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Effect of COVID-19 on patients health-seeking behaviour in Zulfi City

1 Department of Internal Medicine, College of Medicine Majmaah University, Al-Majmaah, Saudi Arabia
2 Department of Medical Student, College of Medicine Majmaah University, Al-Majmaah, Saudi Arabia
3 Department of Family and Community Medicine, College of Medicine Majmaah University, Al-Majmaah, Saudi Arabia
4 Azra Naheed Medical College, Superior University, Lahore, Pakistan

Date of Submission12-Apr-2022
Date of Acceptance13-Oct-2022
Date of Web Publication25-Nov-2022

Correspondence Address:
Waqas Sami,
Azra Naheed Medical College, Superior University, Lahore
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aihb.aihb_67_22


Introduction: During the ongoing COVID-19 pandemic, all perspectives of life were affected by the situation, and as a result, all health services worldwide were overwhelmed, which led to the exhaustion of hospital beds and intensive care units, workforce and resources. This research was done to determine the health-seeking behaviour during the COVID pandemic COVID-19 in the Al Zulfi area and its relation to the monthly number of patient visits to primary health centre before and after the pandemic and the roles and regulations for health-care services. Materials and Methods: This was an observational, cross-sectional study to study the effect of the COVID-19 pandemic on patients' health-seeking behaviour in Zulfi city. Results: Results were obtained from 567 participants; the finding was a decline in the number of patients visiting the health facilities by 65.6% compared in 2019. There were more declines in males than in females (18.5% vs. 15.9%, respectively). Conclusion: Despite the strong impact of COVID-19 on healthcare, the Kingdom of Saudi Arabia is one of the strongest countries in facing this pandemic, providing the best care, educating society and minimizing losses. Under these circumstances, patients' visits to health centres in Zulfi decreased, complications appeared for some patients who rescheduled their appointments, healthcare became electronic, and the patients were satisfied with those services.

Keywords: Behaviour, COVID-19, primary care

How to cite this URL:
Almehmadi B, Althewaikh TM, ALhussain AA, Bin Saqyan AH, Alosaimi MF, Alhayden B, Medani KE, Sami W. Effect of COVID-19 on patients health-seeking behaviour in Zulfi City. Adv Hum Biol [Epub ahead of print] [cited 2022 Nov 30]. Available from: https://www.aihbonline.com/preprintarticle.asp?id=361970

  Introduction Top

The first declaration of the novel coronavirus 2019 infection was on 31st December, 2019, as a new emerging infection in Wuhan, China. The pneumonia case was reported with the identification of a new virus that is called the novel coronavirus 2019. Transmission of novel coronavirus 2019 was assumed to occur by droplets through coughing or sneezing.[1] Most of the patients who have been infected with the COVID-19 virus experienced respiratory illness (ranging from mild to severe) and recovered without the need for specific treatment or medical intervention. The elderly and those with basic and chronic medical conditions, including cardiovascular disease, diabetes, chronic respiratory disease and cancer, develop serious illnesses. Moreover, all health services in the world were affected by the COVID-19 pandemic, which led to the exhaustion of hospital beds, intensive care units, workforce and resources. This exhaustion negatively affected other diseases' management. In Saudi Arabia, many preventive measures were taken, such as the suspension of Umrah, prayers in mosques, closure of schools and workplaces, sports activities, gyms and flights have been stopped. Two weeks of quarantine is mandatory for contacts of confirmed cases of COVID-19. The government offered free treatment and diagnosis for whoever experienced COVID-19 symptoms for Saudis and non-Saudis. As a measure to protect the populations from this new disease, the governments started a package of procedures to minimise the spread of infection such as curfews and social distancing. The COVID-19 pandemic has compelled several firms to close and has contributed to unparalleled trade disruptions in most sectors. Most markets are no longer open, especially for tourism and hospitality. All the organisational functions intend to prioritise and optimise expenditures in the current setting or delay activities without benefit.[2] At the same time, online communication in all fields, including online missions and online shopping, is seeing unprecedented growth. Moreover, the preventive measures for COVID-19 include wearing a mask, keeping a safe distance, cleaning your hands and not touching your eyes, nose, mouth and vaccine of COVID-19.[3]

During the Italian quarantine in Milan (from 9th March, 2020, to 3rd May, 2020), patients who visited San Raffaele Hospital's medical retina and imaging unit were affected by the pandemic.[4]

A study in Turkey in Nevşchir State Hospital and Uşak Training and Research Hospital reveals that the number of health-care seekers has decreased from 1092 to 772 for secondary care and from 1443 to 1114 for tertiary care dermatology outpatient clinics.[5] Moreover, data were collected from five emergency departments in five different states in the USA. There was a significant decline in emergency department visits in all five states as the US case numbers for COVID-19 increased.[6] A study in Indonesia showed that in 2020, during COVID-19, there was a strong decline in patients visiting clinics.[7] In addition, research was conducted by Al Kuwari et al. to study the effect of COVID-19 on primary health-care centres in Qatar in terms of response, modifications of services and development of new alternatives. The overall primary health care centre's services utilisation decreased to 50% in April 2020.[8]

