Older people's challenges accessing health services in central Nepal: a qualitative study using the domain of access framework.
Aging
Nepal
Older people
Primary health care
Qualitative method
Theory of access
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
23 Oct 2024
23 Oct 2024
Historique:
received:
27
03
2024
accepted:
07
10
2024
medline:
24
10
2024
pubmed:
24
10
2024
entrez:
24
10
2024
Statut:
epublish
Résumé
Low- and middle-income countries face rapid population aging. However, the health system has remained largely unprepared to deliver health services to an aging population. As the population is rapidly aging in Nepal, their challenges and experience should be the focus for health care providers to address these issues. There is a paucity of evidence on barriers and facilitators to accessing health care services among older people in Nepal. The aim of this study was to investigate the challenges that older people experience while accessing health services in central Nepal. This qualitative study was conducted between April and June 2023. In-depth interviews were conducted among older people of a municipality in central Nepal, which were analysed thematically using a deductive-inductive approach based on the theory of access. Hypertension and diabetes were the most common health problems among the participants. The affordability of health services was a major issue, although there is a health insurance scheme and a major focus on universal health coverage from the Government of Nepal. Other issues included poor acceptability, poor communication between older people and health staff, and poor accommodation due to a lack of elderly-friendly services, including long wait times in the clinic. Living with family was a major facilitator of access to health care services and was interrelated with multiple domains of access. This study identified barriers to accessing health care services for older adults in Nepal. We found that the affordability of health services, poor acceptability, poor communication between older people and doctors, and a lack of elderly-friendly services are the key challenges experienced by older people. Older people felt that these barriers were easier to overcome when they had family support. Therefore, for those living with their children, family support was reported as the major facilitator.
Sections du résumé
BACKGROUND
BACKGROUND
Low- and middle-income countries face rapid population aging. However, the health system has remained largely unprepared to deliver health services to an aging population. As the population is rapidly aging in Nepal, their challenges and experience should be the focus for health care providers to address these issues. There is a paucity of evidence on barriers and facilitators to accessing health care services among older people in Nepal. The aim of this study was to investigate the challenges that older people experience while accessing health services in central Nepal.
METHODS
METHODS
This qualitative study was conducted between April and June 2023. In-depth interviews were conducted among older people of a municipality in central Nepal, which were analysed thematically using a deductive-inductive approach based on the theory of access.
RESULTS
RESULTS
Hypertension and diabetes were the most common health problems among the participants. The affordability of health services was a major issue, although there is a health insurance scheme and a major focus on universal health coverage from the Government of Nepal. Other issues included poor acceptability, poor communication between older people and health staff, and poor accommodation due to a lack of elderly-friendly services, including long wait times in the clinic. Living with family was a major facilitator of access to health care services and was interrelated with multiple domains of access.
CONCLUSIONS
CONCLUSIONS
This study identified barriers to accessing health care services for older adults in Nepal. We found that the affordability of health services, poor acceptability, poor communication between older people and doctors, and a lack of elderly-friendly services are the key challenges experienced by older people. Older people felt that these barriers were easier to overcome when they had family support. Therefore, for those living with their children, family support was reported as the major facilitator.
Identifiants
pubmed: 39443984
doi: 10.1186/s12913-024-11717-2
pii: 10.1186/s12913-024-11717-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1273Informations de copyright
© 2024. The Author(s).
Références
Mohd Rosnu NS, Singh DKA, Mat Ludin AF, Ishak WS, Abd Rahman MH, Shahar S: Enablers and Barriers of Accessing Health Care Services among Older Adults in South-East Asia: A Scoping Review. Int J Environ Res Public Health 2022, 19(12).
United Nations: World Population Ageing 2020 Highlights: Living arrangements of older persons (ST/ESA/SER.A/451). In.: United Nations Department of Economic and Social Affairs, Population Division (2020); 2021.
