Healthcare Decision-Making Autonomy Among Rural Indonesian Women: The interplay of cultural, educational, and economic factors

Abstract

Background: Autonomy in health decision-making is an important indicator of individual empowerment, especially for women in rural areas. Factors such as cultural norms, family dynamics, geographic access to health services, education level, health literacy, and economic status are thought to influence an individual's ability to determine his or her health measures independently. This study aims to analyze the influence of cultural norms, family dynamics, geographic access to health services, education level, health literacy, and economic status on health decision-making autonomy. This study uses a quantitative design with a cross-sectional approach.

Methods: A total of 720 female respondents of productive age in three rural districts were selected by stratified random sampling. The instrument used is a structured questionnaire that has been validated. Data analysis was carried out multivariate using multiple linear regression using the SPSS program.

Results: Results showed that all independent variables had a significant effect on health decision-making autonomy (p < 0.05). The variable of geographic access to health services had the greatest influence (β = 0.41, 95% CI= 0.30-0.42, p= <0.001), followed by family dynamics (β = 0.22, 95% CI= 0.17-0.30, p= <0.001), education level (β = 0.14, 95% CI= 0.41-1.30, p= <0.001), health literacy (β = 0.12, 95% CI= 0.04-0.14, p= <0.001), cultural norms (β = 0.09, 95% CI= 0.02-0.10, p=0.007), and economic status (β = 0.08, 95% CI=0.01-0.14, p=0.020).

Conclusion: Health decision-making autonomy is significantly influenced by social, economic, and cultural factors. Autonomy-enhancing interventions should consider a multidimensional approach that includes economic empowerment, education, health literacy, and socio-cultural change at the community level.