The primary objective of this study was to determine the older adults' perceptions and expectations regarding healthcare needs and services they believe are required in healthcare services in Bangladesh. Bangladesh's overall population is 169.80 million (enumerated), with an older population (above 60 years) of 9.28%, or 15.3 million [16]. The government spent 3445.40 crores of Taka in 2022-23, with 5.7 million older adults as recipients. The old-age payment program currently covers approximately 40% of older adults. It is worth noting that older adults receive 500 takas per month, with a 65-year-old male limit and a 62-year-old female limit [17]. According to our study, 48% of older adults received or registered for the old age allowance program, which is consistent with Bangladesh's current scenario. About 65% of the older adults had health insurance coverage, with males and urban residents dominating. The majority of the older adults were literate, around 60%.
The findings showed specific sectors where Bangladesh's healthcare sector, particularly older adult care services, comes close to matching elders' expectations and areas where it falls far short. Perceived needs and expectations for more aged adults' healthcare services were derived from older adults' responses in the interview using the 'Kano Model.' The study revealed needs for various aspects and dimensions of services, such as service provider-related needs, service-related needs, different financial needs for receiving health care, accommodation needs, and expectation gaps.
In these cases, the Bangladesh Health Service and other health providers must concentrate on being able to deliver fundamental services like- efficiency of service procedures and appointment system, medical treatment and doctor visiting as scheduled, availability of immunization services, doctors and nurses are careful about treating and examining patient, physical facilities and medical instruments in place to assist older adults persons, adequate fresh water supply at the ward, and clean and well-maintained washroom. Because these services were recognized as a must-have attribute in healthcare facilities by the aged, they were regarded as expected or essential attributes by the older adults, whose presence was taken for granted. In this way, healthcare management can raise its quality in areas that impact patient perceptions of service quality. This case study also demonstrates how an existing worldwide health quality and service quality methodology (Kano Model) developed in various cultural contexts can administer aged healthcare services.
This finding aligns with Yiranbon et al.'s 2014 study in Ghana, which used the 'Kano Model,' consisting of 32 items, to investigate the expectation and perception gap regarding healthcare needs. As with this research paper, most of the items were considered critical or must-be by older adults. Other findings in this field in other countries show similar results, as Anh, 2016, revealed gaps between expectations and perceptions, with expectations exceeding those in one national hospital in Vietnam. In primary healthcare facilities, analysis shows that the gap between expectation and perception was because of 9 differences in patients' perceptions rather than expectations. The most significant gap was detected in empathy [11, 18].
The study also indicated that perceived healthcare needs differed significantly by literacy status and residence type, with rural older adults having a higher mean score. Their knowledge about geriatric health problems and care is limited among Bangladesh older adults, impacting their health-seeking behavior, as they only seek assistance when their health condition deteriorates [19]. According to the findings, respondents' age, residence type, and quality of life significantly impacted their perceived healthcare needs. Patients' perceptions of healthcare interactions differ by age. Patients aged 18–64 were less likely to state that their provider "always" listened to them, "always" showed respect for what they had to say, and "always" spent enough time with them when compared to patients aged 65 and up [19]. Older adults' self-perception of aging is also linked to their desire to seek medical help. A higher risk of health care delay and perceived barriers to care were related to more negative self-perceptions of aging (SPA) [19, 20].
The expected healthcare needs were also significantly varied by marital status and family monthly income, with mean scores higher for married and family incomes less than 15 thousand than others. According to findings, literacy, disease prevalence, and quality of life significantly predicted the older adult's expected healthcare needs. Regarding accessibility, income was the most critical factor related to problems of self-perceived access, although insurance coverage, age, doctor's lack of responsiveness to patient concerns, and gender remained independently associated [21]. Therefore, the patients' representatives can be included in the planning, prioritizing, and fulfilling that vulnerable group's health needs [6, 22].
Strengths of the Study
The key findings of this study were the older adults' expectations and perception gap about healthcare needs in the Bangladesh context, which can contribute to the formulation of future health policies for the more aging adult population.
The research paper's objective was clearly defined, as were the inclusion and exclusion criteria. Multiple databases were searched to validate this research in the context of Bangladesh (PUBMED, Jstore, PMC, and ResearchGate), as there had been few previous studies in this sector. The goal of this research article is to reduce the gap. Furthermore, using the Kano Model, this study introduces a new research dimension to identify healthcare needs and expectations among other population groups (e.g., adolescents and indigenous people's health).
Limitations of the Study
A cross-sectional research design was adopted in this study. However, causal judgments about links observed in the data are impossible. Another disadvantage of the research was that it was limited to a specific geographical site in Bangladesh (Dhaka). As a result, the study's findings may not reflect the experiences of all older people in the country. Data was collected during the COVID-19 breakdown, and getting respondents for this study was a significant difficulty, particularly for older adults. This study only covers the perception and expectations of older adults considering the demand side, while the supply side could not be assessed. Finally, only data from the general population was gathered. This study did not include older adults who live in a particular setting (such as an old home). Their expectations may differ from those of the general older population.