title: A mixed methods exploration of patterns of healthcare utilization of urban women with non-communicable disease in South Africa.
abstract: BACKGROUND
  Despite the growing burden of NCDs in South Africa, very little is known about how people living in urban townships manage these illnesses. In this article we expound upon the findings of a study showing that only one-third of women with an NCD participating in the Birth to Twenty (Bt20) cohort study of Soweto-Johannesburg, South Africa, had sought biomedical services in the previous six months.
  
  
  METHODS
  We evaluated quantitative data from a cross sectional health access survey conducted with adult women (mean age = 44.8) and examined 25 in-depth narrative interviews with twelve women who self-reported at least one NCD from the larger study.
  
  
  RESULTS
  The qualitative findings highlight the potential role of negative experiences of healthcare services and biomedicine in delaying the seeking of healthcare. Multivariate analysis of the quantitative findings found that the possession of medical aid (OR = 1.7, CI = 1.01-2.84) and the self-reported use of patient strategies in negotiating healthcare access (OR = 1.6, CI = 1.04-2.34) were positively associated with the utilization of healthcare services. Belief in the superior efficacy of traditional healers over doctors was associated with delay of NCD treatment (OR = 2.4, CI = 1.14-4.18).
  
  
  CONCLUSIONS
  Our data suggest that low healthcare utilization is due in part to low rates of expectation for consistent and high-quality care and potential mistrust of the medical system. We conclude that both demand-side and supply-side measures focusing on high trust management practices will prove essential in ensuring access to healthcare services.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lopes Ibanez-Gonzalez
authors.forename: Emily
authors.initials: E
authors.lastname: Mendenhall
authors.forename: Shane A
authors.initials: SA
authors.lastname: Norris
mesh_terms: D000328:Adult; D002908:Chronic Disease / Q000628:therapy; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D057566:Self Report; D013019:South Africa; D014505:Urban Population