ArticleBMC public health2025
Barriers to access and factors associated with health care utilization among the adult homeless population in Dhaka, Bangladesh: a mixed method cross-sectional study.
Article in BMC public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe barriers faced by homeless individuals in accessing healthcare and the factors associated with their healthcare utilization in low- and middle-income countries like Bangladesh remain understudied. This study aims to assess individual-level barriers to access healthcare and identify factors influencing its utilization among the homeless population.
methodsWe conducted a mixed-method study between November 2022 and July 2023 in Dhaka, Bangladesh. A cross-sectional survey was conducted with 452 randomly selected adult males and females. Additionally, qualitative interviews were conducted with 6 purposively selected homeless individuals and 4 national-level policymakers. Quantitative data are presented as frequencies (n) and percentages (%). The Chi-square test compared categorical variables, focusing on healthcare utilization, while the logistic regression model identified factors associated with greater healthcare utilization, controlling for confounders. Qualitative data was transcribed, translated, and systematically analyzed.
resultsAround 38% of participants had experienced acute illness in the 30 days preceding the survey, with 67% among them seeking treatment, primarily from local drug stores (65%). Financial constraint (70%) was the primary barrier in this group for not seeking care for acute illness. Additionally, 46% of participants reported chronic illnesses lasting more than 12 months, with about 80% among them being unable to afford regular treatment due to financial constraints (90%). Qualitative findings also reported financial barriers and identified other obstacles, including poor knowledge about care sources, complex healthcare systems, lack of attendants, belief in natural healing, and discrimination at health facilities. The regression model demonstrated that higher healthcare utilization was significantly associated with living with family (AOR: 4.58), having formal education (AOR: 3.41), a shorter duration of homelessness (reference category), and not using illicit narcotic drug or alcohol (AOR: 5.71).
conclusionThe homeless population faces persistent challenges in accessing and utilizing healthcare services. Policymakers should take initiatives for the comprehensive implementation of community outreach programs and mobile health clinics to increase healthcare utilization, as well as targeted health education campaigns to improve health literacy among homeless populations. Expanding social housing programs and scaling up health protection schemes can collectively address healthcare access barriers for the urban poor in Bangladesh.
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