Ageing and health in the South-East Asia Region [ https://www.who.int/southeastasia/health-topics/ageing#:~:text=Ageing%20and%20health%20in%20the,2030%20and%20by%202050%2C%20respectively ].
Prince MJ, Wu F, Guo Y, Gutierrez Robledo LM, O’Donnell M, Sullivan R, Yusuf S. The burden of disease in older people and implications for health policy and practice. Lancet. 2015;385(9967):549–62.
doi: 10.1016/S0140-6736(14)61347-7
pubmed: 25468153
Kelly G, Mrengqwa L, Geffen L. “They don’t care about us”: older people’s experiences of primary healthcare in Cape Town, South Africa. BMC Geriatr. 2019;19(1):98.
doi: 10.1186/s12877-019-1116-0
pubmed: 30947709
pmcid: 6449977
Atakro CA, Atakro A, Aboagye JS, Blay AA, Addo SB, Agyare DF, Adatara P, Amoa-Gyarteng KG, Menlah A, Garti I, et al. Older people’s challenges and expectations of healthcare in Ghana: A qualitative study. PLoS One. 2021;16(1);e0245451.
doi: 10.1371/journal.pone.0245451
pubmed: 33465117
pmcid: 7815149
Mulumba M, Nantaba J, Brolan CE, Ruano AL, Brooker K, Hammonds R. Perceptions and experiences of access to public healthcare by people with disabilities and older people in Uganda. Int J Equity Health. 2014;13:76.
doi: 10.1186/s12939-014-0076-4
pubmed: 25928896
pmcid: 4188877
Jahangir S, Bailey A, Hasan MU, Hossain S, Helbich M, Hyde M. “When I Need to Travel, I Feel Feverish”: Everyday Experiences of Transport Inequalities Among Older Adults in Dhaka. Bangladesh Gerontologist. 2022;62(4):493–503.
doi: 10.1093/geront/gnab103
pubmed: 34282443
Senior Citizens Act, 2063 [ www.lawcommission.gov.np ].
CBS. National population and housing 2021. In., vol. 01: National Statistics Office, Central Bureau of Statistics. 2021;16:10.
CBS. National population and housing census 2021. Vol. 01. Central Bureau of Statistics; 2021.
Aryal GR. The status of elderly people in Nepal. Patan Pragya. 2019;5(1):11–8.
doi: 10.3126/pragya.v5i1.30432
Chalise HN, Saito T, Kai I. Self-reported health: a study of older adults from a developing country–Nepal. Biosci Trends. 2007;1(2):102–7.
pubmed: 20103876
Singh A, Misra N. Loneliness, depression and sociability in old age. Ind Psychiatry J. 2009;18(1):51–5.
doi: 10.4103/0972-6748.57861
pubmed: 21234164
pmcid: 3016701
Sivertsen H, Bjørkløf GH, Engedal K, Selbæk G, Helvik AS. Depression and Quality of Life in Older Persons: A Review. Dement Geriatr Cogn Disord. 2015;40(5–6):311–39.
doi: 10.1159/000437299
pubmed: 26360014
Ghimire S, Baral BK, Karmacharya I, Callahan K, Mishra SR. Life satisfaction among elderly patients in Nepal: associations with nutritional and mental well-being. Health Qual Life Outcomes. 2018;16(1):118.
doi: 10.1186/s12955-018-0947-2
pubmed: 29880002
pmcid: 5992629
Joshi M, Chalise HN, Khatiwada P: Quality of Life of Nepalese Elderly Living in Rural Nepal. 2018.
Acharya S, Ghimire S, Jeffers EM, Shrestha N. Health Care Utilization and Health Care Expenditure of Nepali Older Adults. Front Public Health. 2019;7:24.
doi: 10.3389/fpubh.2019.00024
pubmed: 30828573
pmcid: 6384236
Gautam S. Youths’ Educational Resilience in Rurban Jumla: A Narrative Inquiry. J Educ Res. 2017;5:89.
