Factors influencing the public utilisation of Well Person’s Clinic in a West African country

INTRODUCTION

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity as defined by Whole Health Organization. Ensuring healthy lives and promoting the well-being of all at all ages is the third goal of the sustainable development goals; hence, activities directed at achieving this goal would be of significant interest to the global community.^[1]

The Well Person’s Clinic of the department of community medicine in the Calabar teaching hospital is a clinic that is attended by people who are well, with no apparent disease, who visit the clinic to check how well they are. Only screening tests for common communicable and noncommunicable diseases are carried out in this clinic with the aim of early detection of debilitating health conditions and prompt referrals to specialised units for early diagnosis and prompt treatment. The ultimate goal is to keep people in their continuous state of well-being (health) while reducing sudden death syndromes due to ongoing undetected disease conditions. This is a new paradigm, a shift from the old concept that only sick people visit the hospital for check-ups; the hospital, in this new concept, is for both healthy and sick people to visit and utilise the available health services.

Routine medical checkup (screening) is a form of preventive medicine; it is a helpful practice to promote health in the community^[2] because early diagnosis and treatment of noncommunicable diseases is one of the principles of preventive medicine.^[3] Undergoing general health checkups is a common practice in many developed countries; however, some factors have been attributed to poor attendance in wellness clinic.

A study carried out among 19,351 women in Germany showed that divorce, death of partners, and residence in Eastern Germany were factors that affected attendance, with education having the least effect.^[4] In Nigeria, age below 40 years was seen as a factor that discourages the uptake of services provided in a Well Person’s Clinic.^[5]

According to a study done in Uganda^[6] on health-seeking behaviour of a community to determine how health services were used and, in turn, health outcomes of the population. The study revealed that health-seeking behaviour may be influenced by physical, socioeconomic, cultural and political factors. A key determinant for the health-seeking behaviour was the organisation in many of the health care systems, particularly in Uganda. Illiteracy and poverty, underfunding of the health sectors, inadequate water, and poor sanitation facilities had a big impact on health education. In addition, the cost of services, limited knowledge on some illnesses, well-being, and cultural practices were barriers to the provision of health services.

In a related study done in Malaysia,^[7] the authors opined that most health care systems and policies focused on addressing the needs of children, adolescents, elderly people, and women, and few looked into the health care needs of men. The United States Preventive Services Task Force (USPSTF) recommended screening in younger adults, including men, for hypertension, diabetes, sexually transmitted infections (STIs), HIV, hepatitis, dyslipidaemia, depression, smoking, alcohol and obesity.^[8]

In Nigeria, it has been noted that although a number of Nigerians were aware of routine medical check-ups, they do not, however, practice them.^[9] A study done in Ibadan, Oyo State, Nigeria, showed that the awareness of screening for cervical cancer, which is a component of the screening test done in the Well Person’s Clinic and the uptake of cervical cancer screening service have remained poor in developing countries.^[10]

Well Person’s Clinic in the University of Calabar Teaching Hospital (UCTH) was established in June 2019. At the end of August 2019, only 11 people had attended the clinic. Due to this apparently low service uptake, the Department of Community Medicine organised a hospital-wide seminar on 11th September 2019 to create awareness among the staff of the hospital on the need for conscious and deliberate efforts by hospital staff to avail themselves of the routine screening services to safeguard their health. Immediately after this sensitisation seminar, the attendance increased by 21 persons (however, the majority of these attendees were nonUCTH staff). Patronage by staff of UCTH did not improve months after the seminar was held, despite increasing cases of sudden deaths among staff of UCTH, which could have been prevented if staff members had taken advantage of the screening services. Routine medical check-up (screening) is not a common practice among apparently healthy Nigerians; this makes research in this area very uncommon, too. Hence, our study aims to provide baseline information for local, national, and International Researchers to build upon as a way of contributing to the global body of knowledge. Recommendations from findings in this study may also help to inform policymakers in institutions and society at large to inculcate the culture of screening among individual staff and citizens, since this would be the first step to maintaining a healthy living and reducing the prevalence of sudden death syndrome among our populace. This study was therefore conducted to determine the factors influencing the attendance at Well Person’s Clinic by staff of the University of Calabar Teaching Hospital, as well as to put in place interventional measures to improve their utilisation of this clinic.

MATERIAL AND METHODS

The study was conducted at the UCTH, Calabar, in Cross River State, Nigeria. The teaching hospital was established in 1979 at the former St. Margaret Hospital at Moore Road, in Calabar South Local Government Area. It was later relocated to its present site in the Calabar Municipal Local Government in February 2012. There are 65 departments in the hospital, which also serves as a training centre for undergraduate medical students, postgraduate doctors and allied medical students. The Well Person’s Clinic is managed by the Department of Community Medicine.

