FACTORS AFFECTING HEALTH SEEKING BEHAVIOR OF SENIOR CITIZENS OF DHARAN

Objectives To determine the health status and the factors affecting health seeking behavior of the senior citizens aged 60years and above. Materials and methods A descriptive cross-sectional study based on household survey was adapted. The sample consisted 400 senior citizens resident of Dharan. Simple random sampling technique was employed to select the study subject. Individuals were interviewed through selfdeveloped semi-structured pre-tested questionnaires. Descriptive and inferential statistics (chi-squire test) were used. Results Among 400 respondents, the most frequently reported illness were hypertension(29.3%), diabetes mellitus(8.3%), arthritis/joint pain(24.8%), eye problems(19.0%), hearing problems(3.3%), oral health problems(17.5%), digestive system problems(17.8%), respiratory problems(11.0%), heart disease(3.8%), renal problem(5.3%), skin diseases(7.5%), tuberculosis(3.0%), liver disease(3.0%), mental illness(5.75%),fracture(1.0%), Gynecological problems(7.3%) and male genital (6.3%) problems were also noted. Faith healers were the first treatment choice (97.2%) irrespective of age, gender or ethnicity. After that they visited BPKIHS (36.3%), private practitioner(26.3%), self treatment (11.3%) and self drug-use(6.8%). Half of the respondents utilized formal health institutions only in major chronic conditions. Poverty emerged as a major determinant of health seeking behavior and treatment was considered waste of money (indirect effect 64%) and lack of money (35 .5%) followed by poor attitude of health worker(41%) Conclusion The use of faith healer as first treatment provider, self-treatment, drug over counter shop were indicative factors of the inefficient utilization of health facilities in meeting the health needs of the senior citizens, were ranked the major determinants of factors affecting health seeking behavior of the senior citizens.


Introduction
Aging is a natural process.With reduced ability to generate resources, the elderly lack basic needs that affect their health status and health seeking behavior.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.
There has been a global rise in the population of elderly over past 20 years.The developed countries are now having 16-20% of their population above the age of 65 years.The most rapid increase is expected between the years 2010 and 2030, when the 'baby boom' generation reaches age 65.By 2030, there would be about 70 million elderly; they would represent 20% of the population.In Nepal 6.5% are elderly of the total population, increasing faster than population growth rate.In Sunsari District 35079 are elderly People or 5.6 % of the total population.The total population of Dharan is 95,332 and 5.7% of the population are above 60 years of age.Health status of older people posesses unique challenges because of the multiple dimensions that influence with passing the age.Old age is not a disease in itself, but it becomes a problem when the obvious physical mental changes brought by the advancing age and make them unable to do their own basic things. 8Prevalence of disease rises with the lengthening of the life span and increasing availability of high technical medical care.Older adults have at least one chronic condition and many have multiple conditions.The most frequently occurring conditions from 2000 to 2001 period were hypertension (49.2%), arthritis (36.1%), heart disease (31.1%), cancer (20%), sinusitis (15.1%), and diabetes. 9O defines Health as a state of complete physical, mental and social as well as spiritual well being not merely the absence of disease and infirmity. 1Oxford Learner's dictionary defines Seeking means having, doing, looking etc. and Behaviour means habit, performance, culturally and socially motivated activities.Health Seeking Behaviour is a usual habit of the people of a community that is resulted by the interaction and balance between health needs, health resources, and socio-economic, cultural as well as political and national / international contextual factors.Strategic policy formation in all health care systems should be based on information relating to health promoting and should be based on information relating to health promoting and seeking behaviour and the factors affecting these behaviours.The factors affecting the health seeking behaviours are seen in various contexts: physical, socio-economic, cultural and political.Therefore, the utilization of a health care system, public or private, formal or non-formal, may depend on sociodemographic factors, social structures, level of education, cultural beliefs and practices, gender discrimination, status of women, economic and political systems environmental conditions, and the disease pattern and health care system itself.The aim of this study was to study the factors affecting health seeking behavior of the senior citizens.

