DETERMINANTS OF ROUTINE MEDICAL EXAMINATION AMONG THE COMMUNITY OF NTAAWO VILLAGE, MUKONO DISTRICT

INTRODUCTION

1.0 Introduction

This chapter presents the background of the study, problem statement, purpose of the study, specific objectives, research questions and justification of the study.

1.1 Background of the study

A medical examination (more popularly known as a check-up) is the process by which a medical professional investigates the body of a patient for signs of disease. It generally follows the taking of the medical history an account of the symptoms as experienced by the patient. Together with the medical history, the medical examination aids in determining the correct diagnosis and devising the treatment plan. This data then becomes part of the medical record (Krogsboll et al., 2012).

Routine medical examinations performed on asymptomatic patients for medical screening purposes, these are normally performed by a pediatrician, family practice physician, physician assistant, a certified nurse practitioner or other primary care provider. This routine medical exam usually includes the Head, Eye, Ear, Nose and Throat (HEENT) evaluation. Nursing professionals such as Registered Nurse, Licensed Practical Nurses develop a baseline assessment to identify normal versus abnormal findings. These are reported to the primary care provider (Verghese, 2011).

A medical examination may include checking vital signs, including temperature examination, Blood pressure, pulse, and respiratory rate. The healthcare providers use the senses of sight, hearing, touch, and sometimes smell (in infection, uremia, and diabetic ketoacidosis). Taste has been made redundant by the availability of modern laboratory tests. Four actions are taught as the basis of medical examination: inspection, palpation (feel), percussion (tap to determine resonance characteristics), and auscultation (Guadalajara, 2015).

Although the health implications of communities’ underutilization of health services such as routine medical examination are not fully understood, they coincide with them living shorter lives and perishing from preventable conditions at higher rates. Thus, even as the value of routine health examinations is being debated, it may be important to unearth determinants motivating communities to schedule and obtain them (Link and Phelan, 2008).

The social determinants of health differ depending on the social, economic, political, cultural and physical climate within which they exist. According to the Public Health Agency of Canada (PHAC, 2011), routine medical examine determinants include social support networks, social environments, physical environments, income and social status, employment and working conditions, education and literacy, personal health practices and coping skills, healthy child development, biology and genetic endowment, health services, culture, and gender. Each of these determinants impacts health and is interconnected with the other social determinants.

Communities in Uganda seek help from physicians irrespective of problem severity, schedule fewer routine annual health examinations. More routine health surveillance might counterbalance the markedly earlier onset of and greater morbidity and premature mortality from preventable conditions (eg, cardiovascular disease, stroke, hypertension, and heart failure) experienced by these communities. Thus, the study seeks to assess the determinants of routine medical examination among the community in Ntaawo ward Mukono municipality.

1.2 Problem Statement

Few people in developing countries have access to routine medical examination in health facilities due to a number of factors that have led to high health risks (Ross, 2011). In Uganda alone, the major perceived barriers to access to health care services are lack of money, distance to health facilities not willing to go alone (Link and Phelan, 2008).

In Mukono Church of Uganda hospital, out of 1419 people who came for health services in the month of January 2017, 1173 came when they were ill and 246 patients came for routine medical examinations (20 were diagnosed with hypertension, 9 – diabetes, 1 – renal disease, 210 came for routine counseling and testing (RCT) of HIV and only 3 were diagnosed HIV positive), 6 came for cancer screening.

Despite efforts by the Ministry of health in encouraging people to go routine medical examination especially routine counseling and testing of HIV and cancer screening, the response is still poor. Thus, increasing the burden of mortality and morbidity of people in Uganda due to preventable diseases like cancer, diabetes, hypertension, ulcers which can be detected earlier through routine medical examination. Ntaawo being a village in Mukono contributes to this great problem. Thus, the researcher is interested in assessing the determinants of routine medical examination among the community.

1.3 Purpose of the study

To assess the determinants of routine medical examination among the community of Ntaawo ward, Mukono municipality so that to come up with better recommendations to improve access to routine medical examination.

1.4 Specific objectives

1. To assess the personal determinants that influence access to routine medical examination among the community of Ntaawo ward, Mukono municipality.
2. To identify the socio-economic determinants that influence access to routine medical examination among the community of Ntaawo ward, Mukono municipality.

• To assess the health facility related determinants that influence access to routine medical examination among the community of Ntaawo ward, Mukono municipality.

