Health care seeking behaviuor among the elderly in Hue City

62
Journal of Health and Development Studies (Vol.05, No.02-2021)Nguyen Hoang Lan et al.
INTRODUCTION
Vietnam is facing a rapid increase in aging 
population. Older population, accounted for 
10.2% of the country’s population in 2014, 
has expanded much greater than the preceding 
years with an expected grow to reach almost 
20% of the population by 2035 (1). In 2019, 
average life expectancy at birth of Vietnamese 
people was 71 years old for males and 76.3 
for females (2). Although health status of 
people has been significantly improved for 
the past decades, the difference between 
life expectancy and healthy life expectancy 
at birth (that means that means average 
number of years they live in a ‘healthy’ state 
(3) in Vietnam was relatively higher than in 
other countries. Average number of years 
lived with morbidity was estimated about 
11 years for females and 8 years for males 
(4). According to a survey on the elderly 
in Vietnam in 2011, 65.4% of respondents 
self-assessed their health status at poor or 
very poor level (5). A report of Ministry of 
Health in 2018 showed that 95% elderly 
facing morbidity, mainly non-communicable 
diseases (NCDs) and they often suffer from 
many diseases simultaneously with averagely 
near three diseases per each older person 
(6). Hypertension, cardiovascular diseases 
Health care seeking behaviuor among the elderly in Hue City
Nguyen Hoang Lan1*, Tran Thi Thanh Nga1, Le Thi Bich Thuy1 
ORIGINAL ARTICLES
* Corresponding author: Nguyen Hoang Lan 
Email: nhlan@huemed-univ.edu.vn
1Faculty of Public Health, Hue University of 
Medicine and Pharmacy, Hue University
ABSTRACT
Objectives: the study is to investigate health care seeking behaviour and to identify factors associated 
those behaviour among elderly living in Hue city, Vietnam. 
Methods: 400 old persons who suffered from health problem in the past one month were interviewed 
directly at their house by a structured questionnaire to survey health care seeking behaviour. Multivariate 
logistic regression models were applied to identify factors affecting health care seeking behaviour among 
participants. 
Results: 72.5% of respondents sought treatment services for their acute illness in the past one month 
and 68% of them used prevention services in the past one year before the interview. In general, source 
of income, educational level and severe level of disease influenced health care seeking behaviour among 
participants. 
Conclusions: The findings revealed limitation of the elderly to access health care services, especially 
health preventive services in Hue city. The identified associated factors can help formulate effective public 
health programs to improve health status among the elderly in Hue city as well as in the country in general.
Keywords: health care seeking behaviour, treatment services, health prevention services, the elderly, 
Hue city.
Submited: 16 October, 2020
Revised version received: 11 November, 2020
Published: 26 March, 2021
63
Journal of Health and Development Studies (Vol.05, No.02-2021)Nguyen Hoang Lan et al.
and chronic obstructive pulmonary diseases 
(COPD) are common diseases in the elderly 
in the country (7). One of factors that affected 
health status of the elderly is health care 
seeking behaviour. This behaviour refers to a 
decision or an action taken by an individual 
to maintain, attain, or regain good health and 
to prevent illness (8) This influenced a person 
making decision to use available health care 
services. The present study is to investigate 
health care seeking behaviour and to identify 
factors associated those behaviour among 
elderly living in Hue city, Vietnam. 
METHODOLOGY
Study design
An institution-based cross-sectional study 
Time and location 
Data collection was conducted between July 
and December 2019 in Hue city- the capital 
of Thua Thien Hue province located in the 
Central of Vietnam
Study participants 
Older persons aged 60 years and over met 
inclusive criteria as follows: residents in Hue 
city; suffering from health problem in the past 
month, ability to communicate; agreement to 
participate in the study. Individuals who had 
psychiatric illness were excluded from the 
study. 
Sample size was calculated using formula: 
n = Z2(1 - /2)
p(1-p)
d2
Where: p = 0.48 (proportion of elderly used 
outpatient services according to a study 
of Nguyen Thi Thang, et al among some 
provinces in Vietnam (9) 
d = 0.05 (allowable error) 
 z2
(1- α/2)
 = 1.96 (α = 0.05)
 Sample size calculated was 384.
The elderly persons were enrolled using 
multistage sampling:
- Stage 1: four among total 27 wards in 
the city were selected purposively based on 
geographical characteristics of the city. Two 
wards are located in the north and others are 
in the south of Huong river. The farthest ward 
is 6 km from center of Hue city.
