Health-Seeking Behaviors and its Determinants: A Facility-Based Cross-Sectional Study in the Turkish Republic of Northern Cyprus

An Analysis of the Mode of Delivery, Risk Factors, and Subgroups with High Caesarean Birth Rates Using Robson Classification System

OBJECTIVE

We aimed to understand the utilization of the mode of delivery and related risk factors. Further aimed to apply the Robson classification system to evaluate the data quality and analyze the CS rates in subgroups.

METHODS

We conducted a retrospective descriptive study by reviewing the medical records of all women who delivered at the State Hospital in 2019. A proforma was developed for extracting data from patient records. All women with six obstetric parameters were categorized into Robson groups to determine the absolute and relative contributions of each group to the overall CS rate.

RESULTS

Of 797 deliveries, 401 (50.2%) were CSs. Being older, being Turkish Cypriot, having preterm births, previous CS, multiple fetuses, and having breech or transverse fetal presentations were related to having higher risks of CS. The most common medical indication for CSs (52.3%) was a history of previous CSs. Robson Group 5 contributed the most (50.7%) to the overall CS rate, with the highest absolute contribution of 21.8%. Group 10 and Group 8 were the second and third highest contributors to the overall CS rate, with relative contributions of 25.3% and 9.0%, respectively.

CONCLUSIONS

Findings revealed the substandard quality of obstetric data and a noticeably high overall CS rate. The top priority should be given to improving the quality of medical records. It underscored the necessity of implementing the Robson classification system as a standard clinical practice to enhance data quality, which helps to effectively evaluate and monitor the CS rates in obstetric populations.

Investigating the role of symptom valorisation in tuberculosis patient delay in urban areas in Portugal

BACKGROUND

Diagnosis delay contributes to increased tuberculosis (TB) transmission and morbimortality. TB incidence has been decreasing in Portugal, but median patient delay (PD) has risen. Symptom valorisation may determine PD by influencing help-seeking behaviour. We aimed to analyse the association between symptom valorisation and PD, while characterising individuals who disregarded their symptoms.

METHODS

A cross-sectional study was conducted among TB patients in Lisbon and Oporto in 2019 - 2021. Subjects who delayed seeking care because they did not value their symptoms or thought these would go away on their own were considered to have disregarded their symptoms. PD was categorised using a 21-day cut-off, and a 30-day cut-off for sensitivity analysis. We estimated the effect of symptom valorisation on PD through a directed acyclic graph. Then, a multivariable regression analysis characterised patients that disregarded their symptoms, adjusting for relevant variables. We fitted Poisson regression models to estimate crude and adjusted prevalence ratios (PR).

RESULTS

The study included 75 patients. Median PD was 25 days (IQR 11.5-63.5), and 56.0% of participants had PD exceeding 21 days. Symptom disregard was reported by 38.7% of patients. Patients who did not value their symptoms had higher prevalence of PD exceeding 21 days compared to those who valued their symptoms [PR 1.59 (95% CI 1.05-2.42)]. The sensitivity analysis showed consistent point estimates but wider confidence intervals [PR 1.39 (95% CI 0.77-2.55)]. Being a smoker was a risk factor for symptom disregard [PR 2.35 (95% CI 1.14-4.82)], while living in Oporto [PR 0.35 (95% CI 0.16-0.75)] and having higher household incomes [PR 0.39 (95% CI 0.17-0.94)] were protective factors.

CONCLUSIONS

These findings emphasise the importance of symptom valorisation in timely TB diagnosis. Patients who did not value their symptoms had longer PD, indicating a need for interventions to improve symptom recognition. Our findings also corroborate the importance of the socioeconomic determinants of health, highlighting tobacco as a risk factor both for TB and for PD.

