Factors Shaping Patients Choice of Health Service at the Council-Designated Hospitals in the Lake Zone, Tanzania

Abstract

This study was examined the behavioural factors influencing patients’ health service choice (HSC) to inform strategies for improved health service utilisation. A pragmatic, cross-sectional quantitative approach was employed, grounded in Andersen’s Behavioural Model of Health Service Use (ABMHSU). The study was conducted in Tanzania’s Lake Zone, involving twelve remote Council-Designated Hospitals (CDHs) managed in partnership with Faith-Based Organisations (FBOs) and Local Government Authorities (LGAs), each operated over five years. The sample frame consisted of 587,639 patients aged 15 and above, each with two or more attendances, based on CDHs discharge registers from 2022 - 2023. Using stratified random sampling and Cochran’s formula, a final sample of 384 participants was selected. Data were collected using structured questionnaires and analysed with Exploratory Factor Analysis (EFA) and Logistic Regression Analysis (LRA). The results showed that higher ratings for service quality and environment (Exp(B) = 9.150) and patients’ conditions or relatives’ recommendations (Exp(B) = 3.484, both p < 0.001) significantly increased the likelihood of HSC. In contrast, transportation infrastructure, distance, and service costs were not significant predictors. These findings suggest that CDHs should prioritise improvements in facility cleanliness, staff responsiveness, and patient comfort, while LGAs and FBOs should focus on engaging and educating both patients and family members about available healthcare options. The study’s limited participant scope, single-zonal focus, and cross-sectional design highlighted the need for future research with broader, multi-zonal samples and longitudinal methods to enhance generalisability.