Health care seeking behaviuor among the elderly in Hue City
Journal of Health and Development Studies (Vol.05, No.02-2021)
Nguyen Hoang Lan et al.
ORIGINALARTICLES
Health care seeking behaviuor among the elderly in Hue City
Nguyen Hoang Lan1*, Tran Thi Thanh Nga1, Le Thi Bich Thuy1
ABSTRACT
Objectives: the study is to investigate health care seeking behaviour and to identify factors associated
those behaviour among elderly living in Hue city, Vietnam.
Methods: 400 old persons who suffered from health problem in the past one month were interviewed
directly at their house by a structured questionnaire to survey health care seeking behaviour. Multivariate
logistic regression models were applied to identify factors affecting health care seeking behaviour among
participants.
Results: 72.5% of respondents sought treatment services for their acute illness in the past one month
and 68% of them used prevention services in the past one year before the interview. In general, source
of income, educational level and severe level of disease influenced health care seeking behaviour among
participants.
Conclusions: The findings revealed limitation of the elderly to access health care services, especially
health preventive services in Hue city. The identified associated factors can help formulate effective public
health programs to improve health status among the elderly in Hue city as well as in the country in general.
Keywords: health care seeking behaviour, treatment services, health prevention services, the elderly,
Hue city.
INTRODUCTION
number of years they live in a ‘healthy’ state
(3) in Vietnam was relatively higher than in
other countries. Average number of years
lived with morbidity was estimated about
11 years for females and 8 years for males
(4). According to a survey on the elderly
in Vietnam in 2011, 65.4% of respondents
self-assessed their health status at poor or
very poor level (5). A report of Ministry of
Health in 2018 showed that 95% elderly
facing morbidity, mainly non-communicable
diseases (NCDs) and they often suffer from
many diseases simultaneously with averagely
Vietnam is facing a rapid increase in aging
population. Older population, accounted for
10.2% of the country’s population in 2014,
has expanded much greater than the preceding
years with an expected grow to reach almost
20% of the population by 2035 (1). In 2019,
average life expectancy at birth of Vietnamese
people was 71 years old for males and 76.3
for females (2). Although health status of
people has been significantly improved for
the past decades, the difference between
life expectancy and healthy life expectancy near three diseases per each older person
at birth (that means that means average (6). Hypertension, cardiovascular diseases
* Corresponding author: Nguyen Hoang Lan
Email: [email protected]
1Faculty of Public Health, Hue University of
Submited: 16 October, 2020
Revised version received: 11 November, 2020
Published: 26 March, 2021
Medicine and Pharmacy, Hue University
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Nguyen Hoang Lan et al.
Journal of Health and Development Studies (Vol.05, No.02-2021)
and chronic obstructive pulmonary diseases d = 0.05 (allowable error)
(COPD) are common diseases in the elderly
z2(1- α/2) = 1.96 (α = 0.05)
in the country (7). One of factors that affected
health status of the elderly is health care
seeking behaviour. This behaviour refers to a
decision or an action taken by an individual
to maintain, attain, or regain good health and
to prevent illness (8) This influenced a person
making decision to use available health care
services. The present study is to investigate
health care seeking behaviour and to identify
factors associated those behaviour among
elderly living in Hue city, Vietnam.
Sample size calculated was 384.
The elderly persons were enrolled using
multistage sampling:
- Stage 1: four among total 27 wards in
the city were selected purposively based on
geographical characteristics of the city. Two
wards are located in the north and others are
in the south of Huong river. The farthest ward
is 6 km from center of Hue city.
- Stage 2: from list of the older persons
provided by population collaborator at each
ward, we visited the elderly at their house
and selected participants by using a question
to screen ‘did you suffer from any disease
or illness (such as pain, discomfort, distress,
weakness, fatigue) in the past month?’. The
elderly who answered ‘yes’ and met inclusive
criteria were invited to interview. At last,
400 older persons agreed to participate in the
study.
METHODOLOGY
Study design
An institution-based cross-sectional study
Time and location
Data collection was conducted between July
and December 2019 in Hue city- the capital
of Thua Thien Hue province located in the
Central of Vietnam
Data collection
Study participants
DatawerecollectedbetweenJunetoDecember
2019 by directly interviewing participants at
their house using a structured questionnaire.
The questionnaire included questions about
socio-demographic characteristics (age,
gender, marital status, educational level,
economic classification of household, source
of income, household structure), health status
(chronic disease, acute illness during the
past month, level of disease), and health care
seeking behaviour
Older persons aged 60 years and over met
inclusive criteria as follows: residents in Hue
city; suffering from health problem in the past
month, ability to communicate; agreement to
participate in the study. Individuals who had
psychiatric illness were excluded from the
study.
