The Influence of Social and Behavioral Determinants for Promoting Health in Odisha, India - ACHSM Asia-Pacific Health Leadership Congress in Darwin 2025

Abstract

Background: Access to suitable healthcare reflects both service availability and its acceptability to users. While socioeconomic status (SES) is known to influence healthcare utilization, its independent effect on perceived access remains underexplored. This study examines how socioeconomic and behavioural factors shape perceived access to suitable sources of care for acute illnesses in Odisha, India.

Methods: A cross-sectional household survey was conducted from October 2022 to February 2023 across six districts of Odisha, namely, Rayagada, Kalahandi, Angul, Keonjhar, Khordha, and Kendrapara, representing tribal, industrial, and coastal regions. Using a structured questionnaire adapted from the WHO “Manual for Household Survey to Measure Access and Use of Medicine,” data were collected from 902 households, of which 214 (23.7%) reported acute illnesses. Chi-square tests and binary logistic regression were applied to identify determinants of perceived access (Yes/No).

Results: Overall, 66.8% of households reported finding suitable care, while 33.2% did not. Most were rural (84.6%), and 74.3% sought care outside the home. Non-adherence to treatment was observed in 44.4% of cases. In the adjusted logistic model, location, care-seeking behaviour, treatment adherence, and medicine availability were significant predictors. Urban households had higher odds of accessing suitable care (AOR = 12.67, 95% CI = 1.73–92.82) than rural ones. Households seeking care outside the home (AOR = 4.24), adhering to prescribed medicines (AOR = 14.08), and maintaining medicine stock (AOR = 4.96) were more likely to perceive suitable care. Traditional SES indicators lost significance after adjustment.

Conclusion: Behavioural and attitudinal factors outweighed socioeconomic indicators in determining perceived access to suitable healthcare. Strengthening health communication, promoting adherence, and addressing trust deficits in modern medicine are essential to improve utilization. Policy interventions should bridge rural–urban gaps and integrate culturally acceptable care models to ensure equitable access.