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Socio-demographic determinants of health care-seeking behaviour, self-reported illness and self-evaluated health status in Jamaica.

Introduction

The issue of health care-seeking (or medical-care) behaviour is crucible crucible, vessel in which a substance is heated to a high temperature, as for fusing or calcining. The necessary properties of a crucible are that it maintain its mechanical strength and rigidity at high temperatures and that it not react in an undesirable way with  to all society. All nations rely on its human capital in the creation and pursuit of growth and/or development. The human capital is able to accomplish those desired objectives outlined by the society only on the fundamental premise that the people are in good health. Health is more than the absence of diseases and it includes social, psychological and economic wellbeing. Embedded Inserted into. See embedded system.  in good health is not the least disease, as this is more in keeping with poor health. While poor and good health appears to be on the opposite end of a continuum, for this paper good health denotes the life satisfaction and general acceptance with the happenings of life. On the other hand, poor health speaks to the people's perception of a low quality of life or life satisfaction. Hence, this is in keeping with WHO's conceptualization con·cep·tu·al·ize  
v. con·cep·tu·al·ized, con·cep·tu·al·iz·ing, con·cep·tu·al·iz·es

v.tr.
To form a concept or concepts of, and especially to interpret in a conceptual way:
 of health in the Preamble A clause at the beginning of a constitution or statute explaining the reasons for its enactment and the objectives it seeks to attain.

Generally a preamble is a declaration by the legislature of the reasons for the passage of the statute, and it aids in the interpretation of
 to its Constitution in 1946 (WHO, 1948) which stated, health is not merely the absence of diseases or infirmity Flaw, defect, or weakness.

In a legal sense, the term infirmity is used to mean any imperfection that renders a particular transaction void or incomplete. For example, if a deed drawn up to transfer ownership of land contains an erroneous description of it, an
 but it is the state of complete physical, social and psychological wellbeing.

In spite of a discussion which began in the 1940s, stating that health was a composite function that includes biological, social, psychological, environmental and economic factors (WHO, 1948), Engel (1960, 1977a,1977b,1978, 1980) re-ash this in the late 1950s and was able to use this in the treatment of mentally ill-patient. Prior to Engel conceptual model (i.e. Biopsychosocial model The biopsychosocial model is a general model or approach that posits that biological, psychological (which entails thoughts, emotions, and behaviors) ,and social factors (abbreviated "BPS") all play a significant role in human functioning in the context of disease or illness. ), health was conceptualized, treated and viewed from a biomedical bi·o·med·i·cal
adj.
1. Of or relating to biomedicine.

2. Of, relating to, or involving biological, medical, and physical sciences.
 perspective. This meant that health-care seeking behaviour was primarily based on diseases (or disease causing pathogens) and not based on preventative care. WHO and Engel recognized this uni-dimensional approach to the view and treatment of health, and expanded on this conceptual framework For the concept in aesthetics and art criticism, see .

A conceptual framework is used in research to outline possible courses of action or to present a preferred approach to a system analysis project.
. Despite the contribution of the aforementioned a·fore·men·tioned  
adj.
Mentioned previously.

n.
The one or ones mentioned previously.


aforementioned
Adjective

mentioned before

Adj. 1.
 names, health care-seeking behaviour in Western societies is still fundamentally driven by negative health (illness, or poor health) and not in keeping with the broader framework offered by the World Health Organization.

Health policy makers in the Caribbean continue to rely on biomedical approach biomedical approach,
n medical framework that considers illness to be caused by identifiable agents.
 in the collecting of information upon which they evaluate the health of the society. This is evident in how data are collected from the populace on health. Since 1988, Jamaica has been collecting statistics on illness from the general populace. The data were to be used to aid and assess government policies as well as to guide future programmes. The use of dysfunctions (or illnesses) to measure health is not accepting the multi-dimensions to humans; in recognition that health is more than diseases. It was not until 2007, that the Planning Institute of Jamaica and the Statistical Institute of Jamaica that are responsible for the collection of the data, began collecting data on self-reported health status. Those agents were involved in the collating of data on dysfunction dysfunction /dys·func·tion/ (dis-funk´shun) disturbance, impairment, or abnormality of functioning of an organ.dysfunc´tional

erectile dysfunction  impotence (2).
 and health-care seeking behaviour that were limited to traditional view of health (i.e. visits to health care institutions and health care practitioners; bought medication). This means that all policies were based on the narrow definition of illness on a construct that has broader negative view framework about health, which accounts for Jamaicans (Jamaica Survey of Living Conditions living conditions nplcondiciones fpl de vida

living conditions nplconditions fpl de vie

living conditions living
, 1989-2008; Ministry of Health, 2005) and by extension Caribbean peoples' willingness to visit doctors (Shaw et al., 1999).

An extensive review of health literature revealed that no study was that examine factors that account for health care-seeking behaviour of Jamaicans, as well as the sociodemographic correlates of the health status of those who sought traditional medical care. The importance of why people seek medical care is undoubtedly critical in health policy planning, and it is within this limitation that this study is timely and needed. While studies outside of Jamaica have established different determinants of health-care seeking behaviour (Grover et al., 2006; Vu 2008; Williams et al. 2006; Stekelenburg 2005), this cannot be assumed to apply within the Jamaicans context as the culture, socio-demographic and economic characteristics are different and as such calls for an examination of this phenomenon. Hence, the objectives of this study were to examine self-rated health status and health care-seeking behaviour of Jamaicans; and to ascertain the socio-economic predictors of health care-seekers as well as to determine factors that account for good health status of those who sought health care in order aid public health policy makers and primary care physicians.

Method

The current study extracted a sample of 1,006 respondents based on those who indicated having sought health care in the 4-week period of the survey. The sample was drawn from a large nationally representative cross-sectional descriptive survey of 6,783 Jamaicans (Statistical Institute of Jamaica 2007). The survey was drawn using stratified stratified /strat·i·fied/ (strat´i-fid) formed or arranged in layers.

strat·i·fied
adj.
Arranged in the form of layers or strata.
 random sampling. This design was a two-stage stratified random sampling design where there was a Primary Sampling Unit (PSU PSU - power supply unit ) and a selection of dwellings from the primary units. The PSU is an Enumeration 1. (mathematics) enumeration - A bijection with the natural numbers; a counted set.

Compare well-ordered.
2. (programming) enumeration - enumerated type.
 District (ED), which constitutes of a minimum of 100 dwellings in rural areas and 150 in urban areas. An ED is an independent geographic unit that shares a common boundary. This means that the country was grouped into strata of equal size based on dwellings (EDs). Based on the PSUs, a listing of all the dwellings was made, and this became the sampling frame from which a Master Sample of dwelling was compiled, which in turn provided the sampling frame for the labour force. One third of the 2007 Labour Force Survey (i.e. LFS LFS Linux from Scratch
LFS Labour Force Survey (UK)
LFS Live for Speed (computer racing simulation)
LFS London Film School
LFS Log-Structured File System (Unix, BSD) 
) was selected for the survey (JSLC JSLC Jamaica Survey of Living Conditions
JSLC Jiuquan Satellite Launch Center (China)
JSLC Joint Stock Limited Company
JSLC Jeffries Street Learning Center (Dallas, TX) 
 2007--ie Statistical Institute of Jamaica 2007). The sample was weighted to reflect the population of the nation.

This study used JSLC (2007) which was conducted by the Statistical Institute of Jamaica (STATIN stat·in
n.
Any of a class of drugs that inhibit a key enzyme involved in the synthesis of cholesterol and promote receptor binding of LDL cholesterol, resulting in decreased levels of serum cholesterol.
) and the Planning Institute of Jamaica (PIOJ PIOJ Planning Institute of Jamaica ) between May and August 2007. The researchers chose this survey based on the fact that it is the latest survey on the national population and that it has data on self-rated health status of Jamaicans. A self-administered questionnaire was used to collect the data which were stored and analyzed an·a·lyze  
tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es
1. To examine methodically by separating into parts and studying their interrelations.

2. Chemistry To make a chemical analysis of.

3.
 using SPSS A statistical package from SPSS, Inc., Chicago (www.spss.com) that runs on PCs, most mainframes and minis and is used extensively in marketing research. It provides over 50 statistical processes, including regression analysis, correlation and analysis of variance.  for Windows 16.0 (SPSS Inc; Chicago, IL, USA). The questionnaire was modelled from the World Bank's Living Standards living standards nplnivel msg de vida

living standards living nplniveau m de vie

living standards living npl
 Measurement Study (LSMS LSMS Living Standards Measurement Survey
LSMS Louisiana State Medical Society
LSMS Local Service Management System
LSMS Locally-Self-consistent Multiple-Scattering
LSMS Line-Strip Multibeam System
LSMS Lnp Service Management System
) household survey. There are some modifications to the LSMS, as JSLC is more focused on policy impacts. The questionnaire covered areas such as socio-demographic, economic and health variables. The non-response rate for the survey was 26.2%.

