| Study | Country | Study design (Period of research) | Data collection tool | Representation of REW | Findings |
|---|---|---|---|---|---|
| Ameh et al. 2014 | South Africa | Cross-sectional study (2010) | Interview Simple random sampling 7870 |
74.8% | Education (six and more years of education had a twofold increased odds of using health care compared to those with no formal education) - p < 0.05 (p = 0.001) (OR: 2.49; CI:1.27 - 4.86) Medical aid cover - p < 0.05 (p = 0.001) Occupation - p < 0.05 (p = 0.001) Socioeconomic status - p < 0.05 (p = 0.001) Do not think they are sick enough – significant (P value is not reported) Could not afford the cost of health facility visit - significant (P value is not reported) Inadequate drugs and treatment - significant (P value is not reported) being treated poorly during previous visits - significant (P value is not reported) No transport available - significant (P value is not reported) Inadequate skilled staff - significant (P value is not reported) Do not know where to go - significant (P value is not reported) |
| Bell et al. 2005 | USA | Cross-sectional study (2001 – 2002) | Face-to-face survey Simple random sampling 698 |
49.1% | Education - p < 0.01 Poverty - p < 0.01 On Medicaid vs no Medicaid and income - p < 0.01 Cost of medications for diabetes - p < 0.01 |
| Byles et al. 2006 | Australia | Longitudinal population-based Study (1996, 1999 and 2002) | Survey (mailed) 8387 |
60% | Higher out of pocket costs - significant (P value is not reported) Lower satisfaction with GP services - significant (P value is not reported) Higher use of community healthcare services - significant (P value is not reported) Identified themselves as caregivers - significant (P value is not reported) |
| Chan and Griffiths 2009 | Pakistan | Comparative descriptive study (2006) | Interviewed by information table and questionnaire Convenience sample 125 |
36.0% | Feeling depressed and helpless - p < 0.001 Feeling lack of resources including Medical - p < 0.001 Food - p < 0.001 Clothes - p < 0.001 Shelter - p < 0.001 Financial support - p < 0.001 Social support - p < 0.001 Living alone - p < 0.001 Living with relative and neighbors - p < 0.01 |
| Loosing geographic access to healthcare center after earthquake - significant (P value is not reported) Travel distance - significant (P value is not reported) |
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| Cheng et al. 2005 | China | Cross-sectional study (2001) | Interviewed using a standard questionnaire Randomly selected 190 |
22% | Lack of education (The median delay of patients with an educational level of middle school or above was one third of that of patients with no education) - p < 0.05 Distance from home to township health center (km) - patient delay hazard ratio at 95%CI - 1.04 (0.98-1.11) Distance from home to township health center (km) - health system delay hazard ratio at 95%CI - 1.01 (0.95-1.07) Do not know that their disease was serious (24.7% said that) Poverty (21.1% accepted that) Lack of expensive medical equipment - significant (P value is not reported) Insufficient incentives for village doctors - significant (P value is not reported) |
| Gopalan and Durairaj 2012 | India | Cross-sectional study (2008) | Household survey Multi-stage random stratified sampling 800 |
51.0% | Financial limitations - p < 0.05 (OR 2.00, 95% CI 0.84-4.80) Household response to women’s healthcare needs - p < 0.05 (OR 2.04, 95% CI 1.09-3.83) Lacking other financial support - p < 0.05 (OR 2.13, 95% CI 1.11-4.07) Perceived non-seriousness - significant (P value is not reported) Residing far from health centers (28.4% reported it as a barrier) - P value is not reported |
| Gopichandran and Chetlapalli 2013 | India | Cross-sectional study (2013) | Interview using structured questionnaire Multistage sampling strategy 640 |
11.8% | Healthcare access is determined by trust in doctors. The factors relating to trust in doctors were: Personal relation with doctors - p < 0.05 Behavior of doctors - p < 0.05 Simple appearance of doctors - p < 0.05 Cultural competence of doctors - p < 0.05 |