Methods
This was a descriptive cross-sectional study design based on house hold survey of Dharan municipality, ward No. 3,4,7,8,9,11,13,15,16  and 18. Study population was Senior citizen of 60 years and above residing in Dharan Municipality.Both male and female senior citizens were interviewed.Senior citizens who did not agree for the interview were excluded from the study.Sample was 400 individuals (10% of the elderly) which targets at least 20% of the population having health seeking behaviour among senior citizens of Dharan Municipality, considering 20% of permissible error.From 19 wards of Dharan Municipality, 10 wards were selected through simple random sampling lottery method (non-replacement).As the population in 10 wards of Dharan are heterogeneously distributed a total number of 2489 old aged person were proportionately allocated to each ward.The number of sample (400) from each ward was calculated by.n nh = ---Nh, here h = selected 10 wards and n= require sample size (400) N N = total population of 60+ age (2489) of the selected ten wards, Nh= 60+ population of h th ward First house was selected by the pen rotating tip direction way with simple random sampling.The old age persons were interviewed till the number of samples been collected.If the selected first house did not belong to any member of the geriatric age, this house was excluded and again next selection was made.Data was obtained by face to face interview technique using semi-structured questionnaire.Health problem was found out as reported by the subject or respondent.The collected data were edited and value of every variable was coded by manually before computer entry.Data were entered in Microsoft Excel and then analyzed by means of statistical package for social sciences (SPSS) 11.5 version for window.Findings were presented with suitable charts, graphs and frequency tables.The Chi-squire test was used to identify the association of health seeking behaviour and various factors.

ETHICAL CONSIDERATION
This study was conducted after the approval of concerned authority from college of Nursing BPKIHS Dharan and from the authority of Dharan municipality.The data was collected after obtaining an informed consent and without any compulsion.
A high degree of confidentiality of the personal data was maintained.

DISCUSSION
Research finding constituted with multidimensional ethnic castes.More than half of the respondents were 202(51%), disadvantaged Janajati followed by others were (49%).cast/ Ethnicity was significantly associated (p=0.002)health service utilization.Factors affecting health seeking behaviour was significant associated with decision making by self (72.5%) of the respondents were sought their health problems with formal health facilities (p=<0.03).Study findings also stressed the importance of economical barriers to health care seeking behaviour.Other sources of income and socio-economical status of the family income of the respondents were depicted to have significant association (p <0.001) with the health service utilization.
Factors affecting health seeking behaviour was significant associated with decision making by self (72.5%) of the respondents were sought their health problems with formal health facilities (p=<0.03).
Study findings also stressed the importance of economical barriers to health care seeking behaviour.Other sources of income and socio-economical status of the family income of the respondents were depicted to have significant association (p <0.001) with the health service utilization.
This study showed a significant association (p=<0.001) between disease condition or severity of illness and utilization of the health service.Reason for not seeking the health care facility: the respondents were deprived of the health care due to lack of money (35.3%), and ignorance due to old age (64.0%).Health Needs Assessment and Determents of Health seeking behavior among 756 elderly Nigerians states poverty emerged as a major (50.3%) determinant of health care seeking behaviour followed by nature of illness (28.5%).
The number of diseases were significantly associated (p=<0.035)with health seeking behavior with utilization of health services.
Among the 295 respondents 64% had no problem to afford and 106 could not afford for the treatment.Among the respondents who could not afford for the treatment 36% took loans to get treated from BPKIHS and private practitioners, ask the social support, requested for free health services and reaming, opted for community welfare schemes for the senior citizens.(p=<0.05).The evaluation of the sources of information between the availability of the health services and treatment seeking habit showed significant association (p=<0.001).This study found significant association (p=<0.001) between health seeking behaviour and respondents perception regarding reason for choice of health service for seeking help as 96% visited formal health institution for better treatment/ specialty service.The respondent's knowledge regarding available health facilities is not adequate for utilization of health facilities.Which was significantly associated (p=<0.001) between utilization and availability of the health facilities.

CONCLUSION
Findings of this study showed that the factors affecting health seeking behaviour were significantly associated with type of response of family members,, source of income and economical status of the family, decision makers, severity of illness, cost of treatment, source of information, availability of health facilities, types of health facilities, distance of nearest health facility, ignorance of disease due to old age (deeply rooted cultural belief e.g.old body ill health, stage of setting sun, lack of knowledge regarding the self care etc), 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 and feelings of better treatment available elsewhere rather than formal health institutions.

Fig. 1 :Fig. 1 :
Fig. 1: Percentage distribution of factors hindering for utilization of the health care facilities

Table 3 :
The pattern of health seeking habits was evaluated using numerical codes.The subjects opting for: self treatment during illness was 45(11.3%),visit to a private practitioner/ nursing home was 105(26.3%),used of drug over counter from nearest pharmacy 84(21%), visited to BPKIHS Hospital was 145(36.3%),visited to health post/ subhealth post/ Government hospital/welfare was 13(3.2%),visited to alternative medicine was 8(2.%).