Search

Background: Globalization and urbanization have increased international and internal migration. However, migrants are still not absorbed into the local communities and remain vulnerable groups. Hence, the present study aimed to determine the quality of life (QoL) and healthcare-seeking behavior (HCSB) of internal migrant laborers in Coimbatore, Tamil Nadu. Methodology: An analytical cross-sectional study was conducted in the year 2023 among 321 migrant laborers residing for a minimum duration of 6 months in Coimbatore. A pre-tested questionnaire was used to collect data on socio-demography, QoL (using the WHO BREF scale), HCSB, and healthcare expenses. Ethical clearance was obtained from the institutional ethical committee. Informed written consent was obtained from the participants. Data were analyzed using SPSS version 27. Mann–Whitney U test and Kruskal–Wallis test were used to compare QoL across socio-demographics and HCSB. Results: The overall QoL score was 61, and those in social and environmental domains were also above 60. The QoL was higher in the environmental and social domains than in the physical and psychological domains. Females, married people, those currently living with their family, those working in the organized sector, and those in higher socio-economic status had better QoL than their counterparts. Per capita income had a positive correlation with physical, psychological, and environmental aspects of life. About 68% of those who used private sector healthcare services had catastrophic health expenditures (CHEs). Conclusion: The overall QoL among migrant laborers was moderate. Migrants preferring formal healthcare enjoyed better QoL. Major CHE was for delivery, and hence, the barriers to accessing free government services are to be explored. [ABSTRACT FROM AUTHOR]

Background Healthcare seeking behavior (HSB) and community perception on cholera can influence its management. We conducted a cross-sectional survey to generate evidence on cholera associated HSB and disease perception in populations living in cholera hotspots in Ethiopia. Methods A total of 870 randomly selected households (HHs) in Shashemene Town (ST) and Shashemene Woreda (SW) participated in our survey in January 2022. Results Predominant HHs (91.0%; 792/870) responded "primary health center" as the nearest healthcare facility (HCF). Around 57.4% (247/430) of ST HHs traveled <30 minutes to the nearest HCF. In SW, 60.2% (265/440) of HHs travelled over 30 minutes and 25.9% (114/440) over 4 km. Two-thirds of all HHs paid

Abstract Introduction : Mothers/caregivers should be aware of a newborn’s danger signs and promptly seek medical attention. Hence, this study assessed mothers’/caregivers’ awareness, healthcare seeking behaviors for neonatal danger signs and their determinants in the developing regional state of Ethiopia. Methods A community-based cross-sectional study was employed among mothers/caregivers of neonates in the developing regional state of Ethiopia. The sample was determined in collaboration with the Central Statistics Agency of Ethiopia. Stratified multi-stage cluster sampling was used to recruit the sample. Data were collected through an interviewer administered structured questionnaire using a tablet computer. Descriptive statistics and binary logistic regression were applied to identify determinants of awareness and treatment-seeking behavior for neonatal danger signs. Results The result of the study showed that nearly one-third (32.7%) of the respondents had a good level of awareness of neonatal danger signs, and 69.0% of the respondents had good healthcare-seeking practice about neonatal danger signs. Regional state (Benishangul-Gumuz) [AOR = 1.61; 95% CI (1.09, 2.39)], Muslim’s [AOR = 1.75; 95% CI (1.20, 2.55)] and permission to travel to a health facility [AOR = 0.48; 95% CI (0.37, 0.63)] were determinants of mothers’/caregivers’ awareness about neonatal danger signs. Antenatal care (ANC) attendance and institutional delivery were shown to have a positive association with neonatal healthcare seeking (AOR = 2.14 and AOR = 2.37, respectively). Conclusion In Ethiopia’s developing regional states, mothers/caregivers were remarkably unaware of neonatal danger signs. Region, religion, mothers’/caregivers’ age, and need for permission to travel to a health facility were predictor variables for neonatal danger sign awareness. Better healthcare seeking practices, which are determined by ANC attendance and institutional delivery, are observed in these regions. Federal and regional governments should give these regions due attention. Moreover, regional health bureaus and health professionals should tackle the problem by focusing on the identified factors.

Introduction: : Mothers/caregivers should be aware of a newborn's danger signs and promptly seek medical attention. Hence, this study assessed mothers'/caregivers' awareness, healthcare seeking behaviors for neonatal danger signs and their determinants in the developing regional state of Ethiopia. Methods: A community-based cross-sectional study was employed among mothers/caregivers of neonates in the developing regional state of Ethiopia. The sample was determined in collaboration with the Central Statistics Agency of Ethiopia. Stratified multi-stage cluster sampling was used to recruit the sample. Data were collected through an interviewer administered structured questionnaire using a tablet computer. Descriptive statistics and binary logistic regression were applied to identify determinants of awareness and treatment-seeking behavior for neonatal danger signs. Results: The result of the study showed that nearly one-third (32.7%) of the respondents had a good level of awareness of neonatal danger signs, and 69.0% of the respondents had good healthcare-seeking practice about neonatal danger signs. Regional state (Benishangul-Gumuz) [AOR = 1.61; 95% CI (1.09, 2.39)], Muslim's [AOR = 1.75; 95% CI (1.20, 2.55)] and permission to travel to a health facility [AOR = 0.48; 95% CI (0.37, 0.63)] were determinants of mothers'/caregivers' awareness about neonatal danger signs. Antenatal care (ANC) attendance and institutional delivery were shown to have a positive association with neonatal healthcare seeking (AOR = 2.14 and AOR = 2.37, respectively). Conclusion: In Ethiopia's developing regional states, mothers/caregivers were remarkably unaware of neonatal danger signs. Region, religion, mothers'/caregivers' age, and need for permission to travel to a health facility were predictor variables for neonatal danger sign awareness. Better healthcare seeking practices, which are determined by ANC attendance and institutional delivery, are observed in these regions. Federal and regional governments should give these regions due attention. Moreover, regional health bureaus and health professionals should tackle the problem by focusing on the identified factors. [ABSTRACT FROM AUTHOR]

Objectives: Early isolation and care for Ebola disease patients at Ebola Treatment Units (ETU) curb outbreak spread. We evaluated time to ETU entry and associated factors during the 2022 Sudan virus disease (SVD) outbreak in Uganda. Methods: We included persons with RT-PCR-confirmed SVD with onset September 20-November 30, 2022. We categorized days from symptom onset to ETU entry (“delays”) as short (≤2), moderate (3-5), and long (≥6); the latter two were “delayed isolation.” We categorized symptom onset timing as “earlier” or “later,” using October 15 as a cut-off. We assessed demographics, symptom onset timing, and awareness of contact status as predictors for delayed isolation. We explored reasons for early vs late isolation using key informant interviews. Results: Among 118 case-patients, 25 (21%) had short, 43 (36%) moderate, and 50 (43%) long delays. Seventy-five (64%) had symptom onset later in the outbreak. Earlier symptom onset increased risk of delayed isolation (crude risk ratio = 1.8, 95% confidence interval (1.2-2.8]). Awareness of contact status and SVD symptoms, and belief that early treatment-seeking was lifesaving facilitated early care-seeking. Patients with long delays reported fear of ETUs and lack of transport as contributors. Conclusion: Delayed isolation was common early in the outbreak. Strong contact tracing and community engagement could expedite presentation to ETUs.

