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Determinants of health-seeking behaviour among enrollees of a social health insurance scheme in Anambra state, southeast, Nigeria

Simeon B. Onyemaechi and Uchenna R. Ezenwaka*

Background: Understanding factors that explain the healthseeking behaviour (HSB) among enrollees of Anambra State Health Insurance Scheme (ASHIS) is a critical entry point for improving health outcomes and achieving universal health coverage (UHC).

Aim: To assess the socio-demographic and health facility determinants of health-seeking behaviour among the enrollees of ASHIS in Anambra State, Nigeria.

Subjects and methods: A cross-sectional health facility-based survey involving enrollees of the ASHIS. A total of 447 enrollees were randomly selected from 12 (6 rural and 6 urban) facilities using a multi-stage sampling method. Data was collected on socio-demographics and facility characteristics using a pre-tested, interviewer-administered questionnaire.

Statistical analysis: The data was analyzed using SPSS version 25. Descriptive data were expressed as mean and proportions. Fisher’s exact test was computed to determine the association between dependent and independent variables. Statistical significance was set at a p-value of <0.05.

Results: The mean age of respondents was 42 ± 13.5 years. The overall appropriate change in the HSB among the enrollees since they commenced accessing care under ASHIS was 76%. Majority (96.6%) of them now take prompt action (within 24 hours) while 90.9% of them seek care in a formal health facility when feeling sick. There was a statistically significant association between appropriate HSB and marital status (p<0.04); education (p<0.002); employment (p<0.002); facility location (p<0.04) and ownership of the facility (p<0.00). With respect to prompt care (when) and source of care when feeling sick, educational qualification, employment status, location, and ownership of the facility were statistically significant (p<0.05). Educational level (AOR 1.80, CI 1.06-3.05) predicts appropriate HSB. Other predictors of the appropriate HSB were facility location (AOR 1.49, CI 0.15-0.59) and facility ownership (AOR 2.42, CI 1.21-4.84). Prompt care when sick was not predicted by socio-demographics and facility characteristics.

Conclusions: The major factors determining the appropriate HSB of enrollees of the ASHIS are socio-demographics -educational and employment status and facility characteristics- location and ownership of the health facility.

Published Date: 2022-12-29; Received Date: 2022-12-01