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