Descriptive statistics descriptive statistics

see statistics.
, such as mean, standard deviation In statistics, the average amount a number varies from the average number in a series of numbers.

(statistics) standard deviation - (SD) A measure of the range of values in a set of numbers.
 (SD), frequency and percentage were used to analyze the socio-demographic characteristics of the sample. Chi-square was used to examine the association between non-metric variables, and an Analysis of Variance (ANOVA anova

see analysis of variance.

ANOVA Analysis of variance, see there
) was used to test the relationships between metric and non-dichotomous categorical That which is unqualified or unconditional.

A categorical imperative is a rule, command, or moral obligation that is absolutely and universally binding.

Categorical is also used to describe programs limited to or designed for certain classes of people.
 variables. Logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors.  examined the relationship between the dependent variable and some predisposed pre·dis·pose  
v. pre·dis·posed, pre·dis·pos·ing, pre·dis·pos·es

v.tr.
1.
a. To make (someone) inclined to something in advance:
 independent (explanatory) variables, because the dependent variable was a binary one (self-reported health status: 1 if reported good health status and 0 if poor health).

The results were presented using unstandardized B-coefficients, Wald statistics, Odds ratio and confidence interval confidence interval,
n a statistical device used to determine the range within which an acceptable datum would fall. Confidence intervals are usually expressed in percentages, typically 95% or 99%.
 (95% CI). The predictive power The predictive power of a scientific theory refers to its ability to generate testable predictions. Theories with strong predictive power are highly valued, because the predictions can often encourage the falsification of the theory.  of the model was tested using the Omnibus Test Omnibus tests are a kind of statistical test. They test whether the explained variance in a set of data is significantly greater than the unexplained variance, overall. One example is the F-test in the analysis of variance.  of Model and Hosmer and Lemeshow (2000) to examine goodness of fit Goodness of fit means how well a statistical model fits a set of observations. Measures of goodness of fit typically summarize the discrepancy between observed values and the values expected under the model in question. Such measures can be used in statistical hypothesis testing, e.  of the model. The correlation matrix Noun 1. correlation matrix - a matrix giving the correlations between all pairs of data sets
statistics - a branch of applied mathematics concerned with the collection and interpretation of quantitative data and the use of probability theory to estimate population
 was examined in order to ascertain if autocorrelation Autocorrelation

The correlation of a variable with itself over successive time intervals. Sometimes called serial correlation.
 (or multicollinearity) existed between variables. Based on Cohen cohen
 or kohen

(Hebrew: “priest”) Jewish priest descended from Zadok (a descendant of Aaron), priest at the First Temple of Jerusalem. The biblical priesthood was hereditary and male.
 and Holliday (1982), correlation can be low (weak)--from 0 to 0.39; moderate - 0.4-0.69, and strong - 0.7-1.0. This was used to exclude (or allow) a variable in the model. Wald statistics were used to determine the magnitude (or contribution) of each statistically significant variable in comparison with the others, and the Odds Ratio (OR) for the interpreting of each significant variable.

Multivariate The use of multiple variables in a forecasting model.  regression framework (Asnani, 2008; Bourne Bourne, town (1990 pop. 16,064), Barnstable co., SE Mass., crossed by Cape Cod Canal; settled 1627, inc. 1884. Bourne Bridge (1935), across the canal, made the town an entry point to Cape Cod and a resort and commercial center. , 2008a, 2008b) was utilized to assess the relative importance of various demographic, socio-economic characteristics, physical environment and psychological characteristics of the health status of Jamaicans as well as health care-seeking behaviour. Econometric e·con·o·met·rics  
n. (used with a sing. verb)
Application of mathematical and statistical techniques to economics in the study of problems, the analysis of data, and the development and testing of theories and models.
 analyses were also employed by other scholars in other societies (Grossman, 1972; Hambleton et al., 2005; Smith & Kington, 1997). This approach allowed for the analysis of a number of variables simultaneously. Secondly, the dependent variable is a binary dichotomous di·chot·o·mous  
adj.
1. Divided or dividing into two parts or classifications.

2. Characterized by dichotomy.



di·chot
 one and this statistic statistic,
n a value or number that describes a series of quantitative observations or measures; a value calculated from a sample.


statistic

a numerical value calculated from a number of observations in order to summarize them.
 technique has been utilized in the past to do similar studies. Having identified the determinants of health status from previous studies, using logistic regression techniques, final models were built for women in general as well as for each of the geographical sub-regions (rural, peri-urban and urban areas), using only those predictors that independently predict the outcome. A p-value of 0.05 was used to test the significance level.

Model

The use of multivariate analysis multivariate analysis,
n a statistical approach used to evaluate multiple variables.

multivariate analysis,
n a set of techniques used when variation in several variables has to be studied simultaneously.
 in the study of health and subjective wellbeing (i.e. self-reported health or happiness) is well established (Grossman, 1972; Smith & Kington, 1997; Di Tella et al., 1998; Blanchflower & Oswald, 2004) equally in Jamaica and Barbados (Bourne, 2008a, 2008b; Bourne & McGrowder, 2009; Hutchinson et al., 2005). The current study will employ multivariate analyses in the study of health and health care-seeking behaviour of Jamaicans. The use of this approach is better than bivariate bi·var·i·ate  
adj.
Mathematics Having two variables: bivariate binomial distribution.

Adj. 1.
 analyses as many variables can be tested simultaneously for their impact (if any) on a dependent variable.

Scholars like Grossman (1972), Smith & Kingston (1997), Hambleton et al. (2005), Kashdan (2004), Yi & Vaupel (2002), the World Health Organization pilot work a 100-question quality of life survey (WHOQOL WHOQOL World Health Organisation Quality of Life ) (Orley, 1995) and Diener (1984, 2000) have both used and argued that self-reported health status can be used to evaluate health status instead of objective health status measurement. Other scholars, on the other hand, employed self-reported health conditions to operationalize health of individual (Bourne & McGrowder, 2009). Embedded in the works of those researchers is the similarity of self-reported health status and self-reported dysfunction in assessing health.

The current study will examine whether self-rated health status and self-reported dysfunctions are correlated variables (Equation [1]) as well as to model general self-reported illness (Equation [2]), health care-seeking behaviour of Jamaicans (Equation [3]) and to evaluate the predictors of self-rated health status of Jamaicans (Equation [4]).

[I.sub.t]= f ([H.sub.t]) [1]

where [I.sub.t] is self-reported dysfunction (illness) is a function of current self-rated health status, [H.sub.t].

[I.sub.t]=f ([A.sub.i], [G.sub.i],[HH.sub.i], [AR.sub.i], [H.sub.t], [lnLI.sub.i], lnC, [lnD.sub.i], [ED.sub.i], [MR.sub.i], [S.sub.i], [HI.sub.i], lnY, [[epsilon].sub.i]) [2] where [I.sub.t] (i.e. self-reported illness in current time t) is a function of age of respondents, [A.sub.i] ; sex of individual i, [G.sub.i]; household head of individual i, [HH.sub.i]; area of residence, [AR.sub.i]; current self-reported health status of individual i, [H.sub.t]; logged length of illness, [LI.sub.i]; logged consumption per person per household member, lnC; logged duration of time that individual I was unable to carry out normal activities, [lnD.sub.i]; Education level of individual i, [ED.sub.i]; marital status marital status,
n the legal standing of a person in regard to his or her marriage state.
 of person i, [MR.sub.i]; social class of person i, [S.sub.i]; health insurance coverage of person i, [HI.sub.i]; logged income, lnY; and an error term (i.e. residual error (Mensuration) See Error, 6 (b).

See also: Residual
).

[M.sub.t]=f([A.sub.i], [G.sub.i],[HH.sub.i], [AR.sub.i], [H.sub.t], [lnLI.sub.i], lnC, [lnD.sub.i], [ED.sub.i], [MR.sub.i], [S.sub.i], [HI.sub.i], [[epsilon].sub.i]) [3]

where [M.sub.t] is the health care-seeking behaviour in current time t, is a function of age of respondents, and the other variables were previously stated.

