Barriers to health care utilisation and coping strategies during the COVID-19 pandemic: A cross-sectional survey among the public in Malaysia 10.55131/jphd/2026/240220
Article Sidebar
Main Article Content
Abstract
The COVID-19 pandemic disrupted global healthcare systems, which created significant barriers to accessing services. This cross-sectional study explored the barriers to healthcare access, coping mechanisms, and their consequences among Malaysians during the pandemic. Conducted online from October to November 2020, the survey targeted adults aged 18 and above who used healthcare services from January to October 2020, excluding those unable to understand Malay or English. The validated questionnaire was adapted from NHMS 2019 and existing literature, underwent expert review, translation, and pre-testing. Data were collected via snowball sampling and analysed using SPSS 26.0, guided by the modified Penchansky and Thomas’s theory of access. Significance was set at p < 0.05. Of the 4,062 respondents, most were female (71.4%), adults (73.3%), of Malay ethnicity (69.7%), married (62.8%), and had a tertiary education (81.3%). Approximately one in three respondents reported barriers, mainly in the awareness (70%) and accommodation (18.1%) domains. Significant factors included ethnicity (Chinese), acute conditions, and vehicle ownership. Nearly 70% adopted positive coping strategies, with 70.5% purchasing medication at pharmacies. Improved outcomes (81.9%) were linked to acute conditions, vehicle ownership, and positive coping mechanisms. The findings underscore the need for targeted policies to address healthcare disparities and strengthen healthcare resilience, especially during public health crises.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020 [Internet]. [cited 2024 Jan 3]. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020
Coronavirus Disease (COVID-19) Situation Reports [Internet]. [cited 2023 Dec 29]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
Nshimyiryo A, Barnhart DA, Cubaka VK, Dusengimana JMV, Dusabeyezu S, Ndagijimana D, et al. Barriers and coping mechanisms to accessing healthcare during the COVID-19 lockdown: a cross-sectional survey among patients with chronic diseases in rural Rwanda. BMC Public Health [Internet]. 2021 Dec 1 [cited 2024 Jan 3];21(1):1–11. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-10783-z
Pujolar G, Oliver-Anglès A, Vargas I, Vázquez ML. Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review. Int J Environ Res Public Health. 2022;19(3).
Abdus-salam RA, Balogun RO, Lawal TV, Lawal OO, Lawal RO, Abdulmalik JO, et al. Assessment of anxiety and depression, and coping mechanisms during COVID-19 lockdown among pregnant women. Heliyon. 2022;8(10).
WHO. Second round of the national pulse survey on continuity of essential health services during the COVID-19 pandemic: January-March 2021 [Internet]. CC BY-NC-SA 3.0 IGO. Geneva: World Health Organization, 2020. 2021. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-EHS-continuity-survey-2021.1
Kruse MH, Durstine A, Evans DP. Effect of COVID-19 on patient access to health services for noncommunicable diseases in Latin America: a perspective from patient advocacy organizations. Int J Equity Health [Internet]. 2022;21(1):1–9. Available from: https://doi.org/10.1186/s12939-022-01648-x
Huston P, Campbell J, Russell G, Goodyear-Smith F, Phillips RL, van Weel C, et al. COVID-19 and primary care in six countries. BJGP Open. 2020;4(4):1–6.
Ujang IRM, Hamidi N, Hamid JA, Awang S, Zulkifli NW, Supadi R, et al. The COVID-19 pandemic and disruptions to maternal and child health services in public primary care Malaysia: a retrospective time-series analysis. BMJ Glob Heal. 2023;8(11):1–11.
Mohd Ujang IR, Ab Hamid J, Hamidi N, Ab Rahman AA, Sooryanarayana R. The impact of the COVID-19 pandemic on urban-rural outpatient primary care utilisation in Malaysia: a retrospective time series and spatiotemporal analysis. Int J Equity Health [Internet]. 2025 Feb 13;24(1):43. Available from: https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-025-02406-5
Khair NKM, Lee KE, Mokhtar M. Community-based monitoring in the new normal: A strategy for tackling the covid-19 pandemic in malaysia. Int J Environ Res Public Health. 2021;18(13).
