Rizwana Hussain, Arash Rashidian, Assad Hafeez, Negar Mirzaee


Background: The objective of this study is to explore the factors which influence the health seeking behaviour and utilization of healthcare services of the community in context of geographical, socio-demographic, cultural, economic and educational background. Methods: A community based cross-sectional survey was performed on 900 households in five districts of Punjab from 1st February to 2nd March, 2016. In each of the selected district random sampling method was used for selection of six primary health facilities. 900 household purposively selected around each selected PHCF in opposite direction at distance of 5, 10, 15 km. A pretested questionnaire, WHO operational package (for assessing, monitoring and evaluating country pharmaceutical situations Level IIb) was acquired, and analysed by SPSS 23. Results: In 900 households visited, total population was 5024, out of which females and males were 47.7% and 52.3%respectively. About 95% of community had source of income. The male respondents and females were 95% and 5% respectively. 43.3% of patients visited PHCF, were with the serious complaints. 37% patients in households didn't take medicines when got sick. Females who completed their primary education were same in number as male but after primary education, males were more who perused further education. For 14% of the respondents, PHC was too far and for 61.9% of the respondents, PHC was close to reach.74.5% of the respondents were not satisfied with timings. 42.7% got medicines they need from PHC. Community with access <15 min to PHCF were 57.2%, and >1 hour was 5%. 49.1% of respondents could get free medicines from PHC. 64.4% respondent found medicines expensive at private pharmacies. In 53.3% of the cases, prescriber was doctor and for 47.6% were trained health assistant. Conclusion: There is a potential to improve the health seeking behaviour and PHC utilization by addressing the demand-side (community) factors created by geographical access, socio-economic factors, level of education, cultural beliefs and by healthcare system itself. Male dominance was found. Level of education was more among males. Physical access was a significant barrier. Availability of medicines was low. There was absence of doctor at PHCF.

Keywords: Health seeking behaviour; primary healthcare; barriers

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Shaikh BT, Hatcher J. Health seeking behaviour and health service utilization in Pakistan: challenging the policy makers. J Public Health (Oxf) 2005;27(1):49–54.

Zaidi S, Bigdeli M, Aleem N, Rashidian A. Access to Essential Medicines in Pakistan: Policy and Health Systems Research Concerns. PLoS One 2013;8(5):e63515.

Ensor T, Cooper S. Overcoming barriers to health service access: influencing the demand side. Health Policy Plan 2004;19(2):69–79.

Agha S. The determinants of infant mortality in Pakistan. Soc Sci Med 2000;51(2):199–208.

Kroeger A. Anthropological and socio-medical health care research in developing countries. Soc Sci Med 1982;17(3):147–61.

Ogunlesi TA, Olanrewaju DM. Socio-demographic Factors and Appropriate Health Care-seeking Behavior for Childhood Illnesses. J Trop Pediatr 2010;56(6):379–85.

Katung PY. Socio-economic factors responsible for poor utilisation of the primary health care services in a rural community in Nigeria. Niger J Med 2001;10(1):28–9.

Hunte PA, Sultana F. Health-seeking behavior and the meaning of medications in Balochistan, Pakistan. Soc Sci Med 1992;34(12):1385–97.

Thuan NTB, Lofgren C, Lindholm L, Chuc NTK. Choice of healthcare provider following reform in Vietnam. BMC Health Serv Res 2008;8(1):162.

Kiwanuka SN, Ekirapa EK, Peterson S, Okui O, Rahman MH, Peters D, et al. Access to and utilisation of health services for the poor in Uganda: a systematic review of available evidence. Trans R Soc Trop Med Hyg 2008;102(11):1067–74.

Ahmed SM, Adams AM, Chowdhury M, Bhuiya A. Gender, socioeconomic development and health-seeking behaviour in Bangladesh. Soc Sci Med 2000;51(3):361–71.

Kyomuhendo GB. Low use of rural maternity services in Uganda: impact of women's status, traditional beliefs and limited resources. Reprod Health Matters 2003;11(21):16–26.

Jamal H. Quantifying Sub-national Human Development Indices from Household Survey Data. Research report no 96. 2016. [Internet]. [cited 2017 Nov]. Available from: http://www.spdc.org.pk/Data/Publication/PDF/RR-96.pdf

Rani M, Bonu S. Rural Indian Women's Care-Seeking Behavior and Choice of Provider for Gynecological Symptoms. Stud Fam Plann 2003;34(3):173–85.

Nyamongo IK. Health care switching behaviour of malaria patients in a Kenyan rural community. Soc Sci Med 2002;54(3):377–86.

Yip WC, Wang H, Liu Y. Determinants of Patient Choice of Medical Provider: A Case Study in Rural China. Health Policy Plann 1998;13(3):311–22.

Thorson A, Hoa NP, Long NH. Health-seeking behaviour of individuals with a cough of more than 3 weeks. Lancet 2000;356(9244):1823–4.

Goldman N, Heuveline P. Health-seeking behaviour for child illness in Guatemala. Trop Med Int Health 2000;5(2):145–55.

