HEALTH-SEEKING BEHAVIOR AND ACCESS TO HEALTH CARE FACILITIES

AMONG RURAL RESIDENTS IN LOWER BUSAY, CEBU CITY

______________________________________________________________________
A Research Paper Presented to the
Faculty of the College of Nursing
Cebu Doctors University
Mandaue City
______________________________________________________________________
In Partial Fulfillment of the Course
Requirements of the Degree
Bachelor of Science
In Nursing
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By:

Jan Patrick C. Go

Danise Britchelle C. Ngujo

Xaviera A. Galang

Jason Arnold T. Pepito

Gleziel Ann Marie F. Inot

Jaisa Cristel T. Ramayla

John Brian S. Leguera

Antonette Kaye M. Santos

Angela G. Perez, M.A.N.

Research Mentor
February 23, 2016

Chapter 1
THE PROBLEM AND ITS SCOPE
THEORETICAL FRAMEWORK
Rationale
Each one of us is unique when it comes to seeking things related to our health,
we all have different perspectives, beliefs, traditions and our behavior towards it may
vary. Many things may vary like the accessibility of the health care facilities, educational
background, social and economic status, the distance of facilities, also the severity of
health condition.

Appropriate health seeking behavior is important to lessen complications and

improve the quality of life, but a number of factors has been identified as the causes of
low health care services utilization this includes the following: below average socioeconomic status, lack of physical capacity, traditions, perceptions, superstitions and
cultural beliefs also the educational attainment of mothers.

Our study mainly focus on rural residents in Lower Busay, Cebu City among
these types of people superstition beliefs and cultural practices often lead to selftreatment, home-made remedies are being made, herbal treatment are being utilized
and even consultation with local faith healers. Health teachings from these traditional
healers are very instrumental and cannot be ignored, thus causing delay in treatment
seeking.

In relation to their access and utilization to health care facilities these people are
situated in an area far away from their health care provider, according to one of the
residents from the area he explained that during emergency cases whether its dusk or
dawn they have to travel up to the highway, endeavor such narrow path way or steep
crevices and terrains just to call for help from heath care workers thus causing further
complications to the individual at risk.

Theoretical Background
In this study, the researchers aim to determine how the variable of health seeking
behavior is influenced by the location or the distance of the respondents from the
source of care given in the local community clinic.

We all have in us the attribute in which we behave in a particular manner as to

how we are to manage the alteration in our physical health. This state is what we call
Illness behavior. Thus, illness behavior is an individuals way or action as to how he/she
is going to take remedial measures for his/her own health condition (Trekas 58)

(Mason, 2004) Found that the personality of the rural residence of self-reliance
and independence might cause the individual to delay seeking health care. This can put
an additional burden on rural hospitals, and rural nurses which have sicker patients who
often need emergency care. There issues could be more acute and critical. The lack of
transportation, isolation and remote distances, were often factors that affected rural

individuals from seeking regular health care. Their study also revealed that rural
individuals may be hesitant to travel long distances and might have a lack of trust of
specialist that might be needed for their care and would more often chose a rural
provider that they were familiar with.

David Mechanic in his The concept of illness behavior (1962) points out the
importance of effecting the arrival of ill person at the medical setting in order for
treatment to be effectively administered. This shows that the behavior of the ill individual
in going to a health facility is of importance as well. Sources of treatment may be
available but if there is difficulty or no chance at all of getting that aid, then such ill
individual would remain ill. Volition also does not necessarily comes only from the sick
person but also from the norms, values and fears of those around the individual. In
cases wherein road is steep or narrow, the only way to arrive at a more maneuverable
pathway is for the sick person to be carried not by just one person but by making a
hammock and using bamboo pole to carry the sick. Such way needs the volition of the
sick to sit on the hammock while the persons carrying the hammock need to have
strong will to endeavor such narrow path way or steep crevices.

