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NOTES FROM THE FIELD 

Self-care or Delay in Seeking Healthcare: Reflections 

from the Field 

Shivanand Savatagi Basappa1   

1. INTRODUCTION 

“These days, I do not go to the hospital. If I have a fever or any other 
common disease, I take tulsi and drink hot water. I practise these remedies 
for two to three days. If the symptoms do not subside, then I go to the 
hospital,”2 said a participant from HD Kote taluka in Karnataka, when I 
asked him about his immediate response to health problems.  

I carried out the fieldwork described in this paper on 15–27 February 2021 
to understand self-care practices among families who use traditional 
medicine in HD Kote taluka, Karnataka. This fieldwork was carried out as 
part of a larger research study on self-reliance in primary healthcare among 
families using traditional medicine in HD Kote. Here, I reflect on the self-
care practices of these families and examine the potential impact on health 
outcomes.  

I collected data through field observation and 15 in-depth interviews with 
families from rural, tribal/Adivasi, and urban communities, using the 
purposive sampling method. The age range of participants was 30–60 years. 

                                                        
1 PhD scholar, The University of Trans-disciplinary Health Sciences and Technology (TDU), 

74/2, Jarakabande Kaval, Post Attur via Yelahanka, Bengaluru, Karnataka – 560064, and the 
Institute of Public Health (IPH), 3009, II-A Main, 17th Cross, Krishna Rajendra Rd, 
Banashankari Stage II, Bengaluru, Karnataka – 560070; bsshivabs@gmail.com.  

Copyright © Savatagi 2021. Released under Creative Commons Attribution-NonCommercial 

4.0 International licence (CC BY-NC 4.0) by the author.  

Published by Indian Society for Ecological Economics (INSEE), c/o Institute of Economic 

Growth, University Enclave, North Campus, Delhi 110007.  

ISSN: 2581-6152 (print); 2581-6101 (web). 

DOI: https://doi.org/10.37773/ees.v4i2.479  

2 Exact quote in vernacular language (Kannada): “Ittichina dinagalalli nanu aaspatrege hoguttill. 
Nanage jwara athava samanya kayile enadru bandare, tulsi matt bisi neerannu tegedukolluttene. Idannu 
eradarind mooru dina tagotini, nanage kadime aagalilla andre aaspatrege hoguttene”. Interview with a 
48-year-old farmer, Hirehalli-A village, HD Kote taluka, Karnataka, 17 February 2021. 

mailto:bsshivabs@gmail.com
https://doi.org/10.37773/ees.v4i2.479


Ecology, Economy and Society–the INSEE Journal [160] 

Of the 15 participants, seven were female and eight male. Most of the male 
participants—seven of them—were engaged in agriculture, and the female 
participants were engaged in either coolie (daily wage) or household work. 
The Kabini tributary of the Cauvery, which flows through HD Kote taluka, 
is their main source of irrigation water.  

2. SELF-CARE IN THE CONTEXT OF HEALTH 

Self-care is an integral part of promotive, preventive, curative, and 
rehabilitative care and offers unique opportunities to keep ourselves 
healthy; it is also considered as a renewed approach to primary healthcare 
(WHO 2009). However, the tension between self-care and state-delivered 
primary healthcare has not been sufficiently addressed (Levin and Idler 
1983), which raises scepticism about promoting self-care as a practice. 
Hence, there is a need to reflect on what is self-care, whom it is for, to what 
extent it should be followed, and its position within the health system 
(Webber, Guo, and Mann 2013). In low- and middle-income (LMIC) 
countries like India, traditional medicine is considered an important 
resource for population health, especially primary healthcare (Oyebode et al. 
2016). Homemakers play a significant role in the prevention of many 
diseases and the promotion of health through their nutrition-based 
interventions. Intergenerational knowledge regarding the use of traditional 
medicine potentially adds value to self-care as it can help in making better-
informed decisions.  

2.1 What Is Health, Disease, and Illness According to the 
Participants? 

Self-care for health is rooted in an understanding of proper dietary 
practices, consuming fresh air, physical activity, and other domestic 
activities that can prevent disease (Levin and Idler 1983). My field 
observations show that people had various definitions of health, including 
the absence of disease, being happy and satisfied, and meeting life needs. 
For instance, one interviewee, a resident of Hirehalli B village, said, “Health 
means doing good things and eating well, maintaining cleanliness, living in a 
good environment, getting good sleep, and having the ability to work 
efficiently.” 3  This statement covers the physical, psychological, 
environmental, and value dimensions of health. According to WHO, self-
care is “the ability of individuals, families, and communities to promote 
health, prevent disease, maintain health, and cope with illness and disability 

                                                        
3 Exact quote in vernacular language (Kannada): “Arogya andre chennagiruvudu, chennagi uta, 
nidde maduvudu hagu kelasvannu maduva samrthyavannu honduvudu.” interview with a 40-year-old 
woman homemaker, at Hirehalli B village, HD Kote taluka, Karnataka, on 17 Feb 2021. 



