Age, sex and primary care setting differences in patients’ perception of community healthcare seeking behaviour towards health services

Autoři: Ming Tsuey Lim aff001;  Yvonne Mei Fong Lim aff001;  Seng Fah Tong aff002;  Sheamini Sivasampu aff001
Působiště autorů: Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, Shah Alam, Selangor, Malaysia aff001;  Department of Family Medicine, Universiti Kebangsaan Malaysia, UKM, Bangi Selangor, Malaysia aff002
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article



Understanding the potential determinants of community healthcare seeking behaviour helps in improving healthcare utilisation and health outcomes within different populations. This in turn will aid the development of healthcare policies and planning for prevention, early diagnosis and management of health conditions.


To evaluate patients’ perception of community healthcare seeking behaviour towards both acute and preventive physical and psychosocial health concerns by sex, age and type of primary care setting (as a proxy for affordability of healthcare).


A total of 3979 patients from 221 public and 239 private clinics in Malaysia were interviewed between June 2015 and February 2016 using a patient experience survey questionnaire from the Quality and Cost of Primary Care cross-sectional study. Multivariable logistic regression analysis adjusted for the complex survey design was used.


After adjusting for covariates, more women than men perceived that most people would see their general practitioners for commonly consulted acute and preventive physical and some psychosocial health concerns such as stomach pain (adjusted odds ratio (AOR), 1.64; 95% confidence interval (CI), 1.22–2.21), sprained ankle (AOR, 1.29; 95% CI, 1.06–1.56), anxiety (AOR, 1.32; 95% CI, 1.12–1.55), domestic violence (AOR, 1.35; 95% CI, 1.13–1.62) and relationship problems (AOR, 1.24; 95% CI, 1.02–1.51). There were no significant differences in perceived healthcare seeking behaviour by age groups except for the removal of a wart (AOR, 1.41; 95% CI, 1.12–1.76). Patients who visited the public clinics had generally higher perception of community healthcare seeking behaviour for both acute and preventive physical and psychosocial health concerns compared to those who went to private clinics.


Our findings showed that sex and healthcare affordability differences were present in perceived community healthcare seeking behaviour towards primary care services. Also perceived healthcare seeking behaviour were consistently lower for psychosocial health concerns compared to physical health concerns.

Klíčová slova:

Behavior – Behavioral and social aspects of health – Mental health and psychiatry – Patients – Primary care – Psychological and psychosocial issues – Stomach – Warts


1. Tipping G, Segall M. Health care seeking behaviour in developing countries. An annotated bibliography and literature review. In: Tipping G, Segall M, eds. Development Bibliography 12. Brighton: Institute of Development Studies, Sussex University; 1995.

2. Oberoi S, Chaudhary N, Patnaik S, Singh A. Understanding health seeking behavior. J Family Med Prim Care 2016; 5: 463–464. doi: 10.4103/2249-4863.192376 27843863

3. Van der Hoeven M, Kruger A, Greeff M. Differences in health care seeking behaviour between rural and urban communities in South Africa. International Journal for Equity in Health 2012; 11: 31. doi: 10.1186/1475-9276-11-31 22691443

4. World Health Organisation. Dengue: guidelines for diagnosis, treatment, prevention and control: new edition. Geneva: World Health Organization. 2009. Available from: Cited 25 February 2019.

5. Eide TB, Straand J, Björkelund C, Kosunen E, Thorgeirsson O, Vedsted P, et al. Differences in medical services in Nordic general practice: a comparative survey from the QUALICOPC study. Scand J Prim Health Care 2017; 1–10.

6. Starfield B. Is primary care essential? Lancet 1994; 344: 1129–1133. doi: 10.1016/s0140-6736(94)90634-3 7934497

7. Cai J, Wang X, Ma A, Wang Q, Han X, Li Y. Factors Associated with Patient and Provider Delays for Tuberculosis Diagnosis and Treatment in Asia: A Systematic Review and Meta-Analysis. PLoS One; 10. Epub ahead of print 25 March 2015. doi: 10.1371/journal.pone.0120088 25807385

8. Bifftu BB, Takele WW, Guracho YD, Yehualashet FA. Depression and Its Help Seeking Behaviors: A Systematic Review and Meta-Analysis of Community Survey in Ethiopia. Depression Research and Treatment. Epub ahead of print 2018. doi: 10.1155/2018/1592596 30662771

9. Shaikh BT, Hatcher J. Health seeking behaviour and health service utilization in Pakistan: challenging the policy makers. J Public Health (Oxf) 2005; 27: 49–54.

