title: Shaping healthcare-seeking processes during fatal illness in resource-poor settings. A study in Lao PDR.
abstract: BACKGROUND
  There are profound social meanings attached to bearing children that affect the experience of losing a child, which is akin to the loss of a mother in the household. The objective of this study is to comprehend the broader processes that shape household healthcare-seeking during fatal illness episodes or reproductive health emergencies in resource-poor communities.
  
  
  METHODS
  The study was conducted in six purposively selected poor, rural communities in Lao PDR, located in two districts that represent communities with different access to health facilities and contain diverse ethnic groups. Households having experienced fatal cases were first identified in focus group discussions with community members, which lead to the identification of 26 deaths in eleven households through caregiver and spouse interviews. The interviews used an open-ended anthropological approach and followed a three-delay framework. Interpretive description was used in the data analysis.
  
  
  RESULTS
  The healthcare-seeking behavior reported by caregivers revealed a broad range of providers, reflecting the mix of public, private, informal and traditional health services in Lao PDR. Most caregivers had experienced multiple constraints in healthcare-seeking prior to death. Decisions regarding care-seeking were characterized as social rather than individual actions. They were constrained by medical costs, low expectations of recovery and worries about normative expectations from healthcare workers on how patients and caregivers should behave at health facilities to qualify for treatment. Caregivers raised the difficulties in determining the severity of the state of the child/mother. Delays in reaching care related to lack of physical access and to risks associated with taking a sick family member out of the local community. Delays in receiving care were affected by the perceived low quality of care provided at the health facilities.
  
  
  CONCLUSIONS
  Care-seeking is influenced by family- and community-based relations, which are integrated parts of people's everyday life. The medical and normative responses from health providers affect the behavior of care-seekers. An anthropological approach to capture the experience of caregivers in relation to deciding, seeking and reaching care reveals the complexity and socio-cultural context surrounding maternal and child mortality and has implications for how future mortality data should be developed and interpreted.
authors.affiliation: Department of Public Health Sciences, Division of Global Health, Karolinska Institutet, Stockholm, Sweden. helle.molsted-alvesson@ki.se
authors.forename: Helle M
authors.initials: HM
authors.lastname: Alvesson
authors.forename: Magnus
authors.initials: M
authors.lastname: Lindelow
authors.forename: Bouasavanh
authors.initials: B
authors.lastname: Khanthaphat
authors.forename: Lucie
authors.initials: L
authors.lastname: Laflamme
mesh_terms: D002675:Child, Preschool; D003643:Death; D003657:Decision Making; D005260:Female; D006295:Health Resources / Q000600:supply & distribution*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007812:Laos; D008297:Male; D010290:Parents / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D036301:Qualitative Research; D019452:Terminally Ill / Q000523:psychology