A prospective exploration of people’s experiences of and responses to symptoms in New Zealand and Pakistan

Abstract

Bodily symptoms are a routine aspect of daily life but are usually ignored or treated outside formal healthcare. However, the way people respond to symptoms can affect the progression of serious illnesses as symptoms might be an indication of something serious. Research on symptom prevalence and responses has often relied on data obtained from people recruited from a health care setting or by asking people to recall past illnesses. This will however, miss a substantial proportion of responses for which no or solely lay advice is sought, or which are forgotten due to their transient nature. Furthermore, relatively few studies have been conducted recently, and more seriously, there is a dearth of data outside developed countries and no cross-cultural studies. The thesis aimed to gain insight into symptom prevalence and responses using a prospective design and to adapt such a design in a developing country context with a non-western culture. Additionally, it aimed to measure the extent to which symptom response could be predicted by personal characteristics, attitudes, and beliefs. A telephone sample of randomly selected 152 people from New Zealand (a developed country) and 151 people recruited through stratified intercept method from Pakistan (a developing, non-western country), were used. The participants in the study were healthy individuals aged 18-65 years. The study involved the use of four different study instruments: a computer based test assessing people’s implicit attitudes towards conventional and alternative treatments; an entry questionnaire to collect information on personal characteristics such as demographics, future orientation, impulsivity, beliefs about medicines, and attitudes towards health care providers; email or text messages sent out daily for 30 days asking participants about their level of happiness and wellness and experience of symptoms during the last 24 hours; and a symptom reporting questionnaire to be filled out on the symptomatic days gathering information on type, duration, and severity of symptoms, and the way people responded to them. The questionnaires were originally designed in English and were administered online to the participants in New Zealand. However, for Pakistan, the questionnaires were translated into the national language Urdu and were administered on paper. Symptoms were highly prevalent in both New Zealand and Pakistan, and were likely to include many which may not be recalled in a retrospective study design. Pain was found to be the most commonly experienced symptom followed by respiratory symptoms. The prevalence and frequency of the symptoms was generally higher in Pakistan. Responses to symptoms showed a different pattern in both study settings with ignoring the symptoms as a common response in New Zealand but the least common in Pakistan. Self-medication was a common response in both New Zealand and Pakistan. However, it was limited to OTC medicines in New Zealand but included potentially harmful medicines such as antibiotics in Pakistan. Use of home remedies was a common practice in Pakistan but not in New Zealand. Seeking help for symptoms was not as uncommon in Pakistan as in New Zealand, though doctors were the preferred choice of professional help in both study settings. Personal characteristics, beliefs and attitudes were less useful in predicting responses to symptoms whereas symptom characteristics clearly shaped responses. This prospective study managed to decrease the recall period and was successfully adapted to a developing, non-western country context. The findings highlight the need to improve people’s awareness of self-care through education programmes and media campaigns in order to manage symptoms appropriately and safely. They also underline the need to develop and enforce the laws for prescription only medicines in Pakistan to promote rational use of medicines. I advocate for the importance of transferring health care for day to day symptoms from doctors to pharmacists by increasing public awareness of pharmacists as first port of call for symptoms