World Health Organization. Malaysia: Strong Preparedness and Leadership for a successful COVID-19 Response. World Heal Organ [Internet]. 2020;(20 August). Available from: https://www.who.int/publications/m/item/malaysia-strong-preparedness-and-leadership-for-a-successful-covid-19-response
Ahad NA, Okwonu FZ, Siong PY. COVID-19 Outbreak in Malaysia: Investigation on Fatality Cases. J Adv Res Appl Sci Eng Technol. 2020;20(1):1–10.
Institute for Health Systems Research. Malaysia Health Sector Response to COVID-19 Pandemic [Internet]. Selangor; 2020. Available from: http://library.nih.gov.my/e-doc/flipbook/mhsrcovid19-pandemic-hopedespite-adversity/index.html
Yerger P, Jalloh M, Coltart CEM, King C. Barriers to maternal health services during the Ebola outbreak in three West African countries: a literature review. BMJ Glob Heal [Internet]. 2020 Sep 1 [cited 2024 Aug 22];5(9):e002974. Available from: https://gh.bmj.com/content/5/9/e002974
Jindal M, Chaiyachati KH, Fung V, Manson SM, Mortensen K. Eliminating health care inequities through strengthening access to care. Health Serv Res [Internet]. 2023 Dec;58 Suppl 3(Suppl 3):300–10. Available from: http://www.ncbi.nlm.nih.gov/pubmed/38015865
Penchansky R, Thomas JW. The Concept of Access. Med Care [Internet]. 1981 Feb;19(2):127–40. Available from: http://journals.lww.com/00005650-198102000-00001
Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. Milbank Mem Fund Q Health Soc [Internet]. 1973;51(1):95–124. Available from: http://www.ncbi.nlm.nih.gov/pubmed/4198894
Emilio Carrillo J, Carrillo VA, Perez HR, Salas-Lopez D, Natale-Pereira A, Byron AT. Defining and targeting health care access barriers. J Health Care Poor Underserved. 2011;22(2):562–75.
Saurman E. Improving Access: Modifying Penchansky and Thomas’s Theory of Access. J Heal Serv Res Policy. 2016;21(1):36–9.
Afonso Cortez P, Heila ·, Da M, Veiga S, Ana ·, Stelko-Pereira C, et al. Brief Assessment of Adaptive and Maladaptive Coping Strategies During Pandemic. 123AD [cited 2024 Feb 21]; Available from: https://doi.org/10.1007/s43076-023-00274-y
Cramer P, College W. Understanding Defense Mechanisms. Psychodyn Psychiatry. 2015;43(4):523–52.
Raosoft: An online sample size calculator. Raosoft Inc. 2004.
Department of Statistics Malaysia. Key Findings Population and Hosing Census of Malaysia. Department of Statistics Malaysia. 2021. 10–27 p.
Institute for Health Systems Research (IHSR). National Health and Morbidity Survey (NHMS) 2019: Vol. II: Healthcare Demand. [Internet]. Selangor; 2020 [cited 2021 Dec 8]. Available from: https://iku.moh.gov.my/images/IKU/Document/REPORT/NHMS2019/Report_NHMS2019-HCD-eBook_p.pdf
Yerger P, Jalloh M, Coltart CEM, King C. Barriers to maternal health services during the Ebola outbreak in three West African countries: A literature review. BMJ Glob Heal. 2020;5(9):4–10.
Kyomba GK, Law MR, Grépin KA, Mayaka SM, Mambu TNM, Mbunga BK, et al. Barriers and facilitators to healthcare facility utilization by non-Ebola patients during the 2018–2020 Ebola outbreak in the Democratic Republic of Congo. Glob Heal Res Policy [Internet]. 2024;9(1). Available from: https://doi.org/10.1186/s41256-024-00387-6
Elston JWT, Danis K, Gray N, West K, Lokuge K, Black B, et al. Maternal health after Ebola: Unmet needs and barriers to healthcare in rural Sierra Leone. Health Policy Plan. 2020;35(1):78–90.
Davis LL. Instrument review: Getting the most from a panel of experts. Appl Nurs Res. 1992 Nov 1;5(4):194–7.
Yusoff MSB. ABC of Content Validation and Content Validity Index Calculation. Educ Med J. 2019;11(2):49–54.
Kementerian Belia dan Sukan Malaysia. Dasar Belia Malaysia [Internet]. Putrajaya; 2015. Available from: https://dbbelia.gov.my/images/2022/frontend article/DasarBeliaMalaysia_BM.pdf
Department of Statistics Malaysia. Household Income and Basic Amenities Survey Report 2019. Putrajaya; 2020.
