Lupine Publishers | Journal of Health Research and Reviews
Abstract
This research examined the preponderance of culture noise as barrier
in the channel of communication between health care
providers and patients. The primary objective of the study was to assess
how cultural health beliefs influenced the effectiveness
of communication between health care providers and patients at the Ogume
Primary Health Care Centre in Ndokwa West Local
Government Area of Delta State. A total of 134 respondents were
purposively selected and studied in this work. The triangulation
approach was adopted, using a combination of both survey and in depth
interview methods. While the survey method used the
instrument of questionnaire for data collection, the in depth interview
used the interview guide. The theory of Reasoned Action
provided the framework for the study. The results of the study showed
that the contrariness in the cultural health beliefs of health
care providers and patients negatively influenced the communication
between both parties. Hence, majority of the respondents
exhibited healthcare-default-behaviours such as non-adherence to
doctor’s prescriptions, self-medication and outright resort to
traditional medicine therapy. Therefore, the paper recommends, among
others, adequate education of health care providers to
make them knowledgeable about these cultural health beliefs in rural
settings and their significance in achieving effective provider-
Patient communication as a precursor to securing patients’ confidence,
dependence and adherence to medical instructions.
Introduction
This study was inspired by two separate health related incidents
the researcher was recently exposed to. One was fatal and the other,
which would have been as tragic, was reversed because of timely
intervention by medical orthodoxy. The first was the regrettable
death of a 40years old, educated mother who died during childbirth
at the home of a traditional medicine woman despite medical advice
that the baby in her womb was lying bridged. The second was the
near blindness of my mother from cataract despite being diagnosed
of the problem many years ago by orthodox medical science. While
my mother managed her sight problem with dew drops collected
from cocoyam leaves culturally believed to be efficacious for such
state; the deceased believed the traditional medicine woman
possessed the spiritual powers to ward off the malevolent forces
purportedly responsible for the bridged state of her pregnancy.
Both cases point to the problem of how cultural health beliefs could
constitute noise in the channel of communication between health
care providers and patients. Perhaps if the message of what needed
to be done was effectively communicated in the two cases cited
above, the deceased mother would still be alive and my mother
would have received timely surgical intervention to correct her sight
problem long before now! Health communication is the study and
practice of communicating promotional health information, such as
in public health campaigns, health education, and between doctor
and patients Abroms & Maibach [1]. One of the major purposes of
health communication is to inculcate health literacy in patients that
will enable them make informed personal health choices. It has
been proposed that strong, clear and positive relationships with
physicians can radically improve and increase the condition of a patient
Noar et al. [2]. This is why Edgar and Hyde [3] recommend
interpersonal communication between health care providers
and patients as one of the most effective strategies for achieving
positive health outcomes in patients. Frank et al. [4] corroborate
this position by affirming that effective communication between
physicians and their patients has been associated with patient
outcomes which, incidentally, is the ultimate goal of the health
care providers/patient communication Fong, Anat and Longnecker
[5]. Unfortunately, studies have shown that the goal of achieving
effective communication between health care providers and their
patients has always been beset by a number of barriers one of
which is patients’ cultural beliefs Diette & Rand [6]; Tongue et al.
[7] Recent consensus in public health and health communication
reflects increasing recognition of the important role of culture
as a factor associated with health and health behaviours, as well
as a potential means of enhancing the effectiveness of health
communication programmes and interventions Institute of
Medicine, in kreuter and Mc Clure [8].
Africa, in the portrayal of Andrews and Boyles, in Singleton,
Elizbeth & Krause [9] belongs to the magico-religious and
deterministic groups. While the magico-religious group believes in
supernatural forces or evil spirits inflicting people with ailments as
punishment for sin or the handiwork of evil ones who cast spells
on people; the determinist group believes in the preordainment of
ailments and cure. A corollary to this belief system is the extended
belief in the power of traditional medicine men and the efficacy of
their charms and herbs to reverse the ill-fortune of ill-health. This
predisposition and predilection towards cultural health beliefs and
traditional medicine as an alternative to orthodox medicine has
always constituted a noise element in the effective communication
between health care providers and patients in Africa. This feeling
is expressed in defaults in medical care such as non-adherence
to medical instructions, self medication, procrastinated resort
to medical advice and their attendant complications for health
outcomes. Interestingly, despite the gloomy scenario painted above,
Ojua [10] and Kakung [11], equal believers in the above position, now
express the sentiment that development, civilization and education,
among other factors, have helped to introduce tremendous change
in the beliefs and bahaviour of Africans to orthodox medicine
patronage. Is this true? To be certain, it has become imperative that
a study be conducted to establish the influence of cultural beliefs
on the communication between healthcare providers and the rural
dwellers; their compliance with healthcare providers prescriptions;
and the health information seeking behaviour they exhibit.
