Hindawi

BioMed Research International

Volume 2021, Article ID 8734615, 9 pages
https://doi.org/10.1155/2021/8734615

Research Article
Routine Medical Check-Up and Self-Treatment Practices
among Community-Dwelling Living in a Mountainous Area of
Northern Vietnam

Tam T. Ngo,1 Phong N. Hoang,2 Ha V. Pham,3 Dua N. Nguyen,4 Hoai T. T. Bui,4

Anh T. Nguyen,2 Thinh D. Do,2 Ngan T. Dang,4 Huy Q. Dinh,5 Dao Q. Truong,5
and Tuan A. Le 4
1
Faculty of Health Sciences, Thang Long University, Hanoi 100000, Vietnam
2
E Hospital, Hanoi 100000, Vietnam
3
St. Paul’s Hospital, Hanoi 100000, Vietnam
4
VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Hanoi 100000, Vietnam
5
Hospital of Vietnam National University, Hanoi 100000, Vietnam

Correspondence should be addressed to Tuan A. Le; [email protected]

Received 6 August 2020; Revised 11 April 2021; Accepted 17 April 2021; Published 23 April 2021

Academic Editor: Ali Khani jeihooni

Copyright © 2021 Tam T. Ngo et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This study was conducted to evaluate the routine medical check-up and self-treatment behaviors of people living in a remote and
mountainous setting in Northern Vietnam and identify their associations. A cross-sectional study was conducted on 175 people in
August 2018 in Cao Son commune, Da Bac district, Hoa Binh. Information regarding routine medical check-ups and self-treatment
behaviors was collected by using a structured questionnaire. Multivariate logistic regression was used to examine the associations.
Results show that 24% of the mountainous people had routine medical check-ups in the last 12 months. The rate of self-treatment
in the past three months was 33.7%. The number of chronic diseases (OR = 1:5, 95% CI = 1:0‐2:3), health information sources from
radio/television (OR = 3:3, 95% CI = 1:2‐9:5), or social media (OR = 24:8, 95% CI = 1:2‐512:4) was related to routine medical
check-up. People who did not have routine medical check-up were more likely to have self-treatment practice (OR = 6:3, 95%
CI = 1:9‐21:1) than those who had a regular health check. Promoting health education and communication through mass media
to raise people’s awareness about regular health check-ups is a promising way to improve people’s self-treatment status.

1. Introduction Self-treatment is recognized as one of the global public

health issues [7]. Global research shows that the rate of self-
Ensuring good health for all residents regardless of their geo- treatment, irrespective of whether developed or developing
graphical locations and socioeconomic status is an important countries, is high. For example, the rate of self-treatment is
goal among 17 Sustainable Development Goals [1]. However, 50.0% in India [8], 50.2% in Ethiopia [9], or 35.2% in rural
there are still major disparities in health conditions, health care China [6]. In the United States, 1%-66% of residents used
service access, and use between residents living in remote/rural antibiotics without prescription [10]. Self-treatment or self-
and urban areas in both developed and developing countries medication is defined as individuals purchasing or using
[2–4]. Geographical distance, constrained financial resources, drugs without a prescription or guidance of a physician or
and insufficient health services provided by qualified health other qualified people [11]. Some conventional medicines
professionals are the main barriers for people in remote areas can be used without a doctor’s prescription. However, most
to access health care, which may also increase the risk of self- drugs need to be strictly controlled in terms of their use, espe-
treatment and self-medication in this population [5, 6]. cially antibiotics [12, 13]. The benefits of self-medication or
2 BioMed Research International