- Stage 2: from list of the olde ... 55.5
Commune health center 33 8.3
Private health clinics/hospital 28 7.0
Family medical doctor 25 6.3
Reasons for choosing treatment 
site
Good quality of health services 162 40.5
Affordable medical expenses 66 16.5
Near the house 149 37.3
Regulation of health insurance 282 70.5
Simple formalities 193 48.3
72.5% of elderly reported that they took 
treatment for their acute illness at health 
facilities during the past month before the 
interview. The services that were used most 
were outpatient services (51.2%). More than 
half of participants chose public hospitals for 
their treatment. The most common reasons 
for choosing treatment site were explained 
to be regulation of health insurance, simple 
formalities and good quality of health care 
services, accouting for 70.5%, 48.3% and 
40.5%, respectively (Table 2)
Table 3. Characteristics of health prevention service seeking behaviour of elderly in the 
past one year
Characteristics n Percentage
Health preventive service 
seeking behaviour 
Yes 272 68.0
No 128 32.0
Services used
Vaccination 49 13.2
Periodic health examination 66 16.5
Periodic medical examination 149 37.3
Health education 233 58.3
67
Journal of Health and Development Studies (Vol.05, No.02-2021)
Table 4. Factors associated with treatment seeking behaviour among elderly
Table 3 showed that there were 272 older 
persons used prevention services in the past 
one year before the interview, accounting for 
68%. Health education was service that was 
chosen the most (58.3%), next was periodic 
medical examination (37.3%). 
Factors associated with health care seeking 
behaviour among elderly
Nguyen Hoang Lan et al.
Characteristics OR p value 95% CI
Source of 
income
Working to earn living 1
Retiree/ pensioner 6.3 0.019 1.35 - 28.96
No income 3.4 0.008 1.36 - 8.28
Educational
level
Under secondary school 1
Secondary school & above 3.3 0.006 1.41 - 7.90
Quality of health 
services
Not good 1
Good 5.1 0.001 1.88 - 13.98
Simple 
formalities
No 1
Yes 6.7 <0.001 3.15 - 14.16
Level of illness Minor 1
Moderate/severe 17.7 <0.001 7.75 - 40.25
Table 4 revealed only factors significantly 
associated treatment seeking behaviours 
among elderly in the study (p< 0.05). Elderly 
who were more likely seeking health care 
than their counterparts when suffered from 
acute illness including retirees/pensioners 
and elderly without income (OR: 6.3; 95% 
CI: 1.35-28.96 & OR: 3.4; 95% CI: 1.36-
8.28, respectively), participants attained 
secondary school education and above (OR: 
3.3; 95% CI: 1.41-7.9), the elderly who 
assessed good quality of health care services 
(OR: 5.1; 95% CI: 1.29-6.93), participants 
who were pleasure with formalities at health 
facilities (OR: 6.7; 95% CI: 3.15-14.16) and 
respondents who suffered from moderate 
or servere illness (OR: 17.7; 95% CI: 7.75-
40.25).
68
Journal of Health and Development Studies (Vol.05, No.02-2021)Nguyen Hoang Lan et al.
Table 5. Factors associated with health prevention service seeking behaviour among 
the elderly
Characteristics OR p value 95% CI
Age group 
(years)
≥ 80 1
70-79 2.94 0.021 1.18 - 7.34
60-69 3.72 0.008 1.39 - 9.89
Educational
level
Below secondary school 1
Secondary school & above 3.5 <0.001 1.88 - 6.55
Source of income
Working to earn living 1
Retiree/ pensioner 2.91 0.032 1.09 - 7.77
No income 1.23 0.542 0.63 - 2.43
Co-payment 
level with health 
insurance
20% 1
5% 2.0 0.136 0.80 - 5.07
0% 3.42 0.005 1.45 - 8.09
Level of illness
Minor 1
Moderate/severe 2.96 <0.001 1.73 - 5.09
In table 5, factors which were significant 
relationship with health prevention service 
seeking behaviour among the elderly were 
confirmed following, age group: OR for ’70-
79’: 2.94 (95% CI: 1.18-7.34) and OR for ‘60-
69’: 3.72 (95% CI: 1.39-9.89), educational 
level: OR for ‘secondary school & above’: 
3.5 (95% CI: 1.88-6.55), way of earning: OR 
for ‘retiree/pensioner’: 2.91 (95% CI: 1.09-
7.77) and OR for ‘no income’: 1.23 (95% 
CI:0.63-2.43), co-payment level with health 
insurance: OR for ‘co-payment of 5%’: 2.0 
(95% CI: 0.80-5.07) and OR for ‘co-payment 
of 0%’: 3.42 (95% CI: 1.45-8.09) and level of 
illness: OR for ‘moderate/severe’: 2.96 (95% 
CI: 1.73-5.09).