Younger onset colorectal cancer (CRC) rates continue to rise. Survivors younger than the requisite age of population-based screening guidelines experience adverse symptoms, longer appraisal delays, and more advanced-stage diagnoses. This secondary analysis of interviews with n=252 recently diagnosed CRC survivors was completed to compare younger and older survivors' symptoms, attributed causes, and healthcare seeking assets. The original transcripts and quantitative data were divided into two survivor classifications, younger (age <50 years) (N=64) and older (N=188). Bivariate analyses assessed differences between younger and older survivors for symptoms, attributed causes, and seeking healthcare assets. Multiple logistic regression models adjusting for race, sex, income, education, and stage of diagnosis were conducted for significant bivariate findings. An α level.05 was used to detect significance. Bleeding (훘2=3.8, p =0.05) and loss of appetite/weight differed between survivors (훘2=5.3, p=0.02) but not after controlling for sex and race respectively. Younger survivors were more likely to report being too young/healthy to have cancer (훘2=7.8, p<0.01) and social support encouragement to seek healthcare (훘2=6.4, p=0.01). Having a regular healthcare provider was more common among older survivors (훘2=6.4, p=0.01). Logistic regression models also detected age as a significant predictor for all healthcare seeking assets. Clinical and public health practice can benefit from understanding that CRC symptoms may present similarly but assets that facilitate seeking healthcare appraisal differ based upon age. Expanding knowledge of CRC risk factors and symptoms across healthcare professionals and the general public could promote earlier appraisal regardless of age and improve outcomes for younger survivors. [ABSTRACT FROM AUTHOR]

This study explored the factors associated with healthcare avoidance behavior for menstrual disorders and menopausal symptoms among women in Japan. Using data from a nationally representative cross-sectional online survey conducted in September 2022, responses from 4,950 women aged 25–59 were analyzed. This study applied binomial logistic regression models specifically to participants who reported having ever felt the need to seek healthcare assistance due to health issues related to menstruation and menopause. We computed adjusted odds ratios for key sociodemographic traits, work environment factors, health literacy, menstrual and menopausal symptoms, and attitudes and understanding regarding women’s health, associated with healthcare avoidance behavior in the past 12 months. As a sensitivity analysis, a regression was performed limited to those who are working. The results showed that 50.6% of respondents recognized the need for healthcare support for menstrual or menopausal health issues, but 22.8% exhibited healthcare avoidance in the past year. Younger and high-income individuals showed higher avoidance rates. Those with diagnosed gynecological conditions and those perceiving menstrual pain as something to endure also displayed increased avoidance tendencies. Women experiencing significant health effects beyond work and those lacking understanding of the purpose of health check-ups were more prone to healthcare avoidance. Our results underscore the importance of implementing strategically tailored health education initiatives, and re-examining societal attitudes concerning women's health, in order to cultivate enhanced healthcare-seeking behaviors among women.

Background Ideally health insurance aims to provide financial security, promote social inclusion, and ensure equitable access to quality healthcare services for all households. Community-based health insurance has been operating in Ethiopia since 2011. However, its nationwide impact on universal health coverage has not yet been evaluated despite several studies being conducted. Objective We evaluated the impact of Ethiopia’s community-based health insurance (2012–2021) on universal health coverage. Methods On 27 August 2022, searches were conducted in Scopus, Hinari, PubMed, Google Scholar, and Semantic Scholar. Twenty-three studies were included. We used the Joana Briggs Institute checklists to assess the risk of bias. We included cross-sectional and mixed studies with low and medium risk. The data were processed in Microsoft Excel and analyzed using RevMan-5. The impact was measured first on insured households and then on insured versus uninsured households. We used a random model to measure the effect estimates (odds ratios) with a p value < 0.05 and a 95% CI. Results The universal health coverage provided by the scheme was 45.6% (OR = 1.92, 95% CI: 1.44–2.58). Being a member of the scheme increased universal health coverage by 24.8%. The healthcare service utilization of the beneficiaries was 64.5% (OR = 1.95, 95% CI: 1.29–2.93). The scheme reduced catastrophic health expenditure by 79.4% (OR = 4.99, 95% CI: 1.27–19.67). It yielded a 92% (OR = 11.58, 95% CI: 8.12–16.51) perception of health service quality. The health-related quality of life provided by it was 63% (OR = 1.71, 95% CI: 1.50–1.94). Its population coverage was 40.1% (OR = 0.64, 95% CI: 0.41–1.02). Conclusion Although the scheme had positive impacts on health service issues by reducing catastrophic costs, the low universal health coverage on a limited population indicates that Ethiopia should move to a broader national scheme that covers the entire population.

Background It is of great significance to study the choice of a healthcare institution in patients with multimorbidity in China during the implementation of hierarchical medical system since relevant research is still insufficient. Objective To study the choice of a healthcare institution and associated factors in patients with multimorbidity in China during the implementation of hierarchical medical system, providing a reference for further implementation of the hierarchical medical system and rational allocation of medical resources. Methods A survey using a self-developed questionnaire was conducted with a random sample of patients with multimorbidity who visited the healthcare institutions in Shanghai Yangpu District Central Hospital Medical Consortium〔including Shanghai Yangpu District Central Hospital, and three community health centers (Dinghai, Yanji and Changbai) 〕from June 1, 2019 to January 1, 2020 for collecting their demographics, knowledge related to supportive policies of hierarchical medical system, practical adherence to the policies, willingness to choose a community health center for initial treatment under different controlled conditions of diseases, and considerations when choosing a healthcare institution. Binary Logistic regression was used to analyze the factors influencing the choice of a community health center for initial treatment. Results Of the 1 100 cases who attended the survey, 1 072 (97.45%) who responded effectively were finally included, among whom 85.07% (912/1 072) were older people (≥60 years old). 624 cases (58.21%) have a knowledge of hierarchical medical system; 940 cases (87.69%) approved of concepts proposed by hierarchical medical system; 368 cases (34.33%) were well aware of "1+1+1" type of contracted services; 964 cases (89.93%) had signed the contract of "1+1+1" type of contracted services, among whom 44 cases (4.56%) chose non-designated medical institutions for treatment. Patients who were willing to choose a community health center for initial treatment during the stable phase or when having mildly poorly controlled condition accounted for 86.57% (928/1 072) and 85.82% (920/1 072), respectively. The factors considered by patients when choosing a healthcare institution were ranked as follows (from high to low according to the average comprehensive score) : accessibility (5.50 points), level of medical technology (5.13 points), satisfaction with treatment (3.74 points), medical security (3.60 points), medical expenses (2.93 points), and other factors (2.24 points). Binary Logistic regression analysis showed that age and health insurance were independent influencing factors for the choice of a community health center for initial treatment (P

Abstract Background Acute Respiratory Infection (ARI) is still a major public health problem in Nepal. The prevalence of ARI among under five children was 2.1% in 2019 and many children from marginalized families suffer disproportionately and many of them die without proper care and treatment. The objective of this study was to identify factors associated with childhood pneumonia and care-seeking practices in Nepal. Methods This was a secondary analysis of the Nepal Multiple Indicator Cluster Survey (MICS) 2019, which uses multi-stage Probability Proportional to Size sampling. Data from 6658 children were analyzed using SPSS 22. Chi-square test and logistic regression analysis were conducted with odds ratio and its corresponding 95% confidence interval after adjusting for confounders. Results Children aged 0 to 23 months had1.5 times higher odds of pneumonia compared to the age group 24 to 59 months (AOR = 1.5, CI 1.0–2.3) and children from rural area had 1.9 times the odds of having pneumonia than urban children (AOR = 1.9, CI 1.2–3.2). Underweight children had 2.3 times greater odds of having pneumonia than normal weight children (AOR = 2.3, CI 1.4–3.9). The odds of having pneumonia were 2.5 higher among children of current smoking mothers compared those with non-smoking mothers (AOR = 2.5, CI 1.1–5.7). Similarly, children from disadvantaged families had 0.6 times protective odds of pneumonia than children from non-disadvantaged families (AOR = 0.6, CI 0.4–1.0). Only one quarter of children received treatment from public facilities. Of those who received treatment, nearly half of the children received inappropriate treatment for pneumonia. One in ten children with pneumonia did not receive any kind of treatment at all. Conclusions Pneumonia is still a public health problem in low-income countries. Public health program and treatment services should be targeted to younger children, careful attention should be given to underweight children, and awareness and nutrition related activities should be focused on rural areas. Addressing inequity in access to and utilization of treatment of childhood illnesses should be prioritized. Keywords: Childhood pneumonia, epidemiology, health care seeking behavior, Nepal.