Sample size was calculated using formula:
p(1-p)
d2
Z2
n =
(1 - /2)
In this study the concept “health care seeking
behaviour”referstreatmentseekingbehaviour
(using professional advice or outpatient or
inpatient services) and health prevention
service seeking behaviour.
Where: p = 0.48 (proportion of elderly used
outpatient services according to a study
of Nguyen Thi Thang, et al among some
provinces in Vietnam (9)
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Nguyen Hoang Lan et al.
Journal of Health and Development Studies (Vol.05, No.02-2021)
- Treatment seeking behaviour was divided amongtheelderly. Inthemodel, treatmentand
into 2 groups: ‘Yes’ when the elderly used at
least one treatment service for their illness
and ‘No’ when they did not use any treatment
service or self-treatment for their illness in
the past one month before interview
health prevention service seeking behaviour
were considered dependent variables.
Predictor variables included all participants’
characteristics including socio-demographic
characteristics, economic situation and health
status of participants. An alpha level of 0.05
was considered statistically significant.
- Health prevention service seeking
behaviour was divided into 2 groups: ‘Yes’
when the elderly used at least one among
services following: vaccination, periodic
health examination, periodic medical
examination, health education in the past one
year before interview. ‘No’ when they did not
any those services
Ethical consideration
The study proposal was approved by
University of Medicine & Pharmacy, Hue
University (Decision No: 2279/QĐ/ĐHYD,
dated July 7, 2019). In addition, approval
for data collection at the sites was obtained
from Health Center of Hue city and local
government. The interview of study subjects
was performed with their verbal permission
after they were given adequate information
about the study.
Data analysis
Descriptive statistics such as frequency and
percentage were used to summarize the
personal characteristics and classify health
care seeking behaviour of participants. Two
multivariate logistic regression models
were employed to identify the potential
factors associated with treatment and health
RESULTS
prevention service seeking behaviour the General characteristics of participants
Table 1. Characteristics of participants (n= 400)
Characteristics
Male
n
Percentage
44.3
177
223
209
103
88
Sex
Female
60 – 69
70 – 79
≥ 80
55.7
52.2
25.8
Age group
(Year)
22.0
Mean age (SD): 71.8 (9.1); Min: 60; Max: 97
Under secondary school
Secondary school and above
Working to earn their living
Retiree or pensioner
165
235
85
33.8
66.2
21.3
34.5
44.2
Education level
Source of income
138
177
No income
64
Nguyen Hoang Lan et al.
Journal of Health and Development Studies (Vol.05, No.02-2021)
Single/divorced/widow/widower
126
274
203
197
24
31.5
68.5
50.7
49.3
6.0
Married status
Married
2 generations and below
Number of generations
in family
3 generations and above
Poor/ near poor
Economic situation of
household
Normal
376
129
99
94.0
32.2
24.8
43.0
76.0
24.0
54,5
45,4
37.5
63.5
0%
Co-payment level with
health insurance
5%
20%
172
304
96
Yes
Chronic disease
Form of disease
Level of illness
No
Acute
218
182
150
250
Acute stage of chronic disease
Minor
Moderate/severe
Table 1 showed that participants aged 60-69 health insurance card with co-payment levels
set at 20%, 5% and 0%, accounting for 43%,
24.8% and 32.2%, respectively. Most of
them got at least one chronic disease (76%).
54.5% of participants stated that they suffered
from an acute illness and nearly half of them
experienced acute stage of chronic disease
in the last one month before the interview.
Majority of them (63.5%) got moderate and
severe illness that influenced their daily
activities.
years were the majority (55.2%) with mean
age of 71.8 (SD: 9.1). More than half of
them were female. 66.2% of them attained
secondary school and above. 21.3% of
participants were working to earn their living,
34.5% of them were retiree or pensioners,
left number did not income. 68.5% of them
were maintaining marital status. There were
6% of the interviewee’s households were
classified as poor or near poor. Nearly half
of respondents lived in a family with three
Health care seeking behaviour among the
generations and above. All participants had a elderly
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Nguyen Hoang Lan et al.
