Evaluation of health-seeking behaviour among older people during the COVID-19 pandemic in Bali and Yogyakarta, Indonesia

Abstract

The COVID-19 pandemic poses the highest risk to older people with comorbidities, as the rapid spread of the virus reduces the community's access to formal healthcare facilities. This leads to the search for medical alternatives from several informal health sources. Therefore, this study aims to evaluate healthcare-seeking behaviour (HSB) among older people during the COVID-19 pandemic. It also aims to determine the factors influencing this behaviour. Data were obtained from Older People Community-Based Study in Bali and Yogyakarta province, Indonesia, between December 2020 and March 2021, using a phone survey technique. These were analyzed using bivariate (Chi-square test) and multivariate (logistic regression) analyses, to examine the association between the binary outcome of HSB types and explanatory factors. The result showed that 58.3% of the 1241 participants were female, as most were elementary graduates (31.5%) with the average age being 69 years old. During the pandemic period, 49.8% sought medical care at formal health facilities, with a 36% reduction observed in the visitations to formal wellness centres, compared to the pre-pandemic interval. In the multivariate logistic regression, some positive and significant factors were found to influence HSB in visiting formal health facilities. These factors included higher education level/university (AOR=2.04, p<0.05), unemployed status (AOR=1.36, p<0.05), unhealthy lifestyle (AOR=2.53, p<0.001), chronic hypertension disease (AOR=1.78, p<0.001), diabetes (AOR=3.73, p<0.001), and lung disorder (AOR=2.76, p<0.01). In addition, the proportion of inappropriate HSB was relatively high, leading to the necessity to apply the following alternative healthcare techniques, (1) Telephone consultation with professional clinicians, and (2) Provision of village-level care agents, to help monitor older persons' medical conditions during a health crisis.