Why Do Patients with Mental Disorders Default Treatment? A Qualitative Enquiry in Rural Kwazulu-Natal, South Africa
Abstract
:1. Introduction
2. Methods
2.1. Study Setting
2.2. Study Participants
2.3. Recruitment of Study Participants
2.4. Data Collection
2.5. Data Analysis
3. Findings
3.1. Sociodemographic Characteristics
3.2. Findings from Qualitative Data
3.3. Belief That They Are Cured
“I told myself that I was better, and then I decided to stop taking my medication.” (44 year old male with schizophrenia)
“I saw myself as being alright, I was no longer sick, I am healthy now.” (31 year old female with schizophrenia)
“I felt that my body was feeling better, I felt as if I was healed.” (26 year old male with schizophrenia).
3.4. Lack of Social Support System
“I used to be accompanied by my neighbor when my illness was still worse.” (45 year old female with schizophrenia).
“I stopped because my parents separated and my mother, who used to accompany me to hospital to collect pills, left me and married another man.” (25 year old female with major depression)
“My mother, who used to accompany me died and there was no one else who could accompany me.” (43 year old male with schizophrenia).
3.5. Mobility of Patients
“I was away visiting relatives in Durban. I overstayed. I left my hospital card at home.” (27 year old female with major depression).
“I quarreled with my brother and I decided to cross the border and visit a friend in Mozambique, so that I can cool off and give him some space.” (30 year old male with schizophrenia).
3.6. Denial of Mental Disorder
“Some people take me as somebody who is mentally ill, and they do not seriously take my opinions regarding any matter under discussion. Even if my opinion or advice would have been useful, it is disregarded because I am taken as a person who is not thinking straight because I take pills for mental illness.“ (31 year old female with schizophrenia).
“Me, I do not care that I have not come to collect my pills, what I care about is that my mother is dead.” (43 year old male with schizophrenia).
3.7. Poor or Inadequate Communication
“The doctor did not say for how long I will be on medication. It is just that I was not told here at the hospital that if I stopped taking the pills on my own decision, I shall be at risk of being disturbed in my mind again.” (31 year old female with schizophrenia)
“The nurses did not explain to me that I would be expected to collect my pills at this clinic. I was told that I will collect my pills at the hospital general OPD.” (45 year old female with major depression).
3.8. Disintegrated System of the Hospital
“I was admitted to hospital for another illness. I did not bring my pills for mental illness and even at the hospital, they forgot to give me my medication, although it was written on my hospital carry-card. I thought that if nurses in hospital do not give me these pills while I am admitted, it means that it is not important to drink them always.” (42 year old female with major depression)
3.9. Resorting to Traditional Treatment
“I was happy to be on the pills until my illness got complicated and I had to see a traditional healer. I therefore stopped taking pills because I am still using traditional medicines.” (19 year old male with schizophrenia)
3.10. Other Reasons
4. Discussion
5. Conclusions
6. Recommendations
- i.
- Both health literacy levels and cultural orientation should be specifically addressed as health professionals interact with mentally ill patients, especially in rural communities where general literacy, in addition health literacy, is often lower [33].
- ii.
- Although foreign to scientific medicine, health workers in such areas need to know about the understanding and explanation of certain mental illnesses. In a study conducted in the same province, the cultural conceptualization, understanding, and/or explanation of schizophrenia were found to be a supernatural phenomenon of ukuthwasa [41], which requires a cultural ritual or intervention by a traditional healer that, by default, is not recommended to take place at a health facility. The respect for this cultural view of mental illness is likely to contribute to health workers counseling patients to continue attending their treatment appointments at the health facility. Furthermore, a possible collaboration between traditional and medical practitioners may be forged, with the purpose of traditional healers utilizing their influence to encourage patients to attend health facility treatment.
- iii.
- Both health education and promotion for patients with mental disorders should be tailor-made according to the profile of the community from which the patients come.
- iv.
- It is recommended the findings of this study be used as a basis for a bigger quantitative study to explore specific demographic variables that are associated with treatment default.
7. Limitations of the Study
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Disclaimer
References
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Variables | Frequency | Percentages |
---|---|---|
Gender | ||
males | 11 | 52.38% |
females | 10 | 47.62% |
Age | ||
above 35 | 11 | 52.38% |
below 35 | 10 | 47.62% |
Marital Status | ||
Single | 9 | 42.86% |
Married | 4 | 19.05% |
Divorced | 5 | 23.81% |
Widowed | 3 | 14.28% |
Level of Education completed | ||
Primary education | 12 | 57.14 |
Secondary education | 7 | 33.33% |
No formal schooling | 2 | 9.53% |
Disability Grant | ||
Receives a disability grant | 8 | 38.10% |
Does not receive a disability grant | 13 | 61.90% |
Diagnosis | ||
Schizophrenia | 15 | 71.42% |
Major Depressive Disorder | 6 | 28.58% |
Use of psychoactive substances | ||
Alcohol | 10 | 47.62% |
Dagga | 4 | 19.04% |
Whunga | 1 | 4.76% |
None | 6 | 28.58% |
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Mokwena, K.E.; Ndlovu, J. Why Do Patients with Mental Disorders Default Treatment? A Qualitative Enquiry in Rural Kwazulu-Natal, South Africa. Healthcare 2021, 9, 461. https://doi.org/10.3390/healthcare9040461
Mokwena KE, Ndlovu J. Why Do Patients with Mental Disorders Default Treatment? A Qualitative Enquiry in Rural Kwazulu-Natal, South Africa. Healthcare. 2021; 9(4):461. https://doi.org/10.3390/healthcare9040461
Chicago/Turabian StyleMokwena, Kebogile Elizabeth, and Jabulile Ndlovu. 2021. "Why Do Patients with Mental Disorders Default Treatment? A Qualitative Enquiry in Rural Kwazulu-Natal, South Africa" Healthcare 9, no. 4: 461. https://doi.org/10.3390/healthcare9040461