Why most Togolese people do not seek care for malaria in health care facilities: a theory-driven inventory of reasons.

Using a broad theory of human motivation, the study examined the psychological structure of the reasons evoked by Togolese people for not attending medical facilities when they think they have malaria. Five hundred and thirty-two persons living in Lome, Togo were presented with a questionnaire of motives. Through exploratory and confirmatory factor analyses, a seven-factor structure of motives was found. Participants explained their reluctance to attend medical facilities by the facts that (a) malaria is not a serious illness that deserves much investment, (b) caregivers behave in an aggressive way and try to extort extra money, (c) malaria has always been self-treated at home, and (d) attending the health care facilities is too alarming for the family. The reasons for not attending were not related to the participants' mistrust in biomedicine, their willingness to keep control over things nor a personal feeling of unease.