A survey in April 2020 in India by Ghosh et al., who actively underwent systemic therapy for malignancies in the medical oncology department during the COVID-19 pandemic nationwide lockdown. Sixty-eight patients were chosen to continue chemotherapy, whereas 40 deferred the treatment, and 56 did not know whether to continue or not.[9]

This study aims to determine the effect of COVID-19 on patients' health-seeking behaviour in Zulfi city in Saudi Arabia.

  Materials and Methods Top

An observational, cross-sectional study was conducted in Al Zulfi city. Zulfi city is located south of AL Qassim province by 80 km. The Zulfi governorate is about 5540 km2 and consists of 21 neighbourhoods. The capacity of Zulfi hospital beds is 170. In addition, there are seven primary healthcare centres. The population of Zulfi city is 72,000 people of different nationalities (Saudis and non-Saudis); we study patients who seek medical services in Zulfi primary health centre (PHC) and the hospital outpatient department.

Participants were selected using the stratified cluster sampling technique. The 21 neighbourhoods of Zulfi city were divided into four strata by locality (North, South, East and West). The sample size was calculated according to the population size between the strata. These were selected according to a probability proportional to the population size at the level of each cluster. The equation calculated the sample size, n = Z2pq/d2 × 2 (With 95% confidence and 5% accuracy, the sample size was calculated to be 384). Five hundred and sixty-seven participants responded to the questionnaire.

Data were collected through an online questionnaire distributed to the patients. Data were analysed by a computer programme using SPSS version 24 (IBM SPSS Statistics for Windows Version 24, Armonk, NY: IBM Corp). Pearson Chi-square and Fisher's exact tests were applied to observe associations between qualitative variables. A P = 0.05 was considered statistically significant. There was no physical, emotional, or mental harm to the participants. Confidentiality, respect and dignity are maintained throughout the research process.

  Results Top

The following results were obtained from 567 participants living in Zulfi city. Sociodemographic factors were asked for, along with changing visiting patterns, types of health-care delivery, health-care service satisfaction during the pandemic and complications due to appointment rescheduling.

[Table 1] shows that most participants were Saudi (99.6%), whereas the non-Saudis were (0.4%). Females were 56.8%, whereas males were 43.2%. In addition, most participants were in the age group of 16–30 years (65.4%), and the last ones were in the age group of more than 65 years (0.7%). In addition, single participants made up 60% of the total, followed by married (36.3%), divorced ones (2.5%) and widows (0.4%). Concerning income, those having an income of <10,000 were (51.1%), followed by those who had an income from 10.000 up to 20.000 (28.1%), and more than 20.000 were (20.8%).
Table 1: Distribution of participants according to nationality, gender, age, marital status and income (n=567)

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[Figure 1] shows that those who visited the centre between 1 and 3 visits per year were 412 (72.7%), 4–6 visits per year were 90 (15.9%) participants, 7–9 visits per year were 40 (7.1%) participants and 10–12 visits per year were 25 (4.4%) participants.
Figure 1: Frequency of annual visits to Primary Health Care Center in Zulfi before the pandemic (n = 567)

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[Table 2] shows that 372 (65.6%) of the participants changed the pattern of visits to PHC during a pandemic; only 142 (25%) of them had rescheduled their appointment, whereas most of them 237 (41.9%) did not reschedule their appointment. One hundred and ninety-five (34.4%) of the participants did not change their visiting patterns. Few participants got complications after rescheduling their appointment 91 (16.0%). Participants who did not go to the appointments due to fear of coronavirus were 221 (38.9%), those who did not go to the appointments due to hospital instruction were 120 (21.2%) and those who did not go to the appointments because their health status improved were 226 (39.9%).
Table 2: Distribution of participant's according to changing visiting pattern, reschedule the appointment, complication due to appointments rescheduling and reasons for not going to appointment or hospital

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Most of those who changed their visiting patterns during the pandemic were male (18.5%) and single (37.7%), and the relationship was not statistically significant (P = 0.327) [Table 3].
Table 3: Relationship between changing pattern of visiting health facility and gender and marital status

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In [Table 4], most of those who had complications due to the rescheduling of their appointments were in the age group of 16–30 (10.2%) years, followed by 31–45 (3.5%) years, and the least relation was found in the extreme of age <16 (0.2%) years and the age group of 46–65 (0.7%). No complications in those who are more than 65 years. Most of those who had the complication of the rescheduling were singles (9%) and females (9%), and the relationship was not statistically significant (P = 0.986).
Table 4: Relationship between complication of the rescheduling of hospital visits and age group, gender and marital status