[H.sub.t] =f ([A.sub.i], [G.sub.i],[HH.sub.i], [AR.sub.i], [M.sub.t], [lnLI.sub.i], lnC, [lnD.sub.i], [ED.sub.i], [MR.sub.i], [S.sub.i], [HI.sub.i], [I.sub.t], [J.sub.t], [[epsilon].sub.i]) [4]

where [H.sub.t] is self-rated health status of time period t (i.e. current); [I.sub.t] is self-reported illness in current time period t; [J.sub.t] is self-reported injured in·jure  
tr.v. in·jured, in·jur·ing, in·jures
1. To cause physical harm to; hurt.

2. To cause damage to; impair.

3.
 suffered in the last 4 weeks, and the other variables were previously stated.

Measure

Self-rated health status: "How is your health in general?" And the options were very good; good; fair; poor and very poor. For this study the construct was categorized cat·e·go·rize  
tr.v. cat·e·go·rized, cat·e·go·riz·ing, cat·e·go·riz·es
To put into a category or categories; classify.



cat
 into 3 groups--(i) good; (ii) fair, and (iii) poor. A binary variable was later created from this variable (1=good and fair 0=otherwise).

Self-reported illness (or self-reported dysfunction): The question was asked: "Is this a diagnosed recurring re·cur  
intr.v. re·curred, re·cur·ring, re·curs
1. To happen, come up, or show up again or repeatedly.

2. To return to one's attention or memory.

3. To return in thought or discourse.
 illness?" The answering options are: Yes, Cold; Yes, Diarrhoea; Yes, Asthma; Yes, Diabetes; Yes, Hypertension; Yes, Arthritis; Yes, Other; and No. A binary variable was later created from this construct (1=yes, 0=otherwise) in order to use in the logistic regression.

Income: Total expenditure was used to operationalize income.

Social class: This variable was measured based on the income quintiles Quintiles Transnational Corp. is a contract research organization which serves the pharmaceutical, biotechnology and healthcare industries. History
Quintiles was founded in 1982 by Dennis Gillings and as of 2007 it has 18,000 employees.
: The upper classes were those in the wealthy quintiles (quintiles 4 and 5); middle class was quintile quin·tile  
n.
1. The astrological aspect of planets distant from each other by 72° or one fifth of the zodiac.

2. Statistics The portion of a frequency distribution containing one fifth of the total sample.
 3 and poor those in lower quintiles (quintiles 1 and 2).

Health care-seeking behavior: This is a dichotomous variable which came from the question "Has a doctor, nurse, pharmacist pharmacist /phar·ma·cist/ (fahr´mah-sist) one who is licensed to prepare and sell or dispense drugs and compounds, and to make up prescriptions.

phar·ma·cist
n.
, midwife MIDWIFE, med. jur. A woman who practices midwifery; a woman who pursues the business of an account.
     2. A midwife is required to perform the business she undertakes with proper skill, and if she be guilty of any mala praxis, (q.v.
, healer healer Mainstream medicine A romantic synonym for physician. See Traditional healing.  or any other health practitioner been visited?" with the option (yes or no).

Age is a continuous variable in years.

Age group is classified into 7 groups: children (ages less than 15 years); young adults (ages 15 to 30 years); other adults (ages 31 to 59 years); young-old (or young elderly, ages 60 to 74 years); old-old (or old elderly, ages 75 to 84 years); and oldest-old (or oldest elderly, ages 85 years and older).

Results

The sample was 1,006 respondents (40.5% men and 59.5% women), with a mean age of 41.8 years (SD=27.6 years). Forty-four percent of the sample reported at least good health, 20% at least poor health and 36% indicated fair self-rated health status. However, 97% of the respondents claimed that they have had some dysfunctions; 6% reported being injured due to accidents, and only 11% indicated that their illness was not diagnosed by a health practitioner. Of those who indicated being diagnosed with a recurring ailment ail·ment
n.
A physical or mental disorder, especially a mild illness.
, 5.6% had arthritis, 20.5% hypertension, 12.4% diabetes mellitus diabetes mellitus

Disorder of insufficient production of or reduced sensitivity to insulin. Insulin, synthesized in the islets of Langerhans (see Langerhans, islets of), is necessary to metabolize glucose. In diabetes, blood sugar levels increase (hyperglycemia).
, 9.5% asthma and 14.9% cold. Of those who reported an injury in the last 4 weeks, 19.2% indicated that it was owing to owing to
prep.
Because of; on account of: I couldn't attend, owing to illness.

owing to prepdebido a, por causa de 
 motor vehicle, 46.2% domestic accident and 11.5% mentioned industrial accident (Table 1). Forty-five percent dwelled in urban areas or other towns and 55% in rural areas. Majority of the sample indicated that they have had no formal education (71%) compared to 1.2% tertiary, 15.1% basic or elementary education elementary education
 or primary education

Traditionally, the first stage of formal education, beginning at age 5–7 and ending at age 11–13.
, 8.7% primary or preparatory schooling preparatory school: see school.
preparatory school

School that prepares students for entrance to a higher school. In Europe, where secondary education has been selective, preparatory schools have been those that catered to pupils wishing to enter
 and 4.0% secondary level schooling. Substantially, more Jamaicans do not have health insurance coverage (75.3%); 11.5% private health insurance; 7.6% NI Gold and 5.7% other public health insurance coverage. Two thirds of the sample sought health care and a little over one-half of the respondents were heads of households (Table 1).

One half of the sample had annual incomes of US $5,936.77 (US $1.00 = Ja. $80.47) and 50th percentile percentile,
n the number in a frequency distribution below which a certain percentage of fees will fall. E.g., the ninetieth percentile is the number that divides the distribution of fees into the lower 90% and the upper 10%, or that fee level
 of health expenditure was US $9.94. Forty-seven percent of the respondents were never married (includes common-law), 35.8% were married with 3.0% divorced, 1.8% separated and 12.0 widowed. The median length of an illness was 7 days and a median of 2 days were calculated as the length of time in which an individual was ill (Table 1). Some 54.8% of the sample resided in rural areas, 18.6% in other towns and 26.6% in urban areas. Of the sample, 63.8% responded to the visits to public health care facilities and 64.1% on visits to private health care facilities. Of those who responded to each, 49% attended public health care facilities compared to 57.3% to private health care facilities.

Thirty-eight percent of the sample were classified as poor, 21.0% were in the middle class and 41% as wealthy. Furthermore, 19% were below the poverty line and 21% were in the wealthiest category. Approximately one-half of the rural residents were poor compared to 27% in other towns and 17% in urban areas ([chi square chi square (kī),
n a nonparametric statistic used with discrete data in the form of frequency count (nominal data) or percentages or proportions that can be reduced to frequencies.
] (4) =132.664, p < 0.001, n=1002). A cross tabulation A cross tabulation (often abbreviated as cross tab) displays the joint distribution of two or more variables. They are usually presented as a contingency table in a matrix format.  between self-rated health status and social standing revealed no statistical correlation between the two variables ([chi square] (8) =14.139, p=0.078, n=1002) (Table 2).

An examination of health expenditure, injured in the last 4 weeks, and self-reported dysfunction by area of residence revealed no statistical association (0.088, 0.841, 0.848 respectfully re·spect·ful  
adj.
Showing or marked by proper respect.



re·spectful·ly adv.
) (Table 3). However there were statistical relationships between self-rated health status (p < 0.001), purchase of medication (p=0.020) and health insurance coverage (p<0.001) by area of residence. More women (98.3%) than men (94.8%) reported illness ([chi square] (1) =9.885, p = 0.002, n=1001).

Based on Table 3, rural respondents reported the highest poor self-rated health status (22.8%) compared to those in other towns (10.2%) and urban dwellers (10.8%). Similarly, rural residents reported a lower coverage of health insurance than those in other towns or urban areas.

An examination of head of household by health care-seeking behaviour revealed no statistical correlation ([chi square] (1) =2.010, p=0.088) (Table 4). Furthermore, those who sought health care had a greater mean consumption per capita [Latin, By the heads or polls.] A term used in the Descent and Distribution of the estate of one who dies without a will. It means to share and share alike according to the number of individuals.  (US $2,168.09 [+ or -] US $1,852.36) compared to those who did not seek health care (US $1,847.39 [+ or -] US $1,625.14) [t= -2.834, p=0.005].

A cross tabulation between health care-seeking behaviour and sex of respondents revealed no statistical correlation between the two variables ([chi square] (1) =3.182, p=0.074) (Table 5). Table 5 showed that 68% of women sought health care compared to 62% of men.

On examination, no statistical correlation existed between health care seeking behaviour and self-reported illness of sample ([chi square] (1) =2.052, p=0.105). When this cross tabulation was controlled for sex, there was no difference between men ([chi square] (1) = 1.876, ? value = 0.171, n= 406) and women ([chi square] (1) = 0.712, ? value = 0.399, n= 596) (Table 6).