Peltzer K, Promtussananon S. Health care-seeking behaviour for child illnesses among rural mothers in South Africa: a pilot study. Health SA Gesondheid 2003;8(2):3–13.

Yamasaki-Nakagawa M, Ozasa K, Yamada N, Osuga K, Shimouchi A, Ishikawa N, et al. Gender difference in delays to diagnosis and health care seeking behaviour in a rural area of Nepal. Int J Tuberc Lung Dis 2001;5(1):24–31.

de Zoysa I, Carson D, Feachem R, Kirkwood B, Lindsay-Smith E, Loewenson R. Perceptions of childhood diarrhoea and its treatment in rural Zimbabwe. Soc Sci Med 1984;19(7):727–34.

McNee A, Khan N, Dawson S, Gunsalam J, Tallo VL, Manderson L, et al. Responding to cough: Boholano illness classification and resort to care in response to childhood ARI. Soc Sci Med 1995;40(9):1279–89.

Masaninga F, Chanda E, Chanda-Kapata P, Hamainza B, Masendu HT, Kamuliwo M, et al. Review of the malaria epidemiology and trends in Zambia. Asian Pac J Trop Biomed 2013;3(2):89–94.

Geissler PW, Nokes K, Prince RJ, Odhiambo RA, Aagaard-Hansen J, Ouma JH. Children and medicines: self-treatment of common illnesses among Luo schoolchildren in western Kenya. Soc Sci Med 2000;50(12):1771–83.

Van der Stuyft P, Sorensen SC, Delgado E, Bocaletti E. Health seeking behaviour for child illness in rural Guatemala. Trop Med Int Health 1996;1(2):161–70.

Perez-Cuevas R, Guiscafre H, Romero G, Rodriguez L, Gutierrez G. Mothers' health-seeking behaviour in acute diarrhoea in Tlaxcala, Mexico. J Diarrhoeal Dis Res 1996;14(4):260–8.

Aday LA, Andersen R. A Framework for the Study of Access to Medical Care. Health Ser Res 1974;9(3):208–20.

Hasan IJ, Khanum A. Health care utilization during terminal child illness in squatter settlements of Karachi. J Pak Med Assoc 2000;50(12):405–9.

Siddiqi S, Kielmann A, Khan M, Ali N, Ghaffar A, Sheikh U, et al. The effectiveness of patient referral in Pakistan. Health Policy Plan 2001;16(2):193–8.

Asenso-Okyere WK, Anum A, Osei-Akoto I, Adukonu A. Cost recovery in Ghana: are there any changes in health care seeking behaviour? Health Policy Plan 1998;13(2):181–8.

Ha NT, Berman P, Larsen U. Household utilization and expenditure on private and public health services in Vietnam. Health Policy Plan 2002;17(1):61–70.

WHO. The World health report 2000: Health Systems: Improving Performance. Geneva: World Health Organization; 2000.

Fatmi Z, Avan BI. Demographic, socio-economic and environmental determinants of utilisation of antenatal care in a rural setting of Sindh, Pakistan. J Pak Med Assoc 2002;52(4):138–42.

Stephenson R, Hennink M. Barriers to Family Planning Service Use among the Urban Poor in Pakistan. Asia Pac Popul J 2004;19(2):5–26.

World Bank. Pakistan - Poverty assessment: poverty in Pakistan - vulnerabilities, social caps, and rural dynamics. World Bank Washington, DC; 2002.

UN. Elements for a Draft Declaration on Human Rights and Health Practice. Geneva: United Nations; 2001.

Uzma A, Underwood P, Atkinson D, Thackrah R. Postpartum health in a Dhaka slum. Soc Sci Med 1999;48(3):313–20.

Atkinson S, Ngwengwe A, Macwan'gi M, Ngulube TJ, Harpham T, O'Connell A. The referral process and urban health care in sub-Saharan Africa: the case of Lusaka, Zambia. Soc Sci Med 1999;49(1):27–38.

NoorAli R, Luby S, Hossein Rahbar M. Does use of a government service depend on distance from the health facility? Health Policy Plan 1999;14(2):191–7.

Bhuiya A, Bhuiya I, Chowdhury M. Factors affecting acceptance of immunization among children in rural Bangladesh. Health Policy Plan 1995;10(3):304–12.

Moazam F, Lakhani M. Ethical dilemmas of health care in the developing nations. J Pediatr Surg 1990;25(4):438–41.

Aljunid SM, Zwi AB. Differences in public and private health services in a rural district of Malaysia. Med J Malaysia 1996;51(4):426–36.

Bhatia JC, Cleland J. Health-care seeking and expenditure by young Indian mothers in the public and private sectors. Health Policy Plan 2001;16(1):55–61.

Sadiq H, Muynck AD. Health care seeking behavior of pulmonary tuberculosis patients visiting TB Center Rawalpindi. J Pak Med Assoc 2001;51(1):10–6.

Islam A, Malik FA. Role of traditional birth attendants in improving reproductive health: lessons from the family health project, Sindh. J Pak Med Assoc 2001;51(6):218–22.


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