Household attitudes and associated factors toward community-based health insurance in the Awi Zone, Ethiopia: a community-based cross-sectional study design

Abstract

The CBHI scheme is a financial mechanism intended to protect vulnerable populations, such as low-income and rural communities, from the high costs of healthcare. In many developing nations like Ethiopia, significant out-of-pocket healthcare expenses act as a major barrier to accessing essential medical services. So, this study, aimed to identify factors influencing household attitudes toward community-based health insurance services in Awi zone. A community-based cross-sectional study using a quantitative approach was conducted from 2,939 households using a multistage sampling technique. Attitude was estimated based on 10 likert scale questions and classified depending on cumulative measure. A binary logistic regression model was used to identify factors. For the participants’ response rate was 98% and 56.41% the household had a positive attitude toward CBHI while 43.59% had negative attitude. Attitude was measured based on 10 likert scale question and if respondent say yes for more than 6 equations they have positive attitudes otherwise have negative attitude. Significant variables were gender (AOR: 1.422, 95% CI: 1.05–1.918), marital status (married) (AOR: 2.47, 95% CI: 0.89–3.77), residence (AOR: 0.64, 95% CI: 0.45–0.92), presence of under five children in the household (OR: 0.83, 95% CI: 0.69–0.99), hospitalization cost (AOR: 0.09, 95% CI: 0.01–1.13), presence of chronic illness (OR: 1.40, 95% CI: 1.41–1.71), high level of awareness (AOR: 1.43, 95% CI: 1.00-2.04), satisfaction (AOR: 2.39, 95% CI: 1.32–4.46), and being a beneficiary based on demand (AOR: 0.30, 95% CI: 0.18–0.50). The study concludes that a combination of demographic, socioeconomic, and behavioral factors collectively influences household attitudes toward the CBHI scheme in the Awi zone. While satisfaction and awareness are strong predictors of positive attitudes, factors like marital status and the presence of chronic illness also play a role. Conversely, residence (urban areas), specific beneficiary status, and having young children in the household are associated with negative attitudes. These findings underscore the need for targeted interventions to increase awareness, improve service quality, and address the specific concerns of households with negative perceptions to enhance the overall effectiveness and uptake of the CBHI scheme. Not applicable for clinical trials.