| Harrison and Wardle 2005 | UK | Cross sectional study (2000-2001) | Survey Comprehensive sampling approach 313 |
31.4% | People over 65 years of age are statistically significantly less likely to complete cardiac rehabilitation than people under 65 years of age, thus, Age - p < 0.05 (p = 0.02) Women have a significantly lower rate of completing cardiac rehabilitation than men, thus, Gender - p < 0.05 (p = 0.02) Access to services was the major factor, reported by 50.8% of respondents (P value is not reported) |
| Huong et al. 2007 | Vietnam | Cross-sectional survey (2002) | Pre-coded structured questionnaire Stratified sampling method 2087 |
18% | Patient delay Being female - p < 0.005 Increasing age with increasing distance - p < 0.05 |
| Initial visit to local public health facilities - p < 0.005 Patients delay is longer in rural and remote areas than urban areas - p < 0.005 Healthcare provider (HCP) delay HCP delay is longer for women aged 65 years old and over - p < 0.005 HCP delays were also longer for patients with a high level of education or who visited initially the private sector - p < 0.001 HCP delays were also longer for patients living at more than 5 km distance from the health facility - p < 0.005 HCP delays were also longer for patients living in rural areas - p < 0.0001 |
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| Ingold et al. 2000 | Switzerland | Appropriateness Evaluation Protocol (AEP) (1995-1996) | Research nurse interview Patients who admitted in the hospital 196 |
63.3% | Living alone - p = 0.008 (OR 6.4, 95%CI 1.6 - 24.8) Going out of home - p < 0.05 (p = 0.003) Receive formal in-home help - p < 0.05 (p = 0.031) Depression - significant (P value is not reported) |
| Jordan et al. 2011 | Australia | Cross-sectional study (1996-2004) | Telephone survey Randomly selected 944 |
53.7% | No formal education - p < 0.005 (p = 0.02) Self-management advice for heart failure of women - significant (P value is not reported) Medication taking behavior - significant (P value is not reported) |
| Judd et al. 2006 | Australia | Cross-sectional community survey | Survey Random selection 467 |
28% | Distress - significant (P value is not reported) Lower stoicism - significant (P value is not reported) |
| Judd et al. 2008 | Australia | Cross-sectional community survey | Survey Random selection 579 |
25% | Education equal or less than 12 years of schooling - p < 0.05 Stoicism - significant (P value is not reported) Perceived stigma - significant (P value is not reported) |
| Mariolis et al. 2008 | Greece | Cross sectional study (2006) | Survey questionnaire Stratified randomization 375 |
30% | Lack of education - p < 0.001 Distance to healthcare centers - p < 0.001 Lack of primary healthcare services - significant (P value is not reported) |
| Melese et al. 2004 | Ethiopia | Population-based survey | Interview Multistage cluster sampling 850 |
35% | Direct cost (inability to pay for the medical care) (25.6% respondents reported it as a barrier) - p < 0.05 Indirect cost (lack of money to cover the cost of transport, food and lodging expense for the patient and accompanying person) - (35.4% respondents reported it as a barrier) - p < 0.05 No one to give company - (9.4% respondents reported it as a barrier) - significant (P value is not reported) Distance and lack of transport - significant (P value is not reported) |
| Onwubiko et al. 2014 | Nigeria | Population based, cross sectional descriptive survey (2011) | Researcher administered questionnaire Multi stage cluster random sampling 501 |
40% | Possession of formal education - p < 0.001 (OR 0.3; CI 0.1-0.5) Living alone - p = 0.01 (OR 2.26; CI 1.41-3.63) Ignorance (56.5% respondents reported it as a barrier) - (P value is not reported) Healthcare cost (59.2% respondents reported it as a barrier) - (P value is not reported) Restricted spatial access (67.9% respondents reported it as a barrier) - (P value is not reported) Self-assessment of eye diseases as not serious enough (31.3% respondents reported it as a barrier) - (P value is not reported) Belief that ageing has no cure (20.2% respondents reported it as a barrier) - (P value is not reported) Preference to spiritual treatment (0.9% respondents reported it as a barrier) - (P value is not reported) |