Statement of Problem
One of the major purposes of health communication is to
inculcate health literacy in patients that will enable them make
informed personal health choices and decisions. To achieve
this purpose, Edgar and Hyde [3] recommend interpersonal
communication between health care providers and patients as
one of the most effective strategies for achieving positive health
outcomes in patients, which incidentally, is the ultimate goal of
the health care providers and patient communication Fong, Anat
and Longnecker [5]. After all, patients are the raison’ deter for the
establishment of hospitals, the training of medical personnel and
all the extensive medical programmes of governments all over the
world. Recent consensus in public health and health communication
reflects increasing recognition of the important role of culture as
a factor associated with health and health behaviours (institute of
medicine, in Kreuter and Mc Clure [8]. Africa, in the portrayal of
Andrews and Boyle, in Singleton Elizabeth and Krause [9], belongs
to the magico-religious and determinist cultural belief groups,
who believe that health problems are caused by factors such as
supernatural forces, evil forces, enchantment, preordainment, etc
and that cure can only come from the intervention of powerful
medicine men making use of their charms and herbs. This cultural
belief system is usually expressed in defaults in orthodox medical
care such as resort to alternative medicine, non-adherence to
medical advice and prescriptions, self medication, procrastinated
resort to medical advice and their attendant consequences for
health outcomes such as deterioration of patient health condition,
worsening disease, treatment failures, increased hospitalization,
deaths and increased health care costs Osterberg and Blaschke [12].
In Nigeria, right down to the grassroots, the problem of ill-health
is further compounded by our collectivistic cultural orientation
under which every sick person requires at least one, or more,
healthy family member(s) to take care of him. The cumulative loss of
man hours arising from this situation has far-reaching implications
for our productive capacity as a people. while some studies show
that the goal of achieving effective communication between health
care providers and patients for better health outcomes are still
beset by a number of problems one of which is patients cultural
beliefs Diette & Rand [6]; Tongue et al. [7] others indicate that
development, civilization and education have helped to introduce
tremendous change in the beliefs and behaviour of Africans in this
regard Ojua [10]; Kakung [11], thereby creating a knowledge gap.
Therefore, this study is necessitated by a need to fully comprehend
the place of cultural beliefs in achieving effective interpersonal
communication between health care providers and patients as
a precursor to securing patients’ confidence, dependence and
adherence to orthodox medication.
Objectives of The Study
a) The objectives of the study are as follows:
b) To establish whether cultural health beliefs influence the
interpersonal communication between health care providers
and patients at the Ogume primary health care centre.
c) To determine the extent of influence of cultural beliefs
on the patients’ adherence to medical recommendations and
prescriptions at the centre.
d) To ascertain the influence of cultural health beliefs on the
patients’ health seeking behaviour.
Research Questions
RQ. 1: Do the cultural health beliefs of patients at Ogume
primary health care centre influence their communication with
health care providers?.
RQ. 2: To what extent are the patients’ adherence to health care
providers prescriptions at the centre influenced by their cultural
health beliefs?.
RQ. 3: How do the cultural health beliefs of the patients at the
health centre influence their health seeking behaviour?.
Operational Definition of Terms
Culture: The beliefs of the respondents regarding traditional
medicine practice based on the diagnostic and therapeutic power
of supernatural forces, herbs, stems, roots and other ingredients
associated with the practice.
Health Beliefs: The beliefs of the respondents on the diagnostic
and therapeutic efficacy of traditional medicine.
Healthcare Providers: The Ogume primary healthcare center
staff comprising the doctor, midwives, nurses, health assistants
and record keepers who render healthcare services to patients in
Ogume community who patronize the Ogume primary health care
center.
Culture Noise: The cultural health beliefs of the respondents
that make it psychologically difficult for them to listen, understand,
strictly adhere and implement to the letter the medical instructions,
prescriptions, recommendations and advice communicated to
them by the health care providers in the Ogume Primary Health
Care Center.
Barrier: That which obstructs the reception, comprehension and
adoption of health messages communicated between the healthcare
providers and patients of Ogume primary healthcare center.
Healthcare Provider/Patient communication. The healthcare-based
interpersonal interaction and relationship between healthcare
providers (ie doctors, midwives, nurses, healthcare assistants and
record keepers) and the patients of Ogume primary healthcare
center. Interpersonal communication: Healthcare-related one-onone
verbal and non-verbal communication between the healthcare
providers and patients at the Ogume Primary Healthcare Center.
Health Seeking behaviour: Patients search for a perceived better
diagnostic and therapeutic treatment of diseases and sicknesses.
Theoretical Framework
The theory used for this study is the theory of Reasoned Action.
The theory was developed by Martin Fishbein and Icek Ajzen in
1967 and was derived from previous research that began as the
theory of attitude. The theory aims to explain the relationship
between attitudes and behaviours within human action. It is
used to predict how individuals will behave based on their preexisting
attitudes and behavioural intentions. In other words, an
individual`s decision to engage in a particular behaviour is based
on the outcomes the individual expects will come as a result of
performing the behaviour (Rogers-Gillmore et al., 2002). The ideas
within the theory have to do with an individual`s basic motivation
to perform an action. According to the theory, intention to perform
a certain behaviour precedes the actual behaviour Ajzen & Madden
[13]. Specifically, Reasoned Action predicts that behaviour intent
is caused by two factors namely, attitudes and subjective norms.