10. Babitsch B, Gohl D, von Lengerke T. Re-revisiting Andersen’s Behavioral Model of Health Services Use: a systematic review of studies from 1998–2011. Psychosoc Med 2012; 9: Doc11.

11. Magaard JL, Seeralan T, Schulz H, Brütt AL. Factors associated with help-seeking behaviour among individuals with major depression: A systematic review. PLoS ONE 2017; 12: e0176730. doi: 10.1371/journal.pone.0176730 28493904

12. Sivasampu S, Mohamad Noh K, Chin MC. Quality and Costs of Primary Care (QUALICOPC) Malaysia: Phase I–Public Clinics. Kuala Lumpur: Ministry of Health Malaysia and Harvard T.H. Chan School of Public Health, Harvard University., October 2015. Available from: Cited 23 November 2018.

13. Sivasampu S, Mohamad Noh K, Husin M, Wong XC, Ismail SA. Quality and Costs of Primary Care (QUALICOPC) Malaysia: Phase II–Private Clinics. Kuala Lumpur: Ministry of Health Malaysia and Harvard T.H. Chan School of Public Health, Harvard University., August 2016. Available from: Cited 23 November 2018.

14. Schäfer WLA, Boerma WGW, Kringos DS, De Maeseneer J, Gress S, Heinemann S, et al. QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care. BMC Fam Pract 2011; 12: 115. doi: 10.1186/1471-2296-12-115 22014310

15. Graham JD. Guidance on Agency Survey and Statistical Information Collections. An Office of Management and Budget memorandum. Washington, DC, US. Available from: Citied 23 November 2018.

16. Ministry of Health Malaysia. Health Facts 2017. Putrajaya, Malaysia: Ministry of Health Malaysia. Available from: Cited 8 February 2019.

17. Sivasampu S, Wahab YF, Ong SM, Ismail SA, Goh PP, Jeyaindran S. National Medical Care Statistics (NMCS) 2014. NCRC/HSU/2016.1, Kuala Lumpur: National Clinical Research Centre, January 2016. Available from: Cited 8 February 2019.

18. Ang KT, Ho BK, Mimi O, Salmah N, Salmiah MS, Noridah MS. Factors influencing the role of primary care providers as gatekeepers in the Malaysian public healthcare system. Malays Fam Physician 2014; 9: 2–11.

19. World Health Organization. Regional Office for the Western Pacific. Malaysia health system review. Manila: WHO Regional Office for the Western Pacific, 2012. Avaiaible from: Cited 25 February 2019.

20. Hair JF, Anderson RE, Tatham RL, Black W. Multivariate Data Analysis. 5th ed. Upper Saddle River, NJ: Prentice Hall; 1998.

21. StataCorp. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP, 2015.

22. Thompson AE, Anisimowicz Y, Miedema B, Hogg W, Wodchis WP, Bassler KA. The influence of gender and other patient characteristics on health care-seeking behaviour: a QUALICOPC study. BMC Family Practice 2016; 17: 38. doi: 10.1186/s12875-016-0440-0 27036116

23. Mackenzie CS, Gekoski WL, Knox VJ. Age, gender, and the underutilization of mental health services: the influence of help-seeking attitudes. Aging Ment Health 2006; 10: 574–582. doi: 10.1080/13607860600641200 17050086

24. Hagen K, Bjorndal A, Uhlig T, Kvien TK. A population study of factors associated with general practitioner consultation for non-inflammatory musculoskeletal pain. Ann Rheum Dis 2000; 59: 788–793. doi: 10.1136/ard.59.10.788 11005779

25. Walker BF, Muller R, Grant WD. Low Back Pain in Australian Adults. Health Provider Utilization and Care Seeking. Journal of Manipulative and Physiological Therapeutics 2004; 27: 327–335. doi: 10.1016/j.jmpt.2004.04.006 15195040

26. Robinson ME, Riley JL, Myers CD, Papas RK, Wise EA, Waxenberg LB, et al. Gender role expectations of pain: relationship to sex differences in pain. J Pain 2001; 2: 251–257. doi: 10.1054/jpai.2001.24551 14622803

27. Alabas OA, Tashani OA, Tabasam G, Johnson MI. Gender role affects experimental pain responses: a systematic review with meta-analysis. Eur J Pain 2012; 16: 1211–1223. doi: 10.1002/j.1532-2149.2012.00121.x 22434689

28. Institute for Public Health. National Health and Morbidity Survey 2015. Vol. II: Non-Communicable Diseases, Risk Factors & Other Health Problems. Kuala Lumpur, 2015. Available from: Cited 13 February 2019.