1.5 Research questions

1. What personal determinants influence access to routine medical examination among the community of Ntaawo ward, Mukono municipality?
2. What socio-economic determinants influence access to routine medical examination among the community of Ntaawo ward, Mukono municipality?

• What health facility related determinants influence access to routine medical examination among the community of Ntaawo ward, Mukono municipality?

1.6 Justification for the study

To the community of Ntaawo, the study will help them acquire information on determinants of routine medical examination which help them to have knowledge of the importance of routine medical examination. This will be done by holding a session with them which will take 30 minutes to discuss the results and recommendations of the study.

To local leaders, the findings will form a basis upon which appropriate interventions can be devised to improve access to routine medical examination for their community members. This will be ensured by the researcher giving a report copy to the local leaders.

To health workers, the study will enable them realise the health related determinants that influence people’s access to routine medical examination and hence improve areas which need to be improved.

To other researchers, the research report will act as a source of literature to other future researchers. This will be ensured by putting a copy of the report in the school library.

To the researcher, the research findings will help attain a diploma in midwifery of UNMEB since it’s a requirement. This will be done by disseminating a report book to UNMEB

CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction

This chapter presents literature related to determinants that other researchers have reviewed which is in line with personal determinants, socio economic determinants and health facility related determinants influencing access to routine medical examinations.

2.2 Personal determinants that influence routine medical examination

According to Winklebly (2014), education shapes future occupational opportunities and earning potential in developed countries like US. It also provides knowledge and life skills that allow better-educated persons to gain more ready access to information and resources to promote health services such as medical examination.

According to Atkinson et al (2001), a lack of cultural competency within the health system, cultural barriers, language barriers and low health literacy are some of the factors that influence on routine medical examination access in developing countries.

According to Mare (2012) in his study Socio-Economic Careers and Measurement and Analysis of Mortality, he stated that the work status of women has also been linked to knowledge and use of medical examinations. Women who work outside the home have higher rate of accessing routine medical examination than women who do not work outside home (housewives). Working women, particularly, those who earn cash incomes are assumed to have greater control over household decisions and increased awareness of the world outside home.

Winklebly (2014), also hypothesized that there is a positive correlation between medical examination use and level of education. Other things being equal the higher the level of education the higher medical examination use is expected to be.

The observed variation in medical examination use by place of residence may be attributed to differences in the availability of such social services as education, information about medical examination, access to medical examination and health care services (Lantz, 2008).

Increasing knowledge and awareness of the determinants influencing access to health care services and how they interact can inform effective policy development and improve the availability and accessibility of health care services that fit the needs of different communities. Therefore, increased awareness and knowledge about health issues influences the access to routine medical examination (Lantz, 2008).

Atkinson et al (2001), religion may affect compliance or access to health services. It is recognised also that in most African countries like Uganda, health professionals put into account these types of religious beliefs and values when communicating with patients or users; this may affect ones access to routine medical examination.

Behavior and attitudes towards routine medical examination are also determinant factor for a choice of routine medical examination. Negative attitudes prevent the people from accessing routine medical examination however positives attitudes attract people to access routine medical examination (Lantz, 2008).

Perceived quality of care, which only partly overlaps with medical quality of care, is thought to be an important influence on health care-seeking and routine medical examination. Assessment of quality of services is largely depends on personal experience with health system (Atkinson et al, 2001).

2.3 Socio-economic determinants that influence routine medical examination

UDHS (2011) showed that Ugandan women in the lowest wealth quintile have no access to routine medical examination as those in the highest wealth quintile. Percentage of women in the lowest quintile has no education compared with 38 percent in the highest quintile” shows the obvious fact that wealth and education go hand-in-hand and, together, make the biggest fertility impact. The lower the income levels the higher the access to routine medical examination.

According to Atkinson et al (2001) argues that the location of health services in developing countries may result in poor access for routine medical examination. Also household financial capacity is one of the major factors in the determinants of routine medical examination, and this depends on occupation of family members.

According to Ross (2011) household financial capacity is one of the major factors in the determination of routine medical examination in most African Countries. A limited ability to pay and high hospital costs have been identified as the major barriers for the rural poor wishing to access health care, due to economic difficulties in rural areas women are not able to afford costs related to routine medical examination.

