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Table 3 Overview of Themes and Subthemes behind Different Reasons forDisclosure Patterns among Men and Women

From: Patterns of illness disclosure among Indian slum dwellers: a qualitative study

General category Themes Men Women
Choice of confidants Healthcare professionals as the final recipients of illness disclosure Confidants: spouse and clinical doctors
Reasons: share about chronic illness to ride out intense emotions and to receive treatment
Confidants: husbands and natal families are initial confidants for illnesses that lead to stigma, familial defamation and social penalty
Reasons: feel that natal family members are more compassionate, attentive and considerate caregivers than in-laws
Confidants: occasionally parents, close relatives and sometimes other people
Reasons: people who are going through similar phase and can understand the distress
Confidants: in-laws are involved inmore common health problems
Reasons: do not require emotional support
Confidants: outside the family, informal healers are considered as the initial confidants
Reasons: female-related illnesses and communicable diseases that primarily involve physical examination and that are complex to understand in the lay domain
Confidants: clinical doctors are sought at the final or acute stage
Reasons: mainly sought to cure illnesses
Social norms and fear of future social sanctions driving the choice of confidants Expressing illness is related to:
time, place and person;illness considered as symbol of agony and distress may spread negative vibes during ceremonies and festivals, and can bring illfate to the people who participated
Social sanctions:social penalty drives them to reveal only to spouses or natal families in order to avoid social exclusion, familial defamation and individual disgrace
Expressing illness isrelated to:
time, place and person; talking about illness can bring ominous effect to the people who are related on auspicious occasions that are held at familial and social levels
status, age and gender; prescribed norms drive single and young married couples to talk about common health problems with immediate and extended family
Sexually related illnesses are open for discussion with informal healers (because they treat illness in trying to uphold cultural norms) but not with family members, non-kin and clinical professionals of the opposite sex, who can be deemed to share a liaison relationship
Reasons todelay disclosure Bearable physical burden Illnesses or pain that can be handled are considered too normal to report Ignorance about the severity or effect of an illness results in leaving it unnoticed
Negative prior experiences of illness Job loss in the past prevents reporting the reappearance Exclusion from any sociocultural participation at familial and community level creates an identity crisis for women
Coping with livelihood and everyday financial struggle Income crisis forces men to devote more time to the workplace and downplay the severity of the illness Financial burden compels women to ignore illness as long as possible
Reasons not to delay disclosure Unbearable discomfort Unexplainable and unbearable internal pains are experienced as severe
Therapeutic value of disclosure By discussing illness, emotional, instrumental and informative support can be attained
Fear of unfamiliar illnesses Physical symptoms that cannot be linked to common health problems are cause for confusion, alarm and reporting Skilled to remain calm and composed, and socially approved to report any unfamiliar symptoms immediately
Previous negative outcomes of non-reporting or delay Severe impairment to the body because of ignoring illness
As a result, failure to carry out gender role as provider of livelihood
Severe impairment to the body because of ignoring illness
As a result, failure to carry out gender role as caregiver
Reasons not to disclose Withdrawal as a coping strategy To retain normal balance of life as longas possible by self-coping with difficult feelings
Perceived threat to social image To secure one’s position in the family and society by safeguarding masculine ego
Deteriorated atmosphere in slum environment impeding disclosure Busy coping with adverse physical and mental conditions of the slum Busy coping with adverse physical and mental conditions of the slum