That is, behavioural intention is a function of both attitudes and
subjective norms toward that intention. Also, it is observed that,
depending on the individual and the situation, these factors might
have different impacts on behavioural intention (Miller, 2005). It is
further explained that the factor of attitudes and subjective norms
have two components each that influence behaviour intent. The
two components of attitudes are evaluation and strength of beliefs;
while subjective norms are made up of the components of normative
beliefs and motivation to comply Fishbein & Ajzen [14]. Invariably,
Reasoned Action theory is concerned about how the introspective
consideration of societal norms and personal values impact on
the individual`s decision-making process and eventual behaviour.
This theory is evidently relevant to this work because it is a study
of how cultural health beliefs in our societies and the individuals
understanding of same influence the decision of patients to behave
in conformity with medical instructions, otherwise known as
medical adherence behaviour.
Literature Review
Understanding Culture and Its Influence on Health Beliefs
According to Leininger [15], culture refers to the learned,
shared and transmitted knowledge of values, beliefs and
lifeways of a particular group that are generally transmitted
intergenerationally and influence thinking, decisions and actions
in patterned or in certain ways. In addition to this basic definition
offered by Leininger, Purnel and Paulanka [16] add that culture
is largely unconscious, both implicit and explicit, and dynamic,
changing with global phenomena. Recent consensus in public
health and health communication reflects increasing recognition
of the important role of culture as a factor associated with health
and health behaviours, as well as a potential means of enhancing
the effectiveness of health communication programmes and
interventions Institute of Medicine [17]. It is generally believed
that by understanding the cultural characteristics of a given group,
public health and health communication programmes and services
can be customized to better meet the needs of its members. That
is, the culturally bound beliefs, values and preferences a person
holds influence how he interprets healthcare messages Singleton
et al. [9]. In the view of Resniecow et al. in Kreuter and McClure [8],
concordance between the cultural characteristics of a given group
and the public health approaches used to reach its members may
enhance receptivity, acceptance and salience of health information
and programmes. In an attempt to capture this variability in the
cultural outlook of different peoples, Andrews & Boyle, in
Singleton,
Elizbeth & Krause [9] present health belief models that different
cultural groups use to explain health and illness into magicoreligious,
biomedical and deterministic beliefs. They explain that
magico-religious refers to belief in supernatural forces which
inflict illness on humans, sometimes as punishment for sins, in the
form of evil spirits or disease-bearing foreign objects as may be
found among Latin America, African American and middle Eastern
cultures; biomedical refers to the belief system generally held in the
US in which life is controlled by series of physical and biochemical
processes that can be studied and manipulated by humans, hence
disease is seen as the result of the breakdown of physical parts from
stress, trauma, pathogens or structural changes; and determinism,
the belief that outcomes are eternally preordained and cannot be
changed. Other sub-context cultures that have been advanced by
scholars to explain the relationship between culture and health
beliefs are familism and individualism Andrews & Boyle, in
Singleton et al. [9]; high context and low context cultures Gigar &
Davidhizar [18]; time orientation, present orientation and future
orientation cultures Purnel & Paulanka [16] etc. Each of these
cultural models are believed to influence health beliefs. Indeed,
all cultures have systems to explain what causes illness, how it
can be cured or treated and who should be involved in the process
Mc Lauglin & Braun [19]. The extent to which patients perceive
health information as having cultural relevance for them can have
a profound effect on their reception to information provided and
their willingness to use it. The fact that, cross-cultural variations
also exist within particular culture groups makes the culture-health
care relationship much more interesting.
Cultural Barriers that Affect Healthcare Provider/ Patient
Communication
Beliefs and values affect the doctor-patient relationship and
interactions Tongue et al. [7]. Divergent beliefs can affect healthcare
through competing therapies, fear of the healthcare system, or
distrust of prescribed therapies Diette and Rand [6]. The doctorpatient
relationship is one of the most unique and privileged
relations a person can have with another human being, just as having
access to a well developed and effective association is important
for the experience and objective quality of healthcare. Yet, over the
past few decades, a number of cultural barriers have converged to
reduce the ability of patients to have this archetypal relationship
with physicians Hughes, in Fowler [20]. Fowler categorizes these
cultural barriers into racial concordance of the doctor and patient,
language barriers and medical beliefs. The author cautiously
observes that another barrier to patient-physician communication,
even if they speak the same language, is low health literacy of
the patient which impairs ability to understand instructions on
prescription drug bottles, appointment slips, medical education
brochures, doctor’s directions and consent forms, and the ability to
negotiate complex healthcare systems Of all these cultural barriers,
the barrier of differences in medical beliefs are considered very
fundamental to creating disharmony in the health care provider
and patient communication relationship. As McLaughlin [19] points
out, each ethnic group brings its own perspectives and values into
the healthcare system, and many healthcare beliefs and practices
differ from those of the traditional American healthcare culture.
