Characteristics of respondents and households
Of the total 810 respondents, 70 and 30 percent were from Kailali and Baglung respectively. They were drawn as per the proportional distribution of sample based on the national population and household census 2011 (27). Out of them, more than one fourth [26%] were from rural area. More than half of the respondents [51%] were female. Among them, two third [66%] were the household heads. More than 92 percent were literate, more than half of them had basic and secondary level of education, and 12 percent had bachelor or higher level of education. Forty-one percent household belonged to nuclear family. Fifty-six percent of the total households had upto five members in the family, 42 percent households had six to 10 members and nearly two percent had more than 10 members in the family. Different nine types of household assets and dwelling were assessed to categorize wealth status in three equal class. So, the wealth status of the people comprised one third each of the rich, middle and poor households.
More than half [51%] of the total respondents could feed their family throughout the year; 16, 14 and 11 percent could feed their family upto three months, three to six months, and six to nine months respectively. Similarly, eight percent of them could feed their family nine to 12 months. More than one third [34.6%] of the respondents expressed that minimum one family member had some type of chronic disease. Half of the respondent were enrolled and half other were not-enrolled in the HIP which was already determined during sample size calculation and sample selection. Seventy-two percent of the respondents expressed that they had some knowledge about health insurance and the remaining 28 percent did not have.
Most of the respondents [71%] were informed by the enrollment assistant. Nearly half [49%] of them were informed by Radio/FM, 40 percent from neighbours/peers, 37 percent from Television, 15 percent from family members, 14 percent from female community health volunteers [FCHV] and 11 percent from teachers and Health workers respectively. Nearly two third [66%] of the respondents had knowledge about contribution amount for HI. Seventeen percent of them had HI related books or guidelines. However, only five percent had participated in training and discussion related to HI.
Nearly one third [32%] of the respondents had discussed with peers or neighbours about HI whereas 19 percent of them were informed through social media. Nearly half of the total respondents listened HI related messages from Radio whereas 38 percent of them watched HI related messages from Television. Data show that 27 percent of the respondents saw HI related message on Hoarding Board and 13 percent read HI related message from newspapers. Eighteen percent of the respondents received HI related information from brochure, poster, pamphlet, and flyers.
Family and respondents’ characters; information, education, and communication; and enrollment in health insurance
Out of the total respondents, 50 percent resided in urban area and 49 percent of rural were enrolled. Fifty-three percent of the male respondents were enrolled in HI compare to 47 percent of female were enrolled. Fifty-three percent of the respondents who were the household heads, were enrolled in HI compared to 45 percent of those who were not household head [p<0.05]. Data show that higher the age higher the enrollment rate. Twenty-six percent of the respondents of age less than 20 years were enrolled in HI compared to 44 percent from the age of 21 to 40 years, 59 percent from the age of 41 to 60 years, and 68 percent from the age of more than 60 years [p<0.001]. There were no significant differences between educational level of respondents, types of family, and size of family; and enrollment in HI. More than half (56%) of respondents having rich wealth status were enrolled compared to 46 percent of middle and 49 percent poor wealth status [p<0.05].
Sixty percent of the respondents, who had family member(s) having chronic disease(s), were enrolled in HI compared to 45 percent who had not [p<0.001]. Sixty-eight percent of the respondents who heard about HI were enrolled in HI compared to four percent who did not [p<0.001]. Eighty percent of the respondents, who got information from family members, were enrolled in HI compared to 79 percent from enrollment assistant, 76 percent from FCHV, 75 percent from training or seminars, 74 percent equally from teachers and health workers/Doctors respectively, 69 percent from neighbours, 68 percent from Television, and 65 percent from Radio/FM [p<0.001]. Sixty-nine percent of the respondents, who had knowledge about contribution amount, were enrolled in HI compared to 14 percent who did not have knowledge regarding contribution amount [p<0.001]. Eighty-three percent of the respondents, who had HI related books or guidelines, were enrolled in HI compared to 43 percent of those who had not HI related books or guidelines [p<0.001].