self-treatment include a reduction in the cost of medical ser- remote and mountainous setting in Vietnam and identify
vices, convenience, and affordability, especially for people their associations.
with mild symptoms. However, self-treatment can have seri-
ous consequences, such as the improper use of drugs, uncon- 2. Materials and Methods
trolled side effects, and an increased risk of drug resistance
[14, 15]. Also, self-treatment may delay health facility visits 2.1. Study Design. The study was conducted in August 2018
to detect actual illness [15]. in Cao Son commune, Da Bac district, Hoa Binh. Cao Son
Routine medical check-up plays an essential role in is a typical mountainous commune with rugged terrain,
health care. A routine medical check-up can be defined as which is divided by many mountains with an average altitude
“a routine health-care process usually done by health-care above the sea level of 560 m. The whole locality has nearly
facilities for both genders and for all age groups at different 4,000 people with five main ethnic groups including Kinh,
periods according to the patient risk factors” [16]. Globally, Tay, Dao, Muong, and Thai. Criteria for selecting research
the frequency of routine medical check-ups varies from participants include age 18 and older, who were recognized
country to country. In Germany, the percentage of periodic as having sufficient capability to have their own decision for
health examinations is 50.8% for men and 49.8% for women healthcare seeking. Other inclusion criteria included residing
[17]. Meanwhile, in Saudi Arabia, only 34.3% of middle-aged in the local for at least 12 months and agreeing to participate
and older adults have routine medical check-ups [16]. In in the study. People who were younger than 18 years of age,
Japan, the proportion of people aged 48 and over with rou- did not have sufficient ability to answer the survey (due to ill-
tine medical check-ups is 38.4% [18]. Having health insur- ness, alcohol use, or other reasons affecting cognitive ability),
ance, advanced age, high socio-economic characteristics, and disagree to participate in the study were considered
and excellent social support are factors that facilitate the unsuitable for the study.
use of periodical health care services [19]. The benefits of In this study, we estimated the necessary sample size by
routine medical check-up are undeniable. It can provide using the formula to calculate a population proportion with
information about the health status of service users, detect specified relative precision, with following parameters:
diseases at an early stage, and helps to plan timely treatment, confidence level = 95%, expected prevalence = 57% [23], and
especially for noncommunicable diseases such as cancer or relative precision = 0:13. The required sample size was 172
cardiovascular diseases [20, 21]. Routine medical check-ups residents. The research team will first cooperate with the local
help reduces future hospitalization and associated costs as authorities and the head of the commune health station to set
well as improve health and quality of life. up a sample frame of people living in the commune based on
In Vietnam, prior literature indicated that even in urban ethnic characteristics and the age of 18 years or older. Then,
areas, the proportion of people having routine medical we used a simple random sample using a computer software
check-ups was only 51.2% [22]. On the other hand, self- for selecting participants. Those selected were contacted and
treatment among the general population is alarming. A study invited to the commune health centre on a specific day to
from 1998 found that the rate of self-treatment in mountain- have a health examination and face-to-face interview. If
ous areas was 57% in the last four weeks [23]. Another recent someone refused, the team would select the next person on
study showed that 83.3% of people in mountainous areas in the list. The study participants underwent general health
Central Vietnam had self-treatment practices in the last 12 examinations which were conducted by physicians from the
months [5]. Self-treatment is mainly based on personal expe- Vietnam National University Hospital, Hanoi, E Hospital,
rience or advice from friends, relatives, and drug sellers. With and St. Paul’s Hospital and interviewed by researchers and
geographic barriers and a shortage of medical services in students from the School of Medicine and Pharmacy, Viet-
mountainous areas, it is understandable that people have a nam National University, Hanoi. There were 180 people
high rate of self-treatment when it is difficult to access neces- who were randomly invited to participate in the study. After
sary services in time. data processing, information of 175 people was included in
Although benefits of routine medical check-up have been the analysis (97.2% completion rate).
recognized in literature, limited evidence is available that The research team developed a structured questionnaire
establishes the relationships between routine medical to use for face-to-face interviews. The content of the ques-
check-ups and self-medication in mountainous people. Pre- tionnaire was built based on the literature review and after
vious evidence suggested that one of the most common rea- considering the context of the study setting. We understood
sons for self-treatment is the familiarity of or having that in the study setting, using standardized scales for mea-
previous experience with the treatment [24, 25]. Routine suring self-medication was inappropriate given that the edu-
medical check-up via individualized counselling can help to cation level of the residents was not high. Therefore, we
increase self-efficacy and self-management [26], which might selected simple questions with detailed instructions. We con-
reduce the likelihood of self-treatment [27]. Thus, we sulted with local researchers and health workers to optimize
hypothesized that routine medical check-up was associated contents of the questionnaire. Each interview lasted for 15
with a lower likelihood of self-treatment in this population. minutes. The interviewers were researchers and students of
Understanding this linkage is necessary for further interven- the School of Medicine and Pharmacy, Vietnam National
tions to reduce the self-medication practice in this region. University, Hanoi. These interviewers were trained in com-
This study was conducted to evaluate the routine medical munication and interviewing skills. The questionnaire was
check-up and self-treatment behavior of people living in a pretested with five indigenous peoples with different ethnic
BioMed Research International 3

