Materials and Methods
Study Area
This study was conducted in Ido-Ekiti town in Ido-Osi local government situated in the northern part of Ekiti state, Southwest Nigeria. It is bounded in the east by Ipere and Iludun, in the south by Igbole and Ifinsin axis, and in the north and northwest by Usi and Ilogbo Ekiti[9, 10]
Ido-Ekiti town consists of two wards; Ido 1 and Ido 2 which are subdivided into twenty-two (22) settlements. There are three health facilities in Ido- Ekiti; A Basic Health Center, a Comprehensive Health Center, and Federal Teaching Hospital Ido-Ekiti[23-24]. Yoruba is the predominant tribe and Christianity is the predominant religion practiced. The population of people in the Ido-Osi local government area according to the 2006 census is 160,001and the population of the elderly is 6,060[9,10].
Study Population
The study is a cross-sectional study design that assessed the health care seeking behavioural practices amongst the elderly in Ido-Ekiti. The study populations were all elderly persons aged 65 and above in Ido-Ekiti, Ekiti State Nigeria. The study included elderly of both sexes 65years and above, who were willing to participate in the study. However, Elders 65years and above who were not willing to participate were excluded.
Sample Size and Sampling Technique
The sample size was calculated using Fisher’s formula for estimating the minimum sample size for descriptive studies using the proportion of older people above 50years who consulted a health practitioner (53%)[11], with P-value set at ≤ 0.05 and confidence interval of 95% and a non-response rate of 10%. The final estimated sample size was 420.
A multistage sampling technique was used to recruit the eligible participants. In Stage 1: Ido ward 2 was selected by simple random sampling technique out of the two wards in Ido-Ekiti. In Stage 2: four settlements, Oke-Isoko, Ijemu, Alapo, Isolo were selected by simple random sampling. In Stage 3: A Street was selected in each of the settlements by simple random sampling using all the streets in the settlement as the sampling frame. And in Stage 4: The houses along the street selected in stage 3 were numbered and simple random sampling was employed to select the houses to visit. Equal allocation was used to determine the number of participants in each street, and the required respondents were selected by simple random sampling technique using balloting.
Data Collection
Six data collectors and one supervisor were involved during the data collection process. A pre-tested, interviewer-administered, standardized semi-structured interviewer-administered questionnaire was developed and used to obtain information from participants. The questionnaire had 4 sections that addressed the socio-demographic characteristics, level of awareness of illnesses, the pattern of health care seeking behavioural practices, factors affecting healthcare-seeking behaviour of participants. Data collection was subject to strict controls and procedures which were followed precisely, to ensure that the data was valid, reliable, and useful.
Data Management
Data collected was checked for completeness, edited, coded, and entered into SPSS 25 statistical software for analysis. Descriptive statistics were presented as frequency distribution, means, and percentages. Chi-square and Fisher exact were used to determine the association between socio-demographic variables and Healthcare seeking behaviours and factors associated with healthcare-seeking behaviour. Results were interpreted and a conclusion was drawn using a P-value set at 0.05.
Ethical Approval
Institutional Ethical approval was obtained from Federal Teaching Hospital Ido Ethical Committee. Permission to conduct the study was also sought from the Ido community leaders and verbal and written consent was obtained from the participant before the study was conducted.
Result
The result of the study shows a response rate of 100 percent. The age of elderlies ranged between 65 – 95 years with a mean age of 73.88 ± 6.84 years (Table 1). More than half of the respondents (64.0%) were within the age range 65 – 75 years with Females constituting 61.0%. The majority of respondents were Christians (80.0%) and 97.1% of them were of the Yoruba tribe. More than half (60.5%) of the respondents were married and 37.9% widowed. The majority (87.4%) of the elderlies were unemployed and about half (52.4%) of them had no formal education. The majority (61.7%) had their source of income from work/trades and 32.1% of them were from family. Most of the respondents (82.6%) do not live alone, with the majority living with their spouse (66.9%) and one-quarter (25.4%) living with children. And about half (50.7%) of the respondents are taken care of by their spouses and 44.0% by their children (Table 2).
