D. C. Dickson1, S. A. Christie1, R. A. Dicker2, A. Chichom-Mefire3, C. Juillard1 1University Of California – San Francisco,Center For Global Surgical Studies,San Francisco, CA, USA 2University Of California – Los Angeles,Los Angeles, CA, USA 3University Of Buea,Department Of Surgery And Obstetrics- Gynecology, Faculty Of Health Sciences,Buea, SOUTHWEST REGION, Cameroon
Introduction: People living in Cameroon, a lower middle-income country (LMIC), have a higher than average burden of trauma, suffer from more severe injuries, and face substantial barriers to accessing formal health care services. As LMICs improve health infrastructure to care for injury, understanding how patients use and adapt the formal medical system to meet their needs becomes crucial to guide appropriate investments. This study sought to identify and describe how recently injured Cameroonians move within and between formal and informal care systems and what motivates these transitions.
Methods: Data was collected using semistructured interviews with recently injured people or their adult family members residing in Southwest Region, Cameroon. Participants were recruited from a larger community based survey on injury using stratified purposeful sampling. Interview contents were regularly reviewed to direct further sampling and assess for theoretical saturation. In total, 39 people participated in 34 interviews. Interviews were recorded, transcribed, and, as necessary, translated from local Pidgin into English. Transcripts were iteratively coded by two research team members to identify major themes.
Results: Despite often viewing formal medical care as the best source for treatment after injury, participants frequently described mixing and matching formal and informal care types and sources. Few injured participants were treated with formal care exclusively, and the majority who engaged with formal care at any point left before completing treatment. Reasons given for leaving formal care included: (a) anticipated costs beyond means, (b) unacceptable length of proposed treatment, (c) poorly supported referral to a larger hospital, (d) unsatisfactory treatment progress or outcome, and (e) belief that traditional methods work additively with formal care [Figure]. Factors that motivated people to engage or remain engaged with formal care included: (a) perceived high severity of injury (b) desire for reliable diagnostic tests (c) social support during hospitalization, and (d) financial support from family or others.
Conclusion: Although cost was an important consideration, participants described a range of factors that influenced their decisions and treatment course. These results provide specific opportunities to improve engagement in formal care, such as clarifing expectations around treatment costs and outcomes, and improving and streamlining inter-facility referrals. Given the frequent use of informal care sources, options for engaging informal providers to encourage timely referral should also be explored. Such changes would build on existing positive views of formal care to improve outcomes and reduce morbidity.