According to Link and Phelan (2010) the inequalities in the apparent circumstances of individual’s lives, like individuals’ access to health care, schools, their conditions of work and leisure, households, communities, towns, or cities,  affect people’s ability to lead a flourishing life and maintain health, thus access to routine medical examination.

Women who are working and earning money may be able to save and decide to spend it on a health issues. Several studies find that farming women are less likely to have routine examination than women in other occupations (PHAC, 2011). This may be due to limited financial resources and health services in such areas.

2.4 Health facility related determinants that influence routine medical examination

According to a research carried out by Agency for Healthcare Research and Quality (AHRQ) in the US, 2008, lack of access, or limited access, to health services greatly impacts an individual’s health status. For example, when individuals do not have health insurance, they are less likely to participate in preventive care and are more likely to delay medical treatment.

Unreliable transport is also a barrier to access health services, failure to plan in advance for transport cause higher number of people to forego routine medical examination (Mrisho et al, 2007).

In most developing countries, inadequate knowledge and skills for health workers on management of obstetrics cases can be the barrier for routine medical examination in health facilities, several study found that health workers tend to unnecessary refer pregnant mother to higher level because they don’t know to use partogram which monitor the progress of labour and the woman end up delivering normally. This woman will never come back to that facility due to unnecessary referral to other health facility (Shankwaya, 2008)

Lack of privacy is also documented as a barrier for routine medical examination in health facilities because some older women they don’t want to be attended by younger nurses at health facilities who they think there are like their daughter or younger women they like to be attended by male health workers. In other health facilities there is no special room for such activities. This condition hinders to have access to health facilities (Mrisho et al, 2007)

Health provider behavior and attitudes are also determinant factor, some of the health workers are very rude, using abusive language and refusing to assist the patients, and these attitudes limit access to routine medical examination however positives attitudes of health workers attract people in health facilities (Mrisho et al, 2008).

Distance is one of the determinants for routine examination especially in rural areas where by health facilities are scarcely distributed. It is relevant to have health facility which is well equipped and properly staffed but not accessed by anyone due to walking distance. Shankwaya (2008) noted that the use of health services decline with distance. According to Atkinson et al (2001) argues that the location of health services in developing countries may result in poor access for routine medical examination.

CHAPTER THREE

METHODOLOGY

3.1 Introduction

The chapter focuses on the methods and procedures that will be used in conducting the study which includes; the study design and rationale, study setting and rationale, study population, sample size determination, sampling procedure, inclusion criteria, exclusion criteria, definition of variables, research instruments, data collection procedure, data management, data analysis, ethical consideration, anticipated limitation of the study and dissemination of results.

3.2 Study Design and rationale

The study will be cross sectional and descriptive in design, employing quantitative data collection method. It will be a cross sectional type of design because a number of variables like age, gender, religion, and education will be assessed. The study design will be chosen because it will help to study various determinants i.e. personal, social-economic and health related determinants affecting access to routine medical examination.

3.3 Study setting and rationale

The study will be conducted in Ntaawo ward Mukono municipality. Mukono Municipality is bordered by Kayuga to the north, Wakiso district to the west, Lake Victoria to the south and Buikwe to the east. On 27 August 2014, the national population census put Mukono’s population at 161,996 (UBOS, 2014). The main economic activities that people engage in include farming and businesses. Most people in Ntaawo access routine medical examination from Mukono health IV, Mukono Church of Uganda hospital. This area is chosen because it is near for the researcher to access.

3.4 Study Population

The study will target men and women who live in Ntaawo and are above 18years.

3.4.1 Sample Size Determination

The study will involve 30 respondents. The research will choose only 30 respondents because they are representative enough of the study population and because of the limited finances and time.

3.4.2 Sampling procedure

Purposive sampling will be employed where respondents will be sampled from their homes until the required sample size is obtained.

3.4.3 Inclusion criteria

The study will include men and women who are 18years and above living in Ntaawo village.

3.4.4 Exclusion Criteria

The study will exclude men and women below 18years and are not living in Ntaawo village.

3.5 Definition of variables

Variables are the characteristics of a respondent the researcher wishes to explore or study.

Independent variables

These are the demographic characteristics of the respondents such as age, marital status, education, occupation.

Dependent variable

The dependent variables of the study will be personal determinants and socio-economic variable.

Personal determinants: are the individual determinants that strongly influence their behaviors.

