Acceptable care? Illness constructions, healthworlds, and accessible chronic treatment in South Africa

Jana Fried, B. Harris, J. Eyles, M. Moshabela

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    Achieving equitable access to health care is an important policy goal, with access influenced by affordability, availability, and acceptability of specific services. We explore patient narratives from a 5-year program of research on health care access to examine relationships between social constructions of illness and the acceptability of health services in the context of tuberculosis treatment and antiretroviral therapy in South Africa. Acceptability of services seems particularly important to the meanings patients attach to illness and care, whereas - conversely - these constructions appear to influence what constitutes acceptability and hence affect access to care. We highlight the underestimated role of individually, socially, and politically constructed healthworlds; traditional and biomedical beliefs; and social support networks. Suggested policy implications for improving acceptability and hence overall health care access include abandoning patronizing approaches to care and refocusing from treating "disease" to responding to "illness" by acknowledging and incorporating patients' healthworlds in patient-provider interactions.
    Original languageEnglish
    Pages (from-to)622-635
    JournalQualitative Health Research
    Issue number5
    Early online date31 Mar 2015
    Publication statusPublished - 1 May 2015

    Bibliographical note

    This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License ( which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (


    Global Health Research Initiative (GHRI), a collaborative research funding partnership of the Canadian Institutes of Health Research, the Canadian International Development Agency, Health Canada, the International Development Research Centre, and the Public Health Agency of Canada


    • Africa
    • South
    • health care
    • access to
    • users' experiences
    • HIV/AIDS
    • illness and disease
    • chronic
    • infectious
    • social construction
    • interviews
    • semistructured
    • relationships
    • patient-provider
    • research
    • qualitative
    • social constructionism
    • tuberculosis (TB)


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