Elsevier

Social Science & Medicine

Volume 46, Issue 2, January 1998, Pages 209-225
Social Science & Medicine

What do sequential behavioral patterns suggest about the medical decision-making process?: Modeling home case management of acute illnesses in a rural Cameroonian village

https://doi.org/10.1016/S0277-9536(97)00151-2Get rights and content

Abstract

It is well recognized that much of the world's medical care is in the hands of laypeople. In pluralistic medical settings, laypeople choose what to do first, second, third, and fourth from a variety of treatment options. In retrospect, laypeople's choices can be represented as an ordered series of health-related behaviors. A systematic analysis of such sequential data provides insights into caregivers' patterns of resort and suggests a tentative theory for how laypeople make medical choices.

This study examines sequences of health-related behaviors from a small, Kom-speaking village in Cameroon. Local residents consider seven health actions, including: delaying initial treatment, using various home remedies or pharmaceuticals, going to a government clinic or a Catholic hospital, and consulting a private nurse or a traditional healer. Researchers visited 88 randomly selected compounds on a weekly basis over a 5-month period. Data were collected on the treatments associated with 429 nonchronic episodes.

Analysis of the treatment sequences suggests that residents customarily use delay of treatments as a tactic in the decision-making process. Caregivers were more likely to use home-based treatments and to use them earlier in the treatment sequences than they were to seek treatment from outside the compound. When seeking assistance, caregivers often used traditional healers as a conduit to other outside options. Laypeople used a limited number of unique treatment sequences and avoided the repetition of treatment modalities.

Caregivers act as if they were following three basic tenets. They minimize uncertainty by identifying illness types that require particular health actions and by delaying action. they minimize the cost of care by first resorting to treatments that are less expensive and easier to administer or by reducing the number of treatments tried. And laypeople maximize treatment variety in the hopes of finding at least one treatment that helps stop the illness.

References (60)

  • I. Press

    Problems in the definition and classification of medical systems

    Social Science and Medicine

    (1980)
  • J.D. Stoeckle et al.

    On going to see the doctor: The contributions of the patient to the decision to seek medical aid

    Journal of Chronic Diseases

    (1963)
  • R.P. Abelson et al.

    Decision making and decision theory

  • H.R. Bernard et al.

    The problem of informant accuracy: The validity of retrospective data

    Annual Reviews in Anthropology

    (1984)
  • C.H. Browner

    Margaret Clark's enduring contribution to Latino studies in medical anthropology

    Medical Anthropology Quarterly

    (1994)
  • A. Cartwright

    Some problems in the collection and analysis of morbidity data obtained from sample surveys

    The Milbank Memorial Fund Quarterly

    (1959)
  • E.M. Chilver et al.

    The kingdom of Kom in West Cameroon

  • A.C. Colson

    The differential use of medical resources in developing countries

    Journal of Health and Social Behavior

    (1971)
  • D.W. Conrath

    Organizational decision making behavior under varying conditions or uncertainty

    Management Science

    (1967)
  • I. Deutscher

    What We Say/What We Do: Sentiments and Acts

    (1973)
  • K.M. DeWalt

    The illnesses no longer understand: Changing concepts of health and curing in a rural Mexican community

    Medical Anthropology Newsletter

    (1977)
  • J. Elinson

    Methods of sociomedical research

  • C.J. Erasmus

    Changing folk beliefs and the relativity of empirical knowledge

    Southwestern Journal of Anthropology

    (1952)
  • H. Fabrega

    Toward a model of illness behavior

    Medical Care

    (1973)
  • E. Freidson

    Client control and medical practice

    American Journal of Sociology

    (1959)
  • C.M. Good

    Ethnomedical Systems in Africa: Patterns of Traditional Medicine in Rural and Urban Kenya

    (1987)
  • F.L. Hsu

    A cholera epidemic in a Chinese town

  • J.W. Hutchinson

    Discrete attribute models of brand switching

    Marketing Science

    (1986)
  • C. Izquierdo

    The illness experience: health care choices among Mapuche living in Santiago

  • J.M. Janzen

    The Quest for Therapy in Lower Zaire

    (1978)
  • Cited by (58)

