Rural Hondurans Perceptions about Health and Healthcare Practices
Marson, S.N., Amber Prohaska, S.N., Sheryl Burris, S.N.,
This qualitative descriptive study explored perceptions of health and health practices in a group of rural Hondurans who live in moderate to severe poverty. The participants were recruited from Hondurans who were seeking care from a short-term primary care team from the United States. The sample included 32 participants, between the ages of 18 and 75, who resided in three different rural villages. The health care perceptions of the participants from this pilot study varied in their responses. The participants' spiritual faith was reported to have played an important role in health issues. While the majority of the people used either herbal remedies or folkway remedies to improve health, others preferred Western medicine to treat their ailments. The majority of the men interviewed defined good health as the ability to work long days and acquire food for their family. Future studies regarding health care perceptions of Honduran people will further enhance these findings and answer questions that emerged from this preliminary study. Those future studies should attempt to explore Hondurans’ health perceptions more deeply, perhaps through ethnography or grounded theory methodologies. In addition, methods to enhance and validate the language and cultural barriers observed in this study will improve the reliability of l work in this area.
Keywords: Honduras, Health Perceptions, Healing, Herbal Remedies and Folkway Remedies.
The majority of people in North America value health as an important aspect of a person’s life. Sickness and unhealthiness are, in addition to morbidity and mortality, associated with negative symptoms like depression and pain (Health Alliance Plan, 2006). Likewise, people in the U.S. view illness as an unfortunate and unnecessary part of life that should be combated using either medicinal science, or alternative methods that include folk remedies. People in other cultures however, may perceive health, illness and interventions to maintain their health or treat illness in distinctly different ways (Crigger et al., 2004).
Of all Central and South American countries, Honduras is one of the two poorest (Sachs, 2005). Despite the fact that many healthcare providers from the US and other developed countries serve in Honduras, there are no published studies of healthcare perception and practices of people in Honduras. Effective and culturally sensitive partnerships with people from other cultures are best developed through knowledge of their perceptions about health and their healthcare practices. The focus of this descriptive pilot study we conducted as an unfunded volunteer service project was to investigate the health perceptions and practices of people in three different Honduran villages.
Design. This research was a descriptive, qualitative study in which we collected data through semi-structured interviews. Approval for the study was obtained from the William Jewell College Investigational Review Board prior to implementation.
Setting and sample. The convenience sample of 32 participants was recruited from people who came to a short-term primary care clinic that was conducted by the Brigada de Salud in three villages along the Northern coast of Honduras, Brisas De Chamelecon, Cepadril, and Limpira.
Procedures. Data were collected during the week of May 12-18, 2005. Each participant was interviewed individually. Participants responded verbally to a questionnaire consisting of nine open-ended questions. Participants’ responses were recorded verbatim on paper. The nine questions focused on what the researchers believed to be three prevalent themes: maintaining health, regaining health, and support. Because the majority of the study participants were non-English speaking, an interpreter was present to assure that both the questions asked by the researchers and the answers of the participants were fully understood and recorded. Interpreters were native Hondurans who had been living in the US for varying numbers of years. These were seasoned translators who had been working with the Brigada de Salud for 9 years and translating for the healthcare team for the same period.
Data analysis. A thematic analysis of the responses was conducted. Same or similar answers to the questions were then grouped as similar concepts. Once similar concepts were grouped, themes were identified. Reliability of interpretation was further assured by having two translators present. After both translators agreed on the translations, the researchers reviewed the data information with the translators. The authors were the raters and independent evaluations were compared to assure validity of the themes during analyses of each participant’s information.
Description of the sample. The sample ranged in age from 18-75 years old and included both male and female participants. Participants would fall within Sach’s (2005) categories of moderate to extreme poverty.
Maintaining health. Participants reported that diets helped them maintain their health and healthy foods included vegetables, fruits, poultry, fish, pork, eggs and milk. These products were obtained through farming and raising their own livestock. Although these resources were available, many sold these items rather than using them, and most described diets that lacked variety and consisted mostly of rice and beans. The meat products were consumed sparingly and rationed. The average individual consumed meat two to three times monthly. Careful consideration was taken in providing daily sustenance for the family. For example a family of four may have two chickens available to provide eggs and meat. In order to provide extended resources, conservation was a critical component in meal planning (i.e. eggs could be provided daily for the same cost as a whole chicken—and the chicken would provide only one meal). This finding is consistent with moderate to severe poverty. According to Sachs (2005), people in moderate to extreme poverty are able to meet basic needs but just barely. Extreme poverty is one in which basic needs are not met and people are chronically hungry and malnourished.
