title: Acceptable care? Illness constructions, healthworlds, and accessible chronic treatment in South Africa.
abstract: Achieving equitable access to health care is an important policy goal, with access influenced by affordability, availability, and acceptability of specific services. We explore patient narratives from a 5-year program of research on health care access to examine relationships between social constructions of illness and the acceptability of health services in the context of tuberculosis treatment and antiretroviral therapy in South Africa. Acceptability of services seems particularly important to the meanings patients attach to illness and care, whereas-conversely-these constructions appear to influence what constitutes acceptability and hence affect access to care. We highlight the underestimated role of individually, socially, and politically constructed healthworlds; traditional and biomedical beliefs; and social support networks. Suggested policy implications for improving acceptability and hence overall health care access include abandoning patronizing approaches to care and refocusing from treating "disease" to responding to "illness" by acknowledging and incorporating patients' healthworlds in patient-provider interactions.
authors.affiliation: Coventry University, Coventry, West Midlands, United Kingdom Jana.Fried@coventry.ac.uk.
authors.forename: Jana
authors.initials: J
authors.lastname: Fried
authors.affiliation: University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Harris
authors.affiliation: University of the Witwatersrand, Johannesburg, Gauteng, South Africa McMaster University, Hamilton, Ontario, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Eyles
authors.affiliation: University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.
authors.forename: Mosa
authors.initials: M
authors.lastname: Moshabela
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D002908:Chronic Disease; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D033262:Narration; D011057:Politics; D011247:Pregnancy; D011369:Professional-Patient Relations; D013019:South Africa; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology*; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: Africa, South; HIV/AIDS; health care; health care, access to; health care, users’ experiences; illness and disease, chronic; illness and disease, infectious; illness and disease, social construction; interviews, semistructured; relationships, patient–provider; research, qualitative; social constructionism; tuberculosis (TB)
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