DISCUSSION
Health care seeking behaviour among 
elderly
Among the elderly suffered from health 
problem in the past one month before 
interview, there were 76.6% of them using 
treatment services at health facilities. The 
finding is higher than that of Nguyen Thi 
Thang et al (2015). The author reported 
that 44.4% of older persons in urban area 
in Vietnam visited health facilities for 
treating their illness (9). The improvement in 
Vietnamese government’s policies on older 
person including integrating health care for 
older persons into the current health system 
at four level (10), providing health insurance 
card free for the elderly aged 80 and above 
and utilization of insurance based health 
care services without reference requests 
at provincial level (11) have increased 
opportunity for the elderly to access to health 
facilities. Our result is in line with that of 
Falaha et al in Ethiopia (72.3%) (12). Among 
treatment services used, outpatient services 
69
Journal of Health and Development Studies (Vol.05, No.02-2021)
were chosen by majority of participants 
(51.2%). This is similar to a study of Giang et 
al using data from Viet Nam Household Living 
Standard Surveys (VHLSS) in 2008 (54.1%) 
(13). Normally, except for severe illness, 
outpatient services are the first choice of 
people when faced health problem. Inpatient 
services are solution in case of severe illness 
or ineffective outpatient treatment. Reasons 
for choosing health facilities explained why 
public hospitals were given priority to visit by 
more than half of participants (55.5%). These 
facilities provide insurance- based health 
care services. Similarly, Lena et al reported 
that Vietnamese older patients often visited 
government sites due to trust, familiarity and 
insurance coverage (14).
In term of health prevention service seeking 
behaviour, health education was used by 
more than half of the elderly in the study. This 
is popular service in grassroot level of health 
system in Vietnam, people can access it free 
of charge therefore majority of the elderly 
were interested in. Surprisedly, there were 
76% of participants got at least one chronic 
disease however only 37.3% of them reported 
that they took periodic medical examination 
during the past one year. Number of the 
elderly who used annual periodic health 
examination was fewer. Beside the reason 
is that the elderly can be poor interest in 
their health, out of pocket payment for these 
services might be barrier to their health 
prevention behaviour. The similar reason 
explained lowest percentage of older persons 
in the study taking vaccination (12.3%). 
Our finding is lower than previous studies 
in the world. A report of Europian Center 
of Disease Control (ECDC) showed that 
47.1% of elderly vaccinated against influenza 
(15). There were 59.9%, 55.1% and 20% 
of elderly in Singapore immunized vaccine 
against pneumonia, tetanus and herpes zoter, 
respectively (16). In those countries, fee for 
vaccination in elderly is paid full or partly 
by Government or Health Insurance’s budget 
(15).
Factors associated with health care seeking 
behaviour among the elderly
Factors associated with treatment seeking 
behaviour
Results of multivariate logistic regression 
model showed that source of income, 
educational level, quality of health care 
services, formalities at health facilities and 
severe level of disease influenced treatment 
seeking behaviour among the elderly who 
suffered from acute illness during one month 
before the interview. Older persons who were 
working were often busy for earning their 
living, they could ignore or self-treat their 
minor illness, even moderate illness. This 
can explain lower probability of seeking 
treatment for their acute illness in this group. 
The education of the patients significantly 
affects healthcare decisions. This finding is 
consistent with previous studies in Vietnam 
and in the world. Those with higher education 
tend to choose healthcare providers rather than 
self-treatment (17, 18). Good quality of health 
care services and simple formalities increased 
probability of using treatment services among 
the elderly in our study. Many studies showed 
that quality of care was leading choice criteria 
for health care in patients (14). Severe level 
of disease was associated with decision of 
elderly on treatment services that was also 
reported by some authors (14). 
Factors associated with health prevention 
seeking behaviour
Age, educational level, source of income, co-
payment level and level of illness were factors 
affecting health prevention seeking behaviour 
among older persons in the study. Utilization 
Nguyen Hoang Lan et al.
70
Journal of Health and Development Studies (Vol.05, No.02-2021)
of health prevention services was less as the 
age advanced. Bucatariu et al found that the 
patients aged 65 years and below with chronic 
diseases visited health facilities regularly to 
monitor risk factors and may undergo major 
lifestyle changes such as change of diet, 
walking and yoga (14). The elderly attained 
secondary school and above were interested 
in health promotion and prevention more 
than their counterparts did. Higher education 
level provided more opportunity for people 
to access knowledge on health promotion, 
therefore it could influence their choice 
about positive health behaviour. As earlier 
explanation, busy work decreased opportunity 
to use health prevention services among 
the elderly who were working to earn their 
living. Among health prevention services, 
periodic medical examination is covered by 
health insurance for chronic patients, this 
can be reason why elderly with lower co-
payment level were likely more utilization of 
those services in the study. Understandably, 
the elderly who experienced severe level of 
illness during acute stage were likely more 
aware of usefulness of health prevention 
services, they reported more utilization of 
those services in the study.
