Case Report
Health Care Seeking Behavior of Aged Women: A Study in Narail District
Nurunnahar, Selina Ahmed, Karimun Nessa, Md. Golam Faruk* and Rashmia Sultana
Corresponding Author: Golam Faruk, Lecturer, Sociology, Khulna Islamia College, Khulna-9000, Bangladesh.
Received: September 29, 2024; Revised: October 03, 2024; Accepted: October 06, 2024 Available Online: October 25, 2024
Citation: Nurunnahar, Ahmed S, Nessa K, Md. Faruk G & Sultana R. (2025) Health Care Seeking Behavior of Aged Women: A Study in Narail District. J Nurs Occup Health, 6(1): 591-659.
Copyrights: ©2025 Nurunnahar, Ahmed S, Nessa K, Md. Faruk G & Sultana R. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Bangladesh, a South Asian country with a high population density and limited geographical space, faces significant healthcare challenges and a huge portion belong to aged group. This study focused on the Narail district and aimed to investigate the healthcare-seeking behavior of older women in this region. Additionally, the study seeks to explore the factors that influence these older women's health conditions and identify the significant health problems they encounter. For the study, a survey method was followed through household census and the study was explanatory in nature. Simple random sampling was used to determine sample size, which was 171 in number, and all of them were 60 or above in which a semi-structured interview schedule was conducted during data collection. In this study, findings showed that all respondents in the Narail district experienced various health problems within a year. The primary health problems identified include fever, gastrointestinal illness, aches and pain, respiratory illness, diabetes, and eye-related illness. All respondents sought healthcare during the disease, and the nature of treatment varied. Regarding healthcare-seeking behavior, more than half of the respondents (66.1%) experienced delays in seeking healthcare, while (33.9%) sought healthcare promptly. Most respondents received allopathic treatment (57.9%), while a significant portion opted for homeopathy (28.7%). These treatments were obtained from nearby hospitals or pharmacies. The study also revealed several factors influencing the healthcare-seeking behavior and health conditions of aged women in the study area. These factors included marital status, education level, living arrangement, monthly household income, type of health problems, frequency and duration of health problems, distance of healthcare centers from home, the availability of medical facilities, and economic factors. There was significant relationship between response in health seeking behavior and living arrangement, monthly household income, expenditure and distance in health care centers (P value= 0.000***). There were also significant association between health conditions of the respondents with their age, occupation, assistance status, major health problems, medication course, duration of illness, cost of treatment and mode of transportation (p value= 0.000***).The findings also emphasized the need for initiatives from both government and non-government organizations to improve healthcare services for the aging people in Bangladesh; addressing awareness of prompt healthcare-seeking behavior can contribute to better health outcomes for older women in the Narail district.

