population. The Gbari cultural belief and understanding have developed a stronger root in the

etiology, nature and treatment of illnesses in the area.

Third, cultural belief, knowledge and power are the most influential cultural variable that affects

appropriately or inappropriately (positively/negatively) the Health Seeking Behavior of the Gbaris towards

illness and remedy.

Fourth, there are both medical and alternative healthcare pathways (orthodox and traditional) in Gbari

people with medical dualism is the best practice in terms of health seeking.

Fifth, the nature of Health Seeking Behavior is more appropriate with lesser inappropriateness that signified

the continue prevalence of illnesses in the study area.

Lastly, the relationship between Gbari culture and Health Seeking Behavior amongst the study population

is negative and weak which signified the influence of other moderating factors that were not properly

observed.

81
5.3 Recommendation.

The following suggestions were drawn from the study as follows:

1. More attention should be given to the culture of people by health policy makers and health industry as it

plays a great role in how a local community perceive and label illnesses so that, any meaningful intervention

brought into the health sector could be well accepted, articulated and achieved most especially in rural

communities.

2. Mass public enlightenment and health awareness programs should be introduced by both the government

and the community leaders to educate the Gbaris on the need to have a healthier and friendly environment

which is a panacea to the eradication and control of contagious illnesses in the study area.

3. The government should provide more health care centers to accommodate the demands of healthcare in

the study area.

4. The government should introduce a policy that could harmonize both health care systems (orthodox and

traditional) so that it could contain illnesses affecting the Gbari people. Also, government certified

healthcare centers (both orthodox and traditional) that can be monitored and controlled to provide

multidimensional healthcare services to the people.

5. Traditional healthcare practitioners who are certified should be assisted by the government as they also

participates in the health care industry not abandoning them as it used to be in most communities in Nigeria.

This intervention will go a long way in improving healthcare delivery and structures that are grossly

inadequate.

6. Certified traditional healthcare centres should be incorporated into the health ministry to enhance and

facilitates treatments of illnesses that are local (traditional) and real affecting our local African traditional

communities since such illnesses (that are perceived as spiritual) exist in our communities.

82
5.4 Suggestions for further research.

The following are suggested gabs proffered by the researcher for future study.

1. The research should be replicated amongst other cultural communities in Nigeria.

2. The study could also be revisited to evaluate the effects of the intervening variables as captured in the

work on Health Seeking Behavior amongst Gbari people.

3. The research could be extended to the entire Gbari nation as it only touches one sector (used Gbari Kwa)

out of the two (left out Gbari Ngenge) in the Gbagyi world.

83
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 APPENDIX (A)

GENERAL INSTRUCTION AND GUIDELINES FOR INTERVIEW

Before the commencement of the interview, the researcher will introduce himself and inform the key

informant the following headings regarding the study at hand.

1. Research topic: The researcher will explain verbally the topic: EVALUATION OF CULTURE ON

HEALTH SEEKING BEHAVIOUR AMONG GBAGYI/GBARI PEOPLE IN PAIKORO LOCAL

GOVERNMENT AREA OF NIGER STATE, NIGERIA.

2. Purpose/use of the study: The key informant will be informed about the purpose of the research and it

use to the body of knowledge and the community.

3. Confidentiality and anonymity of the respondent: The key informant will be assured by the researcher

that information gotten will be treated as confidential and used for the purpose of this study. Despite have

bio data of the respondents during interview, the respondents are informed that their responses will be coded

and will not carry any description that will show their real self to protect their image and dignity.

4. Consent of the respondents: A formal letter (introductory letter) will be given to people in authority

(traditional leaders) and medical practitioners. Others that might not understand letters or might be in a state

of not needing a formal letter kike in the case of the sick, they will be verbally asked for the consent and

permission. After such, the interview will be conducted as agreed between the researcher and the key

informant.

Finally, the interview will be recorded to capture all information.

