CHAPTER ONE
INTRODUCTION
- BACKGROUND OF STUDY
Globally, demographic patterns across all nations have changed considerably over the past century, recognized as an achievement for humanity. Factors, such as decreased mortality rates, decreased birth rates, and migration trends, contribute to changes in population structure, and thus, can be directly related to population aging. Defining ‘older’ persons, however, has been challenging across low-, middle- and high-income nations, compelling the United Nations to establish the definition of ‘older’ persons as those persons over age 60 years. As the global population of older persons is estimated to increase from 11% in 2000 to 22% in 2050, population aging will clearly transform all aspects of society, ranging from changes in economic security, employment opportunities, family structure, housing resources, and transportation services. This imminent transition poses the challenge of effective delivery of healthcare services to older persons. Therefore, appraisal of current health systems in developed and developing nations that promote health and well-being are key during the aging process.
Active aging describes the interaction among factors, such as maintenance of health and well-being, involvement in social activities, and overall security or protection, which promote optimal health and well-being during the aging process. Although multiple models of successful aging have targeted biomedical, social or psychological functioning, one popular model, albeit with limitations, remains the Rowe and Kahn model of successful aging, which interconnects three factors: avoidance of disease, active participation in life activities, and high levels of physical or cognitive function. However, the less dynamic nature of this model, in addition to the absence of the influence of psychological health, including positive spirituality, may not elucidate the true role of psychosocial health in successful aging.
Often described as an ambiguous term, psychosocial health represents the multiple, dynamic interactions between social and behavioral variables. The influence of these biological, psychological and social factors on the aging process can influence an individual's well-being, quality of life, and health outcomes. Self-rated quality of life among elderly persons extends beyond physical health, primarily focusing on the ability to independently perform activities of daily living (ADLs) or active social engagement. These constructs, however, reflect dynamic pathways that cannot be fully measured in a cross-sectional manner, which may challenge scientific or social inquiry.
Nigeria, described as culturally and environmentally diverse, is a lower-middle income country in sub-Saharan Africa. It is currently the seventh largest country in the world, and with the fastest population growth, is projected to become the third largest. Due to technological advancements in medicine and water, hygiene and sanitation measures, like other African nations, Nigeria reports a significant increase in survival for persons over age 60.
Healthcare seeking behaviour (HSB) has been defined as, "any action or inaction undertaken by individuals who perceive themselves to have a health problem or to be ill for the purpose of finding an appropriate remedy". Health seeking behaviour can also be referred to as illness behaviour or sick-term behaviour. Health seeking behaviour is situated within the broader concept of health behaviour, which encompasses activities undertaken to maintain good health, to prevent ill health, as well as dealing with any departure from a good state of health.
Inappropriate HSB has been linked to worse health outcomes, increased morbidity and mortality and poorer health statistics. Research into HSB in LMICs suggests several factors influence the HSB of the population and certain segments of the population are more likely to use appropriate HSB than others. Inappropriate HSB and its previously mentioned effects have been found to be skewed among different population segments. For example, in Pakistan, households whose average income was below the minimum wage were less likely to seek formal medical care for their illness than those whose incomes were above the minimum wage.16 In Kenya, almost 70% of pregnant women within households in the upper socio-economic stratum were found to have their deliveries in health facilities compared with 42% among pregnant women in the middle socio-economic stratum and 38% in the low socio-economic stratum.
In a study in Nigeria, as many as 71% of rural dwellers have reported inappropriate HSB during their last illness episode while only 53% of urban dwellers reported inappropriate HSB during their last illness episode. Similarly, Nigerian women living in areas where the ratio of population to Primary Healthcare Centre (PHC) was high (more than 9,000:1) were less likely to have a skilled birth attendant present during childbirth than areas where the ratio of population to Primary Healthcare Centre (PHC) was lower (less than 6,000:1). This disparity makes it necessary to determine the factors affecting HSB among different segments of the population. This is essential to guide policy formulation and implementation. An important aspect of HSB is the choice of healthcare provider made by people when responding to illness episodes.
