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

MUKONO DISTRICT

ABSTRACT

There is increasing burden of mortality and morbidity of people in Uganda due to preventable diseases like cancer, diabetes, hypertension, ulcers which can be detected and treated earlier through routine medical examination. Therefore, the study was carried out with the purpose of assessing the determinants of routine medical examination among the community of Ntaawo so that to come up with better recommendations to improve access to routine medical examination. The specific objectives of the study were; to assess the personal, socio-economic and health facility related determinants that influence access to routine medical examination among their community. The study adopted a cross section and descriptive design employing quantitative approach of data collection. Convenience sampling procedure was used to sample 30 respondents who were interviewed to provide data.

According to personal determinants, 90% had ever had about routine medical examination, 70% would ably define routine medical, 76.7% had ever gone for routine medical examination, 56.5% had gone for routine medical examination once a year, 96.7% said that routine medical examination should be done by everyone. Regarding socio-economic determinants, 70% of the respondents’ communities encouraged routine medical examination and 52.4% of the communities did so through sensitization, 53.3% of the respondents said their jobs affected access to routine medical examination and 43.8% said salaries weren’t enough to cater for medical bills and 76.9% said higher income enables one clear medical associated costs. According to health facility related determinants, 90% of the respondents said that medical workers were available at the hospital, 90% said health facilities were very equipped to carry out routine medical examination, 60% of the respondents lived one kilometer and below to the health facility and 90% said health workers had good attitude towards routine medical examination.

In conclusion, socio-economic determinants affect routine medical examination more compared to personal determinants and health related determinants. Therefore, employers should time to employees to attend routine medical examination and community should improve on their sensitization skills on routine medical examination.

COPYRIGHT

Copyright © (2017) by (Namyalo Agnes)

AUTHORIZATION

            RULES GOVERNING USE OF STUDENT’S WRITTEN WORK FROM PUBLIC HEALTH NURSES’ COLLEGE, KYAMBOGO

Unpublished research report submitted to the PHNC and deposited in the Library, are open for inspection, but are to be used with due regard to the rights of the authors. The author and the School of Nursing grant privilege of loan or purchase of microfilm or photocopy to accredited borrowers provided credit is given in subsequent written or published work.

Author’s Signature: ………………………               Date: ……………………………

Namyalo Agnes

Mukono

Supervisor’s Signature: ………………………         Date: ……………………………

Mrs. Milly Bulwa

Public Health Nurses’ College, Kyambogo

Principal’s Signature: ………………………            Date: ……………………………

Mrs. Kasujja Lwanga Getrude

Public Health Nurses’ College, Kyambogo

DECLARATION

I, Namyalo Agnes declare that this research report is my original work except where citations have been made and have been fully acknowledged. This work has never been presented for any award in any institution of higher learning.

Signature……………………………        Date…………………………………

Namyalo Agnes

(Researcher)     

DEDICATION

I dedicate this research to Mr. Mayengo’s family and Mr. Kiwanuka’s family for all the love, care, patience and sacrifice they have offered to me through my education. I also dedicate to my daughter, Madrine for the patience and endurance during my entire studies.

ACKNOWLEDGEMENTS

I wish to sincerely thank the Almighty God for the knowledge he empowered me with from the beginning of this work to the very end.

Also, my academic supervisor Mrs. Milly Bulwa who has been working hand in hand with me to see that this research becomes a success through interactions and discussions that were fruitful and produced good ideas.

I thank the administration of PHNC who have provided with the necessary guide for compiling this report.

I also dedicate the same work to all the family members for their care, love they gave me throughout the whole of my course financially and spiritually.

I would also like to thank the residents of Ntaawo ward, who provided me with the necessary information for this study

Lastly, I would like to appreciate my friends and fellow students whom I have always approached for help and guidance.

