Health-seeking behavior and healthcare utilization among patients with non-communicable diseases in India: insights from a systematic review

BMC Health Serv Res. 2025 Nov 28;25(1):1548. doi: 10.1186/s12913-025-13441-x.

ABSTRACT

OBJECTIVE: Non-communicable diseases (NCDs) remain the leading cause of mortality in India, imposing a significant healthcare and economic burden. This study evaluates the health-seeking behaviour, healthcare utilization, and financial impact of major NCDs hypertension, diabetes, ischemic heart disease, and chronic kidney disease (CKD).

METHODS: A systematic search was conducted across global health databases, including PubMed, EMBASE, CINAHL, Scopus, Web of Science, ProQuest, and J-Gate. Simultaneously, searches were performed on Indian databases, journal websites, and Google Scholar for studies published between January 2014 and December 2024. A total of 1,462 studies were identified and exported to Rayyan software for screening. Two independent reviewers screened the studies based on predefined eligibility criteria. The quality of included studies was assessed using the Joanna Briggs Institute checklist, while data extraction was performed using Cochrane data collection forms. Meta-analysis was not conducted due to heterogeneity in the included studies. This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS: A total of 44 observational survey-based studies were included in this review. Financial constraints, geographical barriers, and awareness gaps influenced healthcare utilization for NCDs. While 60.5% relied on government services for affordability, 39.4% preferred private care for faster access. Out-of-pocket expenses, particularly for hemodialysis and cardiac interventions, posed a major financial burden. Treatment adherence varied by 70.1% among diabetic patients but only 32.4% among hypertensive women. Stockouts of essential medications in public hospitals and high costs of branded drugs in private facilities further restricted access. Emergency care utilisation was high for ischemic heart disease, while CKD patients faced long-term financial strain due to dialysis and frequent hospitalisations. Despite an increase in telemedicine use during COVID-19, accessibility challenges persisted. Systemic inefficiencies, cultural beliefs, and transportation issues further delayed timely care.

CONCLUSION: This review highlights critical gaps in NCD care in India, particularly in treatment adherence, financial accessibility, and healthcare infrastructure. Strengthening public healthcare services, expanding insurance coverage for long-term NCD management, and integrating community-based interventions are key policy directions. Additionally, targeted strategies to improve health literacy and promote early disease detection are essential to improving health outcomes and reducing inequities in NCD care in India.

TRIAL REGISTRATION: PROSPERO registration number CRD42024576994.

PMID:41316236 | DOI:10.1186/s12913-025-13441-x