ANNALS OF IBADAN POSTGRADUATE MEDICINE
O.O. Latunji1 and O.O. Akinyemi2
Background: Health-seeking behaviours (HSB) are closely linked with the health status of a nation and thus its economic development. Several studies have described HSB within the context of various diseases. However, knowledge of HSB among population sub-groups is still scanty. This study aims to determine factors most important to civil servants when seeking health care.
Methods: A descriptive cross-sectional study was conducted among 337 civil servants working in the Federal Secretariat, Ibadan, Nigeria. An interviewer administered semi-structured questionnaire was used to collect information. Chi-square tests were used to test for associations while binary logistic regression test was used for determining predictors. All data analysis was done at 5% level of significance.
Results: Members of the poorest quartile were 6 times more likely to have inappropriate HSB than the richest quartile (Q4:Q1= 5.83; O.R: 16.12, 95% C.I: 2.61-11.03). Visits to the hospital or clinic (62.2%) was the most common source of healthcare sought. This was followed by visits to the chemist (33.0%), traditional healers (4.3%). A little more than one-third (34.5%) of respondents considered good service delivery as the most important factor affecting HSB. This was followed by proximity (23.9%), affordability (20.4%), prompt attention (8.8%) and readily-available drugs (7.1%). Completing only basic education [O.R: 0.24 (0.06, 0.96)] and out of pocket payment [O.R: 0.04 (9.16, 82.45)] were associated with a reduction in the likelihood of seeking healthcare from formal sources.
Conclusion: Appropriate health-seeking behaviour was found to be high among civil servants. However, lower cadre workers and those with lower levels of education need to be targeted during policy formulation to improve health seeking behaviour. In addition, health insurance schemes should be extended to cover more of the population in order to improve health-seeking behaviour.
Keywords: Health seeking behaviour, Civil servants, Healthcare provider, Service-based characteristics.
Dr. O.O. Akinyemi
Dept. of Health Policy & Mgt.,
College of Medicine,
University of Ibadan,
Healthcare seeking behaviour (HSB) has been defined as, “any action or inaction undertaken by individuals who perceive themselves to have a health problem or to be ill for the purpose of finding an appropriate remedy”.1 Health seeking behaviour can also be referred to as illness behaviour or sick-term behaviour. Health seeking behaviour is situated within the broader concept of health behaviour, which encompasses activities undertaken to maintain good health, to prevent ill health, as well as dealing with any departure from a good state of health.2
Studies that have attempted to describe factors that significantly affect health seeking behaviour during illness episodes can be broadly classified into two groups.2-4 The first group are studies which emphasize the utilization of the formal system, or the health care seeking behaviour of people. The studies that fall under this category involve the development of models that describe the series of steps people take towards health care. These models are sometimes referred to as ‘pathway models’.5 While there are several variations of these models, the Health Belief Model and Andersen’s Health Behaviour Model are often used as a basis in discussions involving HSB.5,6 The second group comprises those studies which emphasize the process of illness response, or health seeking behaviour. These studies demonstrate that the decision to engage with a particular medical channel is influenced by a variety of factors such as socio-economic status, sex, age, the social status, the type of illness, access to services and perceived quality of the service.7,8 Majority of the studies under this second category focus on specific genres of determinants which lie between patients and services such as geographical, social, economic, cultural and organizational factors.9-11 For example, access to health facilities, socio-economic status and perceived quality of service have been found to be significant influencers of health seeking decisions among different population segments.9,12,13 Inappropriate HSB has been linked to worse health outcomes, increased morbidity and mortality and poorer health statistics.14,15 Research into HSB in LMICs suggests several factors influence the HSB of the population and certain segments of the population are more likely to use appropriate HSB than others.
Inappropriate HSB and its previously mentioned effects have been found to be skewed among different population segments. For example, in Pakistan, households whose average income was below the minimum wage were less likely to seek formal medical care for their illness than those whose incomes were above the minimum wage.16 In Kenya, almost 70% of pregnant women within households in the upper socio-economic stratum were found to have their deliveries in health facilities compared with 42% among pregnant women in the middle socio-economic stratum and 38% in the low socio-economic stratum.13
In a study in Nigeria, as many as 71% of rural dwellers have reported inappropriate HSB during their last illness episode while only 53% of urban dwellers reported inappropriate HSB during their last illness episode.17 Similarly, Nigerian women living in areas where the ratio of population to Primary Healthcare Centre (PHC) was high (more than 9,000:1) were less likely to have a skilled birth attendant present during childbirth than areas where the ratio of population to Primary Healthcare Centre (PHC) was lower (less than 6,000:1).18 This disparity makes it necessary to determine the factors affecting HSB among different segments of the population. This is essential to guide policy formulation and implementation. An important aspect of HSB is the choice of healthcare provider made by people when responding to illness episodes. This study seeks to identify which socio-demographic and health service-based factors influence HSB among civil servants, who represent a sizeable proportion of the working population in the country.