DETERMINANTS OF ROUTINE MEDICAL EXAMINATION AMONG THE COMMUNITY OF NTAAWO VILLAGE, MUKONO DISTRICT
INTRODUCTION
This chapter presents the background of the study, problem statement, purpose of the study, specific objectives, research questions and justification 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 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 lab tests. Four actions are taught as the basis of medical examination: inspection, palpation (feel), percussion (tap to determine resonance characteristics), and auscultation (Guadalajara, 2015).
Routine medical examinations have historically served as the primary venue for promoting health care system engagement, early disease detection and management, and preventive screening among asymptomatic adults. Lack of consensus and debates are causing tensions between public expectations, physician support, and US Preventive Services Task Force Guidelines (USPSTF), which are less definitive about the general necessity of routine health examinations than they are about the key role these periodic visits play in the timely receipt of clinically recommended screenings (Ross, 2011).
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 factors 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 factors 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
In Mukono Church of Uganda hospital, 1261 people came for health services in the month of January 2017, 1113 came for other conditions and only 148 patients came for routine medical examinations (20 were diagnosed with hypertension, 9 – diabetes, 1 – renal disease, 60 – malaria, 58 came for voluntary testing of HIV and only 3 were diagnosed HIV positive) . This shows that few people come for routine medical examination and Ntaawo being a village in Mukono contributes to this great problem. Thus, the research 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.
1.4 Specific objectives
- To assess the personal factors that influence access to routine medical examination among the community of Ntaawo ward, Mukono municipality.
- To assess the socio-economic factors that influence access to routine medical examination among the community of Ntaawo ward, Mukono municipality.
- To assess the health facility related factors that influence access to routine medical examination among the community of Ntaawo ward, Mukono municipality.
1.5 Research questions
- What personal factors influence access to routine medical examination among the community of Ntaawo ward Mukono municipality?
- What socio-economic factors influence access to routine medical examination among the community of Ntaawo ward Mukono municipality?
- What health facility related factors 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. This will be done by holding a session with them which will take 30 mins.
To local leaders, the findings will form a basis upon which appropriate interventions can be devised to improve access to routine medical examination. This will be ensured by the researcher giving a report copy to the local leaders.
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 health workers, the study will enable them realise the factors that affect people in accessing routine medical examination
CHAPTER TWO
This chapter presents literature related to teenage pregnancy that other researchers have reviewed which is in line with personal factors and socio economic factors influencing teenage pregnancy.
2.2 Factors that influence routine medical examination
It has been 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. Although both the wives’ and husbands’ education is important there appears to be a consensus that the former is more important than the latter (Winklebly, 2018).
Use of medical examination is higher in urban than rural areas. Urban-rural difference in the adoption of contraception is the highest in Sub Saharan Africa, where the rate is more than twice as high as among urban than among rural in all surveyed countries.
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.
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 use 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 (Deaton, 2009).
Education shapes future occupational opportunities and earning potential. It also provides knowledge and life skills that allow better-educated persons to gain more ready access to information and resources to promote health. Marilyn Winkleby and colleagues examined how education, income, and occupation relate to risk factors for cardiovascular disease; when these were taken together, only education remained as a significant predictor.
Occupational status is a more complex variable, and its measurement varies depending on one’s theoretical perspective about the significance of various aspects of work life. One aspect is simply whether or not one is employed, since the employed have better health than the unemployed have. Although some of this association is a function of the “healthy worker” effect, there is evidence that being unemployed and the length of unemployment affect health status.
Among the employed, occupations differ in their prestige, qualifications, rewards, and job characteristics, and each of these indicators of occupational status is linked to mortality risk. Lower-status jobs expose workers to both physical and psychosocial risks. They carry a higher risk of occupational injury and exposure to toxic substances. In addition, job strain and lack of control over work are greater the lower one’s occupational status. In the Whitehall study of British civil servants, differences of coronary heart disease incidence by occupational grade were largely accounted for by differences in job control (PHAC, 2011).
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), health 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 factors impacts health and is interconnected with the other social determinants.
Due to their heterogeneous nature, rural communities differ among themselves and from those of their urban counterparts in health and health care needs (Chenier, 2000; DesMeules and Pong, 2006). The Royal Commission on the Future of Health Care in Canada, led by Roy Romanow in 2002, found that the biggest concern of rural Canadians regarding the health care system was access to health care services. Rural regions face the most difficulties accessing health services in Canada (Hutten-Czapski, 2001), specifically, challenges related to geography, limited availability of services, lack of health care providers, and increased distance to services.
Less access to prevention, early detection, treatment, and support services in rural areas may further exacerbate these factors, making good health status even more difficult to achieve (Browne, 2009; DesMeules and Pong, 2006; Kirby, 2002; Romanow, 2002).
Charlotte Loppie Reading and Fred Wien (2009) offer a critique of the social determinants of health framework in studying the health of Aboriginal people in Canada, contending that Health Canada’s approach to the social determinants of health excludes the holistic approach to health of Aboriginal cultures that encompasses physical, spiritual, emotional, and mental components.
