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The World Is Not Mine – Barriers to Healthcare Access for Bangladeshi Rural Elderly Women

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Abstract

Social determinants of health is a core cross-cutting approach of the World Health Organization to reduce health inequalities, and places an emphasis on aged care planning in rural areas of low- and lower-middle income countries including Bangladesh. The complex correlated health and social factors in Bangladesh interplay to shape the healthcare access of rural people. This impact is significant for rural elderly women in particular who have been shown to access healthcare in ways that are described as ‘socially determined’. This study aimed to explore how this cohort related their healthcare access to their living circumstances and provided insight into how their healthcare access needs can be addressed. This study was a critical social theoretical exploration from conversational interviews held over three months with 25 elderly women in rural Bangladesh. Two critical social constructs, ‘emancipation’ of Habermas and ‘recognition’ of Honneth, were used in the exploration and explanation of the influence of personal circumstances, society and system on rural elderly women’s healthcare access. The concept of ‘social determinants of healthcare access’ is defined from the physical, emotive, symbolic and imaginative experiences of these women. Interviewing the women provided information for exploration of the determinants that characterized their experiences into an overall construct of ‘The World is Not Mine’. This construct represented four themes focusing on the exclusion from healthcare, oppressive socioeconomic condition, marginalization in social relationships and personal characteristics that led the women to avoid or delay access to modern healthcare. This study confirms that the rural elderly women require adequate policy responses from the government, and also need multiple support systems to secure adequate access to healthcare. As healthcare services are often a reflection of community values and human rights concerns for the elderly, there is a need of recognition and respect of their voice by the family members, society and the healthcare system in planning and implementation of a prudent aged care policy for rural elderly women in Bangladesh.

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Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

SDoH:

Social determinants of health

MHS:

Modern healthcare services

References

  • Abdulraheem, I. S. (2007). Health needs assessment and determinants of health-seeking behaviour among elderly Nigerians: a house-hold survey. Annals of African Medicine, 6(2), 58–63.

    Article  Google Scholar 

  • Ahern, A., & Hine, J. (2015). Accessibility of health services for aged people in rural Ireland. International Journal of Sustainable Transportation, 9(5), 389–395.

    Article  Google Scholar 

  • Alam, N., & Barkat-e-Khuda. (2014). Demographic events and economic conditions of rural households in Bangladesh. Asian Population Studies, 10(3), 304–318.

    Article  Google Scholar 

  • Allen, L., Williams, J., Townsend, N., Mikkelsen, B., Roberts, N., Foster, C., & Wickramasinghe, K. (2017). Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review. The Lancet Global Health, 5(3), 277–289.

    Article  Google Scholar 

  • Ameh, S., Gómez-Olivé, F. X., Kahn, K., Tollman, S. M., & Klipstein-Grobusch, K. (2014). Predictors of health care use by adults 50 years and over in a rural south African setting. Global Health Action, 7(1), 24771.

    Article  Google Scholar 

  • Amin, I. (2017). Perceptions of successful aging among older adults in Bangladesh: an exploratory study. Journal of Cross-Cultural Gerontology, 32(2), 191–207.

    Article  Google Scholar 

  • Andaleeb, S. S., Siddiqui, N., & Khandakar, S. (2007). Patient satisfaction with health services in Bangladesh. Health Policy and Planning, 22(4), 263–273.

    Article  Google Scholar 

  • Araujo, T. D. M., & Iório, M. C. M. (2014). Profile of the elderly population referred for hearing aid fitting in a public hospital. Audiology-Communication Research, 19(1), 45–51.

    Article  Google Scholar 

  • Arcury, T. A., Preisser, J. S., Gesler, W. M., & Powers, J. M. (2005). Access to transportation and health care utilization in a rural region. The Journal of Rural Health, 21(1), 31–38.

    Article  Google Scholar 

  • BBS. (2011). Report of population and housing census. Dhaka: Bangladesh Bureau of Statistics. Ministry of Planning.

    Google Scholar 

  • BBS. (2012). Gender statistics of Bangladesh. Dhaka: Bangladesh Bureau of Statistics. Ministry of Planning.

    Google Scholar 

  • BBS. (2015). Adjusted population and housing census. Dhaka: Bangladesh Bureau of Statistics, Ministry of Planning.

    Google Scholar 

  • Begum, S., & Wesumperuma, D. (2012). Overview of the old age allowance programme in Bangladesh. In S. W. Handayani & B. Babajanian (Eds.), Social protection for older persons: Social pensions in Asia. Asian Development Bank: Philippines.