Social Economic determinants: this refers to how economic activity affects and is shaped by social processes. In general it analyzes how societies progress, stagnate, or regress because of their local or regional economy, or the global economy.

Health facility related determinants: are determinants that affect individuals within the health facility.

3.6 Research Instruments

A interview will be used which will be first pretested on 5 people in Kauga village to assess its effectiveness and accuracy. The interview will be written in English. The interview will also be interpreted in Luganda for the illiterate respondents.

3.7 Data Collection Procedure

A letter of introduction will be obtained from Public Health Nurses’ College which will be given to the LC 1 chairperson who will be explained to the purpose and objective of the study. The LC 1 chairperson will introduce the researcher to the village health team (VHT) member who will help to introduce the researcher to the respondents. The researcher will explain the purpose and objective of the study to respondents and ask for their informed consent. Every respondent who will fit in the inclusion criteria and is willing to consent will be given a interview to answer and for those who don’t understand English and will be assisted by the research assistant. Every completed interview will be collected per day until the desired number of respondents is reached. The researcher will sample 6 respondents per day for a period of 5 days to make a total of 30 respondents.

3.7.1 Data management

This will include all measures put in place to ensure that quality data is obtained. The management will include data editing before leaving the area of study to ensure that there are no mistakes or areas left blank and if any mistakes are found they will be corrected before leaving the field. The researcher will also code the interview and store them in the file for safety and locked in a place which can only be accessed by the researcher.

3.7.2 Data analysis and presentation

The data will be analysed manually by use of pens and papers to tally thereafter quantitative data will be analyzed statistically and presented in tables, figure and narratives.

3.8 Ethical Consideration

A letter of introduction will be obtained from Kyambogo Public Health Nurses College seeking permission to carry out the study. The letter will be presented to the local council one chairperson who will introduce the researcher to the village health team (VHT)member who will help to introduce the researcher to the respondents.  The study will only commence after the purpose and the objectives of the study have been clearly and well explained to participants. Only those who will be willing to participate in the study will be given interview. Respondents will be assured of confidentiality and privacy.

3.9 Anticipated Limitations of the Study

The researcher might face a challenge of limited cooperation from the respondents. This will be overcome by the researcher explaining the purpose of the study to them.

Also the researcher may face a challenge of some respondents who are not literate. This will be overcome by translating to them the meaning of the questions in the language that they understand.

The research may face limited time to carry out research and other classroom work. This will be overcome by the researcher drawing a work plan which will be strictly followed.

The Researcher may be limited by financial resources such as the transport costs and stationery to carry out her research effectively. In an effort to mitigate this shortcoming, the researcher will source for funds from a few relatives.

3.10 Dissemination of results

The results will be disseminated to:-

• Uganda Nurses and Midwives Examination Board (UNMEB)
• Public Health Nurses College (PHNC)
• LCI chairperson.
• Community of Ntaawo.
• Researcher

CHAPTER FOUR

RESULTS

4.0 Introduction

This chapter provides the analysis of study findings and presentation. The chapter presents the findings which are in line with the set objectives: to assess the personal, socio-economic and health facility related determinants that influence access to routine medical examination among the community of Ntawo ward, Mukono district. A total of 30 questionnaires were distributed to 30 different respondents, all the 30 questionnaires distributed were collected. Therefore the response rate was 100%.

4.1 Socio-demographic characteristics of respondents

This section presents the biographic characteristics of respondents in terms of age, sex, tribe, religion, marital status, education levels and occupation. These bio data points at the respondents’ appropriateness in responding to the study questions required for the study to be complete.

Table 1: Socio-demographic characteristics of respondents

Source: Primary Data

Figure 4.1 indicates that majority of respondents (90%) were in the 25 years and above, 6.7% of them in the age group of 23-.25 years of age, 3.3% of them were in the age group of 20-22 years of age and no respondent was in the age group of 18-19 years of age. This implies that most respondents had experience since they were of an age with responsibilities hence they were relied on to give appropriate information on the study under investigation.

