Factors Associated with the Patient’s Decision to Avoid Healthcare during the COVID-19 Pandemic

Abstract

The COVID-19 pandemic has resulted in changes in healthcare use. This study aimed to identify factors associated with a patient’s decision to avoid and/or delay healthcare during the COVID-19 pandemic. We used data from a community-based survey in Portugal from July 2020 to August 2021, “COVID-19 Barometer: Social Opinion”, which included data regarding health services use, risk perception and confidence in health services. We framed our analysis under Andersen’s Behavioural Model of Health Services Use and utilised Poisson regression to identify healthcare avoidance associated factors. Healthcare avoidance was high (44%). Higher prevalence of healthcare avoidance was found among women; participants who reported lower confidence in the healthcare system response to COVID-19 and non-COVID-19; lost income during the pandemic; experienced negative emotions due to physical distancing measures; answered the questionnaire before middle June 2021; and perceived having worse health, the measures implemented by the Government as inadequate, the information conveyed as unclear and confusing, a higher risk of getting COVID-19, a higher risk of complications and a higher risk of getting infected in a health institution. It is crucial to reassure the population that health services are safe. Health services should plan their recovery since delays in healthcare delivery can lead to increased or worsening morbidity, yielding economic and societal costs.

Healthcare Avoidance before and during the COVID-19 Pandemic among Australian Youth: A Longitudinal Study

“…Moreover, large proportions of outpatient and primary healthcare have moved to telehealth since the declaration of COVID-19 as a global pandemic in 2020 [ 9 , 10 ]. This unprecedented and sudden reconstruction of the healthcare system might account for some of the reductions in service access, but it could also be explained by patients’ avoidance of healthcare due to a fear of contracting COVID-19 [ 11 ]. It is commonly known that ‘avoidance’ refers to the act of physically and/or mentally moving away from something, and has been described previously in the context of traumatic or threatening situations such as this COVID-19 pandemic [ 11 , 12 ].…”

“…This unprecedented and sudden reconstruction of the healthcare system might account for some of the reductions in service access, but it could also be explained by patients’ avoidance of healthcare due to a fear of contracting COVID-19 [ 11 ]. It is commonly known that ‘avoidance’ refers to the act of physically and/or mentally moving away from something, and has been described previously in the context of traumatic or threatening situations such as this COVID-19 pandemic [ 11 , 12 ]. Healthcare avoidance is often defined by missing appointments, failing to adhere to therapy, and delaying or avoiding medical care due to cost, time, fear, or a denial of symptoms, among other variables [ 12 , 13 ].…”

“…In several countries, regardless of COVID-19 incidence rates, the proportion of individuals who delayed or avoided healthcare access increased [ 11 ]. For example, a study reported about 40% of the surveyed sample (n = 4977) avoided healthcare due to COVID-19 when the total number of COVID-19 cases was around 2.5 million in the US [ 15 ], while another study conducted in Korea found that more than 70% of their respondents (n = 1000) avoided healthcare in response to the COVID-19 pandemic [ 13 ].…”

“…Young people’s mental and physical health has been adversely affected during the COVID-19 pandemic, and this is compounded by an avoidance of healthcare [ 23 , 27 ]. Researchers have demonstrated that individuals who avoided healthcare due to a fear of infection experienced an increased severity of their diseases and an increased mortality has been observed in part due to greater barriers to treatment [ 11 ]. In Australia, the COVID-19 pandemic worsened three-quarters of young people’s mental health, resulting in greater help-seeking for mental health problems during pandemic periods, whereas help-seeking for other health issues was either similar or reduced [ 28 , 29 , 30 , 31 ].…”

“…Healthcare avoidance has been reported worldwide [ 11 , 13 , 32 ]. Contextualising real or perceived healthcare access barriers and identifying factors related to avoiding healthcare can help healthcare systems, researchers, and policymakers find solutions to overcome these barriers [ 33 , 34 , 35 ].…”