Determinants of Health Service Utilization Among Adults at High Risk of Developing Type 2 Diabetes in Kerala, India.

The purpose of this study was to examine the determinants of health service utilization in a population at high risk of developing type 2 diabetes mellitus in India. Using Andersen's behavioral model of healthcare utilization, multivariate logistic regression analysis was performed on baseline data of the Kerala Diabetes Prevention Program. We examined the association between predisposing, enabling, and need factors with outpatient health service use in the past four weeks and inpatient health service use in the past 12 months. More than a quarter (27.9%) and 12.9% of 1007 participants used outpatient services and inpatient services, respectively. Men were less likely to use outpatient services (odds ratio [OR] = 0.56). Outpatient service utilization was positively associated with low social support (OR = 1.69), low general health status (OR = 5.71), and time off from work due to illness (OR = 8.01). Higher educational status (OR = 0.63), low general health status (OR = 3.59), and time off from work due to illness (OR = 1.21) were associated with increased utilization of inpatient services. Although gender, educational status, and social support had important roles, health service utilization in this study population was largely dependent on general health status and presence of illness.