SOCIO-CULTURAL FACTORS AFFECTING UTILIZATION OF HEALTH CARE SERVICES
The study examined the socio-cultural factors affecting the utilization of health care services in Akpabuyo Local Government Area of Cross River State, Nigeria. Four hypotheses were formulated based on the identified independent variables of the study namely: cultural beliefs, educational status, marital status, and religious affiliation. The survey research design was adopted while data were generated from three hundred (300) randomly selected community members using a forty-four (44) item questionnaire captioned Socio-Cultural Factors and Utilization of Health Care Services Scale (SCFUHSS) and a thirteen (13) item focus group discussion guide (FGD). Simple random sampling, purposive, cluster, and systematic sampling procedures were used at different stages. The study statistically tested the generated data using Pearson Product Moment Correlation Coefficient, Independent t-test, and one-way Analysis of Variance (ANOVA) at 0.05 level of significance. The findings of the study revealed that a significant relationship exists between cultural belief and health care services utilization. Other variables such as educational status, marital status, and religious affiliation were shown to significantly affect the utilization of health care services in the Akpabuyo local government area. A major recommendation was that rural dwellers should be enlightened on the beliefs and practices about health and diseases that are clearly beneficial and clearly harmful in order to gain their full participation in health care services utilization. It was concluded that it is important to understand behavior and health care utilization trends in rural areas and credence given to all determinant factors in the background, importantly socio-cultural factors affect utilization of health care services. (Word count: 250)
TABLE OF CONTENTS
TITLE PAGE i
TABLE OF CONTENTS vi
LIST OF TABLES ix
LIST OF FIGURES x
CHAPTER ONE: INTRODUCTION
1.1 Background of study 1
1.2 Statement of the problem 4
1.3 Research questions 6
1.4 Objectives of study 6
1.5 Statement of hypotheses 7
1.6 Significance of study 7
1.7 Scope of study 8
1.8 Operational definition of terms 9
CHAPTER TWO: LITERATURE REVIEW AND THEORETICAL FRAMEWORK
2.1 Health care services and utilization 10
2.1.1 Cultural belief and utilization of health
2.1.2 Educational status and utilization of health
2.1.3 Marital status and utilization of health care
2.1.4 Religious affiliation and utilization of health care services
2.2 Theoretical framework
2.2.1 Rosenstock health belief model
2.2.2 Mechanic's general theory of help-seeking
2.2.3 Young's choice-making model Limitations of the models and theory
CHAPTER THREE: RESEARCH METHODOLOGY
3.1 Research design
3.2 Research area
3.3 Population of the study
3.4 Sampling procedure
3.5 The sample
3.6 Sources of data collection
3.7.1 Validation of research instrument 53
3.7.2 Reliability of the instrument
3.8 Administration of the instrument 56
3.9 Data preparation 57
3.10 Method of data analysis 58
CHAPTER FOUR: DATA ANALYSIS AND DISCUSSION OF FINDINGS
4.1 General description of data variables 60
4.2 Test of hypotheses 66
4.3 Discussion of findings 76
4.4 Contribution to knowledge 86
CHAPTER FIVE: SUMMARY, CONCLUSION, AND RECOMMENDATIONS
5.1 Summary of study 87
5.2 Conclusion 88
5.3 Recommendations 89
5.4 Suggestions for further studies 90
1.1 Background of the study
Good health is vital to socio-economic development given that it enables people to participate in economic, social and political development. It is also an important indicator of quality of life and a major contributor to human capital. Health is the attainment of a state of complete physical, mental, and social wellbeing of an individual not merely the absence of disease or infirmity (WHO, 2000). The overriding importance of an effective health care delivery system is understood as it represents one of the drivers of development. Sound health of the citizenry ensures greater human development. The wealth of any community can be measured by the health status of its inhabitants.