TABLE OF CONTENTS

DECLARATION.. iii

ABSTRACT.. i

COPYRIGHT.. ii

AUTHORIZATION.. iii

DEDICATION.. iv

ACKNOWLEDGEMENTS. v

TABLE OF CONTENTS. vi

LIST OF FIGURES. ix

LIST OF TABLES. x

DEFINITION OF TERMS. xii

ABBREVIATIONS/ACRONYMS. xiii

CHAPTER ONE: INTRODUCTION.. 1

1.1 Background of the study. 1

1.2 Problem Statement 3

1.3 Purpose of the study. 3

1.4 Specific objectives. 4

1.5 Research questions. 4

1.6 Justification for the study. 4

CHAPTER TWO: LITERATURE REVIEW… 6

2.1 Introduction. 6

2.2 Personal determinants that influence routine medical examination. 6

2.3 Socio-economic determinants that influence routine medical examination. 8

2.4 Health facility related determinants that influence routine medical examination. 9

CHAPTER THREE: METHODOLOGY.. 12

3.1 Introduction. 12

3.2 Study Design and rationale. 12

3.3 Study setting and rationale. 12

3.4 Study Population. 13

3.4.1 Sample Size Determination. 13

3.4.2 Sampling procedure. 13

3.4.3 Inclusion criteria. 13

3.4.4 Exclusion Criteria. 13

3.5 Definition of variables. 14

3.6 Research Instruments. 14

3.7 Data Collection Procedure. 14

3.7.1 Data management 15

3.7.2 Data analysis and presentation. 15

3.8 Ethical Consideration. 15

3.9 Limitations of the Study. 16

3.10 Dissemination of results. 16

CHAPTER FOUR: RESULTS. 18

4.1 Introduction. 18

4.2 Socio-demographic characteristics of respondents. 18

4.3 Socio-economic determinants that influence access to routine medical examination. 25

4.4 Health facility related determinants. 29

CHAPTER FIVE: DISCUSSION, CONCLUSION, RECOMMENDATION AND IMPLICATION    33

5.1 Introduction. 33

5.2 Discussion of the study findings. 33

5.2.1 Socio-demographic characteristics of respondents. 33

5.2.2 Personal determinants of routine medical examination. 34

5.2.3 Socio-economic determinants of routine medical examination. 37

5.1.4 Health related facility determinants of routine medical examination. 39

5.3 Conclusion. 41

5.4 Summary. 42

5.3 Recommendation. 42

5.4 Implications to Nursing Practice. 43

REFERENCES. 44

APPENDICES. 47

APPENDIX I: CONSENT FORM… 47

APPENDIX II: INTERVIEW GUIDE.. 48

APPENDIX III: INTRODUCTORY LETTER.. 54

APPENDIX IV: MAP OF UGANDA SHOWING MUKONO.. 55

APPENDIX V: MAP OF MUKONO SHOWING NTAAWO.. 56

LIST OF FIGURES

Figure 1: Showing occupation of respondents. 19

Figure 2: Shows how often respondents go for routine medical examination. 22

Figure 3: Shows whether respondents thought routine medical examination should be done by everyone  23

Figure 4: Shows response on whether the community encouraged people to go for routine medical examination. 25

Figure 5: Shows response on why the community doesn’t encourage people to go for routine medical examination. 26

Figure 6: Shows response on whether income affects one’s access to routine medical examination) 28

Figure 7: Shows whether the health facility is equipped to carry out routine medical examination  30

Figure 8: Shows distance of the health facility from the respondent’s home. 31

Figure 9: Shows the attitude of health workers towards routine medical examination. 32

LIST OF TABLES

Table 1: Socio-demographic characteristics of respondents. 18

Table 2. If respondents heard about routine medical examination. 20

Table 3: Shows where respondents heard about routine medical examination. 20

Table 4: Shows response on what routine medical examination is. 21

Table 5: Shows whether respondents had ever gone for routine medical examination. 22

Table 6: Shows what encouraged respondents to go for routine medical examination. 23

Table 7: Shows why routine medical examination should be done by everyone. 24

Table 8: Shows response on why routine medical examination should not be done by everyone  24

Table 9: Shows how the community encouraged people to go for routine medical examination  25

Table 10: Shows if job affects respondents’ access to routine medical examination. 27

Table 11: Shows response on how job affects respondents’ access to routine medical examination  27

Table 12: Shows response on how income affects one’s access to routine medical examination  28

Table 13: Shows whether medical workers are always available when one visits the hospital 29

Table 14: Shows response on what respondents did when they failed to see the medical workers when they visited the health facility. 29

Table 15: Shows response on how respondents dealt with lack of equipments in the health facility  30

Table 16: Shows response on whether the distance between the health facility and the community affect accessibility to routine medical examination. 31

DEFINITION OF TERMS

Routine medical examinations is the process of medical screening on asymptomatic patients performed by either a pediatrician, family practice physician, physician assistant, a certified nurse practitioner or other primary care provider.

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.

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

Social Economic determinants: this refers to how economic 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.