[161] Shivanand Savatagi Basappa 

with or without the support of a health-care provider” (WHO 2013). 
Critical reflection on this definition shows that self-care is a comprehensive 
approach that includes the promotion, prevention, and maintenance of 
health. Thus, self-care seems to be embedded within people’s 
understanding and practices concerning health.  

I also collected responses on reasons for disease or illness. One participant, 
a farmer in a village named MC Tholalu, indicated that the use of chemical 
fertilizers was a major cause of disease and illness. He said, “Sir, now 
everyone is using chemical fertilizers, but, earlier, they used organic 
fertilizers. The food used to be very tasty and there was no disease. Now 
there are many different types of fertilizers, so now there are many 
diseases.” 4  This understanding of disease was common across all 
participants whose occupation was agriculture. Participants’ beliefs about 
the reasons for disease varied across rural, urban, and tribal/Adivasi 
communities. In urban communities, participants believed that diseases 
were caused mainly by food habits and reduced physical activity, while 
Adivasis and tribals cited addiction to bad habits (e.g., smoking and 
drinking) as the predominant reason for disease.  

 

Figure 1: Self-care Practices among Study Participants 
Source: Original work, diagram is formed based on the themes obtained from the 
preliminary analysis of the data 

The activities that participants undertook to take care of their health ranged 
from physical activity to spiritual practices, as Figure 1 shows. Urban, rural, 

                                                        
4 Exact quote in vernacular language (Kannada): “Sir, evag ellaru rasayanik gobbar balastare, 
modalu novella kottige gobbar upayogistiddu, uta tumba ruche aagirtittu hagu yavude kayile irtiralilla. Evag 
bere bere chemicals use madtare, adakke bahala rogagalu bandidave”. Interview with a 60-year-old 
male farmer, at MC Tholalu village, HD Kote taluka, Karnataka, on 21 Feb 2021.  



Ecology, Economy and Society–the INSEE Journal [162] 

and Adivasi communities were aware of the importance of physical activity. 
However, their practices varied. For rural and Adivasi communities, 
physical activity was a part of daily work, since they were engaged in 
agriculture and domestic activities. Things were different in the urban 
context, as the lifestyle there involved less activity, and participants had to 
allocate a specific time to go for a walk, exercise, or practise yoga. Personal 
hygiene included individual care and cleanliness of domestic animals and 
the surroundings, which was also considered part of self-care across all 
contexts. 

Highlighting the importance of food, participants mentioned that they 
maintain their health by consuming “natural” foods that they grow in their 
own fields. Among the villagers, the notion of healthy food was strongly 
associated with food being free from chemicals. Apart from physical activity 
and consumption of natural food, most participants used home remedies to 
treat common health ailments; these included medicinal plants such as 
nagadali (Ruta graveolens), dodda patre (Coleus amboinicus), chitramoolika (Plumbago 
zeylanica), ondelaga (Centella Asiatica), tulsi (Ocimum tenuiflorum), hibiscus (Rosa-
Sinensis), simiribu (Simarouba), ginger (Zingiber Officinale), and pepper (Piper 
nigrum). Their first response to common illnesses was using these home 
remedies for two to three days, and if the symptoms did not subside, then 
they visited a hospital for further treatment. When I asked them to show 
me these home remedies, one participant took me around his village and 
showed me 10 plants that grew on the streets and in his field. Thus, the 
health-related practices of these households were based on the local 
ecosystem. The participants’ approach to health was not about getting 
medicine, but how they live with their local resources and ecosystem and 
regulate their lifestyle accordingly. Additionally, respondents also spoke 
about culture and tradition, spiritual practices, and values like honesty, 
trustworthiness, and responsibility as part of their self-care. Thus, self-care 
originates from the interaction between various factors; it is a 
comprehensive approach that includes promotion, prevention, and curative 
aspects.  