Similarly, 73 percent of the respondents, who participated in training or discussion of HI related programme, were enrolled in HI compared to nine percent of those who did not participate [p<0.01]. Seventy-three percent of the respondents, who discussed with peers or neighbours about HI related issues, were enrolled in HI compare to 39 percent of those who did not discuss [p<0.001]. Sixty-two percent of the respondents, who listened HI related information from Radio/FM, were enrolled in HI compare 39 percent of those who did not listen [p<0.001]. Likewise, 63 percent of the respondents, who watched HI related message from Television, were enrolled in HI compare to 42 percent of those who did not watch [p<0.001]. Moreover, 68 percent of the respondents, who seen HI related message from Hoarding Board [HB], were enrolled in HI compare to 44 percent of those who did not see HB [p<0.001]. Sixty-four percent of the respondents, who read HI related message from newspaper, were enrolled in HI compared to 48 percent of those who did not read newspaper [p<0.01]. Similarly, 68 percent of the respondents, who had seen HI related information from brochure, poster or pamphlet, were enrolled in HI compare to 46 percent of those who did not [p<0.001].
Multivariate analyses of background characteristics; exposure to IEC; and enrollment in HI
We used multivariate analysis in three models. In first model, we obtained background characteristics and enrollment in HI. In second model we presented exposure to communication and enrollment in HI. Lastly, in third model all these variables were included for further prediction.
According to Model I, it was found that higher the age higher the chances of enrollment. Respondents age 21 to 40 years, 41 to 60 years, and more than 60 years were 1.9 [aOR = 1.916] times, 3.2 times [aOR = 3.200, p<0.05], and 4.4 times [aOR = 4.352, p<0.05] more likely to enroll in HI respectively compared to age less than 21 years but not significant in Model III. Model I shows, the respondents who had family member(s) having chronic disease(s) were more likely to enroll in HI [aOR = 1.536, p<0.01] compared to the family who had not chronic disease(s) within family member(s) but the result was not consistent in Model III.
The Model II shows the respondents who heard about health insurance were 20.5 times more likely to enroll compared to those who did not [aOR = 20.521, p<0.001]. Similarly, the respondents who had knowledge about contribution amount for health insurance were 4.9 times more likely to enroll than those who did not have [aOR = 4.925, p<0.001]. Likewise, the respondents who had health insurance related books or guidelines were 5.1 times more likely to enroll in HI than those who had not [aOR = 5.117, p<0.001]. Interestingly, the respondents who interact with peers or neighbours were 1.9 times more likely to enroll in HI compare to those who did not interact [aOR = 1.883, p<0.01].
Model III shows some similar and some contradictory projection compared to Model I and Model II. Age groups more than 20 years were more likely to enroll in HI compared to age upto 20 years which was the similar prediction with Model I. Model II and Model III have nearly the same result compared to Model I. The respondents who heard about HI were more likely to enroll in HI [aOR = 20.229, p<0.001] compared to those who did not. The result seems similar to Model II. In the same way, the respondents, who had heard about HI, knowledge on contribution amount, were more likely to enroll in HI [aOR = 5.176, p<0.001] compared to those who had not. The respondents having HI related books or guidelines were more likely to enroll in HI [aOR = 4.812, p<0.001] that was also the same result with Model II. The participants who had participated in the HI related training were less likely to enroll in HI compared to those who did not.
Interaction with peers and neighbours played positive role in enrollment. The respondents who interacted about HI with neighbours or peers were 1.7 times more likely to enroll in HI [aOR = 1.739, p<0.01] compared to those who did not. The result was same to Model II. Multivariate analysis shows that Radio and or TV had no more influencing role in enrollment. Similarly, newspaper, poster, pamphlet, flayer or brochure had no positive and influencing role to the enrollment in HI. But The participants who saw HI related message from Hoarding Board were 1.3 times more likely to enroll in HI compared to those who did not.