title: Access and barriers to healthcare in the Kingdom of Saudi Arabia, 2013: findings from a national multistage survey.
abstract: OBJECTIVE
  We analysed data from a large household survey to identify barriers to healthcare in the Kingdom of Saudi Arabia.
  
  
  METHODS
  The Saudi Health Interview Survey (SHIS) is a national multistage survey of individuals aged 15 years or older. The survey combined a household questionnaire and a laboratory blood analysis. We used a backward elimination multivariate logistic regression model to measure association between (1) diagnosis, (2) treatment, and (3) control of hypertension or diabetes and sociodemographic factors, history of diagnosis with chronic conditions, and type of, and distance travelled to, the clinic last visited.
  
  
  RESULTS
  Between April and June 2013, a total of 10,735 participants completed SHIS and were invited to the local health clinics. Among hypertensive individuals, women, older individuals, and those previously diagnosed with diabetes and hypercholesterolaemia were more likely to have been diagnosed with hypertension than their counterparts. Among participants diagnosed with hypertension, the likelihood of being treated increased with age and education. The likelihood of having uncontrolled blood pressure despite treatment increased with education and a history of diagnosis with hypercholesterolaemia. Type of clinic visited and distance travelled to last clinic visit were not associated with diagnosis or treatment of hypertension or control of blood pressure. Similar factors were associated with the likelihood of diagnosis and treatment among individuals with diabetes. Having uncontrolled glycated haemoglobin levels, despite treatment, was less common among those who visited governmental clinics other than those of the Ministry of Health, compared with those who visited Ministry clinics.
  
  
  CONCLUSIONS
  Our findings highlight the importance of individual characteristics in healthcare-seeking practices rather than system-based potential barriers. Saudis seem to mostly seek healthcare when sick. Hence, the Saudi Ministry of Health needs to implement a comprehensive plan including health education and investigations, to understand the barriers and bottlenecks to healthcare-seeking behaviour.
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
authors.forename: Charbel
authors.initials: C
authors.lastname: El Bcheraoui
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
authors.forename: Marwa
authors.initials: M
authors.lastname: Tuffaha
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
authors.forename: Farah
authors.initials: F
authors.lastname: Daoud
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Kravitz
authors.affiliation: Ministry of Health of the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia.
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: AlMazroa
authors.affiliation: Ministry of Health of the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Al Saeedi
authors.affiliation: Ministry of Health of the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Memish
authors.affiliation: Ministry of Health of the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Basulaiman
authors.affiliation: Ministry of Health of the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia.
authors.forename: Abdullah A
authors.initials: AA
authors.lastname: Al Rabeeah
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
authors.forename: Ali H
authors.initials: AH
authors.lastname: Mokdad
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy; D004522:Educational Status; D005260:Female; D006293:Health Promotion; D006296:Health Services / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012529:Saudi Arabia; D055815:Young Adult
keywords: PREVENTIVE MEDICINE; PRIMARY CARE