Based on Figure 1, there was no statistical difference between self-reported health status of men and women ([chi square] (2) =5.618, p=0.060) (Figure 1). Figure 2 showed that 55.8% of the respondents who indicated that they did not seek health care self-reported good health compared to 37.6% of those who said "yes" they visited a traditional medical care facility or practitioner. Twenty-four percent of those who sought medical care reported poor health compared to 13% who mentioned "no" to seeking health care in the past 4-weeks; whereas more people who sought medical care indicated fair health status than those who reported poor health status ([chi square] (2) =33.298, p < 0.001).

All the old-old and the oldest-old reported an illness compared to 97% of young-old, 90.7% of young adults and children (98.1%) (Figure 3).

A statistical relation was found between self-reported illness and age cohort of respondents ([chi square] (35) = 453.697, p < 0.001, n=992). The association was a moderately strong one (contingency coefficient = 0.560). Figure 4 showed that 37% of children had cold, 20% asthma, 21% unspecified Adj. 1. unspecified - not stated explicitly or in detail; "threatened unspecified reprisals"
specified - clearly and explicitly stated; "meals are at specified times"
 compared to 13% of young adults who had cold, 15% asthma and 40% unspecified and this change after 31 years. The three leading causes of morbidity morbidity /mor·bid·i·ty/ (mor-bid´it-e)
1. a diseased condition or state.

2. the incidence or prevalence of a disease or of all diseases in a population.


mor·bid·i·ty
n.
 for other aged-adults were unspecified (28%), hypertension (25%) and diabetes mellitus (15%). Hypertension was significantly more for those older than 60 years, with rate being the highest for the oldest-elderly (Figure 4). Based on Figure 4, 31% of young elderly reported hypertension compared to 44% of old-old and 47% of oldest-old whereas for diabetes mellitus, the most number of cases were reported by young-old (26%), then old-old (17%), oldest-old (17%) and other aged-adults (15%).

The cross tabulation between visits to public health care facilities and area of residents revealed a statistical correlation ([chi square] (2) = 18.332, p < 0.001, n=641) as well as a relationship between private health care facilities and area of residents ([chi square] (2) = 22.147, p < 0.001, n=644). Based on Figure 5, most of the rural residents attended public health care facilities (56.9%) while most of the other town residents visited private health care facilities.

An examination of visits to health care facilities and social class revealed a statistical correlation: public ([chi square] (2) = 35.874, p < 0.001, n=641) and private ([chi square] (2) = 37.025, p < 0.001, n=644). The poor were more likely to attend public health care facilities (63.3%) compared to the middle class (52.5%) and the wealthy (36.6%), indicating that the rich were substantially probable to visit private health agencies (68.8%) compared to the poor (41.7%) and those in the middle class (57.9%) (Figure 6).

Results: Multivariate Analyses

Using logistic regression analyses, self-rated health status was found to be a significant statistical predictor of self-reported dysfunction (Table 7): good self-rated health status with reference to poor self-rated health status (OR=0.271, 95%CI=0.081, 0.915).

The model had statistically significant predictive power (Model [chi square]=12.183, p=0.002; Hosmer and Lemeshow goodness of fit [chi square]=0.000, P = 1.00) and correctly classified 96.9% of the sample (correctly classified 100% of those who indicated self-reported dysfunctions and 0% of those who do not have dysfunctions. The logistic regression model can be expressed as: Log (probability of self-reported dysfunction/probability of not having dysfunction = 4.195 - 1.304 (1=Good Self-rated Health Status, 0=otherwise). Furthermore, the odds of reporting a dysfunction for those who indicated good health status was 82.9% which is less likely than the odds of reporting a dysfunction for those with poor health status (Table 7).

Predictors of Self-reported dysfunction

From the sample, three factors were found to be predictors of self-reported illness: logged consumption (OR=0.088, 95%CI= 0.008, 0.961); social class of the individual (upper class--OR=76.024, 95%CI=1.846, 3130.54); and age of respondents (OR=1.095, 95%CI=1.024, 1.171) (Table 8).

Table 8 revealed that self-reported dysfunction model had a significant predictive power (Model [chi square]=27.515, p=0.001; Hosmer and Lemeshow goodness of fit [chi square]=1.450, P = 0.93), and correctly classified 99.7% of the sample (correctly classified 95.8% of those who indicated self-reported dysfunctions and 0% of those who do not have dysfunctions.

The findings revealed that when the demographic variables were included with self-rated healthy status, the latter was no longer significant (Table 8).

Predictors of Health Care-Seeking Behaviour

Based on Table 9, from the logistic regression, 5 variables are statistically significant predictors: Age of respondents (OR=1.031, 95%CI=1.014, 1.049); Area of residence (Other towns with reference to rural area--OR=0.5, 95%CI=0.278, 0.902); logged consumption (OR=3.605, 95%CI=1.814, 7.167); marital status (married--OR=0.468, 95%CI=0.260, 0.843; divorced, separated or widowed--OR=0.383, 0.163, 0.903) and social class (Upper class--OR=0.319, 95%CI=0.106, 0.958).

Health Care-Seeking Behaviour Model had statistically significant predictive power (Model [chi square]=49.628, p=0.001; Hosmer and Lemeshow goodness of fit [chi square]=13.900, P = 0.84), and correctly classified 77.8% of the sample (correctly classified 97.8% of those who sought health care and 13.3% of those who did not seek health care (Table 9). The logistic regression model can be expressed as: Log (probability of seeking health care/probability of not seeking health care = -14.059 + 0.031 (Age in years) - 0.692 (1=Other Town, 0=Rural area) + 1.282(logged consumption) - [0.759(1=if married, 0=single) + 0.959(1=if divorced, 0=single)] -1.144(1=if upper class, 0=otherwise) (Table 9).

Predictors of Self-rated Health Status

Health status of those who seek health care can be predicted by 3 factors. These are logged duration of the individuals to carry out their normal activities (OR=0.594, 95%CI=0.413, 0.855); age of respondents (OR=0.967, 95%CI=0.949, 0.986) and area of residence (urban area--OR=2.415, 1.195, 4.881; other towns--OR=2.514, 1.162, 5.442).

The Health Status Model was a statistically predictive one (Model [chi square]=59.824, p=0.001; Hosmer and Lemeshow goodness of fit [chi square]=4.324, P = 0.827), and correctly classified 77.2% the sample (correctly classified 34.5% of those who reported good health status and 93.0% of those who do not (Table 10). The logistic regression model can be expressed as: Log (probability of self-reported good health status/probability of not reporting good health = 1.219 - 0.520 (logged duration unable to work) + [0.882(1=Urban area, 0=otherwise) + 0.922(1=other town, 0=otherwise)] - 0.033(Age) (Table 10).

Discussion

Two thirds of the sample mentioned that they sought medical care in the last 4-week, while marginally more individuals who indicated having sought health care, reported fair health status than those who claimed good health status. Interestingly, 9 out of 10 respondents reported an illness with 89 out of every 100 opined that their illness was diagnosed by a health care practitioner. Rural residents were 2.4 times more likely to report poor health status than other town dwellers; whereas urban residents were one-half less likely to evaluate their health as poor. A critical finding of this study is that 51 out of every 100 rural residents were poor, while the ratio was 27 out of 100 in other towns and 17 out of 100 in urban areas. In spite of the high report of illness and that 5 out of 19 respondents had diagnosed chronic recurring illness (i.e. diabetes mellitus, arthritis, asthma, and hypertension); only 6 out of 10 respondents purchased the prescribed pre·scribe  
v. pre·scribed, pre·scrib·ing, pre·scribes

v.tr.
1. To set down as a rule or guide; enjoin. See Synonyms at dictate.

2. To order the use of (a medicine or other treatment).
 medication. The study revealed that good health status was negatively correlated with self-reported dysfunctions. However, when the sociodemographic variables were introduced within the model, health status dissipated dis·si·pat·ed  
adj.
1. Intemperate in the pursuit of pleasure; dissolute.

2. Wasted or squandered.

3. Irreversibly lost. Used of energy.
 as a factor of self-reported dysfunctions. Of the socio-demographic variables chosen to be tested in the self-reported dysfunction model, consumption, social class and age of respondents were found to be determinants. Whereas, this is so for the abovementioned a·bove·men·tioned  
adj.
Mentioned previously.

n.
The one or ones mentioned previously.
 variables the determinants of health care-seeking behaviour of Jamaicans were age, area of residents, consumption, marital status, and social class; with duration of time unable to work, area of residents and age of respondents.