ABBREVIATIONS/ACRONYMS

HEENT:         Head, Eye, Ear, Nose and Throat

HIV:               Human Immune deficiency Virus

LC:                 Local council

MoH:              Ministry of Health

PHAC:           Public Health Agency of Canada

RCT:              Routine Counseling and Testing

RME:             Routine Medical Examination

UBOS             Uganda Bureau of Statistics

UDHS:            Uganda Demographic and Health Survey

UNFPA:         United Nations Family Planning Association

UNMEB:        Uganda Nurses and Midwives Examination Board

USA                United States of America

USPSTF:        US Preventive Services Task Force Guidelines

VHT:              Village Health Team

WHO:             World Health Organisation

CHAPTER ONE

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).

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 (e.g. cardiovascular disease, stroke, hypertension, and heart failure) experienced by these communities. Thus, the study sought to assess the determinants of routine medical examination among the community in Ntaawo ward Mukono central division.

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 which is utilized by Ntaawo community for medical services, 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 (Mukono Church of Uganda Record, 2017). This clearly reveals that low number of patients seek for routine medical examination.

Uptake of routine medical examination 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 and treated earlier through routine medical examination. Thus, the researcher took interest to assess the determinants of routine medical examination among the community of Ntaawo.

1.3 Purpose of the study

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

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

1.5 Research questions

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

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

1.6 Justification for the study

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

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

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

To the researcher, the research findings would help attain a diploma in midwifery of UNMEB since it’s a requirement. This would be ensured 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 was 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 a study by Hannah, (2012) on the factors affecting access to healthcare services by intermarried Filipino women in rural Tasmania, it was found out that cultural beliefs and practices hindered participants’ access to routine medical examinations, particularly those from rural areas. They find it hard to adopt the new health practices. For instance, it was mentioned that ‘their practices have been part of their lives since birth’. Thus, accepting and adopting new health practices affects their accustomed ways of maintaining health and wellbeing, as well as accessing the new health services.

According to a study by Magoma et al., (2010), on the high antenatal care coverage and low skilled attendance in a rural Tanzanian district, it was established that increasing knowledge and awareness of the determinants influencing access to antenatal 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 in Tanzania. Therefore, increased awareness and knowledge about health issues influences the access to routine medical examination.

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.

According to Kinney et al., (2010), 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.

Fiscella, Franks & Clancy (2008), 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.

A longitudinal study carried out by Green & Pope (2009) on social factors and the use of medical services, the study found out that more than ninety percent of women attending antennal clinic but less than half of them frequently did routine medical examination in health facility. The study also found out that a higher number of respondents had a positive attitude towards medical examination implying that majority of them went for routine medical examination.

In a study done by Adler & Newman, (2012), in Uganda on Low use of rural maternity services in Uganda, the study revealed that 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 largely depends on personal experience with health system.

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 Fiscella, Franks & Clancy (2008), 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)

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 Fiscella, Franks & Clancy (2008), 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 was 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 was cross sectional and descriptive in design, employing quantitative data collection method. It was a cross sectional type of design because a number of variables like age, gender, religion, and education was assessed. The study design was chosen because it helped to study various determinants.

3.3 Study setting and rationale

The study was conducted in Ntaawo ward Mukono central division. Mukono Central division 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, Ntaawo’s population is 14957 (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 was chosen because most people didn’t turn up for RME.

3.4 Study Population

The study targeted men and women who lived in Ntaawo and are above 18years.

3.4.1 Sample Size Determination

The study involved 30 respondents. The researcher chose only 30 respondents because they were representative enough of the study population and because of the limited finances and time.

3.4.2 Sampling procedure

Convenience sampling was employed where respondents was sampled from their homes until the required sample size was obtained.

3.4.3 Inclusion criteria

The study included men and women who were 18years and above living in Ntaawo village and who consented to participate in the study

3.4.4 Exclusion Criteria

The study excluded men and women below 18years and were not living in Ntaawo village and those who failed to consent.

3.5 Definition of variables

Variables were the characteristics of a respondent the researcher wished to explore or study.

Independent variables

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

Dependent variable

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

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

Social Economic determinants: this refers factors that influence how a particular group acts within society including their actions as consumers.

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

3.6 Research Instruments

An interview was used which was first pretested on 5 people in Kauga village to assess its effectiveness and accuracy. The interview was written in English. The interview was also interpreted in Luganda for the illiterate respondents. It had closed and open ended questions.

3.7 Data Collection Procedure

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

3.7.1 Data management

This included all measures put in place to ensure that quality data was obtained. The management included data editing before leaving the area of study to ensure that there were no mistakes or areas left blank and if any mistakes were found they were corrected before leaving the field. The researcher also coded the interview and stored them in the file for safety and locked in a place which could only be accessed by the researcher.

