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Perceptions, health seeking behavior and utilization of maternal and newborn health services among an indigenous tribal community in Northeast India—a community-based mixed methods study

BACKGROUND: Evidence suggests that healthcare utilization among tribal communities in isolated regions can be influenced by social determinants of health, particularly cultural and geographical factors. The true mortality and morbidity due to these factors in remote tribal communities are often unde...

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Autores principales: Cáceres, Ángela León, Ramesh, Rohan Michael, Newmai, Puisaumaliu, Kikon, Rhondemo, Deckert, Andreas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10358725/
https://www.ncbi.nlm.nih.gov/pubmed/37483938
http://dx.doi.org/10.3389/fpubh.2023.1139334
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author Cáceres, Ángela León
Ramesh, Rohan Michael
Newmai, Puisaumaliu
Kikon, Rhondemo
Deckert, Andreas
author_facet Cáceres, Ángela León
Ramesh, Rohan Michael
Newmai, Puisaumaliu
Kikon, Rhondemo
Deckert, Andreas
author_sort Cáceres, Ángela León
collection PubMed
description BACKGROUND: Evidence suggests that healthcare utilization among tribal communities in isolated regions can be influenced by social determinants of health, particularly cultural and geographical factors. The true mortality and morbidity due to these factors in remote tribal communities are often underestimated due to facility-dependent reporting systems often difficult to access. We studied the utilization of health services for maternal and newborn care and explored how cultural beliefs, perceptions, and practices influence the health-seeking behavior (HSB) of an indigenous tribal community in Northeast India. METHODS: Within a concurrent triangulation design, the combined results from 7 focus group discussions and 19 in-depth interviews, and the 109 interviews of mothers from a community-based survey were interpreted in a complementary manner. The qualitative data were analyzed using a conceptual framework adapted from the socio-ecological and three-delays model, using a priori thematic coding. Multivariable logistic regression was carried out to identify factors associated with home delivery. RESULTS: Only 3.7% of the interviewed mothers received the four recommended antenatal check-ups in health centers, and 40.1% delivered at home. Mothers residing in the villages without a health center or one that was not operational were more likely to deliver at home. HSB was influenced significantly by available finances, the mother’s education, low self-esteem, and a strong belief in traditional medicine favored by its availability and religious affiliation. The community sought health services in facilities only in emergency situations, determined primarily by the tribe’s poor perception of the quality of health services provided in the irregularly open centers, locally available traditional medicine practitioners, and challenges in geographical access. National schemes intended to incentivize access to facilities failed to impact this community due to flawed program implementation that did not consider this region’s cultural, social, and geographical differences. CONCLUSION: The health-seeking behavior of the tribe is a complex, interrelated, and interdependent process framed in a medical pluralistic context. The utilization of health centers and HSBs of indigenous communities may improve when policymakers adopt a “bottom-up approach,” addressing structural barriers, tailoring programs to be culturally appropriate, and guaranteeing that the perceived needs of indigenous communities are met before national objectives.
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spelling pubmed-103587252023-07-21 Perceptions, health seeking behavior and utilization of maternal and newborn health services among an indigenous tribal community in Northeast India—a community-based mixed methods study Cáceres, Ángela León Ramesh, Rohan Michael Newmai, Puisaumaliu Kikon, Rhondemo Deckert, Andreas Front Public Health Public Health BACKGROUND: Evidence suggests that healthcare utilization among tribal communities in isolated regions can be influenced by social determinants of health, particularly cultural and geographical factors. The true mortality and morbidity due to these factors in remote tribal communities are often underestimated due to facility-dependent reporting systems often difficult to access. We studied the utilization of health services for maternal and newborn care and explored how cultural beliefs, perceptions, and practices influence the health-seeking behavior (HSB) of an indigenous tribal community in Northeast India. METHODS: Within a concurrent triangulation design, the combined results from 7 focus group discussions and 19 in-depth interviews, and the 109 interviews of mothers from a community-based survey were interpreted in a complementary manner. The qualitative data were analyzed using a conceptual framework adapted from the socio-ecological and three-delays model, using a priori thematic coding. Multivariable logistic regression was carried out to identify factors associated with home delivery. RESULTS: Only 3.7% of the interviewed mothers received the four recommended antenatal check-ups in health centers, and 40.1% delivered at home. Mothers residing in the villages without a health center or one that was not operational were more likely to deliver at home. HSB was influenced significantly by available finances, the mother’s education, low self-esteem, and a strong belief in traditional medicine favored by its availability and religious affiliation. The community sought health services in facilities only in emergency situations, determined primarily by the tribe’s poor perception of the quality of health services provided in the irregularly open centers, locally available traditional medicine practitioners, and challenges in geographical access. National schemes intended to incentivize access to facilities failed to impact this community due to flawed program implementation that did not consider this region’s cultural, social, and geographical differences. CONCLUSION: The health-seeking behavior of the tribe is a complex, interrelated, and interdependent process framed in a medical pluralistic context. The utilization of health centers and HSBs of indigenous communities may improve when policymakers adopt a “bottom-up approach,” addressing structural barriers, tailoring programs to be culturally appropriate, and guaranteeing that the perceived needs of indigenous communities are met before national objectives. Frontiers Media S.A. 2023-07-06 /pmc/articles/PMC10358725/ /pubmed/37483938 http://dx.doi.org/10.3389/fpubh.2023.1139334 Text en Copyright © 2023 Cáceres, Ramesh, Newmai, Kikon and Deckert. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Public Health
Cáceres, Ángela León
Ramesh, Rohan Michael
Newmai, Puisaumaliu
Kikon, Rhondemo
Deckert, Andreas
Perceptions, health seeking behavior and utilization of maternal and newborn health services among an indigenous tribal community in Northeast India—a community-based mixed methods study
title Perceptions, health seeking behavior and utilization of maternal and newborn health services among an indigenous tribal community in Northeast India—a community-based mixed methods study
title_full Perceptions, health seeking behavior and utilization of maternal and newborn health services among an indigenous tribal community in Northeast India—a community-based mixed methods study
title_fullStr Perceptions, health seeking behavior and utilization of maternal and newborn health services among an indigenous tribal community in Northeast India—a community-based mixed methods study
title_full_unstemmed Perceptions, health seeking behavior and utilization of maternal and newborn health services among an indigenous tribal community in Northeast India—a community-based mixed methods study
title_short Perceptions, health seeking behavior and utilization of maternal and newborn health services among an indigenous tribal community in Northeast India—a community-based mixed methods study
title_sort perceptions, health seeking behavior and utilization of maternal and newborn health services among an indigenous tribal community in northeast india—a community-based mixed methods study
topic Public Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10358725/
https://www.ncbi.nlm.nih.gov/pubmed/37483938
http://dx.doi.org/10.3389/fpubh.2023.1139334
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