Imlach F, McKinlay E, Kennedy J, Pledger M, Middleton L, Cumming J, et al. Seeking Healthcare During Lockdown: Challenges, Opportunities and Lessons for the Future. Int J Heal Policy Manag [Internet]. 2022;11(8):1316–24. Available from: https://doi.org/10.34172/ijhpm.2021.26
Mularczyk-Tomczewska P, Zarnowski A, Gujski M, Jankowski M, Bojar I, Wdowiak A, et al. Barriers to accessing health services during the COVID-19 pandemic in Poland: A nationwide cross-sectional survey among 109,928 adults in Poland. Front Public Heal. 2022;10.
Aledo-Serrano Á, Mingorance A, Jiménez-Huete A, Toledano R, García-Morales I, Anciones C, et al. Genetic epilepsies and COVID-19 pandemic: Lessons from the caregiver perspective. Epilepsia. 2020;61(6):1312–4.
Dopfer C, Wetzke M, Zychlinsky Scharff A, Mueller F, Dressler F, Baumann U, et al. COVID-19 related reduction in pediatric emergency healthcare utilization - A concerning trend. BMC Pediatr. 2020;20(1):1–11.
Ang ZY, Cheah KY, Shakirah MS, Fun WH, Anis-Syakira J, Kong YL, et al. Malaysia’s health systems response to COVID-19. Int J Environ Res Public Health. 2021;18(21).
Pandey KR, Yang F, Cagney KA, Smieliauskas F, Meltzer DO, Ruhnke GW. The impact of marital status on health care utilization among Medicare beneficiaries. Med (United States). 2019;98(12).
Bastani P, Mohammadpour M, Samadbeik M, Bastani M, Rossi-Fedele G, Balasubramanian M. Factors influencing access and utilization of health services among older people during the COVID − 19 pandemic: a scoping review. Arch Public Heal. 2021;79(1):1–11.
Cochran AL, McDonald NC, Prunkl L, Vinella-Brusher E, Wang J, Oluyede L, et al. Transportation barriers to care among frequent health care users during the COVID pandemic. BMC Public Health [Internet]. 2022;22(1):1–10. Available from: https://doi.org/10.1186/s12889-022-14149-x
Wolfe MK, McDonald NC, Holmes GM. Transportation Barriers to Health Care in the United States: Findings From the National Health Interview Survey, 1997-2017. Am J Public Health. 2020;110(6):815–22.
Subramaniam Kalianan R, Woon YL, Hing YL, Leong CT, Lim WY, Loo CE, et al. Appointment structure in Malaysian healthcare system during the COVID-19 pandemic: The public perspective. BMC Health Serv Res [Internet]. 2022;22(1):1–8. Available from: https://doi.org/10.1186/s12913-021-07456-3
Ting RSK, Foo PL. Counseling Chinese Communities in Malaysia - The Challenges and Needs in Mental Health Service Deliverancee. 2018;(September):23–49.
Kyaw HK, Than KK, Diaconu K, Witter S. Community stressors and coping mechanisms in accessing the health system during a double crisis: a qualitative case study from Yangon Region, Myanmar. Int J Equity Health [Internet]. 2023;22(1):1–11. Available from: https://doi.org/10.1186/s12939-023-01851-4
Alam MS, Abdelsalam EFA. Comparative Study on the Socioeconomic and Political Conditions of Indian and Chinese Communities in Malaysia. Sprin J Arts, Humanit Soc Sci. 2023;2(09):35–53.
Fitzpatrick AL, Powe NR, Cooper LS, Ives DG, Robbins JA, Enright E. Barriers to health care access among the elderly and who perceives them. Am J Public Health. 2004;94(10):1788–94.
Chan E, Procter-Gray E, Churchill L, Cheng J, Siden R, Aguirre A, et al. Associations among living alone, social support and social activity in older adults. AIMS Public Heal [Internet]. 2020 [cited 2024 Apr 23];7(3):521. Available from: /pmc/articles/PMC7505797/
Ghimire S, Shrestha A, Yadav UN, Mistry SK, Chapadia B, Yadav OP, et al. Older adults with pre-existing noncommunicable conditions and their healthcare access amid COVID-19 pandemic: A cross-sectional study in eastern Nepal. BMJ Open. 2022;12(2).