Faye Abdellah brings into light the role of an effective care provider to be
possible only when there is right knowledge, attitude and skills. But on the other side,
her theories includes facilitating for the promotion of health and prevention of diseases.
This means that a health care provider does not act only during an ill person is present

but also prior to it. For the study of the researchers, an ill person would have difficulty
already of travelling to the nearest care provider. Therefore its good also to view the
behavior of the residents on how they are willing to prevent getting sick. Among such
behaviors are if they are willing to wake up early and walk the narrow pathway in order
to ensure that their babies get vaccinated, or for pregnant women to walk slowly for
hours till they are able to reach the clinic for prenatal, or for residents to bring their pets
for immunization against rabies. The theory of Abdellah is one that is relevant in
bringing up how the behavior of the residents are in order to remain healthy by
prevention.
Jean Harman Watson (1979), defines human caring in nursing as a human-tohuman process through therapeutic interpersonal interactions. In this study, the
researchers aim also to determine how the residents are able to overcome the barriers
or difficulty they experience just to avail of treatment or preventive management from
their nearest clinic. It is not easy for the residents but present census shows that their
population is still increasing thus signaling that they are able to survive or multiply. And
their growth in population and decrease in sickness signals that the behavior they have
is somehow effective in order to achieve optimum health.

Review of Related Literature

Illness behavior
When a person become ill, he or she may behave in certain ways to cope up with
the certain health problem. Sociologists refer this as Illness Behavior. Illness behaviors
are the actions and management a person would do to know his or her condition so he
or she can get appropriate intervention. How people behave and cope when they are ill
varies and is affected by many variables, such as age, sex, socioeconomic status,
occupation, education, traditions and cultural beliefs, even religion (Kozier et al. 2004).

Acute Illness is often more of an annoyance than of serious consequence. If

hospitalized, an adolescents and adults motivation to recover and to resume normal
activities is strong. Because independence and self-sufficiency are important to
adolescents and adults, they will not easily accept the dependent sick role. Although
chronic illness is less common, their occurrence can lead to delayed development, loss
of independence, and permanent changes in personal and career goals. (Taylor, et. al.,
2001)

Health Seeking Behavior

Taking care of our health is really a vital and essential part of our lives. The aim of
prolonging our lives is important that is why people are continuously looking and finding
for ways for the betterment of their health. We have so many ways of taking care of our
health depending on our own beliefs, cultures and traditions. People may have different
health-seeking behaviors depending on a lot of factors. One factor may be because of
the geographical area. People living in far-off places like the ones in the rural area are
most probably experiencing not being able to gain access to health care facilities and
the services being offered.

Healthcare Access in Rural Communities

According to Healthy People 2020, rural residents are often experiencing barriers
in accessing healthcare services and in return limit their ability to get the care they
need. The following are barriers rural residents experience in relation to their access to
health care services and utilization: a health care facility located far away from their
homes, the availability of the transportation for them to reach their health care provider,
financial constraints and also their ability to communicate about their health problems
and complaints to their health care provider.

In rural places, people need to travel greater distances just to have access to
health care services and get a consultation with their health care provider. Often, due to
geographic distance, environmental and climatic barriers, challenging roads, rural
residents may have limitations in accessing health care services.

Rural residents usually experiences some barricade to health care services

available in the near area, thus the ability to get the care that they deserve will now
have a limitation. In order for the residents in rural areas to have a satisfactory health
care access, the accessibility of the health care services must be feasible as evidenced
by readily available health care services that can be attain in a timely manner.There a
lot of factors which play a vital role in accessing the healthcare services it involves,
mode of transportation,distance from the heath care services and other financial
measures.

The uncommon geographic placement tend to develop difficulty of the residents

in rural areas to travel lengthy distances in order to access their respective healthcare
services.In rural areas, the population need to navigate greater distances to access
different locations of the health care delivery system.Rural population will have a limited
access to health care services as a result of inadeaquate public transportation and
challenges that residents usually are facing in the road.

The accessibility of the health care services would also depend on the age of the
individual living in the particular area. It is found out that elderly residents who have a
persistent illness or condition that requires an annual intervention requires numerous
visits to outpatient health care services and thus will involve dependable mode of
transportation. The educational attainment of the resident will also exposed them for low
health literacy because of lower educational attainment since a lot of people living in
rural area are suffering from poverty as a result, finite education is attained.

