Abstract
Background:
Healthcare-seeking behavior is a decision-making process governed by an individual's conduct, community norms, and expectations, as well as provider-related characteristics and manners. This study determined factors associated with healthcare seeking behavior of automobile artisans in Abakaliki.
Materials and Methods:
A descriptive cross-sectional survey of 380 artisans was carried out. Respondents were selected using multi-stage sampling method and semi-structured interviewer administered pretested questionnaire was used to gather information. Data were analyzed using SPSS software, and the Chi-squared test was used to test for association at 5% level of significance.
Results:
The mean age of the artisans was 31.3 ± 10.3 years, and the mean monthly income was N15277. Less than half of the respondents (47.7%) sought medical care in pharmacy/patent medicine stores. A significant association was found between distance to the facility for medical care and period of delay before seeking care (P = 0.01). Bruises (45.3%) and cuts (32.3%) were the most prevalent injuries sustained in the preceding 12 months. A significantly high proportion of those who had bruises and cuts traveled >6 km to seek care and less than half of the respondents (47.6%) who reside within 5 km radius to place of medical care patronized pharmacy/patent medicine shops. However, higher proportion of those with cuts (52.0%) and burns (62.5%) compared to other types of injury went to the hospitals no matter the distance.
Conclusions:
The artisans have poor health-seeking behavior and majority sought medical care in pharmacy/patent medicine shops rather than hospitals. However, a significant proportion of those with injuries used hospitals regardless of the distance. It is, therefore, imperative to establish healthcare facilities within 5 km radius from where they live and work.
Keywords: Abakaliki, artisans, automobile, healthcare, injuries, prevalence, seeking behavior
INTRODUCTION
The study of human behavior is an art and dealing with solving its problem is science. One of the dynamics of human behavior is how they react in case of sickness. Healthcare-seeking behavior is defined as any action undertaken by individuals who perceive themselves to have a health problem or to be ill for the purpose of finding an appropriate remedy.1 Healthcare-seeking behavior is preceded by a decision-making process that is further governed by individuals and/or household department, community norms, and expectations as well as provider-related characteristics and conduct.1 For this reason, the nature of healthcare-seeking is not homogeneous depending on cognitive and noncognitive factors that call for a contextual analysis of care-seeking behavior. The context may be a factor of cognition or awareness, sociocultural as well as economic factors.2
The determinants of healthcare-seeking behavior can be described as the status of women (cultural), age and sex (biological), household resources (socioeconomic), costs of care (economic), distance and physical access (geographical), perceived quality (organizational), and quality of drugs. Understanding these determinants of healthcare, demand provides a basis on which governments can reform health policy.3,4 This study determined healthcare-seeking behavior of artisans in mechanic Site, Abakaliki, Nigeria.
MATERIALS AND METHODS
This was a descriptive cross-sectional study carried out among Artisans in Abakaliki. Popular artisan groups include auto mechanics, electricians, welders, fashion designers, carpenters, and painters. The artisans exist in associations of groups with a common interest, the basis on which they could also protect and promote their health and welfare, and each group has an average of 200 registered members. The various of artisans have monthly meetings during which registered members pay varying amounts of money as monthly dues and leviess. Only artisans registered with their association who gave consent were studied.
A minimum sample size of 380 was obtained using the Leslie Fischer's formula: n = Z2pq/d2, with confidence interval set at 95%, normal deviate Z = 1.96 and d = 0.05. Multistage sampling technique was adopted, and a proportionate number of questionnaires were allocated to each stratified group based on their total number. During their monthly meetings, the attendance list was used as a sampling frame and the systematic random method was used to select participants with sampling interval of three until total number of questionnaires allocated to that group was exhausted.
Research instruments were semi-structured interviewer- administered pretested questionnaires. The study variables include sociodemographic characteristics and healthcare-seeking behavior. Three-trained research assistants were engaged for data collection. The questionnaires were translated into the local language and back-translated in English for ease of clarity of its content. Ethical approval was obtained from the Federal Teaching Hospital, Abakaliki, Nigeria, whereas written informed consent was obtained from the individual participants. Data obtained were validated by double entry and random checks and analyzed using the SPSS software version 22 (IBM Corporation, Armonk, New York, USA). Frequency tables were generated and relevant summary statistics computed. The Chi-squared test of association was used at significance level of P < 0.05.