Background: Health-seeking behaviour is defined as ‘any activity undertaken by individuals who perceive themselves to have a health problem or to be ill for the purpose of finding an appropriate remedy. The severity of the disease among elderly is influenced by one important factor which is health seeking behaviour. To regain their lost health status the elderly must seek the treatment. The way people conceptualize the cause of their health problem and their perception of symptoms plays an important role in seeking healthcare. Health seeking behaviour is influenced by few factors like illiteracy, misconception, income, family composition, social isolation and dependency. Objective: To assess the healthcare seeking behaviour among the geriatric population residing in the field practise area of a Medical College in South East Delhi. Methodology: Community-based cross-sectional study conducted in South East Delhi. • The sample size was calculated as 350 considering a relative error of 3% at 95% level of significance and 10% non-response rate. Stratified random sampling with probability proportional to size was applied to the population registered at UHTC & RHTC area of a medical college in southeast Delhi. Households were selected by systematic random sampling. Persons aged > 60 years from the households were selected for the study. A self-designed, pre-tested, validated, structured questionnaire was used to collect the data. Results In our study it was found that the majority of the participants take treatment when they fall sick ie 99.5%. Of those who take treatment 54% go forconsultation whereas 48% take over the counter medication and 33% do home remedies. Out of the 54% who consult, 78.7% visit Private health facility and 21.3% visit Public health facility. Out of the 78.7% who visit private health facility 65.9% visit Non registered medical practitioner and 7.1% don’t even know whether their doctor is registered or not. Majority of the participants ie 86% preferred health facility within 1kms of their house & it was also a major reason for choosing a health facility for consultation. 98% of the participants visit only in case of illness. 52% were accompanied by their children or daughter in law and 26% visited alone. Conclusion: The participants favoured more private than public healthcare institutions. Nearby medical facilities were favoured, and non-registered medical professionals comprised the majority of them. Almost all senior people received therapy of some kind rather than dismissing it as an issue unique to ageing.

The current study, which expects to fill in the gap in research on transgender sex workers in India, examines the sexual identity negotiation, risk perception and condom compliance, sexual health screening and testing behavior, contextual barriers to healthcare seeking, and barriers to community mobilization among this population. The study was conducted in the red-light districts of Kolkata and rural subdivisions of West Bengal, and Eastern India. Transgender sex workers comprise 15% of the sex workers’ populace in India, yet they are an understudied and underserved group in the commercial sex sector. It is anticipated that the study will help to formulate future programmatic interventions that can cater more effectively to the health needs of Indian transgender commercial sex workers, contribute to the HIV/STI risk reduction among this group, and reduce barriers to attaining health.

Community-based health insurance is a new and promising concept for delivering easily accessible, affordable, and efficient healthcare services. More importantly, a significant risk pooling arrangement between the wealthy and poor. So far, little has been done regarding community-based health insurance and healthcare seeking behavior in developing countries. Therefore, the aim of this study was to assess healthcare seeking behavior of households due to the introduction of the scheme and associated factors in Addis Ababa. Community-based cross-sectional study was conducted among 270 male and 207 female respondents. The data was collected using standardized and pretested questionnaire and it was analyzed using SPSS software. A bivariate and multivariable logistic regression analysis was applied to determine the relationship between healthcare seeking behavior and determinant variables. Finally, statistical association was declared with a p-value of less than 0.05 in the multivariable logistic regression analysis. The proportion of people who had appropriate healthcare-seeking behavior was 47.31% (95 %CI: 43.27–51.39%). Furthermore, having more than four children [AOR: 0.171, 95%, CI:(0.403–0.99)], being Muslim [AOR: 1.712, 95 %CI: (1.117 2.625)], owning a government house [AOR: 4.472, 95%, CI: (2.037–9.819)], and having under-five children [AOR: 0.548, 95%, CI: (0.375–0.801)] were factors significantly associated with healthcare-seeking behavior. Even though this study was conducted in an urban area, it showed that the magnitude of appropriate healthcare-seeking behavior was low. Therefore, the government of Ethiopia should work to improve housing conditions and family planning provision for the residents to improve the healthcare seeking behavior of community-based health insurance users.

To examine the relationship between knowing that a friend or family member became ill with, or died from, COVID-19 and receiving a vaccine dose within four months of the FDA's Emergency Use Authorization. A national sample of 1,517 respondents were surveyed from April 7 to April 12, 2021, 1,193 of whom were eligible for the vaccine when the data were collected. Respondents who knew someone who became ill with COVID-19 (AOR = 2.32, 95 % CI 1.74–3.09) or knew someone who died (AOR = 2.29, 95 % CI 1.32–3.99) from COVID-19 were more likely to receive at least a single COVID-19 vaccine dose. Encouraging people to share their COVID-19 illness and bereavement experiences with their local network such as friends, families, social-networks and via social media might help increase vaccine uptake. [ABSTRACT FROM AUTHOR]

Background: Acute Respiratory Infection (ARI) is still a major public health problem in Nepal. The prevalence of ARI among under five children was 2.1% in 2019 and many children from marginalized families suffer disproportionately and many of them die without proper care and treatment. The objective of this study was to identify factors associated with childhood pneumonia and care-seeking practices in Nepal. Methods: This was a secondary analysis of the Nepal Multiple Indicator Cluster Survey (MICS) 2019, which uses multi-stage Probability Proportional to Size sampling. Data from 6658 children were analyzed using SPSS 22. Chi-square test and logistic regression analysis were conducted with odds ratio and its corresponding 95% confidence interval after adjusting for confounders. Results: Children aged 0 to 23 months had1.5 times higher odds of pneumonia compared to the age group 24 to 59 months (AOR = 1.5, CI 1.0–2.3) and children from rural area had 1.9 times the odds of having pneumonia than urban children (AOR = 1.9, CI 1.2–3.2). Underweight children had 2.3 times greater odds of having pneumonia than normal weight children (AOR = 2.3, CI 1.4–3.9). The odds of having pneumonia were 2.5 higher among children of current smoking mothers compared those with non-smoking mothers (AOR = 2.5, CI 1.1–5.7). Similarly, children from disadvantaged families had 0.6 times protective odds of pneumonia than children from non-disadvantaged families (AOR = 0.6, CI 0.4–1.0). Only one quarter of children received treatment from public facilities. Of those who received treatment, nearly half of the children received inappropriate treatment for pneumonia. One in ten children with pneumonia did not receive any kind of treatment at all. Conclusions: Pneumonia is still a public health problem in low-income countries. Public health program and treatment services should be targeted to younger children, careful attention should be given to underweight children, and awareness and nutrition related activities should be focused on rural areas. Addressing inequity in access to and utilization of treatment of childhood illnesses should be prioritized. Keywords: Childhood pneumonia, epidemiology, health care seeking behavior, Nepal. [ABSTRACT FROM AUTHOR]