3.7.2 Data analysis and presentation

The data was analysed manually by use of pens and papers to tally thereafter quantitative data was analyzed statistically and presented in tables, figure and narratives inform of percentages and frequencies.

3.8 Ethical Consideration

A letter of introduction was obtained from Kyambogo Public Health Nurses College seeking permission to carry out the study. The letter was presented to the local council one chairperson who introduced the researcher to the village health team (VHT) member who helped to introduce the researcher to the respondents.  The study only commenced after the purpose and the objectives of the study had been clearly and well explained to participants. Only those who were willing to participate in the study were interviewed. Respondents were assured of confidentiality and privacy.

3.9 Limitations of the Study

The researcher faced a challenge of limited cooperation from the respondents. This was overcome by the researcher explaining the purpose of the study to them and the benefits of the study to the community.

Also the researcher faced a challenge of some respondents who were not literate. This was overcome by translating to them the meaning of the questions in the language that they understand.

The research faced a challenge of limited time to carry out research and other classroom work. This was overcome by the researcher drawing a work plan which was strictly followed.

The Researcher was 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 sourced for funds from a few relatives.

3.10 Dissemination of results

The results were disseminated to:-

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

CHAPTER FOUR

RESULTS

4.1 Introduction

This chapter provides the results that were obtained from data analysis and are presented in figures and tables in form of frequencies and percentages. Data was collected from a sample of 30 respondents by means of an interview guide. The results presentation was based on the study objectives

4.2 Socio-demographic characteristics of respondents

Table 1: Socio-demographic characteristics of respondents

According to age, majority of respondents 12/30 (40%) were aged 36-45 years and the minority of the respondents were 4/30 (13.3%) 18-25years.

Regarding sex, majority of respondents 23/30 (76.7%) were female and the minority 07 (23.3%) of the respondents were male.

For tribe, most of the respondents 12/30 (40%) were and the least 3/30 (10%) of the respondents were Musoga.

Religion, Highest number of respondents 09/30 (30%) were Anglicans and the lowest number 3/30 (10%) of the respondents were Catholics.

Regarding education, most of the respondents 70% (21/30) had reached tertiary/University level and none of the respondents had never gone to school.

Figure 1: Showing occupation of respondents                                           (n =30)

From figure 1 above, majority 10 (33.3%) of respondents were business persons and the minority 01 (3.3%) was a farmer.

4.3 Personal determinants influencing access to Routine medical examination

Table 2. If respondents heard about routine medical examination

From Table 2, majority of the respondents 27/30 (90%) had ever heard of routine medical examination while 3/30 (10%) mentioned no.

Table 3: Shows where respondents heard about routine medical examination

From table 3 above, highest number 14/27 (51.9%) of the respondents heard about RME from health workers and the lowest number 03/27 (11.1%) of the respondents heard RME from media.

Table 4: Shows response on what routine medical examination is

From table 4 above, a greater number 21/30 (70%) of respondents mentioned that is the process by which a medical professional investigates the body of a patient for signs of disease on a routine basis and the least number 02/30 (6.7%) of the respondents revealed is the process by which a medical professional investigates the body of a patient for signs of disease.

Table 5: Shows whether respondents had ever gone for routine medical examination

From table 5 above, most respondents 23/30 (76.7%) mentioned that they had ever gone for routine medical examination and the least number 7/30 (23.3%) had never gone for routine medical examination.

Figure 2: Shows how often respondents go for routine medical examination

(n =23)

Results in figure 2 above indicate that; most respondents 13/23 (56.5%) of the respondents indicated once in a year and the least 02 (8.7%) of the respondents indicated monthly.

Table 6: Shows what encouraged respondents to go for routine medical examination

From the table 6 above, highest number 12 (52.2%) of respondents indicated health condition, and the lowest number 01 (4.3%) of the respondents said community sensitization.

Figure 3: Shows whether respondents thought routine medical examination should be done by everyone                                                                                    (n = 30)

From figure 3 above, majority 29/30 (96.7%) of respondents thought routine medical examination should be done by everyone and the minority 1/30 (3.3%) thought that routine medical examination should not be done by everyone.

Table 7: Shows why routine medical examination should be done by everyone

Results in table 7 above; most respondents 13/29 (44.8%) indicated that everyone should go for routine medical examination to get early treatment and the least number 07/30 (24.1%) of the respondents mentioned to stay healthy.