characteristics before conducting the collection on a larger Table 1: Sociodemographic characteristics and health status.
scale. This pilot study enabled the research team to adjust
the content of the questionnaire to the culture and language Characteristics n %
of the local people. Gender
The questionnaire included following sections: demo- Male 42 24.0
graphic characteristics, health status and health service use Female 133 76.0
and access, and self-treatment. The questionnaire is pre- Ethnic
sented in the Supplemental file (available here).
Kinh 21 12.2
Demographic information such as age, gender, marital
status, ethnicity, occupation, number of people living with, Tay 62 36.1
and status of health insurance was collected. Dao 40 23.3
For health status, we asked them to report any acute Muong 49 28.5
symptoms and chronic conditions that they suffered in the Job
last four weeks and last three months, respectively. The Farmer 148 86.1
acute symptoms might include headache, backache, allergy, Others 24 14.0
constipation, cough, sore throat, sneezing/runny nose, fever,
Education
worm infections, helminths, diarrhoea, food poisoning, eye-
sore, or others. Meanwhile, the chronic conditions might Elementary 15 8.6
include high/low blood pressure, cardiovascular diseases, Secondary 79 45.1
diabetes, cancer, asthma, epilepsy/psychiatry, HIV AIDS, High school and above 81 46.3
gastrointestinal disease, osteoarthritis, or other disabilities. Marital status
People were classified in “Having any acute symptoms in Single 29 16.7
the last four weeks” and “Having any chronic diseases in Married 145 83.3
the last three months” if they reported that they had any
Health insurance
of these acute symptoms or chronic conditions. We con-
Yes 164 94.3
firmed the information based on medical examination
before the interview. We also asked them to report their No 10 5.8
health information sources (including friends/relatives; pos- Having acute symptoms in the last 4 weeks
ters/banners; Internet/social media; mobile phone messages; Yes 171 97.7
radio, television; loudspeaker; newspapers, books; and No 4 2.3
health workers). Having chronic diseases in the last 3 months
For measuring health service access, routine medical Yes 162 92.6
check-up use, and self-treatment, participants were asked
No 13 7.4
following questions: “What is the nearest medical facility
from your home?”, and “How far is the nearest facility from Mean SD
your home?”. Then, we asked them whether they had rou- Age 53.2 15.7
tine medical check-up in the past 12 months with a ques- Number of people living in a household 4.2 1.6
tion “In the past 12 months, did you have routine medical Number of acute diseases 2.9 1.6
check-up?” (yes/no) and the frequency of routine medical Number of chronic diseases 1.9 1.1
check-up (“In the past 12 months, how often have you
had routine medical check-up?”). We used a series of ques-
tions to ask them to report their self-treatment practices. 2.3. Ethical Consideration. Research participants were briefly
First, we asked the participants to report solutions when introduced to the study goals and their rights when partici-
they had illness in the past 3 months (“During the past 3 pating in the study. They have the right to withdraw from
months, when having any symptoms or illnesses, what did the study at any time without affecting the use of health care
you do to handle them?”). If they reported self-treatment services at health facilities. They did not receive any compen-
practices, they were asked about the symptoms they experi- sation for participating in the study. The research proposal
enced, kind of medicine they bought, the criteria for medi- was approved by the Institutional Review Board of School
cation selection, and the reasons why they bought medicine of Medicine and Pharmacy, Vietnam National University,
by themselves. Hanoi.

