Effects of Health System Complexity on Antibiotics Use in Ethnic Group of Maechaem District, Chiang Mai

Abstract

Objective:To explain how health system complexity affects antibiotics use among the ethnic group of Maechaem District, Chiang Mai. Methods: The study was qualitative research conducted through in-depth interviews, observations, and documentary research. Informants were 32 information-rich individuals (10 members of ethnic group of Maechaem using or seeking antibiotics, and 22 informants on the context of the community). The study employed explanatory model of illnesses to identify factors at the individual level, ecological model of health to identify factors at the individual level up to the policy level, and theory on complexity. Data analysis was conducted through thematic analysis. Results: By defining wound and pain as “inflammation (karn akseb)”, together with the perception from the interaction with healthcare providers that “anti-inflammatory drugs (ya kae akseb)” could cure “inflammation”, and experiences on treatments of one-selves and others formed attitudes towards antibiotics use among ethnic group. External factors were multi-dimensional, e.g. relationship within the community, socio-economic situation within ethnic group, occupation, being in a remote area, public policies on rational drug use and consumer health protection of the authority, shortness of qualified health personnel and limited access to effective health care, convenient access to antibiotics both in public and private settings including drugstores and groceries. All of which related to the complexity affected antibiotics use. Conclusion: Antibiotics use among Maechaem ethnic group is complex due to the interwoven internal and external factors. Understanding such complexity enables the effort on promoting rational drug use to become comprehensive, more relevant to the problems and sustainable.