Paper short abstract:

We present findings of recent in-depth interviews conducted with patients with podoconiosis, a lifelong progressive condition common in tropical highland areas of Africa. Particular emphasis is given to recognition of the condition, to health-seeking behaviours and to perspectives on self-care.

Paper long abstract:

Podoconiosis is a chronic, non-infectious disease affecting individuals exposed to red clay soil in highland tropical areas. The condition is characterised by lymphoedema (limb swelling) and episodes of intense pain. Podoconiosis is very disabling, limits patients' ability to work, and leads to psychological harm through exclusion from school, community and religious meetings. Care of lymphoedema requires adherence to a simple regime of self-care practices, including foot hygiene, elevation, exercise and self-referral if appropriate.

In-depth interviews were used to explore the complex interaction between cultural beliefs, lay treatment-seeking behaviour and self-care practices among podoconiosis patients in northern Ethiopia. These were examined in the context of patients' wider understanding of illness that is chronic in nature. Dixon-Woods' theoretical model of Candidacy was used to explore the stepwise decisions made by patients towards treatment. This model remains underused in the context of chronic diseases in rural African societies and the present study focused on its early stages, namely the way patients come to recognise their illness and how this influences subsequent treatment choices. Particular consideration was given to overlap and potential conflict between lay and biomedical pathways to care. The role of social taboo and support networks on these first steps towards treatment were explored, including how they ultimately influenced timely access to healthcare and adoption of effective self-care practices.

Preliminary results highlight the importance of faith-based ("holy water") and herbal treatments. Self-care barriers include concern over cold water required for foot washing, possibly from belief that podoconiosis is associated with "chills".