Studying complex interactions among determinants of healthcare-seeking behaviours: Self-medication for STI symptoms in female sex workers
Résumé
Objectives: To describe frequency and determinants of self-medication for symptoms of sexually transmitted infections in a female sex worker population. To present a methodology exploring the best predictors as well as the interactions between determinants of self-medication. Methods: Cross-sectional survey of 4,153 female sex workers carried out in Peru. We estimated the prevalence of self-medication from the subsample of participants who had experienced symptoms of sexually transmitted infections in the last 12 months (n=1,601), and used successive logistic regression models to explore the determinants. Results: Self-medication prevalence for a reported symptomatic episode during the last 12 months was 32.1% [95% CI 29.8 to 34.6]. It was negatively correlated with work in brothels (adjusted OR 0.51 [95% CI 0.28-0.93], p=0.028) and awareness of STI services available for female sex workers (adjusted OR 0.49 [95% CI 0.29-0.81], p=0.006). Other determinants were organised at different levels of proximity to the outcome creating pathways leading to self-medication. Conclusions: The importance of the staggered analysis presented in this study resides on its potential to improve the understanding of associations between determinants and, consequently, the targeting of interventions. We observed that awareness of STI services available for female sex workers increases access to healthcare, which in turn decreases self-medication. Additionally, the sharing of information that takes place between brothel-based female sex workers was also related to a diminishing prevalence of self-medication. These two main predictors provide an opportunity for prevention programmes, in particular those designed to be led by peers.
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