Ideally health insurance aims to provide financial security, promote social inclusion, and ensure equitable access to quality healthcare services for all households. Community-based health insurance has been operating in Ethiopia since 2011. However, its nationwide impact on universal health coverage has not yet been evaluated despite several studies being conducted. We evaluated the impact of Ethiopia's community-based health insurance (2012–2021) on universal health coverage. On 27 August 2022, searches were conducted in Scopus, Hinari, PubMed, Google Scholar, and Semantic Scholar. Twenty-three studies were included. We used the Joana Briggs Institute checklists to assess the risk of bias. We included cross-sectional and mixed studies with low and medium risk. The data were processed in Microsoft Excel and analyzed using RevMan-5. The impact was measured first on insured households and then on insured versus uninsured households. We used a random model to measure the effect estimates (odds ratios) with a p value < 0.05 and a 95% CI. The universal health coverage provided by the scheme was 45.6% (OR = 1.92, 95% CI: 1.44–2.58). Being a member of the scheme increased universal health coverage by 24.8%. The healthcare service utilization of the beneficiaries was 64.5% (OR = 1.95, 95% CI: 1.29–2.93). The scheme reduced catastrophic health expenditure by 79.4% (OR = 4.99, 95% CI: 1.27–19.67). It yielded a 92% (OR = 11.58, 95% CI: 8.12–16.51) perception of health service quality. The health-related quality of life provided by it was 63% (OR = 1.71, 95% CI: 1.50–1.94). Its population coverage was 40.1% (OR = 0.64, 95% CI: 0.41–1.02). Although the scheme had positive impacts on health service issues by reducing catastrophic costs, the low universal health coverage on a limited population indicates that Ethiopia should move to a broader national scheme that covers the entire population. [ABSTRACT FROM AUTHOR]

Background: After years of planning, in 2024 the government of Ethiopia proposes to introduce a compulsory Social Health Insurance (SHI) program for formal sector employees. The proposed scheme will provide access to contracted healthcare facilities at a premium of 3% of the gross monthly income of employees with another 3% coming from the employer. Objectives: Several studies have examined the willingness to pay (WTP) this premium, however, little is known about the healthcare seeking behavior (HSB) of formal sector employees. This paper investigates both – the determinants of healthcare seeking behavior and among other aspects, WTP the premium. Through these explorations, the paper sheds light on the potential challenges for implementation of SHI. Methods: Descriptive statistics, logit, and multinomial logit (MNL) models are used to analyze retrospective survey data (2,749 formal sector employees) which covers the major regions of the country. Findings: Regarding outpatient care, a majority of the visits (55.9%) were to private healthcare providers. In the case of inpatient care, it was the opposite with a majority of healthcare seekers visiting public sector hospitals (62.5%). A majority of the sample (67%) supported the introduction of SHI but only 24% were willing to pay the proposed SHI premium. The average WTP was 1.6% of gross monthly income. Respondents in the two richest income quintiles were more likely to oppose SHI and consider it unfair. Conclusion: The prominent role of the private sector and the resistance to SHI amongst the two richest income quintiles, suggests that the SHI program needs to actively include private healthcare facilities within its ambit. Additionally, concerted efforts at enhancing the quality of care available at public health facilities, both, in terms of perception and patient-centered care and addressing drug and equipment availability bottlenecks, are needed, if SHI is to garner wider support. [ABSTRACT FROM AUTHOR]

The current study, which expects to fill in the gap in research on transgender sex workers in India, examines the sexual identity negotiation, risk perception and condom compliance, sexual health screening and testing behavior, contextual barriers to healthcare seeking, and barriers to community mobilization among this population. The study was conducted in the red-light districts of Kolkata and rural subdivisions of West Bengal, and Eastern India. Transgender sex workers comprise 15% of the sex workers' populace in India, yet they are an understudied and underserved group in the commercial sex sector. It is anticipated that the study will help to formulate future programmatic interventions that can cater more effectively to the health needs of Indian transgender commercial sex workers, contribute to the HIV/STI risk reduction among this group, and reduce barriers to attaining health. [ABSTRACT FROM AUTHOR]

Abstract Background Despite rising incomes and rapid economic growth, there remains a significant gender gap in health outcomes among rural children in China. This study examines whether the gender gap in child health is related to the behavior of caregivers when seeking healthcare, and whether healthcare subsidies help to bridge the gender gap in rural health outcomes. Methods Focusing on vision care specifically, we draw on data from a randomized controlled trial of 13,100 children in Gansu and Shaanxi provinces in China that provided subsidized eyeglasses to myopic children in one set of schools (henceforth, referred to as the treatment schools) and provided prescription information but not subsidized eyeglasses to myopic children in another set of schools (control schools). Results The baseline results reveal that while female students generally have worse vision than male students, they are significantly less likely than male students to be taken by their caregivers to a vision exam. The experimental results indicate, however, that caregivers respond positively to both health information and subsidized healthcare, regardless of the gender of their children. When prescription information is paired with a subsidy voucher for healthcare (a free pair of eyeglasses), the uptake rate rises dramatically. Conclusions The gender gap in healthcare can be minimized by implementing subsidized healthcare policies. Trial registration The protocol for this study was approved in full by Institutional Review Boards at Stanford University (Palo Alto, California, USA) and the Zhongshan Ophthalmic Center of Sun Yat-sen University (ZOC, Guangzhou, China). Permission was received from local Boards of Education in each region and from the principals of all schools. The principles of the Declaration of Helsinki were followed throughout. The original trial (Registration site: http://isrctn.org . Registration number: ISRCTN03252665 ) was designed to study the effect of providing free spectacles on children’s educational performance. The original trial was retrospectively registered on 09/25/2012.

Background: After years of planning, in 2024 the government of Ethiopia proposes to introduce a compulsory Social Health Insurance (SHI) program for formal sector employees. The proposed scheme will provide access to contracted healthcare facilities at a premium of 3% of the gross monthly income of employees with another 3% coming from the employer. Objectives: Several studies have examined the willingness to pay (WTP) this premium, however, little is known about the healthcare seeking behavior (HSB) of formal sector employees. This paper investigates both – the determinants of healthcare seeking behavior and among other aspects, WTP the premium. Through these explorations, the paper sheds light on the potential challenges for implementation of SHI. Methods: Descriptive statistics, logit, and multinomial logit (MNL) models are used to analyze retrospective survey data (2,749 formal sector employees) which covers the major regions of the country. Findings: Regarding outpatient care, a majority of the visits (55.9%) were to private healthcare providers. In the case of inpatient care, it was the opposite with a majority of healthcare seekers visiting public sector hospitals (62.5%). A majority of the sample (67%) supported the introduction of SHI but only 24% were willing to pay the proposed SHI premium. The average WTP was 1.6% of gross monthly income. Respondents in the two richest income quintiles were more likely to oppose SHI and consider it unfair. Conclusion: The prominent role of the private sector and the resistance to SHI amongst the two richest income quintiles, suggests that the SHI program needs to actively include private healthcare facilities within its ambit. Additionally, concerted efforts at enhancing the quality of care available at public health facilities, both, in terms of perception and patient-centered care and addressing drug and equipment availability bottlenecks, are needed, if SHI is to garner wider support.

Abstract Background Siaya County in Western Kenya has one of the highest maternal mortality rates in Kenya. We sought to elucidate factors that influence mothers’ decisions regarding where to seek obstetrical care, to inform interventions that seek to promote effective use of obstetric services and reduce maternal mortalities. To guide our research, we used the “Three Delays Model”, focusing on the first delay—seeking care. While interventions to reduce maternal mortalities have focused on addressing delays in accessing and receiving care, context-specific data on drivers of the first delay are scarce. Methods We used a mixed-method study to assess how maternal decision-making of birth location is influenced by personal, contextual, and cultural factors. We conducted structured interviews with women aged 14 years or older living in Siaya, Bondo, and Yala, rural districts in Western Kenya. We then conducted focus group interviews with a subset of women to elucidate this question: How do drivers of the first delay (i.e., seeking care) affect the decision to seek home versus hospital delivery, potentially negatively influencing maternal mortality. Results Three hundred and seven women responded to the surveys, and 67 women (22%) from this group participated in focus group interviews. Although we focused on type 1 delays, we discovered that several factors that impact type 2 and type 3 delays directly contribute to type 1 delays. Our findings highlighted that factors influencing women’s decisions to seek care are not simply medical or cultural but rather contextual, involving many elements of life, particularly in rural communities. Conclusions It is imperative to address multiple-level factors that influence women’s decisions to seek care and have in-hospital deliveries. To curtail maternal mortality in rural Western Kenya and comparable settings, targeted interventions must take into consideration these important influencers.