The expectation that the patients will conform to mainstream
values frequently creates communication and care barriers that
are further compounded by differences in language and education
between patients and providers from different backgrounds. Fowler
[20] maintains that when the two parties, comprising the doctor
and the patient, have different views on medicine, the balance of
cooperation and understanding can be difficult to achieve. This
perception gap may negatively affect treatment decisions, and
therefore may influence patient outcomes despite appropriate
therapy Platt & Keating [21]. Patients construct their own versions
of adherence according to their personal worldviews and social
contexts which result in a divergent expectation of adherence
practice Tongue et al. [7]; Sawyert & Aroni [22]; Middleton et al.
[23]. Therefore, it is important to identify and address perceived
barriers and benefits of treatment to increase patient adherence
to medical plans by ensuring that the benefits and importance
of treatment are understood Platt & Keating [21]. According to
reports, Bolivia’s healthcare system is particularly invaded by this
cultural barrier. As Bruun & Elverdam [24] put it, medical pluralism
is a common feature in the Bolivian healthcare system, consisting
of three overlapping sectors: the folk sector, the traditional sector
and the professional sector. Whether in Bolivia, India, China or
Africa, differences in medical health beliefs constitute a significant
barrier to effective patient and provider communication which is
absolutely necessary to giving and receiving adequate healthcare
Fernadez [25].
Health Disparities: The Importance of Culture and
Health Communication
Health disparities have been well documented even in systems
that provide unencumbered access to healthcare, suggesting that
factors other than access to care – such as culture and health
communication – are responsible Thomas, Fine & Ibrahim [26].
Some of the causal factors that have been blamed for the problem
of health disparities relate to individual behaviours, provider
knowledge and attitudes, organization of the healthcare system,
societal and cultural values. Accordingly, efforts to eliminate health
disparities must be informed by the influence of culture on the
attitudes, beliefs, and practices of not only minority populations
but also public health policy makers and the health professionals
responsible for the delivery of medical services and public health
interventions designed to close the gap Thomas et al. [26] Cultural
competence and patient centerednesss are two of such health
intervention programmes designed to improve healthcare quality
and thereby bridge the health disparity gap Saha et al. [27]. To
achieve this purpose, healthcare providers must see the patients
as unique; maintain unconditional positive regard for them; build
effective rapport; use the psychosocial model to explore patients
beliefs, values and meaning of illness, and to find common ground
regarding treatment plans. Evidently, cultural congruence of
patient, provider and message creates the right harmony for the
enhancement of interpersonal communication and care. Therefore,
Thomas et al. [26] propose the strategic matching of the cultural
characteristics of all populations ethnic, racial or minority group
with public health interventions designed to affect individuals
within the group. It is their conviction that this may enhance
receptivity to, acceptance of, and salience of health information
and programmes. This approach is consistent with the documented
evidence that factors such as belief systems, religious and cultural
values, life experiences, and group identify act as powerful filters
through which information is received, hence such factors should be
considered in the development of health communication campaigns
as well as in the healthcare provider and patient communication.
Cultural Explanation for Patients’ Non-Compliance with
Medical Recommendations and Prescriptions
A patients culture not only shapes the meaning of the
individuals behavior but also that persons health seeking and
health related behaviours. Medication adherence is a major
health behavior known to have a positive influence on patients
quality of life. Boykins & Carter [28]. An increasing number of
investigations have found positive relationships between clinicalpatient
communication, treatment compliance, and a variety of
health outcomes, including a better emotional wellbeing, lower
stress and burn out symptoms, lower blood pressure, and a better
quality of life (for both doctors and patients) Romani & Ashkar
[29]; Street et al. [30]; in Amutio Kareaga et al. [31]. For example, in
a study conducted by Fuertes et al. [32] using a sample of 101 adult
outpatients from a rheumatology clinic, the results demonstrated
that physician-patient working alliance predicted outcome
expectations, patient satisfaction and adherence. Conversely,
studies have also shown that non-adherence constitutes a major
problem in achieving desired outcomes in the management of
chronic diseases hypertension management Agyemang C et al.
[33] and other consequential implications for healthcare such as
deterioration of patient health conditions, worsening of disease,
treatment failures, increased hospitalization, death and increased
health care costs Osterberg & Blasche [12]. Incidentally, spirituality
and religiosity are some of the socio-cultural variables that have
been identified as determinants of such health behaviour as nonadherence
to medication and medical instructions. Accordingly,
there has been a growing tendency in the medical field to accord
recognition to these socio-cultural health beliefs in conformity
with the dictates of cultural competency and the perceived health
benefits Penman, Oliver & Harrington [34]. McLaughlin & Braun
[19] posit that cultural issues (such as spirituality and religiosity)
play a major role in patient adherence. This position is corroborated
by Miller, Thorsen & Mohr [35]; Ejikeme [36] in their submission
that spiritual and religious activities have been noted to strengthen
the faith of people and assist them with decision-making in health–
related practices. Therefore, scholars and healthcare practitioners
are better advised to channel more efforts towards maximizing
the utility benefits of spirituality and religiosity in eliciting patient
adherence behaviour.