Figure1 is a bar chart that shows Majority of the respondents in the study have poor health-seeking behavioural practices 172(64.7%) while 94(35.3%) have good health-seeking behavioural practices. Respondents that were considered to have poor health-seeking behavioural practices in this study were those that either self-medicated, did nothing, pray and seek for supernatural healing, visited patent medicine store while those respondents that consulted a doctor in either a public or private health care facility were considered to have good health-seeking behaviour
Table 1: Socio-demographic characteristics of the respondents-Age,Gender,Marital Status
Variable
|
Frequency(n)
|
Percentage(%)
|
Age (years)
|
|
|
65 – 75
|
269
|
64.0
|
76 – 85
|
123
|
29.3
|
86 – 95
|
28
|
6.7
|
Mean ± SD
|
73.88 ± 6.84
|
|
Range
|
65 – 95
|
|
Gender
|
|
|
Male
|
164
|
39.0
|
Female
|
256
|
61.0
|
Marital status
|
|
|
Married
|
254
|
60.5
|
Separated/divorced
|
7
|
1.7
|
Widowed
|
159
|
37.9
|
Religion
|
|
|
Christian
|
336
|
80.0
|
Muslim
|
81
|
19.3
|
Traditionalist
|
3
|
0.7
|
Tribe
|
|
|
Yoruba
|
408
|
97.1
|
Others
|
12
|
2.9
|
Employment status
|
|
|
Employed
|
43
|
10.2
|
Unemployed
|
367
|
87.4
|
Retired
|
10
|
2.4
|
Table 2: Socio-demographic characteristics of the respondents-Level of education and Source of income.
Variable
|
Frequency(n)
|
Percentage (%)
|
Highest level of education
|
No formal education
|
220
|
52.4
|
Primary school
|
150
|
35.7
|
Secondary school
|
32
|
7.6
|
Tertiary school
|
18
|
4.3
|
Source of income
|
|
|
Family
|
135
|
32.1
|
Work/trades
|
259
|
61.7
|
Farming
|
26
|
6.2
|
Do you live alone
|
|
|
Yes
|
73
|
17.4
|
No
|
347
|
82.6
|
Persons living with (n =347)
|
Spouse
|
232
|
66.8
|
Children
|
88
|
25.4
|
Other relatives
|
20
|
5.8
|
Not stated
|
7
|
2.0
|
Who takes care of you
|
|
|
Nobody
|
10
|
2.4
|
Spouse
|
213
|
50.7
|
Children
|
185
|
44.0
|
Relatives
|
12
|
2.9
|
n=4
Table 3 shows the health-seeking behavior and health problems of the respondents; Sixty-three percent of the respondents reported having a health challenge within the last one year. The nature of illness reported includes; Joint pain (Arthritis) (28.6%), Malaria fever (29.7%), high Blood Pressure (13.2%) as most prevalent, Diabetes (3.0%), and Prostate problem (3.0%) were least reported. Only about one-third (35.3%) of this Respondent sought healthcare from Doctors. More than half (57.9%) of Respondent who had poor healthcare-seeking behaviour practiced self-medication.
In table 4, two-third (68.0%) of respondents who utilized Orthodox health care, visited a public health facility, whereas 29.8% visited a private facility. Less than half (46.8%) of them were satisfied with services rendered, on the other hand, 53.2% of them were dissatisfied. The majority (90%) of respondents who were dissatisfied with the services reported length of time for consultation, the attitude of health workers, unavailability of a physician, poorly organized hospital services, and high cost of services as reasons for dissatisfaction. About 48.9% of those who had visited healthcare facilities for health challenges indicated not being willing to patronize the hospital again when sick. For respondents that fell sick more than once in the last year preceding the study, the last episode was taken as a reference point in the study to minimize recall bias.
Table 3: Distribution of respondents’ health seeking behavior to their illnesses
Table 5 shows factors that hindered the respondents from seeking orthodox’s care. This include the respondents' knowledge of the disease (87.4%),cost of health care (85.7%),length of time of consultation(79.0%),poor access to a health care facility(79.3%),and lack of support from relations(73.8%).Confidentiality issues and beliefs of respondents least affected their seeking Orthodox health practitioner care.
Table 6 and table 7 show the Association between socio-demographic variables and health-seeking behavioral practices among the respondents who fell sick within the last year preceding the study. Only employment status and levels of education were statistically associated with health-seeking behavioural practices. About 61.3% of employed elderlies had good health-seeking behaviour as compared to the unemployed (32.5%) and the retired (0%). Furthermore, 84.6% of those with tertiary education as their highest level of education had good health-seeking behavioural practices as compared with those with no formal education (29.1%), primary education (35.9%), and secondary education (44.4%).
The following factors are statistically significant to the health care seeking behavioural practices among the respondents namely the cost of healthcare, accessibility of health facility, beliefs of respondents, length of time before consultation, confidentiality issues, and lack of support from relations, with their p values of less than 0.001 as shown in table 8. Respondent's knowledge of the disease was not significantly associated with their health-seeking behavioural practices (p-value of 0.190).