As a result of declining fertility, mortality as well as improved public health interventions, population ageing has been a world-wide phenomenon. People today are living longer and generally healthier lives.1 Health seeking behavior is the act of making a decision to seek or not to seek health care from qualified medical personnel when not feeling well. Factor affecting health seeking behavior among elderly is found to be significantly associated with types of health facilities, distance of nearest health facility, ignorance of disease due to old age, poverty, poor attitudes of health worker, lengthy treatment process, trust on god for healing if ill, living alone and lack of someone to take them to hospitals.3 Old age and ill-health are perceived to be inseparable entities. Seeking health care from a formally qualified doctor is avoided due to high costs. Flexibility of health care providers in receiving payment is a crucial deciding factor of whether or not to seek treatment, and even the type treatment sought. Attribution of ill health to ageing, low economic status and negative attitude of health workers towards the care of the elderly are some of the factors associated with delay in seeking health care. Some factors that determine health behaviour may be physical, socio-economic, cultural or political.5 Indeed, the utilization of a health care system may depend on educational levels, economic factors, cultural beliefs and practices. Other factors include environmental conditions, sociodemographic factors, and knowledge about the facilities, gender issues, political environment, and the health care system itself.
Good health is basic to human welfare and is a fundamental objective of social and economic development. Health seeking behavior relates to the willingness of an individual to seek help when ill and also where a person seeks medical care and preferable treatment among others. Studying health seeking behavior in a community is an important tool in understanding how healthcare facilities are utilized and identifying the determinants of poor utilization of available health-care facilities.
The behaviors of individuals are influenced by belief systems, household decision-making to seek care, social network, and economic status. The factors affecting an individual's health seeking behavior vary between households and communities. Some of the factors reported by several studies that significantly affect the health seeking behavior of poorer households especially those in the rural areas include the availability of specialists; lack of resources and out-of-pocket financing of health-care services; socio cultural taboos and prevalence of traditional healthcare in the environment; poor access to good health-care services; and also the prevalence of traditional healthcare in the environment; educational attainment; family size; and perception of severity of illness.
Poor healthcare-seeking behavior has been shown to contribute to ineffective prevention and control of morbidity and mortality related to health conditions. Self-treatment is usually the first line of management of many diseases in developing countries; many people have knowledge of common traditional treatments and most usually patronize readily available patent medicine dealers.
In Nigeria, over 60% of its population lives in the rural areas. These areas are most neglected and deprived of modern health-care infrastructures and services that are essential for the promotion and maintenance of good health. In Edo State, 65% of the population live and work in rural areas where diseases and health-related conditions cause high morbidity and mortality. In addition, there is a wide gap between the desired and actual health-care services that the people get due to poor maintenance of civil infrastructures, lack of basic hospital equipment, lack of supportive services, poor quality of services, and poor facility utilization.
According to Mion (2003), the delivery of health care to the older adults has been recognized to be more complex than that of younger adults because, the elderly persons utilize the majority of health care service while the complex needs have implication for future health care delivery to the geriatric population, Specifically in Nigeria, where the number of elderly citizens has been on the increase and their health needs receiving popular recognition. Findings on elderly health issues can be used to guide the formulation of comprehensive health services and health education policies and intervention programs for elderly men and women in Nigeria, (World Health Organization (2006). Moe, (2012), highlighs that aging process and problems related to elderly should be better understood so that effective elderly health prevention can be planned and implemented. The need to improve the delivery of care for older adults in home and community settings will be unavoidable although the broad diffusion of transformative technologies offers a significant means to advance the effort of improving quality and reducing cost of care, (Centre for Technology and Aging, 2009).
- STATEMENT OF THE PROBLEMS
Various Studies have attempted to describe factors that significantly affect health seeking behaviour during illness episodes can be broadly classified into two groups. The first groups are studies which emphasize the utilization of the formal system, or the health care seeking behaviour of people.