Table 8: Shows response on why routine medical examination should not be done by everyone

From table 8 above, 1/1 (100%) of respondents mentioned some people cannot afford routine medical examination.

4.3 Socio-economic determinants that influence access to routine medical examination

Figure 4: Shows response on whether the community encouraged people to go for routine medical examination                                                               n = 30

From figure 4 above, majority 21/30 (70%) of respondents mentioned that the community encouraged people to go for routine medical examination and the minority 9/30 (30%) of the respondents said the community doesn’t encourage people to go for routine medical examination no.

Table 9: Shows how the community encouraged people to go for routine medical examination

Results in table 9 above, the highest number 11/21 (52.4%) of respondents said that the community encouraged people to go for routine medical examination through sensitization and the lowest number 92/21 (9.5%) revealed through village meetings.

Figure 5: Shows response on why the community doesn’t encourage people to go for routine medical examination                                                               (n = 9)

Figure 5 above indicate that, most respondents 6/9 (66.7%) said that the community doesn’t encourage people to go for routine medical examination due to less resources and the least number 3/9 (33.3%) of the respondents said less efforts by the ministry.

Table 10: Shows if job affects respondents’ access to routine medical examination

From table 10, a greater number 16/30 (53.3%) of the respondents indicated that job affected their access to routine medical examination and the least number 14/30 (46.7%) of the respondents said job does not affects their access to routine medical examination.

Table 11: Shows response on how job affects respondents’ access to routine medical examination

Results in table 11 above indicate that, majority 7/16 (43.8%) of the respondents said that their salary is not enough to cater for routine medical bills and the minority 04 (25%) of the respondents indicated tight work schedules affect their access to routine medical examination.

Figure 6: Shows response on whether income affects one’s access to routine medical examination                                                                                        (n = 30)

From figure 6 above, most respondents 26/30 (86.7%) said that income affects their access to routine medical examination and the least number 4/30 (13.3%) of respondents said that income doesn’t affect their access to routine medical examination.

Table 12: Shows response on how income affects one’s access to routine medical examination

Results table 12 above indicate that, majority 20/26 (76.9%) of respondents said that higher income enables one to clear associated costs and the minority 6/23.1 (13.3%) revealed that low incomes limits one’s expenditure.

4.4 Health facility related determinants

Table 13: Shows whether medical workers are always available when one visits the hospital

From table 13 above, a greater number 27/30 (90%) of respondents indicated that medical workers were always available when they visited the hospital and lower number 3/30 (10%) of respondents said that indicated medical workers were not available when they visited the hospital.

Table 14: Shows response on what respondents did when they failed to see the medical workers when they visited the health facility

Results in table 14 above indicate that, most 02/03 (66.7%) of the respondents said try another nearby health facility and the least 01/03 (33.3%) said wait for the health worker.

Figure 7: Shows whether the health facility is equipped to carry out routine medical examination                                                                                       n=30

From table 7 above, a greater number 27/30 (90%) of respondents mentioned that the health facility is equipped to carry out routine medical examination and the least number 3/30 (10%) said the health facility is not equipped to carry out routine medical examination.

Table 15: Shows response on how respondents dealt with lack of equipments in the health facility

Results in table 15 above indicate that, the highest number 02/03 (66.7%) of respondents said that they went to another health facility and the lowest number 01/03 (33.3) said that they went back home.

Figure 8: Shows distance of the health facility from the respondent’s home

                                                                                                            (n=30)

Findings in figure 8 above indicate that, majority 18/30 (60%) of the respondents stayed below 1km from the health facility and none of the respondent stayed above 5km from the health facility.

Table 16: Shows response on whether the distance between the health facility and the community affect accessibility to routine medical examination

From table 16 above, most respondents 24/30 (80%) said that the distance between the health facility and the community does not affect their accessibility to routine medical examination and few respondents 6/30 (20%) indicated that the distance between the health facility and the community affects their accessibility.

Figure 9: Shows the attitude of health workers towards routine medical examination

(n = 30)

From figure 9 above, majority 27/30 (90%) of respondents said that health workers had a positive attitude towards routine medical examination and the minority 3/30 (10%) of the respondents reported negative attitude.

CHAPTER FIVE

DISCUSSION, CONCLUSION, RECOMMENDATION AND IMPLICATION

5.1 Introduction

This chapter contains discussion of the study findings, conclusions, recommendations and suggestions for further studies. The discussion of the study findings, conclusions and recommendations were done in accordance with the study objectives as follows.

