Living environment, social support, and informal caregiving are associated with healthcare seeking behaviour and adherence to medication treatment: A cross-sectional population study.

Erik Berglund,Per Lytsy,Ragnar Westerling

doi:10.1111/hsc.12758

Abstract

Despite the well‐known associations between local environment and health, few studies have focused on environment and healthcare utilisation, for instance healthcare seeking behaviour or adherence. This study was aimed at analysing housing type, behaviour based on perceived local outdoor safety, social support, informal caregiving, demographics, socioeconomics, and long‐term illness, and associations with health‐seeking and adherence behaviours at a population level. This study used data from the Swedish National Public Health Survey 2004–2014, an annually repeated, large sample, cross‐sectional, population‐based survey study. In all, questionnaires from 100,433 individuals were returned by post, making the response rate 52.9% (100,433/190,000). Descriptive statistics and multiple logistic regressions were used to investigate associations between explanatory variables and the outcomes of refraining from seeking care and non‐adherence behaviour. Living in rented apartment, lodger, a dorm or other was associated with reporting refraining from seeking care (adjusted OR 1.16, 95% CI 1.00–1.22), and non‐adherence (adjusted OR 1.22; 95% CI 1.13–1.31). Refraining from going out due to a perceived unsafe neighbourhood was associated with refraining from seeking care (adjusted OR 1.59, 95% CI 1.51–1.67) and non‐adherence (adjusted OR 1.26, 95% CI 1.17–1.36). Social support and status as an informal caregiver was associated with higher odds of refraining from seeking medical care and non‐adherence. This study suggests that living in rental housing, refraining from going out due to neighbourhood safety concerns, lack of social support or informal caregiver status are associated with lower health‐seeking behaviour and non‐adherence to prescribed medication.

Highlights

Healthcare utilisation (HCU) includes utilisation of hospital re‐ sources, home‐care resources, and physician resources and is im‐ portant for healthcare planning (Sofianopoulou, Rushton, Rubin, & Pless‐Mulloli, 2012)
This study aims to inves‐ tigate the associations between health‐seeking behaviour (HSB) for medical care and primary non‐adherent behaviour with housing type, outdoor neighbourhood safety, social support and informal caregiving in the general Swedish population
The results show that HSB and adherence were associated with refraining from going out due to a perceived unsafe neighbourhood; these results are in line with previous research that identified the perceptions of crime and violence as predictors of health (Stockdale et al, 2007)

Summary

Introduction

Healthcare utilisation (HCU) includes utilisation of hospital re‐ sources, home‐care resources, and physician resources and is im‐ portant for healthcare planning (Sofianopoulou, Rushton, Rubin, & Pless‐Mulloli, 2012). HSB, like other factors such as socioeconomic circumstances and healthcare provider behaviour, is critical for access to healthcare services, and an important determinant of health (Braveman, Egerter, Cubbin, & Marchi, 2004). Vulner‐ able groups are less likely than non‐vulnerable groups to seek care in accordance with their expected needs (Agerholm, Bruce, Ponce de Leon, & Burstrom, 2013). Factors associated with HSB and HCU include level of income (Burstrom, 2002), gender (Westin, Ahs, Brand Persson, & Westerling, 2004), education level (Westin et al, 2004), perceived discrimination (Wamala, Merlo, Bostrom, & Hogstedt, 2007a), and lack of confidence in medical services (Westin et al, 2004)

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