Exploring pension access and health-seeking behavior among older adults in South Kerala: A mixed-methods study

A BSTRACT Background: India has overtaken China as the most populous country, causing an increase in the proportion of older adults. 8.6% of India’s population is olde adults and is projected to rise to 19% by 2050; in Kerala, the proportion is already 12.6%. Financial insecurity is a major determinant of poor health and inequitable healthcare access among the elderly. Social security measures such as pensions play an important role in influencing health-seeking behaviour, particularly in primary care settings. This study assessed the prevalence of pension coverage among community-dwelling older adults, examined their health-seeking behaviour, and healthcare utilization pattern. Methods: A mixed-methods community-based cross-sectional study was conducted in Mallapuzhassery Panchayat, Kerala, from March 2021 to July 2022 among 124 adults aged ≥65 years selected using simple random sampling. Data were collected using an interviewer-administered semi-structured questionnaire. Statistical analysis was performed using SPSS. Associations were assessed and p <0.05 was considered statistically significant. Qualitative data were collected through purposive in-depth case studies among participants who experienced a major health event in the preceding year and analyzed using content analysis. Results: Pension coverage was observed in 82.3% of participants, predominantly through non-contributory social pensions. Possession of a below-poverty-line ration card was the only significant predictor of pension receipt. Pensions met health-related expenses for 65.3% of participants. Good health-seeking behaviour was observed in 60.4%. Government health facilities were the primary source of treatment (48.4%) and medicines (54%). Pension amount explained 43.4% of the variation in monthly medication expenditure. Conclusion: Social pensions enhance access to primary healthcare among older adults. Strengthening social security measures and addressing socioeconomic determinants are essential to improve health-seeking behaviour in an ageing population.