    • The use of different indicators for interpreting the local knowledge loss on medical plants

      2017, Revista Brasileira de Farmacognosia
      Citation Excerpt :

      Medical pluralism in the context of some local populations can be explained by different factors, including the frequent contact with the influential urban area (Giovannini et al., 2011) the perception of some diseases as incurable by biomedicine, such as the “spirit” disease, “evil eye” or other “culture bound syndromes” (Amorozo, 2004; Vossen et al., 2014); and increased economic power of some populations (Quilan and Quilan, 2007). Furthermore, the use of traditional medicine and biomedicine can increase the amplitude of therapeutic choices that human population uses, increasing the range of possible solutions for the treatment of diseases (Ryan, 1998; Bhasin, 2007). Thus, this set of factors justifies the therapeutic choices and again weakens the argument about the knowledge loss, demonstrating that this knowledge can be hybridized (Soldati and Albuquerque, 2012).

    • Sequential actions as markers of behavioural and cognitive processes: Extracting empirical pathways from data streams of complex tasks

      2016, Computers and Education
      Citation Excerpt :

      If indicators are captured and analysed as independent of time or sequence, it means that scores on a particular indicator do not contain information on its temporal location and do not take into account if the indicator (and hence the underlying observable behaviour) was observed after the occurrence of other indicators. From a behavioural perspective, sequences provide information about underlying cognitive processes that relate to measuring performance (Cooper & Shallice, 2006; Ryan, 1998; Yamauchi & Beer, 1994). The difference between events and sequences is related to the difference between competence and performance as these concepts are framed in the measurement of complex tasks.

    • "So they believe that if the baby is sick you must give drugs.." The importance of medicines in health-seeking behaviour for childhood illnesses in urban South Africa

      2013, Social Science and Medicine
      Citation Excerpt :

      In order to overcome the afore-mentioned limitations and maximise the validity of the results, a mixed-method approach with triangulation of data was used. In patterns or hierarchies of resort, the trend in health-seeking behaviour in many parts of the world is to begin with home remedies or the lowest cost treatment (Kroeger, 1983; Nyamongo, 2002; Ryan, 1998). Results from this study indicate that this would depend on the illness, the caregiver's age, SES group, level of education as well as the child's age.

    • Understanding careseeking 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

      2013, Social Science and Medicine
      Citation Excerpt :

      Table 2 summarises their characteristics and a full list of included studies and their characteristics can be found in the Supplementary Data. Many of the included studies are cited in the findings below but those not cited are listed here (Adjei et al., 2009; Ahmed et al., 1994; Ahorlu et al., 2007; Almroth et al., 1998; Amofah et al., 1995, 1998; Amuyunzu-Nyamongo and Nyamongo, 2006; Arulogun and Gregory, 2009; Azevedo et al., 1991; Babaniyi et al., 1994; Birbeck, 1999; Bukirwa et al., 2008; Dugas et al., 2009; Ebuehi and Adebajo, 2010; Eriksen et al., 2005; Falade et al., 2005; Foster and Vilendrer, 2009; Hill et al., 2003; Idowu et al., 2008; Irimu et al., 2008; Jamieson, 2006; Jinadu et al., 1996; Kamat, 2006; Kaona and Tuba, 2005; Kikwilu and Hiza, 1997; Lerer et al., 1995; Malik et al., 2006; Mboera et al., 2007; Mogotlane, 1988; Mwangome et al., 2010; Mwenesi et al., 1995; Nkwi et al., 1994; Nsungwa-Sabiiti et al., 2004; Okunribido et al., 1997; Opiyo et al., 2007; Othero et al., 2008; Patel et al., 1988; Pilkington et al., 2004; Promtussananon and Peltzer, 2003; Ryan, 1998; Sabuni, 2007; Sircar and Dagnow, 1988; Stekelenburg et al., 2002; Teka and Dagnew, 1995; Tolhurst et al., 2008; Winch, Gilroy, et al., 2008; Yoder, 1995). The majority of the included studies were conducted in East (n = 47) and West (n = 48) Africa.

    View all citing articles on Scopus
    View full text