Primary Healthcare Centres: Institution and Evolution
in Nigeria
The international conference on primary health defines
primary healthcare as “essential healthcare based on practical,
scientifically sound and socially acceptable methods and
technology made universally accessible to individuals and their
families in the community through their full participation and at
cost that community and country can afford to maintain at every
stage of their development in the spirit of self determination”
WHO, in Metiboba [37]. The needs in the health sector led to the
establishment, among others, of primary healthcare centres (PCH)
as the centre piece of health development in Nigeria Akande [38].
The scheme which was established by the Gowon administration
in 1975 as part of the Third National Development Plan (1975-
1980) had the following objectives: increase the proportion of
the population receiving healthcare from 25-60 percent; correct
imbalances in the location and distribution of health institutions
and provide the infrastructures for all preventive health
programmes such as control of communicable disease, family
health, environmental health nutrition and others and establish a
health care system best adapted to the local conditions and to the
level of health technology Sorungbe, in Metiboba [37]. Accordingly,
the basic plan for the implementation of the scheme was to build
in each local government area a comprehensive health institution
that woud serve as the headquarters of the services, four primary
health centres and 20 health clinics designed for a population of
150,000 Akande [38]. Government had since improved on this
projection in terms of number of health centres available in each
local government in Nigeria. However, despite government’s good
intention in establishing this scheme, critical observers have
continued to complain about its poor implementation. Aside from
political, administrative and infrastructural factors militating
against the successful implementation of the scheme so far,
observers believe that the scheme still suffers from inadequate
awareness and mass mobilization for increased involvement of the
citizenry in PHC activities. For instance, Metiboba [39] insists that
a great proportion of the rural population in many communities do
not seen to know what PHC is all about, nor are they aware of the
various services under the scheme.
Ogume Primary Health Care Centre
There are a total of 15 primary health care centres in Ndokwa
West Local Government Area of Delta State and the Ogume Primary
Health Care Centre is one of them. Prior to the coming of the Ogume
primary health care centre in 2005, the building housing the centre
was first used as the Community’s local dispensary in 1955, before it
metamorphosed into a maternity clinic some years afterwards
Emenimadu [40]; Ochonogor [41]. Ever since, the maternity has
remained a prominent feature in the Ogume medical history. This is
so much so that, more than 10 years after it has been upgraded to a
primary health care centre, the indigenes still see it as a maternity
clinic. This lack of awareness is, according to accounts, one of the
reasons for the evident low patronage of the primary health care
centre by the male population of the community till date. Recently,
however, the state government constructed buildings meant for
two new primary health care centres at Ogbe Ogume and Ogbagu
Ogume quarters. These are yet to be occupied, except for the
overgrown weeds that now occupy the premises. In the meantime,
the male population continues to shun the health care centre that is
in use for some other speculative reasons.
Method of Study
The research design of this study was based on the triangulation
method. Wimmer and Dominick [42] define triangulation within
the context of mass media research as the use of both qualitative
and quantitative methods to fully understand the nature of a
research problem. The complementary use of both qualitative
and quantitative methods derives from a need to achieve a more
dependable and reliable result. Under quantitative, the survey
research method was adopted, while indepth interview was
adopted under the qualitative approach. A total of 120 respondents
were used for the survey method while another 14 respondents
were used for the indepth interview. All the respondents were
representative of patients in Ogume community receiving diagnostic
and therapeutic attention at the Ogume primary healthcare center.
Questionnaire and interview guide containing questions relevant
to the cultural health beliefs of the respondents and its influence on
their adherence to medical prescriptions were administered for the
survey and indepth interview methods respectively.
Area of Study
The area of study is the ogume community in Ndokwa West
Local government Area of Delta State. Ogume community is one
of the 16 clans that make up Ndokwa West Local Government
Area. Ogume is comprised of seven quarters namely, Ogbe-Ogume,
Ogbole, Umuchime, Igbe, Utue and Obodougwa. Although, these
seven quarters were originally given three primary healthcare
centers, situated one each in Ogbe Ogume, Ogbole and Utue quarters
only the one in Ogbe-Ogume is presently functional.
Population of Study
The population of study is represented here by the rural
dwellers in the seven quarters that comprise Ogume community.
The National Population Census Figure of 2006 credits Ogume
with a total of 28,654 persons. Given the benefit of population
growth and the time lapse between 2006 and 2017, there is need
to statistically project a population figure for Ogume in 2017 using
formula: PP = GP X PI X T; meaning
PP = projected population
GP = given population
PI = Population increase Index given as 2.28% by the United
Nations for developing nations all over the world
T = The duration of time between the year of given population
and year of study.
Therefore,
PP = 28,654 x 2.28% x 2017-2006
PP = 26, 654 x 2.28 X 11
PP = 28,654 X 0.0228X11
PP = 7,186.4
Actual population = 28654+7,186
35,840
Therefore the projected population of Ogume Community
which will be used for this study is 35, 35,840.