Keywords: Aged women, Health, Diseases, Healthcare seeking behavior
INTRODUCTION

Aging is a critical topic encompassing various aspects such as demography, economy, food and nutrition, health, education, and human rights. While there is no universally agreed-upon age bracket for categorizing individuals as elderly, the United Nations defines those aged 60 and above as older. Aging has become a pressing social issue in Bangladesh, primarily due to the gradual breakdown of traditional family structures. Most literature identifies individuals over 60 as part of the elderly population in the country. The majority of elderly individuals in Bangladesh confront significant hardships, including financial insecurity, age-related health problems, limited access to healthcare, and social exclusion. These challenges contribute to their socioeconomic vulnerability [1]. Among the elderly population in Bangladesh, older women represent a particularly vulnerable group concerning healthcare and access to necessary services [2]. One of the main reasons behind this problem is less knowledge of healthcare-seeking behavior. Due to recent socio-economic changes, traditional support for older adults is gradually becoming more vulnerable in our society [3]. In many societies, women's health is adversely affected by discrimination rooted in sociocultural factors, creating numerous social barriers to accessing healthcare services. Rural women, in particular, exhibit inappropriate healthcare-seeking behavior due to factors such as their lack of awareness about health issues, social stigma, socioeconomic constraints, communication difficulties within families, and the absence of essential healthcare services [4]. Most of the rural people in Bangladesh live on the poverty line, and they cannot afford to have good treatment [3]. The quality of healthcare providers, effectiveness, cost, opportunity, medical facilities, treatment facilities, disease, health vulnerability, the standard of living, symptoms of illness, duration of illness, socioeconomic status, etc., all have an impact on how older women in rural areas seek healthcare [5]. Elderly women face significant threats from poverty and social exclusion. Those without a living partner, both women and the oldest one, report poorer health status and encounter more significant obstacles across various domains. The challenges faced by illiterate and partner less women are numerous, including health problems. Additionally, elderly women in pastoral areas commonly experience eye problems, hearing impairments, musculoskeletal disorders, gastrointestinal issues, diabetes, dermatological problems, and sleeping disturbances [6]. The situation is further exacerbated in rural areas where older individuals lack access to adequate healthcare facilities due to the greater distance between health centers than in urban areas. In developing Asian nations, particularly Bangladesh, the aging population aged 60 and older endures a life of poverty, misery, inadequate access to healthcare, and poor nutrition. Economic challenges are particularly pronounced among older age groups. To the best of our knowledge, numerous studies have been conducted on the health-seeking attitudes of rural people in Bangladesh. Some previous studies have tried to analyze the coping strategies of elderly people in case of illness, along with related contributing factors. The study sought to answer the three critical decisions of health-seeking behavior for older people: "where" to take the person, "who" can accompany the older individual, and "how" the finances can be managed. They emphasize financial factors that play a crucial role in seeking health care in the backdrop of poverty of the elderly and their families, which is a burden for most poor rural families [7]. Another study aimed to understand the individual experiences of older people in Bangladesh regarding healthcare-seeking and accessibility, their affordability, and coping strategy by considering the social and cultural aspects of healthcare utilization during their sickness with an emphasis on the promotion of the healthcare condition of senior citizens [8]. A study mentioned in their studies that socioeconomic status is a strong determinant of health-seeking behavior among the elderly [5,9,10]. defined that only one-third of the total respondents (33.8%) visited an experienced healthcare professional with the lowest amount of modern health. One of the studies found that an individual's socioeconomic status determines the ability to afford and access healthcare services and is thus an essential factor in engaging in health-seeking behavior [11]. However, despite the research, there remains a significant gap in understanding the influencing factors of health-seeking behavior. Previous literature showed that treatment-seeking is a multidimensional issue and identified factors compelling treatment-seeking behavior. There were also many works on the seeking behavior of aged women, but in these particular regions of Narail District, research papers on the healthcare-seeking behavior of aged women were rare. Given this grim reality, it becomes evident that addressing the healthcare-seeking behavior of aged women in the Narail district is an immensely challenging task. Their specific healthcare needs and demands pose a growing challenge that warrants attention. Addressing these pressing issues effectively, it is crucial to expand our understanding of variables that are well-suited for analyzing health disparities in the older population [12]. In this perspective, exploring the dimensions for more significant insights into their healthcare-seeking behavioral patterns is essential. Those methodological interpretations and statistical analyses give us direction in conducting the proposed study. Understanding these dimensions is crucial for identifying possible initiatives to improve further healthcare access and outcomes for aged women, particularly those residing in rural areas of Bangladesh. The study will benefit from understanding the measurable effects of different dimensions that influence aged women's healthcare-seeking behavior.

MATERIALS AND METHODS

Aging is a natural process of life span but in developing countries, aged person especially women lead a vulnerable life due to many socio-economic factors. This study was explanatory in nature and conducted using quantitative research design and numeric data. The survey method schedule was conducted collect data from the respondents. The total number of aged women was 307, considering the attributes of the unit of analysis from the three mentioned villages of Narail Upazila. The sample size of the study was 171, using simple random sampling. Fieldwork was conducted in two months of 2022, September and October, respectively, using an interview schedule. The data processed were analyzed and interpreted by using appropriate statistical techniques, both descriptive and inferential statistical techniques (Table 1).


Variables of the Study

The study was conducted with both independent and dependent variables. The independent variables are age, religion, marital status, education, living arrangement, size of the family, types of Houses, head of the household, total household income, total household expenditure, types of health problems, and duration of illness. The dependent variables are a response to seeking healthcare, nature of treatment, place of treatment, etc.

Ethical consideration

To conduct the study, permission was obtained from the authority of the respective Upazila. With their consent, data were collected from the study area. During the fieldwork, the researcher introduced themselves, disclosed the nature and purpose of the study, and obtained verbal consent from the respondents. Moreover, to keep the participants' anonymity, their names were not included in the interview schedule, and they were also assured that the information was only used for study purposes.

RESULTS

Most of the respondents had moderate health problems. All the respondents were suffering many health problems within the last year. The result reveals that the majority of the respondents (24.6%) suffered from diabetics, fever (23.4%), Gastrointestinal illness (11.1%), Aches and pain (15.2%), and other like blood pressure, kidney disease, skin disease, eye related problems, and waterborne illness respectively among the most common diseases suffered by respondents such as fever (17.0%), Gastrointestinal Diseases (13.5%), blood pressure (21.6%), eye diseases (15.2%), diabetics (12.3%), and Aches and Pain (20.0%) respectively. Most women suffered from these diseases in a short period (Table 2).


The above table explored the determining factors of health problems and healthcare-seeking behavior of aged women. In this table, it was found that the medical facility (49.1%) was in such a low condition that it greatly affected the respondents' health problems and healthcare-seeking behavior. The economic conditions of respondents (45.5%) had a highly adverse impact on their health problems and healthcare seeking behavior, 43.3% had medium effects, and 11.7% had low influences (Tables 3 & 4).