This was a cross-sectional descriptive study, and the study population was both male and female members of staff of UCTH, Calabar, who gave their consent to participate in this study. The minimum sample size, “n,” was calculated using the Cochran formula^[11], which was 361.

A multistage sampling was used to select participants for the study. The first stage involved stratifying the existing 65 departments into 7 departments using simple random sampling by balloting.

The second stage comprised the selection of 2 units from each department using simple random sampling by balloting. Proportionate allocation was applied to each unit.

In the third stage, a simple random sampling technique (by balloting) was also employed to select participants from each unit until the required minimum sample size was attained.

A semi-structured self-administered pretested questionnaire (self-designed) was used to collect data from the study population. Pretesting of the questionnaire was done at a health centre, Calabar (to test for validity and need for adjustment). Questionnaires were manually sorted and coded before entry of the data. The data were analysed using the statistical package for the social sciences (SPSS) version 21.0 and were summarised and presented using frequency tables, bar charts, and pie charts.

Ethical clearance was obtained from the research ethics committee of the University of Calabar Teaching Hospital. Informed consent was obtained from the respondents, who were informed appropriately on the purpose and contents of the exercise and were assured of anonymity and confidentiality of any information provided.

RESULTS

A total of three hundred and sixty-one (361) clients who responded were included in the study. Majority 262 (73%) of the respondents cited lack of awareness of the existence of the clinic in the institution, accounting for the highest reason for not patronizing the Well Person’s Clinic, other reasons included; busy schedule 105(29.1%) cost of service 47(13.0%), attitude of health workers 27(7.5%), fear of outcome 27(7.5%), Not aware of the service 241(66.8%), attending clinic elsewhere 24(6.6%), religious belief 13(3.6%) as shown in Table 1.

The majority, 227(63%) of the respondents carried out routine medical checkups periodically, while 134(37%) did not go for routine medical checkups. They gave various reasons for this exercise. Most, 83(36.6%) of them said that they undertake routine medical check-up as a norm; 73 (32.2%) of them indicated that they had to go for routine medical screening because it was a requirement for job pre-employment; while 63(22.7%) indicated that it was based on the advice of a health personnel; 3(1.3%) of the respondents however gave other reasons [Figure 1].

Close

Figure 1:

Reasons adduced for the uptake of routine medical check-ups.

Export to PPT

The majority of the respondents, 216 (95%), opined that a routine medical checkup was necessary, out of which 83(36.6%) go for a routine check-up once yearly, 63(27.8%) attended twice yearly, 18(7.9%) thrice yearly, while 63(27.8%) attended more than thrice a year. These respondents, even though they accepted routine checkups, had varying opinions regarding their importance [Figure 2].

Close

Figure 2:

Opinion about routine medical examination.

Export to PPT

Only 99(27%) were aware of the existence of the Well Person’s Clinic in UCTH, out of which 40(40.5%) got to know about it through a friend or a colleague, 32 (32.3%) knew through the awareness program organized by the institution; 14(14.1%) said it was through social media platforms, while 13(13.1%) said it was from other sources, as shown in Figure 3.

Close

Figure 3:

Source of information about the Well Person’s Clinic.

Export to PPT

Only a fraction, 55 (55.6%) of those respondents who had visited the Well Persons’ Clinic were indifferent about the level of satisfaction with the services offered by the Clinic during their visits, as shown in Figure 4.

Close

Figure 4:

Perception of quality of services offered.

Export to PPT

The majority, 135 (37.4%) of the respondents were between the ages of 30 and 39 years, with a mean age of 37.35±8.5. A larger proportion, 192 (53.2%), of the respondents were females; 350 (97.0%) were Christians, 353 (97.8%) had tertiary education as their highest qualification, and 185 (51.2%) were non-clinical staff [Table 2].

DISCUSSION

This study evaluated the factors affecting the utilisation of the Well Person’s Clinic by staff of the University of Calabar Teaching Hospital. Studies have shown that the majority of Nigerians are aware of routine medical checkups; however, only a few people practice them.^[12,8]

In our study, the level of awareness of the existence of the Well Person’s Clinic by staff of the hospital was low (27%). The majority (73%) of the respondents were not aware of the existence of the clinic in the hospital, and even among those who were aware of the existence of the clinic, about 40.4% of them did not know where the clinic was located. About 60% of the respondents who claimed to be aware of the clinic did not know the official clinic days. The majority (40%) of the respondents who were aware of the clinic got to know about it from a friends/colleague, while a few of them (14%) got to know about the clinic through social media.