Abstract Background To better understand the distribution and consumption patterns of resources in different ethnic groups and at different levels of economic development, this paper chose to describe the healthcare seeking behavior in Shanghai. Methods The data are from the Sixth Health Service Survey of Shanghai, which encompasses 23,198 permanent residents. Descriptive analyses were conducted to estimate the number of patients who reported health-related symptoms and healthcare-seeking behaviors per 1,000 residents. Logistic regression analyses were conducted to examine differences in reporting health-related symptoms and healthcare-seeking behaviors by age, gender and area of residence. Results This paper have mapped the ecology of healthcare in Shanghai in 2018. Of 1000 individuals considered during a 1-month period, 444 reported sickness, 433 received treatment, 288 went to medical institutions, 195 went to primary medical institutions, 86 took a self-healing approach, 26 received TCM services, 7 were hospitalized, and 3 underwent surgery. Conclusions Age is a risk factor leading to disease, medical treatment, self-medication, medical institution visits, TCM service, hospitalization and surgery. But age is a protective factor in the use of primary health care services. By gender, the number of people receiving medical services was similar, but women were statistically more likely to have surgery. As the income level increased, the number of patients and people receiving medical services showed a decreasing trend. Compared with the local population, the probability of non-local people visiting medical institutions was lower and statistically significant. Compared with the people who had health insurance, fewer uninsured people reported sickness and utilized healthcare services.

Background: The “two-week visiting rate in those needing to visit” has been examined extensively as an important indicator of healthcare seeking behavior in China. Nevertheless, its relationship with health behaviors, such as physical activity, remains unknown. In addition, a significant difference exists between urban and rural Chinese people in terms of physical activity and healthcare seeking behavior. This study sought to investigate the relationship between physical activity and the two-week visiting rate by conducting a stratified analysis. Methods: The analysis included 5,801 participants aged above 15 years old. Multivariable logistic regression was applied to analyze the association after adjusting for possible confounding variables. Urban and rural differences were investigated using stratified analysis. Results: Adjusted estimates showed that those who were physically active were more likely to visit a healthcare facility, but only among the whole sample (adjusted odds ratio (AOR) = 1.45, 95% confidence interval (CI): 1.26‒1.66) and the rural sample (AOR = 1.56, 95% CI: 1.21‒2.01), and not among the urban sample. Conclusions: Educating people on physical activity may help in improving healthcare seeking behavior and vice versa. Additionally, health interventions may be tailored based on different settings.

BackgroundHealthcare resources are always more limited compared with demand, but better matching supply with demand can improve overall resource efficiency. In countries like China where patients are free to choose healthcare facilities, over-utilization and under-utilization of healthcare resources co-exist because of unreasonable healthcare seeking behavior. However, scholarship regarding the spatial distribution of utilization for healthcare resources, resulting from unreasonable spatial tendencies in healthcare seeking, is rare.MethodsIn this article, we propose a new External Patient Healthcare Index (EPHI) to simulate the spatial distribution of utilization for healthcare resources, based on the Two-Step Floating Catchment Area (2SFCA) method, which is widely used to assess potential spatial accessibility. Instead of using individual-level healthcare utilization data which is difficult to obtain, the EPHI uses institution-level aggregated data, including numbers of inpatient/outpatient visits. By comparing the estimated utilization (based on local healthcare institution services provision) with the expected utilization (based on local population morbidity), guest patients (e.g., patients flowing in for treatment) and bypass patients (patients flowing out) can be identified. To test the applicability of this index, a case study was carried out on China's Hainan Island. The spatial tendencies of patients for inpatient and outpatient services were simulated, then incorporated with spatial access to healthcare resources to evaluate overall resource allocation efficiency, thus guiding future resource allocations and investment for policy makers and healthcare providers.ResultsThe EPHI revealed that bypass activities widely exist on Hainan Island in both inpatient and outpatient care, with patients tending to travel from less developed regions with fewer healthcare resources to more highly developed regions with more healthcare resources to receive healthcare. Comparison with spatial accessibility demonstrated how bypass activities on Hainan produced an under-utilization of doctors in less developed regions and over-utilization of doctors in more developed coastal regions.ConclusionsThis case study on Hainan Island demonstrates that this new index can very clearly identify both the sources and sinks of patient spatial tendencies. Combining these results with spatial accessibility of healthcare resources, how efficiently the available supply matches the utilization can be revealed, indicating wide-ranging applicability for local governments and policymakers.

Background: Despite rising incomes and rapid economic growth, there remains a significant gender gap in health outcomes among rural children in China. This study examines whether the gender gap in child health is related to the behavior of caregivers when seeking healthcare, and whether healthcare subsidies help to bridge the gender gap in rural health outcomes. Methods: Focusing on vision care specifically, we draw on data from a randomized controlled trial of 13,100 children in Gansu and Shaanxi provinces in China that provided subsidized eyeglasses to myopic children in one set of schools (henceforth, referred to as the treatment schools) and provided prescription information but not subsidized eyeglasses to myopic children in another set of schools (control schools). Results: The baseline results reveal that while female students generally have worse vision than male students, they are significantly less likely than male students to be taken by their caregivers to a vision exam. The experimental results indicate, however, that caregivers respond positively to both health information and subsidized healthcare, regardless of the gender of their children. When prescription information is paired with a subsidy voucher for healthcare (a free pair of eyeglasses), the uptake rate rises dramatically. Conclusions: The gender gap in healthcare can be minimized by implementing subsidized healthcare policies. Trial registration: The protocol for this study was approved in full by Institutional Review Boards at Stanford University (Palo Alto, California, USA) and the Zhongshan Ophthalmic Center of Sun Yat-sen University (ZOC, Guangzhou, China). Permission was received from local Boards of Education in each region and from the principals of all schools. The principles of the Declaration of Helsinki were followed throughout. The original trial (Registration site: http://isrctn.org. Registration number: ISRCTN03252665) was designed to study the effect of providing free spectacles on children's educational performance. The original trial was retrospectively registered on 09/25/2012. [ABSTRACT FROM AUTHOR]

Abstract Background Seeking healthcare in children is unique since parents decide upon the type and frequency of healthcare services accessed. Mothers/caregivers lower healthcare seeking behavior is one of the major reason for increased morbidity and mortality from childhood illness in developing countries. Hence, this study aimed to assess healthcare seeking behavior of mothers/caregivers towards childhood illnesses in selected health centers of Addis Ababa, Ethiopia. Methods A facility-based cross-sectional survey was conducted on 422 sampled mothers/caregivers of children age 0–59 months, from April 18 to May 11, 2016. Ten health centers were selected using simple random sampling technique and proportionate number of participants were included from each health centers. A pre-tested, semi-structured questionnaire was used to collect data. Data were analyzed using SPSS version 20.0. Descriptive statistics was used to summarize socio-demographic characteristics and multivariable logistic regression was employed to identify factors associated with of healthcare seeking behavior. Result In case of illnesses, 26.5% of mothers/caregivers sought healthcare for their children. Among the common childhood illnesses, acute respiratory tract infection and diarrhea accounted for 47.6 and 31%, respectively. Mothers/caregivers healthcare seeking behavior towards common childhood illnesses were influenced by child’s age (AOR = 1.78, 95% CI:1.02, 3.13), education of mothers/caregivers (AOR = 4.24, 95% CI:1.32, 13.63), family size (AOR = 3.83, 95% CI:1.06, 13.78), perception of severity of illnesses (AOR = 2.00, 95% CI:1.05, 3.84), previous experience of similar illnesses (AOR = 3.67, 95% CI:1.36, 9.86) and previous history of under-five child death (AOR = 13.31, 95% CI:5.13, 34.53). Conclusions The common under-five childhood illnesses were acute respiratory tract infection and diarrhea. The study also revealed that there was a delay in seeking healthcare and this was significantly associated with age of the child; mothers/caregivers level of education; family size; perception of illness severity; previous experience of similar illnesses and under-five child death.