CONCLUSIONS AND 
RECOMMENDATIONS 
The findings from the study showed limitation 
of the elderly to access health care services, 
especially health prevention services in Hue 
city. In general, source of income, educational 
level, quality of health care services and 
severe level of disease were factors affecting 
health care seeking behaviour among older 
persons. In addition, good quality of health 
care services and simple formalities at health 
facilities attracted more older patients to 
visit health care sites while the younger ones 
and lower level of co-payment with health 
insurance influenced positive behaviour 
seeking health prevention among the elderly. 
The identified associated factors can help 
formulate effective public health programs to 
improve health status among elderly in Hue 
city as well as in the country in general.
Conflict	 of	 interest:	 The authors have no 
potential conflict of interest. 
REFERENCES
1. Vietnam National Committee on Aging, The 
United Nations Population Fund. Towards a 
comprehensive national policy for an ageing 
Viet Nam. Hanoi; 2019.
2. Press release: Results of the Population and 
Housing Census in 2019 [press release]. Hanoi: 
General Statistics Office, Dec 19 2019. In 
Vietnamese.
3. World Health Organization. Healthy life 
expectancy (HALE) at birth [cited 2020 Sep 
15]. Available from: https://www.who.int/data/
gho/indicator-metadata-registry/imr-details/66.
4. Ministry of Health. Vietnam Joint Annual 
Health Review 2016, towards the goal of aging 
a healthy population in Vietnam, Hanoi. Hanoi: 
Ministry of Health; 2018. In Vietnamese.
5. Kham LV. The issue of the elderly in Vietnam 
today. Vietnam Journal of Social Sciences. 
2014;80(7):77-86. In Vietnamese.
6. Portal MoH. Vietnam still has many challenges 
in healthcare for the elderly. Hanoi: Ministry 
of Health Portal; 2018 [cited 2020 Apr 12]. 
In Vietnamese. Available from: https://www.
moh.gov.vn/chuong-trinh-muc-tieu-quoc-
gia/- /asset_publ isher /7ng11fEWgASC/
content/viet-nam-con-nhieu-thach-thuc-trong-
cong-tac-cham-soc-suc-khoe-nguoi-cao-
tuoi?inheritRedirect=false.
7. Linh HBP. Research on the level of health 
literacy and its related factors of people in Thuy 
Xuan ward, Hue city: University of Medicine 
and Pharmacy, Hue University; 2016. In 
Vietnamese.
8. Olenja J. Editorial Health seeking behaviour 
in context. East African medical journal. 
2003;80(2):61-2.
9. Thang NT. Situation and factors affecting the 
difference in the use of medical examination 
Nguyen Hoang Lan et al.
71
Journal of Health and Development Studies (Vol.05, No.02-2021)Nguyen Hoang Lan et al.
and treatment services in some provinces in 
the socio-economic regions of Vietnam in 
2015. Hanoi: National Institute of Hygiene and 
Epidemiology; 2017. In Vietnamese.
10. Hoang PV. Vietnam’s experience in promoting 
healthy ageing. Hanoi: Ministry of Health.
11. Circular 40/2015 / TT-BYT: Regulations 
on registration of medical examination and 
treatment from primary health insurance and 
referral to medical examination and treatment 
covered by Health Insurance, (2015).
12. Falaha T, Worku A, Meskele M, Facha W. 
Health care seeking behaviour of elderly people 
in rural part of Wolaita Zone, Southern Ethiopia. 
Health Science Journal. 2016;10(4):1.
13. Long GT, Dai Thu B. Access of older persons 
to health insurance and health-care services in 
viet nam: current state and policy options. Asia-
Pacific Population Journal. 2014;28(2):69-89.
14. Bucatariu L, George B. Patient Perception 
and Choice Factors Related to International 
Hospitals: A Study in Ho Chi Minh City, 
Vietnam. Journal of Health & Medical 
Informatics. 2017;8(3):8-277.
15. European Centre for Disease Prevention and 
Control. Seasonal influenza vaccination and 
antiviral use in EU/EEA Member States. 2018 
Dec 18.
16. Nguyen MH, Li Chen L, Lim KW, Chang 
WT, Mamun K. Vaccination in older adults 
in Singapore: a summary of recent literature. 
Proceedings of Singapore Healthcare. 
2015;24(2):94-102.
17. Shukla M, Ahmad S, Brajesh Anand P, Ranjan 
R. A study on health care seeking behaviour 
among elderly in a rural area of eastern Uttar 
Pradesh. National Journal of Multidisciplinary 
Research and Development. 2017;2(2):15-8.
18. Thuan NTB, Lofgren C, Lindholm L, Chuc 
NTK. Choice of healthcare provider following 
reform in Vietnam. BMC Health Services 
Research. 2008;8(1):162.