Many theories (or models) have been developed to explain health care-seeking behaviour of people and these are widely used by Caribbean public health policy makers in planning health demands and needs of societies. The disadvantages in using those theories (Health Belief Model; Theory of Reasoned Actions The theory of reasoned action (TRA), developed by Martin Fishbein and Icek Ajzen (1975, 1980), derived from previous research that started out as the theory of attitude, which led to the study of attitude and behavior. ; Theory of Planned Behaviour; Transtheoretical Model The transtheoretical model of change in health psychology explains or predicts a person's success or failure in achieving a proposed behavior change, such as developing different habits. It attempts to answer why the change "stuck" or alternatively why the change was not made.  and Stages of Change; Precaution Adoption Process Model) are that they were not developed from data collected from the populace. These theories are atypical atypical /atyp·i·cal/ (-i-k'l) irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type.

a·typ·i·cal
adj.
 to Caribbean or in particular Jamaica. They are germane ger·mane  
adj.
Being both pertinent and fitting. See Synonyms at relevant.



[Middle English germain, having the same parents, closely connected; see german2.
 the context that the culture is different along with other indigenous characteristics. The use of health care-seeking models which are not biased to the culture means that we mis-prescribed solutions which are for the targeted population. According to according to
prep.
1. As stated or indicated by; on the authority of: according to historians.

2. In keeping with: according to instructions.

3.
 Glanz et al. (2002), while it is reasonable to assume that a theory such as Health Belief Model is applicable to different cultures, it also is important to realize that constructs may have to be adapted to make them more relevant to the target culture. Those modifications may be applicable with some generalizability to developing nations, but this does not suggests its comprehensive understanding of Caribbean peoples or Jamaicans.

Although the Health Belief Model did not emerge from data in Jamaica or the wider Caribbean, it has some merits which we examine in this study. This conceptual model is a framework for health behaviour. The Health Belief Model (HBM HBM Human Body Model
HBM Human Brain Mapping
HBM Hottinger Baldwin Messtechnik GmbH (German company)
HBM High Bone Mass
HBM Hybrid Bilayer Membrane
HBM Humming Bird Medal
HBM Her/His Britannic Majesty
) was developed in the 1950s by some social psychologists The following is a list of academics, both past and present, who are widely renowned for their groundbreaking contributions to the field of social psychology.

: Top - 0–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

A
  • Robert P.
 in the United States Public Health Service United States Public Health Service (USPHS),
n.pr a major division of the Department of Health and Human Services. The USPHS provides oversight of the following agencies: the Centers for Disease Control and Prevention (CDC); Food and Drug Administration
. It was designed to account for the failure of people to become involve in preventative and detection disease programmes (Hochbaum, 1958; Rosenstock, 1960); and then it evolved to peoples's response to symptoms (Kirscht, 1974) with a later expansion that entails individuals' behaviour in response diagnosed dysfunctions (Becker, 1974). Hence, embedded in the HBM are preventative actions, illness behaviour, and sick-role behaviour, suggesting that dysfunction is the primary focus of this model. This work does not concur CONCUR - ["CONCUR, A Language for Continuous Concurrent Processes", R.M. Salter et al, Comp Langs 5(3):163-189 (1981)].  with the HBM as it was found that health status was not correlated with health care-seeking behaviour of Jamaicans. However, marital status, area of residence and social class (i.e. upper class with reference to poor) were found to be negative determinants of health care-seeking behaviour while age and consumption were positive determinants.

The current study revealed that consumption was the most significant predictor of health care-seeking behaviour of Jamaicans followed by age of respondents. It was found that those who are able to spend more on consumer expenditure are 4 times more likely to seek medical care, which concurred with Brow brow (brou) the forehead, or either lateral half of it.

brow
n.
1. The eyebrow.

2. See forehead.



brow

the forehead, or either lateral half of it.
 et al (2008). Biological ageing means a greater likelihood for people to seek health care and this concurs with other studies (Bourne, McGrowder & Nevins, in print; Bourne 2009; Brown et al 2008; Erber 2005; Brannon & Fiest 2004; Costa 2002; Buzina 1999; CAJANUS 1999; Anthony 1999) as the reasons are linked to increased biological conditions. According to Morrison (2000), there is a shift from infectious communicable diseases communicable diseases, illnesses caused by microorganisms and transmitted from an infected person or animal to another person or animal. Some diseases are passed on by direct or indirect contact with infected persons or with their excretions.  to chronic non-communicable diseases A non-communicable disease or NCD is a disease which is not infectious. Such diseases may result from genetic or lifestyle factors. Those resulting from lifestyle factors are sometimes called diseases of affluence.  as a rationale for the longevity longevity (lŏnjĕv`ĭtē), term denoting the length or duration of the life of an animal or plant, often used to indicate an unusually long life.  of the Anglophone Caribbean The term Anglophone Caribbean is used to refer to the independent English-speaking countries of the Caribbean region. Upon a country's full independence from the United Kingdom, Anglophone Caribbean  populace. This research concurs with Morrison. The findings on in this study revealed that as people age, the typology typology /ty·pol·o·gy/ (ti-pol´ah-je) the study of types; the science of classifying, as bacteria according to type.

typology

the study of types; the science of classifying, as bacteria according to type.
 of diseases change from cold, diarrhoea and asthma to diabetes mellitus, hypertension and arthritis. The probability of the first three illnesses resulting in mortality is lower than the latter three morbidities.

In Jamaica, statistics showed that among the 10 leading cause of mortality for males 5 years and older were external causes, cerebrovascular diseases cerebrovascular disease Neurology Any vascular disease affecting cerebral arteries–eg ASHD, diabetic vasculopathy, HTN, which may cause a CVA or TIA with neurologic sequelae–speech, vision, movement of variable duration. , diabetes mellitus, ischaemic heart diseases Ischaemic (or ischemic) heart disease, or myocardial ischemia, is a disease characterized by reduced blood supply to the heart. It is the most common cause of death in most western countries.

Ischaemia means a "reduced blood supply".
, malignant neoplasm neoplasm or tumor, tissue composed of cells that grow in an abnormal way. Normal tissue is growth-limited, i.e., cell reproduction is equal to cell death.  and hypertension, while for females 5 years and older the diseases were diabetes mellitus, cerebrovascular diseases, hypertension, ischaemic heart disease, external cause and heart diseases (Statistical Institute of Jamaica, 2008). On the other hand, the leading mortality among males and females under 5 years were disorders relating to relating to relate prepconcernant

relating to relate prepbezüglich +gen, mit Bezug auf +acc 
 gestation GESTATION, med. jur. The time during which a female, who has conceived, carries the embryo or foetus in her uterus. By the common consent of mankind, the term of gestation is considered to be ten lunar months, or forty weeks, equal to nine calendar months and a week.  and fetal fetal /fe·tal/ (fe´tal) of or pertaining to a fetus or the period of its development.

fe·tal
adj.
Of, relating to, or being a fetus.
 growth, respiratory distress Respiratory distress
A condition in which patients with lung disease are not able to get enough oxygen.

Mentioned in: Lung Cancer, Non-Small Cell
, other respiratory conditions, other congenital malformations congenital malformation Congenital defect A heterogenous group of structural defects, which are usually identified at birth Major CMs, US PDA, hypospadias, clubfoot, ventricular septal defect, hydrocephalus, Down syndrome, hip dislocation, valve stenosis , and perinatal perinatal /peri·na·tal/ (-na´t'l) relating to the period shortly before and after birth; from the twentieth to twenty-ninth week of gestation to one to four weeks after birth.

per·i·na·tal
adj.
 conditions. Hence, the study concurs with the statistics and Morrison's claim that the typology of diseases shift with the ageing of an individual. In addition another study found that the sixth leading causing of mortality for elderly in Barbados, Trinidad and Tobago Trinidad and Tobago (trĭn`ĭdăd, təbā`gō), officially Republic of Trinidad and Tobago, republic (2005 est. pop. 1,088,000), 1,980 sq mi (5,129 sq km), West Indies. The capital is Port of Spain. , St. Lucia, Montserrat, Guyana, Dominica, Barbados and Bahamas were fundamentally the same. They were respiratory infections Noun 1. respiratory infection - any infection of the respiratory tract
respiratory tract infection

infection - the pathological state resulting from the invasion of the body by pathogenic microorganisms
, cerebrovascular diseases, hypertension, diabetes, malignant neoplasm, and diabetes mellitus, which reinforced the primary finding that 39 out of every 100 Jamaican reported being diagnosed with diabetes mellitus, hypertension and arthritis and the unspecified group was 23 out of 100 respondents. Among the diseases in the unspecified category would be malignant neoplasm. In 2007, statistics indicated that 8.5% of the Jamaica's population was less than 5 years; 9.7% was 5 to 9 years; 10.3% was 10 to 14 years, meaning that 28.6% of the population was children. With approximately 71% of Jamaica's population ages 15 years and older, this explains the high probability of chronic diseases accounting for more deaths than communicable communicable /com·mu·ni·ca·ble/ (kah-mu´ni-kah-b'l) capable of being transmitted from one person to another.

com·mu·ni·ca·ble
adj.
Transmittable between persons or species; contagious.
 and illnesses affecting children.

