Determinants of health-seeking behaviour among internal migrants in Ghana: A study of the North South migration

Abstract

Background: Healthcare access and utilisation among internal migrants in Ghana present complex challenges influenced by various social, economic, and structural factors. Addressing these challenges requires a comprehensive understanding of the barriers and facilitators shaping health-seeking behaviour within this population. This study aims to provide such insights by thoroughly examining the determinants of health-seeking behaviour among internal migrants in Ghana. Methods: This study utilised multiple approaches to answer the research questions. These approaches included a literature review, two quantitative analyses using regressions, two qualitative analyses involving a Delphi, and in-depth interviews. A systematic review was initially conducted to identify the gaps in the literature regarding the determinants of health-seeking behaviour in Africa. Regression analyses were then conducted to identify the barriers and facilitators of health-seeking behaviour among internal migrants in Ghana using the Ghana Living Standard Survey Round 7 (GLSS7) dataset from the Ghana Statistical Service (GSS). Using the same dataset, regressions were conducted to measure the impact of healthcare costs on the factors influencing healthcare service utilisation among this vulnerable population. Delphi study to solicit information on the perspective of healthcare deliverers regarding internal migrants’ health-seeking behaviour in Ghana was conducted. Finally, in-depth interviews were conducted to identify the socio-cognitive perceptions regarding internal migrants’ health-seeking behaviour in Ghana. Results: The review revealed gaps in the literature regarding migrant healthcare. The analyses revealed an 8% lower healthcare service utilisation rate among internal migrants, highlighting existing access barriers. Self-care practices were prevalent, with more than 90% of respondents relying on them. Demographic factors significantly influenced healthcare utilisation: individuals aged 18-35 and females exhibited higher utilisation rates. Enabling factors like health insurance and income showed mixed associations, while financial capability strongly influenced healthcare seeking. There was no significant relationship between illness type and service utilisation. Determinants of out-of-pocket healthcare expenditure included age, education, location, marital status, and place of seeking healthcare. Barriers identified through the Delphi study included appointment wait times, language difficulties, and financial constraints, while insurance possession and higher income levels facilitated healthcare access. Policy recommendations focused on active insurance policies and education. Awareness levels varied, with 40% considering healthcare crucial, and coping strategies included reliance on support networks and self-care practices. Conclusion: This study meticulously addresses the barriers and facilitators of health-seeking behaviour among internal migrants in Ghana through four well-defined objectives. Integrating quantitative and qualitative methodologies enhances the exploration, offering nuanced insights into healthcare access and utilisation. The findings contribute significantly to healthcare discourse, providing a reliable foundation for targeted interventions, policy improvements, and future research endeavours, ultimately fostering healthcare equity for internal migrants in Ghana.