Journal of Health and Development Studies (Vol.05, No.02-2021)
Table 2. Characteristics of treatment seeking behaviour of the elderly
in the past one month
Characteristics
n
Percentage
Yes
290
110
140
205
107
103
222
33
72.5
27.5
35.0
51.2
26.8
25.8
55.5
8.3
Treatment seeking behaviour
No treatment/ self-treatment
Taking medical advice
Outpatient
Services used
Inpatient
Central hospital
Public hospitals
Commune health center
Private health clinics/hospital
Family medical doctor
Good quality of health services
Affordable medical expenses
Near the house
Treatment site selected
28
7.0
25
6.3
162
66
40.5
16.5
37.3
70.5
48.3
149
282
193
Reasons for choosing treatment
site
Regulation of health insurance
Simple formalities
72.5% of elderly reported that they took their treatment. The most common reasons
treatment for their acute illness at health for choosing treatment site were explained
facilities during the past month before the to be regulation of health insurance, simple
interview. The services that were used most formalities and good quality of health care
were outpatient services (51.2%). More than services, accouting for 70.5%, 48.3% and
half of participants chose public hospitals for 40.5%, respectively (Table 2)
Table 3. Characteristics of health prevention service seeking behaviour of elderly in the
past one year
Characteristics
n
Percentage
68.0
Yes
272
128
49
Health preventive service
seeking behaviour
No
32.0
Vaccination
13.2
Periodic health examination
Periodic medical examination
Health education
66
16.5
Services used
149
233
37.3
58.3
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Nguyen Hoang Lan et al.
Journal of Health and Development Studies (Vol.05, No.02-2021)
Table 3 showed that there were 272 older chosen the most (58.3%), next was periodic
persons used prevention services in the past medical examination (37.3%).
one year before the interview, accounting for
Factors associated with health care seeking
behaviour among elderly
68%. Health education was service that was
Table 4. Factors associated with treatment seeking behaviour among elderly
Characteristics
OR
1
p value
95% CI
Source of
income
Working to earn living
Retiree/ pensioner
6.3
3.4
1
0.019
0.008
1.35 - 28.96
1.36 - 8.28
No income
Educational
level
Under secondary school
Secondary school & above
3.3
0.006
1.41 - 7.90
Quality of health Not good
1
5.1
1
services
Good
0.001
<0.001
<0.001
1.88 - 13.98
3.15 - 14.16
7.75 - 40.25
Simple
No
formalities
Yes
6.7
1
Level of illness Minor
Moderate/severe
17.7
Table 4 revealed only factors significantly secondary school education and above (OR:
associated treatment seeking behaviours 3.3; 95% CI: 1.41-7.9), the elderly who
among elderly in the study (p< 0.05). Elderly assessed good quality of health care services
who were more likely seeking health care (OR: 5.1; 95% CI: 1.29-6.93), participants
than their counterparts when suffered from who were pleasure with formalities at health
acute illness including retirees/pensioners facilities (OR: 6.7; 95% CI: 3.15-14.16) and
and elderly without income (OR: 6.3; 95% respondents who suffered from moderate
CI: 1.35-28.96 & OR: 3.4; 95% CI: 1.36- or servere illness (OR: 17.7; 95% CI: 7.75-
8.28, respectively), participants attained 40.25).
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Nguyen Hoang Lan et al.
Journal of Health and Development Studies (Vol.05, No.02-2021)
Table 5. Factors associated with health prevention service seeking behaviour among
the elderly
Characteristics
OR
1
p value
95% CI
≥ 80
Age group
(years)
70-79
2.94
3.72
1
0.021
0.008
1.18 - 7.34
1.39 - 9.89
60-69
Below secondary school
Secondary school & above
Working to earn living
Retiree/ pensioner
No income
Educational
level
3.5
1
<0.001
1.88 - 6.55
2.91
1.23
1
0.032
0.542
1.09 - 7.77
0.63 - 2.43
Source of income
20%
Co-payment
level with health
insurance
5%
2.0
3.42
1
0.136
0.005
0.80 - 5.07
1.45 - 8.09
0%
Minor
Level of illness
Moderate/severe
2.96
<0.001
1.73 - 5.09
In table 5, factors which were significant Among the elderly suffered from health
relationship with health prevention service
seeking behaviour among the elderly were
confirmed following, age group: OR for ’70-
79’: 2.94 (95% CI: 1.18-7.34) and OR for ‘60-
69’: 3.72 (95% CI: 1.39-9.89), educational
level: OR for ‘secondary school & above’:
3.5 (95% CI: 1.88-6.55), way of earning: OR
for ‘retiree/pensioner’: 2.91 (95% CI: 1.09-
7.77) and OR for ‘no income’: 1.23 (95%
CI:0.63-2.43), co-payment level with health
insurance: OR for ‘co-payment of 5%’: 2.0
(95% CI: 0.80-5.07) and OR for ‘co-payment
of 0%’: 3.42 (95% CI: 1.45-8.09) and level of
illness: OR for ‘moderate/severe’: 2.96 (95%
CI: 1.73-5.09).
problem in the past one month before
interview, there were 76.6% of them using
treatment services at health facilities. The
finding is higher than that of Nguyen Thi
Thang et al (2015). The author reported
that 44.4% of older persons in urban area
in Vietnam visited health facilities for
treating their illness (9). The improvement in
Vietnamese government’s policies on older
person including integrating health care for
older persons into the current health system
at four level (10), providing health insurance
card free for the elderly aged 80 and above
and utilization of insurance based health
care services without reference requests
at provincial level (11) have increased
opportunity for the elderly to access to health
facilities. Our result is in line with that of
Falaha et al in Ethiopia (72.3%) (12). Among
treatment services used, outpatient services
DISCUSSION
Health care seeking behaviour among
elderly
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Nguyen Hoang Lan et al.