RESULTS
Table 1 shows that the mean age of the artisans was 31.3 ± 10.3 years, with the mean income of N15277. In Table 2, less than half of the respondents (47.7%) sought medical care in pharmacy shops or patent medicine stores. A large proportion of the respondents (12.7%) delayed for >7 days before seeking medical care. The main reason for the delay in seeking treatment as reported by 49.5% was the belief that the illness was minor and that they would get over it without treatment, whereas 26.6% of the respondents delayed because of lack of money for the treatment. A significantly high proportion of respondents (55.0%) used their savings to settle medical bills. Table 3 shows that 45.3% and 32.3% of the respondents sustained bruises and cuts, respectively, in the past 12 months. Table 4 shows that there is a statistically significant association between monthly income and preferred place of care (P = 0.03). Furthermore, a significant relationship was found between distance to the place of seeking care and period of delay before seeking care (P = 0.01) and preferred place of care (P = 0.002). A significantly high proportion of those who had bruises and cuts in the workplace traveled as far as 6 to 10 km to seek care, and 52.9% of those who had electric shock traveled > 10 km for medical care. Less than half of the respondents (47.6%) who reside or work within 5 km radius to a place of medical care patronized pharmacy shops/patent medicine store. Higher proportion of the low income than that of high-income earners patronized traditional/herbal healers. However, a significantly higher proportion of respondents with cuts (52.0%) and burns 62.5%) than other types of injuries patronized hospitals irrespective of the distance. Table 5 shows that majority (47.1%) of those that had electric shock preferred the hospital for care while most (43.8%) of those with bone injuries favoured the herbalist.
Table 1.
Socioeconomic characteristics of respondents (n=380)
| Variables | Frequency, n (%) |
|---|---|
| Age group (years) | |
| 15-25 | 38 (10) |
| 26-35 | 128 (33.7) |
| 36-45 | 112 (29.5) |
| >45 | 102 (26.8) |
| Mean±SD | 31.3±10.3 |
| Gender | |
| Male | 292 (76.8) |
| Female | 88 (23.2) |
| Marital status | |
| Single | 101 (26.6) |
| Married | 279 (73.4) |
| Educational status | |
| No formal education | 10 (2.6) |
| Primary | 39 (10.3) |
| Secondary | 260 (68.4) |
| Tertiary | 71 (18.7) |
| Artisan group | |
| Auto mechanic | 133 (35) |
| Electrician | 53 (13.9) |
| Welder | 27 (7.1) |
| Painter | 24 (6.3) |
| Carpenter | 81 (21.3) |
| Fashion designer | 48 (12.6) |
| Others | 39 (10.2) |
| Income per month (Naira) | |
| <15,000 | 163 (42.9) |
| 15,000-24,999 | 111 (29.2) |
| 25,000-34,999 | 44 (11.6) |
| 35,000-44,999 | 35 (9.2) |
| 50,000 and above | 27 (7.1) |
| Mean income | 15,277 |
SD - Standard deviation
Table 2.
Respondents healthcare-seeking behavior (n=380)
| Variables | Frequency (%) |
|---|---|
| Preferred place for healthcare | |
| Hospitals | 162 (42.6) |
| Traditional/herbal medicine/spiritualist | 37 (9.7) |
| Pharmacy/patent medicine store | 181 (47.7) |
| Visits the hospital whenever ill (n=162) | |
| Yes | 39 (24.1) |
| No | 123 (75.9) |
| Distance to the place for healthcare (km) | |
| 5 or less | 233 (61.3) |
| 6-10 | 95 (25.0) |
| >10 | 52 (13.7) |
| The delayed time before seeking care (days) | |
| 2 | 251 (66.1) |
| 5 | 80 (21.1) |
| 7 or more | 49 (12.8) |
| Reasons for delay in seeking care | |
| Minor illness/hope to get over illness without treatment | 188 (49.5) |
| Expensive/lack money for the treatment | 101 (26.6) |
| Distance to the place for seeking care | 47 (12.3) |
| Long waiting time at the place for care | 23 (6.1) |
| Others | 21 (5.5) |
| Reasons for choice of place of care | |
| Quality of care | 129 (33.9) |
| Nearest to a place of residence/work | 121 (31.9) |
| Not expensive | 106 (27.9) |
| Free treatment | 13 (3.4) |
| Others | 11 (2.9) |
| Sources of money for payment of bills | |
| Savings | 209 (55.0) |
| Sales of belongings | 31 (8.2) |
| Borrowed/assistance from friends | 104 (27.3) |
| Paid in kind | 19 (5.0) |
| Others | 17 (4.5) |
Table 3.