The general health of a member of any society can be seen as part of an interrelated set of conditions which has to do with one's capacity to adjust to the immediate environment and to utilize it to the optimum advantage. Globally, health services are known to be provided at different levels by different agencies and specialists.
In Nigeria, health services are taken care of by the three tiers of government, namely:- the Federal, State and Local governments. These are also supported by organizations and private individuals who establish and own private medical services. Addressing health issues in rural communities has been prioritized in policy agenda in most developing nations. Primary Health Care delivery system has been implemented in Nigeria. "Primary Health Care delivery service is an essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community can afford to maintain at every stage of their development in the spirit of self determination" (Ekwuruke, 2005: 1).
The affirmation by the Alma-Ata declaration of 1978 by World Health Assembly (WHA) states the access and utilization of basic health care services as a fundamental right and responsibility of all. However, after over three decades, the reality is that many, particularly in rural areas are still not adequately utilizing basic health care services (Jegede, 2002). The challenges of utilizing basic health care services in Akpabuyo Local Government Area, a rural area in Cross River State are essential problems to sustainable health care. The larger percentage of illness and diseases putting burden on Akpabuyo rural populace and other places is centred around the utilization of Primary Health Care services.
Jegede (2002) observes that various governments in Nigeria have tried to take health facilities to the rural areas in its health care delivery system. However, inadequate utilization of health care services in rural villages such as Akpabuyo has highly contributed to the increase in mortality rate amongst children and pregnant women. United Nations Population Fund (UNPF) 2005 states that there is higher probability for a child born in a developing country to die within the early age mostly before age five than those born in the developed countries even when the diseases leading to these deaths are preventable through vaccinations and basic health services.
The issue of non-utilization of health care services in rural areas is a critical setback to the health status of rural dwellers. According to United Nations Development Programme (UNDP, 2005) thirty thousand children die each day in rural areas from diseases that are preventable; more than five hundred thousand women die during child birth and complications in pregnancy, over one million under five years old children die of malaria every year, approximately twenty million people have died of HIV/AIDs while over thirty eight million are living with the disease, eight million people develop active tuberculosis each year out of which two million die (Miller, 2005). Elaborating further, Lawal (2009) asserts that the non-utilization of health care services in rural areas may not be disassociated from socio-cultural factors. The factors affecting health care are varied and far-reaching. Having high quality accessible health care and utilization is important. Lawal (2009) argues that socio-cultural factors are important to consider when it comes to proper health care services.
Although efforts have been made to ensure availability of health care services in rural areas there seem to be little positive results in the area of utilization. This is traceable to socio-cultural factors like cultural belief, educational status, marital status, employment rate and religious affiliations. Based on this reason, the researcher was motivated to find out if utilization of health care services in Akpabuyo Local Government Area of Cross River State is influenced by socio-cultural factors.
1.2 Statement of the problem
The rate of utilization of basic health care services in our rural areas has in recent times posed a serious concern to medical sociologists and health policy makers. Health care delivery institutions appear less patronized by rural dwellers this may perhaps explain the high maternal and infant mortality rate, high fertility rate and increase in sexually transmitted infections in rural areas (UNDP, 2005).
Health care service has undergone a lot of transformation in order to improve healthcare utilization. There have been policies to make health care service in rural areas accessible and affordable through various agencies such as Primary Health Care services. Efforts have been made to promote healthy behaviour to help mobilize communities for action on health related issues and to target outreach communities for health services. Also, measures such as free pre-natal and neo-natal care have been put in place.
Equally, enlightenment programme and health education have been provided (Anam & Antai, 2010).
Practically, Primary Health Care system has been set up in the Local Government Area for easy access and affordability to individuals and families with their full participation and the overall goal is to render basic health care services to all in the rural areas. Regrettably, despite all these ongoing efforts the health of rural dwellers in Akpabuyo Local Government Area appear not to have improved over the years. Observations revealed inadequate access and utilization of health care services from available health care facilities by the people. This, perhaps accounts for the noticeable health care problems such as increase in maternal and child morbidity rates, ravaging pandemics of HIV/AIDS, malaria and other life threatening diseases such as undiagnosed hypertension which may result in unconsciousness and death may be inevitable.
