Healthcare-seeking behaviour in a pluralistic system: evidence from non-communicable diseases management in Kerala, India

This study examines household health status and healthcare-seeking behaviour for managing non-communicable diseases (NCDs) in Kerala, India, characterized by an advanced demographic and epidemiological transition, an ageing population, and a pluralistic healthcare system in which modern and traditional systems, such as Ayurveda, coexist. Drawing on Andersen’s behavioural model and Kroeger’s Pathways and Determinants framework, and using data from 1,120 households across seven districts, the analysis employs a two-stage approach using logit and multinomial logit models to capture pathways from diagnosed NCDs to treatment-seeking behavior and healthcare choice. The findings indicate a high NCD burden, with 62 per cent of households reporting at least one condition. Logit results show that the likelihood of reporting diagnosed NCDs over the 365-day period is driven by need factors, particularly pre-existing conditions and age, while rural residence and larger household size increase this likelihood. Higher education among household heads is associated with a lower likelihood of reporting diagnosed NCDs. Estimated probabilities indicate that over 63 per cent of households are in high or very high NCD risk categories. Among households with NCDs, 87 per cent seek modern medicine, 5.4 per cent opt for Ayurveda, mainly for musculoskeletal conditions, and 7.4 per cent forgo treatment. Multinomial logit results show that healthcare choice is influenced by need, predisposing, and enabling factors. Ayurveda use is condition-specific and reflects informed preferences driven by accessibility, affordability, and trust, rather than substituting modern medicine. In contrast, treatment avoidance reflects constraints such as lack of insurance, poor access, and social disadvantage. The findings highlight the need to strengthen early detection, improve access and financial protection, and enhance coordination across healthcare systems to ensure equitable utilisation of healthcare services.