title: Perspectives on child diarrhoea management and health service use among ethnic minority caregivers in Vietnam.
abstract: BACKGROUND
  In Vietnam, primary government health services are now accessible for the whole population including ethnic minority groups (EMGs) living in rural and mountainous areas. However, little is known about EMGs' own perspectives on illness treatment and use of health services. This study investigates treatment seeking strategies for child diarrhoea among ethnic minority caregivers in Northern Vietnam in order to suggest improvements to health services for EMGs and other vulnerable groups.
  
  
  METHODS
  The study obtained qualitative data from eight months of field work among four EMGs in lowland and highland villages in the Northern Lao Cai province. Triangulation of methods included in-depth interviews with 43 caregivers of pre-school children (six years and below) who had a case of diarrhoea during the past month, three focus group discussions (FGDs) with men, and two weeks of observations at two Communal Health Stations (CHGs). Data was content-analyzed by ordering data into empirically and theoretically inspired themes and sub-categories assisted by the software NVivo8.
  
  
  RESULTS
  This study identified several obstacles for EMG caregivers seeking health services, including: gender roles, long travelling distances for highland villagers, concerns about the indirect costs of treatment and a reluctance to use government health facilities due to feelings of being treated disrespectfully by health staff. However, ethnic minority caregivers all recognized the danger signs of child diarrhoea and actively sought simultaneous treatment in different health care systems and home-based care. Treatments were selected by matching the perceived cause and severity of the disease with the 'compatibility' of different treatments to the child.
  
  
  CONCLUSIONS
  In order to improve EMGs' use of government health services it is necessary to improve the communication skills of health staff and to acknowledge both EMGs' explanatory disease models and the significant socio-economic constraints they experience. Broader health promotion programs should address the significant gender roles preventing highland mothers from seeking health services and include family elders and fathers in future health promotion programs. Encouraging existing child health care practices, including continued breastfeeding during illness and the use of home-made rehydration solutions, also present important opportunities for future child health promotion.
authors: Department of International Health, Immunology and Microbiology, University of Copenhagen, Denmark. thtr@sund.ku.dk
authors: Thilde
authors: T
authors: Rheinländer
authors: Helle
authors: H
authors: Samuelsen
authors: Anders
authors: A
authors: Dalsgaard
authors: Flemming
authors: F
authors: Konradsen
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D002675:Child, Preschool; D003153:Community Health Services / Q000706:statistics & numerical data*; D003967:Diarrhea / Q000188:drug therapy* / Q000208:ethnology*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D012424:Rural Population; D014744:Vietnam; D055815:Young Adult