A qualitative study of motivations and barriers to formal healthcare utilisation among informal caregivers of older adults in Ghana

Informal caregivers of older adults in low- and middle-income countries, including Ghana, face health challenges and increased healthcare needs. They also report suboptimal healthcare use, which may undermine their health outcomes. Understanding the specific factors that motivate or hinder formal healthcare utilisation is crucial for informing interventions to improve health outcomes among this population group. This study explores the motivations and barriers to formal healthcare utilisation among informal caregivers of older adults in Ghana. This descriptive phenomenological study, conducted in the Ashanti Region of Ghana, used Levesque’s Patient-Centred Access to Healthcare Framework (hereafter Levesque’s framework) to understand the motivations and barriers to formal healthcare utilisation among informal caregivers of older adults. Forty-five informal caregivers (aged 18 and above) of older adults (aged 50 and over) were purposively sampled. Rigor was enhanced through credibility, dependability, confirmability, and transferability. Interview data were collected until saturation was reached and analysed thematically. Two main themes were identified from the data: 1) motivations and; 2) barriers to formal healthcare utilisation. Motivations included acceptability (providers’ professionalism), approachability (health perceptions), and affordability (low costs and enrolment in the National Health Insurance Scheme [NHIS]). Barriers involved appropriateness (misdiagnosis), affordability (financial barriers and limited NHIS coverage), availability and accommodation (time poverty and non-availability of specialists), and acceptability (poor provider attitudes). Affordability and acceptability serve as both motivations and barriers to formal healthcare utilisation. Findings generally support Levesque’s framework, highlighting multidimensional factors including acceptability, approachability, affordability, appropriateness, availability, and accommodation serving as motivations and barriers to formal healthcare utilisation among informal caregivers of older adults. Addressing these barriers and also strengthening the motivations through improved health insurance coverage, quality of patient care, and financial support can boost formal healthcare utilisation, thereby supporting Sustainable Development Goals 3 (Good Health and Well-being) and 10 (Reduced Inequalities).