Before the use of modern medicine began and the knowledge of the reason behind ill health, man ascribed ill health to all sorts of things among which are the anger of the gods or deity recognized by the community or adversary of their enemies. All these affected the health seeking behaviour of people with such believe which in turn lead them to seek traditional healers and use of charms for protection.

The concept of studying health seeking behaviors has evolved with time. Today, it has become a tool for understanding how people engage with the health care systems in their respective socio-cultural, economic and demographic circumstances. All these behaviors can be classified at various institutional levels: family, community, health care services and the state. 

In places where health care systems are considered expensive with a wide range of public and private health care services providers, understanding health seeking behaviors of different communities and population groups is important to combat unaffordable costs of health care.

In our pervious article, we understood health seeking behaviour to be ‘’an action and inaction of a person or group of people towards their health and the health of others around them’’. We further learnt about the manner in which people deal with illness in health care and the reason behind poor health seeking choices. Since health seeking behaviour is a wide topic and cannot be understood in just one read, the article will be divided into parts and several aspects of health seeking behaviour in Nigeria will be discussed in several other articles.

Different studies show that a person’s decision to take part in a particular medical channel is influenced by a variety of social-economic variables, sex, age, social status of women, types of illness, access to services and perceived quality of the service.

A recent United Nations (UN) article (1999) highlights that Nigeria is the most populous black nation and one of the poorest countries in the world. Despite the country's immense human and natural resources, little social progress has been made. Two-thirds of a population of more than 100 million live below the poverty line, and one-third survive on less than a dollar a day.

Determinants of health seeking behaviour and their models

There are various models to explain the different determinants of Health-seeking behaviors. Andersen’s grouping of factors influencing determinants into 3 main categories: population characteristics, health care systems and the external environment. Next, another researcher focused on the individual’s health behaviour and adoption of the sick role. This model specifically focuses on one’s health behaviour and it ignores the effect of social network on the decision-making process.

All of these models of determinants and factors influence health-seeking behaviors are vital as it helps us to understand how and why one would seek care earlier than others. As for illnesses that require immediate care, such models are informative as it contributes to interventions for the reduction of transmission and complications arising from neglect.

Irwin Rosenstock (1966) proposed the Health-Belief Model to explain why people fail to engage in positive health -related behaviors.  According to the model an individual’s perceived threat (e.g. susceptibility to the disease, severity of the disease) and their perceived barriers (e.g. cost, inconvenience) and benefit (e.g. avoid illness) will influence their likelihood of taking action (e.g. getting screened for high blood pressure).

For instance, Dr. Gabrielle Saunders of the National Center for Rehabilitative Audiology Research (NCRAR) revealed the results of a recent study at the 2012 International Hearing Aid Research Conference, supporting the use of the Health-Belief Model to explain the uptake in hearing aids among 233 individuals who completed the Hearing Health Belief Questionnaire. The questionnaire was developed by Dr. Saunders and is designed to assess six Health-Belief Model constructs: benefits, barriers, susceptibility, severity, self-efficacy and personal responsibility. The results of Dr. Saunders’ study indicated that those individuals who wore their hearing aids regularly (>4 hours per day) perceived hearing well to be more beneficial, saw fewer barriers to using hearing aids, and took more personal responsibility than those individuals who either did not pursue amplification, or if they did, did not wear their hearing aids on a regular basis.

Clearly, the Health-Belief Model can explain hearing health-seeking behavior and should help clinicians identify which of their patients are likely to be successful users of hearing aids and those who may require additional support and counseling before they are ready to pursue amplification.

Globally, under-five mortality rate has decreased by 56%, from an estimated rate of 93 deaths per 1000 live births in 1990 to 41 deaths per 1000 live births in 2016. About 20 000 fewer children died every day in 2016 than in 1990.

Evidence on health seeking-behavior has been recorded in a few local studies. A good health-seeking behavior between pregnant mother also includes consulting a doctor during the prenatal (for mother’s immunization against tetanus), natal (place of delivery and help at delivery) and postnatal (immunization of the child) period, especially when disease symptoms are apparent. Education of mother and father and their work status have strong effect on child survival in developing countries.

5.6 million children under age five died in 2016, 15 000 every day.  As a result, it is important for parents to take charge of their children illness by getting appropriate care as soon as possible. Finding a suitable health care is vital particularly in areas with limited access to health services.

 A group of researchers have revealed that, although healthcare seeking process have the potential to greatly reduce child mortality in developing countries, there is still a large number of children that die without ever reaching a health facility due to delays in seeking care. Other barriers include beliefs of parents and expectation of the outcome of therapy. malnutrition is associated with higher morbidity rates, proximity to the health facility and availability of funds were also important in determining health-seeking behavior as well as premature termination of treatment. In addition, parent’s socioeconomic status, age of the child, severity and level of dysfunction determine their health-seeking attitude.

In Nigeria, the government has made efforts to ensure that the citizens are more alert when it comes to their health and to influence their health seeking behaviour through the establishment of primary health centers in all part of the country. This is very vital because the world is changing towards healthy living; this is as a result of primary healthcare declaration in Almata in 1978 which is in line Okonkwo (2004) who asserted that the component of primary healthcare include: education, and information on health problem and promotion of their prevention and control : support for adequate food supply and nutrition :assurance of safe water: and maternal- child health care, including family planning  and immunization: the treatment of common ailments and injury mental health and the provision of safe essential drugs.

One might think that by changing knowledge, behaviour is automatically expected to change but it is not always the case as can be seen in previous example giving in the first episode of this article of a woman who had body pains and was prescribed powder substance and lime juice. This is to say health seeking behaviour determinants are multifactorial. 

In subsequent editions we shall explore the peculiar situations in Nigeria including hazards of poor health seeking behaviours, their determinants and ways to improve them.