5.2 Discussion of the study findings

5.2.1 Socio-demographic characteristics of respondents

According to age, majority of respondents 12/30 (40%) were aged 36-45 years and the minority of the respondents were 4/30 (13.3%) 18-25years. This implied that the highest number of respondents provided required information basing on experience. Regarding sex, majority of respondents 23/30 (76.7%) were female and the minority 07 (23.3%) of the respondents were male. This implied that female participated more than men because they were available. For tribe, most of the respondents 12/30 (40%) were Baganda and the least 3/30 (10%) of the respondents were Basoga. This implied that most views were got from Baganda since the study was carried out in central region. Religion, highest number of respondents 09/30 (30%) were Anglicans and the lowest number 3/30 (10%) of the respondents were Catholics. This implied that Ntaawo is dominated by Anglicans. Regarding education, most of the respondents 70% (21/30) had reached tertiary/University level and none of the respondents had never gone to school. This implied that most respondents were educated and had access to information concerning RME. From figure 1 above, majority 10 (33.3%) of respondents were business persons and the minority 01 (3.3%) was a farmer. This implied that business persons were easily accessible because Ntaawo was mainly having many people dealing in business and were willing to provide information.

5.2.2 Personal determinants of routine medical examination

From Table 2, majority of the respondents 27/30 (90%) had ever heard about routine medical examination. This implied that most respondents had acquired information about routine medical examination and hence would access the services. This was in line with (Magoma et al., 2010) who established that increasing knowledge and awareness of the determinants influencing access to antenatal 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 in Tanzania.

Study findings in Table 3, majority 14/27 (51.9%) of the respondents had ever heard about routine medical examination from health workers. This implied that health workers were doing a great work to inform people about routine medical examination. This finding concurred with (Peiris, Brown, and Cass, 2008) who wrote that when care providers promote trust, reciprocity, effective communication, and shared decision-making with Aboriginal patients, they can promote awareness of the available health services.

From table 4 in chapter four, majority of respondents 21/30 (100%) knew routine medical examination as the process by which a medical professional investigates the body of a patient for signs of disease on a routine basis. Therefore respondents had knowledge of what routine medical examination was; therefore information was got from people who were aware of the study under investigation. This finding was in line with (Krogsboll et al., 2012) defined routine medical examination as the process by which a medical professional investigates the body of a patient for signs of disease on a routine basis.

Study findings in table 5, respondents were asked further on whether they had ever gone for routine medical examination and majority 23/30 (76.7%) of respondents had ever gone routine medical examination. This implied that respondents were aware of routine medical examination and were practicing it.

Results in figure 2, the study also sought to find out how often they access to routine medical examination and results indicated that; most 13/23 (56.5%) of the respondents indicated once in a year.  This implied that most people did not have access to routine medical examination often. This disagreed with Hannah and Le (2012) whose study in Australia showed that most people went for medical check ups on a routine basis whether they had a severe problem or not.

Study findings from table 6, the highest number 12 (40%) of respondents indicated that their health condition encouraged them to go for routine medical examination. This implied that people go for routine medical examination as a result of the health condition that they are in. Similar findings have been found by the study done in Botswana on the factors associated with non-use of health services in which people use less of health services when they are well off (Letamo, et al 2003).

From figure 3 in chapter four revealed that, majority 29/30 (96.7%) of respondents thought routine medical examination should be done by everyone. This implied that respondents were aware of the benefits one gets from going for routine medical examination. This study finding agrees with (Yanagisawa et al 2006) in Cambodia who found that antenatal care was a positive determinant of facility delivery only for women who attended the service four times or more. This might be due to the fact that during antenatal clinic visits, especially if started early, women are provided with health education and information about the benefits of delivering in health facility.

Results in table 7 indicated that, most respondents 13/29 (44.8%) said that everyone should go for routine medical examination because it would enable them to get early treatment.  This implied that respondents were aware of the benefits of routine medical examination as certain conditions would be diagnosed and treated earlier. This finding concurs with that of (Verghese, 2011) who stated that routine medical examinations is 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.

Results from table 8 indicated that, 1/1 (100%) of respondents said that some people cannot afford routine medical examination. This implied that routine medical examination is expensive and may not be affordable to everyone. This study finding is in agreement with (Gabrysch & Campbell 2009) who stated that financial capacity is one of the major factors in the determinants of health, and this depends on one’s occupation. People with higher status occupations could be more able to use facilities. High status occupations are associated with greater wealth, making it easier for the family to pay costs associated with skilled delivery care.