| Peltzer 2004 | South Africa | Empirical study Health belief model given by Brown and Segal (2000) |
Face to face interview with self-administered questionnaire 100 |
30% | Took something else for high blood pressure apart from prescription medication - p < 0.001 Faith healing - p < 0.001 Using over the counter drugs - p < 0.05 Cost of medications - p < 0.001 Forgetting to take medications - - p < 0.001 Ignorance of side effects - p < 0.001 Has not explained the medical problems to patients - p < 0.01 |
| Pullen et al. 2001 | USA | Descriptive correlational design (Health Behavioral models) | Computer-assisted interviewing system (Telephone survey) Convenience sampling 102 |
100% | The influence of providers’ recommendations on service utilization - p < 0.001 Distance - significant (P value is not reported) Sources of health information - significant (P value is not reported) |
| Masud et al. 2005 | Bangladesh | Baseline survey (Health Behavioral model) (2003) | Structured interviews Random selection 966 |
62% | Self-care tendency - significant (P value is not reported) Education to seek healthcare from formal allopathic healthcare providers - p < 0.01 (OR 1.50; CI 1.15 - 1.96) Poverty to seek healthcare from formal allopathic healthcare providers - p < 0.05 (OR 0.75; CI 0.60 - 0.95) |
| Weaver and Gjesfjeld 2014 | USA | Cross-sectional study (Multivariate logistic regression) (2002-2003) |
Telephone survey Second-stage randomization 4,311 |
35% | Education- p < 0.01 Household income - p < 0.01 No insurance in the past year - p < 0.001 Easy source of care - p < 0.01 Contact doctor as last resort - p < 0.05 |
| Xu and Borders 2003 | USA | Longitudinal survey (Behavioral model) (2001) | Telephone interview Random selection 1062 |
71.56% | Education less than high school - p = 0.05 Employment (not working) - p = 0.04 Insurance coverage (no insurance) - p < 0.01 Not taking prescription drugs - p < 0.01 Lack of pharmacies - p < 0.01 |
| Yamasaki-Nakagawa et al. 2001 | Nepal | Cross-sectional study | Face-to-face interviews 336 |
15% | Education (illiteracy) - p < 0.001 Travelling time - p < 0.001 (Women had a longer total delay than men, p = 0.034) Initial visit to a traditional healer - p < 0.001 (P = 0.012) Fees paid to healthcare providers - significant (P value is not reported) |
| Young et al. 2000 | Australia | Longitudinal Study (1996 – 1997) |
Postal questionnaire Community sampling 4,577 |
40% | Out of pocket payment - significant (P value is not reported) Shortage of female GPs - significant (P value is not reported) Poor access to afterhours care – significant (P value is not reported) Waiting times - significant (P value is not reported) Cost of GP visit - significant (P value is not reported) |
| Young et al. 2001 | Australia | Longitudinal Study (1997) | Baseline survey through HSS questionnaire Random selection 4452 |
47% | Out of pocket payment per GP visit - p < 0.001 Distance - p < 0.001 Skepticism (the value of medical care) - p < 0.001 |
| Abdulraheem 2007 | Nigeria | Cross-sectional study (2004) | Survey & Interviews Proportional sampling 1125 |
54% | Poverty reduces the number of seeking healthcare from qualified medical practitioner - 0.46 (0.38 - 0.67) Education increases the number of seeking healthcare from qualified medical practitioners - 0.59 (0.48-0.87) Distance - significant (p value is not reported) Waiting times - significant (p value is not reported) Availability of services - significant (p value is not reported) Living alone - significant (p Value is not reported) |
| Adu-Gyamfi and Abane 2013 | Ghana | Human ecology of disease triangle model (Life-cycle determinant model given by (Meade & Earickson in 2000) |