Despite the low level of awareness of the availability of a clinic within the hospital for routine medical checks among the respondents, most of the respondents opined that routine medical checkups are important; however, about a third of the respondents, 134 (37.4%), had never gone for a routine medical checkup before. This is similar to a study carried out among traders in the Southeastern region of Nigeria, who, despite their high level of awareness of routine medical checkups, did not practice it (Eke et al, 2010).^[13] This low patronage of routine medical check-ups underscores the need for greater advocacy to encourage workers to undergo this exercise periodically.

In this study, even among the respondents who claimed to go for medical checkups, the majority, 83(36.6%), went for routine medical checkups once a year, which needs to be improved upon. Some reasons advanced by the respondents for the low patronage of the clinic were: poor awareness of the services, busy schedules, attending elsewhere, fear of the outcome of results, cost of the service, distance of the facility from their offices, attitude of health workers in the clinic and religious beliefs.

Lack of awareness of the services provided by the Well Person’s Clinic is the highest-ranked reason for the low attendance at the clinic. In another similar study,^[14] it was observed that, for any healthcare service to be successful, there is a need for greater public awareness and information of potential benefits of the services, which places the responsibility for creating awareness about the existence of the clinic and the services offered in the department of community medicine UCTH.

Another reason adduced by some of the respondents for their non-patronage of the routine check-up services was that they have busy or crowded schedules. About two thirds 66(66.7%) of those who were aware of the service offered by the clinic but were unable to attend attributed it to their busy work schedules, and opined that the clinic would have better patronage if it were operational during weekends.

About one-third (30.3%) of respondents who were aware of the services provided by the Well Person’s Clinic cited their religious beliefs as the reason for not attending the clinic. This finding was in agreement with the authors of a similar study,^[15] who found that religious belief, the use of traditional African medicine and patient perception of reality influenced their health-seeking behaviour. Hence, the need to factor in the religious and cultural nuances of people when planning health interventions programmes or activities.

Affordability and proximity of the services were other reasons given by some of the respondents as factors that influenced their utilisation of the services of the clinic. Among the 262 respondents who did not patronise the Well Clinic, 47(18%) of them affirmed that they would have patronised the clinic if it were under the national health insurance scheme (NHIS), while 22(8.4%) of the respondents were of the view that the Well Person’s Clinic was located far from their offices. These findings are corroborated by findings from a study^[16] in which their respondents mentioned cost and lack of proximity to the facility as barriers to access.

Data from a survey of 522 doctors was collected in a study to determine the medical care-seeking behaviour of doctors in Nigeria. The result showed that the majority of them (80.5%) had one form of illness or the other in the year preceding the survey. Only 35% of them reportedly consulted another doctor during their illness. Most of the consultations (61.2%) were informal in the form of over the phone (45.6%), corridor (33.3%) and home visit (21.1%) and just 18.4% of the consultations occurred within 24 hours of the onset of illness. A low number (19.5%) of them had a regular source of medical care. Screening for illnesses was generally below expectations. Just 6 out of 431(1.4%) male doctors had screened for prostate cancer, while 39 out of 86(45.3%) females had screened for cervical cancer. The study showed that Nigerian doctors were often reluctant patients, who frequently tend to delay medical care.^[17]

A study of the factors influencing health-seeking behaviour of health workers in a tertiary institution in Sokoto, North West Nigeria, reported that, although the idea of periodic medical checkup was perceived to be generally good, the fear of the outcome of investigations was the major factor that was seen as preventing health workers from going for voluntary medical checkups.^[17]

Among the respondents who knew about the services offered by the clinic, 27(27.3%) did not visit the clinic for consultation owing to the fact that they were afraid of the outcomes of the screening tests. This finding in our study was similar to that in another study^[18], where the authors found that the major factor preventing health workers from going for voluntary medical checkups was the fear of the disclosure of the outcome of investigations. They were, however, positively disposed to the idea of having periodic medical checkups.

The attitude of the health workers in the clinic was also mentioned as a drawback to the utilisation of the services by clients (teaching hospital staff). Among those who patronised the Well Person’s Clinic,, 27 (27.3%) complained of a delay in service rendered when they attended the clinic.

With regards to the willingness of the respondents to recommend the clinic to their friends, relatives and families, a great proportion, 149(66%) of the respondents were positively disposed to recommend the clinic to their family members and friends because they believed there were competent hands at the clinic to provide the care they needed. Moreover, they also believed that availing oneself of routine medical checkups was important for optimising one’s wellbeing.

CONCLUSION

Our study revealed that the majority (73%) of the respondents were not aware of the existence of the Well Persons’ Clinic in the institution. The low level of awareness was to a large extent responsible for the poor uptake of the services provided in the clinic. There is also a need for the NHIS to incorporate the services of the Well Person’s Clinic,as a routine service. There is a need to create more awareness of the presence, functionality and usefulness of the clinic to stimulate the interest of the public and staff of the institution to take up regular medical checkups.