4 - Rural-Urban Disparities in Health and Health Care in Africa: Cultural Competence, Lay-beliefs in Narratives of Diabetes among the Rural Poor in the Eastern Cape Province of South Africa
Corresponding Author(s) : Olajide Oloyede
African Sociological Review,
Vol. 21 No. 2 (2017): African Sociological Review
Abstract
Rural-urban disparities in health and health care in Africa have been well described; yet, they
remain relatively of less concern among many issues in health and health care in Africa. The
disparities have been documented to exist in the utilization of cardiac diagnostic and therapeutic
procedures, prescription of analgesia for pains, treatment of diabetes (e.g. gym exercise). Among
the fundamental root causes of these disparities, which, can be gathered through studies of the
health care systems (biomedical and African health systems) are variations in patients’ health
beliefs, values, preferences and behaviour. Informed by the need to address the seemingly wide
rural-urban disparities in health and health care in Africa, this paper brings to the fore rural
patients’ recognition of symptoms, threshold for seeking care and the ability to understand
disease management strategy, all of which are part of the variations in patients’ health beliefs
and values. The strategy adopted for foregrounding these disparities is through narratives of
diabetes by patients in a rural context in South Africa. The chief aim is to contribute towards
improving the quality of health care through incorporating patients’ understanding of health.
The narrative is subsumed under cultural competence and lay beliefs.
Keywords
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- Aday, L.A. (1993) At risk in America: the health and healthcare needs of vulnerable populations in the United States 1ˢᵗ ed., San Fransisco: Jossey-Bass Publishers Beck, U (1992)
- Risk Society, Towards a New Modernity, London: Sage Publication Bell, S. E. (1999) Narratives and lives: Women’s health politics and the diagnosis of cancer for DES daughters. Narrative Inquiry, 9, pp. 347-389
- Betancourt, J.R., Green, A.R., Carillo, J.E., and Park, E.R (2005) Cultural Competence and Health Care Disparities, Key Perspectives and Trends. Health Affairs, 24, 499-505.
- Bury, M (1991) Sociology of chronic illness: A review of research and prospects. 13(4), 451-467
- Clandinin, D. J. and Connelly, F. M. (2000) Narrative inquiry: Experience and story in qualitative research. San Francisco: Jossey-Bass Ezzy, D. (2000). Illness narratives: Time, hope and HIV. Social Science and Medicine, 50, 605-617
- Frank, A. W. (1995) The wounded storyteller: Body, Illness and ethics. Chicago: University of Chicago Press
- Fryback, P. B. and Reinert, B. R. (1999). Spirituality and people with potentially fatal diagnoses, 34 (1), 13-22
- Giddens, A. (1990) The consequences of Modernity, Cambridge: Polity Press
- Good, B. J. (1994). Illness representations in medical anthropology: a reading of the field. In: Medicine, Rationality and Experience – An Anthropological Perspective. Cambridge: Cambridge University Press, pp. 25-64
- Heijmans, M. J. W. M.(1998) Coping and adaptive outcome in chronic fatigue syndrome: importance of illness cognitions. Journal of Psychosomatic Research, 45, 39-51
- Hyden, L. C. (1997) Illness and narrative. Sociology of Health and Illness, 19, 48-69 Landis, B. J.(1996) Uncertainty, spiritual well-being, and psychosocial adjustment to chronic illness. Issues in Mental Health Nursing, 17, 217-231
- Lavizzo-Mourey, R., Mackenzie, E. (1996) Cultural competence: an essential hybrid for delivering high quality care in the 1990s and beyond. Transaction of the American Clinical Climatology Association, VII: 226-238
- Leventhal, H., Meyer, D., and Nerenz, D. (1980) The commonsense representation of illness danger.
- In S. Rachman (Ed.), Contributions to medical psychology, Volume 2, Oxford: Pergamon Press
- Leventhal, H., Nerenz, D., R., and Steele, D. J. (1984) Illness representation and coping with health threats. In A. Baum, S. E. Taylor, and J. E. Singer (Eds), Handboo ogy and health. London; Erlbaum Murray, M (1999) The storied nature of health and illness. In M. Murray and K. Chamberlain (Eds.), Qualitative health psychology: Theory and methods (pp. 47- 63). Thousand Oaks,CA: Sage Murray, M. and McMillan, C. (1988) Working class women’s view of cancer. Belfast: Ulster Cancer Foundation
- Norris, S. L., Engelgao, M. M., Narayan, K. M. (2001) Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care. 24:561-587 O’Neill, D. P., and Kenny, E. K. (1998) Spirituality and chronic illness. Image: Journal of Nursing Scholarship, 30 (3), 275-280
- Obuaku, Chinwe (2014) Essential Medicines in Nigeria Foregrounding Access to Affordable Essential Medicines, African Sociological Review Vol 18: 2, 2014 pp36-53.
- Oloyede, O (2012) The management of diabetes among the rural poor in South Africa: A Rural Health Study Unpublished Research Report. University of the Western Cape Orbell, S, Johnston, M., Rowley, D., Espley, A., and Davey, P. (1998). Cognitive representations of illness and functional and affective adjustment following surgery for osteoarthritis. Social Sciences and Medicine, 47, 93- 102
- Radley, A (1993) Worlds of illness: Biographical and cultural perspectives on health and disease.