Prevalence of workplace injuries among respondents (in the past 12 months)
| Injury | Frequency (%) |
|---|---|
| Bruises | 172 (45.3) |
| Cuts | 123 (32.3) |
| Burns | 24 (6.3) |
| Electric shock | 17 (4.5) |
| Dislocation/sprain/fracture | 16 (4.2) |
| Others | 28 (7.4) |
Table 4.
Test of association with delayed time before seeking care and preferred place of care among the artisans
| Variables | Delayed time before seeking care (days) |
Preferred place of care |
||||||
|---|---|---|---|---|---|---|---|---|
| 2 | 5 | ≥7 | P | Hospitals | Traditional/herbal | Pharmacy/patent medicine | P | |
| Gender | ||||||||
| Male | 65 (22.3) | 133 (45.5) | 94 (32.2) | 0.12 | 97 (59.9) | 25 (65.8) | 102 (56.7) | 0.23 |
| Female | 39 (44.3) | 27 (30.7) | 22 (25.0) | 65 (40.1) | 13 (34.2) | 78 (43.3) | ||
| Educational level | ||||||||
| Primary or less | 26 (53.1) | 11 (22.4) | 12 (24.5) | 0.61 | 32 (19.8) | 19 (50.0) | 67 (37.2) | 0.06 |
| Secondary | 103 (39.6) | 79 (30.4) | 78 (30.0) | 45 (27.8) | 13 (34.2) | 61 (33.9) | ||
| Tertiary | 27 (30.0) | 25 (35.2) | 17 (23.9) | 85 (52.4) | 6 (15.8) | 52 (28.9) | ||
| Monthly income (Naira) | ||||||||
| <15,000 | 74 (45.4) | 43 (26.4) | 46 (28.2) | 0.17 | 23 (14.2) | 15 (39.5) | 51 (28.3) | 0.03 |
| 15,000-24,999 | 47 (42.4) | 51 (45.9) | 13 (11.7) | 34 (20.9) | 10 (26.3) | 32 (17.8) | ||
| 25,000-34,999 | 18 (40.9) | 17 (38.6) | 9 (20.5) | 35 (21.7) | 6 (15.7) | 28 (15.6) | ||
| 35,000-44,999 | 15 (42.8) | 13 (37.1) | 7 (20.0) | 29 (17.9) | 5 (13.2) | 31 (17.2) | ||
| 50,000 and above | 11 (40.7) | 10 (37.0) | 6 (22.3) | 41 (25.3) | 2 (5.3) | 38 (21.1) | ||
| Distance to place of seeking care (km) | ||||||||
| 5 or less | 57 (24.5) | 85 (36.5) | 91 (39.0) | 0.01 | 73 (31.3) | 49 (21.0) | 111 (47.6) | 0.002 |
| 6-10 | 8 (44.4) | 5 (27.8) | 5 (27.8) | 10 (55.6) | 5 (27.8) | 3 (16.7) | ||
| >10 | 9 (42.8) | 7 (33.3) | 5 (23.8) | 12 (57.2) | 5 (23.8) | 4 (19.0) | ||
Table 5.
