Exploring the socio-ecological factors of healthcare-seeking behaviour among patients/people from Rural Unqualified Health Providers in the rural settings in West Bengal, India

Rural Unqualified Health Practitioners (RUHPs) are popular among the rural population for primary healthcare in India. The RUHPs primarily provide basic healthcare for minor illnesses to millions of people. Patients/people in the rural areas often seek healthcare from RUHPs due to multiple social, economic, and cultural factors. Therefore, using the “social-ecological model (SEM)” as the theoretical base, this study attempts to explore the significant factors that influence health-seeking behaviour, with medical shops of RUHPs being the preferred option, in West Bengal state in India. Using SEM, we developed a comparative analysis between user experiences and provider perceptions. We conducted a primary survey using the pre-prepared semi-structured and unstructured open-ended guide. The household heads (n = 150), RUHPs (n = 75), Primary Health Centres (PHCs), and Sub-Centre staff (n = 30) were the participants in this survey. Transcripts were coded using the thematic content analysis method. Based on SEM, we grouped socio-ecological factors of seeking care into four significant levels: Individual (people’s traditional beliefs, poor health education, gender, and predisposed experiences), Interpersonal (strong social cohesion, tight social bondage, trust and networks, and social support), Community (neighborhood effect, primary resource based activities and livelihood, economic hardship, and density of the medical shop) and Institutional (uneven facility distribution, odd location, resource-related issues, limited and poor quality of services, and gender of staff at Sub-centres). Therefore, the study highlighted that multiple social-ecological factors are responsible for pushing people to RUHP for healthcare in rural areas in West Bengal. • People’s traditional beliefs, poor health education, gender, predisposed experiences, trust and belief systems, primary livelihood activities, and economic hardship are the user-side factors that trap people within the basket of informal services. • RUHPs are famous among people because of proximity, social ties, and bondage. • Location of the public healthcare facility, distance, resources unavailability, limited/poor services, and gender of the staff in Primary Health Centres (PHCs) and Sub-Cenres were the responsible factors for pushing people to RUHP’s door.