Questionnaire and interview guide Multi-stage sampling 120 |
10% | Place of residence in terms of healthcare centers - p < 0.05 (p = 0.021) Utilization of healthcare facilities outside one’s locality considering time, distance, cost of transport and the nature of the roads - p < 0.05 (p = 0.001) Education - significant (p value is not reported) Married women utilize local healthcare facilities more than single people p< 0.05 (p = 0.027) Health insurance coverage - significant (p value is not reported) Inadequacy of health care facilities such as personnel, equipment and medicine significant (p Value is not reported) |
| Blay et al. 2008 | Brazil | Cross-sectional study (1995-1996) | Structured in-person interviews Multi stage random sampling 7040 |
66.0% | Education (< 4 years / 4+ years) - Demographic+ Health Conditions - for outpatient visit: 0.88 (0.74 - 1.05) Education (< 4 years / 4+ years) - Demographic+ Health Conditions - for any hospitalization: 1.34 (1.08-1.65) |
| Education (< 4 years / 4+ years) - Demographic+ Health Conditions - for more than one hospitalization: 1.12 (0.73-1.72) Income (0 = low, 1 = high) - Demographic+ Health Conditions – for outpatient visit: 1.16 (1.01–1.34) Income (0 = low, 1 = high) - Demographic+ Health Conditions – for any hospitalization: 1.03 (0.89-1.20) Income (0 = low, 1 = high) - Demographic + Health Conditions - for more than one hospitalization: 1.01 (0.76-1.35) Employment (0 = No, 1 = Yes) - Demographic + Health Conditions - for outpatient visit: 0.72 (0.60-0.85) Employment (0 = No, 1 = Yes) - Demographic + Health Conditions - for any hospitalization: 0.84 (0.68-1.04) Employment (0 = No, 1 = Yes) - Demographic + Health Conditions - for more than one hospitalization: 0.66 (0.42-1.05) Private health insurance (0 = No, 1 = Yes) - Demographic + Health Conditions - for outpatient visit: 2.42 (2.11-2.77) Private health insurance (0 = No, 1 = Yes) - Demographic + Health Conditions - for any hospitalization: 1.18 (1.03-1.36) Private health insurance (0 = No, 1 = Yes) - Demographic + Health Conditions - for more than one hospitalization: 1.18 (0.91-1.52) |
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| De-Guzman et al. 2014 | Philippine | Health Belief Model and Healthcare Utilization Model conjoint analysis (2012) |
Survey 304 |
64.14% | Quality of health care service - p < 0.05 Cost of health care services - p < 0.05 Extent of information received from health care provider - p < 0.05 A weak positive relationship was identified between private practice and educational attainment (r =.152) and income (r =.206) A weak negative correlation was noted in terms of preference to seek health care from a health center, (r =.173) |
| Heinrick et al 2008 | Germany | Cross-sectional study | Health economic interview Randomly selected 452 |
64.0% | Healthcare costs (95% CI 3203-4257) with no significant difference between sexes. This healthcare cost includes: Inpatient care cost - no significant difference identified between men and women Pharmaceuticals cost - p < 0.05 (p = 0.002) Cost for outpatient physician services - no significant difference identified between men and women Assisted living - p < 0.05 (p = 0.008) Medical supply and dentures - p < 0.05 (p = 0.019) |
| Outpatient non-physician services - p < 0.05 (p = 0.023) Transportation cost - no significant difference identified between men and women - significant (p value is not reported) |
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| Iecovich and Carmel 2009 | Israel | Behavioral model (2006) | Face-to-face interviews Stratified sample 1255 |
56.8% | Economic difficulties in visiting specialists - p < .01 Mobility difficulties in visiting specialists - p < .001 Transportation difficulties in visiting specialists - p < .001 Education - significant (p value is not reported) |
| Odaman and Ibiezugbe 2014 | Nigeria | Behavioral model | Face to face interview Systematic random sampling 514 |
