When darkness falls at mid-day: young patients' perceptions and meanings of chronic illness and their implications for medical care.

BACKGROUND This study illustrates the perceptions and meanings that patients who have had the onset of certain chronic diseases at young adulthood ascribe to their condition of chronic illness. The paper further examines the implications of such perceptions and construction for medical care. DESIGN Qualitative and ethnography. SETTING Outpatient chronically ill patients were recruited from the Korle Bu Teaching Hospital, Accra Ghana. Patients were followed up and studied in-depth in their homes. PARTICIPANTS Purposive sample of 24 consenting patients diagnosed of cancer, renal disease and stroke. METHODS Anthropological data collection techniques mainly in-depth interviews, narratives, conversation and observations were used. Issues explored included patients' perceptions, causal explanations, meanings ascribed to diagnosis, and search for treatment and cure. RESULTS Young adults had very low knowledge of chronic illnesses and did not consider themselves at risk to chronic diseases. The search for diagnosis, upon the presentation of symptoms, was long and winding. Families of young patients were more likely to make future search for "spiritual diagnoses" than elderly patients and their families. Keeping silent and maintaining secrecy about diagnosis are important ways by which young adult patients cope with their condition. Irrespective of the prognosis, young patients nurture a strong hope of cure. CONCLUSION Young adults diagnosed of certain chronic illnesses ascribe supernatural interpretations to their disease condition. These determine their attitude to their condition as well as health seeking behaviours adopted by them and their families. Responses interfered with their biomedical care and thus have implications for health promotion and healthcare planning and policy.