Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Jeremy I. Schwartz

Abstract

This study sought to explore the healthcare journeys of patients recently diagnosed with heart failure (HF) in Uganda. Using a semi-structured guide developed in collaboration with Ugandan colleagues, we conducted in-depth interviews with 19 patients diagnosed with HF within the past three months across four regional referral hospitals in Uganda. Interviews were conducted in the participant’s preferred language (English, Luganda, Lugbara, Lugisu, or Swahili) using trained research assistants (RAs) and were recorded, transcribed verbatim, and thematically analyzed using the socioecological framework (SEM) to capture individual, interpersonal, community, and systemic-level barriers to HF care.Findings revealed a total of 11 themes spread across various levels of the SEM – Individual-level themes included a Lack of Health Awareness, Misconceptions about Illness, Personal Faith, Impact on Daily Life, and Comorbidities. Interpersonal-level themes included Social, Emotional, and Financial Support Systems, and Sociocultural Beliefs about Illness. Community level themes included Healthcare Access and Systematic Challenges, as well as Traditional Medicine Use. Societal themes included Financial Burdens and Patient Recommendations. Overall, findings revealed that patients had little to no awareness of HF prior to diagnosis, misattributing early symptoms to aging, environmental exposures, or infectious disease. Cultural beliefs provided alternative explanations of supernatural causes, further delaying care by prompting patients to seek traditional healers and/or delay allopathic care. 3 Patients often only sought biomedical care when symptoms significantly impacted income-generating activities. Participants were frequently met with misdiagnoses at initial points of medical contact, where they were often treated for asthma, tuberculosis, malaria, or peptic ulcer disease. When patients finally reached referral hospitals capable of HF diagnosis, they experienced additional delays due to long wait times, medication stockouts, unsafe conditions, and financial barriers due to high cost of consultation fees, diagnostic services, and medications. This study highlights the complex interplay of individual, interpersonal, communal, and societal elements that illustrate the delayed diagnostic journeys of HF patients in Uganda. These findings underscore the need for improved HF awareness campaigns, targeted health worker training at primary healthcare centers, financial assistance programs for diagnostic services, and integration of HF management into Uganda’s existing non-communicable disease (NCD) initiatives.

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This is an Open Access Thesis.

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