Soc Sci Med. 1998 Jan; 46(2): 209-25.

What do sequential behavioral patterns suggest about the medical decision-making process?: modeling home case management of acute illnesses in a rural Cameroonian village.

Ryan GW.

Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California-Los Angeles 90095, USA.

It is well recognized that much of the world's medical care is in the hands of laypeople. In pluralistic medical settings, laypeople choose what to do first, second, third, and fourth from a variety of treatment options. In retrospect, laypeople's choices can be represented as an ordered series of health-related behaviors. A systematic of such sequential data provides insights into caregivers' patterns of resort and suggests a tentative theory for how laypeople make medical choices. This study examines sequences of health-related behaviors from a small, Kom-speaking village in Cameroon. Local residents consider seven health actions, including: delaying initial treatment, using various home remedies or pharmaceuticals, going to a government clinic or a Catholic hospital, and consulting a private nurse or a traditional healer. Researchers visited 88 randomly selected compounds on a weekly basis over a 5-month period. Data were collected on the treatments associated with 429 nonchronic episodes. Analysis of the treatment sequences suggests that residents customarily use delay of treatments as a tactic in the decision-making process. Caregivers were more likely to use home-based treatments and to use them earlier in the treatment sequences than they were to seek treatment from outside the compound. When seeking assistance, caregivers often used traditional healers as a conduit to other outside options. Laypeople used a limited number of unique treatment sequences and avoided the repetition of treatment modalities. Caregivers act as if they were following three basic tenets. They minimize uncertainty by identifying illness types that require particular health actions and by delaying action. They minimize the cost of care by first resorting to treatments that are less expensive and easier to administer or by reducing the number of treatments tried. And laypeople maximize treatment variety in the hopes of finding at least one treatment that helps stop the illness.