Comparing the Illness Perception, Help-Seeking Behaviors, and Healthcare Determinants Between the Rural and Suburban Indigenous People in Malaysia: A Socio-Biological Perspective.

Due to the health disparities among the Indigenous population, this theory-driven study aimed to compare the suburban and rural Indigenous populations in their illness perceptions, help-seeking behaviors, and determinants of healthcare utilization. Between 2022 and 2023, we conducted a community-based structured survey with the Orang Asli (OA, Indigenous people) residing in suburban (N = 70) and rural regions (N = 131) of Peninsular Malaysia. The orally administered survey consists of demographic and socio-economic info, indigenously developed measurements of illness expression, explanations for illnesses, help-seeking methods, and determinants of healthcare seeking. Through statistical analysis, we found that the suburban group had higher identification of chronic symptoms and adoption of lifestyle-related explanations for their illnesses compared to the rural group. Meanwhile, the rural group was significantly higher in utilization of traditional healthcare for their illnesses than the suburban group. In terms of determinants in seeking modern healthcare services, the rural group endorsed external support, and the suburban group endorsed personal autonomy significantly higher than their counterparts. Adopting the lens of strong-ties weak-ties theory and Indigenous healthcare social determinism, we interpret the findings as a cultural misfit between the Western colonial healthcare system and OA's traditional way of being. Differently located OAs would need specific resources (internal vs. external) to overcome the structural barriers to healthcare access. Therefore, we advocate for systemic interventions in crafting culturally responsive practices and policies to reduce healthcare disparities.