    Google Scholar 

  • Bergeron, C. D., Hilfinger Messias, D. K., Friedman, D. B., Spencer, S. M., & Miller, S. C. (2018). Involvement of family members and professionals in older women’s post-fall decision making. Health Communication, 33(3), 246–253.

    Article  Google Scholar 

  • Biswas, P., Kabir, Z. N., Nilsson, J., & Zaman, S. (2006). Dynamics of health care seeking behaviour of elderly people in rural Bangladesh. International Journal of Ageing and Later Life, 1(1), 69–89.

    Article  Google Scholar 

  • Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.

    Article  Google Scholar 

  • Braun, V., & Clarke, V. (2014). What can “thematic analysis” offer health and wellbeing researchers? International Journal of Qualitative Studies on Health and Well-Being, 9(26152), 1–2.

    Google Scholar 

  • Braveman, P., & Gottlieb, L. (2014). The social determinants of health: it's time to consider the causes of the causes. Public Health Reports, 129(1_suppl2), 19–31.

    Article  Google Scholar 

  • Braveman, P., Egerter, S., & Williams, D. R. (2011). The social determinants of health: coming of age. Annual Review of Public Health, 32, 381–398.

    Article  Google Scholar 

  • Brinda, E. M., Kowal, P., Attermann, J., & Enemark, U. (2015). Health service use, out-of-pocket payments and catastrophic health expenditure among older people in India: the WHO study on global AGEing and adult health. Journal of Epidemiology and Community Health, 69(5), 489–494.

    Article  Google Scholar 

  • Fairclough, N. (2013). Critical discourse analysis and critical policy studies. Critical Policy Studies, 7(2), 177–197.

    Article  Google Scholar 

  • Ferdous, T., Kabir, Z. N., Wahlin, Å., Streatfield, K., & Cederholm, T. (2009). The multidimensional background of malnutrition among rural older individuals in Bangladesh–a challenge for the millennium development goal. Public Health Nutrition, 12(12), 2270–2278.

    Article  Google Scholar 

  • Ferdous, T., Cederholm, T., Kabir, Z. N., Hamadani, J. D., & Wahlin, Å. (2010). Nutritional status and cognitive function in community-living rural Bangladeshi older adults: data from the poverty and health in ageing project. Journal of the American Geriatrics Society, 58(5), 919–924.

    Article  Google Scholar 

  • Habermas, J. (1984). The theory of communicative action (Vol. 1). Boston: Beacon press.

    Google Scholar 

  • Habermas, J. (1989). The theory of communicative action. Lifeworld and system: A critique of functionalist reason (Vol. 2). Boston: Beacon press.

    Google Scholar 

  • Hamiduzzaman, M. (2018). The world is not mine: Factors and issues of rural elderly women’s access in medical care services in Bangladesh. PhD Thesis. Adelaide: Flinders University.

  • Hamiduzzaman, M. (2020). Self-reported seasonal symptoms and diseases and primary healthcare utilization among rural elderly women in Sylhet district, Bangladesh. Journal of UOEH, 42(2), 175–185.

    Article  Google Scholar 

  • Hamiduzzaman, M., De Bellis, A., Kalaitzidis, E., & Abigail, W. (2016). Factors impacting on elderly women’s access to healthcare in rural Bangladesh. Indian Journal of Gerontology, 30(2), 235–260.

    Google Scholar 

  • Hamiduzzaman, M., De Bellis, A., Abigail, W., & Kalaitzidis, E. (2017). The social determinants of healthcare access for rural elderly women - a systematic review of quantitative studies. The Open Public Health Journal, 10(1), 244–266.

    Article  Google Scholar 

  • Hamiduzzaman, M., de Bellis, A., Abigail, W., & Kalaitzidis, E. (2018a). Elderly women in rural Bangladesh: Healthcare access and ageing trends. South Asia Research, 38(2), 113–129.

    Article  Google Scholar 

  • Hamiduzzaman, M., De Bellis, A., Abigail, W., & Kalaitzidis, E. (2018b). Social determinants of rural elderly women’s healthcare access: a systematic review of qualitative literature. The Indian Journal of Social Work, 79(4), 469–496.

