Health Care-Seeking Behavior Among Homeless Individuals Under Universal Health Coverage in Taiwan: A Health Belief...

Area of Science:

• Public Health
• Health Behavior Research
• Sociomedical Sciences

Background:

• Taiwan's universal National Health Insurance (NHI) aims for equitable access.
• Homeless populations may experience a
• coverage paradox
• where legal entitlement doesn't ensure actual healthcare engagement.
• The Health Belief Model (HBM) provides a framework for understanding health-related behaviors.

Purpose of the Study:

• To investigate the factors influencing healthcare engagement propensity among homeless individuals in Taiwan.
• To apply the Health Belief Model (HBM) to understand self-reported healthcare engagement in this population.
• To identify key predictors of healthcare engagement beyond sociodemographic variables.

Main Methods:

• Face-to-face interviews were conducted with 124 randomly sampled homeless individuals in Northern Taiwan.
• Hierarchical regression analysis was used to compare the predictive power of sociodemographic variables and HBM constructs.
• Key HBM constructs assessed included perceived susceptibility, perceived severity, self-efficacy, and perceived barriers.

Main Results:

• HBM constructs significantly increased the explanatory power of healthcare engagement propensity from 19% to 41.0%.
• Perceived susceptibility (β=0.38) and perceived severity (β=0.34) were the strongest positive predictors.
• Perceived barriers (β=-0.23) remained a significant negative predictor, indicating non-financial obstacles persist.
• Low perception of health threat, due to normalization of poor health, emerged as a primary bottleneck.

Conclusions:

• Healthcare engagement for homeless individuals is influenced by perceived health threats and barriers, not solely by insurance coverage.
• A low perception of health risk, stemming from the normalization of adverse health conditions, is a critical barrier.
• Recommended interventions include street-based health screenings to raise risk awareness and health navigators to address non-financial barriers to care.