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Assessment of Factors Influencing Health Care Service Utilization in Rural Area of Bangladesh

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Assessment of Factors Influencing Health Care Service Utilization in Rural Area of Bangladesh International Journal of Community Medicine and Public Health Howlader MH et al. Int J Community Med Public Health. 2019 Sep;6(9):3710-3716 http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040 DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20193641 Original Research Article Assessment of factors influencing health care service utilization in rural area of Bangladesh M. Hasan Howlader, M. Ashfikur Rahman*, M. Imtiaz Hasan Rahul Development Studies Discipline, Khulna University, Khulna, Bangladesh Received: 24 June 2019 Accepted: 06 August 2019 *Correspondence: M. Ashfikur Rahman, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Access to health care services is one of the important preconditions for ensuring good health that is influenced by many socio-demographic characteristics of the individual population as well as policy interventions. The main objective of this study was to identify the factors that determine healthcare service utilization in rural area of Bangladesh. Methods: A cross-sectional descriptive study was carried out in the Rangpur union of Dumuria Upazila of Khulna division in Bangladesh. Data were collected from 195 household heads administering a structured questionnaire. The study applies principal component analysis (PCA) for determining the factors that affect health care services utilization. Results: Need factors (chronic diseases, disability, child sickness, and old aged parents) play the pivotal role to utilize the health care services. The second important factor that contributes to access to health care services is enabling factors consisting of income, distance to the nearest health care center, health cards/health insurance, land ownership, types of latrine use, and membership in a community group. The predisposing factors i.e. age, sex, religion, occupation and education have the least significant role in utilizing health care services. Conclusions: Utilization of health care services depends mostly on the perception and attitudes of people towards disease and disability. So, policy interventions should be taken to raise awareness among people along with regular monitoring of the activities of health care providers. Keywords: Access, Health care services and utilization, Need factors INTRODUCTION domain. In the public health context, it is very significant to examine the factors that affect health-seeking behavior It is widely established that good health is one of the and health services utilization from individual to 2 most essential indicators of human development. So, community level. Inequalities in access to health care facilitating proper health service is a prerequisite for services has been taken considerable attention by various 3 furthering human development and without giving proper scholars in the present public health research sphere. health care services, human development is not possible. WHO pointed out that providing at least basic health But, ensuring proper health care service and utilizing the services for the poor and underprivileged without any remaining health services is the most complex behavioral barriers ensuring, physical accessibility or acceptability phenomenon.1 Therefore, health care service utilization is of services universally is meant to be health services 4 an important issue to be discussed in the public health utilization. International Journal of Community Medicine and Public Health | September 2019 | Vol 6 | Issue 9 Page 3710 Howlader MH et al. Int J Community Med Public Health. 2019 Sep;6(9):3710-3716 But still, in developing countries, people have less access Participants to proper health care services comparing to developed countries it is thus prime challenges for developing The adult residents aged 18 years and above of both sexes countries to ensure adequate health services for all its who have visited at least once in UHC or CC for any citizens particularly for the underprivileged without any primary health care service during January 1 to February differentiation.5 28, 2018 were considered for the study subject. There were 4105 people of the above criteria visited in these In Bangladesh, there exist well-arranged three tires of two places. So, the study population was 4105 primary health care services, i.e. Upazila Health Complex comprising 3284 males and 821 females. Using the (UHC) at the sub-district level, union health and family formula of Taro-Yamane (1967) 195 samples was welfare centres (UHFWC) at the union (collection of few determined with 7% confidence interval (margin of villages) levels and community clinic (CC) at the village error).12 Two data collectors visited the households of level.6 But due to a lack of proper management and people having the above criteria and explained the study adequate facilities, these services are not reached to the aim and assured them that their identity would be kept marginalized people. Health care services utilization confidential. Their verbal consent was sought before the largely depends on some circumstantial and social factors collection of data. So, the people who gave verbal that determine the extent of health service utilization. consent to participate in the study were interviewed using a pre-structured questionnaire. The questionnaire was In this current study, socio-economic and demographic pre-tested before the actual data collection begun and was factors were analyzed with the help of the Andersen– approved by the development studies discipline of Newman behavioral model which is very common and Khulna University. The completeness of the widely accepted to examine the factors related to health questionnaire was checked just immediately after the services utilization. Previous study by Li et al pointed out interview. that need factors played a significant contribution to the use of existing health services utilization than enabling or predisposing factors in China whereas in Korea predisposing and need factors influence to receive existing health services than that of enabling factors.7,8 The main rationale of conducting the study is the growing inequalities of health services utilization particularly in developing countries like Bangladesh where the poor people are likely to be faced disparities in entertaining health services. Previous studies in Pakistan, Uganda, Korea, Nigeria and also many other developing countries found that health disparities in utilization of health care service is responsible for worsening the overall health status of the disadvantaged.8-11 So, the present was undertaken to determine the factors that affect health care services utilization in rural area. METHODS Figure 1: Conceptualization of factors affecting health Setting care service utilization. Following a cross-sectional research design, this study Conceptualization of the factors with variables was conducted in the Rangpur Union of Dumuria Upazila under Khulna Zilla from March 1 to March 31, 2018. It is The Andersen-Newman health behavior model has three a rural area where more than 80 percent of residents are chief components or factors, which later elaborated with economically dependent on agriculture. This area was several contributing variables or factors that influence selected purposively among the 14 unions of Dumuria and affect people’s potentiality to avail the prevalent Upazila. The people of this union are heavily reliant on health services.7,13 Predisposing factors are those that the UHC, CC and UHFWC for the emergency health care reflect the individual’s socio-demographic factors like services. Besides, people of this area also utilize age, sex, religion, number of family members, education, traditional healing practices. The transportation system and occupation, beliefs, and attitudes).3,7,11,14 The for reaching in the health care centers include van, enabling factors11 are the individual’s or household’s rickshaw, boat, motorcycle, easy bike as the roads are preference to receive the health services like family narrow and without brick or concrete. In order to get income, health insurance or card, land ownership, types major surgical interventions and physical check-ups for of houses and latrines and membership.1 Need factors critical diseases, people have to go to the divisional cities. denote the health status or perceived health outcomes International Journal of Community Medicine and Public Health | September 2019 | Vol 6 | Issue 9 Page 3711 Howlader MH et al. Int J Community Med Public Health. 2019 Sep;6(9):3710-3716 which stimulate to take action as an urgent basis i.e. negative value exerts the opposite direction between the chronic diseases perceived self-health disability, variables. children's sickness, old aged parents, etc.).8,14,15 RESULTS To conventionalize the model in the Bangladeshi context some exceptional variables like (membership of a Table 1 demonstrates the socio-demographic community or political groups, land ownership, latrine characteristics corresponding to factors of health care use) are introduced newly. The factors with variables are utilization of the participants. The age of the respondents delineated in (Figure 1). was (25 to 77) with an average of (49.42±9.18) years.15 Majority of the households (77.9%) were male-headed Statistical
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