    Article  Google Scholar 

  • Hamiduzzaman, M., Torres, S., Fletcher, A., Islam, M. R., & Greenhill, J. (2020). Aging, care and dependency in multimorbidity: How relationships affect older Bangladeshi women use of homecare and health services. MedRxiv. https://www.medrxiv.org/content/medrxiv/early/2020/06/22/2020.06.19.20126078.full.pdf

  • Honneth, A. (2001). Recognition or redistribution? Theory, Culture and Society, 18(2–3), 43–55.

    Article  Google Scholar 

  • Honneth, A. (2007). Recognition as ideology. In B. V. D. Brink & D. Owen (Eds.), Recognition and power: Axel Honneth and the tradition of critical social theory. Cambridge: Cambridge University Press.

    Google Scholar 

  • Hossen, A. (2010). Bringing medicine to the hamlet: Exploring the experiences of older women in rural Bangladesh who seek health care. PhD thesis. Canada: Wilfrid Laurier University.

  • Hossen, M. A. (2016). Older women (user) perspective toward service delivery system of government hospital: a study on some upazila health complex of Bangladesh. Society & Change, 10(1), 18–27.

    Google Scholar 

  • Hossen, A., & Westhues, A. (2010). A socially excluded space: restrictions on access to health care for older women in rural Bangladesh. Qualitative Health Research, 20(9), 1192–1201.

    Article  Google Scholar 

  • Hossen, M. A., & Westhues, A. (2011). Rural women's access to health care in Bangladesh: swimming against the tide? Social Work in Public Health, 26(3), 278–293.

    Article  Google Scholar 

  • Hossen, A., & Westhues, A. (2012). In search of healing between two worlds: the use of traditional and modern health services by older women in rural Bangladesh. Social Work in Health Care, 51(4), 327–344.

    Article  Google Scholar 

  • Hossen, A., & Westhues, A. (2013). Bangladeshi elderly immigrants in Southern Ontario: Perspectives on family roles and intergenerational relations. Journal of International Social Issues, 2(1), 1–15.

  • Huang, H., Sharifian, F., Feldman, S., Yang, H., Radermacher, H., & Browning, C. (2018). Cross-cultural conceptualizations of ageing in Australia. Cognitive Linguistic Studies, 5(2), 261–281.

    Article  Google Scholar 

  • Iecovich, E., & Carmel, S. (2009). Differences in accessibility, affordability, and availability (AAA) of medical specialists among three age-groups of elderly people in Israel. Journal of Aging and Health, 21(5), 776–797.

    Article  Google Scholar 

  • Islam, M. N., & Nath, D. C. (2012). A future journey to the elderly support in Bangladesh. Journal of Anthropology, 2012, 1–6.

    Article  Google Scholar 

  • Jordan, S., Wilson, A., & Dobson, A. (2011). Management of heart conditions in older rural and urban Australian women. Internal Medicine Journal, 41(10), 722–729.

    Article  Google Scholar 

  • Kabir, Z. N., Ferdous, T., Cederholm, T., Khanam, M. A., Streatfied, K., & Wahlin, Å. (2006). Mini nutritional assessment of rural elderly people in Bangladesh: the impact of demographic, socio-economic and health factors. Public Health Nutrition, 9(8), 968–974.

    Article  Google Scholar 

  • Kabir, R., Khan, H. T., Kabir, M., & Rahman, M. T. (2013). Population ageing in Bangladesh and its implication on health care. European Scientific Journal, 9(33), 34–47.

    Google Scholar 

  • Kalam, I. M., & Khan, H. T. (2006). Morbidities among older people in Bangladesh: evidence from an ageing survey. BRAC University Journal, 3(2), 75–83.

    Google Scholar 

  • Kalin, Y. (2011). Access to and Utilization of Health Services in Rural Bangladesh-A Gender Perspective. Master’s thesis. Sweden: Lund University.

  • Lee, Y. M., Yu, H. Y., You, M. A., & Son, Y. J. (2017). Impact of health literacy on medication adherence in older people with chronic diseases. Collegian, 24(1), 11–18.

    Article  Google Scholar 

  • Marmot, M., Friel, S., Bell, R., Houweling, T. A., Taylor, S., & Commission on Social Determinants of Health. (2008). Closing the gap in a generation: health equity through action on the social determinants of health. The Lancet, 372(9650), 1661–1669.

    Article  Google Scholar 

  • Miyawaki, C. E. (2015). A review of ethnicity, culture, and acculturation among Asian caregivers of older adults (2000-2012). SAGE Open, 5(1), 21–58.