Sample Size and Sampling Technique
The study adopted the purposive sampling technique also
known as judgmental sampling. The merit of purposive sampling
stems from the fact that the researchers skill and fore-knowledge of
sample characteristics, to a large extent, guide researchers choice
of samples Nwodu [43]. The method imbues in the researcher the
prerogative of judgment in selecting his respondents based on
certain predetermined criteria. In this case, the predetermined
criteria for choosing the respondents are as follows: one, they
must be patients that have been in consultation with a healthcare
provider in the health care center; two, such patient would have
been in treatment at the health center between March and May,
2017; and three, they must be knowledgeable about the cultural
health belief practices in Ogume Community. That constitute the
focus of this study. After a series of visits to the health care center,
especially on Tuesdays and Thursdays which are their busiest days,
120 respondents were purposively chosen for the survey approach,
while another 14 respondents, two each from the seven quarters
of Ogume Community were purposively chosen for the indepth
interview.
Data Presentation and Analysis
Data obtained in this study are presented and analysed under
two separate categories. While data obtained through the survey
method are presented and analyzed using frequency table and
simple percentages for ease of understanding; data obtained
from the interview method are analyzed using the explanation
building technique. Under the survey approach, a total of 136
copies of questionnaires were distributed. Out of this number, 120
copies were returned and found valid for use, representing 82.2% return rate, while the unused 16 copies represent 11.8%. On the
other hand, 14 respondents were used for the in depth interview
approach and their responses were analyzed using the explanation
building technique.
Table 1 above shows a sex distribution of female respondents,
109 (90.8%) as against 11 (9.2%) male respondents. It also
shows that majority of the respondents, numbering 72 (60%), are
between the age range of 20-30 years old. Others are 20 (16.7%)
respondents between ages 31 – 41; 12 (10%) respondents between
42 – 52, 12 (10%) respondents between 53-63 years and only 4
(3.3%) respondents in the age range of 64 – 74 years old. Also, there
is clear indication that majority of the respondents, 80(66.7%) are
barely educated with most of them possessing First School Leaving
Certificate (Primary Six) and ordinary level school certificate.
Others are 16 (13.3%) respondents with A/L, OND and NCE; 12
(10%) respondents with Bachelors and above. Another 12 (10%)
respondents did not have any formal education. On marriage, it
is evident from the records that majority of the respondents, 92,
representing 76.7% are married while 20 (16.7%) are single and 8
(6.6%) are divorced.
Table 1: Demographic Composition of Respondents.
Data from Survey Method
a. RQ. I: Do the cultural health beliefs of patients at the
Ogume health care centre influence their communication with
their health care providers? (Table 2).
Table 2: Respondents Views on How Cultural Health Beliefs
Influence Communication with Their Health Care Providers.
As is evident from data on the above table, 66 of the respondents
representing 55% expressed the opinion that their cultural health
beliefs impeded effective communication between them and their
health care providers; 50 of them, representing 41.7%, indicated
that their cultural health beliefs did not in anyway influence their
communication with their health care providers; while 4(3.3%)
respondents were not sure whether their cultural health beliefs
influenced their communication or not.
b. RQ. 2: Do the cultural health beliefs of patients at Ogume
Health Care Centre influence their adherence to the health care
providers prescriptions? (Table 3).
Table 3: Respondents Position on the Influence of Their Cultural
Health Beliefs on their Adherence to the Health Care Providers
Prescriptions.
From the above table, it is evident that the adherence behaviour
of a high majority of the respondents was influenced by their cultural
health beliefs. There are a total of 88 (73.3%) of such respondents.
On the other hand are those respondents, 24(20%) who believe
that their adherence to medical advice The management of the
health centre blames this low patronage of men on cultural beliefs
which make it a taboo for most men in the community to see a 1-7
day old baby. They explain that in order to avoid such occurrence,
which is very likely in the health centres’ primary midwifery
service, the men keep their distance from the health centre. Other
opinions blame it on lack of awareness among the male population
that the health centre offers healthcare services outside of the more
common antenatal, midwifery and child immunization functions.
was not affected by their cultural health beliefs. Another group
of respondents, numbering 8(6.7%) failed to venture an opinion,
either way.
c. RQ. 3: Do the cultural health beliefs of patients at the
Ogume health care centre influence their health seeking
behaviour? (Table 4).
Table 4: Respondents Perception of How Their Cultural Health
Beliefs Influence Their Health Seeking Behaviour.
The above given responses show that virtually all the
respondents, 114 amounting to 95%, believe that their cultural
health beliefs influenced their health seeking behaviour. On the
other hand, a few of them, 4(3.3%), are of the opinion that their
health seeking behaviour is not influenced by their cultural health
beliefs. In between these positions are 2(1.7%) respondent who
chose to sit on the fence on the question as to whether or not their
cultural health beliefs influence their health seeking behaviour
or not. The above table shows that 78(65%) of the respondents
consented to the fact that the family members influenced them on
the choice of traditional medicine for treatment, while 40(33.3%)
answered in the negative. Only 2(1.7%) respondents could neither
say yes nor not (Table 5).
