Abstract
sBackgroundWith regards to equity, the objective for health care systems is “equal access for equal needs”. We examined associations of predisposing, enabling and need factors with health facility utilization in areas with high HIV prevalence and few people being aware of their HIV status.MethodsThe data is from a population-based survey among adults aged 15years or older conducted in 2003. The current study is based on a subset of this data of adults 15–49 years with a valid HIV test result. A modified Health behaviour model guided our analytical approach. We report unadjusted and adjusted odds ratios and their 95% confidence intervals from logistic regression analyses.ResultsTotals of 1042 males and 1547 females in urban areas, and 822 males and 1055 females in rural areas were included in the study. Overall, 53.1% of urban and 56.8% of rural respondents utilized health facilities past 12 months. In urban areas, significantly more females than males utilized health facilities (OR=1.4 (95% CI [1.1, 1.6]). Higher educational attainment (10+ years of schooling) was associated with utilization of health facilities in both urban (OR=1.7, 95% CI [1.3, 2.1]) and rural (OR=1.4, 95% CI [1.0, 2.0]) areas compared to respondents who attained up to 7 years of schooling. Respondents who self-rated their health status as very poor/ poor/fair were twice more likely to utilize health facilities compared to those who rated their health as good/excellent. Respondents who reported illnesses were about three times more likely to utilize health facilities compared to those who did not report the illnesses. In urban areas, respondents who had mental distress were 1.7 times more likely to utilize health facilities compare to those who had no mental distress. Compared to respondents who were HIV negative, respondents who were HIV positive were 1.3 times more likely to utilize health facilities.ConclusionThe health care needs were the factors most strongly associated with health care seeking. After accounting for need differentials, health care seeking differed modestly by urban and rural residence, was somewhat skewed towards women, and increased substantially with socioeconomic position.
Highlights
IntroductionThe objective for health care systems is “equal access for equal needs”
With regards to equity, the objective for health care systems is “equal access for equal needs”
Higher educational attainment (10+ years of schooling) was associated with utilization of health facilities in both urban (OR=1.7, 95% confidence intervals (CI) [1.3, 2.1]) and rural (OR=1.4, 95% CI [1.0, 2.0]) areas compared to respondents who attained up to 7 years of schooling
Summary
The objective for health care systems is “equal access for equal needs”. There is an increased awareness of the inequality in access to healthcare services [1] and this has renewed the government’s commitment to improve the health status of the poor [2]. The model has evolved over time and has considered visits, those initiated by the individual, to be a consequence of predisposing, enabling, and need variables. In this model, ‘predisposing’ refers to demographic factors such as social status, education, and beliefs; ‘enabling’ is the ability of an individual to secure services through income, health insurance, and community factors such as availability of health care services; and ‘need’ refers to the perceived illness or health status. The model is mainly used to test the impact of factors, other than ‘need for care’, on the utilization of health care services [16]
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