Table 2.
Factors associated with healthcare accessing and healthcare utilisation in slums from service user’s (demand side) perspective
| Factors | Healthcare accessing | Healthcare utilisation |
| Personal and biological factors | ||
| Age | (−) Age52–55 | (±) Age21 39–51; (+) age of household head18 |
| Gender | (±) Sex53 55 57 58 | (±) Sex18 21 41 45 51 56 58; (male) sex of household head133 |
| Ethnicity | Ethnicity21 | |
| Migration | (−) Recent migration21 49 65–68; (−) relocation48; (−) return to home village21 | |
| Biological | (+) Symptoms such as fever, tachypnoea, chest in drawing, persistent vomiting52 55 64; having disease53 | Type of illness45 58; (+) having a disability47; (+) morbidity21 51 62 63 |
| Other personal | (−) Tobacco habits69; (+) family history of cancer and history of cancer screening69 | (−) Birth order of sick child21 46 59–61; (−) parity42 46 62 148 |
| Cognitive and experiential factors | ||
| Knowledge/experience of symptoms and illnesses | (+) Perception of symptoms70 or illness52 72 76; (±) knowledge of symptom/disease52 77 78; (−) denial and complacency71 | (+) Experience of child death50; (+) planned pregnancy50; (+) perceived health status83 and health problem39 73 75; (+) knowledge of symptom82; disease79 80 |
| Ability/experience in handling health-related conditions and perceived needs for accessing health services | (+) Awareness of the need for healthcare services38 53 55; (−) home remedies70 or management of childhood illness52 84 | (+) Perceived needs for healthcare services21 67 74 75 90 93 112 128; (−) home delivery81 |
| Perception/knowledge/experience/preference of health services | (−) Fear of mistreatment71 100 and (−) doubts about medical care38 78 99; gender-induced affordability101; (−) provider shopping70 | (positive) Perception of healthcare services21 42 63 75 83 85–89 and providers21 84 93 111 124; (+) knowledge of health services21 42 48 60 67 74 81 85 90–93 or facilities21 94 95; (+) previous use of related healthcare services39 42 49 59 61 66 79 96 97; (−) bad experiences of friends and relatives at healthcare facilities94; (−) misunderstanding or fear21 67 74 75 88 98 128; gender healthcare worker preference87, (−) side effect81; lack of trust45 |
| Socioeconomic factors | ||
| Socioeconomic status | (−) Social class103; social group (caste) of caregiver53 | (+) Socioeconomic status21 39 40 46 56 61 81 102; caste108 114; (-) insecure or poor residential background21 46 68 81; (+) possession of ration card68 |
| Marital status | (married) Marital status69 | (married) Marital status18 41; duration of marriage42 |
| Family composition and living arrangement | (−) Family size53 | (±) Family type39 50 115 126; (±) family size66 68; (−) number of children in household21 44 48; (+) number of male children149; (+) housing condition21 |
| Education | (+) Education53 55 57 69 | (+) Education39 41–43 48 56 58 60 61 65–67 80–82 106–108 114–116 126 148; (±) husband education44 50; (+) mother’s education and literacy21 43 46 56 59 |
| Income and wealth | (+) Income55 117; (+) wealth54 57; (−) inability to afford care19 38 76 78 84 89 100 109 110 | (+) Income41 49 50 67 80 104; (+) wealth21 48 60 65 105–108; (−) financial constraint21 45 73 86 102 111–113 |
| Occupation | (+) Occupation53 57 69 | (+) Employment21 65 83 118 126; (±) occupation48 66 80 82 104 148; (±) occupation of spouse50 60 or household68 |
| Social support | (−) Difficulty in reaching services (security risk at night)99; (+) accompanying person76; decision-making person for seeking healthcare53 | (+) Family support74 87; (+) social connectedness93; (+) socioeconomic support121; permission for immunisation by decision-maker128 |
| Competing priorities/lack of time | (−) Competing priorities (ability to work and income)119; (−) not want to miss work70; (−) lack of time100 120 | (−) Competing priorities73 81 93; (−) risk of lost income21; (−) parents being too busy21 |
| Physical environment | ||
| Distance from health facility | Proximity of healthcare facilities38 54 76 84 122; geographical distance of formal healthcare101 | (−) Distance from health facility21 46 80 85 95 108 123–126 |
| Transport | (+) Travel assistance76; (−) no transportation38 | (−) Lack of transportation82 95 102; (−) variability in traffic congestion127 |
| Environment of residence area | (−) Difficulty in reaching services (darkness at night)99 | Residential background21 68 105 |
| Cultural and religious factors | ||
| Religion | Religion69 | Religion41 56 59 75 114 128 |
| Sociocultural influence | (−) Stigma78 101 129; mother tongue69; (−) difficulties in disclosing the symptoms, (−) neglecting behaviours and sociocultural influences77; (+) cultural competency of care101; (+) easy communication101; living with the burden of cultural expectations101; (−) no permission to seek care from family38 | (−) Exposure to media79 97; stigma128; (−) cultural expectation for women after birth and fear of stigma for pregnancy out of wedlock93 |
| Tradition | (−) Traditional medicine99 | (−) Traditional remedies75; (−) home remedies86 |
| Legal, political and policy factors | ||
| Legal issues | (−) Perceived illegality of abortion78 | Type of slums and possession of a ration card79 |
| Health system factors | ||
| Accessibility | (+) Ease of access101; (−) late facility opening times84 | (−) Limited access to the services due to location90 93; (−) timing of services21 86; household visit by health workers21 |
| Quality and safety of services | Quality of treatment and expected outcome of therapies38 101; (−) delay in advising related tests70; referral70; optimal examination84 109; (−) provider shopping70 | Quality of service66 85 86 91 112 124; (−) adverse events75 |
| Charges for health services | (+) Insurance coverage of both public and private providers and of extended family members150 | (−) Average out-of-pocket healthcare expenditure133; healthcare insurance18 63 82 |
| Service organisation and delivery arrangement | (−) Medical turnover and overload or healthcare providers130; (+) government/NGO facility117; (−) private hospital38; early engagement by healthcare workers54 | Attitude of healthcare providers86 95; mode of delivery39 56 59 62 81 151; (−) hospitals refused to accept health insurance cards94 |
| Facility and resources | Availability of medicines and supplies84 109; (−) lack of healthcare facilities144 | Type of healthcare facility40 85 95 116 131 133; inadequate resources90; (+) number of available healthcare workers46; (−) unavailability of female birth attendants112 |
| Waiting time | (−) Waiting time72 84 109 | (−) Waiting time85 86 111 132 |
(−) Negative association; (±) inconsistent/conflicting evidence or context dependent; (+) positive association.
NGO, non-governmental organisation.