3. REFLECTIONS 

According to the participants, health is not only a physical or biological 
state—it has to do with the ecosystem and integration of body and mind. 
While a small section of the participants had a narrow understanding of 
health as the absence of disease, the majority linked health with multiple 
factors. The individual definitions of health also varied depending upon the 
context, age, and life stage of the participant. Therefore, for the 
participants, health is a multidimensional phenomenon embedded within 
the larger concept of well-being. The health behaviour of an individual is 



[163] Shivanand Savatagi Basappa 

shaped by their everyday needs, which comprise bodily needs, economic 
needs, social relations, emotional needs, and therapeutic needs. Self-care is a 
part of health behaviour and includes home-based solutions to health 
problems. It also entails having knowledge of the disease or illness and 
understanding our bodily responses—in other words, intellectual and 
embodied knowledge. Thus, the ability of an individual to make use of local 
knowledge and resources seemed to be an important part of their definition 
of self-care. It was evident that the practice and understanding of self-care 
were contextual and influenced by various factors, such as knowledge, 
values, traditions and culture, individual skills, and environmental and 
health system factors. Since health problems and suffering are obvious in 
communities, adopting coping strategies suggested by neighbours and other 
community members and accepting support from them are also considered 
as part of self-care.   

Individuals with illnesses are likely to try multiple solutions that could be 
medical or non-medical. Thus, it is difficult to categorize household 
practices as self-care or delays in seeking healthcare, as they may have 
varying degrees of effectiveness. The challenges of availability, accessibility, 
and affordability of institutional health interventions continue; there is still 
an ongoing debate about evidence-based practice versus practice-based 
evidence, and self-care falls in the latter category. Of course, there is greater 
value attached to medical knowledge, but one modality of treatment or 
intervention is not always the best. There is a need to emphasize pluralistic 
healthcare approaches for better health outcomes. In the case of pluralistic 
healthcare approaches, individuals need to be able to make informed 
decisions regarding their selection of healthcare services. This ability holds 
good even for self-care practices. Therefore, if communities make better-
informed decisions in their practice of self-care, they have the potential to 
produce better health outcomes and strengthen the health system. 
Otherwise, there might be continued delays in seeking healthcare, which 
can lead to detrimental effects on health. 

ACKNOWLEDGEMENTS 

I acknowledge the contributions of Dr Prashanth, Dr Unnikrishnan, and Dr 
Harini Nagendra for their critical reviews. I also acknowledge the financial 
support from the Indian Council of Medical Research (ICMR) through the 
Senior Research Fellowship (SRF) Award; Friends of Hope Trust, London, 
UK, for their PhD fellowship support; and the Institute of Public Health, 
Bengaluru, and the University of Trans-disciplinary Health Sciences and 
Technology, Bengaluru, for their TDU-IPH PhD fellowship award. I thank 
Swami Vivekananda Youth Movement (SVYM) organization for facilitating 



Ecology, Economy and Society–the INSEE Journal [164] 

my fieldwork, and I also acknowledge the support I received from all the 
study participants who shared their data. 

 

REFERENCES 

Levin, Lowell S, and Ellen L Idler. 1983. "Self-care in Health." Annual Review of 
Public Health 4(1): 181-201. https://doi.org/10.1146/annurev.pu.04.050183.001145 

Oyebode, Oyinlola, Ngianga-Bakwin Kandala, Peter J Chilton, and Richard J 
Lilford. 2016. "Use of Traditional Medicine in Middle-Income Countries: A WHO-
SAGE Study." Health Policy and Planning 31(8): 984-91. 
https://doi.org/10.1093/heapol/czw022 

Webber, David, Zhenyu Guo, and Stephen Mann. 2013. "Self-Care in Health: We 
Can Define It, but Should We Also Measure It?" Self-care Journal 4(5): 101-106. 

World Health Organization. Regional Office for South-East Asia. 2009. "Self Care 
in the Context of Primary Health Care." WHO Regional Office for South-East 
Asia. Accessed August 13, 2019. https://apps.who.int/iris/handle/10665/206352 

World Health Organization. Regional Office for South-East Asia. 2013. Self Care for 
Health: A Handbook for Community Health Workers & Volunteers. Accessed August 13, 
2019. https://apps.who.int/iris/handle/10665/205887 

 

https://doi.org/10.1146/annurev.pu.04.050183.001145
https://doi.org/10.1093/heapol/czw022
https://apps.who.int/iris/handle/10665/206352
https://apps.who.int/iris/handle/10665/205887

