Household Healthcare Seeking Patterns for Emergent ill-health in Migori, Western Kenya

Zachary Arochi Kwena^1*Elizabeth Bukusi¹Chanda Mwamba²Norton M Sang¹Felix O Okoth¹Jennifer F Morton³Anna Winters⁴Derek Pollard⁴Alastair Van Heerden⁵Hilton Humphries⁵Dino Rech⁶Meagan Bemer⁷Shawna Cooper⁸Anjali Sharma²Paul Drain⁹

• ¹Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
• ²Center for Infectious Disease Research in Zambia, Lusaka, Zambia
• ³University of Washington, Department of Global Health, Seattle, United States
• ⁴Akros, Lusaka, Zambia, Lusaka, Zambia
• ⁵Human Sciences Research Council, Pretoria, South Africa
• ⁶Audere, Johnannesburg, South Africa
• ⁷University of Washington Department of Global Health, Seattle, United States
• ⁸Audere Technical Institute, Sanford, United States
• ⁹University of Washington School of Medicine, Seattle, United States

Background: Healthcare-seeking decisions reflect personal assessments of illness etiology and severity to determine whether, how, and where to seek care. Understanding these contexts enables targeted interventions to address barriers and ensure timely access to quality services. We examined patterns of household healthcare seeking for emergent ill-health in western Kenya. Methods: As part of a multi-site mixed-methods study evaluating a patient-centered, digitally-facilitated self-testing intervention, we analyzed 16 in-depth interviews and two focus group discussions (n=14) in Migori County, Kenya. Guided by the Andersen Expanded Behavioral Model, we explored psychosocial, enabling, and need factors influencing household decisions. Results: We found that a complex interplay of psychosocial, enabling, and need factors determined if, when, and where households sought care for ill members. Psychosocial influences included prevailing community norms that favored home remedies and self-medication prior to formal care as in the quote below: 'we will start with home remedy, then to self-medication, then we will start looking for those healers…'. Enabling factors, particularly long waiting times, poor service quality, and lack of transport, discouraged timely facility use, leading households to rely on local pharmacies or alternative providers as reported by this participant 'When you come here [hospital], you will stay for too long, and then… you will be sent to the chemist to buy medication. So, I am taking the cheaper route, I just go to the chemist [pharmacy] direct I take the medicine…' Distance to facilities, financial barriers, and lack of health insurance compromise care-seeking. Need-related considerations, especially perceived illness severity, attribution of cause, and the identity of the affected household member (with children prioritized), determined the urgency and type of care sought as illustrated in the quote 'There are some infections that you do not go to the hospital and some that you have to go to the hospital. So, it depends on the disease you have'. Conclusion: Household healthcare-seeking decisions were shaped by a dynamic interplay of psychosocial, enabling, and need factors. Addressing these multifaceted barriers through targeted, context-specific interventions, such as enhancing health infrastructure and integrating different providers, is crucial to ensuring timely access to quality healthcare.