TREATMENT SEEKING BEHAVIOUR AND TRIGGERS AMONG PATIENTS WITH CHRONIC ILLNESSES DURING COVID-19 PANDEMIC: A QUALITATIVE STUDY

ABSTRACT

Background: Public health strategies, many of which required restricting movement of people, such as lock-downs and social-distancing measures had to be resorted to world-wide, to reduce the incidence and transmission of COVID-19, leading to a decline in healthcare utilization by non-COVI-19 patients, which is detrimental to people suffering from chronic-illnesses. This study aimed to assess treatment-seeking behavior among patients with chronic illnesses during the pandemic and the new normal. Methods: This qualitative study involved in-depth interviews with sixteen patients aged 30 -55 years with chronic diseases. Three focus group sessions were also held. The indepth interviews and focus group discussions were conducted until saturation point was achieved. Purposive sampling was used, and data were analyzed thematically. The study centers were two public hospitals and one general practitioner setting in Sri Lanka. Findings: Three main themes were identified. Namely, change of treatment seeking behaviour, difficulties in healthcare access and adherence and high out of pocket expenditure. Majority had diabetes, hypertension or both. Trigger factors for changing the healthcare setting during the pandemic were long waiting times, lack of staff to conduct the clinic, lack of drugs and investigations, and fear and anxiety associated with the pandemic. Treatment access and adherence were found difficult due to lack of high expenditure on transportation, prolonged waiting times, difficulties in buying the drugs, and spending on laboratory investigations. The reasons for high cut-off pocket expenditures were mostly for transportation, drugs, consultations and investigation. Some mentioned that due to difficulties in obtaining the treatment, they resort to adopting a healthy lifestyle, taking indigenous medication, and taking the drugs in a different frequency and regime. Very few agreed that they received the drugs via the postal service but stated that this was not regular, and that not all the drugs were available. Conclusion: Healthcare system-related and patient-related factors lead people to change their treatment-seeking behavior. Any health intervention to promote people's treatment-seeking behavior and to continue acess and adherence, especially for a chronic illness, should consider these complex trigger factors of individual needs, goals, and issues.