title: Using Qualitative Methods to Explore Lay Explanatory Models, Health-Seeking Behaviours and Self-Care Practices of Podoconiosis Patients in North-West Ethiopia.
abstract: Podoconiosis (endemic non-filarial elephantiasis) is a chronic, non-infectious disease resulting from exposure of bare feet to red-clay soil in tropical highlands. This study examined lay beliefs about three under-researched aspects of podoconiosis patients' care: explanatory models, health-seeking behaviours and self-care.
  
  
  
  In-depth interviews and focus group discussions were undertaken with 34 participants (19 male, 15 female) between April-May 2015 at podoconiosis treatment centres across East and West Gojjam regions in north-west Ethiopia.
  
  
  
  Explanatory models for podoconiosis included contamination from blood, magic, soil or affected individuals. Belief in heredity or divine punishment often delayed clinic attendance. All participants had tried holy water treatment and some, holy soil. Herbal treatments were considered ineffectual, costly and appeared to promote fluid escape. Motivators for clinic attendance were failure of traditional treatments and severe or disabling symptoms. Patients did not report self-treatment with antibiotics. Self-care was hindered by water being unavailable or expensive and patient fatigue.
  
  
  
  A pluralistic approach to podoconiosis self-treatment was discovered. Holy water is widely valued, though some patients prefer holy soil. Priests and traditional healers could help promote self-care and "signpost" patients to clinics. Change in behaviour and improving water access is key to self-care.
authors.affiliation: Brighton and Sussex Medical School, Brighton, United Kingdom.
authors.forename: Harrison S
authors.initials: HS
authors.lastname: Banks
authors.affiliation: Debre Markos University, Debre Markos, Ethiopia.
authors.forename: Girmay
authors.initials: G
authors.lastname: Tsegay
authors.affiliation: Debre Markos University, Debre Markos, Ethiopia.
authors.forename: Moges
authors.initials: M
authors.lastname: Wubie
authors.affiliation: IOCC Podoconiosis Project, Debre Markos, Ethiopia.
authors.forename: Abreham
authors.initials: A
authors.lastname: Tamiru
authors.affiliation: Brighton and Sussex Medical School, Brighton, United Kingdom.
authors.forename: Gail
authors.initials: G
authors.lastname: Davey
authors.affiliation: Brighton and Sussex Medical School, Brighton, United Kingdom.
authors.forename: Max
authors.initials: M
authors.lastname: Cooper
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000529:Complementary Therapies; D003469:Culture; D004604:Elephantiasis / Q000209:etiology* / Q000628:therapy*; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008519:Medicine, Traditional; D008875:Middle Aged; D036301:Qualitative Research; D012424:Rural Population; D012648:Self Care; D012987:Soil; D026443:Spiritual Therapies
chemical_list: D012987:Soil