2.2. Statistical Analysis. Data were processed and analyzed 3. Results

using the Stata 15.0 software. Descriptive statistics with per-
centage and frequency, mean, and standard deviation were Among the 175 participants, the average age was 53.2
calculated. Multivariate logistic regression model was used (SD = 15:7), with the ages ranged from 19 to 90. The majority
to assess factors associated with regular medical check-ups of respondents were female (76.0%), ethnic minorities
as well as the relationship between regular medical check- (87.8%), and farmers (86.1%). The percentage of people with
ups and self-treatment. p value <0.05 is used to determine education from upper secondary and higher was the highest
statistical significance. at 46.3%. Most people were married (83.3%) and had health
4 BioMed Research International

Table 2: Healthcare access and routine medical check-up.

Characteristics n %
The nearest medical facility (n = 175)
Commune health stations 168 96.0
Others 7 4.0
Routine medical check-up in the last 12 months (n = 175)
Yes 42 24.0
No 133 76.0
Frequency of routine medical check-up in the last 12 months (n = 42)
Every three months 25 59.5
Every six months 7 16.7
Every 12 months 7 16.7
≥12 months 3 7.1
Health information sources (n = 175)
Friends/relatives 66 37.7
Television, radio 82 46.9
Loudspeaker 90 51.4
Health worker 6 3.4
Social media 3 1.7
Distance to the nearest facility (km), mean (SD) 4.0 (4.7)

insurance (94.3%). The average number of people living in a than those who had a regular medical check in the past 3
household was 4.2 (SD = 1:6) people. The average number of months.
acute symptoms in the past four weeks was 2.9 (SD = 1:6),
while the average number of chronic illnesses in the last three 4. Discussion
months was 1.9 (SD = 1:1) (Table 1).
Table 2 shows that, in the 12 months before the study, This study contributed to the current literature to emphasize
24% of the people had regular medical check-ups; most of a lack of regular medical check-ups, as well as proposed ini-
them had regular visits every 12 months (70.6%). Most peo- tial relationship between this health behavior and self-
ple lived closest to the commune health station (96.0%), with treatment. This is particularly important issue in the commu-
an average distance from home to the nearest medical facility nity, especially in the mountainous settings where self-
of 4.0 (SD = 4:7) km. The primary source of health informa- treatment is very common. Our results showed that a low
tion was loudspeakers (51.4%) and radio/television (46.9%). proportion of people had routine medical check-up in the
Only 3.4% of participants heard health information from last 12 months and a moderate prevalence of self-treatment
health workers. in the last 3 months. Our research also shows the evidence
Table 3 also shows that the rate of self-treatment in the that not having routine medical check-up was closely related
past three months was 33.7%. The majority of residents had to self-treatment among people in this region.
self-treatment when they had headache (63.8%) and fever This study shows that the percentage of people with reg-
(32.8%). Pain relief drug and antibiotics were major medicine ular health check-ups in the past 12 months was low at 24%.
bought by residents at 36.2%. Most of them reported that Our finding was significantly lower than the rate in other
they described the symptoms to the pharmacists and bought studies in urban in Vietnam (51.2%) [22] or in the world
the drugs followed their recommendations (84.5%). Three such as Germany, Saudi Arabia, and Japan [16–18]. Routine
most common reasons for self-treatment included “Having medical check-up plays an important role in keeping health
previous experience with similar health problems” (29.3%), service users up-to-date on their health status, as well as
“Not having time for visiting health facility” (25.9%), and screening and detecting chronic conditions that are hidden
“Mild symptoms” (20.7%). or at an early stage, which, in turn, helps to make appropriate
The regression model results in Table 4 show that the treatment strategies [19, 22]. However, some studies have
number of chronic diseases (OR = 1:5, 95% CI = 1:0‐2:3), shown that the role of routine medical check-up is ques-
health information sources from radio/television (OR = 3:3, tioned due to high costs, unclear benefits, or uncertain
95% CI = 1:2‐9:5), or social media (OR = 24:8, 95% CI = 1:2 quality [28–30]. In Vietnam, a previous study showed that
‐512:4) was related to routine medical check-up in the past patients doubted the quality of doctors and medical services,
12 months. especially at the primary health care level [31–33]. Our
Results of Table 5 show that, after adjusting to other fac- research was conducted in mountainous areas; thus, it was
tors, those who did not have regular health checks were six difficult for local people to access health services at higher
times more likely to self-treat (OR = 6:3, 95% CI = 1:9‐21:1) levels of the health system (such as district or provincial
BioMed Research International 5

Table 3: Self-treatment practice.

