The fact that more women than men participated in both urban and rural communities might be. because women are more likely to seek and use health care, possess greater knowledge about health, are compliant with a therapeutic regimen and monitor the health of others as well as their own health, , although not explicitly explored in this study. Significantly fewer people in rural communities were interviewed as data saturation was quicker reached indicative of more homogeneousity. The difference between employment rate in urban communities and that in rural communities, as found in this study, indicated that members of urban communities were more likely to be employed. This is confirmed by Banerjee et al. , who pointed out that unemployment has risen in South Africa since the first democratic elections in 1994, among several other reasons because there is a mismatch between places where jobs were available in the formal sector are and places where (unemployed) people live. Consequently, the available weekly budget for participants from rural communities was significantly smaller. The source of this income obviously differed for employed and unemployed participants. During the interviews, the researchers in the field probed for income from day jobs, especially in interviews with participants who considered themselves as unemployed. This still did not explain the unexpected difference between employed and unemployed rural participants with regard to their available weekly budget. The difference might be ascribed to factors such as that family members (e.g. adult children who are employed) regularly send money home to the unemployed family members. In rural communities, there were often more unemployed participants receiving grants than there were employed participants in paid work. In addition, the unemployed participants received more money in the form of grants than the employed earned through their labour. Most grants were Child Support Grants, which are provided by the government to ensure that caregivers of young children living in extreme poverty are able to access financial assistance in the form of a cash transfer to supplement, rather than replace, household income . The review of the Child Support Grant in 2008 confirmed that among individuals who were eligible for the grant, caregivers in rural or informal urban areas were more likely to receive the grant than those in formal urban areas .
Participants living in urban communities rated their health significantly better than rural participants. Health status is linked to socio-economic status, and could therefore be related to the fact that unemployment is more prevalent among rural participants, who consequently have less money available to spend on good nutrition and health care. Although visits to governmental health clinics and (prescribed) medication at these facilities are free of charge in South Africa, transport to these services is not available for everyone, due to an absence of transport or a lack of money to pay for transport. This is especially the case in rural communities, where distances to health clinics can be relatively long . Furthermore, there is a significant difference in terms of rated health across different age groups in urban and rural communities. Urban participants of 65 years and older and rural participants in the age group 35 to 44 years rated their health the poorest. The urban participants of 65 years and older possibly experience health problems associated with aging, whereas the health problems of the younger rural group could possibly be ascribed to the fact that the HIV prevalence among this age group is significantly higher than among the other age groups. The urban population is also older than the rural population, which could explain why the different age groups in the communities rated their own health differently. Almost half the urban and rural participants felt sick on one or more days in the preceding 30 days and both urban and rural participants who felt sick rated their health worse than other participants. Members of urban communities were likely to rate the severity of this illness higher, and most of them were able to treat themselves successfully, whereas rural participants were less likely to do so. Although medication is available for free at health clinics, there are often long queues, which makes going to the clinic a day trip. Urban communities have local pharmacies where medication can be purchased without a prescription, but rural areas lack these facilities.
Urban participants rated the impact of diabetes, cancer and heart problems on their daily lives larger than rural participants did. A possible reason why these diseases are reported more frequently by the older participants in urban communities is that these diseases better known among that age group. Effects of the epidemiological transition are also visible in these urban communities, and changes in lifestyle, including dietary and activity patterns, resulted in an increased incidence of non-communicable diseases. Increasing urbanisation also accounts for increasing levels of stress and a decline of the traditional social support systems . Rural participants, in turn, rated the impact of tuberculosis on their daily lives larger. Tuberculosis had a higher prevalence in rural areas than in urban areas and therefore had a bigger impact on the daily lives of rural participants. Most participants in both urban and rural communities rated the impact of HIV or AIDS as large and participants in both communities indicated that its effect was worse than that of any other disease. The prevalence of HIV or AIDS was similar in urban and rural communities.
Urban and rural participants have similar expectations of the different health care providers: they expect (proper) treatment and want to be healed or to receive help. However, urban and rural participants have different patterns of utilisation of health care providers. Members of urban communities preferred to visit a private medical doctor, whereas rural participants preferred to visit a health clinic. Again, this was also related to the available weekly income, since a health clinic provides free care and a medical doctor in private practice does not. Urban participants considered the care provided by a private medical doctor, for which they must pay, as superior to that provided by a health clinic, mainly because the service was better. Rural participants reported that they had to be very ill before they would visit a private medical doctor. The main motivation for visiting a doctor in private practice or a health clinic was the same for most urban and rural participants, namely because they were sick/ill or not feeling well. Another important reason for urban participants to visit a health clinic is to obtain monthly treatment for non-communicable diseases, such as hypertension and diabetes.
A large number of respondents, both urban (67.2%) and rural (69.1%), indicated that they never visit a traditional healer. This is confirmed by Hirschowitz et al., who found that 33.3% of the African urban population and 30.7% of the African rural population of South Africa visit a traditional healer . In contrast, Pinkoane et al.  found that an estimated 80% of the black population use traditional medicine. Approximately a third of this study population (urban and rural) visited a traditional healer primarily to address social problems. Urban participants in particular would visit a traditional healer when Western science did not improve their condition. Significantly, rural participants attached equal importance to social problems and to incidents of suspected witchcraft as reasons for visiting a traditional healer.
25.2% of urban participants and 24.4% of rural participants described access to health care as insufficient. Most urban and rural participants considered their access to health care sufficient, although 55.0% of the urban participants and 45.6% of the rural participants experienced difficulties with accessing health care. Both urban and rural participants experienced difficulties with regard to transport/distances to facilities, financial constraints, and/or the service provided by the health care facilities, not to the same extent. Dissatisfaction with the service included problems with the provision and availability of medication, the number and quality of the staff, facilities (including equipment), service hours and the capacity (ability to attend all the patients within a reasonable time). Small available budgets restrict the choice of health care providers, both in the case of urban and rural participants, and may also compel people to delay seeking health care . Furthermore, because the public health service in South Africa is overburdened and under-staffed, waiting times are excessive and consultation times too short to be effective . These findings confirm results of previous studies that financial considerations , perceived quality of a health care provider and the geographic location of the provider  are important criteria influencing an individual’s choice [24, 25].