Investigator(s)
| Submitter |
Ugyen Tshering Chumey PHC,Bumthang Ugyen Tshering 
|
| Principal Investigator |
Ugyen Tshering Chumey PHC,Bumthang Ugyen Tshering
|
| Co-Investigator(s) |
Sonam Dendup Haa Hospital Sonam Dendup
|
| Co-Investigator(s) |
Rinchen Pemba Kamichu PHC,Wangduephodrang Rinchen Pemba
|
| Co-Investigator(s) |
Ugyen Chophel Wangduephodrang Hospital Ugyen Chophel
|
| Co-Investigator(s) |
Thinley Dorji CRRH hospital,Gelephu Thinley Dorji
|
Title(s) and abstract
| Scientific title | Patterns of Health seeking behavior |
| Public title | Health seeking behavior |
| Background | Good health and well-being are one of the listed Sustainable Developmental Goals targeting universal coverage of health, which comprises healthcare services like health promotion to prevention, treatment, rehabilitation, and palliative care. In Bhutan, the health system is integrated into Allopathic and Traditional medicine providing free health services to citizens through the three-tiered structure (primary, secondary and tertiary level). The Spiritual/Local Healing System is primarily an oral tradition and thus lacks documentation. This medical knowledge is passed down from generation to generation, from parents to children and master to apprentice. The spiritual/local healing system is diverse and comprises of conducting rituals for spiritual healing, doing herbal concoctions, correction of dislocation/fracture bones and appealing to the supernatural beings (Doenchoe) at home during the illness. Bhutanese people are deeply rooted with strong faith in religious rites and offerings for the spiritual/local healing for health, so challenges are active in convincing the people residing in rural areas to seek health services across the country. People visit the hospital for Allopathic or Traditional medicine services only if home-based spiritual/local healing is not helpful. When they do visit the hospital, some patients are in critical condition, resulting in longer hospital stays or mortality. Such inappropriate health-seeking behavior (HSB) among Bhutanese harms people's health outcomes, increases the community’s transmission risk, increases the disease burden, and causes premature death. With the growing prevalence of health-seeking behavior in our country, it is becoming increasingly important to study this trend and engage various stakeholders in advocacy efforts |
| Objectives | This study aims to describe the proportion of patients with acute and chronic medical conditions who seek spiritual and local healing services, or home-based treatment prior to visiting health facilities. The study will focus on patients presenting at the general outpatient departments of three selected health centers between 01 June 2025 and 31 August 2025, to describe: 1. Socio-demographic and clinical profile of patients who seeks spiritual/local healing services prior to visit the health facilities. 2. Pattern of initial health seeking behavior (visit to spiritual/local healers and astrologers, performing rites, performing pawo, etc) 3. Expenditure on initial health-seeking behavior (monetary expenditure, time, offerings in kind, etc) 4. Source of information on spiritual/local healers 5. Level of satisfaction with health-seeking behavior 6. Common themes of advice received from the spiritual/local healers |
| Study Methods | This is a mixed-methods study with a quantitative (cross-sectional study) and qualitative (in-depth interviews with patients) in concurrent triangulation design. The quantitative component of the study will be reported using the STROBE guideline and the qualitative component will use the COREQ guideline The study will be done among patients visiting at three selected health centres: Chumey Primary Health Centre under Bumthang district, Kamichu Primary Health Centre under Wangdue Phodrang district, and Haa Hospital under Haa district. In this study we will conduct a survey and interview to 451 patients from 01 June 2025 to 31 August 2025. Study population Quantitative: Patients who will visit the selected health centre will be invited to study. Inclusion criteria: Adult patient above 18 years; those who provide consent. Exclusion criteria: Physically impaired patient; Patient who is unwilling to participate. Qualitative: It is expected to undertake 10 – 15 in-depth interviews. Sample size calculation and sampling method Quantitative: The sample size was calculated for proportions using OpenEpi, Version 3. Based on a patient population of 15,296, taking an assumption that 50% would prefer spiritual intervention as the first step as a health-seeking behaviour and a 5% margin of error, the sample size was 375. With a dropout rate of 20%, the final sample size was 451 patients. A proportionate sampling will be done from the three selected sites, as shown in Table Study site No of patients Proportion (%) Sample size Chumy PHC 3019 19.7 89 Haa Hospital 7530 49.2 222 Kamichu PHC 4746 31.0 140 Total 15296 100.00 451 A stratified random sampling will be employed. Every third patient registered at the general outpatient counter will be invited to participate. The parti |
| Expected outcomes and use of results | The outcomes and uses of the results can significantly impact both individuals and public health systems. We can understand how different demographic groups (age, gender, income level, education) seek spiritual/local healing services prior to visit health care services, and the factors influencing these decisions. It may also reveal disparities in healthcare access among different social, economic, financial groups, gender-based differences, or ethnic disparities in who seeks Spiritual/local healing services prior to visit health services and when. By recognizing all those aforementioned patterns, it will help in shaping the policies by providing the evidence on the most effective ways to improve health outcomes through health seeking behavior change. It will also help policymakers and healthcare providers on which factors need to be addressed to encourage more people to seek timely and appropriate care by developing strategies like public education campaigns or community health awareness programs to enhance knowledge and trust in health systems. This finding not only helps in national health policy level to develop strategy and guidelines in accordance to the data but it can als |
| Keywords | health behavior, spiritual healer, local healer,awareness program |
Research Details
| Student research | No |
| Start Date | 01-Apr-2025 |
| End Date | 31-Dec-2025 |
| Key Implementing Institution | Ministry of Health |
| Multi-country research | No |
| Nationwide research | No |
| Bhutan | |
| Research Domain(s) | Non-communicable diseases & Healthy Lifestyles |
| Research field(s) | Other (Pattern of health seeking behavior) |
| Involves human subjects | Yes |
| Intervention Evaluation Research | |
| Data Collection | Primary data |
| Proposal reviewed by other Committee | Approved |