There is also a national realization that residents in rural areas are facing barriers
to wellness and health compared to those faced by residents in urban areas.Rural
residents often face a pile of burdens regarding transportation to health care services
due to its unique geographic distance.Urban areas often has an access to medical
services since they dont have a problem when it comes to traveling distance, and
nearby health clinics and other medical institutions are readily available.

Supporting Studies
A study entitled "Access to Health Care Services in An Australian Rural Area".
This study focuses on investigating access to health care facilities by considering
access limits such as accessibility for transportation, availability of health services and
affordability to meet the cost for health services in Australia. Some participant were
satisfied with the health care service some were not because of concerns like difficulty
to access transport, payment for services and absence of emergency services . This
study showed that their rural residents are having difficulty in accessing health care
facilities which calls for immediate corrective actions.
Another study entitled "Health Seeking Behavior and Challenges in Utilizing
Health Facilities in Wakiso District, Uganda" by D. Musoke, P. Boynton, C. Butler, and
M. B. Musoke (2014). The reason of the study is to Assess the health seeking practices
and challenges in utilizing health facilities in a rural community in Uganda. Final results
revealed that the majority of participants (84%), in their community, did not know that
community health workers existed. While 89% knows that mobile clinics existed in their
community, only 28% had received such services in the past month. The participants'
health seeking behavior the last time they were sick was associated with age (p =
0.028) and occupation (p = 0.009). The most significant challenges in utilizing health
services were regular stock-out of drugs, high cost of services and long distance to
health facilities. Final conclusion was by increasing the frequency of mobile clinics and
strengthen the community health workers strategy we can be able to potentially
increase access to health care facilities in the rural area.

Several studies has already been conducted to further widen the knowledge in
peoples way of accessing health care in variations of situation in different communities
especially the rural ones. According to the study of Dina Balabanova,Justin Parkhurst,
Martin Mckee, Barbara McPake (2014) on the Access to health care: taking into
account health systems complexity, which focuses on the understanding of the how
people who have low and middle income access care. The study combines and utilizes
different findings from various kinds of studies regarding the utilizer and the providers
different practices and beliefs. Previous theoretical frameworks often describe access to
be a one-stop contact with the health system, hindered by numerous impediments.
Those existing theoretical frameworks was not able to contend with the complexities
included in accessing the different health services; non-linear relationships, continuums
of skill and time required in the provision of care, the communities role in interposing
the access of the members and the dynamic way of providers and patients in
interacting.

Another study entitled "Healthcare-seeking Behavior in Rural Ethiopia" by A. D.

Mebratie, E. Van de Poel, Z. Yilma, D. Abebaw, G. Alemu, and A. S. Bedi (2014). Their
study is to inquire the basis of healthcare-seeking behavior. Their study deals with three
issues: when to seek modern care; where to seek modern care; whether to seek
modern care; They stated in their study, as a result, that There is a relationship
between socioeconomic status and choice providers mainly for adult-related conditions
with households who can afford, they seek medical care compared to those in poorer
household. The residents in poorer household usually postpone their seeking of medical

care but for the both households they both act faster when its already child-related
condition. The researchers concluded that the inability of healthcare utilization is not
directed by the unable to recognize health problems or due to a low recognized need for
modern care. Reducing the payment for medical care introduces an important role in
improving the access to a health care facility especially to those who belong to the poor
household.

Another study entitled "Health Seeking Behaviour among the Rural Dwellers in
Ekiti State, Nigeria" by Oluwatuyi O, (2010). This study is focuses on the reasons how
the rural residents in the area seek medical services. The outcome of the study showed
that there are factors affecting the way they seek medical service. These are the
following: the type of illness experienced by the resident, the money available at that
time, how severe the illness is, service available, age, educational background,
household position and religion. Among the factors involved, 42% is the type of illness,
20% for the money available at that time, 5% for the age of the resident and 5% for the
household position. Since the rural residents are isolated from the health care facilities,
this study proposes that the rural areas should be provided with health care facilities
that they can easily access. There should also be a complete equipment and providing
more medical staff available in the health care facility to provide better care to the rural
residents.