The current findings indicate that health status is not determined by health care-seeking behaviour, self-reported illness or length of illness. This speaks volume about the culture of unwillingness to visit traditional medical practitioners, and adds more information to the discussion, of illness and mortality. Jamaicans are unlikely to visit health care practitioners owing to their perspective of illness, severity of illness and the likely of the dysfunction to cause mortality. When illness is equated to mortality, the probability of seeking medical care will be high. A part of the reason for this health care-seeking behaviour is embedded in the culture as illness is viewed as weakness. Another explanation for this low probability is Jamaicans involvement of non-traditional medical care behaviours. To address ill-health, Jamaicans visit spiritual advisers (i.e. unknown as obeah men). These individuals perform the similar functions like the traditional health practitioners except surgeries. The data used for this study excluded non-traditional medical healers, and so underestimate the coverage of medical care-seeking behaviour of sample.

There is a finding which appears paradoxical as people who resided in urban areas do not exhibit greater or lower health care-seeking behaviour than those who dwelled in rural areas. Rural residents were more likely to seek medical care than other town dwellers while more consumption was positively correlated with seeking more health care. Interestingly, the wealthy spent more on consumption than the poor, yet the poor sought more medical care-seeking behaviour than upper class Jamaicans. Although rural residents were more likely to be poorer than other Jamaicans and that they were more likely to spend less than urban and other town dwellers. Embedded in this finding, is the fact that it is not higher social class that determines health seeking behaviour but money. Those in the upper class may have access to more financial resources, but rural residents have greater social network which avails them of extended economic resources. Rural residents have more children, and the culture within those areas is such that the wider community is willing to aid each other for consumption including medical care. Another issue that is not on the surface of the finding is the fact that they (i.e. rural residents) were attending more to medical care than other town dwellers and there is no evidence of statistical difference in health-seeking behaviour between rural versus urban residents, owing to disproportionally dis·pro·por·tion·al  
adj.
Disproportionate.



dispro·portion·al·ly adv.
 more of them in the country than other dwellers. The wide primary health care coverage which is inexpensive means that Jamaicans even if they are poor can access health care. Where the difference will be is in access to private health care service, and this is basic fundamentally on one's ability to afford it and not on wanting to access the service.

The inverse (mathematics) inverse - Given a function, f : D -> C, a function g : C -> D is called a left inverse for f if for all d in D, g (f d) = d and a right inverse if, for all c in C, f (g c) = c and an inverse if both conditions hold.  correlation between self-reported dysfunction and consumption, showed a positive association between health care-seeking behaviour and consumption within the context that those in the upper class have a greater degree of reporting illness, means that there is a cultural bias that explains Jamaicans unwillingness to seek health care. This study did not initially examine lifestyle behaviour of Jamaicans, but given that consumption expenditures are constituted of meal and non-consumption expenditures, consumption being a negative predictor of self-reported illness, suggests that Jamaicans were involved in relatively good decisions that are lowering illness. The positive relations between health care-seeking behaviour and consumption are indicators of preventative lifestyle practices. This is so, because in 2006, 70% of Jamaicans who reported ill-health sought medical care (Planning Institute of Jamaica and Statistical Institute of Jamaica, 2008) compared to 66% in this study (in 2007), within the context that inflation increased by 194.7% over 2006 (in 2007), this means that increased consumption expenditure does not necessarily mean more meal consumed or non-consumption as this change is owing to price increases. With more Jamaicans attended private health care facilities, inflation would increase costing of the offered services.

The current study found that rural residents had the least self-evaluated health status, and thereby justify more of them seeking medical care than upper class Jamaicans. Another explanation for more rural residents attended health care institution is owing to greater percentage of them in older ages than in other geographic zones. Age is a negative determinant determinant, a polynomial expression that is inherent in the entries of a square matrix. The size n of the square matrix, as determined from the number of entries in any row or column, is called the order of the determinant.  of health status and positively correlated with self-reported dysfunction, and accounts for more rural residents demanding more health care than other people in Jamaica. This study refined the finding of Grover el's work (2006). They found that significantly more urban area dwellers take self medication compared to rural area residents (see also, Sudha et al, 2003). In this study, it was revealed that that more urban dwellers purchased over the counter medication than rural residents; but that it was other town dwellers (i.e. semi-urban) that significantly used self medication than rural area people. This means that self treatment was more an urban and/or semi-urban phenomenon than a rural area reality. On the other hand, rural area residents significantly purchased more prescribed medication than other town dwellers, while urban area settlers bought more prescribed medicine compared to rural and semi-urban residents. This study went further than Grover et al. (2006) and Sudha (2003), when it examined those who did not buy by area of residence. The current work revealed that significantly more rural area residents did not purchase medication than residents in other geographic areas.

Interestingly health care-seeking did not differ significantly between the sexes, which concur with a study by Williams et al (2006). One of the explanations for this non-significance can be accounted for based on the non-significant disparity dis·par·i·ty  
n. pl. dis·par·i·ties
1. The condition or fact of being unequal, as in age, rank, or degree; difference: "narrow the economic disparities among regions and industries" 
 in health status and self-reported dysfunctions of males and females.

Conclusion

Jamaica is comprised of peoples of different ethnic; socialization socialization /so·cial·iza·tion/ (so?shal-i-za´shun) the process by which society integrates the individual and the individual learns to behave in socially acceptable ways.

so·cial·i·za·tion
n.
; social class; geographic zones and culturalization, and this accounts for a difference in belief system and health behaviour. This disparity must be taken into consideration when designing public health programmes. Hence, the wholesale utilization of any health model that is developed outside of the society or even medication of such a theory is not necessarily applicable to the nation. The current study revealed that health behaviour is a function of socio-demographic variables. Poverty which is synonymous to rural areas influences people choice in visits to health care-seeking facilities. An interesting consideration of rural residence with those than residents of other geographic zones is the culture and its influence on health care-seeking behaviour and other such decisions. Home remedy A home remedy is a treatment to cure a disease or ailment that employs certain spices, vegetables, or other common items from the kitchen. Home remedies may or may not have actual medicinal properties that serve to treat or cure the disease or ailment in question, as they are  and non-traditional healers (i.e. obeah men) is a substitute product that is used more by rural dwellers than others, because of the retention of the African tradition. While urban and other town residents were exposed to this culture and socialization, their higher level of education, access to more information and financial resources account for re-socialization and new re-adaptation to traditional medical care utilization. Therefore, when health literacy health literacy Health care A measure of a person's ability to understand health-related information and make informed decisions about that information; HL includes interpreting prescriptions and following self care insturctions. Cf Literacy.  and public health programmes are fashioned in Jamaica or other developing societies, health care-seeking behaviour model must not only be modified but must utilize data from those nations to address the health needs of the geopolitical ge·o·pol·i·tics  
n. (used with a sing. verb)
1. The study of the relationship among politics and geography, demography, and economics, especially with respect to the foreign policy of a nation.

2.
a.
 zones and not some model developed for developed societies with some modifications. The findings of this study suggests that health service professionals need to increase awareness about the benefits of purchasing prescribed medication, and that this must be more so for rural and urban residents.

