Utilization of Primary Health Care Services in Rural and Urban Areas in Shiraz

Different factors affect individuals’ behaviors when they encounter a health problem or a disease. This cross-sectional study was conducted to analyze health-seeking behaviors and utilization pattern of primary health care services among the households living in Shiraz, Iran. This household survey was conducted among 500 households living in urban and rural areas, selected through three-stage sampling during 2016 - 2017. The data were collected via a questionnaire designed by the researcher (Cronbach’s alpha coefficient: 0.747), and the questions were answered by the most informed family members. The data were then analyzed using Chi-square, independent samples t-test, one-way analysis of variance (ANOVA) and Pearson correlation coefficient. We found that 52.4% of the subjects were female, 65.6% were married and 34.4% had academic education. Furthermore, 95% were under the coverage of a health insurance, of which 64.4% had social security insurance. The mean age of the participants was 39.08 years. In terms of socio-economic characteristics of the households, 52.4% had a personal house and 56.6% were in the income group of 10 - 20 million Rials. The average household size was 3.86. Further, 41.8% of the households had elderly member(s), 49.6% had hypertensive patient(s) and 32.8% of the households had diabetic member(s). Only 31.2% of the participants said they needed consultation on high-risk behaviors. According to our findings, the subjects had inappropriate health-seeking behaviors (direct referral to a specialist physician and disregarding the problem) when facing four out of the seven services surveyed (about 60%). The most important reason for disregarding the problem was that it did not seem serious to the individuals. Our results showed when facing simple illnesses, education level (P = 0.003), age (P = 0.001), insurance (P = 0.000), type of insurance (P = 0.000), income level (P = 0.001), residence (P = 0.001) and type of referral system (P = 0.004) had a statistically significant relationship with the possibility seeking service and the level of services utilized. The factors affecting the utilization of primary health care services when requiring nutritional counseling, psychological services, counseling for high-risk behaviors, elderly care, as well as hypertension and diabetic care were different. In half of the studied first-level health services, referral to specialist physicians was more common; this behavior would increase the health costs of the country. Therefore, it seems necessary to improve the quality of primary health care services, promote culture and adopt policies to encourage the referral system usage and carry out patient screening.