Abstract
It is widely accepted that healthcare-seeking behaviour is neither limited to nor terminated by access to one single healthcare provider. Yet the sequential conceptualisation of healthcare-seeking processes has not diffused into quantitative research, which continues to analyse healthcare access as a “one-off” event. The ensuing lack of understanding healthcare behaviour is problematic in light of the immense burden of premature death especially in low- and middle-income countries. This paper presents an alternative approach. Based on a novel survey instrument, we analyse original survey data from rural India and China that contain 119 unique healthcare pathways among 637 respondents. We offer three applications of how such sequential data can be analysed to enhance our understanding of people's health behaviour. First, descriptive analysis of sequential data enables more a comprehensive representation of people's health behaviours, for example the time spent in various healthcare activities, common healthcare pathways across different groups, or shifts in healthcare provider access during a typical illness. Second, by analysing the effect of mobile technology on healthcare-seeking process characteristics, we demonstrate that conventional, sequence-insensitive indicators are potentially inconsistent and misleading approximations when compared to a more precise, sequence-sensitive measure. Third, we describe how sequential data enable transparent and flexible evaluations of people's healthcare behaviour. The example of a sequence-insensitive evaluation suggests that household wealth has no statistical link to an illustrative “ideal” form of public healthcare utilisation. In contrast, sequence-sensitive evaluations demonstrate that household wealth is associated with an increased likelihood of bypassing referral processes and approaching unregulated and costly informal and private practitioners before accessing a public clinic. Sequential data therefore do not only reveal otherwise neglected locational idiosyncrasies, but they also yield deeper insights into the drivers of people's health behaviours compared to a conventional approach to “access to healthcare.”
Highlights
People in low- and middle-income countries die on average more than 20 years younger than high-income-country citizens (Institute for Health Metrics and Evaluation, 2012; World Bank, 2015)
Sequential data and sequence analysis offer further insights into the characteristics of common healthcare processes, for example the time spent in various healthcare activities, common healthcare pathways across different groups, or shifts in healthcare provider access during the course of an illness
This paper illustrated the use of analytical tools to capture and assess sequential healthcare behaviours
Summary
People in low- and middle-income countries die on average more than 20 years younger than high-income-country citizens (Institute for Health Metrics and Evaluation, 2012; World Bank, 2015). The majority of quantitative analyses of healthcare behaviour in low- and middle-income countries instead adopts a single-stage approach, implying that the patient “chooses” once from a portfolio of healthcare options (GómezOlivé et al, 2013; Hardon, 1987; Mohan et al, 2008; Moshabela et al, 2012) Such simplified single-stage analyses can help to track national progress towards achieving universal health care by providing simplified and standardised measures of healthcare access that allow for easy measurement and comparison. The author analyses the data statistically to highlight the transitions between different forms of treatment, but the ethnographic approach is impractical for the collection and quantitative analysis of representative healthcare behaviour data These quantitative studies are exceptions in the literature and most studies of sequential healthcare-seeking processes are qualitative (Kibadi et al, 2009; Moshabela et al, 2011; Shaikh et al, 2008).
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