Table 5: Respondents Perception on Family Members Influence
in Taking Traditional Medicine.
Data From Indepth Interview
The researcher subjected 14 of the purposively selected
respondents, two each from the seven quarters that comprise the
Ogume Community, to in-depth interview. Four basic questions
along the lines of the study research questions guided the interview
sessions. The responses are analysed as follows:
Influence of Cultural Health Beliefs on the Communication
between the Health Care Providers and Patients
On this count, majority of the interviewees expressed the
opinion that their cultural health beliefs greatly impeded their
communication with their health care providers. They explained
that their mind-set, arising from prior cultural health beliefs in
traditional medicine, affected their trust and confidence in the
competence of orthodox health care providers in the treatment of
certain ailments. In the words of one of such respondents, Chief
Lucky Ogwu, “there is a limit to what oyibo doctors can treat”.
He listed some of these as bone fractures, diabolic poisoning and
convulsion in children. According to him, in situations where
orthodox medicine resorts to amputation for orthopaedic care,
traditional medicine successfully sets the fractured area straight
with the use of herbal applications. Another of the respondents
who shares this opinion, Mrs. Cecilia Opone, was emphatic that no
matter what the health care providers say, she will continue to take
herbal medicine for her antenatal care. According to her, herbal
medicine helps reduce the size of the placenta, which she calls “our
mother” and thereby, potentially reducing the risk of complicated
labour. However, on the reverse side, a few of the respondents said
their cultural health beliefs do not influence their communication
with health care providers. One of such respondents, Mrs. Abigail
Oji, said that she had relied on traditional medicine during her first
pregnancy and lost the baby in infancy. Ever since, she has resorted
to orthodox medicine with better results. Hence, she now follows
medical instructions to the letter.
Influence of Cultural Health Beliefs on Patients’ Adherence
to Health Care Providers Prescriptions
Majority of the respondents admitted that their cultural health
beliefs negatively influenced their willingness to adhere to health
care providers prescriptions. In her reaction, Mrs. Paulina Nzeukwu
complained that after several visits to the health center, she
resorted to herbal medicine to solve the problem of the mysterious
pain in her stomach which several X-rays could not detect. Hence,
she discontinued her orthodox medication. In his account, Chief
Lucky Ogwu insisted that you cannot mix them (English and
Native medicine) because even English medicine are made from
herbs too. According to him, “mixing them could cause overdose”.
Hence, anytime he takes traditional medicine, he stops his orthodox
medication regardless of health care providers instructions. On the
flipside, a few of the interviewees maintained that they strictly
adhere to health care providers instructions.
Influence of Cultural Beliefs on Patients Health Seeking
Behaviour
All the respondents were emphatic that their health seeking
behaviour towards a perceived better and more satisfactory
treatment was positively influenced by their cultural beliefs in
the diagnostic and therapeutic efficacy of medicine, orthodox or
traditional. As one of the respondents who opted for anonymity, put
it, “if I do not seek for better treatment where I believe I can get it,
that means I am playing with my life”. This sentiment summarized
the feeling of all the interviewees on this issue.
Discussion of Findings
a. Objective I: set out to establish whether cultural
health beliefs influence health care providers and patients
communication at the health care centre. The findings show
that patients’ cultural health beliefs adversely influenced
their communication with the health care providers. This
communication problem stemmed from the contrariness in the health beliefs of both parties. This finding echoes earlier
findings by researchers in this area. Fernandez [25] had found
that differences in medical health beliefs constitute a significant
barrier to effective patient and provider communication which
is absolutely necessary to giving and receiving adequate
healthcare. Fowler [20] in his own study found that when the
two parties, comprising the patient and the provider, have
different views on medicine, the balance of cooperation and
understanding can be difficult to achieve. This is also consistent
with the findings of McLaughlin and Braun [19] that the
barriers of differences in medical beliefs are fundamental to
creating disharmony in the health care provider and patient
communication.
b. Objective 2: The finding that patients’ health beliefs
negatively influenced their adherence to health care providers
prescriptions conforms with the findings of earlier works on
the subject. McLaughlin and Braun [19] had found that cultural
issues such as religiosity and spirituality play a major role in
patient adherence. Schouten [44] found that there is more
misunderstanding, less compliance and less satisfaction in
medical visits of patients with differing health beliefs from
those of their health care providers. This finding resonates with
those of Thorsen & Miller [35]; Ejikeme [36] who found that
spiritual and religious activities have been noted to strengthen
the faith of people and assist them with decision making in
health related practices such as adherence. Other studies also
found that patients construct their own personal worldviews
and social contexts which results in divergent expectations
of adherence practice Tongue et al. [7]; Sawyer & Aroni [22];
Middleton et al. [23].
c. On objective 3: which is how patients’ cultural health
beliefs influence their health seeking behaviour, the findings
show that majority of the respondents’ health seeking
behaviours were influenced by their cultural health beliefs.