4.1.2 Tribe of respondents

The study also sought to identify the tribe of respondents and it was delighted with different kinds of tribes. The identification of respondent’s tribe gives knowledge on how different tribes perceive the variables under study. The results obtained are presented below;

Figure 4.2: Tribe of respondents

Source: Primary Data

Figure 4.2 above shows that, majority of the respondents (40%) said Muganda, followed by 34% of the study respondents who indicated others, 13% of them said Munyankole, while 10% of the respondents said Musoga and only 3% of them said Mukiga. This shows that Ntaawo ward has people of different tribes as there were also Acholi, Samia, Banyoro, Bagungu and Bagwere. This implies that the study findings had information of people who not only have stayed in Ntaawo ward but also other areas of Uganda, therefore their experiences outside of Ntaawo ward were also captured in the study.

4.1.3 Religion of respondents

The study also sought to identify the religion of respondents and it was delighted with different kinds of religion affiliations. Different tribes have different perceptions towards routine medical examination; therefore these differences were captured in this study. The results obtained are presented below;

Figure 4.3: Religion of respondents

Source: Primary Data

From figure 4.3 above, majority of respondents 09(30%) were Anglicans, 07(23.3%) of the respondents were Muslims, 06(20%) of them were Pentecost while 05(16.7%) were seventh day Adventist and only 10% of the study respondents were Catholics. This shows the majority were Anglicans however, the study got information different religious affiliations since their ideas were also needed.

4.1.4 Highest level of education of respondents

The study also sought to identify the highest level of respondents and it was found out that there were different levels of education attained by study respondents. The results were obtained and are presented below;

Figure 4.4: Highest level of education of respondents

Source: Primary Data

From figure 4.4 above, majority of respondents constituting 70% (21) had reached tertiary/University level, 17% (05) of the respondents had reached secondary level and only 13% (04) were of primary level. This shows that most respondents had acquired a higher level of education however; the study also needed the views of those in the lower levels of education on the determinants of routine medical examination.

4.1.5 Occupation of respondents

The study also sought to identify the occupation of respondents. Occupation of respondents helped to identify how each occupation affects access to routine medical examination. The results were obtained and are presented below;

Figure 4.5: Occupation of respondents

Source: Primary Data

From figure 4.5 above, majority of respondents constituting 33.3% (11) were doing business, 30% (09) of the respondents involved in other economic activities, 23.3% (07) were housewives, 6.7% (02) were civil servants and only 3.3% (01) were farmers. This shows that most respondents were doing something as a source of income therefore this also gave different ideas on how occupation type influences one’s access to routine medical examination.

4.2 Personal determinants

The study sought to identify the personal determinants that influence access to routine medical examination and results were obtained and presented below;

From study findings majority of the respondents 90% (27) had knowledge of routine medical examination. And most of them lamented that routine medical examination is the process by which a medical professional investigates the body of a patient for signs of disease on a routine basis.

Respondents were asked further on whether they had ever gone for routine medical examination and 90% (27) of the respondents indicated that they had ever routine medical examination. Only 10% (03) had not acquired any routine medical examination.

Figure 4.6: How often they access routine medical examination

Source: Primary Data

The study also sought to find out how often they access to routine medical examination and results indicate that; 21 (70%) of the respondents indicated not often, 03 (10%) showed not at all and 06 (20%) of the respondents indicated often. This means that most people do not have access to routine medical examination often which may be attributed to several factors.

Table 4.1: Factors that influence access to medical examination

Source: primary data

From the table above, majority of the respondents 09 (30%) indicated education level, 07 (23.3%) of them indicated attitude, 06 (20%0 of the respondents indicated other factors, 16.7% of the study respondents said culture and only 10% of the respondents said distance. This means that people have different reasons why they do not often have access to routine medical examination as above.

Distance is one of the determinants especially in areas where by health facilities are scarcely distributed. It is irrelevant to have health facility which is well equipped and properly staffed but not accessed due to long walking distance.

Although most respondents lived closer to health facilities only a few access routine examination ; this means there were other factors which hinders apart from distance such as attitude, education level attained, culture and others.

4.3 Socio-economic determinants

The study sought to determinants the socio-economic determinants that influence access to routine medical examination. Results were obtained and are presented below;

Peer groups

Study respondents were asked if they had peer groups and majority of the respondents 18 (60%) said no while the remaining 12 (40%) of the respondents indicated yes. This means that most people do not have peer groups in Ntaawo ward however, a significant percentage indicated yes implying that some people have peer groups.

Those who indicated yes were required to indicate what they talk about with their peer groups concerning medical check up and various answers were given; including the advantages of routine medical examination and how it is vital to human beings however they also discussed about other health issues apart from medical check ups.

