{
  "issue_key": "vol10-no2-2026",
  "volume": 10,
  "number": 2,
  "season": "Spring 2026",
  "year": 2026,
  "sequence": 7,
  "type": "research-report",
  "section": "Research Report",
  "title": "Navigating pluralistic health systems: Healthcare-seeking behaviour among people with disabilities in Bangladesh",
  "subtitle": null,
  "slug": "navigating-pluralistic-health-systems-healthcare-seeking-behaviour-among-people",
  "corporate_author": null,
  "authors": [
    {
      "given_name": "Ilias",
      "family_name": "Mahmud",
      "credentials": "PhD",
      "affiliation": "Head of Programmes and Academic Monitoring, London Churchill College; Director, LCC Research Centre",
      "email": "ilias.mahmud@lcc.ac.uk",
      "orcid": "0000-0003-2870-7715",
      "is_corresponding": true,
      "sequence": 1
    }
  ],
  "abstract": "Healthcare-seeking behaviour among people with disabilities in low- and middle-income countries remains insufficiently understood, particularly in contexts where biomedical, traditional and religious systems of care coexist. This study examines how people with disabilities in Bangladesh navigate formal and informal healthcare sectors before reaching specialised rehabilitation services. A sequential exploratory mixed-methods design was employed. Qualitative data were collected through in-depth interviews with 12 individuals with disabilities and four caregivers of children with disabilities, together with one focus group discussion with five individuals with disabilities. These findings informed a cross-sectional survey of 100 participants, comprised of people with disabilities and caregivers of children with cerebral palsy attending the Centre for the Rehabilitation of the Paralysed in Savar, Dhaka. Qualitative data were analysed thematically, and quantitative data were analysed using descriptive statistics, Chi-square tests and Fisher’s exact tests. Most participants initiated some form of treatment promptly after recognising illness; yet access to appropriate rehabilitation was often substantially delayed. Care pathways were dynamic and pluralistic: 82% of participants used both formal and informal sectors, and 36% used both concurrently. Healthcare-seeking decisions were shaped by illness interpretation, the influence of close kin, perceived treatment failure, gendered constraints and weak referral systems. Supernatural explanations of illness were significantly associated with informal healthcare utilisation. The findings suggest that delayed rehabilitation should not be understood simply as individual delay, but as the cumulative outcome of iterative therapeutic pathways produced through the interaction of cultural meanings, social relations and fragmented health-system responses. Disability-inclusive health systems require earlier referral, decentralised rehabilitation and culturally competent communication with patients and families.",
  "keywords": [
    "healthcare-seeking behaviour",
    "disability",
    "medical pluralism",
    "rehabilitation",
    "Bangladesh"
  ],
  "first_page": 25,
  "last_page": 41,
  "pdf_start": 26,
  "pdf_end": 42,
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  "notes": [],
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      "kind": "table",
      "file": "figures/table-01-p31.png",
      "caption": "Table 1. Socio-demographic characteristics of participants (n=100)",
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      "caption": "Table 3. Key determinants of selected health-seeking behaviours",
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      "caption": "Figure 1. Pathways of health-seeking behaviour among people with disabling conditions in Bangladesh: explanatory models, sectoral pathways and drivers of movement (adapted from Kleinman, 1980; medical pluralism framework).",
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