Factors Affecting the Use of Outpatient Services Among Rural Population in Sabah, Malaysia
Main Article Content
Abstract
Introduction: Health outcomes in Sabah are generally below the national average and may be even worse in rural areas with limited health resources. Primary care plays a crucial role in facilitating appropriate referrals to secondary care through outpatient services. This study uses Andersen's behavioural model to assess outpatient healthcare utilisation in Nabawan, examining user characteristics and variables impacting service usage. Materials and methods: Guided face-to-face interviews were conducted between February and May 2019 in 25 villages, with 438 respondents randomly selected in the Nabawan district. Participants were asked if they had visited an outpatient facility in the past two weeks. Descriptive statistics were used to assess respondent characteristics, while multiple logistic regression analysis was employed to investigate the relationship between various factors and outpatient care usage. Results: From the total respondents, 17.8% (78) reported visiting an outpatient facility in the preceding two weeks. Those who reported moderate or mild health restrictions were eight times more likely to need outpatient treatment than those with no health limitations (AOR = 7.6, 95% CI = 1.990, 29.040). Additionally, individuals with one illness were three times more likely to use outpatient care (AOR = 2.630, 95% CI = 1.220, 5.660), while those with multiple illnesses were seven times more likely (AOR = 6.770, 95% CI = 2.680, 17.090). Conclusion: Individuals' belief in their own needs, including self-reported health restrictions and disease history, drives them to seek care. This belief may also affect their adherence to medical advice, treatment recommendations, and follow-up care.
Downloads
Article Details
References
Mohamad Noh K. Primary Health Care Reform in 1CARE for 1Malaysia. Int J Public Health Res. 2011;50–6. Available from: https://journalarticle.ukm.my/3352/.
Rannan-Eliya RP, Anuranga C, Manual A, Sararaks S, Jailani AS, Hamid AJ, et al. Improving Health Care Coverage, Equity, and Financial Protection through a Hybrid System: Malaysia’s Experience. Health Aff. 2016;35(5):838–46. https://doi.org/10.1377/hlthaff.2015.0863.
Jaafar S, Mohd Noh K, Muttalib KA, Othman NH, Healy J, Maskon K, et al. Malaysia Health System Review. Vol. 3. World Health Organization; 2013. Available from: http://www.wpro.who.int/asia_pacific_observatory/hits/series/Malaysia_Health_Systems_Review2013.pdf.
Ministry of Health Malaysia. Health Indicators 2021. Putrajaya: Ministry of Health; 2021. Available from: https://www.moh.gov.my/index.php/pages/view/58?mid=19.
Bakar AKA, Zainuddin AA, Teng AK, Awaludin A, Baharuddin A, Mahadir B, et al. National Health and Morbidity Survey 2011 (NHMS 2011): Non-Communicable Disease. Vol. 2. Institute for Public Health Malaysia; 2011. Available from: https://iku.gov.my/nhms-2011.
Bakar AKA, Ghani AAA, Rahman AB, Zainuddin AA, Jai AN, Chandran A, et al. National Health & Morbidity Survey 2015 (NHMS 2015): Non-Communicable Diseases, Risk Factors & Other Health Problems. Vol. 2. Institute for Public Health Malaysia; 2015. Available from: https://iku.gov.my/nhms-2015.
World Health Organization. Human Resources for Health Country Profiles: Malaysia. Geneva: World Health Organization; 2014. Available from: https://www.moh.gov.my/index.php/pages/view/1919?mid=1563.
Nasirin C, Lionardo A. Administering the Inclusiveness of Neglected Low-income Urban Families to Access Healthcare Services: A Qualitative Inquiry. Univ J Public Health. 2021;9(5):263–7. https://doi.org/10.13189/ujph.2021.090508.
Pampel FC, Krueger PM, Denney JT. Socioeconomic Disparities in Health Behaviors. Annu Rev Sociol. 2010;36:349–70. https://doi.org/10.1146/annurev.soc.012809.102529.
Department of Statistics Malaysia. Press Release: GDP by State, 2010–2015. 2016. Available from: https://v1.dosm.gov.my/v1/index.php?r=column/pdfPrev&id=Y1NNYUhXO.
Ministry of Economy Malaysia. Incidence of Poverty by Ethnic Group, Strata and State, Malaysia, 1970–2019. Putrajaya: Ministry of Economy; 2023. Available from: https://www.ekonomi.gov.my/en/socio-economic-statistics/household-income-poverty-and-household-expenditure.
Institute for Public Health Malaysia. National Health and Morbidity Survey 2019 (NHMS 2019): Non-Communicable Diseases: Risk Factors and Other Health Problems. Vol. 3. Institute for Public Health; 2019. Available from: http://www.iku.gov.my/nhms-2019.