From the researcher’s observation, peer groups also contribute to one’s access or use of routine medical examination. Issues discussed in a peer group are vital to one’s wellbeing and can add knowledge and morale to access certain things in life.

Occupation/Job

Study respondents were also required to indicate whether one’s job affects their access to routine medical examination. From findings, majority of the respondents 19(63.3%) indicated yes. Some respondents were quoted saying;

“As I always work throughout the day, I fail to get free time to go for check ups”

“When I am at work, I can not take my family and myself for check ups on a routine basis”.

“Like when I have to work from morning to evening and by the time I finish, its past time. Therefore I fail…… and this happens daily”

Therefore from the above, most people who work are not able to have access to routine medical examination because of the tight schedules they have at work. Some finish their work late and may not be able to go for check ups.

Income

Study respondents were required to identify whether one’s income affects their access to routine medical examination and results show that;

Most respondents 30 (100%) indicated that income influences people to have access to medical examination. House hold financial capacity is one of the major factors in the determination of routine medical examination, and this depends on mother occupation and husband occupation. Wives of husbands with higher status occupations could be more able to access routine medical examination. High status occupations are associated with greater wealth, making it easier for the family to pay costs associated with skilled routine medical examination

Education level

Study findings indicated 28 (93.3%) of the respondents revealed that educated people have access to routine medical examination than uneducated ones. Some respondents were quoted saying;

“Educated people know the importance of routine medical check ups”

“Because they have access to information concerning medical examination”

“Educated people understand that some diseases like cancer show no signs until it’s too late so they opt for routine check ups”

Therefore the above indicates that educated people have access to medical check ups than uneducated ones due to the knowledge they have concerning medical examination.

4.4 Health facility related determinants

The study also sought to determinant the health facility related determinants that influence access to routine medical examination. Results were obtained and are presented below;

Skilled medical workers

Human resources (medical workers) for health is still challenging in Ntaawo ward where by there are few required health workers who are in place. The study has found that 06(16.7%) of respondents who intended to go for routine medical examination they gave up due poor services and unfriendly services at health facility. Shortage of staff discourages respondents to use health facility for routine medical examination.

Medical supplies and equipment

On the other hand, even if competent staff are available, they cannot use their skills without medical supplies and equipment’s.

In Ntaawo ward due to inadequate drugs, Medical equipment and supplies, despite of good policies and efforts, the use of health facility for routine medical examination has not risen.

Distance

Distance is one of the determinants for routine medical examination. It is irrelevant to have health facility which is well equipped and properly staffed but not accessed by the people for routine medical examination due to transport expenses. Those who lived more than 5km from health facility were four times less likely to utilize health facility for routine medical examination compared to those lived within 5KMS.

The preventive effect of distance in accessing routine medical examination at health facility is stronger when combined with lack of transport and poor roads. This study had found that 03(10%) of respondents who did have access to routine medical examination at health facility was due to long distance and lack of transport problem they delivered at home.

REFERENCES

Agency for Healthcare Research and Quality (AHRQ). National healthcare disparities report, 2008. Rockville (MD): U.S. Department of Health and Human Services.

Atkinson M, Clark M, Clay D, et al (2001). Systematic review of ethnicity and health service access for London. Coventry: Centre for Health Services Studies, University of Warwick.

Hertzman, C. (2009). Population Health and Human Development, in Developmental Health and the Wealth of Nations, ed. New York: Guilford Press.

Lantz, P.M. (2008). Socioeconomic Determinants, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of U.S. Adults. Journal of the American Medical Association.

Link, B.G. and Phelan, J. (2010). Social Conditions as Fundamental Causes of Disease. Journal of Health and Social Behavior.

Mare, R.D. (2012). Socio-Economic Careers and Differential Mortality among Older Men in the U.S in Measurement and Analysis of Mortality. Oxford: Clarendon.

Pamuk, J.G (2009), Low use of health services; Impact of women status, traditional beliefs and limited resources.

Ross, C.E. and Mirovsky, J. (2011). “Does Unemployment Affect Health?” Journal of Health and Social Behavior.

Shankwaya, S. (2009). Study to explore barriers to utilization of maternal delivery services in Kazungula district, Zambia.

Winkleby, M.A. (2014). Socioeconomic Status and Health: How Education, Income, and Occupation Contribute to Risk Determinants for Cardiovascular Disease. American Journal of Public Health.

