title: Coping with uncertainty during healthcare-seeking in Lao PDR.
abstract: BACKGROUND
  Uncertainty is regarded as a central dimension in the experience of illness and in the processes of alleviating it. Few studies from resource-poor settings have investigated this and how it interacts with other factors. This study aims to shed light on how healthcare-seeking develops in the context of multiple medical alternatives and to understand what bearing uncertainty has on this process.
  
  
  METHODS
  The study was conducted in six purposively selected rural communities in Lao PDR. In each community, two focus group discussions were held: first with mothers and then with fathers of children younger than five years old. Eleven in-depth interviews with caregivers of severely sick children were conducted. Subsequently, traditional healers, drug vendors, community health workers, nurses and medical doctors were recruited for interviews or group discussions. The data were transcribed and key themes and similarities were identified. Additional readings were conducted to better understand the interactions of factors during which uncertainty was identified as one of several factors mentioned during interviews and focus group discussions.
  
  
  RESULTS
  Care-seekers expressed a strong preference for initially seeking local providers. Subsequently, multiple providers were consulted to increase the chances of recovery. This resulted in patients leaving the health facilities before recovery and in ending the recommended treatment regime prematurely. These healthcare-seeking decisions reflect the social significance of being a responsible caregiver and of showing respect for household norms. In general, healthcare-seeking was shrouded in uncertainty when it came to selecting the right provider, the likelihood of finding the real cause of the illness, spending savings on treatments and ultimately the likelihood of recovery.
  
  
  CONCLUSIONS
  Care-seekers' initial strong preference for local providers irrespective of the providers' legitimacy indicates the need for a robust primary healthcare system. Care-seekers' subsequent consultations must be understood in the light of their uncertainty regarding the skills of the available providers. The social connotations of seeking healthcare including the vulnerability of poor households in public health facilities were taken into account to only a limited extent by health workers. Health workers should have greater awareness of the social and cultural aspects of seeking care.
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen, Stockholm, 18A 171 77, 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: D000223:Adaptation, Psychological; D017028:Caregivers / Q000523:psychology*; D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D003153:Community Health Services / Q000191:economics / Q000592:standards; D017281:Cost of Illness; D005260:Female; D017144:Focus Groups; D006282:Health Personnel / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D007812:Laos / Q000453:epidemiology; D008297:Male; D008428:Maternal Mortality; D011320:Primary Health Care / Q000191:economics / Q000592:standards; D036301:Qualitative Research; D012424:Rural Population; D035501:Uncertainty
keywords: Healthcare-seeking behavior, Uncertainty, Maternal and child mortality, Qualitative Interviews, Lao PDR