Journal of Health and Development Studies (Vol.05, No.02-2021)
were chosen by majority of participants respectively (16). In those countries, fee for
(51.2%). This is similar to a study of Giang et vaccination in elderly is paid full or partly
alusingdatafromVietNamHouseholdLiving by Government or Health Insurance’s budget
Standard Surveys (VHLSS) in 2008 (54.1%) (15).
(13). Normally, except for severe illness,
Factors associated with health care seeking
outpatient services are the first choice of
behaviour among the elderly
people when faced health problem. Inpatient
services are solution in case of severe illness
or ineffective outpatient treatment. Reasons
for choosing health facilities explained why
public hospitals were given priority to visit by
more than half of participants (55.5%). These
facilities provide insurance- based health
care services. Similarly, Lena et al reported
that Vietnamese older patients often visited
government sites due to trust, familiarity and
insurance coverage (14).
Factors associated with treatment seeking
behaviour
Results of multivariate logistic regression
model showed that source of income,
educational level, quality of health care
services, formalities at health facilities and
severe level of disease influenced treatment
seeking behaviour among the elderly who
suffered from acute illness during one month
before the interview. Older persons who were
working were often busy for earning their
living, they could ignore or self-treat their
minor illness, even moderate illness. This
can explain lower probability of seeking
In term of health prevention service seeking
behaviour, health education was used by
more than half of the elderly in the study. This
is popular service in grassroot level of health
system in Vietnam, people can access it free treatment for their acute illness in this group.
of charge therefore majority of the elderly The education of the patients significantly
were interested in. Surprisedly, there were affects healthcare decisions. This finding is
76% of participants got at least one chronic consistent with previous studies in Vietnam
and in the world. Those with higher education
tend to choose healthcare providers rather than
self-treatment (17, 18). Good quality of health
care services and simple formalities increased
probability of using treatment services among
the elderly in our study. Many studies showed
that quality of care was leading choice criteria
for health care in patients (14). Severe level
of disease was associated with decision of
elderly on treatment services that was also
reported by some authors (14).
disease however only 37.3% of them reported
that they took periodic medical examination
during the past one year. Number of the
elderly who used annual periodic health
examination was fewer. Beside the reason
is that the elderly can be poor interest in
their health, out of pocket payment for these
services might be barrier to their health
prevention behaviour. The similar reason
explained lowest percentage of older persons
in the study taking vaccination (12.3%).
Our finding is lower than previous studies
in the world. A report of Europian Center
of Disease Control (ECDC) showed that
47.1% of elderly vaccinated against influenza
(15). There were 59.9%, 55.1% and 20%
of elderly in Singapore immunized vaccine
against pneumonia, tetanus and herpes zoter,
Factors associated with health prevention
seeking behaviour
Age, educational level, source of income, co-
payment level and level of illness were factors
affecting health prevention seeking behaviour
among older persons in the study. Utilization
69
Journal of Health and Development Studies (Vol.05, No.02-2021)
Nguyen Hoang Lan et al.
of health prevention services was less as the and lower level of co-payment with health
age advanced. Bucatariu et al found that the insurance influenced positive behaviour
patients aged 65 years and below with chronic seeking health prevention among the elderly.
diseases visited health facilities regularly to The identified associated factors can help
monitor risk factors and may undergo major formulate effective public health programs to
lifestyle changes such as change of diet, improve health status among elderly in Hue
walking and yoga (14). The elderly attained city as well as in the country in general.
secondary school and above were interested
Conflict of interest: The authors have no
potential conflict of interest.
in health promotion and prevention more
than their counterparts did. Higher education
level provided more opportunity for people
REFERENCES
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therefore it could influence their choice
about positive health behaviour. As earlier
explanation, busy work decreased opportunity
to use health prevention services among
the elderly who were working to earn their
living. Among health prevention services,
periodic medical examination is covered by
health insurance for chronic patients, this
can be reason why elderly with lower co-
payment level were likely more utilization of
those services in the study. Understandably,
the elderly who experienced severe level of
illness during acute stage were likely more
aware of usefulness of health prevention
services, they reported more utilization of
those services in the study.
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RECOMMENDATIONS
The findings from the study showed limitation
of the elderly to access health care services,
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health care seeking behaviour among older
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