Effects of demographic and socio-economic factors on dissatisfaction with formal healthcare utilisation among older adults with very low incomes in Ghana

Abstract

The older adult population has increased in the past few decades, and this is coupled with an increasing burden of chronic non-communicable diseases and a higher rate of healthcare utilisation among this population group. However, studies on healthcare utilisation have not tackled the healthcare service use dissatisfaction dynamics and associated factors, especially among older adults with very low incomes surviving under a social protection programme. The purpose of this study was to estimate demographic and socio-economic factors driving dissatisfaction with the utilisation of formal healthcare services among older adults with very low incomes in Ghana. Using data from a larger Ageing, Health, Lifestyle and Health Services survey conducted in the Atwima Nwabiagya District of Ghana, we estimate dissatisfaction with formal healthcare utilisation using multivariate logistic regression analysis. The study revealed that about 29% of the participants were dissatisfied with utilising formal healthcare services. The study showed that females (adjusted odd ratio (AOR): 0.42, 95% CI: 0.15–0.76) and those with high school education (AOR: 0.35, 95% CI: 0.23–0.79) were significantly less likely to be dissatisfied with the utilisation of formal healthcare services compared with males or those with no formal education. We found that participants who earned a monthly income of GH¢201 or more were significantly more likely to be dissatisfied with the utilisation of formal healthcare services than those who earned less than GH¢100 (AOR:1.16, 95% CI: 1.06–3.94). Our findings provide evidence that few older adults with very low incomes are dissatisfied with using formal healthcare services. The study has shown that demographic and socio-economic factors, particularly, gender, income, marital status, and education, are significant drivers of dissatisfaction with formal healthcare utilisation among older adults with very low incomes. This study, therefore, has implications for policy, practice, and future research decisions.

Keywords:

• patient acceptance of healthcare
• sociodemographic factors
• health services accessibility
• ageing
• health policy
• patient satisfaction

Public interest statement

Studies have shown that older adults tend to utilise more healthcare services because of the health challenges associated with increasing ageing. However, in Ghana and other low-and middle-income countries, older adults tend to face several barriers to healthcare utilisation (such as communication, transportation, financial, and transportation) which are likely to impact their satisfaction with formal healthcare utilisation. Yet, the literature on demographic and socio-economic factors predicting dissatisfaction with formal healthcare use among older adults with very low incomes is scant in sub-Saharan Africa and Ghana in particular. Drawing evidence from a probability based cross-sectional survey, this study examined the effects of demographic and socio-economic factors on dissatisfaction with formal healthcare use among older adults with very low incomes in Ghana. The study revealed that females and participants with high school education were significantly less likely to be dissatisfied with the utilisation of formal healthcare services compared with males and those with no formal education, respectively. We discuss the implications of this study for policy, practice, and future research.

Acknowledgements

We acknowledge our study participants for providing the study data and the authors and publishers whose works were consulted.

Disclosure statement

No potential conflict of interest was reported by the author(s).

List of abbreviation

AHLHS-	=	Ageing, Health, Lifestyle and Health Services Survey
AOR-	=	Adjusted Odd Ratio
CHRPE-	=	Committee on Human Research and Publication Ethics
SPSS-	=	Statistical Package for Social Sciences

Ethics approval and consent to participate

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Furthermore, ethics approval for this study was granted by the Committee on Human Research Publication and Ethics (CHRPE), School of Medical Sciences, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital, Kumasi, Ghana (Ref: CHRPE/AP/311/18). Also, the purpose of the study was explained to the study participants before their informed written and verbal consents were obtained. Again, they were assured of the strict confidentiality and anonymity of the data they provided. They were further assured that their participation in the study was voluntary and that they were free to opt out at any time.

Data and material availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Authors contribution

WA-D conceived the study. JAB, JOA, DA, JO-A, AAM and WA-D contributed to the design. WA-D collected the data. WA-D and JOA analysed the data. JAB, WA-D, JOA and DA drafted the manuscript. AAM, JOA, JO-A and DA reviewed the draft. All authors accept final responsibility for the paper. All authors read and approved the final manuscript.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors

Notes on contributors

Joseph Asumah Braimah

Dr. Joseph Asumah Braimah is currently a postdoctoral researcher at the Department of Public Health Sciences, Queen’s University, Canada. His research interests include Environment and Health; Ageing and Health; Health Disparities, Maternal Health, and Food Security.

Joseph Oduro Appiah

Dr. Joseph Oduro Appiah is an Assistant Professor of Sustainability at the Department of Sustainability, Western Oregon University, United States. His research interests are Land Change, Environmental Change, Human-Environment Interactions, Geographies of Health and Healthcare, Human-Dimension of Resources and Sustainability.

Dina Adei

Dr. (Mrs) Dina Adei is an Associate Professor at the Department of Planning, Kwame Nkrumah University of Science and Technology, Ghana. Her research interest covers areas such as Health Services Planning, Occupational Health and Safety, Macroeconomic Policy and Planning, and Human-Environment Interactions.

Justice Ofori-Amoah

Justice Ofori-Amoah is currently working with the Ghana Health Service as a District Director of Health Services. His research interests are Disease Outbreak Investigation, Epidemiology, Neglected Tropical Disease (NTDs) and Health Services Research.

Anthony Acquah Mensah

Anthony Acquah Mensah holds an MPhil in Planning from the Department of Planning, Kwame Nkrumah University of Science and Technology, Ghana. His research interests cover Land Governance, Smart Cities, Urban Planning and Health Systems.

Williams Agyemang-Duah

Williams Agyemang-Duah is currently a PhD Candidate at the Department of Geography and Planning, Queen’s University, Canada. His research interests include Geographies of Health and Healthcare, Geographies of Ageing, Geographies of Care, Human-Environment Interactions.