Characteristics n %
Self-treatment practice in the last three months (n = 175)
No 114 66.3
Yes 58 33.7
Symptoms when practicing self-treatment (n = 58)
Fever 19 32.8
Headache 37 63.8
Stomachache 9 15.5
Cough 12 20.7
Osteoarthritis pain 12 20.7
Allergy 2 3.4
Other 10 17.2
Type of medicine bought (n = 58)
Pain relief 21 36.2
Antibiotics 21 36.2
Others 16 27.6
Criteria when buying medicine for self-treatment (n = 58)
Remember drug’s name 3 5.2
Using prescriptions in previous medical examination 3 5.2
Describing symptoms to pharmacists 49 84.5
Using drugs available at home 2 3.4
Others 1 1.7
Reasons for self-treatment (n = 58)
Having previous experience with similar health problems 17 29.3
Mild symptoms 12 20.7
Not having time for visiting health facility 15 25.9
Not having enough money for visiting health facility 5 8.6
Medical facility is far away 8 13.8
Confidentiality 1 1.7

level). Therefore, in order to have routine medical check-up, should have regular health check-ups at least every six
people could only go to commune health centres, which were months [35]. This phenomenon may be because the eco-
the nearest health care facility. According to previous reports, nomic conditions of the people in this area were low; thus,
the shortage of human resources and medical equipment at although most people have health insurance cards, they
commune health stations in mountainous areas remains seri- might still worry that they did not have enough financial
ous [34]. As a result, this facility may not be able to provide resources if they performed regular check-ups more
the necessary medical examination and treatment services frequently.
for routine medical check-up, making it difficult to motivate Our results were consistent with some previous studies
people to have regular health check-ups. According to our showing that people who suffered from diseases or illnesses
observations, the available of resources in local commune were more likely than other people to have regular health
health stations was consistent with this perception. Although check-ups [22]. This result may be explained by the fact that
we have not yet assessed the perception of people about the when they have regular health check-ups, their diseases could
service quality of the commune health station in this study, be detected early as well as treated and managed on time. On
previous studies have shown that some individuals did not the other hand, our research emphasized the importance of
believe in the quality of medical examination and treatment some health communication channels such as radio/televi-
capacity of health staff at the commune health station [31– sion or social media in promoting people to get regular
33]. This could be a major barrier when promoting the rou- medical check-ups. Indeed, the main sources of health infor-
tine medical check-up behavior in the mountainous people. mation for local people were radio/television, friends/rela-
This study also found that among those having routine med- tives, and loudspeakers. Meanwhile, the role of local health
ical check-up, the majority of people had health check-ups at workers in health communication and education in the com-
low frequency—once within 12 months, while according to munity had not been emphasized. We assumed that, even if
the recommendations of the Ministry of Health, people people were communicated about the benefits of regular
6 BioMed Research International

Table 4: Associated factors with a routine medical check-up.