Injuries in the work place, distance to, and preferred place of care
| Injury types | Distance to a place of care (km) |
Preferred place of care |
||||||
|---|---|---|---|---|---|---|---|---|
| ≤5 | 6-10 | >10 | Total | Hospitals | Traditional/herbal | Pharmacy/patent medicine | Total | |
| Bruises | 43 (25.0) | 107 (62.2) | 22 (12.8) | 172 | 55 (31.9) | 23 (13.4) | 94 (54.7) | 172 |
| Cuts | 39 (31.7) | 71 (57.7) | 13 (10.6) | 123 | 64 (52.0) | 11 (8.9) | 48 (39.0) | 123 |
| Burns | 7 (29.2) | 9 (37.5) | 8 (33.3) | 24 | 15 (62.5) | 3 (12.5) | 6 (25.0) | 24 |
| Electric shock | 3 (17.6) | 5 (29.4) | 9 (52.9) | 17 | 8 (47.1) | 4 (23.5) | 5 (29.4) | 17 |
| Dislocation/sprain/fracture | 4 (25.0) | 6 (37.5) | 6 (37.5) | 16 | 5 (31.2) | 7 (43.8) | 4 (25.0) | 16 |
| Others | 11 (39.3) | 9 (32.1) | 8 (28.6) | 28 | 11 (39.3) | 5 (17.9) | 12 (42.8) | 28 |
DISCUSSION
Healthcare-seeking behavior can be influenced by the availability, quality and price of services, as well as social group, health views, residences, and personal features of the users.5,6 In addition, people's choice of healthcare differs in sociodemographic, socioeconomic, and cultural compositions which affect their healthcare-seeking behavior.7
The low level of education of most respondents in this study may be because Abakaliki is inhabited mostly by agrarians with low-socioeconomic index and as such most people instead of going to school ventured into agriculture, petty trading, and roadside mechanic. This resulted to a very low-mean monthly income of ₦15,277 (Nigerian Naira). This finding is at variance with that in Kogi, Nigeria, where a significant proportion of the respondents had postsecondary education with relatively higher mean monthly income.8 Although the large proportion of respondents attained low educational level, significantly high proportion had a relatively shorter period of delay before seeking medical care when ill. This finding is in contrast with other findings where a short period of delay before seeking medical care was found among those with higher educational attainment.8 Early presentation to a place of medical care is likely to reduce complications arising from such illnesses and also to some extent reduce cost.
Almost half of the respondents delayed seeking medical treatment because they thought that the illness was minor and that they would get over the ailment without treatment while a quarter of respondents delayed because of lack of money for the treatment. Therefore, wider coverage of National Health Insurance Scheme could be an approach to ensure that many Nigerians overcome the challenge of out-of-pocket payment for medical bills. The World Health Organization promotes the principle that whatever system of health financing a country adopts, it should not deter people from seeking and utilizing health services.9,10 This then means that payment at the point of service could be eliminated or at least be related to ability to pay.
Majority of the respondents sought medical care in the pharmacy shops and or patent medicine stores when ill. This finding is similar to that found in a study on healthcare-seeking behavior among women in Southeast Nigeria which showed that most respondents sought medical care at patent medicine stores followed by the visit to the government hospitals.11 Patent medicine shops are numerous in our environment and provide quick response to clients without the protocol of opening treatment cards and detailed documentation as obtains in the hospital. This is regarded as quackery in our context and should be prohibited by law. It could make clients prone to polypharmacy, inadequate treatment, and drug resistance.
More than half of the respondents paid for healthcare from their personal savings, whereas a large proportion was able to pay through borrowing from friends. A situation whereby as much as 8.6% of the respondents sold their properties to pay for healthcare should be a cause for worry as most of these properties are likely to be disposed at “give-away” prices. Health Insurance Scheme is, therefore, the most reasonable option for financing healthcare in low- and middle-income countries.9 The apparently slow pace in the implementation of the scheme will continue to deprive a large number of people access to good healthcare in this part of the world.
A significantly high proportion of those who had bruises and cuts in the workplace traveled as far as 6–10 km to seek medical care and more than half of the artisans who had electric shock traveled >10 km for medical care. Geographical access to a health facility is a serious problem in the studied population with a significantly high proportion of them accessing health facilities farther than 5 km from their workplace. This finding is in consonance with other findings from Ethiopia12 and Asia.13
A higher proportion of the low income than that of high-income earners patronized traditional/herbal healers for the treatment. Monthly income was significantly associated with healthcare-seeking behaviors (preferred place of care). This was corroborated by studies from Congo Republic14 and Jamaica.15 The plausible justification could be that the lower income level is linked with inaccessibility and low-level awareness about modern medicine. However, significantly higher proportion of the respondents with cuts and burns than other types of injury in the workplace patronized hospitals irrespective of the distance from the place of residence or work. This could be due to the severity of the injuries and fear of possible complications that could interfere with the performance of their regular duties. The desire to recover quickly and get back to business could be a motivation to seek appropriate medical care.