Speck S. “They Moved to City Areas, Abroad”: Views of the Elderly on the Implications of Outmigration for the Middle Hills of Western Nepal. Mountain Res Dev. 2017;37:425–35.
doi: 10.1659/MRD-JOURNAL-D-17-00034.1
DoHS: National Health Policy 2019. In. Kathmandu, Nepal Department of Health Service, Ministry of Health and Population; 2019.
WHO: World report on ageing and health. In. Geneva: World Health Organization, ; 2015.
Acharya S, Ghimire S, Jeffers EM, Shrestha N: Health Care Utilization and Health Care Expenditure of Nepali Older Adults. Frontiers in Public Health 2019, 7.
Sharma Bhattarai LP. Older people’s exclusion from healthcare services in Nepal: An analysis of the political economy of development aid, domestic policy and research. Geriatr Gerontol Int. 2013;13(2):243–9.
doi: 10.1111/j.1447-0594.2012.00947.x
CBS: National Population and Housing Census 2011 In., vol. 01. Kathmandu, Nepal: Central Bureau of Statistics, Nepal; 2012.
Fusch PI, Ness LR: Are we there yet? Data saturation in qualitative research. 2015.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.
doi: 10.1191/1478088706qp063oa
Hazzan AA, Dauenhauer J, Follansbee P, Hazzan JO, Allen K, Omobepade I. Family caregiver quality of life and the care provided to older people living with dementia: qualitative analyses of caregiver interviews. BMC Geriatr. 2022;22(1):86.
doi: 10.1186/s12877-022-02787-0
pubmed: 35101000
pmcid: 8802743
Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med Care. 1981;19(2):127–40.
doi: 10.1097/00005650-198102000-00001
pubmed: 7206846
Russell DJ, Humphreys JS, Ward B, Chisholm M, Buykx P, McGrail M, Wakerman J. Helping policy-makers address rural health access problems. Aust J Rural Health. 2013;21(2):61–71.
doi: 10.1111/ajr.12023
pubmed: 23586567
Saurman E. Improving access: modifying Penchansky and Thomas’s theory of access. J Health Serv Res Pol. 2016;21(1):36–9.
doi: 10.1177/1355819615600001
Paneru DP, Adhikari C, Poudel S, Adhikari LM, Neupane D, Bajracharya J, Jnawali K, Chapain KP, Paudel N, Baidhya N, et al. Adopting social health insurance in Nepal: A mixed study. Front Public Health. 2022;10.
Khanal GN, Bharadwaj B, Upadhyay N, Bhattarai T, Dahal M, Khatri RB. Evaluation of the National Health Insurance Program of Nepal: are political promises translated into actions? Health Res Pol Syst. 2023;21(1):7.
doi: 10.1186/s12961-022-00952-w
Wasti SP, van Teijlingen E, Rushton S, Subedi M, Simkhada P, Balen J, Adhikari SR, Adhikary P, Balen J, Bajracharya B, et al. Overcoming the challenges facing Nepal’s health system during federalisation: an analysis of health system building blocks. Health Res Pol Syst. 2023;21(1):117.
doi: 10.1186/s12961-023-01033-2
Shrestha A, Ghimire S, Kinney J, Mehta R, Mistry SK, Saito S, Rayamajhee B, Sharma D, Mehta S, Yadav UN. The role of family support in the self-rated health of older adults in eastern Nepal: findings from a cross-sectional study. BMC Geriatr. 2024;24(1):20.
doi: 10.1186/s12877-023-04619-1
pubmed: 38178009
pmcid: 10768249
Parsuraman G, Vijayakumar P, Anantha Eashwar VM, Dutta R, Mohan Y, Jain T, Kumar D, Chandru N, Sivakumar K. An epidemiological study on quality of life among elderly in an urban area of Thirumazhisai. Tamilnadu J Family Med Prim Care. 2021;10(6):2293–8.
doi: 10.4103/jfmpc.jfmpc_1636_20
pubmed: 34322427
Khanal P, Rai S, Chalise HN: Children’s Migration and Its Effect on Elderly People: A Study at Old Age Homes in Kathmandu. 2018, 1.
