Dissertation: Health Care Seeking in Nicaragua: Researching the Interface Between Economics, Cultural Understanding, and Practical Logic

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Health and disease are experienced within social contexts. For people living in poverty, health care seeking decisions are made in conjunction with considerations of how to allocate scarce resources to meet the needs of multiple household members. Much of the international health literature has focused on sociocultural factors that impact health care seeking. Yet little research has been conducted on the ways that economic factors directly and indirectly constrain or facilitate health care seeking strategies in poor households. The proposed study will examine how sociocultural factors, economics, and social relations articulate in health care and resource decision-making among poor and lower middle income households in Nicaragua, a country with high rates of child morbidity and mortality as well as high rates of maternal mortality. Utilizing participant observation and semi-structured interviews, the researcher, an anthropology graduate student at the University of Arizona, will prospectively follow fifty rural households in a municipality of the department of Masaya over the course of a year. Ethnographic research is needed in local contexts to assess how multiple factors impacting on health seeking articulate during actual illness episodes. In addition to providing doctoral training for a promising woman scientist, the proposed study will help fill the gap in the paucity of ethnographic research into contemporary health issues for Nicaraguans living in poverty, and assess the cross-cultural applicability of theoretical and methodological approaches to the study of health care seeking.