FACTORS INFLUENCING

CARE SEEKING OUTSIDE

THE HOME WHEN THE
CHILD IS SICK
Presentation for Qualitative Research Method Study
(Taufiq Anshari Rasak_59122110)

TROPICAL MEDICINE AND GLOBAL HEALTH

NAGASAKI UNIVERSITY
Nagasaki, 06th April 2023
Introduction

Children's health depends on their parents (Mishra, 2019). When a child is

sick, parents will try to find health care for their child either in their own home or
looking for treatment outside their home. In care-seeking, some factors influence
parents. Family interactions, home decision-making processes, household resource
management, and gender roles may also significantly impact care-seeking
behaviors. (Colin et al., 2013). Therefore, this study conducted to determine the
factors influencing care-seeking outside the home when the child is sick.

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Objectives
To understand the factors influencing care-
seeking outside the home when the child is sick.
Specific Objectives:
a. To determine the care givers / decision-makers for
each pathway in care-seeking.
b. To Identify the enabling factors of care-seeking
outside the home.
c. To Identify the barriers of care-seeking outside the
home.
METHODS
1. Purposive Sampling
2. Interview
3. Hybrid Approach (Deductive and Inductive Coding)
4. Analyzed codes with NVivo software analysis

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CONCEPTUAL FRAMEWROK

This model can assist in providing

an overview of typical patterns of
decision-making and care
pathways and a range of care-
seeking choices. Additionally
personal and contextual factors
also impacted treatment
decisions, which were viewed as a
dynamic process.

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Adopted from Colvin et al. (2013)
Thematic Analysis (Deductive Coding)
TEORY THEMES CATEGORIES CODES REFERENCES

1. Interpretation or Recognize Symptoms Fathers Recognize the Symptoms 2

Caregiver's Recognition Daughter suffers by crying all day long and

2. Cause and Severity of Illness 3
and Response to Illness holding her ears
3. Previous Experience of Illness and Mothers are the primary caregivers when child
2
Child Rearing is sick, assisted by father
Communication for advice seeking between
1. Family Relationship 2
father and mother
Household a. Perception that the disease will cure faster,
decision Seeking Advice and 1
Negotiating Access 2. Clarity of Diagnosis and Severity of but the situation was persisted
making Symptoms
and within the Family
b. Father advice to hospital 2
pathways
of care 3. Control Over Financial Resource Father provides the financial 1
Colvin et
al. (2013) Using Middle Layer
between Home and Medicine Available at Home Mother Give Medication at Home 4
Clinic
a. Accessed proper health services from
3
hospitals
1. Ability to Access
Accessing Formal
b. Parents bring children to the hospital 2
Biomedical Service
2. Perception of Power Diagnosis and
Trust and Accurate diagnosis 2
Treatment

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Thematic Analysis (Inductive Coding)

REFERENCES CODES CATEGORIES THEMES

2 a. Start after return from hospitals
(05.00 PM)
Caregivers Action
b. The wife and the aunt take care FOLLOW UP
2 TREATMENT AT
the daughter in the house
HOME
1 a. Fully recovered in the next day
Daughter’s Condition
3 b. The condition was going better

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FINDINGS (1)
1. Caregiver's Recognition and Response to Illness
The father was the first person to recognize the symptoms.
When the child was sleeping, there were significant changes in his
body and behavior "I was the first person to recognize,
because I noticed the situation has changed to my daughter
and I informed my wife that there is something wrong with our
daughter…I was recognized the symptoms around 9.00 pm”.
After that, the father was followed up by addressing the severity of
the illness "My first action is to check the severity of the
disease...she was crying while touching at her right ear”.
When the parents recognize their child is sick, the mother acts as
the caregivers and assist by the father all over the night "Most of
the time my wife is with kids. But I'm also responsible for Figure Generated by Nvivo
making sure that but this time".
FINDINGS (2)
2. Seeking Advice and Negotiating Access within the Family

Through communication between the father and

the mother, the father suggested taking his daughter to
the hospital. This is due to considering the severity of
the illness. "It was just a normal conversation
because my wife...we should just think that it was a
normal thing, but for me I was a bit aggressive to
push her so that we can go quickly to the
hospital". In addition, the father is also responsible for
financially providing treatment when his child is sick
"I'm the one. I'm the head of the family".
Figure Generated by Nvivo
FINDINGS (3)
3. Using Middle Layer between Home and Clinic