Purpose: To assess the relationship between healthcare seeking behaviors and glycemic control in patients with type 2 diabetes. Methods: A secondary data analysis was conducted among patients with type 2 diabetes from a randomized controlled trial conducted in a tertiary hospital, Bangladesh. Data on health center use, healthcare providers visited, self-monitoring of blood glucose, blood pressure, foot care, and physical activity were collected through structured questionnaires. Uncontrolled diabetes was defined as HbA1c ≥ 7%. Multivariable logistic regression models were performed. Result: Of the 265 patients (mean age 50.3 ± 9.9 years; 49.8% females), the majority (71.3%) had uncontrolled diabetes. More than one-third (34.9%) of the participants did not visit their physician or a healthcare center during the previous 3-months. Only 12.4% of participants checked their blood glucose, and 35.8% checked their blood pressure during the last week. Participants who did not visit a physician or a healthcare center during the past 3 months had twice the odds of having uncontrolled diabetes, compared with those who visited during the same period [OR 2.12, 95% CI (1.02–5.14), p = 0.04]. Conclusion: Regular consultation with a physician or visiting a healthcare center might help to improve glycemic control in patients with type 2 diabetes in Bangladesh. [ABSTRACT FROM AUTHOR]

Background: Siaya County in Western Kenya has one of the highest maternal mortality rates in Kenya. We sought to elucidate factors that influence mothers' decisions regarding where to seek obstetrical care, to inform interventions that seek to promote effective use of obstetric services and reduce maternal mortalities. To guide our research, we used the "Three Delays Model", focusing on the first delay-seeking care. While interventions to reduce maternal mortalities have focused on addressing delays in accessing and receiving care, context-specific data on drivers of the first delay are scarce.Methods: We used a mixed-method study to assess how maternal decision-making of birth location is influenced by personal, contextual, and cultural factors. We conducted structured interviews with women aged 14 years or older living in Siaya, Bondo, and Yala, rural districts in Western Kenya. We then conducted focus group interviews with a subset of women to elucidate this question: How do drivers of the first delay (i.e., seeking care) affect the decision to seek home versus hospital delivery, potentially negatively influencing maternal mortality.Results: Three hundred and seven women responded to the surveys, and 67 women (22%) from this group participated in focus group interviews. Although we focused on type 1 delays, we discovered that several factors that impact type 2 and type 3 delays directly contribute to type 1 delays. Our findings highlighted that factors influencing women's decisions to seek care are not simply medical or cultural but rather contextual, involving many elements of life, particularly in rural communities.Conclusions: It is imperative to address multiple-level factors that influence women's decisions to seek care and have in-hospital deliveries. To curtail maternal mortality in rural Western Kenya and comparable settings, targeted interventions must take into consideration these important influencers. [ABSTRACT FROM AUTHOR]

Background: To better understand the distribution and consumption patterns of resources in different ethnic groups and at different levels of economic development, this paper chose to describe the healthcare seeking behavior in Shanghai.Methods: The data are from the Sixth Health Service Survey of Shanghai, which encompasses 23,198 permanent residents. Descriptive analyses were conducted to estimate the number of patients who reported health-related symptoms and healthcare-seeking behaviors per 1,000 residents. Logistic regression analyses were conducted to examine differences in reporting health-related symptoms and healthcare-seeking behaviors by age, gender and area of residence.Results: This paper have mapped the ecology of healthcare in Shanghai in 2018. Of 1000 individuals considered during a 1-month period, 444 reported sickness, 433 received treatment, 288 went to medical institutions, 195 went to primary medical institutions, 86 took a self-healing approach, 26 received TCM services, 7 were hospitalized, and 3 underwent surgery.Conclusions: Age is a risk factor leading to disease, medical treatment, self-medication, medical institution visits, TCM service, hospitalization and surgery. But age is a protective factor in the use of primary health care services. By gender, the number of people receiving medical services was similar, but women were statistically more likely to have surgery. As the income level increased, the number of patients and people receiving medical services showed a decreasing trend. Compared with the local population, the probability of non-local people visiting medical institutions was lower and statistically significant. Compared with the people who had health insurance, fewer uninsured people reported sickness and utilized healthcare services. [ABSTRACT FROM AUTHOR]

Challenges in accessing and utilising TB treatment are a major reason for the existing gaps in tuberculosis (TB) control in India. Twenty qualitative interviews were conducted with women who were attending or had attended a directly observed treatment short course (DOTS) clinic in Kolkata, India. The resulting data were analysed using a thematic approach. Our results indicated that women experienced several challenges categorised as (1) DOTS specific challenges, (2) lack of client friendly services, and (3) resource constraints. DOTS specific challenges included having to come to the clinic for medicines, lack of privacy, providers minimising contact with patients, length of treatment, drug side effects and pill burden. Lack of client friendly services led to mistrust in government services and a preference for private providers, which was compounded by corruption in the medical system. Inability to complete household duties due to inflexible clinic hours, long lines and overcrowded spaces, and mistreatment from providers were further challenges faced by women. Lastly, resource constraints meant women faced financial difficulties with additional treatment costs and suffered from lack of adequate food and nutrition. Our findings lead to several recommendations for addressing these challenges that should help improve women's experiences with DOTS TB treatment. [ABSTRACT FROM AUTHOR]

The theory of the optimal-consumption leisure choice under price dispersion describes the phenomenon of moral hazard as the customer’s reaction on unfair insurance policy. The unfair insurance offer does not equalize marginal costs of propensity to seek healthcare with marginal benefits on purchase. Under unfair insurance policy consumers increase ex post healthcare seeking activities and they optimize their consumption of medical services. The analysis of moral hazard results in the assumption that the increase in the time horizon of the unfair insurance offer makes it fair and moral hazard becomes inefficient. The time horizon competition between insurance companies can eliminate moral hazard effect that clears the way to the competitive equilibrium.

Background: Healthcare seeking behaviors among children with musculoskeletal disorders are poorly understood. We sought to analyze healthcare seeking delays among children with chronic musculoskeletal conditions in Nepal and identify predictors of clinically significant delays. Methods: A cross-sectional study was conducted at a large pediatric musculoskeletal rehabilitation center in Nepal. Baseline sociodemographic data and healthcare seeking behaviors were assessed via interviews with 75 randomly selected caregivers. Delays of at least 3 months between disease recognition and presentation to a health worker were considered clinically significant. Predictors of significant delay were assessed via multivariable logistic regression. Results: Clubfoot was the most common condition seen in the study sample (N = 33; 37%). Mean and median presentation delays were 33 months and 14 months, respectively. Sixty-seven percent of children were delayed at least 3 months and 40% were delayed at least 2 years. Caregiver occupation in agriculture or unskilled labor was associated with an increased risk of delayed presentation (adjusted OR = 4.05; 95% CI: 1.36–12.09). Conclusions: Children with chronic musculoskeletal disorders in Nepal face significant delays in accessing healthcare. This poses a major clinical problem as the delayed diagnosis and treatment of childhood musculoskeletal disorders can complicate management options and decrease long-term quality of life.