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  Discussion Top

This study was about the effect of COVID-19 on patients' health-seeking behaviour in Zulfi city. The COVID-19 pandemic has led to a rise in fear, anxiety, stress and depression among the population, and this was the significant role and leading factor in changing the visiting pattern to health facilities. In our results of the study in 2020, consisting of 567 participants, the finding was a decline in the number of patients visiting health facilities by 65.6% compared in 2019, and this was consistent with the studies done in Turkey and Qatar.[5],[8]

Moreover, after analysing the results, there was more decline in males than in females (18.5% and 15.9%, respectively). Unlike the Italian study, in which the patients who had visited San Raffaele hospital's medical retina during 2020, the females showed more decline than males (82.3% for females and 68% for males).[4]

The study showed that 20.3% of participants were infected with COVID-19 and the reasons for changing seeking health behaviour were mainly due to the fear of coronavirus and less likely due to hospital instructions.

The study showed the different relationships between changing patterns of health facilities and different variables; there were more in the age group between 16 and 30 (41.8%) years and more in single individuals (37.7%), and all these relations were statistically insignificant.

In addition, the study showed that few patients (16%) got complications due to their appointment rescheduling, and this was probably due to compensating services that the ministry of health affords to the patients, which include (home healthcare, telemedicine, online physician consultation and drug delivery to their houses).

During the COVID-19 pandemic, the primary health-care authorities in Zulfi developed a strategy to separate respiratory patients and other medical problems in the health facilities by using different lines for entrance. For example, the orange line for respiratory problems and the green line for other conditions. In addition, there were isolation rooms equipped with negative air pressure for suspected patients with COVID-19. Furthermore, the medical staff had specific instructions to ensure patients' safety by wearing full personal protective equipment such as (eye protection, face masks, wearing gowns and gloves) and good hand hygiene. Furthermore, the ministry of health in the kingdom of Saudi Arabia had chosen some centres to be responsible for the COVID-19 test around the kingdom, and in Zulfi city, the centre had been in charge of the COVID-19 test Alkhalidiah primary healthcare centre. Despite all the measures, the number of primary health-care visitors in Zulfi city declined from 7726 visits per month in 2019 to 4632 visits per month in 2020.

  Conclusion Top

Despite the strong impact of COVID-19 on healthcare, the Kingdom of Saudi Arabia is one of the strongest countries in facing this pandemic, providing the best care, educating society, and minimising losses. Under these circumstances, patients' visits to health centres in Zulfi decreased, complications appeared for some patients to reschedule their appointments, healthcare became electronic, and the patients were satisfied with those services.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Available from: https://www.who.int/news/item/29-06-2020-covidtimeline. [Last accessed on 2022 Mar 10].  Back to cited text no. 1
Available from: https://www.moh.gov.sa/Ministry/vro/Documents/Health-Vision-7.pdf. [Last accessed on 2022 Mar 18].  Back to cited text no. 3
Borrelli E, Grosso D, Vella G, Sacconi R, Querques L, Zucchiatti I, et al. Impact of COVID-19 on outpatient visits and intravitreal treatments in a referral retina unit: Let's be ready for a plausible “rebound effect”. Graefes Arch Clin Exp Ophthalmol 2020;258:2655-60.  Back to cited text no. 4
Kutlu Ö, Güneş R, Coerdt K, Metin A, Khachemoune A. The effect of the “stay-at-home” policy on requests for dermatology outpatient clinic visits after the COVID-19 outbreak. Dermatol Ther 2020;33:e13581.  Back to cited text no. 5
Jeffery MM, D'Onofrio G, Paek H, Platts-Mills TF, Soares WE 3rd, Hoppe JA, et al. Trends in emergency department visits and hospital admissions in health care systems in 5 states in the first months of the COVID-19 pandemic in the US. JAMA Intern Med 2020;180:1328-33.  Back to cited text no. 6
Rhatomy S. Impact of COVID-19 on primary care visits: Lesson learned from the early pandemic period. J Community Empowerment Health 2020;3:108-17.  Back to cited text no. 7
Al-Kuwari MG, Abdulmalik M, Bakri AH, Gibb J, Kandy MC, Swamy S, et al. The COVID-19 Pandemic Impact on Primary Health Care Services: An Experience from Qatar. World Family Medicine Journal/Middle East Journal of Family Medicine 2021;19:105-10; DOI:10.5742/MEWFM.2021.94033.  Back to cited text no. 8
Ghosh J, Ganguly S, Mondal D, Pandey P, Dabkara D, Biswas B. Perspective of oncology patients during COVID-19 pandemic: A prospective observational study from India. JCO Glob Oncol 2020;6:844-51.  Back to cited text no. 9


  [Figure 1]

  [Table 1], [Table 2], [Table 3], [Table 4]


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