THE PROBLEM
Statement of the Problem
This study aims to assess the level of compliance in the utilization of health
care facilities in relationship to the distance between the infrastructure and
the people who needs care among residents living in Lower Busay, Cebu City
Specifically, the study aims at answering the following:
1. What is the profile of respondents according to:
1.1 age
1.2 gender
1.3 civil status
1.4 highest educational attainment
1.5 family income
1.6 number of years residing
1.7 Distance from nearest health care facility
1.8 Family demographics
2. Determine the behavior of respondents towards health
seeking
3. Determine the respondents access to health care facilities
3.1 Health Center
3.2 Hospitals
3.3 Doctors clinic
3.4 Hospices
4. Is there a significant relationship between health-seeking
behavior and access to health care facilities?
5. From the findings what output could be formulated based
on the results of the study?

Significance of this study

The importance of behavior towards health and access to health care services
should be given emphasis and not be taken for granted. Knowing and assessing the
behaviors regarding the health of the population I relation to the distance between
health care facilities and the residents of Lower Busay, Cebu City would have a
profound impact in ensuring an environment that is conducive. The study is significant
to the following:
Community Residents. It will serve as an enlightenment and awareness for them to
know the availability of health care facilities. The community residents will readily
approach the health care facilities available in their area in that will provide them health
education in the promotion of health and prevention of illnesses
Barangay Officials. They are presented with the real challenge in promoting the
interest of the residents through the promotion of health by coordinating with barangay
health officials in terms of lifesaving services. It is important to perform their duties and
responsibilities through enforcement of the maintenance and operation of facilities in
health promotion.
Researchers. It serves as an information about the importance of accessible health
care facilities and health-seeking behavior acted by the respondents. It provides
additional background and knowledge regarding the significance of distance between
the residents' homes and an available health care facility is a vital factor in the
development of a health seeking behaviour. Distance may have an effect on how the

residents of Lower Busay attain good health, either the residents travel to a health care
center or perform home remedies.
Future Researchers. It serves as an added reference if they make researches similar
in nature.

Scope and Limitation

Scope:
The scope of this study focused on the correlation between access to health care
facilities and the developed health-seeking behavior of the residents of Lower Busay,
Cebu City. Rural residents who have been residing in the area for almost 10years. This
study was conducted in Lower Busay, Cebu City
Limitations:
The study was limited to only the population who resides in Lower Busay, Cebu
City. The success of the study was highly dependent on the data provided by the
respondents. The sincerity and honesty in answering the questions would also affect the
results

RESEARCH METHODOLOGY
Research Design
The study utilized Descriptive-Correlational research design to identify the
correlation between health-seeking behavior and access to health care facilities among
rural residents in Lower Busay, Cebu City

Research Environment
The study was conducted in Lower Busay, Cebu City this place is suitable for our
study since the residents living in this area are situated in a place with no proper roads,
far from the main highway, almost 5km away from the nearest health center, downhill
and terrain.
Research Respondents
The respondents of the study will be the residents of Lower Busay, Cebu City,
there will be 129 residents that will be taken as part of the study. The survey will collect
quantitative data that will be taken using random sampling on the range of different
Health- Seeking Behaviors of the residents.
Inclusion Criteria:
a) that they reside in Lower Busay, b) that they are willing to cooperate and participate
in the study, c) the participants of the study will be 18 years old and above, and d) the
residents will be able to understand simple English
Exclusion Criteria:
Those who do not fit the criteria mentioned above

Research Instruments
The researchers will be modifying a particular questionnaire from the internet by
another author to be able to gather data for the study chosen. The primary aim of the
questionnaire is to be able to find out the people's behavior in terms of seeking for
health care and their access to the health care facilities that are available in their area.
This people specifically, are the rural residents of Busay, Cebu City. This study will be
using a questionnaire with both open and closed questions. Open questions will be
answered accordingly by the respondents as to their extent with any open comments.
Closed questions will have preceded answers such that it can be answerable by a
simple yes or no and will allow for the researchers to focus in aiming for the
respondents to come up with answers particularly emphasized for the said study to be
done.
The said questionnaire will be used by the researchers in the process of
gathering the data necessary:
The three research tool that will be utilized in this study will be the Chinese
Citizen Health Literacy Questionnaire (China Health Education Centre, 2008) ,Scale of
the General Status and Illness Behavior Questionnaire by Issy Pilowsky and Neil
Spence
Chinese Citizen Health Literacy Questionnaire includes four dimensions (belief
literacy, behavior literacy, knowledge literacy and skill literacy) the questionnaire has a
Cronbach coefficient of 0.904, indicating high reliability and good content validity.

