Caregivers’ perceptions of childhood pneumonia in Western Kenya: a theory of practice perspective

Abstract

Caregivers' beliefs about their children’s health, perceived causes of illness, and approaches to treatment significantly influence health-seeking behavior. Using Bourdieu’s Theory of Practice, we explore the influence of caregivers’ social and cultural capital within a specific social environment that shapes pneumonia perceptions. An ethnographic study, a combined mixed method qualitative study, was conducted between April and October 2024. A total of 14 in-depth interviews, 3 focus group discussions, and 11 caregivers participated in the participant observation. Transcribed interviews were analyzed using a phenomenological hermeneutic approach by reading and re-reading transcripts to identify recurrent themes and interpret the understanding of childhood illnesses, perceptions of pneumonia, and how they influence health-seeking behavior. Caregivers have reported three main causes of pneumonia: exposure to cold, hereditary factors, and pathogens. All caregivers identified exposure to cold, such as cold weather or riding motorcycles, as a cause of pneumonia. Few knew that germs could cause pneumonia, while a few believed that pneumonia was hereditary. Asthma, perceived as a hereditary condition, is also believed to cause pneumonia. However, there is confusion regarding whether pneumonia and asthma are distinct illnesses or the same condition. Regardless of the specific belief, exposure to the cold remained the most dominant and widely accepted explanation for pneumonia across all caregivers. Additionally, there was no widely recognized local terminology for pneumonia; instead, caregivers described it using literal descriptions of observed symptoms, such as coughing, chest congestion, and difficulty in breathing. Caregivers’ symptom-based interpretations reflected reliance on observable signs rather than biomedical diagnostic labels. Perceptions of pneumonia and terminologies were predominantly shaped by cultural beliefs and interactions within the social environment. To minimize the gap between biomedical and culturally mediated knowledge, culturally sensitive health education programs that emphasize the recognition of key pneumonia symptoms using locally understandable languages and concepts should be developed and initiated.