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Paul Andrew Bourne (Dip Ed Dip Ed (in Britain) Diploma in Education , BSc, MSc, PhD candidate)

Department of Community Health and Psychiatry

Faculty of Medical Sciences

University of the West Indies, Jamaica

Email: paulbourne1@yahoo.com
Table 1: Demographic Characteristic of Sample

Variable                                Number (n)   Percentage

Sex:
  Men                                      407          40.5
  Women                                    599          59.5
Self-rated Health Status
  Very good                                122          12.2
  Good                                     317          31.6
  Fair                                     361          36.0
  Poor                                     173          17.3
  Very poor                                 29           2.9
Health Care-Seeking Behaviour
  No                                       348          34.6
  Yes                                      658          65.4
Household Head
  No                                       559          55.6
  Yes                                      447          44.4
Marital Status
  Married                                  265          35.8
  Never married (includes common-law)      351          47.4
  Divorced                                  22           3.0
  Separated                                 13           1.8
  Widowed                                   89          12.0
Injured in last 4-week
  No                                       942          93.7
  Yes                                       63           6.3
Diagnosed Recurring Illness
  Cold                                     148          14.9
  Diarrhoea                                 27           2.7
  Asthma                                    94           9.5
  Diabetes mellitus                        123          12.4
  Hypertension                             204          20.5
  Arthritis                                 56           5.6
  Other                                    232          23.4
  No                                       109          11.0
Health Insurance
  Private                                  115          11.5
  NI Gold                                   76           7.6
  Other Public                              57           5.7
  No                                       756          75.3
Self-reported dysfunction
  None                                      31           3.1
  Have                                     971          96.9
Annual Income Median                        US $5, 936.77

Table 2: Self-rated Health Status by Social Standing

                   Social Standing

Health                              Middle
Status:   Poorest       Poor        class

Good       70 (37.0)    78 (41.9)    94 (44.8)
Fair       66 (34.9)    71 (38.2)    73 (34.8)
Poor       53 (28)      37 (19.9)    43 (20.5)
Total     189          186          210

                   Social Standing

          Upper
Health    Middle        Upper
Status:   class         Class         Total

Good      103 (50.0)    94 (44.5)     439 (43.8)
Fair       68 (33.0)    83 (39.3)     361 (36.0)
Poor       35 (17.0)    34 (16.1)     202 (20.2)
Total     206          211          1,002

[chi square](8)=14.139, p=0.078, n=1002

Table 3: Health care, injured, self-rated health status,
buy medication, and health insurance coverage by area of residence

                                          Area of residence

Variable                                 Urban      Other towns

Injured in last 4-week
  No                                252 (94.4)       174 (93.0)
  Yes                                 15 (5.6)         13 (7.0)
Self-rated Health status
  Very good                           26 (9.7)        34 (18.3)
  Good                              104 (38.8)        60 (32.3)
  Fair                              104 (38.8)        70 (37.6)
  Poor                               29 (10.8)        19 (10.2)
  Very poor                            5 (1.9)          3 (1.6)
Buy Medicine in last 4-weeks
  Buy, Prescribed                   173 (66.0)       109 (60.6)
  Buy, partial prescribed              6 (2.4)          2 (1.1)
  Buy, prescribed over counter         9 (3.4)         12 (6.7)
  Buy, over counter medicine          14 (5.3)         11 (6.2)
  Did not buy, prescribed              9 (3.4)          1 (0.6)
  None prescribed required           51 (19.5)        45 (25.0)
Health Insurance Coverage
  Yes, Private                       50 (18.7)        29 (15.5)
  Yes, Government                     21 (7.9)         16 (8.6)
  Yes, Other Public                   14 (5.2)         11 (5.9)
  No                                182 (68.2)       131 (70.2)
Self-reported dysfunction
  None                                 8 (3.0)          7 (3.7)
  Yes                               257 (97.0)       180 (96.3)
Annual Income Mean (SD)          US $10,249.43     US $8,241.77
                                 (US $8,613.98)   (US $6,570.46)
Social class
  Poor                               44 (16.4)        51 (27.3)
  Middle                             49 (18.4)        42 (22.4)
  Upper                             174 (65.2)        94 (50.3)
Public facilities
  No                                109 (59.2)        71 (61.2)
  Yes                                75 (40.8)        45 (38.8)
Private facilities
  No                                 63 (33.9)        37 (31.6)
  Yes                               123 (66.1)        80 (68.4)

                                       Area of
                                     residence

Variable                                Rural    pvalue

Injured in last 4-week                              0.841
  No                                516 (93.6)
  Yes                                 35 (6.4)
Self-rated Health status                          < 0.001
  Very good                          62 (11.3)
  Good                              153 (27.9)
  Fair                              187 (34.2)
  Poor                              125 (22.8)
  Very poor                           21 (3.8)
Buy Medicine in last 4-weeks                        0.020
  Buy, Prescribed                   331 (62.9)
  Buy, partial prescribed             10 (1.9)
  Buy, prescribed over counter         8 (1.5)
  Buy, over counter medicine          27 (5.1)
  Did not buy, prescribed             22 (4.2)
  None prescribed required          128 (24.4)
Health Insurance Coverage                         < 0.001
  Yes, Private                        36 (6.6)
  Yes, Government                     39 (7.1)
  Yes, Other Public                   32 (5.8)
  No                                443 (80.5)
Self-reported dysfunction                           0.848
  None                                16 (2.9)
  Yes                               534 (97.1)
Annual Income Mean (SD)           US $6,361.03    < 0.001
                                 (US $4,849.60)
Social class                                      < 0.001
  Poor                              282 (51.2)
  Middle                            120 (21.8)
  Upper                             149 (27.0)
Public facilities                                 < 0.001
  No                                147 (43.1)
  Yes                               194 (56.9)
Private facilities                                < 0.001
  No                                175 (51.3)
  Yes                               166 (48.7)

Table 4: Head of Household by Health Care-Seeking Behaviour

                     Health Care-Seeking Behaviour

                     No           Seek Care    pvalue

Head of Household:                             0.088

No                   204 (58.6)   355 (54.0)

Yes                  144 (41.4)   303 (46.0)
Total                348          658

[chi square] (1)=2.010, p=0.088, n=1006

Table 5: Health Care-Seeking Behaviour by Sex of Respondents

                              Sex

                    Man          Woman     pvalue

Health Care-Seeking Behaviour:             0.074

Did not seek care   154 (37.8)   194 (32.4)

Seek health care    253 (62.2)   405 (67.6)
Total               407          599

[chi square] (1) =3.182, p=0.074, n=1006

Table 6: Health Care-Seeking Behaviour by Illness, Controlled for Sex

                     Self-reported Illness

                     Yes          No

                     Male (1)

Health         No    149 (38.9)   5 (23.8)
Care-seeking
behaviour

               Yes   236 (61.3)   16 (76.2)

Total                385          21

                     Self-reported Illness

                     Yes          No

                                  Female (2)

Health         No    191 (32.6)   2 (20.0
Care-seeking
behaviour

               Yes   395 (67.4)   8 (80.0)

Total                586          10

(1) [chi square] (1) = 1.876,   value = 0.171, n= 406

(2) [chi square] (1) = 0.712,   value = 0.399, n= 596

Table 7: Logistic Regression: Self-rated Health Status as predictor
of Self-reported Dysfunctions

                                                     95.0% C.I.

Dependent variable:
Self-reported                       Std     Odds     Lower,
Dysfunction           Coefficient   Error   ratio    Upper

Good Health Status         -1.304    0.62    0.271   0.081, 0.915 *

Fair Health Status          0.065   0.736    1.067   0.252, 4.513
([dagge]) Poor
  health status

Constant                    4.195   0.582   66.333   --

[chi square] (2) =12.183, p = 0.002; n = 998

-2 Log likelihood = 264.094

Hosmer and Lemeshow goodness of fit [chi square]=0.000, P = 1.00.

Nagelkerke [R.sup.2] =0.050

Overall correct classification = 96.9%

Correct classification of cases of self-reported dysfunctions =100.0%

Correct classification of cases of no dysfunctions =0.0%

([dagger]) Reference group

* p < 0.05, ** p < 0.01, *** p < 0.001

Table 8: Logistic Regression: Predictors of Self-reported
Dysfunctions

                                 Coefficient   Std. Error

Urban area                           -0.090        0.861
Other town                           -0.438        0.923
([dagger]) Rural area

Health insurance                      0.966        0.933
Log consumption                      -2.430        1.219
Log health expenditure               -0.495        0.291
Log length of illness                -0.031        0.336
Log duration unable to work          -0.369        0.367

Secondary or Tertiary                            8847.72
                                     20.338            3

([dagger]) No formal education

Married                              -0.174        1.025
Divorced, separated,
                                     -1.545        1.326
widowed
([dagger]) Never Married

Middle class                          2.080        1.108
Upper class
                                      4.331        1.897

([dagger]) Poor

Head household                       -1.404        0.913
Sex (1=Man)                          -0.959        0.725
Age
                                      0.091        0.034

Good health status                    0.046        0.989
Fair health status                    0.670        0.923
Logged income                         0.420        0.638
Constant                             26.315       14.148

                                                95.0% C.I.

