Title : Patterns of health care seeking behavior among adults with recent health issues in the Dominican Republic
Abstract:
Background: Health-care-seeking behavior among adults is shaped by intersecting socioeconomic, perceptual, and system-level factors that have been documented across Latin America. Evidence shows that many adults initially interpret symptoms through personal and social lenses and resort to self-medication or pharmacy purchases, turning to formal facilities only when the condition is judged serious. Obstacles such as long waiting times, limited provider availability, transportation difficulties, and insufficient health information delay timely care even when services are nominally free. Building on these regional and local insights, this study investigates the patterns of health care seeking among adults who reported a recent health issue in Santiago and Santo Domingo.
Methodology: A secondary analysis was conducted using data from the 2024 Provincial Health Survey (ENPASA), implemented by the Ministry of Public Health and the Pontificia Universidad Católica Madre y Maestra. The study included adults (≥18 years) residing in Santo Domingo and Santiago who reported a recent health problem. Health care seeking behavior as outcome was categorized as use of public or private health facilities, health issue or physical trauma, health care provider, and medical management. Independent variables included sex, age group, health insurance coverage and type, and city of residence. Descriptive analyses and chi-square tests were performed using SPSS version 19, with statistical significance set at p<0.05.
Results: A total of 1,290 adults (666=51.6% from Santo Domingo; 624=48.4% from Santiago) were included. Overall, 77.5% engaged in healthcare seeking behavior, 81.9% in Santo Domingo versus 73.9% in Santiago (p<0.01). Health insurance coverage was high (88.7% overall; 59.2% private, 40.8% public). 46.3% used public facilities, 43.1% private centers, 6.9% pharmacies, and 3.8% other sites; thus 88.9% were managed by formal providers. In Santo Domingo, half of the users preferred public facilities, whereas in Santiago private centers were more common. 80.62% of the participants obtained treatment prescribed by health care provider. Women reported a recent health problem more often than men (14.5% vs 8.8%; p=0.002). Young adults (18–25 yrs) were more likely to seek care from pharmacies (33.3%; =0.007) compared to older age groups, who predominantly used formal services. 61.1% of participants who did not seek medical care reported receiving treatment, compared to 86.3% among those who sought care (p=0.001).
Conclusion: Healthcare-seeking behavior among adults in the Dominican Republic is generally high and predominantly directed toward formal providers. Utilization was lower in Santiago than in Santo Domingo, and differences by sex and age were evident, with young adults more likely to rely on pharmacies. Despite high insurance coverage, a considerable proportion did not seek professional care, suggesting that factors beyond financial access influence care-seeking patterns. Targeted strategies are needed to promote equitable and appropriate healthcare utilization.
Keywords: Adult, Disease, Dominican Republic, Health Care Seeking Behavior, Insurance Coverage, Physical Trauma, Self-Medication
