Attitudes toward neurosurgery in a low-income country: a qualitative study.
OBJECTIVE
To adapt a study exploring the needs of neurosurgery patients in a tertiary care hospital in Canada to examine, for the first time, the perspectives of neurosurgery patients in a low-income country with limited health care resources.


METHODS
Semistructured interviews were conducted with 25 neurosurgery patients at Tikur Anbessa Specialized Teaching Hospital in Addis Ababa, Ethiopia. Interviews were conducted in Amharic or Oromo, translated into English, and subjected to modified thematic analysis.


RESULTS
The following 5 themes emerged: 1) With limited resources, many patients did not seek information outside of that obtained during the clinical encounter. 2) Patients valued direct verbal communication and deferred to the surgeon's authority. 3) Religion played an instrumental role in patient attitudes toward surgery. 4) Most patients did not feel anxious about surgery. 5) A few patients did not inform family members about their medical condition.


CONCLUSIONS
Qualitative research methodology in neurosurgery can be successfully adapted from resource-abundant to resource-poor contexts. In low-income countries, patients are faced with limited options for self-education and self-empowerment, and fatalistic and paternalistic attitudes may be prevalent. Local cultural values and expectations can influence practice differently than they do in resource-rich countries.
Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
Alexa
A
Bramall
Department of Neurosurgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
Hananiah
H
Djimbaye
Department of Neurosurgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
China
C
Tolessa
Department of Neurosurgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
Hagos
H
Biluts
Department of Neurosurgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
Mersha
M
Abebe
Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada. Electronic address: mark.bernstein@uhn.ca.
Mark
M
Bernstein
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D001416:Back Pain / Q000523:psychology / Q000601:surgery; D001932:Brain Neoplasms / Q000523:psychology / Q000601:surgery; D005002:Ethiopia; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000523:psychology*; D010045:Outpatients / Q000523:psychology*; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D011203:Poverty / Q000523:psychology*; D036301:Qualitative Research; D055815:Young Adult
Developing countries; Ethiopia; Neurosurgery; Qualitative research