    Article  Google Scholar 

  • Nipun, A., Prakash, S. V., Kumar, S. A., & Danish, I. (2015). Healthcare services utilization by geriatric population in rural area of district Bareilly, India. International Journal of Current Microbiology and Applied Sciences, 4(5), 720–727.

    Google Scholar 

  • Rahman, M. M. (2009). Health status and health needs among the aged population in Chapai Nawabganj district of Bangladesh. Indian Journal of Gerontology, 23(1), 32–41.

    Google Scholar 

  • Read, S., Grundy, E., & Foverskov, E. (2016). Socio-economic position and subjective health and well-being among older people in Europe: a systematic narrative review. Aging & Mental Health, 20(5), 529–542.

    Article  Google Scholar 

  • Strasser, R., Kam, S. M., & Regalado, S. M. (2016). Rural health care access and policy in developing countries. Annual Review of Public Health, 37, 395–412.

    Article  Google Scholar 

  • Sultana, A. M. (2010). Socio-cultural dimensions of women’s discriminations in rural communities. Ozean Journal of Social Sciences, 3(1), 31–38.

    Google Scholar 

  • Sun, X., Liu, K. U. N., Webber, M. P., & Shi, L. (2017). Individual social capital and health-related quality of life among older rural Chinese. Ageing and Society, 221–242.

  • Terraneo, M. (2015). Inequities in health care utilization by people aged 50+: evidence from 12 European countries. Social Science & Medicine, 126, 154–163.

    Article  Google Scholar 

  • Tran, B. X., Nguyen, L. H., Nong, V. M., & Nguyen, C. T. (2016). Health status and health service utilization in remote and mountainous areas in Vietnam. Health and Quality of Life Outcomes, 14(1), 85.

    Article  Google Scholar 

  • Uddin, M. N., & Hamiduzzaman, M. (2009). Problems and prospects of decentralised rural healthcare system in Bangladesh. SUST Journal of Public Administration, 2(1), 47–75.

    Google Scholar 

  • Uddin, M. T., Islam, M. N., Alam, M. J., & Baher, G. U. (2010). Socio-eonomic status of elderly of Bangladesh: a statistical analysis. Journal of Applied Sciences, 10(23), 3060–3067.

    Article  Google Scholar 

  • Zhang, X., Dupre, M. E., Qiu, L., Zhou, W., Zhao, Y., & Gu, D. (2017). Urban-rural differences in the association between access to healthcare and health outcomes among older adults in China. BMC Geriatrics, 17(1), 151–161.

    Article  Google Scholar 

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Acknowledgements

The authors are thankful to the participants who provided their time and shared their healthcare seeking experiences. They grateful to the Ministry of Health & Family Welfare, Bangladesh for assisting in the recruitment of participants. Acknowledgement also goes to Werner Menski, Emeritus Professor of South Asian Laws, School of Law (SOAS), University of London, for his valuable time and effort in reviewing the manuscript and provide valuable feedback.

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Authors and Affiliations

  1. College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia

    Mohammad Hamiduzzaman

  2. College of Medicine & Public Health, Flinders University Rural Health SA, Flinders University, GPO BOX 852, Renmark, South Australia, 5341, Australia

    Mohammad Hamiduzzaman

  3. College of Nursing & Health Sciences, Flinders University, Bedford Park, South Australia, Australia

    Anita De Bellis, Wendy Abigail, Evdokia Kalaitzidis & Ann Harrington

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  1. Mohammad Hamiduzzaman
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  2. Anita De Bellis
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Contributions

MH made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data. Responsible for drafting the manuscript and revising it critically for important intellectual content. ADB, WA and EK made substantial contributions to shaping the conception and design. Involved in drafting the manuscript and revising it critically for important intellectual content. AH involved in reviewing the manuscript and revising it critically for important intellectual content. All authors read and approved the final manuscript.

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Correspondence to Mohammad Hamiduzzaman.

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The authors declared no conflicts of interest.

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This study is approved by Social and Behavioral Research Ethics Committee of Flinders University [Project No. 6705].

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Hamiduzzaman, M., De Bellis, A., Abigail, W. et al. The World Is Not Mine – Barriers to Healthcare Access for Bangladeshi Rural Elderly Women. J Cross Cult Gerontol 36, 69–89 (2021). https://doi.org/10.1007/s10823-020-09420-w

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