Routine medical check-up

Factors
OR p 95% CI
Ethnic
Kinh Ref
Tay 0.6 0.43 0.1 2.2
Dao 0.2 0.07 0.0 1.2
Muong 0.8 0.80 0.2 3.2
Gender
Male Ref
Female 0.7 0.46 0.3 1.8
Job
Famer Ref
Others 0.4 0.26 0.1 1.8
Education
Elementary Ref
Secondary 0.3 0.14 0.1 1.5
High school and above 0.2 0.08 0.0 1.2
Health insurance
No Ref
Yes 2.9 0.21 0.6 14.7
Receiving medical information from relatives/friends
No Ref
Yes 2.0 0.23 0.6 6.0
Receiving medical information from television, radio
No Ref
Yes 3.3 0.02 1.2 9.5
Receiving medical information from the loudspeaker
No Ref
Yes 0.4 0.09 0.1 1.2
Receiving medical information from a medical worker
No Ref
Yes 0.7 0.78 0.1 8.1
Receiving medical information from social media
No Ref
Yes 24.8 0.04 1.2 512.4
Number of people living in a household 0.9 0.64 0.7 1.2
Number of acute diseases 1.0 0.74 0.7 1.3
Number of chronic diseases 1.5 0.03 1.0 2.3
Distance to the nearest facility (km) 1.1 0.22 1.0 1.1

medical check-ups via these common channels, their aware- some studies in the world and Vietnam [5, 23, 37–40]. This
ness of this issue may be inadequate, thereby reducing their difference is probably due to the different recall times, as pre-
belief in this health behavior. Research in Japan shows that vious studies often asked for 12 months, while our study
belief in routine medical check-up was an important factor asked for three months because we want to limit recall bias
in promoting this service use [36]. Therefore, designing cul- which occur when people have to remember events for long
tural communication messages of local people and taking periods. Moreover, other characteristics such as sociodemo-
advantage of the popularity of these communication chan- graphic characteristics or healthcare accessibility should also
nels to increase awareness and health belief to promote be considered. For example, in our setting, there were less
health behaviors and routine medical check-up are needed. than five drug stores in the local community, and none of pri-
In this study, we found that 33.7% of people self-treated vate clinic was found, suggesting that people in this locality
during the past three months. This result was lower than in has limited access to health care as well as drug sellers.
BioMed Research International 7

Table 5: Association between self-treatment and routine medical check-up.

Self-treatment
Factors
OR p value 95% CI
Routine medical check-up
Yes Ref
No 6.3 0.00 1.9 21.1
Ethnic
Kinh Ref
Tay 0.5 0.32 0.2 1.8
Dao 1.3 0.73 0.3 5.9
Muong 0.5 0.34 0.1 1.9
Gender
Male Ref
Female 1.5 0.37 0.6 3.8
Job
Famer Ref
Others 1.0 0.96 0.3 3.7
Education
Elementary Ref
Secondary 2.1 0.37 0.4 10.9
High school and above 2.1 0.40 0.4 12.3
Health insurance
No Ref
Yes 0.8 0.76 0.1 4.7
Receiving medical information from an acquaintance
No Ref
Yes 0.5 0.13 0.2 1.3
Receiving medical information from television/radio
No Ref
Yes 1.1 0.91 0.4 2.6
Receiving medical information from the loudspeaker
No Ref
Yes 0.7 0.46 0.3 1.8
Receiving medical information from a medical worker
No Ref
Yes 0.3 0.40 0.0 4.1
Receiving medical information from media network
No Ref
Yes 2.5 0.55 0.1 46.2
Number of people living in a household 1.2 0.13 0.9 1.5
Number of acute diseases 1.1 0.68 0.8 1.3
Number of chronic diseases 1.0 0.83 0.7 1.4
Distance to the nearest facility (km) 1.0 0.74 0.9 1.1

Results of our study were similar to some previous studies study among mountainous residents in Vietnam found
when they showed that in people with self-treatment behav- limited knowledge and awareness of these people about anti-
iors, they frequently went to pharmacy stores and consulted biotic resistance and appropriate antibiotic use [43]. Our
with pharmacists to buy drugs as a main information source finding suggested the need to design effective strategies to
for decision-making [5, 41]. It is important to consider that manage self-treatment behavior in the mountainous area.
more than one-third of self-medicating people buy antibi- This study confirmed our hypothesis when showing that
otics without a prescription. Vietnam has been well- routine medical check-up was negatively associated with self-
documented as a hotspot of antibiotic resistance [42]. A prior treatment. Indeed, people who had routine medical check-up
8 BioMed Research International

could be consulted about the current disease, as well as how [3] B. Guo, X. Xie, Q. Wu et al., “Inequality in the health services
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