Predictors of risk of financial hardship and coping with computed tomography utilization in Limbe, Cameroon: a sequential explanatory mixed-methods study.

Abstract Background Computed tomography (CT) is still fairly expensive in Cameroon and is mainly accessed through out-of-pocket (OOP) payments. Its introduction to peripheral health facilities in communities where many live below the poverty line and do not have financial risk protection is a laudable effort though current price listings suggest a mismatch with the purchasing power of potential users. Risk of financial hardship after CT use is an expected reality and we sought to determine predisposing factors and elaborate on how users adapt and cope. Methods We carried out a sequential explanatory mixed methods study with a quantitative hospital-based survey of CT users followed by an in-depth interview of some purposively selected participants who reported risk of financial hardship after CT use. Data was summarized using frequencies, percentages and 95% confidence intervals. Logistic regression was used in multivariable analysis to determine predictors of risk of financial hardship. Themes emerging from the in-depth interviews were categorized. Quantitative and qualitative data were integrated. Results A total of 372 participants were surveyed with a male to female sex ratio of 1:1.2. The mean age (standard deviation) was 52(17) years. CT scans of the head and facial bones accounted for 63% (95%CI: 59%-68%) and the top three indications were suspected stroke (27% [95%CI: 22%-32%]), trauma (14% [95%CI: 10%-18%]) and persistent headaches with blurred vision (14% [95%CI: 10%-18%]). Seventy-two percent (95%CI: 67%-76%) of respondents declared being at risk of financial hardship after CT use and predictors in the multivariable analysis were low socioeconomic status (aOR: 0.19 [95%CI: 0.10-0.38]; p<0.001) and not having any form of financial risk protection (aOR: 3.59 [95%CI: 1.31-9.85]; p=0.013). Coping strategies included relying on family members and friends for financial assistance, lobbying hospital administration, social services and healthcare staff for a reduction of the direct cost, and borrowing of money. Conclusion The risk of financial hardship is a real threat to CT utilization and some users resort to different practices to minimize the burden of OOP payments. Opportunities to improve CT affordability should be enhanced to reduce this burden and the negative consequences of the coping strategies.