The availability of home remedies provide the mother

give medicine to her daughter. The medicine has been
prepared if the child suddenly gets sick by buying it from a
drugstore “Once my wife has a tendency of buying
medicines for prevention one our children get favor…
My wife recognizes that there are many medications at
home, like the painkillers. So, when one of our kids is
sick. She always has given the drugs like that”.
Therefore, the drug was administered twice before bringing
Figure Generated by Nvivo
the child to the hospital. "Just take one or two times. The
first one was in the night, and the other medication was
in the morning".
FINDINGS (4)
4. Accessing Formal Biomedical Service
Families can access the biomedical service in the hospital at 1
p.m. "It was in the afternoon, around 1.00 p.m.". The decision was
made because the father left for work in the morning. "In the
morning, I had some business to do. I went to work to fix some
issues. Then I decided to come back in the afternoon". In
addition, the family chooses to go to the hospital for an examination
because of the trust in the services provided by the doctor in
providing proper care. "So, the doctors just said that there is a
problem in the ear, and they said that disease is normal for the
kids. It sometimes happens for most, for some kids, but for some
kids." Moreover, the availability of equipment in the hospital is a Figure Generated by Nvivo

consideration in selecting providers. "You know, equipment for

measurement, so you can miss some things, but for the bigger
hospitals, everything will be there".
FINDINGS (5)
5. Follow-Up Treatment at Home
Follow-up care was carried out after returning from the hospital.
"Yeah, after completion of my treatment, we went back home
normally...it was around 5.00. PM". In addition, the mother is assisted
by the child's aunt, while the father focuses on continuing his work.
"Most of the time my wife, and the Lady, I've told, because I'm the
head of the family, I must go and search for them”. The treatment
that is carried out is to give medicine according to the doctor's
prescription and do observation of the daughter's condition. "According
to the drugs that were given, the medicines we started, we gave our
daughter medicines to use recommended by the doctor”. Therefore,
the results of the treatment recognized by showing good quality sleep in
the night and improvement condition in the next morning. “Then that
night we slept; she complained not that much. Then we came to
realize that there's some improvement in the morning". Figure Generated by Nvivo
CASE DIAGRAM
1st DAY 2nd DAY 3rd DAY
MORNING – 1.00
09.00 PM PM 05.00 PM MORNING
FATHERS MOTHER GIVE 2ND HOME RETURN FROM HOSPITAL IMPROVEMENT CHILD
MEDICATION TREATMENT START FOLLOW UP
RECOGNIZE THE TREATMENT
CONDITION (CURE)
SYMPTOMS & DELAY ON BRING TO
HOSPITAL (FATHER WENT MOTHERS AND END OF THE
CHECK SEVERITY TO WORK) DAUGTER’S AUNT AS TREATMENT
OF THE ILLNESS FAMIILY BRING DAUGHTER
CAREGIVERS
MOTHER GIVE HOME TO HOSPITAL
MEDICATION TREATMENT
ACCESS TO MEDICAL
ASSISTED BY FATHERS SERVICE
FATHER DECIDE TO DOCTOR PRESCRIBED DAUGHTER FEEL
HOSPITAL DRUGS BETTER

MIDNIGHT 01.00 PM NIGHT

CARE SEEKING OUTSIDE
CARE SEEKING INSIDE HOME HOME
FOLLOW-UP TREATMENT
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 DISCUSSION / CONCLUSION (1)
Based on the results that have been found, each pathway shows a difference in
whom the caregivers are involved. The father was the first to recognize the
symptoms and see the severity of the illness. The mother is the primary caregiver
when her child is sick, such as providing drug treatment at home. The mother always
does this because of her experience in always preparing medicine when a child is sick.
Meanwhile, the father plays a role in making decisions for advice-seeking and
bringing the child to the hospital, considering the severity of the symptoms and
financial availability. Moreover, the mother and aunt carry out follow-up care at
home because the father goes to work. This analysis suggests that the role of the
mother is more dominant to provide home treatment for children. While the father
acts as a decision-maker in advice care-seeking outside the home.

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 DISCUSSION / CONCLUSION (2)
In addition, the enabling factors of care-seeking outside the home can be identified.
The first is the severity of the illness. The parents assumed he had no previous experience with
the disease because the child cried all night, clutching his ear, prompting the father to take him to
the hospital. The second is home remedies, but the effort do not bring improvement to the child.
The third is the consideration of financial availability, which can provide an opportunity to
continue treatment at the hospital. Lastly, there is trust in the health services provided by the
hospital because of the professionalism of the health workers, and the availability of adequate
medical equipment encourages families to bring their children to the hospital.

On the other hand, the barriers of care-seeking outside the home is the inability of
other family members to bring the child to the hospital without a father, causing delays in
accessing health care. This was because his father left for work in the morning and required his
family to wait for him to come home before bringing the daughter to the hospital.

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LIMITATION
This study could not identify the disease suffered by the child because of the
informant limited in remembering past events. Additional informants, such as
interviewing the mother or the aunt, are needed for data clarity.

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References
Colvin, C. J., Smith, H. J., Swartz, A., Ahs, J. W., de Heer, J., Opiyo, N., Kim, J. C.,
Marraccini, T., & George, A. (2013). Understanding care seeking for child illness in
sub-Saharan Africa: A systematic review and conceptual framework based on
qualitative research of household recognition and response to child diarrhoea,
pneumonia and malaria. In Social Science and Medicine (Vol. 86, pp. 66–78).
https://doi.org/10.1016/j.socscimed.2013.02.031

Mishra, K., Mohapatra, I., & Kumar, A. (2019). A study on the health seeking behavior
among caregivers of under-five children in an urban slum of Bhubaneswar,
Odisha. Journal of Family Medicine and Primary Care, 8(2), 498.
https://doi.org/10.4103/jfmpc.jfmpc_437_18

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Thank you
Taufiq Anshari Rasak
taufiqanshari@gmail.com