89
 APPENDIX (B)
INTERVIEW
1. Please sir, can you tell us about yourself (including name, age, educational background etc.).
2. Have you ever falling sick before?
3. How did you know that you are ill?
4. What is the first thing you do after understanding that there is a problem with your body?
5. Did you talk to anyone about the things you are feeling/experiencing?
6. What treatment did the person advice you to take and why?
7. Did you follow the advice?
8. What are the factors (things) you look into (considered) while taking a healthcare?
9. In the family, who decides for healthcare?
10. In your view, what are the reasons why people go for traditional medicine/healthcare?
11. In your view, what are the reasons why people go for hospital/orthodox medicine/healthcare?
12. As a Gbagyi (Gbari) person, how can you define health and illness?
13. Please mention the common illnesses present among Gbagyi (Gbari) community here in Paikoro?
14. Can you tell me more about these common illnesses in relation to their perceived cultural cause, origin,
nature, and how it could be remedied?
15. What is the cultural belief of this on these illnesses you mentioned?
16. What are the causes of these common illnesses you mentioned?
17. in study books (most researches), there are illnesses that are naturally caused, can you tell me as many
as you can mention affects people in Gbari land?
18. in study books (most researches), there are illnesses that are spiritually caused by evil spirits or evil
doers, can you tell me as many as you can mention that affects people in Gbari land?
19. What are the cultural factors (things) that affect health seeking among Gbagyi (Gbari) community?
Thank you very much for your time and contribution sir.

90
 APPENDIX (C)
GENERAL INSTRUCTION AND GUIDELINES FOR QUESTIONNAIRE

This is a questionnaire guide designed for M.Sc. Program on the topic: EVALUATION OF CULTURE
ON HEALTH SEEKING BEHAVIOUR AMONG GBAGYI/GBARI PEOPLE IN PAIKORO LOCAL
GOVERNMENT AREA OF NIGER STATE, NIGERIA. This instrument will be administered in Paikoro
Local Government Area of Niger State, Nigeria. The purpose of this research is for academic motive (M.Sc.
Program). The respondents are assured of their safety in relation to the research. Data generated here will
be used only for the purpose which it was designed. Please answer the questions bellow to the best of your
knowledge. Thank you for your response.

Yours sincerely,

Zakariyya Muhammad

(Researcher)

91
 APPENDIX (D)
QUESTIONNAIRE
INSTRUCTION: Please attempt to the following questions to the best of your knowledge. Tick the
box provided which correspond to your right option and write where necessary.
1. How old are you?
20-40 years 41-60 years 61-80 years
2. Your gender please?
Male Female

3. Are you married?

Yes No

4. What is the source of your income (money)?

Farming Business Government job others (specify)
..........................................
5. What is the level of your formal education (school)?
Primary Secondary Tertiary no formal education (school)

6. Describe your place of residence (living) in Paikoro?

Town Village others (specify).
................................................................
7. Have you ever falling ill before? Yes No

8. Did you have the knowledge from your culture (Gbari) about the illness?
Yes. No

9. If yes, what is the cultural name of the illness? Please

write.................................................................................................................................................................
......................................................................................................................................................
10. When you started feeling ill, who did you first talk to about what you are feeling?
Parents husband/wife others (specify)………………………………………
92
12. Why did you choose to first inform your option in question (10) about your illness? Please write
the
reason(s) .........................................................................................................................................................
......................................................................................................................................................
13. How did you come to know exactly what is/was wrong with you?

Self-diagnosis Family/friends hospital/medical doctor traditional doctor

14. Where did you first seek for treatment?

Self/home treatment Hospital/medical doctor traditional doctor

15. What is the reason why you choose your answer in question (14) above? Please write your
reason(s)................................................................................................................................................
...............................................................................................................................................................
16. In case the first treatment did not give the needed result, what other treatment option you would
choose?
Traditional treatment. Hospital/orthodox treatment. Others (specify)
........................
17. Will your cultural belief and knowledge about the illness and treatment affects the choice for
seeking healthcare when you are ill?
Yes. No
18. If yes, what other factors (things) you may consider in choosing healthcare whenever you are sick?
Please tick as many as you may consider.