- London: Routledge Relf, M. V. (1997) Illuminating meaning and transforming issues of spirituality in HIV disease and AIDS: An application of Parse’s theory of human becoming. Holistic Nursing Practice, 10(1), 68-76
- Sebastian, J.R (1994) Definitions and theory underlying vulnerability. In Sebastian, J.R., Bushy, A. (Eds) Special populations in the community: advances in reducing health disparities.
- Gaithersburg (MD): Aspen Publishers Scharloo, M., Kaptein, A. A., Williams, J., Hazes, J. M., Willems, L. N. A., Bergman, W., and Rooijmans, H. G. M. (1998) illness perceptions, coping and functioning in patients with rheumatoid arthritis, chronic obstructive pulmonary disease and psoriasis. Journal of Psychosomatic Research, 44, 573-585
- William chronic illness: Narrative re-constructions ealth and Illness 6, 174-200
References
Aday, L.A. (1993) At risk in America: the health and healthcare needs of vulnerable populations in the United States 1ˢᵗ ed., San Fransisco: Jossey-Bass Publishers Beck, U (1992)
Risk Society, Towards a New Modernity, London: Sage Publication Bell, S. E. (1999) Narratives and lives: Women’s health politics and the diagnosis of cancer for DES daughters. Narrative Inquiry, 9, pp. 347-389
Betancourt, J.R., Green, A.R., Carillo, J.E., and Park, E.R (2005) Cultural Competence and Health Care Disparities, Key Perspectives and Trends. Health Affairs, 24, 499-505.
Bury, M (1991) Sociology of chronic illness: A review of research and prospects. 13(4), 451-467
Clandinin, D. J. and Connelly, F. M. (2000) Narrative inquiry: Experience and story in qualitative research. San Francisco: Jossey-Bass Ezzy, D. (2000). Illness narratives: Time, hope and HIV. Social Science and Medicine, 50, 605-617
Frank, A. W. (1995) The wounded storyteller: Body, Illness and ethics. Chicago: University of Chicago Press
Fryback, P. B. and Reinert, B. R. (1999). Spirituality and people with potentially fatal diagnoses, 34 (1), 13-22
Giddens, A. (1990) The consequences of Modernity, Cambridge: Polity Press
Good, B. J. (1994). Illness representations in medical anthropology: a reading of the field. In: Medicine, Rationality and Experience – An Anthropological Perspective. Cambridge: Cambridge University Press, pp. 25-64
Heijmans, M. J. W. M.(1998) Coping and adaptive outcome in chronic fatigue syndrome: importance of illness cognitions. Journal of Psychosomatic Research, 45, 39-51
Hyden, L. C. (1997) Illness and narrative. Sociology of Health and Illness, 19, 48-69 Landis, B. J.(1996) Uncertainty, spiritual well-being, and psychosocial adjustment to chronic illness. Issues in Mental Health Nursing, 17, 217-231
Lavizzo-Mourey, R., Mackenzie, E. (1996) Cultural competence: an essential hybrid for delivering high quality care in the 1990s and beyond. Transaction of the American Clinical Climatology Association, VII: 226-238
Leventhal, H., Meyer, D., and Nerenz, D. (1980) The commonsense representation of illness danger.
In S. Rachman (Ed.), Contributions to medical psychology, Volume 2, Oxford: Pergamon Press
Leventhal, H., Nerenz, D., R., and Steele, D. J. (1984) Illness representation and coping with health threats. In A. Baum, S. E. Taylor, and J. E. Singer (Eds), Handboo ogy and health. London; Erlbaum Murray, M (1999) The storied nature of health and illness. In M. Murray and K. Chamberlain (Eds.), Qualitative health psychology: Theory and methods (pp. 47- 63). Thousand Oaks,CA: Sage Murray, M. and McMillan, C. (1988) Working class women’s view of cancer. Belfast: Ulster Cancer Foundation
Norris, S. L., Engelgao, M. M., Narayan, K. M. (2001) Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care. 24:561-587 O’Neill, D. P., and Kenny, E. K. (1998) Spirituality and chronic illness. Image: Journal of Nursing Scholarship, 30 (3), 275-280
Obuaku, Chinwe (2014) Essential Medicines in Nigeria Foregrounding Access to Affordable Essential Medicines, African Sociological Review Vol 18: 2, 2014 pp36-53.
Oloyede, O (2012) The management of diabetes among the rural poor in South Africa: A Rural Health Study Unpublished Research Report. University of the Western Cape Orbell, S, Johnston, M., Rowley, D., Espley, A., and Davey, P. (1998). Cognitive representations of illness and functional and affective adjustment following surgery for osteoarthritis. Social Sciences and Medicine, 47, 93- 102
Radley, A (1993) Worlds of illness: Biographical and cultural perspectives on health and disease.
London: Routledge Relf, M. V. (1997) Illuminating meaning and transforming issues of spirituality in HIV disease and AIDS: An application of Parse’s theory of human becoming. Holistic Nursing Practice, 10(1), 68-76
Sebastian, J.R (1994) Definitions and theory underlying vulnerability. In Sebastian, J.R., Bushy, A. (Eds) Special populations in the community: advances in reducing health disparities.
Gaithersburg (MD): Aspen Publishers Scharloo, M., Kaptein, A. A., Williams, J., Hazes, J. M., Willems, L. N. A., Bergman, W., and Rooijmans, H. G. M. (1998) illness perceptions, coping and functioning in patients with rheumatoid arthritis, chronic obstructive pulmonary disease and psoriasis. Journal of Psychosomatic Research, 44, 573-585
William chronic illness: Narrative re-constructions ealth and Illness 6, 174-200