Scale of the General Status The survey instrument adapted standardized and
validated questions across several domains, including health-related behaviors, health
status, and sociodemographic characteristics.
Illness Behavior Questionnaire by Issy Pilowsky and Neil Spence that measures
the ways individuals experience and respond to their health status

Procedures for Gathering Data

DATA GATHERING
The researchers will set schedule with the barangay captains and will go to the
locale with the permission of the research coordinator and research mentor. For the first
group of respondents, the researchers will approach kindly, introduce themselves and
orient the study about their own health seeking behavior and their access to their health
care facilities to be conducted at their respective houses since we will be doing home
visits. For the residents, through random sampling, the researchers will go from house
to house in different sitios in the different barangays until the sample size will be met. At
each house, they will introduce themselves to the family and orient those who will take
part of the study. The respondents who will agree and sign the informed consent will be
given a maximum of 1 hour to answer the questionnaire. Clear instructions will be given
to guide the respondents. The collection of the answered questionnaires will be followed
for tabulation, analysis and interpretation.

Preliminary preparation
The researchers will first send a formal letter to the Dean of Cebu Doctors University
College of Nursing for the approval to conduct the research study. They will send a
transmittal letter to the barangay captains of the selected barangay to request for the
updated population of adults in their barangay ages 18 years old and above. The
researchers will ask assistance from the University statistician to gain a sample size.
After which, the researchers will send transmittal letters to the barangay captains, for
the approval to conduct the study. The respective heads of the area will be informed in
full disclosure as to the nature of the study.
The study questionnaires will be approved for validity by the research groups
mentor, research coordinator and the schools psychometrician. The researchers will
then make and modify the tools and will be pilot tested to ensure validity. The
researchers will submit a manuscript to the ethics committee, for approval of the
research study.
Actual data gathering

Statistical Treatment of Data

Formula:

Definition of Terms
For the purpose of allowing the readers to understand more of our research
topic, our research title which is "Health-Seeking Behavior and Access to Health Care
Facilities Among Rural Residents in Busay, Cebu City" is broken down one by one and
context by context to further explain each word independently and as related to each
other.
Health-Seeking Behavior- is a state in which a person in stable health is actively
seeking ways to alter his or her personal habits or environment in order to move toward
a higher level of health. In this sentence the term 1 is used to mean that health-seeking
behavior is a particular manner of an individual in finding for ways and means to be able
to achieve a stable state of health. Stable health in this context is the aim of achieving
age-appropriate illness prevention measures.
Accessibility- is defined as something that can be used, approached, entered or
reached. In this sentence the term 2 is used to mean that accessibility is the relationship
between the location of the health care services and the clients location. It describes
the level of ease in affording to access the health care facility available in the area of
Busay, Cebu City.
Health care facilities- are places that provide health care. They include hospitals,
clinics, outpatient care centers, and specialized care centers, such as birthing centers
and psychiatric care centers. In this sentence, the term 3 is used to mean that health
care facilities are places particularly buildings, institutions, structures which are
established for the main reason of delivering the health care services that they offer to

the rural residents of Busay, Cebu City who will be seeking for their services and
accessing their health facilities.
Rural area- is an open swath of land that has few homes or other buildings, and not
very many people. In this sentence, term 4 is used to mean that rural areas are areas
far from the city/ major town which has a low population density.
Residents- are people who reside in a particular place permanently or for an extended
period of time. In this sentence, the term 5 is used to mean that residents are people
who are currently living in the chosen area for the research study which is Busay, Cebu
City. They are specifically the rural residents of Busay, City of Cebu.