Age/gender of the sick Perceived Nature/type of illness

Cost/money available for healthcare Distance to healthcare facility

Place of residence (living)of the sick Effectiveness of treatment option

If others (specify)...............................................................................................................................

19. In Gbagyi/Gbari people, who gives the directive (power) within the family when one is ill to go
for healthcare?
Father Mother Others (specify)
........................................................

93
20. What did you think is the reason why the person above holds the power to allow the sick to go for
treatment?

Richest in the family That's how it is in our culture Head of the family

Others (specify)............................................................................................................................
21. How long will it take before you could be granted the permission to seek for healthcare outside
the family?

Within first (3) days of illness. After the first (3) days of illness

Others (specify)............................................................................................................................
22. List any (4) common illnesses found among Gbagyi/Gbari people you know?
a)......................................................................b)................................................................
c).......................................................................d)................................................................
23. What did you think are the causes of these illnesses you mentioned above? Please list any (4)?
a)...................................................................... b)................................................................
c)....................................................................... d)................................................................
24. In study books (researches), there are illnesses that are naturally caused, can you list any (2) that
is affecting Gbagyi/Gbari people in Paikoro?
a)...................................................................... b)................................................................

25. In study books (researches), there are illnesses that are spiritually caused by either evil spirits or
evil doers, can you list any (2) that is affecting Gbagyi/Gbari people in Paikoro?
a).............................................................................................................................................
b).............................................................................................................................................
26. In your view, list (4) the reason(s) that makes people to choose traditional medicine and treatment
to hospital/orthodox treatment and medicine?
a).............................................................................................................................................
b).............................................................................................................................................
c).............................................................................................................................................
d).............................................................................................................................................
27. In your view, list (4) the reason(s) that makes people to choose orthodox treatment and medicine
to traditional treatment and medicine?
a).............................................................................................................................................
b).............................................................................................................................................
c).............................................................................................................................................
d).............................................................................................................................................

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28. What are the cultural factors that affect illnesses among Gbagyi/Gbari people? Please write any
(4):
a).............................................................................................................................................
b).............................................................................................................................................
c).............................................................................................................................................
d).............................................................................................................................................
29. What are the general cultural beliefs on illnesses among Gbagyi/Gbari people? Please write any
(4):
a).............................................................................................................................................
b).............................................................................................................................................
c).............................................................................................................................................
d).............................................................................................................................................
Thank you for your participation sir.

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 APPENDIX (E)

(1) Symmetric Measures

Asymptotic
Standardized Approximate Approximate
Value Errora Tb Significance
Interval by Pearson's R
-.341 .023 -7.087 .000c
Interval
Ordinal by Spearman Correlation
-.365 .024 -7.643 .000c
Ordinal
N of Valid Cases 384
a. Not assuming the null hypothesis.
b. Using the asymptotic standard error assuming the null hypothesis.
c. Based on normal approximation.

(2) Descriptive
Statistics
Mean Std. Deviation N
culturalfactorsHSB 1.2376 .53510 384
healthseekingbehav
1.3708 .48364 384
iour

(3)
Correlations
culturalfactorsHSB healthseekingbehaviour
culturalfactorsHSB Pearson Correlation 1 -.341**
Sig. (2-tailed) .000
N 384 384
healthseekingbehav Pearson Correlation -.341** 1
iour Sig. (2-tailed) .000
N 384 384
**. Correlation is significant at the 0.01 level (2-tailed).

(4) Reliability
Statistics
Cronbach's
Alpha Based
on
Cronbach' Standardized
s Alpha Items N of Items
.666 .649 8
VARIABLES: COMMON ILLNESS, CULTURAL FACTORS AFFECTING HEALTH SEEKING
BEHAVIOR, CAUSES OF ILLNESS, PATHWAYS, CHIOCE OF ORTHODOX, CHIOCE OF
TRADITIONAL, CULTURAL POWER, NATURE OF HEALTH SEEKING BEHAVIOR.

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APPENDIX F

97
APPENDIX G

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