Health knowledge and care seeking behaviour in resource-limited settings amidst the COVID-19 pandemic: A qualitative study in Ghana

Abstract

Background The emergence of a pandemic presents challenges and opportunities for healthcare, health promotion interventions, and overall improvement in healthcare seeking behaviour. This study explored the impact of COVID-19 on health knowledge, lifestyle, and healthcare seeking behaviour among residents of a resource-limited setting in Ghana. Methods This qualitative study adopted an exploratory design to collect data from 20 adult residents in the Cape Coast Metropolis using face-to-face in-depth interviews. Data collected were analysed thematically and statements from participants presented verbatim to illustrate the themes realised. Results Health knowledge has improved due to COVID–19 in terms of access to health information and increased understanding of health issues. There were reductions in risky health-related lifestyles (alcohol intake, sharing of personal items, and consumption of junk foods) while improvements were observed in healthy lifestyles such as regular physical exercise and increased consumption of fruits and vegetables. COVID–19 also positively impacted health seeking behaviour through increased health consciousness and regular check-ups. However, reduced healthcare utilization was prevalent. Conclusion The COVID–19 pandemic has presented a positive cue to action and helped improved health knowledge, lifestyle, and care seeking behaviour although existing health system constrains and low economic status reduced healthcare utilization. To improve health systems, health-related lifestyles and healthcare seeking behaviour as well as overall health outcomes even after the pandemic wades off, COVID–19 associated conscious and unconscious reforms should be systematically harnessed.

Factors Associated with the Patient’s Decision to Avoid Healthcare during the COVID-19 Pandemic

“…We based our analysis on Andersen’s Behavioural Model of Health Services Use, which identified three main types of factors deemed to influence health service use: (i) predisposing, which included sociodemographic characteristics and health beliefs, namely, attitudes and values regarding health and health services; (ii) enabling, encompassing financing and organisational factors; and (iii) need for care, which incorporated individual and contextual predictors, such as the perceived need for health services and evaluated need and epidemiological indicators of morbidity [ 2 , 9 , 25 ]. Thus, we grouped the variables deemed as potential determinants of healthcare avoidance into four dimensions: predisposing, enabling, need for care and COVID-19 specific ( Table 1 ).…”

“…The World Health Organization (WHO) declared the novel coronavirus disease 2019 (COVID-19) a global pandemic on 11 March 2020 [ 1 ]. Restrictive measures were implemented to contain the pandemic, such as lockdowns, stay-at-home orders, movement restriction and closure of schools and non-essential businesses [ 2 , 3 ]. Additionally, several countries temporarily cancelled non-urgent medical activity to ensure the best care for COVID-19 cases, diverting attention from non-COVID-19 care and a reduction in care for these conditions [ 2 , 3 , 4 , 5 ].…”

“…Restrictive measures were implemented to contain the pandemic, such as lockdowns, stay-at-home orders, movement restriction and closure of schools and non-essential businesses [ 2 , 3 ]. Additionally, several countries temporarily cancelled non-urgent medical activity to ensure the best care for COVID-19 cases, diverting attention from non-COVID-19 care and a reduction in care for these conditions [ 2 , 3 , 4 , 5 ]. The health services reorganisation might partially explain this reduction to respond to COVID-19, but the reduction might also be explained by the patient’s avoidance or delay regarding attending healthcare due to the fear of getting COVID-19.…”

Effect of COVID-19 Pandemic on HIV/AIDS, Tuberculosis, Malaria, and Maternal and Child Health Services, Uganda, 2020

“…There was no signi cant difference in the average number of suspected fevers total malaria cases, malaria con rmed cases and malaria treated before and during the Covid-19 pandemic (Table 2). Similarly, there was no signi cant difference in the number of HIV+ pregnant women initiated on ART for eMTCT at any visit irrespective of when tested HIV+ by health facilities during the COVID-19 pandemic 4 (SD=8.7); p = 0.564 compared to before the COVID-19 pandemic 5 (SD=8.1) (Table 5) The reduction might also be owed to the barrier posed by patients' fears of contracting Covid-19 [10]. In addition, many healthcare seekers could have perceived negative reception at the facility during COVID-19 by the health professionals as in Ghana [10].…”

“…Similarly, there was no signi cant difference in the number of HIV+ pregnant women initiated on ART for eMTCT at any visit irrespective of when tested HIV+ by health facilities during the COVID-19 pandemic 4 (SD=8.7); p = 0.564 compared to before the COVID-19 pandemic 5 (SD=8.1) (Table 5) The reduction might also be owed to the barrier posed by patients' fears of contracting Covid-19 [10]. In addition, many healthcare seekers could have perceived negative reception at the facility during COVID-19 by the health professionals as in Ghana [10]. They noted that healthcare were applying unfriendly and high-level infection prevention protocols especially to patients presenting with cough and u symptoms which affected care seeking among the population.…”