Using Andersen’s behavioral model of health care utilization in a decentralized program to examine the use of antenatal care in rural western Ethiopia

Abstract

BackgroundIn Ethiopia, most women do not make the minimum number of antenatal care (ANC) visits recommended by WHO. This study modeled predisposing, enabling, need, and external environmental factors in the utilization of decentralized health facilities for ANC services in rural western Ethiopian communities. MethodsA community-based, cross-sectional study was conducted in Gida Ayana Woreda (District) among 454 women. Data were collected through structured questionnaires. Multinomial logistic regression was used to model the association between the explanatory variables and the use of recommended and fewer than recommended visits for ANC with reference to the base model, no ANC visits. ResultsOnly 15.2% of women made the recommended minimum number of ANC visits. Women with fewer than 2 children (AOR 10.7; 95% CI 3.0-8.4) were 10.7 times more likely received ANC service as recommended. Women with a delivery of 2 or more (AOR 9.7; 95% CI 3.7-5.2) home visits by health extension workers (HEWS) were 9.7 times more likely receiving minimum ANC services. Involvement in gainful activities had 4 times higher log odds of seeking recommended ANC (AOR 4.0; 95% CI 1.4-11.7). Women who experienced high fever were more likely to obtain the recommended ANC services (AOR 7.1; 95% CI 2.9-7.5). Residents of Ayana Kebele decentralization entity were 60% more likely to make the recommended number of visits to ANC (AOR 24.6; 95% CI 4.8-15.2).

Prenatal HIV Test Uptake and Its Associated Factors for Prevention of Mother to Child Transmission of HIV in East Africa

“…It is a well-validated and most widely adopted theoretical framework that permits systematic identification of factors that influence individual decisions to use or not to use available health care services [ 40 ]. Several studies have used this conceptual model to study health care utilization [ 41 , 42 , 43 , 44 ]. The selection of study variables to be included in this study was done based on the purpose of this research, previously published literature from low- and middle-income countries [ 45 , 46 ], and the availability of information regarding the relevant variables.…”

“…It is a well-validated and most widely adopted theoretical framework that permits systematic identification of factors that influence individual decisions to use or not to use available health care services [40]. Several studies have used this conceptual model to study health care utilization [41][42][43][44].…”

Testing a Practitioner-Friendly Behavior Model in Pakistan, India, and Nigeria

“…After multiple iterations over 3 decades, Andersen's model took health behavior explicitly into account [10]. While the model has been used in LMICs to look at outcomes such as antenatal care and contraceptive use, and studies have shown the effects of demographic and socio-economic factors, enabling factors, and perceived need on health services utilization [11,12], the insights offered in terms of behavioral processes themselves have been limited. Moreover, the extent to which this model has contributed to the incorporation of social and behavior change (SBC) in the design, implementation, and evaluation of health systems interventions is not obvious.…”

Disparities in Oral Healthcare Access Due to the COVID-19 Pandemic

“…Therefore, the ramifica-F. Namrata, Z. G. Loewy tions can be underpinned using Andersen's 2014 theory of health service use [14]. This comprehensive model explains the interaction between people, the external environment, and the healthcare systems [15]. Multiple factors, including cultural, economic, social, and individual characteristics, primarily predispose people to accessing healthcare [14].…”

“…The model also posits that the enabling factors, including health services organization, governance, and financing, may decrease or increase access to healthcare [14]. Patients' behavioral factors, including professional and personal, also influence access to healthcare services [15]. The model is pertinent because it links patient satisfaction as desired outcomes to health; this theory is therefore relevant to understanding access to dental healthcare [14].…”