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Year : 2014 | Volume : 2 | Issue : 1 | Page : 37 - 39  


Short Communications
Perceptions and health-seeking practices among an urban population of Tamil Nadu, India- A baseline survey

Assistant Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Kancheepuram District, Tamil Nadu, India.

Abstract

An increasing urban population in India brings to focus the need to improve health care services to meet the demands. Knowledge on health-seeking practices of the target population would be an essential first step to achieve health care for all. This was a short-term survey conducted between January and March 2012 in an urban area of Tamil Nadu. Majority of the participants (92.5%) were aware of health care facilities at accessible distance. But knowledge regarding curative and immunisation services available in the hospitals was inadequate (61.5% and 88.5% respectively). A positive preference towards public facilities was observed. 86% sought hospitals, 4% Over-the-counter drugs and 6% sought home remedies for common illness. Only 73% of the participants had awareness about health insurance schemes, only 23% of the families were covered by health insurance. The health-seeking practices reflected the inadequate awareness related to health services. These findings stress the need for equipping the population with adequate information regarding the availability of services and motivate appropriate utilization.

Key words: health-seeking; perceptions; practices; urban

Corresponding Author: Dr. Geetha Mani, Plot no. 428, Arul Nagar, Nandhivaram Guduvancheri, Kancheepuram district, Tamil Nadu, India. E-mail ID: drgeethammc@gmail.com

Introduction

The proportion of Indian population in urban areas has increased from 27.8% in 2001 to 31.16% in 2011.1 This transition of increasing urban population brings to focus the need for reorientation of the health care services to cater to increasing demands and thereby develop a healthy human resource capital. Knowledge on health-seeking practices of the target population would be an essential first step to achieve health care for all.

            Information about health-seeking practices of the population has important policy implications in the improvement of health care systems and services and also provides solutions to improve health-seeking behaviour among the users. Though there have been extensive research on health-seeking practices among rural population, there is a paucity of similar studies in urban areas where majority of the health facilities are concentrated. This study was a baseline survey to assess the perceptions and practices related to health-seeking among an urban population in Tamil Nadu, India.

Materials and methods

This community-based, descriptive, cross-sectional survey was conducted during January to March 2012 in Choolai, an urban area of Tamil Nadu, India. Assuming at least 50% of the population sought health care for needed illness, the sample size was calculated using the formula, N=Z2pq/d2, (allowable error(d)= 15%). Accounting for 10% non-response, the final sample size arrived at was 200. Using the list of households in the study area as the sampling frame, the required sample size was chosen by systematic random sampling.

A pre-tested, semi-structured schedule was prepared in English, translated into local language, and back-translated to check for consistency and clarity. The study was conducted after obtaining necessary approval from concerned authorities. One earning member from each household was chosen and administered the questionnaire. Informed consent was obtained from participants after they were explained about the study and ensured complete confidentiality.

Data was entered in Microsoft Office Excel 2007 and statistical analysis was performed using Statistical Package for Social Sciences (SPSS). Descriptive data was expressed in frequency and percentages.

Results

Perceptions

The participants were questioned for their knowledge on the nearest health care facilities and 185 (92.5%) were aware of atleast one primary, secondary and tertiary care facility, both in government and private sector at an accessible distance. The proportion of population with adequate knowledge on curative health care services and immunisation services available at these hospitals were 61.5% (123 out of 200) and 88.5% (177 out of 200) respectively. Only 147 (73.5%) participants were aware of health insurance schemes.

Close to three-fourths (73%) felt that health care services are for curative purposes and that only sick persons should seek health care while the rest felt that hospitals should be also be utilised for preventive purposes such as screening and immunisation services (64 out of 200). A positive preference towards private hospitals was expressed by 35% (130 people) of the population, while 65% of the participants felt that government hospitals are as good as private facilities. Sixty-nine percent had a favourable opinion against buying over-the-counter drugs (138 participants) and 56% (112 participants) were of the opinion that a person can discontinue prescribed medications when he gets better.

Practices

The distribution of type of health care sought for common illness by the participants is as follows: hospital (86%, 172), OTC drugs (8%, 16) and home or herbal remedies (6%, 12). The common illnesses for which home/herbal remedies were preferred by the 28 participants are fever (13, 46.4%), cough (20, 71.4%), joint pain (21, 75%), head ache (23, 82.1%), abdominal pain (4, 14.3%), diarrhoea (6, 21.4%) and injury and wounds (9, 32.1%).

Comparing the preference for type of hospitals sought, 65% of the participants preferred government hospitals, while 35% preferred private hospitals. Table 1 depicts the distribution of health-care seeking practices among the study population.

Table 1: Health-care seeking practices among the study participants

Questions

Frequency of positive response

Percentage

Do you seek health care immediately for common illness (fever, cough, diarrhoea)?

191

 

95.5

 

Have you ever bought OTC medications any time in the past?

55

27.5

Do you always read and follow prescribed instruction while using a drug?

87

43.5

Do you always complete the prescribed schedule of medication?

122

61

Have you ever used health care facilities for preventive services like screening?

94

47

Are the children in your household immunized for age?

174

87

Is your family covered by health insurance?

46

23

 

            All nine participants who never sought immediate medical attention for common illnesses reported lack of time due to their work-timings as the reason.