Health care services are a major component towards providing quality living, it is a common problem that such services has poise a greater challenges on the health seeking behaviour of the aged individual in Niger State. Health Care is a top social problem facing the aged today the lack of awareness of health care services has poised a treat on the health of the aged, inadequate and poor health care facility management are some of the factors affecting the seeking behaviour of the aged towards practice and utilization particularly those residing in rural areas and poor implementation of National Health Policy. Majority of the aged persons had age associated illnesses such as blood pressure, cardiac problems, diabetes, joint pains, kidney infections, cancer and tuberculosis that take a long time to treat which particularly affect their health seeking behaviour. Aged individuals are found to have patronized traditional healers, resorted to self medication using local herbs or visit chemists‘shops whenever they are sick. This research therefore seeks to assess health related aging problems and health care seeking behaviour among the older adults in uke, Anambra state, Nigeria.
- AIMS AND OBJECTIVES
The main aim and objective of this research is to examine the knowledge of health related aging problems and health care seeking behaviour among the older adults in uke, Anambra state, Nigeria. Other objectives of this study include:
1.to determine the relationship between knowledge of health related aging problems and health care seeking behaviour among the older adults in uke, Anambra, Nigeria.
2. to examine the effect of aging on health care seeking behaviour among older adults in uke, Anambra state.
3. to identify which socio-demographic and health service-based factors influence health care seeking behaviour.
4. to examine if aging has any influence on health care seeking behaviour has among the older adults in uke, Anambra, Nigeria.
5. to examine whether the aged persons are aware of the health problems affecting them in uke, Anambra state.
6. to identify the challenges of the older adults in Uke, Anambra state in seeking healthy care.
- RESEARCH HYPOTHESIS
1. What is the relationship between knowledge of health related aging problems and health care seeking behaviour among the older adults in uke, Anambra, Nigeria?
2. What is the effect of aging on health care seeking behaviour among older adults in uke, Anambra state?
3. Which socio-demographic and health service-based factors influence health care seeking behaviour?
4. Does aging have any influence on health care seeking behaviour among the older adults in uke, Anambra, Nigeria?
5. Are aged persons are aware of the health problems affecting them in uke, Anambra state?
6. What are the challenges of the older adults in Uke, Anambra state in seeking healthy care?
- STATEMENT OF RESEARCH HYPOTHESIS
1. H0: Knowledge of health related aging problems has no significant effect on health care seeking behaviour among the older adults in uke, Anambra, Nigeria.
2. H1: Knowledge of health related aging problems has significant effect on health care seeking behaviour among the older adults in uke, Anambra, Nigeria.
- SIGNIFICANCE OF STUDY
The study will be necessary to determine the factors affecting Health Seeking Behaviour among different segments of the population.
This study is essential to guide policy formulation and implementation on health seeking behaviour among older adults in different communities and the country at large. The study will also significantly give an important aspect of Health Seeking Behaviour is the choice of healthcare provider made by people when responding to illness episodes especially among the older adults.
The study will further motivate law makers to formulate policies regarding health of the older adults by making available appropriate provision of health facilities are for older adults to access easily when needed in Anambra State.
Various NGOs Non -governmental organization would also find this study useful in designing comprehensive health education campaign for the aged persons as well be a motivating factor to resident health personnel’s to educate the people on the importance of health seeking behaviour in uke, Anambra state.
Lastly, the findings of this study will serve as a research tool to future researchers while researching into health related issues especially as it concerns the older adults.
- SCOPE OF STUDY
The study covers knowledge of health related aging problems and health care seeking behaviour among the older adults in uke, Anambra, Nigeria.
- LIMITATION OF STUDY
1. Financial constraint- Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
2. Time constraint- The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.
- DEFINITION OF TERMS
Knowledge: facts, information, and skills acquired through experience or education; the theoretical or practical understanding of a subject.
Health care: the organized provision of medical care to individuals or a community. Health care, health-care, or healthcare is the maintenance or improvement of health via the prevention, diagnosis, and treatment of disease, illness, injury, and other physical and mental impairments in people.
Seeking behaviour: seeking behavior refers to the way people search for and utilize information. Health-seeking behaviour has been defined as a “sequence of remedial actions that individuals undertake to rectify perceived ill-health.”