Twenty-five percent of the respondents reported using traditional medicines and herbs to maintain health. The herbs that were reported used most frequently, albahaca (basil), chamomile, chula and valerian root, were indigenous to this population. Many of the villagers used herbs individually in teas, or in conjunction with each other to form a poultice or a topical analgesic rub.
The role hygiene played in maintaining health was less frequently identified as a health promoting intervention. Cross contamination in this population has been reported as high due to the proximity of water dwellings, livestock and lack of education in the area of proper hand hygiene (Trevett, Carter & Tyrrel, 2004). Based on the responses, it appeared that participants did not understand the cause and effect of many controllable health issues related to infection control and proper hygiene. Only 5% of our participants acknowledged the importance of proper hand and oral hygiene as part of health maintenance.
Work also played an integral part of maintaining health. The ability to work and support the family through monetary gains helped to provide food, which in turn would sustain the individual and family’s health. Similarly, Rutherford and Roux (2002) reported in a study of villagers from El Salvador that their participants defined ‘being healthy’ as the ability to provide food.
Regaining health. Methods used for regaining health included both traditional folk and Western medicine. Of the 32 participants who answered this question, 48% stated that they sought care through a village herbalist for various ailments, while 47% used Western medications for their illnesses. The remaining 5% of the participants reported that they went to a hospital when caring for their illnesses. Some claimed that the public care clinics that provided Western medicine were hard to get to, required long waits, and often medications were not available. According to the interviewed participants, supplies and resources in the hospitals were scarce. If people were hospitalized, they were required to provide their own linens and medications. The only responsibility the medical staff provides during a hospital stay is basic care, like bathing and medication administration, if the patient is unable to care for him or herself (WHO, 2006). This perceived lack of care was a deterrent for the majority of participants and only in extreme cases did individuals seek hospitalization.
The participants also seek help from curanderos who are similar to shamans/medicine men, in other cultures. These curanderos reportedly provide guidance in the areas of spiritual strife, physical ailments, and community support. The curanderos use herbal remedies in a variety of ways, such as chews, as a poultice, teas and topical analgesics. The tea was used to alleviate sore throat, cough, gastritis, and fatigue. Poultices and topical analgesics were applied to treat skin eruptions, arthritis, menstrual cramps, and muscle strains.
Spiritual and Community Support. The questions regarding support elicited two main responses: community and faith. Participants rely on each other in their communities. There are no safety nets, so families and neighbors come to the aid of others. The rural communities had little transition, with the same families reported having the same neighbors for years.
Participants placed great importance on religious beliefs. The participants believed that God delivers both blessings and hardships. For example, one may believe a familial illness is caused by generational sins. Suffering and hardship were expected and were often reduced by divine interventions or endured through faith. Villarruel and Ortiz De Montellano (1992) also found spiritual beliefs important in their study of Mexican American’s attitudes toward pain.
This exploratory study used a small, non-representative sample; therefore, findings cannot be generalized to other Honduran groups. Furthermore, the student researchers, although guided by an expert researcher, had limited knowledge and understanding of the participants' culture and beliefs. Because this was a pilot exploratory study, the questions that we asked were very broad. In future research, a more structured methodology such as grounded theory should be used to yield richer data.
Very little research has been done in developing nations related to the population’s beliefs and health practices. To improve the future healthcare of underserved populations in countries such as Honduras will require that healthcare professionals determine better and culturally sensitive approaches to maintaining health and providing care. This preliminary qualitative descriptive study took an initial step toward that goal by exploring perceptions of health and health practices in a group of rural Hondurans who live in moderate to severe poverty.
The convenience sample for the study included 32 participants between the ages of 18-75 for three rural villages. Participants completed a structured, open-ended questionnaire. Responses were analyzed for themes. Themes identified included maintaining health, regaining health and support. Although the majority of the people used either herbal remedies or folkway remedies to improve health, others preferred Western medicine to treat their ailments. The community and spiritual beliefs played an important part in health and illness for the participants studied.
Future studies regarding health and illness perceptions of Honduran people will further enhance this existing pilot study. The future study would benefit by using a larger sample and a more structured methodology that could better describe these complex and multifaceted phenomena.
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Health Alliance Plan (2006). Healthy living: depression and chronic disease. Retrieved April 29, 2006 online at: http://www.hap.org/healthy_living/depression/depchronic.php
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Sachs, J.D. (2005). The end of poverty. London: Penguin Books.
Trevett, A. F., Carter, R. C., & Tyrrel, S. F. (2004). Water quality deterioration: a study of household drinking water quality in rural Honduras. International Journal of Environmental Research, 14(4): 273-283.
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