Andersen RM. Revisiting the Behavioral Model and Access to Medical Care: Does It Matter? J Health Soc Behav. 1995;36(1):1–10. https://doi.org/10.2307/2137284.
Dutton D. Financial, Organizational and Professional Factors Affecting Health Care Utilization. Soc Sci Med. 1986;23(7):721–35. https://doi.org/10.1016/0277-9536(86)90121-8.
Evans RG, Stoddart GL. Producing Health, Consuming Health Care. Soc Sci Med. 1990;31(12):1347–63. https://doi.org/10.1016/0277-9536(90)90074-3.
Grossman M. On the Concept of Health Capital and the Demand for Health. J Polit Econ. 1972;80(2):223–55. Available from: http://www.jstor.org/stable/1830580.
Rosenstock IM. Why People Use Health Services. Milbank Q. 2005;83(4):1–32. https://doi.org/10.1111/j.1468-0009.2005.00425.x.
Andersen RM. National Health Surveys and the Behavioral Model of Health Services Use. Med Care. 2008;46(7):647–53. https://doi.org/10.1097/MLR.0b013e31817a835d.
Madyaningrum E, Chuang YC, Chuang KY. Factors Associated with the Use of Outpatient Services among the Elderly in Indonesia. BMC Health Serv Res. 2018;18(1):707. https://doi.org/10.1186/s12913-018-3512-0.
Ham OK, Lee CY. Predictors of Health Services Utilization by Hypertensive Patients in South Korea. Public Health Nurs. 2007;24(6):518–28. https://doi.org/10.1111/j.1525-1446.2007.00664.x.
Anis-Syakira J, Jawahir S, Abu Bakar NS, Mohd Noh SN, Jamalul-Lail NI, Hamidi N, et al. Factors Affecting the Use of Private Outpatient Services among the Adult Population in Malaysia. Int J Environ Res Public Health. 2022;19(20):13663. https://doi.org/10.3390/ijerph192013663.
Hanafiah ANM, Jailani AS, Rahim FIA, Yong FCC, Lin KY, Ismail MH, et al. National Health & Morbidity Survey 2019 (NHMS 2019): Healthcare Demand. Vol. 2. Institute for Public Health Malaysia; 2020. Available from: https://iku.gov.my/nhms-2019.
Ministry of Health Malaysia. National Health & Morbidity Survey 2015 (NHMS 2015): Healthcare Demand. Vol. 3. Institute for Public Health Malaysia; 2015. Available from: https://iku.gov.my/nhms-2015.
Department of Statistics Malaysia. Key Findings Population and Housing Census of Malaysia 2020: Administration District. 2022. Available from: https://newss.statistics.gov.my.
Aris T, Yusoff MFM, Ghani AAA, Hamid HAA, Omar MA, Ahmad NA, et al. National Health & Morbidity Survey 2015 (NHMS 2015): Methodology & General Findings. Vol. 1. Institute for Public Health Malaysia; 2015. Available from: https://iku.gov.my/nhms-2015.
van Doorslaer E, O’Donnell O, Rannan-Eliya RP, Somanathan A, Adhikari SR, Garg CC, et al. Effect of Payments for Health Care on Poverty Estimates in 11 Countries in Asia: An Analysis of Household Survey Data. Lancet. 2006;368(9544):1357–64. https://doi.org/10.1016/S0140-6736(06)69560-3.
Organisation for Economic Co-operation and Development. Adjusting Household Incomes: Equivalence Scales. What Are Equivalence Scales? OECD; 2008. Available from: https://www.oecd.org/els/soc/OECD-Note-EquivalenceScales.pdf.
Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful Selection of Variables in Logistic Regression. Source Code Biol Med. 2008;3(1):17. https://doi.org/10.1186/1751-0473-3-17.
Government of Malaysia. Seventh Malaysia Plan. Kuala Lumpur: Government of Malaysia; 1996. Available from: https://www.ide.go.jp/library/English/Publish/Reports/Apec/pdf/1997_15.pdf.
Ministry of Health Malaysia. Annual Report 2014. Putrajaya: Ministry of Health; 2014. Available from: https://www.moh.gov.my/index.php/pages/view/58?mid=19.
Department of Statistics Malaysia. Household Income and Basic Amenities Survey Report 2020. Putrajaya: Department of Statistics Malaysia; 2020. Available from: https://v1.dosm.gov.my.