The results evidenced that the patients’ health beliefs in the
diagnostic and therapeutic power of medicine propelled
them to seek for help from orthodox or traditional doctors,
depending on the cultural perspectives of individual patients.
While the majority sought help in traditional medicine, others
who believed otherwise sought better and more satisfactory
medical attention from orthodox healthcare providers. The
findings here correspond with those of Ojua [10]; Katung [11];
Ejikeme [36] that the typical Nigerian rural dwellers resort to
traditional medicine on the one hand; and to chemist shops,
health centres and hospitals on the other hand for the treatment
of sicknesses and diseases. In a related study on the Bolivian
health care system, Bruun & Elverdam [24] had found a similar
feature of medical pluralism in health seeking behaviour. Table
1 revealed a low level of patronage of the health centre by the
male population of the community. The management of the
health centre blames this low patronage of men on cultural
beliefs which make it a taboo for most men in the community to
see a 1-7 day old baby. They explain that in order to avoid such
occurrence, which is very likely in the health centres’ primary
midwifery service, the men keep their distance from the health
centre. Other opinions blame it on lack of awareness among
the male population that the health centre offers healthcare
services outside of the more common antenatal, midwifery and
child immunization functions. This finding is in tandem with
the finding of Resniecow et al in Kreuter & Mc Clure [8] that,
concordance between cultural characteristics of a given group
and the public health approaches used to reach its members
may enhance receptivity, acceptance and salience of health
information and programmes. Also, the findings lend credence
to an earlier finding by Metiboba [39] that a great proportion
of the rural population in many communities do not seem to
know what primary health care centre is all about, nor are they
aware of the various services under the scheme. Furthermore,
Table 5 shows clearly that an overwhelming number of the
respondents were influenced by family members to take
traditional medicine. This finding corroborates an earlier
finding by Andrews & Boyle (2008) that cultural systems such
as familism and individualism affect the health beliefs and
health behaviours of patients in African Communities. Again,
the findings of this study are consistent with the principles
that govern the theory of reasoned action. Specifically,
reasoned action predicts that behavioural intents are caused
by individual attitude and the subjective norms towards that
intention. It is further stated that, depending on the individual
and the situation, these factors might have different impacts on
behavioural intention Miller [45]. This theory is relevant to this
work because it is a study of how the patients’ cultural health
beliefs and understanding of same influence their decision to
were influenced by cultural health beliefs and advice of family
members. Finally, it is instructive to note that the findings of the
two methods used for this study (survey method and indepth
interview) are constituent with each other with the findings
of one reinforcing and lending credence to the findings of the
other.
Conclusion and Recommendations
The pre-eminence of good health over all other concerns
of man is an incontrovertible fact of life. It is for this reason that
responsible and responsive governments all over the world
establish hospitals, train medical personnel and embark on all
other extensive medical programmes designed to secure an
effective health care system for its citizens. As part of this extended
programme, health communication activities are carried out to
inculcate health literacy in patients that will enable them make
informed personal health choices. Edgar & Hyde [3] recommend
interpersonal communication between health care providers
and patients as one of the most effective strategies for achieving
positive health outcomes in patients. Unfortunately, studies have shown
that the goal of achieving effective communication between
healthcare providers and their patients has always been beset
by a number of barriers one of which is patients’ cultural beliefs
Diette & Rand [6]; Tongue et al [7]; Ejikeme [36]. Incidentally,
the findings of this study corroborate these earlier findings as it
relates to cultural health beliefs constituting noise in the channel
of communication between health care providers and patients, and
thereby, impeding effective communication between the parties
[46,47]. These cultural health beliefs, usually expressed in medical
plurality and non-adherence to orthodox medical prescriptions;
come with dire consequences among which are deterioration of
patient health condition, worsening of disease, treatment failures,
increased hospitalization, deaths and increased healthcare costs
Osterberg and Blasche [12]. Given the consequences of cultural
health beliefs to effective provider patient communication and its
implications for patient health outcomes, the paper recommends
as follows:-
a. One, that there should be enhanced facilitation of health
communication and education for health care providers and
receivers alike at the rural level on the significance of cultural
health beliefs in achieving a sustainable health care system.
b. Two, that the Ministries of information and health at the
local government areas should embark on concerted public
awareness campaigns directed at the rural populace on the
availability and benefits of the primary health care centres
closest to them.
c. Three, that professional communicators who are
indigenes of the rural communities should be drafted as part
of the medical staff at primary health care centres with the
aim of fostering a trust-yielding and confidence-boosting
interpersonal relationship between the health care providers
and patients at the centres.
d. Four, that town hall or village square meetings should
be regularly organized, with qualified medical personnel as
speakers, to address the rural dwellers on the risk implications
of non-adherence, self-medication and such other abuses as
well as disabuse their minds about certain traditional medicine
related misconceptions they have.
e. Finally, that there should be more localized studies
on the all-important place of cultural health beliefs and
their implications, not only for effective provider patient
communication but also for eventual positive patient outcomes.
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