Reasons for not seeking formal healthcare after injuries: A qualitative study with injured individuals in four low- and middle-income countries
Injuries are a major cause of morbidity and mortality in low- and middle-income countries, but many individuals do not seek care within formal healthcare systems. Although previous studies have highlighted barriers to healthcare, limited attention has been given to the experiences of those who remain beyond the formal systems. This study explored why injured individuals in Ghana, Pakistan, Rwanda and South Africa did not seek hospital care. Ninety-seven participants were purposively sampled from rural and urban settings. Interview data were analysed thematically, drawing on biosocial and pluralistic understandings of care. Across countries and settings, participants described how decisions not to seek care were influenced by the combined effects of out-of-pocket costs, transport challenges, past experiences with providers and long waiting times. These factors interacted with sociocultural factors, including beliefs, family influences and trust in indigenous healers. However, formal healthcare was not entirely rejected. Rather, care seeking was dynamic and contingent, with participants navigating decision-making based on affordability, perceived effectiveness and acceptability of treatment. The findings highlight that seeking care for injury should be understood within broader structural and sociocultural contexts. Improving access to formal injury care requires contextually grounded, culturally responsive approaches that acknowledge pluralistic care practices and reflect lived experiences of injury.
Authors
- Derbew Fikadu Berhe (ORCID: https://orcid.org/0000-0002-0669-9241)
- Huba Atiq (ORCID: https://orcid.org/0000-0001-9988-7518)
- Abebe Bekele (ORCID: https://orcid.org/0000-0003-0018-9096)
- Nadine Mugisha (ORCID: https://orcid.org/0000-0002-1722-3986)
- Agnieszka Ignatowicz (ORCID: https://orcid.org/0000-0002-5863-0828)
- Tamlyn MacQuene
- Frederick Sarfo-Antwi (ORCID: https://orcid.org/0000-0002-6792-4510)
- Antonio Belli (ORCID: https://orcid.org/0000-0002-3211-9933)
- Alfredo Palacios (ORCID: https://orcid.org/0000-0001-7684-0880)
- Leila Ghalichi (ORCID: https://orcid.org/0000-0003-3690-2359)
- Ghislaine Umwali
- Barnabas Tobi Alayande (ORCID: https://orcid.org/0000-0002-1326-6452)
- Ntombekhaya Tshabalala (ORCID: https://orcid.org/0000-0002-3395-931X)
- Pascal Nzasabimana
- Jean Claude Byiringiro (ORCID: https://orcid.org/0000-0002-6445-1797)
- Alemayehu Amberbir (ORCID: https://orcid.org/0000-0002-7071-520X)
- Yeukai Chideya (ORCID: https://orcid.org/0009-0005-6383-4138)
- Anita Eseenam Agbeko (ORCID: https://orcid.org/0000-0002-3505-3052)
- Napoleon Bellua Sam (ORCID: https://orcid.org/0000-0002-9056-551X)
- Adams Dramani
- Zaheer Babar Chand
- Denys Ndangurura
- Ebenezer Kwame Amofa
- Ngirabeza Oda Munyura
- Grace Peaston
- Lambert Nzungize
- Equi-Injury Group first
- Stephen Tabiri
- Olwethu Nodo
- Eric Twizeyimana
- John Whitaker
- Lucia D'Ambruoso
- Kathryn Chu
- Debra Sithole
- Junaid Razzak
- Zabin Wajid Ali
Institutions
- Aga Khan University (PK)
- University of Botswana (BW)
- Centre For Development Studies (IN)
- University of the Witwatersrand (ZA)
- University of Aberdeen (GB)
- Stellenbosch University (ZA)
- Tamale Teaching Hospital (GH)
- Kwame Nkrumah University of Science and Technology (GH)
- University College Birmingham (GB)
- Department of Health and Aged Care (AU)
- University of Rwanda (RW)
- Institute of Biophysics and Biomedical Engineering (BG)
- Kwame Nkrumah University (ZM)
- Centre for Global Health Research (CA)
- University of Global Health Equity (RW)
- University of York (GB)
- University for Development Studies (GH)
Publication Details
- Journal
- Global Public Health
- Published
- 2026-04-06
- DOI
- https://doi.org/10.1080/17441692.2026.2650929
- Primary Topic
- Injury Epidemiology and Prevention
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- National Institute for Health and Care Research