APPENDICES

APPENDIX I: CONSENT FORM

Researcher: Namyalo Agnes

Topic: Determinants of routine medical examination among the community of Ntaawo ward, Mukono Municipality

The purpose of this study is to assess determinants of routine medical examination among the community and the objectives of the study are to assess the personal determinants, socio economic determinants and health facility related determinants influencing access to routine medical examination.

The information you give will be treated with maximum confidentiality and you are assured of privacy.

No names will be included in this research but only numbers. This research is for academic purposes only and no financial benefits will be given.

This research will take you 20 – 30 minutes to complete.

I have clearly explained the purpose and objectives of the study to the respondents and he/she has understood and consented to participate.

Signature: ……………………………… Date: …………………………………

(Researcher)

I have clearly understood the purpose and objectives of the study and voluntarily accept to participate in the study.

Signature: …………………………… Date: …………………………………

(Respondent)

APPENDIX II: BUDGET

APPENDIX III: WORK PLAN

APPENDIX IV

INTERVIEW GUIDE

Topic: determinants of routine medical examination among the community of Ntaawo Ward, Mukono Municipality

Respondent NO.: …………………………

INSTRUCTIONS

1. Answer all questions in this interview guide
2. Don’t mention your name.

SECTION A: SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS

1. Age
2. 18 – 25
3. 26 – 35
4. 36– 45
5. 46 and above
6. Sex
7. Male
8. Female
9. Tribe
10. Muganda
11. Musoga
12. Munyankore
13. Other (Specify)………………………………………………..

4. Religion
5. Catholic
6. Anglican
7. Muslim
8. Pentecostal
9. Seventh Day Adventist
10. Others (specify)………………………………………………….
11. Marital status?
12. Single
13. Married
14. Divorced
15. Widowed
16. Other (specify)…………………………………………………

6. Level of education?
7. Uneducated
8. Primary
9. Secondary
10. Tertiary/University

7. What is your main occupation?
8. Farmer
9. Business
10. Civil servant
11. House wife
12. Other (specify)………………………………………………..

SECTION B: PERSONAL DETERMINANTS OF ROUTINE MEDICAL EXAMINATION

8. Have you ever heard about routine medical examination?
9. No
10. Yes
11. If yes, where did you hear it from?
12. Hospital
13. Media
14. Health worker
15. Peers
16. Family member
17. Others (specify) ………………………………………

10. What is routine medical examination?
11. Is the process by which a medical professional investigates the body of a patient for signs of disease.
12. Is the process by which a medical professional investigates the body of a patient for signs of disease on a routine basis.
13. Is the examination of sick people
14. Is the examination of sick people in the hospital
15. Others specify………………………………………………………………
16. Have you ever gone for routine medication examination?
17. No
18. Yes
19. How often do you go for routine medical examination?
20. Weekly
21. Monthly
22. Every year
23. Others (specify) …………………………………………………………..
24. What encouraged you to go for routine medical examination?
25. Peers
26. Health worker
27. Sensitization
28. Family member
29. Health condition
30. Others (specify) …………………………………………………………….

14. Do you think routine medical examination should be done by everyone?
15. No
16. Yes
17. If yes, why?

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

16. If no, why?

………………………………………………………………………………………

………………………………………………………………………………………

SECTION C: SOCIO – ECONOMIC DETERMINANTS

17. Does your community encourage you to go for routine medical examination?
18. Yes
19. No
20. If yes how?

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

19. If no why?

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20. Do you think your job affects your access to routine medical examination?
21. Yes
22. No
23. If yes how?

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22. Do you think that one’s income affects ones access to routine medical examination?
23. Yes
24. No
25. If yes, how?

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SECTION D: HEALH FACILITY RELATED DETERMINANTS

24. Are the medical workers always available when you visit the hospital for routine medical examination?
25. Yes
26. No
27. If no, what do you do?

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26. Is the health facility equipped to carryout routine medical examination?
27. Yes
28. No
29. If no, how do you deal with it?

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28. How far is your home to the health facility?
29. Below 1km
30. 2km
31. 3-5km
32. Above 5km

29. Does the distance to the health facility hinder you from accessing routine medical examination?
30. Yes
31. No
32. What is the attitude of health workers towards routine medical examination?
33. Positive
34. Negative

THANK YOU FOR YOUR TIME