                                 Odds Ratio    Lower, Upper

Urban area                           0.914     0.169, 4.939
Other town                           0.645     0.106, 3.941
([dagger]) Rural area

Health insurance                     2.626    0.422, 16.343
Log consumption                      0.088     0.008, 0.961 *
Log health expenditure               0.610     0.345, 1.079
Log length of illness                0.970     0.501, 1.875
Log duration unable to work          0.691     0.337, 1.419

Secondary or Tertiary             68054095
                                         4     0.000, 0.000

([dagger]) No formal education

Married                              0.840     0.113, 6.267
Divorced, separated,
                                     0.213     0.016, 2.871
widowed
([dagger]) Never Married

Middle class                         8.005    0.912, 70.228
Upper class                                          1.846,
                                    76.024
                                                    3130.54 *
([dagger]) Poor

Head household                       0.246     0.041, 1.471
Sex (1=Man)                          0.383     0.093, 1.586
Age                                                  1.024,
                                     1.095
                                                      1.171 **
Good health status                   1.047     0.151, 7.274
Fair health status                   1.955    0.320, 11.927
Logged income                        1.521    0.435, 5.317
Constant                                --              --

[chi square]=27.515, p < 0.001

-2 Log likelihood = 74.212

Hosmer and Lemeshow goodness of fit [chi square]=1.450, P = 0.993

Nagelkerke [R.sup.2]=0.303

Overall correct classification = 99.7%

Correct classification of cases of self-reported dysfunction =95.8%

Correct classification of cases of without self-reported
dysfunction =0.0%

([dagger]) Reference group

* p < 0.05, ** p < 0.01, *** p < 0.001

Table 9: Logistic regression: Variables Explaining Health Care-
Seeking Behaviour

Variable                         Coefficient   Std. Error

Age                                   0.031        0.009
Sex (1=Man)                          -0.357        0.273
Head Household                       -0.407        0.284

Urban Area                            0.061        0.329
Other Town                           -0.692        0.300
([dagger]) Rural

Good Health Status                   -0.563        0.355
Dummy Health Insurance                0.434        0.303
Fair Health Status                   -0.054        0.319
Log Length of illness                -0.077        0.110
Log Consumption                       1.282        0.351
Log Duration unable to work           0.102        0.131

Secondary or Tertiary                 0.467        0.660
([dagger]) No formal education

Married                              -0.759        0.300
Divorced, separated or
                                     -0.959        0.437
widowed
([dagger]) Never married

Middle class                         -0.483        0.425
Upper class                          -1.144        0.562
([dagger]) Poor

Constant                            -14.059        3.952

                                              95.0% C.I.

Variable                         Odds ratio   Lower, Upper

Age                                  1.031       1.014, 1.049 ***
Sex (1=Man)                          0.700       0.410, 1.195
Head Household                       0.665       0.381, 1.161

Urban Area                           1.063       0.558, 2.025
Other Town                           0.500       0.278, 0.902 *
([dagger]) Rural

Good Health Status                   0.569       0.284, 1.142
Dummy Health Insurance               1.543       0.852, 2.794
Fair Health Status                   0.948       0.507, 1.771
Log Length of illness                0.926       0.746, 1.149
Log Consumption                      3.605       1.814, 7.167 ***
Log Duration unable to work          1.108       0.856, 1.432

Secondary or Tertiary                1.596       0.437, 5.821
([dagger]) No formal education

Married                              0.468       0.260, 0.843 *
Divorced, separated or
                                     0.383       0.163, 0.903 *
widowed
([dagger]) Never married

Middle class                         0.617       0.268, 1.419
Upper class                          0.319       0.106, 0.958 *
([dagger]) Poor

Constant                             0.000                 --

[chi square] (16) =49.628, p < 0.001

-2 Log likelihood = 439.317

Hosmer and Lemeshow goodness of fit   2=13.900, P = 0.84

Nagelkerke [R.sup.2]=0.050

Overall correct classification = 77.8%

Correct classification of cases of seeking health care =97.4%

Correct classification of cases of not seeking health care =13.3%

([dagger]) Reference group

* p < 0.05, ** p < 0.01, *** p < 0.001

Table 10: Logistic Regression: Variables of Good Self-rated Health
Status

Variable                         Coefficient   Std. Error

Log Consumption                     0.105        0.463
Log Health Expenditure              0.105        0.170
Log Length of illness              -0.078        0.148

Log Duration unable to             -0.520        0.185
work

Secondary or Tertiary               0.633        0.675
([dagger]) No formal education

Married                            -0.037        0.347
Divorced, separated or
                                    0.112        0.500
widowed
([dagger]) Never married

Middle Class                       -0.358        0.485
Upper class                        -0.765        0.678
([dagger]) Poor

Self-reported illness              -1.804        1.108
Self-report injury                 -1.073        0.887
Health Insurance                    0.454        0.324

Urban Area                          0.882        0.359
Other Town                          0.922        0.394
([dagger]) Rural area

Age                                -0.033        0.010
Sex (1=Man)                         0.181        0.336
Head Household                      0.130        0.332
Constant                            1.219        5.534

                                              95.0% C.I

Variable                         Odds ratio   Lower, Upper

Log Consumption                    1.111      0.448, 2.753
Log Health Expenditure             1.110      0.796, 1.550
Log Length of illness              0.925      0.692, 1.236

Log Duration unable to             0.594      0.413, 0.855 **
work

Secondary or Tertiary              1.884      0.502, 7.073
([dagger]) No formal education

Married                            0.963      0.488, 1.900
Divorced, separated or
                                   1.118      0.420, 2.978
widowed
([dagger]) Never married

Middle Class                       0.699      0.270, 1.808
Upper class                        0.465      0.123, 1.760
([dagger]) Poor

Self-reported illness              0.165      0.019, 1.446
Self-report injury                 0.342      0.060, 1.943
Health Insurance                   1.575      0.834, 2.973

Urban Area                         2.415      1.195, 4.881 *
Other Town                         2.514      1.162, 5.442 *
([dagger]) Rural area

Age                                0.967      0.949, 0.986 **
Sex (1=Man)                        1.199      0.620, 2.317
Head Household                     1.139      0.594, 2.184
Constant                           3.385      --

[chi square] =59.568, p < 0.001

-2 Log likelihood = 303.022

Hosmer and Lemeshow goodness of fit   2=4.324, p = 0.827

Nagelkerke [R.sup.2]=0.254

Overall correct classification = 77.2%

Correct classification of cases of good self-rated health =34.5%

Correct classification of cases of not seeking health care =93.0%

([dagger]) Reference group

* p < 0.05, ** p < 0.01, *** p < 0.001

Figure 1: Self-rated Health Status by Sex of respondents (n=1,002)

        Men   Women

Good   47.6   41.2
Fair   31.9   38.9
Poor   20.5   19.9

Note: Table made from bar graph.

Figure 2: Self-evaluated health status and health
care-seeking behaviour

                  Self-evaluated health status

       Health care seeking: Yes   Health care-seeking: No

Good           37.6                      55.8
Fair           38.9                      30.9
Poor           23.8                      13.3

Note: Table made from bar graph.

Figure 3: Self-reported illness by age group of respondents

                Self-reported illness by age group

                      Yes   No

Children             98.1   1.9
Young adults         90.7   9.3
Other adults         97     3
Young old            96.4   3.6
Old Old             100     0
Oldest old          100     0

Note: Table made from bar graph.

Figure 4: Self-reported diagnosed recurring Illness by
Age cohort of respondents

                      YES,    YES,        YES,     YES,
                      COLD    DIARRHOEA   ASTHMA   DIABETES

1=Children            37.35      5.06      19.84      1.17
2=Young adults        13.46      1.92      15.38      2.88
3=Other-aged adults    7.36      2.01       5.69     14.72
4=Young old            4.17      1.04       3.65     25.52
5=old Elderly          7.27      2.73       1.82     17.27
6=Oldest Elderly       0.00      3.33       3.33     16.67

                      YES,             YES,        OTHER
                      HYPERTENSIONES   ATHRITIES   (SPECIFY)   NO

1=Children                 0.00           0.00       21.01     15.56
2=Young adults             5.77           0.96       40.30     19.23
3=Other-aged adults       25.42           5.69       28.43     10.70
4=Young old               31.25          11.46       16.67      6.25
5=Old Elderly             43.64          12.73       11.82      2.73
6=Oldest Elderly          46.67           6.67       20.00      3.33

Note: Table made from bar graph.

Figure 5: Percentage of persons who visited public or private
health care facilities

               Public facilities   Private facilities

Poor                 63.3                 41.1
Middle class         52.5                 57.9
Upper class          36.6                 68.8

Note: Table made from bar graph.

Figure 6: Percentage of visits to public or private health facilities
by social class

               Public facilities   Private facilities

Poor                 63.3                 41.1
Middle class         52.5                 57.9
Upper class          36.6                 68.8

Note: Table made from bar graph.
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Author:Bourne, Paul Andrew
Publication:International Journal of Collaborative Research on Internal Medicine & Public Health (IJCRIMPH)
Article Type:Report
Geographic Code:5JAMA
Date:Jun 1, 2009
Words:10257
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