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. 2023 Apr 6:13:100187.
doi: 10.1016/j.lansea.2023.100187. eCollection 2023 Jun.

Foregone health care in adolescents from school and community settings in Indonesia: a cross-sectional study

Minh D Pham  1   2 , Susan M Sawyer  3   4   5 , Paul A Agius  1   2   6 , Elissa C Kennedy  1   2   3 , Ansariadi Ansariadi  7 , Fransiska Kaligis  8   9 , Tjhin Wiguna  8   9 , Nisaa R Wulan  1 , Yoga Devaera  10 , Bernie E Medise  9   10 , Aida Riyanti  11 , Budi Wiweko  12 , Karly I Cini  1   3   4   5 , Thach Tran  2 , Jane Fisher  2 , Stanley Luchters  13   14   15 , Peter S Azzopardi  1   5   16
Affiliations

Foregone health care in adolescents from school and community settings in Indonesia: a cross-sectional study

Minh D Pham et al. Lancet Reg Health Southeast Asia. .

Abstract

Background: Adolescence is a development period marked by the onset of a new set of health needs. The present study sought to quantify the prevalence of foregone care (not seeking medical care when needed) and identify which adolescents are at greater risk of having unmet healthcare needs.

Methods: A multi-stage random sampling strategy was used to recruit school participants (grade 10-12) in two provinces in Indonesia. Respondent driven sampling was used to recruit out-of-school adolescents in the community. All participants completed a self-reported questionnaire which measured healthcare seeking behaviours, psychosocial wellbeing, use of healthcare services, and perceived barriers to accessing healthcare. Multivariable regression analysis was performed to examine factors associated with foregone care.

Findings: A total of 2161 adolescents participated in the present study and nearly one in four adolescents reported foregone care in the past year. Experiences of poly-victimisation and seeking care for mental health needs increased the risk of foregone care. In-school adolescents who reported psychological distress [adjusted risk ratio (aRR) = 1.88, 95%CI = 1.48-2.38] or had high body mass index (aRR = 1.25, 95%CI = 1.00-1.57) were at greater risk of foregone care. The leading reason for foregone care was lack of knowledge of available services. In-school adolescents predominantly reported non-access barriers to care (e.g., perception of the health concern or anxiety about accessing care) whereas most out-of-school adolescents reported access barriers (e.g., did not know where to get care or could not pay).

Interpretation: Foregone care is common among Indonesian adolescents, especially in adolescents with mental and physical health risks. Differences between in-school and out-of-school adolescents suggest that interventions to promote appropriate healthcare use will need tailoring. Further research is needed to determine causal relationships around barriers in access to healthcare.

Funding: Australia-Indonesia Centre.

Keywords: Adolescence; Cross-sectional study; Foregone care; Health services access; Indonesia; Respondent-driven sample.

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Conflict of interest statement

This study was supported by funding from the Health Cluster of the Australia-Indonesia Centre. Peter S. Azzopardi holds a 10.13039/501100000925National Health and Medical Research Council Emerging Leadership Investigator Grant. Jane Fisher is funded by a Professorial Fellowship from the Finkel Family Foundation. Authors declare no other conflict of interests.

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