Although not recognized by the PHAC, the historical effects of relations with Europeans was recognized as a fundamental social determinant of health among Aboriginal populations around the world at the WHO’s International Symposium on the Social Determinants of Indigenous Health (CSDH, 2007). Increasing knowledge and awareness of the factors 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 diverse Labrador communities.
The social determinants of health in poverty describe the factors that affect impoverished populations’ health and health inequality. Inequalities in health stem from the conditions of people’s lives, including living conditions, work environment, age, and other social factors, and how these affect people’s ability to respond to illness. These conditions are also shaped by political, social, and economic structures. The majority of people around the globe do not meet their potential best health because of a “toxic combination of bad policies, economics, and politics”. Daily living conditions work together with these structural drivers to result in the social determinants of health.
Poverty and poor health are inseparably linked. Poverty has many dimensions – material deprivation (of food, shelter, sanitation, and safe drinking water), social exclusion, lack of education, unemployment, and low income – that all work together to reduce opportunities, limit choices, undermine hope, and, as a result, threaten health. Poverty has been linked to higher prevalence of many health conditions, including increased risk of chronic disease, injury, deprived infant development, stress, anxiety, depression, and premature death. According to Loppie and Wien, these health afflictions of poverty most burden outlying groups such as women, children, ethnic minorities, and the disabled. Social determinants of health – like child development, education, living and working conditions, and healthcare- are of special importance to the impoverished.
According to Moss, socioeconomic factors that affect impoverished populations such as education, income inequality, and occupation, represent the strongest and most consistent predictors of health and mortality. 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, according to the WHO. The inequitable distribution of health-harmful living conditions, experiences, and structures, is not by any means natural, “but is the result of a toxic combination of poor social policies and programmes, unfair economic arrangements, and bad politics.” Therefore, the conditions of individual’s daily life are responsible for the social determinants of health and a major part of health inequities between and within countries. Along with these social conditions, “Gender, education, occupation, income, ethnicity, and place of residence are all closely linked to people’s access to, experiences of, and benefits from health care.” Social determinants of disease can be attributed to broad social forces such as racism, gender inequality, poverty, violence, and war. This is important because health quality, health distribution, and social protection of health in a population affect the development status of a nation. Since health has been considered a fundamental human right, one author suggests the social determinants of health determine the distribution of human dignity.
Health status is determined by the interplay of physical, social and economic factors, known as the social determinants of health. The World Health Organization (WHO) defines the social determinants of health as, the conditions in which people are born, grow, live, work and age… shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries (Commission on the Social Determinants of Health, 2008, p. 1).
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 factors i.e. personal, social-economic and health related factors 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. The stable food is matooke and potatoes. 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 who are 18years and above.
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 health workers, community members and local leaders.
3.4.4 Exclusion Criteria
The study will exclude all those who are below 15years.
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 factors and socio-economic variable.
Personal factors: are the individual factors that strongly influence their behaviors.
Social Economic factors: 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.
3.6 Research Instruments
A questionnaire will be used which will be first pretested on 5 people in Kauga village to assess its effectiveness and accuracy. The questionnaire will be written in English. The questionnaire 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 questionnaire to answer and for those who don’t understand English, they will be given Luganda copies and will be assisted by the research assistant. Every completed questionnaire 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 questionnaire 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 questionnaire. 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 may be due to their own reasons among themselves being that they have limited time and interest in providing the information required. However, the researcher will strive to explain to them the importance of the study as academic so as to get their cooperation.
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. However, the researcher will draw 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.
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- Brunner, “Stress and the Biology of Inequality,” British Medical Journal (17 May 1997): 1472–1476.
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For a summary, see O.M. Wolkowitz, E.S. Epel, and V.I. Reus, “Antiglucocorticoid Strategies in Treating Major Depression and Improving Health Outcome,” in Physical Consequences of Depression, ed. J. Thakore (Petersfield, U.K.: Wrightson Biomedical Publishing, 2001), 181–213
; R. Surwit and M. Feinglos, “Relaxation Induced Improvement in Glucose Tolerance Is Associated with Decreased Plasma Cortisol,” Diabetes Care 7, no. 2 (1984): 203–204
; and S. Cruess et al., “Reductions in Herpes Simplex Virus Type 2 Antibody Titers after Cognitive Behavioral Stress Management and Relationships with Neuroendocrine Function, Relaxation Skills, and Social Support in HIV-Positive Men,” Psychosomatic Medicine 62, no. 6 (2000): 828–837.
↵
We have focused in this essay on disparities associated with SES; there are also marked disparities by race/ethnicity in the United States. Some of these disparities may be due to socioeconomic disadvantage, but unique factors associated with discrimination and cultural factors may also exist. We did not include these issues here, but they must be factored in when considering policy approaches to health disparities more broadly.
↵
A.R. Tarlov, “Public Policy Frameworks for Improving Population Health,” in Socioeconomic Status and Health in Industrial Nations, ed. Adler et al., 281–293.
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