Topic Theme Supporting Quote “So would you think that you and your family are in good health now?” Overwhelmingly the group said they were in fair health, but not excellent health.  They are also aware that they are vulnerable to situations that might decrease their health status. “I am OK and so are the kids. It is not excellent…but pretty good. “No special problems. Everyone is healthy.”   Health conditions the workers were most concerned about for themselves and families were mixed with lifestyle diseases and infectious diseases. “I have high blood sugar but not high BP” “There is lot of stress in my life and then sometimes my stomach gets upset.” “I am just concerned about Dengue fever” “There are no problems in the household apart from TB.” “What do you think about the ESIC medical services that are currently being provided to you and your family?” Five people have never used the ESIC services for various reasons.  They either had bad experiences and do not want to go back or they are new to the company and has not had a chance to use them. “I don’t use ESIC now after that experience. I use private clinics.” “I have not been to ESIC. I go to homeopathic doctor when needed.”     Many workers have problems with the clinics sponsored by ESIC.    “I go there because I have to. They make it so difficult that I would not like to go back again.”   Many reported specific problems when they were at the clinic.   Long wait times: “You have to stand in line, it takes a lot of time. One has to take a day off.” Clinics provide poor quality of care, delayed treatments  and lack of facilities “Here the dispensary is quite useless.” & “My wife had an operation in her ears. I did a lot of treatment within ESIC and then they gave a date for the operation after one year.” & “Both kids were born with C section. Had to be done in private clinic as ESIC has no facility for that.” Corruption: “(In response to the ESIC clinic worker being ineffective) When I gave him a Rs.50 note, all the work got done.” &  “The problem is long waiting time. Somebody comes in a car and hands them Rs.50 …they get seen immediately. We waited a full day and nothing happened.”   Workers generally prefer private clinics, because they are more efficient (time-saving) and tend to treat right away.  The drawback is that they have to pay out of pocket. “Normally I prefer to pay to private clinics as the treatment is done in time.” “If there is a major issue, I go to a nice private doctor first before ESIC.” “For small diseases I go to a private clinic. It is less waste of time and more efficient.”   When price is prohibitive, then they must fall back on ESIC “The private clinics are very expensive for major health issues. I go to ESIC then.” “If the management provided health programs…would it be useful?”   Overwhelmingly workers were interested in participating in all types of programs, including avoidance of infectious and non-infectious diseases. “This would be definitely beneficial as my knowledge about these issues is limited. Yes, I would. If the opportunity arises, then we can both attend (including wife), otherwise just myself.”   Preferred Frequency/Timing     “Weekly would be nice. At least once a month.” Many insisted that work comes first, so they cannot cut into those hours but they would be willing to stay after work: “I will attend after work if needed. I don’t want company to suffer.” & “Best time is after work.”   Some preferred to come alone and some wanted to bring their families (almost split)                 Will come: “Yes, I would like my wife to attend if she can come.” & “I will attend but if convenient then my wife will attend as well.” & “My wife will come if needed.” Will not come: “I will attend. I would like them (wife/son) to attend but it is not possible as they do not live here.” & “My family will not be able to come as it is very far for her. I will come alone.” & “She works in the school and it will be difficult for her to attend.” Eating in the cafeteria/canteen Overwhelmingly, they reported that they do not eat from the canteen Mostly because they bring food from home: “Normally I get it from home” & “I bring food from home. Don’t eat in the canteen.” Possible reason is that the food is not good quality: “I have eaten in the cafeteria only a few times. The food is very average. I bring my food from home.” “What does you wife do to keep you healthy and maintain it? How does she encourage you?” Workers reported that she encourages them to eat to healthy diet. “She tells me on the phone not to eat too many fried foods and eat outside.” & “She is very careful and makes sure I take lunch.”   She also provides healthy foods. “She makes sure we don’t eat stale food.” & “She is responsible and keeps doing things. Not too much sugar, light meals etc.”   Many also reported that their wives were more times strict than passive. “My wife is careful in controlling my diet.  She is strict.” & “She does not use too much oil and spices. Even if I say I want it, she restricts it.”   Fried Foods “My wife now limits the amount of fried foods and sweets at home.”   Other behaviors less frequently reported. “She does the exercises with me. I can’t do them without her.” “She is aware of the insect bites and uses nets for the kids and us.” “She keeps the house clean.” “Is there anything you can do for your wife or your kids that they be healthy?” Many reported that they are currently doing the best they can, given their situation.  It also appeared that the women were in control of many of the household responsibilities and decisions. “I am doing for the family what I can.” & “I do the best I can.”   Other issues. “Buy fruits but she does not eat.” “I buy fresh foods and fruits.”   “…avoids fast food restaurants” “Any other Health Issues” Many said that there were no other health issues they were concerned about.     Few reported the following issues: Reiterating the point that the company and ESIC should be doing something more:     “There should be monthly check-up. I have never had a BP check. I gave blood at blood bank…..that was the last time I got some checkup. There are no checkups, There should be camps. People will come.” “Please make sure that these programs are held. We will keep learning then.”   Money is prohibiting them to make good health decisions: “How can one be concerned about healthy diet when things are so expensive. There is not enough money to go around.”   Educational programs, targeting prevention of chronic and infectious diseases as well as environmental diseases were brought up. There was significant interest in learning about good diet. “You told me of the 3 kinds of programs. I would like to attend all three types.”         “I would like to know what I should be eating. What kind of oils to use, should I be eating boiled foods. This would be beneficial.” “Education is key.”

Table 3: Results from semistructured, one-on-one interviews of ESIC workers in India (n =25).