It is in response to this situation that the researcher was motivated to identify socio-cultural variables that may be relevant in explaining the utilization of health care services in Akpabuyo Local Government Area. The issue is: to what extent is utilization of health care services influenced by cultural belief, marital status, educational status and religious affiliation?
1.3 Research questions
The following research questions were used to guide the study:
i. To what extent does cultural belief influence utilization of health care services in Akpabuyo Local Government Area?
ii. What influence has marital status on the utilization of health care services?
iii. How does educational status influence utilization of health care services in Akpabuyo Local Government Area of Cross River State?
iv. How does religious affiliation influence utilization of health care services in Akpabuyo Local Government Area of Cross River State?
1.4 Objectives of the study
The purpose of this study was to determine the socio-cultural factors that influence the utilization of health care services in Akpabuyo Local Government Area of Cross River State. The specific objectives include:
1. To determine the relationship between cultural belief and utilization of health care services in Akpabuyo Local Government Area.
2. To find out if marital status has any influence on utilization of health care services.
3. To find out if educational status has any influence on utilization of health care services in Akpabuyo Local Government Area of Cross River state.
4. To find out if religious affiliation has influence on utilization of health care services in Akpabuyo Local Government Area.
1.5 Statement of hypotheses
The following hypotheses were formulated to guide the study:
1. Cultural belief has no relationship with utilization of health care services in Akpabuyo Local Government Area of Cross River State.
2. Marital status does not exert any influence on the utilization of health care services.
3. Educational status of the people has no influence on utilization of health care services in Akpabuyo Local Government Area of Cross River State in Nigeria.
4. There is no influence of religious affiliations on the utilization of health care services in Akpabuyo Local Government Area of Cross River State.
1.6 Significance of the study
The findings of this study will be of great benefit to government, health care providers, medical sociologists and researchers. To government, it will help them be aware of factors that influence the utilization of health care services and work out modalities to ensure the promotion of good health amongst rural dwellers. To health care providers, the findings will help them to consider the views and belief system of the people while rendering health care services to the people.
To medical sociologists, the study is likely to help them identify the barriers to utilization of health care services by rural dwellers. In other words, the influence of factors such as cultural belief, educational status, marital status and religious affiliations on the utilization of health care services will be understood. This will make room for recommendations to the authorities concern. They will also realize that the health of rural dwellers in developing countries is challenged by socio-cultural factors and proffer solutions to them as social scientists. To the public, it will eliminate misconceptions about modern health care services and promote health consciousness in them. Finally the findings of this study will add to the body of already existing literature.
1.7 Scope of the study
The study was restricted to Akpabuyo Local Government Area of Cross River State. It involved all the political wards in the local government and was equally restricted to four socio-cultural factors only; these are cultural belief, educational status, marital status and religious affiliations. These variables constituted the independent variables and the dependent variable was utilization of health care services.
1.8 Operational definition of terms
Socio-cultural factors: these refer to the social and cultural variables that influence health care utilization and they are; Cultural belief: refers to the practice of using herbs, performing sacrifices and patronizing traditional medical practitioners for treatment of ailment instead of western medical practitioners. Educational status: It is referred to level of knowledge acquired that may promote the desire or willingness to use health care services.
Marital status: It is used in the study to refer to married or unmarried people who constitute the population of study. Religious affiliation: It refers to one's religious belief Christianity, Islam or African traditional practice that may influence an individual's decision on health care issues.
Utilization of health care services: This refers to the ability of the rural populace to use health care services during ill-health. Health care services: They are facilities provided by government to care for the sick or well in order to promote wellbeing of the people. Health care delivery: Implementation of care to the rural dwellers or rendering health care to rural dwellers..