Obinna Onwujekwe and colleagues have documented a major problems with health seeking behavior surveys – people do not always give valid responses. This is not to say that people lie, but the interview situation can be a complex social interaction in which things are not always as they seem. In Onwujekwe’s study while respondents indicated that their preferred source of care for malaria illness were public and private clinics, their main actual source of care for recent malaria episodes were the patent medicine dealers.
Perceptions of whatÂ are ideal and expected behaviors often differ from what people actually do. For example with guinea worm 75% of residents in rural southwestern Nigeria said that clinics offered the best treatment for the disease. Examination of clinic records during the same time found that only about 3% of actual sufferers attended a clinic.
When asked why, villagers complained thatÂ guinea wormÂ could not beÂ cured with western medicine and that treatment which included bandaging the open ulcer agnered the worm and made the disease worse. In fact a fair number of people who were treated at clinic actually attended for another reason, and the health worker just happened to notice the guinea worm ulcer.
Another issue is gender. in Onwujekwe’s survey a majority of the respondents were female. Women in health surveys have been found to give ‘don’t know’ responses more often than men. The interview is a formal social situation with a visitor to the home. Sometimes women may not feel comfortable giving opinions on behalf of their households.
The key lesson from these experiences is that while we urgently need data on whether people are actually gaining universal access to malaria treatment services, we need to take caution in how we approach interviewees and how they believe they should answer us. Interview techniques that set people at ease and find several different ays to ask the same question about treatment choices can help improve data collection. Only with valid responses,Â will we learn if our services are reaching people and where improvements are needed.