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The Lived Experience of Seeking Health Care Through Medical

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The Lived Experience of Seeking Health Care Through Medical THE LIVED EXPERIENCE OF SEEKING HEALTH CARE THROUGH MEDICAL TOURISM: AN INTERPRETIVE PHENOMENOLOGICAL STUDY OF ALASKAN PATIENTS TRAVELING INTERNATIONALLY FOR MEDICAL AND DENTAL CARE A DISSERTATION SUBMITTED TO THE GRADUATE DIVISION OF THE UNIVERSITY OF HAWAI‘I AT MĀNOA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN NURSING DECEMBER 2010 By Lee Ann Eissler Dissertation Committee: John Casken, Chairperson Kristine Qureshi Joyce Vogler Neil MacNaughton B. Jeannie Lum UMI Number: 3448673 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. UMI 3448673 Copyright 2011 by ProQuest LLC. All rights reserved. This edition of the work is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, MI 48106-1346 i Acknowledgements I am most grateful to my committee chair, Dr. John Casken. Within moments of meeting him, I knew that he shared my fascination with our international health care environment. His scholarly guidance, expertise, and support throughout the dissertation process were absolutely invaluable. I would also like to thank my committee members Dr. Kristine Qureshi, Dr. Joyce Vogler, Dr. Neil MacNaughton, and Dr. Jeannie Lum for their contributions. The supportive staff at the University of Hawai‘i at Mānoa, School of Nursing made my tenure as a distance student so much easier. The medical travelers who participated in this study deserve special recognition. Through their words, the world of medical tourism from the patient perspective is now highlighted. I wish them all ongoing health, wherever in the world they find it. A very special thank you to my friends and family who supported, listened, and edited tirelessly. Their unfailing words of encouragement and ongoing confidence in my abilities mean the world to me. Above all, my love and thanks to Bill for being my travel partner in all of life’s journeys. ii Abstract Purpose: A growing number of people from many countries are traveling internationally to obtain medical care. The purpose of this study is twofold: (a) to explore the experiences of international travel for the purpose of medical or dental care from the perspective of patients from Alaska and (b) to develop insight and understanding of the essence of this phenomenon. Study Design and Methods: The study is conceptually oriented within a model of health seeking behavior. Using a qualitative, interpretive phenomenological design, a purposive sample of fifteen Alaskan medical tourists who have experienced international travel for the objective of medical or dental care were individually interviewed. The data was analyzed using a hermeneutic process of inquiry to uncover the essential meaning of the experience. Results: The hermeneutic analysis of the participants’ narrative accounts allowed the themes of Motivation, Research, Obtaining Care, Follow-up, Advice, and Future Health Care to emerge. Sub-themes are used to further categorize data for increased understanding. The thematic analysis provides insight into the essential structure of the lived experience of the medical tourism phenomenon. Improved understanding of medical tourism provides further information about a modern approach to health seeking behavior. The conceptual definition and model for health seeking behavior are updated. Implications: Increased understanding of the experience of obtaining health care internationally and motivation for this nature of health seeking behavior from the patient perspective is needed in the global health care arena. Nursing professionals will benefit by being better able to advocate for patients’ choices in health seeking behavior, counsel regarding medical tourism options, provide follow-up health care after medical tourism, and actively participate in global health policy discussions. iii Table of Contents Acknowledgements .......................................................................................................................... i Abstract ........................................................................................................................................... ii List of Figures ................................................................................................................................ vi List of Tables ................................................................................................................................ vii Chapter One .................................................................................................................................... 1 Introduction ..................................................................................................................................... 1 Problem Statement ...................................................................................................................... 2 Research Question ...................................................................................................................... 2 Definition of Terms..................................................................................................................... 2 Significance of the Study ............................................................................................................ 3 Literature Review of Medical Tourism ....................................................................................... 5 History of medical tourism. .................................................................................................... 6 Medical tourism today. ........................................................................................................... 7 Medical tourism care............................................................................................................... 9 Motivation for medical tourism. ........................................................................................... 10 Concerns. .............................................................................................................................. 15 Impact on developing countries. ........................................................................................... 17 Summary ................................................................................................................................... 18 Chapter Two.................................................................................................................................. 19 Conceptual Orientation - Health Seeking Behavior ...................................................................... 19 Background ............................................................................................................................... 19 Examples and Contributing Factors in Health Seeking Behavior ............................................ 21 Definitions of Health Seeking Behavior ................................................................................... 23 Health Seeking Behavior Model ............................................................................................... 24 Future Health Seeking Behavior ............................................................................................... 27 Chapter Three................................................................................................................................ 28 Methodology ................................................................................................................................. 28 Phenomenology......................................................................................................................... 28 Sample....................................................................................................................................... 29 Human Subject Considerations ................................................................................................. 30 Recruitment ............................................................................................................................... 31 Data Collection ......................................................................................................................... 31 Analysis..................................................................................................................................... 32 iv Quality....................................................................................................................................... 33 Limitations ................................................................................................................................ 33 Conclusion ................................................................................................................................ 35 Chapter Four ................................................................................................................................. 36 Results ........................................................................................................................................... 36 Sample....................................................................................................................................... 36 Findings....................................................................................................................................
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