5.2.3 Socio-economic determinants of routine medical examination

Findings in figure 4, revealed that majority 21/30 (70%) of respondents mentioned that the community encouraged people to go for routine medical examination. This implied that the community is a major player in encouraging people to go for routine medical examination. Study finding is in agreement with (Kinney et al., 2010) who  argued that early booking of antenatal care clinic and completion of more than four visits need to be promoted at community level as those attending antenatal clinic early acquire enough information about safe delivery.

Results in table 9 in chapter four indicated that, the highest number 11/21 (52.4%) of respondents said that the community encouraged people to go for routine medical examination through sensitization. This implied that the community of Ntaawo ward has been sensitized on health issues. This finding concurs with (Kyomuhendo, 2003) who stated that continuous community sensitization about health services would increase the number of pregnant mother for antenatal care so as to hit the national target.

From figure 5 in chapter four, results indicated that, most respondents 6/9 (66.7%) said that the community doesn’t encourage people to go for routine medical examination due to less resources. This implied that the Ministry of Health has not allocated enough funds to cater for community sensitization on health issues. This study finding agree with (Letamo et al., 2003) who argued that allocation of more funds by the government to communities can help improve the health status of many communities and this includes constructing more health facilities.

From table 10 in chapter four, a greater number 16/30 (53.3%) of respondents said that jobs affected their access to routine medical examination. This implied that most people who work have low access to routine medical examination.

Findings in table 11 indicated that majority 7/16 (43.8%) of respondents said that people who work may have low access to routine medical examination because their salary is not enough to cater for routine medical bills. This implied that most people with jobs also may not go for routine medical examination because of financial limitations, tight schedules they have at work. This finding contradicts with PHAC (2011) who stated that women who are working and earning money may be able to save and decide to spend it on a health issues. And non-working women are less likely to have routine examination than women in other occupations. This may be due to limited financial resources and health services in such areas.

The study findings in figure 6, revealed that most respondents 26/30 (86.7%) said that income affects one’s access to routine medical examination. This implied that income influences people to have access to medical examination. This agrees with UDHS (2011) whose study showed that women in the lowest wealth quintile have no access to routine medical examination as those in the highest wealth quintile.

Results table 12 in chapter indicated that, majority 20/26 (76.9%) of respondents said that higher income enables one to clear associated medical costs. This implied that income affects people access to routine medical examination. This agrees with (Rose, 2011) whose study showed that financial capacity is one of the major factors in the determination of routine medical examination, and this depends on one’s occupation. High status occupations are associated with greater wealth, making it easier for the family to pay costs associated with skilled routine medical examination.

5.1.4 Health related facility determinants of routine medical examination

Study findings in table 13, indicated that 27/30 (90%) of respondents emphasized that the medical workers are available when one visits the hospital for routine medical examination. This implied that there are many required health workers who are in place. This finding however does not agree with (Shankwaya, 2008) who argued that 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.

Results in table 14 indicated that, most respondents 02/03 (66.7%) said that when they failed to see the medical workers, they tried another nearby health facility. This implied that shortage of staff discouraged people to use health facility for routine medical examination. This agrees with (Yanagisawa et al., 2006) who in his study in Cambodia, found that health workers tend to unnecessary refer pregnant mother to higher level because they don’t know how to use partogram which monitor the progress of labour and the woman end up delivering normally.

Furthermore, results in figure 7 in chapter four revealed that 27/30 (90%) of respondents said that the health facility is equipped to carry out routine medical examination. This implied that many health facilities are equipped to carry out routine medical examination. This finding is in line with (Pamuk, 2009) whose study found out that an equipped health facility encourages people to go health services.

Results in table 15 above indicated that the highest number 02/03 (66.7%) of respondents said that they dealt with lack of equipments in the health facility by trying another health facility. This implied that people always use other health facilities when they don’t find the necessary equipments. This finding agrees with (Shankwaya, 2008) whose study found out that available competent staffs cannot use their skills without medical supplies and equipment’s.

Study results indicated in figure 8 that, majority 18/30 (60%) of the respondents mentioned that they stayed below 1km from the health facility. This implied that 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 1km. This finding concurs with Shankwaya (2008) who noted that the use of health services decline with distance

Findings in table 16 revealed that, most respondents 24/30 said that the distance between the health facility and the community does not affect their accessibility to routine medical examination. This implied that most people have access to routine medical examination due to near proximity to health facilities. Only a few do not have access to routine medical examination as a result of long distance. 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 finding concurs with Atkinson et al (2001) who argues that the location of health services in developing countries may result in poor access to routine medical examination.