29. Chomi EN, Mujinja PG, Enemark U, Hansen K, AD Kiwara. Health care seeking behaviour and utilisation in a multiple health insurance system: does insurance affiliation matter? International Journal for Equity in Health 2014; 13: 25. doi: 10.1186/1475-9276-13-25 24645876

30. Andersen RM, Yu H, Wyn R, Davidson PL, Brown ER, Teleki S. Access to Medical Care for Low-Income Persons: How do Communities Make a Difference?: Medical Care Research and Review. Epub ahead of print 18 August 2016. doi: 10.1177/107755802237808 12508702

31. Garcovich S, Colloca G, Sollena P, Andrea B, Balducci L, Cho WC, et al. Skin Cancer Epidemics in the Elderly as An Emerging Issue in Geriatric Oncology. Aging Dis 2017; 8: 643–661. doi: 10.14336/AD.2017.0503 28966807

32. Montgomery K, Bloch JR, Bhattacharya A, Montgomery O. Human papillomavirus and cervical cancer knowledge, health beliefs, and preventative practices in older women. J Obstet Gynecol Neonatal Nurs 2010; 39: 238–249. doi: 10.1111/j.1552-6909.2010.01136.x 20576067

33. Stockdale SE, Tang L, Zhang L, Belin TR, Wells KB. The effects of health sector market factors and vulnerable group membership on access to alcohol, drug, and mental health care. Health Serv Res 2007; 42: 1020–1041. doi: 10.1111/j.1475-6773.2006.00636.x 17489902

34. Deeks A, Lombard C, Michelmore J, Teede H. The effects of gender and age on health related behaviors. BMC Public Health 2009; 9: 213. doi: 10.1186/1471-2458-9-213 19563685

35. Unützer J, Schoenbaum M, Druss BG, Katon WJ. Transforming mental health care at the interface with general medicine: report for the presidents commission. Psychiatr Serv 2006; 57: 37–47. doi: 10.1176/ 16399961

36. Ismail SIF. Patterns and risk factors with help- seeking for common mental disorders in an urban Malaysian community. London School of Hygiene and Tropical Medicine, 2011. Availaible from: Cited 16 February 2019.

37. Caldwell TM, Jorm AF, Dear KBG. Suicide and mental health in rural, remote and metropolitan areas in Australia. The Medical Journal of Australia 2004; 181: S10–S14. 15462636

38. Razali SM, Khan UA, Hasanah CI. Belief in supernatural causes of mental illness among Malay patients: impact on treatment. Acta Psychiatr Scand 1996; 94: 229–233. doi: 10.1111/j.1600-0447.1996.tb09854.x 8911557

39. Liu S-I, Lu R-B, Lee M-B. Non-psychiatric physicians’ knowledge, attitudes and behavior toward depression. J Formos Med Assoc 2008; 107: 921–931. doi: 10.1016/S0929-6646(09)60015-2 19129052

40. Yeap R, Low WY. Mental health knowledge, attitude and help-seeking tendency: a Malaysian context. Singapore Med J 2009; 50: 1169–1176. 20087554

41. Committee on the Science of Changing Behavioral Health Social Norms, Board on Behavioral, Cognitive, and Sensory Sciences, Division of Behavioral and Social Sciences and Education, et al. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change. Washington (DC): National Academies Press (US). Available from: Cited 24 February 2019.

42. Tan WP, Ng CJ, Ho C, Tan HM. Men’s Health Status in Asia: Data from the Asian Men’s Health Report (AMHR). Journal of Men s Health 2014; 11: A22.

43. Ministry of Health Malaysia. Malaysian Mental Healthcare Performance. Technical Report MOH/S/CRC/55.18(TR)-e, Putrajaya, Malaysia: Ministry of Health Malaysia, 2016. Available from: Cited 25 February 2019.

Článek vyšel v časopise


2019 Číslo 10
Nejčtenější tento týden