Adhikari R, Ranjitkar U, Chand A: Factors Associated With Quality of Life of Senior Citizens Residing in Tarakeshwor Municipality, Kathmandu; 2018.
Ambati NR: Assessing the Life Satisfaction of Elderly Living in Old Age Homes in the City of Ahmedabad. 2019.
Mekonnen HS, Lindgren H, Geda B, Azale T, Erlandsson K. Satisfaction with life and associated factors among elderly people living in two cities in northwest Ethiopia: a community-based cross-sectional study. BMJ Open. 2022;12(9):e061931.
doi: 10.1136/bmjopen-2022-061931
pubmed: 36581991
pmcid: 9438199
Hogg W, Rowan M, Russell G, Geneau R, Muldoon L. Framework for primary care organizations: the importance of a structural domain. Int J Qual Health Care. 2008;20(5):308–13.
doi: 10.1093/intqhc/mzm054
pubmed: 18055502
Lubenow J, Barrêto A, Nogueira J, Silva A: Access for the Elderly to Primary Health Care Services: an Integrative Review. Int Arch Med 2016, 9.
Ansari Z. A Review of Literature on Access to Primary Health Care. Aust J Prim Health. 2007;13:80–95.
doi: 10.1071/PY07026
Chen J, Zhao M, Zhou R, Ou W, Yao P. How heavy is the medical expense burden among the older adults and what are the contributing factors? A literature review and problem-based analysis. Front Public Health. 2023;11:1165381.
doi: 10.3389/fpubh.2023.1165381
pubmed: 37397714
pmcid: 10313336
Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, Brand H. Consortium Health Literacy Project E: Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health. 2012;12(1):80.
doi: 10.1186/1471-2458-12-80
pubmed: 22276600
pmcid: 3292515
Yadav UN, Thapa TB, Mistry SK, Ghimire S, Yadav KK, Boateng GO, O’Callaghan C. Biosocial and disease conditions are associated with good quality of life among older adults in rural eastern Nepal: Findings from a cross-sectional study. PLoS One. 2020;15(11):e0242942.
doi: 10.1371/journal.pone.0242942
pubmed: 33253232
pmcid: 7704002
Ghimire S, Singh DR, McLaughlin SJ, Maharjan R, Nath D. Health Care Utilization by Older Adults in Nepal: An Investigation of Correlates and Equity in Utilization. Int J Health Serv. 2022;52(2):236–45.
doi: 10.1177/0020731420981928
pubmed: 33430683
Amani PJ, Hurtig AK, Frumence G, Kiwara AD, Goicolea I, San Sebastiån M: Health insurance and health system (un) responsiveness: a qualitative study with elderly in rural Tanzania. BMC Health Serv Res 2021, 21(1):1140.
Karki S, Bhatta DN, Aryal UR: Older people’s perspectives on an elderly-friendly hospital environment: an exploratory study. Risk Manag Healthc Policy 2015, 8:81–89.
Panday S, Bissell P, Teijlingen Ev, Simkhada P: Perceived barriers to accessing Female Community Health Volunteers’(FCHV) services among ethnic minority women in Nepal: A qualitative study. PloS one 2019, 14(6):e0217070.
Ashworth HC, Roux TL, Buggy CJ: Healthcare accessibility in the rural plains (terai) of Nepal: physical factors and associated attitudes of the local population. Int Health 2019, 11(6):528–535.
Paudel R, Upadhyaya T, Pahari D: People’s Perspective on Access to Health Care Services in a Rural District of Nepal. JNMA; J Nepal Med Assoc 2011, 52:20–24.
Types of Care [ https://www.myagedcare.gov.au/types-care ].
DoHS: Geriatric Health Service Strategy In: Geriatric Health Service Strategy Kathmandu, Nepal Department of Health Services, Ministry of Health and Population (2021–2030).