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Abstract
Introduction Non-communicable diseases (NCDs) are the leading cause of mortality globally. In Africa, they are expected to increase by 25% by 2030. However, very little is known about community perceptions of risk factors and factors influencing health-seeking behaviour, especially in fragile settings. Understanding these is critical to effectively address this epidemic, especially in low-resource settings.
Methods We use participatory group model building techniques to probe knowledge and perceptions of NCD conditions and their causes, health-seeking patterns for NCDs and factors affecting these health-seeking patterns. Our participants were 116 local leaders and community members in three sites in Western Area (urban) and Bombali District (rural), Sierra Leone. Data were analysed using a prior framework for NCD care seeking developed in Ghana.
Results Our findings suggest adequate basic knowledge of causes and symptoms of the common NCDs, in rural and urban areas, although there is a tendency to highlight and react to severe symptoms. Urban and rural communities have access to a complex network of formal and informal, traditional and biomedical, spiritual and secular health providers. We highlight multiple narratives of causal factors which community members can hold, and how these and social networks influence their care seeking. Care seeking is influenced by a number of factors, including supply-side factors (proximity and cost), previous experiences of care, disease-specific factors, such as acute presentation, and personal and community beliefs about the appropriateness of different strategies.
Conclusion This article adds to the limited literature on community understanding of NCDs and its associated health-seeking behaviour in fragile settings. It is important to further elucidate these factors, which power hybrid journeys including non-care seeking, failure to prevent and self-manage effectively, and considerable expenditure for households, in order to improve prevention and management of NCDs in fragile settings such as Sierra Leone.
- health systems
- cardiovascular disease
- diabetes
- hypertension
- qualitative study
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Footnotes
Handling editor Stephanie M Topp
Correction notice This article has been corrected since it was published online. Affilitions and funding updated.
Contributors Alastair Ager, Kelly Elimian, Ibrahim Bou-Orm and Elizabeth Lemor were part of the data collection team. Mohamed Samai helped to review the final draft and provided context-specific guidance.
Funding This study/project is funded by the National Institute for Health Research (NIHR) [NIHR Global Health Research programme (project reference 16/136/100)/NIHR Research Unit on Health in Situations of Fragility]. The views expressed are those of the author (s) and not necessarily those of the NIHR or the Department of Health and Social Care. We would like to thank all who contributed insights through their participation in our research.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study was granted ethical approval by the research and ethics review committee of Queen Margaret University, Edinburgh, and the Sierra Leone Ethics and Scientific Review Committee at the Ministry of Health and Sanitation, Sierra Leone. Written consent was obtained from the participants after detailed information about the research was explained. No personal identifiers were included in the reporting of findings.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.