Noncommunicable Disease Service Utilization from the Upgraded Primary Care Centers: A Cross-Sectional Study from Kerala, India

Abstract

ABSTRACT Introduction: World Health Organization recommends the integrated management of noncommunicable diseases (NCDs) in primary care. Hence, this study aimed to determine the NCD service utilization from an upgraded primary care center and to find the reasons for nonutilization. Materials and Methods: This community-based cross-sectional analytical study was conducted among 387 individuals aged 30 years and above in a selected upgraded primary care center. A validated semistructured questionnaire was used. A log-binomial regression was done, and adjusted prevalence ratios (aPR) were calculated. Results: The prevalence of utilization of NCD services from upgraded primary care center was 55.3% (95% confidence interval [CI] 50.2–60.3). The screening or treatment service utilization for hypertension, diabetes, and cardiovascular diseases was reported to be 54% (95% CI 48.9–59.1), 37.5% (95% CI 32.6–42.5), and 7.2% (95% CI 4.9–1.3), respectively. The reasons for the nonutilization of services were preference for the private sector (35.3%), distance to the facility (27.2%), and lack of awareness regarding the amenities at family health centers (11.3%). The younger age (aPR = 1.70, 95% CI 1.29–2.23, P = 0.033), unemployment (aPR = 1.46, 95% CI 1.01–2.10, P = 0.043), and social class (aPR = 1.62, 95% CI 1.16–2.26, P = 0.004) were significantly associated with NCD service nonutilization. The willingness to avail of NCD services among nonutilizers was 46.8% and salaried individuals had a high chance of unwillingness (aPR = 5.01, 95% CI 1.69–14.78, P = 0.003) compared to daily waged workers. Conclusion: Nearly half of the participants were not utilized upgraded primary care centers for NCD care. Strengthening outreach services and improving awareness among beneficiaries may improve the utilization in the community.