Patient's Perspective on Factors Affecting Health-Seeking Behavior in Al-Ahsa, Saudi Arabia

 Background There are different determinants of health-seeking behaviors. Studying health-seeking behaviors and their factors help governments use the existing health resources properly for a potent healthcare system. This study aimed to evaluate the factors influencing health-seeking behavior in Al-Ahsa. Methods The study is a questionnaire-based observational cross-sectional study of the factors influencing health-seeking behaviors in the general population of the Al-Ahsa governorate. A non-probability convenience sampling technique was used to acquire the sample. The study followed all ethical considerations and received approval from King Faisal University. Results A total sample of 481 participants completed the study questionnaire. 21.2% of people visited the health centers for medical checkups despite having no symptoms, while 29.1% admitted to avoiding the health centers despite knowing they needed medical attention. Additionally, the majority of patients prefer government-run health facilities (58.6%), while 41.4% prefer the commercial sector. When experiencing any health complaints, precisely 70.7 % of women go to a medical facility, compared to 61.8% of men (P=.038). In addition to that, 68.5% of participants with intermediate economic status visit healthcare centers for any symptoms compared to 50% of others with high financial status (P=.049). Specifically, 73.3% of participants diagnosed with a disease or chronic diseases visited healthcare centers for clinical symptoms compared to 64.3% of others without (P=.049). Conclusion This study identified that most participants with chronic diseases seek medical care for any symptom, and the participants with an intermediate economic status are more likely to go to a governmental primary healthcare center for any symptoms. The findings of this research provide insights for the government and policymakers to create effective strategies and manage the existing resources in Al-Ahsa.

Impact of COVID-19 on Health Seeking Behavior of Patients with Chronic Disease at Public Hospitals in Jimma Zone, South West Ethiopia

Background

COVID-19 is a global pandemic with unprecedented medical, economic and social consequences affecting nations across the world. This epidemic arises while chronic diseases are continued to be a public health concern. Though evidence is generated on its impact on the health care system, little is known about the Impact of COVID −19 on the care-seeking behavior of chronic patients.

Objective

To assess the Impact of COVID-19 on healthcare-seeking behavior of patients with chronic diseases attending follow-up at public hospitals in Jimma zone, South West Ethiopia.

Methods

Facility-based cross-sectional study design was employed. The sample was calculated using the single population proportion formula. Hospitals were selected by using simple random sampling. Then, the final calculated sample size for the study was proportionally allocated to each selected hospital. Data were collected from 400 participants through face-to-face interviews and card reviews. Data were entered into Epi-Data version 3.1 and then exported to SPSS version 23 for analysis. Binary and multivariable logistic regression analyses with 95% CI for odds ratio (OR) were used to identify significant factors.

Results

Of the total respondents 156 (39.0%) of them had poor health-seeking behavior. Contact history with COVID −19 patient (AOR = 2.8; 95% CI = 1.1–7.0), perceived moderate depression (AOR = 2.3; 95% CI = 1.2–4.2), perceived extreme depression (AOR = 4.3; 95% CI = 1.8–10.5), shortage of medication (AOR = 2.4; 95% CI = 1.0–6.2) increases the odds of poor health-seeking behavior. In addition, the odds of poor health-seeking in patients with no formal education were higher compared to patients with higher educational status (AOR = 2.7; 95% CI = 1.0–9.0).

Conclusion

COVID −19 outbreaks affected the health-seeking behavior of patients with chronic diseases. The impact was found to be more significant among patients who had a contact history with COVID −19 patients. Moreover, perceived depression, shortage of medication, and low educational status were significant predictors of poor health-seeking behavior. Therefore, working on the barriers to the health-seeking behavior of chronic patients may reduce the effect of COVID-19.

The Urban-Rural Disparities and Associated Factors of Health Care Utilization Among Cancer Patients in China

Objective

This study aimed to examine the urban-rural disparities and associated factors of health care utilization among cancer patients in China.

Methods

This study used the data collected from a cross-sectional survey conducted in China. A total of 1,570 cancer survivors from three urban districts and five rural counties were selected by using a multistage stratified random sampling method. We measured health care utilization with the way of cancer diagnosis, the number of hospitals visited, and receiving alternative therapies. Chi-square test was used to examine the differences between urban and rural cancer patients. Binary logistic regression analysis was performed to explore the determinants of health care utilization.