This paper examines the healthcare seeking behavior of household members in Nigeria, specifically focusing on the sources of healthcare services. Traditional and orthodox sources have coexisted in the provision of healthcare services, but this study goes further to show that orthodox services can be accessed through trained healthcare professionals (HCPs) or patent medicine vendors (PMVs); traditional services are mainly offered by herbalists. There are Christians and Muslims who consult faith homes/centers that operate purely on faith and prayer for healing. An estimation model, which involved health-seeking decision, was applied and it was estimated through nested multinomial logit (NML) technique. Data were drawn from the 2010 Harmonised Nigeria Living Standards Survey (HNLSS) conducted by the National Bureau of Statistics. Results demonstrate that individuals tend to consult traditional, PMVs and churches/mosques ahead of HCPs as a result of age and urban/rural locations. The demand for HCP care increases with household income as well as the number of household members. [ABSTRACT FROM AUTHOR]

Background Healthcare seeking behaviors among children with musculoskeletal disorders are poorly understood. We sought to analyze healthcare seeking delays among children with chronic musculoskeletal conditions in Nepal and identify predictors of clinically significant delays. Methods A cross-sectional study was conducted at a large pediatric musculoskeletal rehabilitation center in Nepal. Baseline sociodemographic data and healthcare seeking behaviors were assessed via interviews with 75 randomly selected caregivers. Delays of at least 3 months between disease recognition and presentation to a health worker were considered clinically significant. Predictors of significant delay were assessed via multivariable logistic regression. Results Clubfoot was the most common condition seen in the study sample (N = 33; 37%). Mean and median presentation delays were 33 months and 14 months, respectively. Sixty-seven percent of children were delayed at least 3 months and 40% were delayed at least 2 years. Caregiver occupation in agriculture or unskilled labor was associated with an increased risk of delayed presentation (adjusted OR = 4.05; 95% CI: 1.36–12.09). Conclusions Children with chronic musculoskeletal disorders in Nepal face significant delays in accessing healthcare. This poses a major clinical problem as the delayed diagnosis and treatment of childhood musculoskeletal disorders can complicate management options and decrease long-term quality of life. [ABSTRACT FROM AUTHOR]

Studies on ecology of medical care can provide valuable information on how people seek healthcare in a specific geographic area. The objective of this study was to update a 2003 report on the ecology of medical care in Japan, identifying relevant changes in healthcare patterns. We collected information based on a prospective health diary recorded for a month in 2013 (n = 4548; 3787 adults and 797 children) using a population-weighted random sample from a nationally representative panel. We compared our overall and stratified findings with a similar study conducted in 2003. During a one-month period, per 1000 adults and children living in Japan, we estimated that 794 report at least one symptom, 447 use an over-the-counter (OTC) drug, 265 visit a physician's office, 117 seek help from a professional provider of complementary or alternative medicine (CAM), 70 visit a hospital outpatient clinic (60 community-based and 10 university-based), 6 are hospitalized, and 4 visit a hospital emergency department. After adjusting for demographic variables, we found that healthcare seeking behaviors were influenced by age, gender and area of living. Compared with the 2003 study, participants in this study had fewer symptoms, fewer physician and emergency room visits, and less OTC use, but reported higher frequency of CAM use (p < .01 for all). Compared with 2003, reported symptoms, physician visits and OTC use has decreased, while CAM use has increased. Our findings may be useful to policymakers in Japan in a context where healthcare expenditure and a rapidly aging population are two challenging issues. [ABSTRACT FROM AUTHOR]

Introduction: Lung cancer is a major contributor of burden of disease globally. Early diagnosis plays a crucial role in determining the patient's prognosis. However, diagnostic constraints and healthcare-seeking behavior in rural areas contribute to the increased mortality and morbidity associated with this disease., Case Presentation: The authors present a case that came in with mood and personality changes who was diagnosed with lung cancer with metastasis in the brain and did not seek health care services despite a prolonged duration of her neurocognitive symptoms., Clinical Discussion: Rural communities face multiple barriers to early diagnosis and treatment, including healthcare-seeking behavior. It is crucial to develop policies aimed at addressing these barriers in order to enhance the health status of rural Nepal., Conclusion: The presentation of lung cancer with atypical symptoms can contribute to delays in diagnosis and treatment, ultimately impacting the overall prognosis of the patient. Late presentation to healthcare centers further exacerbates the burden of the disease, emphasizing the critical importance of proper healthcare-seeking behavior., Competing Interests: The authors declare that they have no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Due to a lack of survey of health care seeking behavior for influenza, the actual magnitude of influenza in Beijing of China has not been well described.Methods: During 2013-2014 influenza season, two cross-sectional household surveys were carried out respectively during the epidemic and non-epidemic season of influenza. A structured survey was undertaken with individuals who were ≥18 years selected by a multistage random sampling method in the study. Health care seeking behaviors were then examined to estimate the actual case number of influenza, using a multiplier model.Results: A total of 14,665 adults were interviewed. 61.9% of ILI cases consulted a physician. The consultation rate during epidemic period is higher than that during non-epidemic period (67.9% vs. 52.3%). Similarly, the proportion of healthcare usage of general hospital during epidemic period is higher than that was during non-epidemic period (27.1% vs. 19.0%, p = 0.008). Lack of insurance and education reduced healthcare seeking significantly in this study. It was estimated that there were 379,767 (90% CI = [281,934, 526,565]) confirmed cases of influenza amongst adults in Beijing, during 2013-2014 influenza season, with an incidence rate of 2.0%.Conclusions: The surveillance system for ILI and virological data has the potential to provide baseline case number to estimate the actual annual magnitude of influenza. Given the changes in healthcare seeking behavior over time, sentinel surveillance on healthcare seeking behavior are required to be established for better estimate of the true case number of influenza. [ABSTRACT FROM AUTHOR]

Background: Influenza often causes winter and summer epidemics in subtropical regions, but few studies have investigated the difference in healthcare seeking behavior of patients with influenza-like illness (ILI) between these two epidemics.Methods: Household telephone surveys were conducted using random digit dialing in Hong Kong during July-August 2014 and March-April 2015. One adult from each household was interviewed for ILI symptoms and associated healthcare seeking behaviour of themselves and one child in the household (if any), during the preceding 30 days. Healthcare seeking behavior of respondents with self-reported ILI was compared between summer and winter influenza. Logistic regression was used to explore the factors associated with healthcare seeking behavior.Results: Among 516 and 539 adult respondents in the summer and winter surveys, 22.6 and 38.0 % reported ILI symptoms, and 40.9 and 46.8 % of them sought medical care, respectively. There was no significant difference in healthcare seeking behavior between the summer and winter epidemics, except a higher proportion of self-medication in summer in the adult respondents. Among 155 and 182 children reported by the adults in both surveys, the proportion of self-reported ILI was 32.9 and 40.1 % in the summer and winter surveys, respectively. Of these children, 47.1 and 56.2 % were brought for medical consultation in summer and winter, respectively. Women, adults with diabetes and those with symptoms of cough, shortness of breath, and runny nose were more likely to seek medical consultations for ILI symptoms. The factors associated with seeking medical consultations in children with ILI symptoms included being female, age under 10 years, and with symptoms of sore throat or vomiting. Those older than 60 years were less likely to self-medicate, whereas regular smokers and those with symptom of sore throat were more likely to do so.Conclusion: Healthcare seeking behavior of the general public was not significantly different between these two epidemics. However ILI was associated with increased healthcare utilization in both winter and summer epidemics in Hong Kong. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of intergenerational support from children on older adults' healthcare seeking behaviors and to provide suggestions to help promote sensible healthcare seeking behaviors in older adults., Methods: Based on the data from the 2016 baseline data and the 2018 national tracking survey of China Family Panel Studies (CFPS), a total of 5690 respondents aged 60 years and older with surviving children were selected for the study. Logistic regression was used to analyze the effect of children's intergenerational support on older adults' healthcare seeking behavior., Results: The probability of seeing a doctor in the last two weeks was relatively higher among older adults whose children provided financial support (odds ratio [ OR ]=1.129, 95% confidence interval [ CI ]: 1.004-1.271, P <0.05), but the effect of whether children provided financial support on one-year hospitalization was not significant ( P >0.05). Daily care support from children contributed positively to both seeing a doctor in the last two weeks and one-year hospitalization among older adults ( OR =1.155, 95% CI : 1.021-1.307, P <0.05; OR =1.204, 95% CI : 1.053-1.378, P <0.01), while whether or not older adults saw their children daily had no significant effect on either seeing a doctor in the last two weeks or one-year hospitalization among older adults ( P >0.05)., Conclusion: Intergenerational support from children has an important influence on the healthcare seeking behaviors of older adults. The advantageous role of children's intergenerational support should be made full use of. In addition, formal channels of social support should be improved to alleviate the pressure on children to provide intergenerational support and suggestions should be provided to promote sensible healthcare seeking behaviors in older adults, so as to further improve the overall health level of older adults., (Copyright© by Editorial Board of Journal of Sichuan University (Medical Sciences).)

