A conceptual model for pluralistic healthcare behavior: results from a qualitative study in southwestern Uganda
Medical pluralism, or concurrent utilization of multiple therapeutic modalities, is common in various international contexts, and has been characterized as a factor contributing to poor health outcomes in low-resource settings. Traditional healers are ubiquitous providers in most regions, including the study site of southwestern Uganda. It is not well understood why patients in pluralistic settings continue to engage with both therapeutic healthcare modalities, rather than simply selecting one
... mply selecting one or the other. The goal of this study was to identify factors that motivate pluralistic healthcare utilization, and create a general, conceptual framework of pluralistic health behavior. Methods: In-depth interviews were conducted between September 2017 and February 2018 with patients seeking care at traditional healers (N=30) and at an outpatient medicine clinic (N=30) in Mbarara, Uganda; the study is nested within a longitudinal project examining HIV testing engagement among traditional healer-utilizing communities. Inclusion criteria included age 18 years or older, and ability to provide informed consent. Participants were recruited from healer practices representing the range of healer specialties. Following an inductive approach, interview transcripts were reviewed and coded to identify conceptual categories explaining healthcare utilization. Results: We identified three broad categories relevant to healthcare utilization among study participants: 1) traditional healers treat patients with "care"; 2) biomedicine uses "modern" technologies; and 3) peer "testimony" influences healthcare engagement. These categories describe variables at the healthcare provider, healthcare system, and peer levels that interrelate to motivate individual engagement in pluralistic health resources. Conclusions: Patients perceive clear advantages and disadvantages to biomedical and traditional care in medically pluralistic settings. We identified factors at the healthcare provider, healthcare system, and peer levels which influence patients' therapeutic itineraries. Our findings provide a basis to improve health outcomes in medically pluralistic settings, and underscore the importance of recognizing traditional healers as important stakeholders in community health.