Determinants of the use of public healthcare facilities for primary care of diabetes and hypertension in Urban Mysuru, India: a mixed-methods cross-sectional study 2022.

Abstract

Abstract Background Noncommunicable diseases (NCDs) are one of the leading causes of morbidity and mortality in India. This study aimed to ascertain the individual, household, community, and health systems level factors influencing the demand of public healthcare network for primary management of diabetes and hypertension in a city in South India. Methods A mixed-methods cross-sectional study was conducted in Mysuru City, Karnataka. For quantitative inquiry, three-stage sampling strategies were followed and interviewed 6007 households comprising 2078/11978 (17.3%) individuals aged 30 and above with known diabetes or hypertension using structured questionnaires and different hierarchical levels of the workforce at 23 urban public health facilities. Andersen’s Behavioural Model of Healthcare Utilization, Multivariate logistic regression and Erreyger’s concentration indices were employed to unravel the socio-economic-demographic and contextual determinants driving the utilization of either public or private healthcare facilities for primary care of Diabetes and Hypertension. For Qualitative inquiry, we used multifarious techniques, such as a) four Key Informant Interviews (KII) conducted with policymakers at the state and city level with the help of semi-structured interview guides, b) 12 focus group discussions (FGDs) conducted with a homogenous group of respondents (men and women with diabetes and hypertension, frontline health workers and c) 36 In-depth Interviews (IDIs) d) 04 Public engagement workshops. Results The prevalence of diabetes and hypertension was greater in females (52.9% and 57.4%, respectively). More than two-thirds of surveyed population (68.4% and 64.6%) sought care for diabetes and hypertension from heterogeneous private providers. Socio-structural factors such as the level of education, occupation status, religion and caste, and individual characteristics such as living standards and insurance coverage (inverse and direct relationship, respectively) and facilities having high-technical and process quality scores and absence of multimorbidity impacted the likelihood of utilization of the public health system for management of diabetes and hypertension care. Erreyger's Indices established the inequality in access to public health facilities for treatments for both diabetes and hypertension among the poor. Conclusion The findings revealed a pervasive gap in the utilization of public health facilities for management of NCDs, by the urban poor despite the financial burden to seek care from private providers. Various demand and supply side recommendations can be propounded to augment the coverage and quality of public facilities for NCD management.