From figure 9 in chapter four, majority 27/30 (90%) of respondents said that health workers had a positive attitude towards routine medical examination. This implied that most people are encouraged and find routine medical examination easy; therefore can easily use it. These findings are in line with Lantz (2008) who argued that behavior and attitudes towards routine medical examination are also determinant factors to access routine medical examination. Negative attitudes prevent the people from accessing routine medical examination however positives attitudes attract people to access routine medical examination.

5.3 Conclusion

From analysis of the results, the study concluded that;

The personal determinants that influence access to routine medical examination include knowledge and awareness and sensitization.

The socio-economic determinants that influence access to routine medical examination include income levels and occupation

The health facility related determinants include availability of medical workers, medical equipments and supplies, distance and attitude.

5.4 Summary

Most respondents (90%) were educated about RME through sensitization however only 76.7% had ever gone for routine medical examination.

The highest number of respondents (86.7%) were affected by their income levels and jobs (53.3%) which influenced their access to RME.

Majority of respondents (90%) were influenced by availability of medical workers and their attitude towards RME.

5.3 Recommendation

5.3.1 To the Ministry of health/government

The Ministry of health should allocate more funds on health issues so that all procedures are performed in each facility to improve access to routine medical examination.

The government should improve infrastructure in the region to expand access to routine medical examination and broaden the scope of routine medical examination to residents. Increasing bandwidth in the region will serve as a viable solution to improving access to routine medical examination in Ntaawo ward.

The local government should improve health education among residents of Ntaawo especially routine medical examination. This would increase knowledge about routine medical examination and in the end improve access to routine medical examination.

5.3.2 To the health worker

Health workers should encourage workshops and seminars to educate people on routine medical examination.

5.3.3 To the respondents

Respondents should attend seminars on health issues.

5.4 Implications to Nursing Practice

• Nurses should advocate for lowering the charges of routine medical examination.
• They should also improve on health education

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.

Duong.V.D, Binns. C.W, Lee. H.A & Hipgrave. B.D (2004), Measuring client perceived quality of maternity services in rural Vietnam. International Journal for Quality in Health Care; Volume 16, Number 6: pp. 447–452

Ensor & Cooper, (2004); overcoming barriers to health service access: influencing the demand side

Guadalajaram, I.O. (2011). Utilization of Health Care Services by Pregnant Mothers during Delivery: A community based study in Nigeria

Hannah, C.T, Lê Q (2012). Factors affecting access to healthcare services by intermarried Filipino women in rural Tasmania: a qualitative study. University Department of Rural Health, University of Tasmania, Launceston, Tasmania, Australia

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

Kinney MV, Kerber KJ, Black RE, Cohen B, Nkrumah F, et al. (2010) Sub-Saharan Africa’s Mothers, Newborns, and Children: Where and Why Do They Die?

Krogsboll, G., Urassa E, Lindmark G, Nystrom L (2010). Determinants of utilization of delivery services by pregnant women in Rwanda

Kyomuhendo G (2003), Low use of rural maternity services in Uganda; Impact of women status, traditional beliefs and limited resources

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.

Letamo, G., DeAllegri, M., Riddeb, V., Valérie, R., MalabikaSarkera, L, Tiendrebéogoc, J, et al, (2003), Determinants of utilization of maternal care services after the reduction of user fees: A case study from rural Botswana.

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

Magoma, M., Requejo, J., Oona M.R, Simon, C, and Filippi,V ,(2010). High ANC coverage and low skilled attendance in a rural Tanzanian district: a case for implementing a birth plan intervention.

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.

Peiris, D., Brown, A., & Cass, A. (2008). Addressing inequities in access to quality health care for indigenous people. Canadian Medical Association Journal, 179(10), 985-986.

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.

Verghese, B.B. (2011) Socioeconomic and physical distance to the maternity hospital as predictors for place of delivery: an observation study from Nepal. BMC Pregnancy and Childbirth 4, 8.

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.

Yanagisawa et al (2006); Determinants of skilled birth attendance in rural Cambodia

APPENDICES

APPENDIX I: CONSENT FORM

Researcher: Namyalo Agnes

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

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

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. School
13. Media
14. Health worker
15. 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?

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

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

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

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

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

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?

………………………………………………………………………………………

………………………………………………………………………………………

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

………………………………………………………………………………………

………………………………………………………………………………………

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

APPENDIX III: INTRODUCTORY LETTER

APPENDIX IV: MAP OF UGANDA SHOWING MUKONO

APPENDIX V: MAP OF MUKONO SHOWING NTAAWO