Objective: Healthcare seeking behavior of caregivers for their children greatly varies. Especially for children, not to seek healthcare when it is necessary may cause serious consequences. The aim of this study is to determine the time span for seeking healthcare for children and factors related with it. Methods: A cross-sectional / analytic design was chosen for the study. Participants were caregivers of 203 children registered to 3 family health units in Izmir / Bornova - Altindag district. Data were collected via a questionnaire consisting of questions about demographic characteristics of children, caregivers and household as well as questions about the characteristics of current encounter and attitudes and behaviors of caregivers. Questionnaire was applied face to face. Results: Average time for seeking health care was 4.0±5.3 days. 59.6% of caregivers stated that they gave medicine at home before coming to the doctor. Majority of the caregivers firstly tried to treat illness at home and sought for healthcare if symptoms did not regress or they progress. Fever significantly shortened admission time. Conclusion: Caregivers who applied first time for a given complaint, those whose children have fever and those who state accessibility as a cause of waiting for seeing doctor go to their family physicians in a shorter time for children's current. [ABSTRACT FROM AUTHOR]

Abstract: Background: Studies that assessed predictors of patient delay to seek healthcare for acute myocardial infarction lack generalization to all patient population as it investigated patients who survived coronary events. Objectives: To evaluate utility of using surrogates to proxy patients who cannot be interviewed and to examine patients–surrogate agreement. Design: A cross-sectional descriptive survey study. The cognitive and emotional domains of the modified Response to Symptoms Questionnaire were used to interview participants. Participants and settings: A convenient sample of patient–surrogate pairs was collected (n =109). Hospitalized patients with acute myocardial infarction were eligible if they were at least 18 years old, hemodynamically stable, pain free or controlled pain during interview, and could identify a surrogate. Exclusions (n =45) were patients transferred from other hospitals or those who had acquired heart attack following their admission. A surrogate was defined as an individual who witnessed the onset of symptoms and whom the patient has articulated symptoms with prior to admission. Methods: Patient and surrogate were interviewed independently. Decision delay time was assessed by assisting participants and surrogates to triangulate the time of symptom onset and time of decision to seek help by placing it in the context of events that they would remember. The intraclass correlation coefficient was used to assess agreement. Results: Patients were mainly men (81%), married (79%) and ranged in age from 39 to 78 years while surrogates were mostly women (74%) and 55% of them were patients’ spouses. Surrogates ranged in age from 18 to 75 years. Intraclass correlation coefficients levels varied across different variables ranging from lack of agreement (p >0.05) to almost perfect agreement with decision delay time having the highest correlation coefficient (86%, p <0.05). Cognitive variables had higher agreement than emotional variables. Significant emotional variables’ agreement ranged form 28% to 39% and significant cognitive variables’ agreement ranged form 64% to 68%. Female surrogates (n =81) had higher agreement levels with their respective patients than male surrogates (n =28). Conclusions: Utilizing surrogates to proxy patients’ account of decision delay time and its cognitive predictors is practical and feasible. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate current literature on predictors of pre-hospital delay among patients with acute myocardial infarction (AMI). Methods: Medline, CINHAL, and Psych Info databases were searched using keywords: attitude to illness/health, health beliefs, help/health seeking behavior, health behavior, psychosocial factors, treatment delay, socioeconomic factors, time factors, pre-hospital delay, and symptoms. These keywords were combined with AMI to identify literature published during 1995–2008. Results: Twenty-six data-based research articles were identified. Delay varied across literature and median pre-hospital delay was often reported due to distribution skewness resulting from extremely prolonged values (1.5–15.2h). Six categories of predictors influenced pre-hospital delay; socio-demographic, symptom onset context, cognitive, affective/psychological, behavioral, and clinical factors. Pre-hospital delay was shortest when the decision to seek healthcare was facilitated by family members or coworkers and when symptoms suggestive of heart attack were continuous and severe. Conclusion and practice implications: Developing interventions programs to reduce pre-hospital delay for high-risk patients is warranted. Because decision delay is the only modifiable part by intervention, it is recommended that future investigations and interventions attend to decision time as the primary variable of interest instead of combining it with transportation time. Moreover, content of patient education need to emphasize on symptom awareness and recognition, and prompt and proper patient actions for optimum results. Also, in order to eliminate sampling bias resulting from investigating surviving AMI patients, it is recommended that future studies incorporate data from both surviving and surrogates of non-surviving AMI patients. [Copyright &y& Elsevier]

Background: Seeking healthcare in children is unique since parents decide upon the type and frequency of healthcare services accessed. Mothers/caregivers lower healthcare seeking behavior is one of the major reason for increased morbidity and mortality from childhood illness in developing countries. Hence, this study aimed to assess healthcare seeking behavior of mothers/caregivers towards childhood illnesses in selected health centers of Addis Ababa, Ethiopia.Methods: A facility-based cross-sectional survey was conducted on 422 sampled mothers/caregivers of children age 0-59 months, from April 18 to May 11, 2016. Ten health centers were selected using simple random sampling technique and proportionate number of participants were included from each health centers. A pre-tested, semi-structured questionnaire was used to collect data. Data were analyzed using SPSS version 20.0. Descriptive statistics was used to summarize socio-demographic characteristics and multivariable logistic regression was employed to identify factors associated with of healthcare seeking behavior.Result: In case of illnesses, 26.5% of mothers/caregivers sought healthcare for their children. Among the common childhood illnesses, acute respiratory tract infection and diarrhea accounted for 47.6 and 31%, respectively. Mothers/caregivers healthcare seeking behavior towards common childhood illnesses were influenced by child's age (AOR = 1.78, 95% CI:1.02, 3.13), education of mothers/caregivers (AOR = 4.24, 95% CI:1.32, 13.63), family size (AOR = 3.83, 95% CI:1.06, 13.78), perception of severity of illnesses (AOR = 2.00, 95% CI:1.05, 3.84), previous experience of similar illnesses (AOR = 3.67, 95% CI:1.36, 9.86) and previous history of under-five child death (AOR = 13.31, 95% CI:5.13, 34.53).Conclusions: The common under-five childhood illnesses were acute respiratory tract infection and diarrhea. The study also revealed that there was a delay in seeking healthcare and this was significantly associated with age of the child; mothers/caregivers level of education; family size; perception of illness severity; previous experience of similar illnesses and under-five child death. [ABSTRACT FROM AUTHOR]