System, institutional, and client-level factors associated with formal healthcare utilisation among older adults with low income under a social protection scheme in Ghana

Archives of Public Health

Research

Dennis Asante¹  Williams Agyemang-Duah²  Joseph Oduro Appiah³  Anthony Acquah Mensah⁴  Anthony Kwame Morgan⁴  Isaac Verberk Mensah⁵  Prince Peprah⁶ 

[1] College of Medicine & Public Health, Rural and Remote Health, Flinders University, Adelaide, South Australia, Australia;Department of Geography and Planning, Queen’s University, Kingston, Canada;Department of Geography, Environment & Spatial Analysis, Cal Poly Humboldt, Arcata, California, United States;Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana;Department of Social Sciences, St. Ambrose College of Education, Wamfie, Bono Region, Ghana;Social Policy Research Centre, Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia;

关键词: System factors;    Institutional factors;    Client preference factors;    Formal healthcare utilisation;    Older adults with low income;    Social protection scheme;    Ghana;   

DOI  :  10.1186/s13690-023-01063-w

 received in 2022-12-22, accepted in 2023-03-15,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundIn sub-Saharan African context, effect of system, institutional and client-level factors on formal healthcare utilisation among older adults with low income, especially those under a social protection scheme (called Livelihood Empowerment against Poverty [LEAP] programme) is least explored in the literature. However, an adequate understanding of how these factors contribute to formal healthcare utilisation among older adults who are classified as poor (in terms of low income) is important to inform health policy decisions. The aim of this study, therefore, was to examine the contributions of system, institutional and client-level factors in formal healthcare utilisation among older adults with low income under the LEAP programme in Ghana.MethodsData associated with this study were obtained from an Ageing, Health, Lifestyle and Health Services survey conducted between 1 and 20 June 2018 (N = 200) in the Atwima Nwabiagya Municipal and Atwima Nwabiagya North District of Ghana. Multivariable logistic regressions were used to determine system, institutional and client-level factors associated with formal healthcare utilisation among older adults with low income under the LEAP programme in Ghana. The significance of the test was set at a probability value of 0.05 or below.ResultsThe study revealed that participants who relied on the LEAP programme and/or health insurance subscription to cater for their healthcare expenses (AOR: 11.934, CI: 1.151-123.777), those whose family/caregivers decided on when and where to use formal healthcare (AOR:12.409; CI: 2.198–70.076) and those who did not encounter communication problem with healthcare providers (AOR: 1.358; CI: 1.074–3.737) were significantly more likely to utilise formal healthcare services compared with their counterparts. The study further found that participants who perceived the attitude of healthcare providers as poor (AOR: 0.889; CI: 0.24–0.931) and those who spent 20–40 minutes at the healthcare facility were significantly less likely to utilise formal healthcare services compared with their counterparts (AOR: 0.070; CI: 0.006–0.195).ConclusionOur findings suggest that reducing waiting time at healthcare facilities, improving social protection and/or health insurance schemes, improving patient-doctor communication and promoting attitudinal change programmes (such as orientations and supportive supervision) for healthcare providers may help to facilitate the use of needed formal healthcare services by older adults with low income in Ghana.

【 授权许可】

CC BY   
© The Author(s) 2023. corrected publication 2023