Lee L. Sabah State Economic Planning Unit Report. Sabah: World Vision Malaysia; 2004. Available from: https://www.ohchr.org/sites/default/files/Documents/Issues/Poverty/VisitsContributions/Malaysia/World_Vision_Malaysia.pdf.
Department of Statistics Malaysia. Key Findings Population and Housing Census of Malaysia 2020 (Version 2.0). Putrajaya: Department of Statistics Malaysia; 2023. Available from: https://www.dosm.gov.my.
The Vibes. Nabawan Road ‘Accessible’ but Bridge Repairs Ongoing: Deputy Works Minister. The Vibes. 2022 May 25. Available from: https://www.thevibes.com/articles/news/63271/nabawan-road-accessible-but-bridge-repairs-ongoing-deputy-works-minister.
Heiman HJ, Artiga S. Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. Kaiser Commission on Medicaid and the Uninsured. 2015;1(11):1–11. Available from: https://collections.nlm.nih.gov/catalog/nlm:nlmuid-101740257-pdf.
Newbold KB, Eyles J, Birch S. Equity in Health Care: Methodological Contributions to the Analysis of Hospital Utilization within Canada. Soc Sci Med. 1995;40(9):1181–92. https://doi.org/10.1016/0277-9536(94)00229-M.
Bennett IM, Chen J, Soroui JS, White S. The Contribution of Health Literacy to Disparities in Self-Rated Health Status and Preventive Health Behaviors in Older Adults. Ann Fam Med. 2009;7(3):204–11. https://doi.org/10.1370/afm.940.
Van der Heyden JHA, Demarest S, Tafforeau J, Van Oyen H. Socio-economic Differences in the Utilisation of Health Services in Belgium. Health Policy. 2003;65(2):153–65. https://doi.org/10.1016/S0168-8510(02)00213-0.
Goroh MMD, Rajahram GS, Avoi R, Van Den Boogaard CHA, William T, Ralph AP, et al. Epidemiology of Tuberculosis in Sabah, Malaysia, 2012–2018. Infect Dis Poverty. 2020;9(1):1–11. https://doi.org/10.1186/s40249-020-00739-7.
Budreviciute A, Damiati S, Sabir DK, Onder K, Schuller-Goetzburg P, Plakys G, et al. Management and Prevention Strategies for Non-communicable Diseases (NCDs) and Their Risk Factors. Front Public Health. 2020;8:574111. https://doi.org/10.3389/fpubh.2020.574111.
Gelberg L, Andersen RM, Leake BD. The Behavioral Model for Vulnerable Populations: Application to Medical Care Use and Outcomes for Homeless People. Health Serv Res. 2000;34(6):1273–302. Available from: https://pubmed.ncbi.nlm.nih.gov/10654830/.
George PP, Heng BH, De Castro Molina JA, Wong LY, Wei Lin NC, Cheah JTS. Self-reported Chronic Diseases and Health Status and Health Service Utilization - Results from a Community Health Survey in Singapore. Int J Equity Health. 2012;11(1):44. https://doi.org/10.1186/1475-9276-11-44.
Denton FT, Spencer BG. Chronic Health Conditions: Changing Prevalence in an Aging Population and Some Implications for the Delivery of Health Care Services. Can J Aging. 2010;29(1):11–21. https://doi.org/10.1017/S0714980809990390.
Javadzade SH, Sharifirad G, Radjati F, Mostafavi F, Reisi M, Hasanzade A. Relationship Between Health Literacy, Health Status, and Healthy Behaviors among Older Adults in Isfahan, Iran. J Educ Health Promot. 2012;1:31. https://doi.org/10.4103/2277-9531.100160.
Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health Literacy and Public Health: A Systematic Review and Integration of Definitions and Models. BMC Public Health. 2012;12(1):80. https://doi.org/10.1186/1471-2458-12-80.
Liang GQ, Ling TS, Fiona FPW, How YC, Yen LS. Health Literacy Among Adult Patients with Chronic Diseases in Sabah. Borneo J Med Sci. 2022;16(3):33–42. https://doi.org/10.51200/bjms.v16i3.3675.
World Health Organization. Health in All Policies: A Framework for Country Action. Geneva: World Health Organization; 2020. Available from: https://www.afro.who.int/publications/health-all-policies-framework-country-action.
United Nations. Sustainable Development Goals (SDG). New York: United Nations; 2022. Available from: https://sdgs.un.org/.
Ministry of Health Malaysia. National Strategic Plan for Non-Communicable Diseases. Putrajaya: Ministry of Health Malaysia; 2016. Available from: https://www.moh.gov.my/moh/resources/Penerbitan/Rujukan/NCD/NationalStrategicPlan/FINAL_NSPNCD.pdf.