CONCLUSIONS
Majority of the artisans patronized pharmacy/patent medicine dealers more than hospitals during illness, and they delayed more than 7 days before seeking medical remedy. Perceived severity of the injury is the most important determinant for visiting a hospital or clinics. Delay in seeking care for health can be costly and dangerous. It is therefore necessary to increase awareness of this problem to the public through health education. Public health facilities should be made more accessible to people to improve utilization, especially among the self-employed and the low-income earners.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Ihaji E, Gerald EU, Ogwuche CH. Educational level, sex and church affiliation on health seeking behaviour among parishioners in Makurdi metropolis of Benue state. JEPER. 2014;1:311–6. [Google Scholar]
- 2.Kakkar R, Kandpal SD, Negi KS, Kumar S. To study health seeking behaviour of population catered by rural health training centre, Rajeev Nagar. Indian J Prev Soc Med. 2013;44:3–4. [Google Scholar]
- 3.David L. Determinants of Health Seeking Behaviour in Uganda-Is it Just Income or User Fees That are Important? UK: University of Manchester; 2004. [Last accessed on 2018 Aug 02]. Available from: http://unpan1.un.org/intradoc/groups/public/documents/NISPAcee/UNPAN018976 . [Google Scholar]
- 4.Ogunlesi TA, Olanrewaju DM. Socio-demographic factors and appropriate health care-seeking behavior for childhood illnesses. J Trop Pediatr. 2010;56:379–85. doi: 10.1093/tropej/fmq009. [DOI] [PubMed] [Google Scholar]
- 5.Amin R, Shah NM, Becker S. Socioeconomic factors differentiating maternal and child health-seeking behavior in rural Bangladesh: A cross-sectional analysis. Int J Equity Health. 2010;9:9. doi: 10.1186/1475-9276-9-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Yimer S, Holm-Hansen C, Yimaldu T, Bjune G. Health care seeking among pulmonary tuberculosis suspects and patients in rural Ethiopia: A community-based study. BMC Public Health. 2009;9:454. doi: 10.1186/1471-2458-9-454. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Pemunta NV, Obara TB. Toward a reconceptualization of the “urban” and “rural” as conceptual and analytical categories in the social sciences. Arts Soc Sci J. 2012;2012:1. [Google Scholar]
- 8.Akande TM, Owoyemi JO. Healthcare-seeking behaviour in Anyigba, North-Central, Nigeria. Res J Med Sci. 2009;3:47–51. [Google Scholar]
- 9.Health Reform Foundation of Nigeria. Nigerian Health Review. Publication of Health Reform Foundation of Nigeria. 2006 [Google Scholar]
- 10.Health Reform Foundation of Nigeria. Nigerian Health Review. Primary Health Care in Nigeria: 30 Years after Alma Ata. Publication of Health Reform Foundation of Nigeria. 2007 [Google Scholar]
- 11.Uzochukwu BS, Onwujekwe OE. Socio-economic differences and health seeking behaviour for the diagnosis and treatment of malaria: A case study of four local government areas operating the Bamako initiative programme in South-East Nigeria. Int J Equity Health. 2004;3:6. doi: 10.1186/1475-9276-3-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Girma F, Jira C, Girma B. Health services utilization and associated factors in Jimma Zone, South West Ethiopia. Ethiop J Health Sci. 2011;21:85–94. [PMC free article] [PubMed] [Google Scholar]
- 13.Ghose B, Zhaohui C, Zhifei H. Understanding the social determinants of TB and HIV in South Asia. Peer J Pre Prints. 2014;2:13–5. [Google Scholar]
- 14.Chenge MF, Van der Vennet J, Luboya NO, Vanlerberghe V, Mapatano MA, Criel B. Health-seeking behaviour in the city of Lubumbashi, democratic republic of the Congo: Results from a cross-sectional household survey. BMC Health Serv Res. 2014;14:173. doi: 10.1186/1472-6963-14-173. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Bourne PA. Socio-demographic determinants of Health care-seeking behaviour, self-reported illness and self-evaluated health status in Jamaica. Int J Collab Res Intern Med Public Health. 2009;1:101–30. [Google Scholar]