Results

Among 1,570 participants, 84.1% were diagnosed with cancer after developing symptoms, 55.6% had visited two and above hospitals, and 5.7% had received alternative therapies. Compared with urban cancer patients, rural ones were more likely to be diagnosed with cancer after developing symptoms (χ2 = 40.04, p < 0.001), while they were less likely to visit more than one hospital (χ2 = 27.14, p < 0.001). Residence area (urban/rural), health insurance type, household income, age at diagnosis, tumor site, stage of tumor, and survival years were significantly associated with health care utilization of cancer patients (p < 0.01).

Conclusions

Health care utilization was suboptimal among cancers patients in China. Rural cancer patients had less health care utilization including screenings and treatments than urban ones. Policymakers should implement specific strategies to ensure equitable utilization of cancer care. More attention should be paid to the disadvantaged groups and rural cancer patients. Prioritizing health resources allocation is needed to prevent, screen, and treat cancers in rural areas.

An integrative model of patients' perceived value of healthcare service quality in North Cyprus

Background

Improving healthcare quality has become an essential objective for all health institutions worldwide to address the need to improve services, manage costs and satisfy patient expectations about the quality of care. As health is one of the leading service sectors of the North Cyprus economy, analysing patients’ perceived value of healthcare service quality is crucial. In this research, a comparative analysis of existing models revealed affordability, acceptability and accessibility as the leading modern service quality indicators affecting patients’ perceived value of healthcare service quality. The quality of services is a leading factor impacting business competition and retention dictated by the current market. This study aimed to investigate the factors that influence patient perceptions of healthcare service quality in North Cyprus.

Methods

A self-administered questionnaire was carried out among 388 patients of public and private hospitals in North Cyprus, and the data were analysed using partial least squares-structural equation modelling.

Results

Empirical results highlight that the acceptability of healthcare services is a prerequisite for perceiving a high value of service quality. The affordability and accessibility of services, respectively, were less effective. Results concerning mediating effects confirm that acceptability could fully mediate the relationship between affordability and perceived value and could partially mediate the impact of accessibility on the perceived quality of healthcare services.

Conclusion

This study contributes to healthcare theory and practice by developing a conceptual framework to provide policymakers and managers with a practical understanding of factors that affect healthcare service quality.

Self-Reported Morbidity and Health-Seeking Behavior and its Predictors Among a Geriatric Population in Western Ethiopia: Community-Based Cross-Sectional Study

Background

Planning for health care services provision depends on the morbidity profile, health-seeking behavior (HSB), and its predictors. Thus, this study aimed to identify the level of self-reported morbidity, HSB and its predictors.

Patients and Methods

A community-based cross-sectional study was conducted among the geriatric (≥60 years) population in West Shoa Zone. A multi-stage systematic sampling technique was employed to select the study participants. After testing for collinearity, variables with p-value <0.25 on binary logistic regression were entered into backward multivariate logistic regression analysis with statistical significance at p-value <0.05.

Results

With a response rate of 98%, 779 study participants were recruited. The median (IQR) age of the respondents was 70 (70–78) years. Five hundred eighty-four (3/4) of the study participants reported that they experienced morbidity at least once in the year before interview. Of 584 study participants, 53.9% had poor HSB. Living in village (p-value = 0.034), being housewife (p-value = 0.048), wealth index [being rich (p-value = 0.033), being in moderate economic status (p-value= 0.001), and being poor (p-value= 0.049) relative to richest], being head of polygamous household (p-value= 0.019), non-smoker (P-value = 0.012), not having community-based health insurance coverage (CBHI) (p-value< 0.0001), having ≤3 times number of illness (p-value <0.0001), self-medication (p-value < 0.0001), not having hypertension (p-value=0.016), not having diabetes mellitus (DM) (p-value=0.012), and not having oro-dental problem (p-value= 0.043) were positively associated with poor HSB. Nevertheless, self-perceived mild severity of illness (p-value= <0.0001), good health status (p-value= 0.001), and not having musculoskeletal problem (p-value< 0.0001) were negatively associated with poor HSB.

Conclusion

There was a high prevalence of self-reported morbidity and poor HSB. There should be an effort to improve the HSB and CBHI utilization of the geriatric population by all stakeholders. Moreover, modifiable predictors of HSB needs to be improved.