Discussion

Majority of the participants (92.5%) were aware of the health care facilities at accessible distance. But the knowledge regarding curative and immunisation services available in the hospitals were inadequate (61.5% and 88.5% respectively). Most participants (73%) opined that health services are for curative purposes only. A positive preference towards public facilities was observed in this study population.

In our study, 86% sought hospitals, 4% OTC drugs and 6% sought home remedies for common illness. Shah et al in urban Ahmedabad reported that about 50% chose hospitals and about 44% preferred OTC drugs and traditional healers.2 Simsekoglu et al reports a different picture, where 53% sought hospitals, 19% used self-medication or OTC drugs and 2% sought traditional medicines in a Turkish population.3 The home/herbal remedies or OTC drugs were preferred by 10% for certain specific illnesses. This is in accordance with the results reported by Rahman SA.4 According to Raza et al 11% reported seeking OTC drugs.5

Sixty-five percent participants sought government facilities for their families. A higher preference for private facilities was observed by Shah et al and Islam et al among urban populations of Ahmedabad and Indore respectively and by Dominic et al and Raza et al among rural populations.2,6,7,5 This finding varies from that reported by Muriithi MK in urban Kenya where majority visited alternate health facilities.8

Only 73% of the participants had awareness about health insurance schemes and only 23% of the families were covered by health insurance. Though considerably higher than that reported by Gumber et al (9%) and Shah et al in urban and rural Ahmedabad (8.4%% and 2.4% respectively), this figure is grossly inadequate.9,2 Ellis et al also reports similar low insurance coverage, though there was recognisable difference between organised and unorganised sector.10 Simsekoglu et al reported 94% coverage for health insurance.3

The health-seeking practices were reflective of the inadequate awareness related to health services. More than one-fourth had bought OTC drugs in the past. Only 61% of the families ever completed the prescribed schedule, 47% had sought health care for preventive services and only 87% reported that children in their families had been completely immunized. These findings stress the need for equipping the population with adequate information regarding the availability of services and motivate appropriate utilization.

Ahmed et al also emphasises the need for encouraging the people to opt for the official services.11 Muriithi MK and Thompson et al also suggests that information on the availability and quality of available health services plays an important role in improving health-seeking practices of people.

This study is a baseline survey and the health-seeking practices were not correlated with the possible socio-demographic variables and other determinants. A long-term study covering a broader population is being planned. Nevertheless, this study identifies that though majority of health services are concentrated in urban areas, the awareness and health-seeking practices among this population in inadequate.  

Conclusion

This study stresses the need for continuous efforts to raise community awareness regarding the importance of seeking health care for preventive and curative services from organised services and trained personnel.

References

  1. Urban population in India jumps to 31. The Indian Express, New Delhi edition dated August 22, 2012. Available at http://archive.indianexpress.com/news/urban-population-in-india-jumps-to-31-/99169. Accessed on April 19, 2014.
  2. Shah T, Patel M, Shah V. Health care seeking behavior of urban and rural community in Ahmedabad district. Int J Med Sci Public Health 2013; 2(4): 908-11.
  3. Simsekoglu O, Aydemir N. Health-seeking practices and psycho-social factors related to health behaviors in a Turkish sample. J Behav Health 2014;3(1):17-24
  4. MacKian S. A review of health seeking behaviour: problems and prospects. UK Department of International Development. Health Systems Development Programme- Working paper series 5. 2003, p6
  5. Raza WA, Panda P, Van de Poel E, Dror DM, Bedi AS. Healthcare Seeking Behavior among Self-help Group Households in Rural Bihar and Uttar Pradesh, India (No. 575). International Institute of Social studies. 2013, ISS Working Paper Series / General Series (Vol. 575, pp. 1–32). Retrieved from http://hdl.handle.net/1765/50172
  6. Islam M, Montgomery M, Taneja S. Abt Associates Inc. Urban Health and Care-Seeking Behavior: A Case Study of Slums in India and the Philippines- Final Report. Bethesda, Maryland, The Partners for Health Reformplus Project, Abt Associates Inc. September 2006. P 60-61
  7. Dominic RA, Shashidhara YN, Nayak MG. Health seeking behavior of rural adults. Nitte University Journal of Health Sciences 2013;3(3):77-82.
  8. Muriithi MK. The determinants of health-seeking behavior in a Nairobi slum, Kenya. European Scientific Journal 2013; 9(8):151-64
  9. Gumber A, Kulkarni V. Health insurance for the workers in the informal sector, Detailed results from a pilot study, New Delhi. National Council of Applied Economic Research, New Delhi, 2000.
  10. Ellis RP, Alam M, Gupta I. Health insurance in India: Prognosis and prospectus. Economic and Political Weekly 2000;35(4):207.
  11. Ahmed S, Chowdhury M, Bhuiya A. Micro-Credit and emotional Well-being: Experience of Poor Rural Women from Matlab, Bangladesh. World Development, 2001; 29(11): 1957-1966
  12. Thompson R, Miller N, Witter S. Health seeking behavior and the rural/urban variations in Kazakhstan. Health Economics 2003;12:553-64.

Acknowledgement: The authors are grateful to the participants for their enthusiastic participation in the study.

Source of Support: Nil. Conflict of Interest: None.

 

 





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