Background
Informal networks are important for social support for slum residents of Low and Middle-Income Countries (LMICs), where maintaining health is crucial for household income and formal healthcare provision is scarce. Consulting personal or online-based networks (known as lay consultation) during illness can influence personal treatment decisions, but there was scarce evidence from slums. This thesis aimed to (i) examine the use, characteristics and influence of lay consultation networks in slums of Nigeria, and (ii) explore experiences of using the networks.
Methods
A mixed-methods approach was adopted. A systematic review was initially conducted to synthesize evidence on lay consultation for symptoms and illnesses in slums of LMICs. A cross-sectional survey was conducted among adults in two slums in Nigeria to describe their lay consultation networks. This was followed by interviews to explore experiences of lay consultation in more depth.
Key findings
Most participants spoke to lay consultants during illness. The lay consultants used per illness episode were few and were mostly close network members. Use of online sources of advice was scarce largely due to poor access to smart devices and poor digital health literacy. Lay consultation was multi-dimensional, involving casual reporting of health concerns as part of daily bonding, exchanging advice and information about health, emotional and practical support. Lay consultation networks significantly influenced participants’ choice of health care services. However, lay consultation had negative aspects, including facilitating the transfer of unhelpful advice, discriminating and stigmatizing people with certain characteristics and intruding on a patient’s privacy, contributing to worse health outcomes. Participants were strongly agentic in how they selected lay consultants and adopted advice from others.
Conclusion
This thesis highlights the potential of engaging lay consultation networks in health education interventions and creating a formal health resource as cost-effective means to support treatment decisions in slums.