50.8% | Females have less financial responsibility than males for medical needs - significant (p value is not reported) Financial dependency increases on children with age (30.6% to 50.6% and 80.0% at ages 65-74 years, 75-84 years and 85+ years respectively) - (p value is not reported) |
| Ruthig et al. 2009 | USA | Cross sectional study | In-person interviews Systematic random sampling 6813 |
61% | Education - p < .001 Income - p < .001 Lack of health insurance - p < .001 Absence of regular care provider - p < .001 |
| Sharma, Mazta and Parashar 2013 | India | Cross-sectional study (2010-2011) | Interview Simple random sampling 400 |
25% | Perception that disease due to age (49.6% respondents reported it as a barrier) - p value is not reported Health services too far (19.1% respondents reported it as a barrier) - p value is not reported Use of over the counter drugs (12.5% respondents reported it as a barrier) - p value is not reported Trust god for healing (15.8% respondents reported it as a barrier) - p value is not reported Lack of money (6.0% v) - p value is not reported No body to take to hospital (3.5% respondents reported it as a barrier) - p value is not reported Poor attitude of healthcare workers (6.0% respondents reported it as a barrier) - p value is not reported |
| Sudore et al. 2006 | USA | Cross-sectional study (1999-2000) | An in-person clinic assessment of health literacy Random sampling 2512 |
52% | Limited health literacy - p < .01(OR 51.55; CI 51.03-2.34) Income - p < .001 Depression - p < .001 Lacking insurance for medications (OR51.73; CI 51.23-2.43) Shortage of doctors - p < .01 |
| Liu et al. 2007 | China | Cross sectional study (2006) | Standardized questionnaire Random sampling 550 |
45.8% | Women living alone had visited or telephoned a physician less than the women living with children - p < .05 Women living alone have lower income than women living with children - significant (p value is not reported) Cost (64% empty nesters reported it as a barrier) - p < .01 |
| Lack of coverage by the health plan (37% empty nesters reported it as a barrier) - p < .01 Inability to find someone to take the individual to the provider’s office (28% empty nesters reported it as a barrier) - p < .01 Lack of healthcare information (24% empty nesters reported it as a barrier) - significant (p value is not reported) Long waiting time for an appointment (24% empty nesters reported it as a barrier) - significant (p value is not reported) Bad experience with healthcare system (21% empty nesters reported it as a barrier) - significant (p value is not reported) Distance to healthcare centers (18% empty nesters reported it as a barrier) - significant (p value is not reported) Did not think visiting a doctor could help (18% empty nesters reported it as a barrier) - significant (p value is not reported) Could not contact a familiar physician (12% empty nesters reported it as a barrier) - significant (p value is not reported) |
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| Borders 2004 | USA | Behavioral Model | Telephone survey 2,097 |
70.0% | Always see personal doctor/nurse - p < 0.05 Always see specialists - p < 0.001 Getting care after long waiting times (Always/usually see doctor/nurse as soon as want for routine care) - p < 0.05 Health insurance coverage - p < 0.05 Transportation difficulties - p < 0.001 |
| Hong et al. 2004 | USA | Cross sectional study | Interviewed by telephone Random digit dialing sampling 586 |
52% rural women, however, the number of elderly women were not specified | Health insurance coverage - p < 0.05 (p = 0.0001) Transportation - p < 0.05 (p = 0.02) |
| Nipun et al. 2015 | India | Cross sectional study (2013-2014) | Face-to- face interview Systematic random sampling 200 |
50% | Education - p < 0.05 (p = 0.0298) Socioeconomic status - p < 0.05 (p = 0.0409) Cannot afford (36% respondents reported it as a barrier) - significant (p value is not reported) Long waiting time (16% respondents reported it as a barrier) - significant (p value is not reported) Long distance (16% respondents reported it as a barrier) - significant (p value is not reported) |