This result presents the association between the response in seeking healthcare behavior and its covariates. It was noted from the relation that respondents’ age had highly statistically significant effects on response in seeking healthcare by  11.413 and P 0.003. The table also reveals that marital status had a statistically significant effects on seeking healthcare behavior by  6.469 and P 0.039. Similarly, with the respondents' education, living arrangements were also highly statistically significant, with the respondent’s seeking healthcare by (x2= 9.835 and p <0.007) and (x2= 20.886 and P<0.000), respectively, in this table. The receiving assistance by x2= 1.344 and P Table 5).

This table reveals the association between health conditions and their covariates. These results showed that the respondent's age statistically affected the health condition by x2= 53.511 and P

DISCUSSION

This study aimed to explore the healthcare-seeking behavior of aged women under three factors: 1. Predisposing factors, 2. Enabling factors, and 3. Need factors as outlined in Andersen’s Behavioral Model of Health Services Use [13,14]. The healthcare-seeking behavior of aged women is highly associated with their personal, living, social-economic, and surrounding conditions. In developing countries like Bangladesh, many impediments affect the healthcare-seeking behavior of aged women. The current study found that most respondents were between 60 and 69 years old, followed by 70 to 79 and above 80 years old, respectively. A significant portion of the respondents were illiterate, and the rest had primary and secondary levels of education, respectively; according to the current study findings, the predisposing factors of respondent age were highly statistically significant with seeking healthcare and place of treatment. It was identified that most of the respondents above 70 needed to seek healthcare properly and promptly and faced more significant health problems. A different study found that younger people were more likely to seek healthcare earlier than older people [15]. The study's findings show that almost two-thirds of the respondents delayed seeking healthcare during illness. They generally seek healthcare delayed because most of the respondent live under the poverty line, their vulnerable socioeconomic conditions and the unavailability of healthcare centers nearby are highly influenced to seek healthcare later. Almost similar study found that most aged women seeking healthcare are delayed due to an individual's socioeconomic status, which is thus an essential factor [16]. The bivariate analysis (chi-square test) result also reveals a statistically significant relationship between marital status, living arrangements and their preference for healthcare. Most of the respondents who were divorced, widows and or children with families seeking healthcare were delayed. Similarly, the study in Bangladesh reported that seeking healthcare had a significant relation with their living arrangements and marital status [1]. A study also found a similarity between the respondents living arrangements and seeking healthcare; the majority who lived alone and in children's houses faced frequent health problems but delayed in seeking healthcare [17]. It was examined that most respondents have completed primary education, and the rest are illiterate. Result founded that the level of education had a highly significant relationship with seeking healthcare. A study in Nigeria shows that the high quality of education had a significant relationship with seeking healthcare promptly [18]. Some studies have found that older women with higher levels of education and those living in extended families are more likely to seek healthcare services.


For instance, a study on determinants of healthcare-seeking behavior among older women in rural Bangladesh revealed that the rates of seeking healthcare services were higher among older women with primary and secondary education, those living with spouses and children, and those residing in extended families with seven or more members [19]. This study shows that respondents who are working sought their healthcare promptly and decided to seek healthcare during illness compared to those who were not working [20]. They reported a more substantial relationship between respondents' working status and earning money when seeking healthcare. From the findings, it was also found that most of the respondents were suffering from fever, gastrointestinal illness, respiratory illness, aches and pain, diabetics, and skin or eye-related problems that were also found in this result of [21]. Near fifty percent of respondents faced discrimination for getting healthcare services due to lack of knowledge, poor economic conditions, or living in rural areas. Previous researchers also reported similar findings that rural women faced various forms of discrimination or harassment due to a lack of proper knowledge about proper healthcare facilities and also dominated by doctors, nurses as well as hospital staff [22]. The Pearson correlation result interprets a statistically positive and negative relation between respondents' age and monthly household income, cost of treatment, distance of health center from home, medical access, and response to seeking healthcare.

CONCLUSION

A pressing concern associated with aging in developing countries like Bangladesh is the health of the elderly population, particularly older women. These individuals face a multitude of health issues, including gastrointestinal problems, hypertension, diabetes, fever, eye-related conditions, asthma, and more. Most elderly women are economically dependent on others, lack primary education, savings, or access to allowances, and live with their children or within their household. Factors such as monthly family income and treatment costs were identified as significant impediments to seeking healthcare for aged women, leading to delays in seeking healthcare during illness. This finding could serve as an underpinning for developing an effective intervention that can promote health and well-being among aged women, ultimately leading to growing health outcomes for these rural vulnerable groups of people. It suggests that government and non-government organizations should collaborate to address poverty alleviation among the elderly, including initiatives like social safety net programs. There is a need to establish healthcare centers at the rural level in Bangladesh to improve healthcare access. It underscores the importance of addressing socioeconomic barriers and improving healthcare accessibility to enhance the quality of life for this vulnerable demographic.

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