A Cross-sectional Study to Assess the Barriers to Healthcare-Seeking Behaviour among Undergraduate Students in a Medical College, Bengaluru

Introduction

Medical students experience high levels of stress and psychological morbidities compared to students pursuing other professional courses.¹ Academic and social factors such as busy curriculum, the frequency of exams taken, and high parental expectations can affect a medical graduate’s long-term health.²

Health-seeking behavior is a response to illness that prompts a person to undertake activities to remedy the problem or prevent illness. There is a paradoxical situation where, despite the availability of professional health care at close range 24/7, medical students are unwilling to avail this for their benefit.³ Health-seeking behavior not only affects the present, but also determines the care search and care practice of medical undergraduates in the future. Therefore, a better understanding of students’ perceptions and self-reported barriers to health care utilization is critical in addressing unmet needs.

Objectives

• To estimate the barriers in seeking help from health care services by undergraduate students

• To compare physical and mental health seeking behaviours

Materials and Methods

Study design: Cross-sectional study

Place of study: Bangalore Medical College and Research Institute, Bengaluru

Study population: Medical undergraduate students, Bengaluru

Study period: June-July 2021

Sample size: 147 participants4

Inclusion criteria

• Medical students from all professional years

• Students consenting to participate in the study

Exclusion criteria

• Students unwilling to provide consent

Method

The study was conducted among 147 medical undergraduate students at a Government Medical College in Bengaluru. As per the previous study conducted by Menon V et al., the mean (SD) total barrier score (both mental and physical health care barriers) was 62.2±7.7. With a relative precision of 2%, the sample size for the present study was calculated as 147. Sample size for each professional year was calculated by probability proportion to size and was estimated as 40, 36, 35, 36. In each professional year, the required students were selected using simple random sampling by computer generated numbers.

Data collection

After obtaining informed consent, data were collected using a pre-tested, semi-structured, face-validated questionnaire through an online interview method. Barriers to Healthcare Seeking Questionnaire (BHSQ), a 28-item questionnaire tool about perceived barriers to seeking health care services was used.⁴ The questionnaire consisted of questions pertaining to sociodemographic information, substance dependency, and barriers to medical and physical health care. Data were entered in MS Office Excel and analyzed using SPSS software version 20.0.

Results

Overall, among 147 students who completed the questionnaire, 63.3% were males and 36.7% were female participants (Figure 1). The mean age of first, second, third, and fourth year students was 19.6, 20.6, 21.1, and 23 years respectively. Majority of the students came from an urban background (85.7%), 81.6% of the participants were from nuclear families. Around 61.2% of the students lived in dormitories. Only 27.9% of participants had a healthcare-related family member. 34.7% of participants had self-reported medical illness, while 4.8% had self-reported mental illness (Figure 2). 74.1% of participants reported having self-treated for physical health issues and 32% had sought advice/help from seniors or peers for mental health issues. 31.8% of participants used alcohol, while 12% reported that alcohol use caused harm. Similarly, 9.5% and 3% of participants used tobacco and cannabis, respectively (Table 1).

The mean (SD) score for barriers for physical health care was 31.60±4.8 and the mean score for barriers for mental health care was 31.91±5.3 (Table 2). The correlation between mental and physical health barriers according to Pearson’s correlation was 0.794 with a p-value of <0.001 (Table 3). Fear of unwanted procedures, expense, and side effects were the most common barriers Table 4). The tendency to self-medicate for physical problems was significantly associated with it. Increase in seniority was not associated with alcohol, tobacco, or cannabis consumption.

There was a strong correlation between mental and physical health care scores

Discussion

The study identified several barriers reported by medical students for seeking healthcare services, and the barriers differed for seeking help for mental and physical health problems. Fear of unwanted intervention, Cost, fear of side effects were most common barriers to health care seeking.

Although there is a paucity of comparable literature from developing countries, many of the barriers reported by our students are similar as the findings from the west carried out among medical students and interns.

Conclusion

In the present study, 63.3% of the participants were males and 36.7% were females. The mean age of first, second, third, and fourth year students was 19.6, 20.6, 21.1, and 23 years, respectively. 34.6% of the participants had self-reported medical illnesses, while 4.76% had selfreported mental illnesses. 31.8% of the participants consumed alcohol and 12% reported that alcohol consumption caused harm. The highest score for seeking medical care was 82 and the lowest was 31, with the mean (SD) of the physical health care barriers subscale being 31.60±4.8 and the mental health care barriers subscale being 31.91±5.3, with an overall barrier score of 63.52±9.57. Interventions (70), cost (66), fear of side effects (51), fear of judgment (49), and stigma (47) were the most common barriers in accessing health care.

Recommendation

Improving the delivery of health services in medical schools by providing appropriate guidance and counseling to new medical students and their inclusion in the curriculum to create awareness among medical students. Establishment of a split student clinic on campus and in the hostel to increase access to health care. Conducting awareness sessions on seeking health care and encouraging peer counseling and motivation to seek treatment for their health issues, which may impact their training and future performance as clinicians.

Conflicts of Interest

Nil