Haridoss Madhumitha, Nandi Dhruva, Rajesh Lenin Raji, John Shiny P, Anantharaman V V, Janardhanan Rajiv
Division of Medical Research, Faculty of Medicine and Health Sciences, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, Kattankulathur, India.
Department of Community Medicine, Faculty of Medicine and Health Sciences, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, Kattankulathur, India.
Front Public Health. 2025 Jun 11;13:1580824. doi: 10.3389/fpubh.2025.1580824. eCollection 2025.
India faces a growing burden of non-communicable diseases (NCDs), particularly diabetes, cardiovascular conditions, and cancer, straining the healthcare system. Given the urgent need for prevention and management, a systematic review and meta-analysis (SRMA) of health-seeking behaviors for NCDs is essential to guide targeted interventions to improve health outcomes.
The SRMA protocol was registered in PROSPERO (CRD42023476381) and conducted adhering to the Preferred Reporting Items of Systematic reviews and Meta-Analysis (PRISMA) 2020 guidelines. PubMed-Medline and Scopus databases were searched from inception to October 27, 2023. Eligible studies focused on adults (>18 years) with NCDs covered under the National Programme for prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and stroke (NPCDCS). Data extraction and risk of bias assessment were conducted using predefined criteria. Meta-analysis of quantitative data was performed using DerSimonian and Laird random-effect model.
From 2,917 identified studies, 64 were included in the SRMA, with 40 suitable for meta-analysis. The meta-analysis revealed that 72.72% (95% CI 59.48-85.97%, = 99.97%) of individuals sought treatment for existing health conditions, with 73.09% (95% CI 54.01-92.16%, = 99.18%) preferring allopathy, compared to 8.89% (95% CI 5.56-12.22%, = 86.73%) preferring Alternative medicine with a significant heterogeneity. Major barriers to seeking treatment included illness not considered serious [0.4785 (95% CI 0.4556-0.5013)] and financial constraints [0.3263 (95% CI 0.1457-0.5069)], with delays in cancer treatment attributed to lack of disease awareness [0.5091 (95% CI 0.0294-0.9888)] and painlessness [0.4502 (95% CI 0.3312-0.5692)]. Private healthcare facilities (51.26, 95% CI 42.85-59.67%) were preferred over government facilities (33.78, 95% CI 28.10-39.45%).
This SRMA provide a comprehensive overview of health-seeking behavior for NCDs in India. The findings underscore the complex interplay of socioeconomic, cultural, and systemic factors influencing healthcare access and outcomes. Targeted interventions addressing barriers identified in this review are imperative for improving public health and reducing the burden of NCDs in India.
印度面临着日益沉重的非传染性疾病负担，尤其是糖尿病、心血管疾病和癌症，这给医疗系统带来了压力。鉴于预防和管理的迫切需求，对非传染性疾病的就医行为进行系统评价和荟萃分析（SRMA）对于指导有针对性的干预措施以改善健康结果至关重要。
SRMA方案已在国际前瞻性系统评价注册库（PROSPERO，注册号CRD42023476381）中注册，并按照系统评价和荟萃分析的首选报告项目（PRISMA）2020指南进行。从数据库创建至2023年10月27日，对PubMed-Medline和Scopus数据库进行了检索。符合条件的研究聚焦于国家癌症、糖尿病、心血管疾病和中风预防与控制计划（NPCDCS）所涵盖的患有非传染性疾病的成年人（年龄>18岁）。使用预定义标准进行数据提取和偏倚风险评估。采用DerSimonian和Laird随机效应模型对定量数据进行荟萃分析。
从2917项已识别的研究中，64项被纳入SRMA，其中40项适合进行荟萃分析。荟萃分析显示，72.72%（95%置信区间59.48 - 85.97%，I² = 99.97%）的个体因现有健康状况寻求治疗，73.09%（95%置信区间54.01 - 92.16%，I² = 99.18%）的个体倾向于选择西医治疗，相比之下，8.89%（95%置信区间5.56 - 12.22%，I² = 86.73%）的个体倾向于选择替代医学，存在显著异质性。寻求治疗的主要障碍包括认为疾病不严重[0.4785（95%置信区间0.4556 - 0.5013）]和经济限制[0.3263（95%置信区间0.1457 - （此处原文疑似有误，推测应为0.5069）0.5069）]，癌症治疗延迟归因于缺乏疾病认知[0.5（此处原文疑似有误，推测应为0.5091）091（95%置信区间0.0294 - 0.9888）]和无痛感[0.4502（95%置信区间0.3312 - 0.5692）]。与政府医疗机构（33.78，95%置信区间28.10 - 39.45%）相比，私立医疗机构更受青睐（51.26，95%置信区间42.85 - 59.67%）。
本SRMA全面概述了印度非传染性疾病的就医行为。研究结果强调了社会经济、文化和系统因素在影响医疗服务可及性和结果方面的复杂相互作用。针对本综述中确定的障碍采取有针对性的干预措施对于改善印度的公共卫生和减轻非传染性疾病负担至关重要。
