"Her hospital card is missing": a qualitative investigation into the facilitators of and barriers to formal healthcare use among sickle cell patients in Ghana.

Background: Access to and use of healthcare is a crucial aspect of sickle cell disease (SCD) management. However, healthcare utilisation is often challenging, particularly among sickle cell patients. Adequate utilisation of healthcare services for people with SCD could improve their life expectancy. As no previous empirical work has been available, this study explores the facilitators of and barriers to formal healthcare use among SCD patients in Ghana.

Methods: This study was conducted using a phenomenological approach in the Ashanti Region of Ghana. A convenience sampling technique was used to recruit 27 parents of children with SCD and adults with SCD. Data were collected from October 2022 to November 2022. Interview guides were used to collect data on demographic and socio-economic factors, as well as facilitators of and barriers to formal healthcare utilisation. Data were analysed using thematic analytical frameworks.

Results: The mean age of the participants was approximately 22 years [8-56 years], and most were females (n = 16). Also, 6 of them had no formal education. The results showed that fear of health consequences for not using formal healthcare, experience of severe pain and crisis, and trust in the services offered by formal healthcare providers serve as facilitators of formal healthcare use among the participants. The results further demonstrated that barriers to formal healthcare use were financial barriers, location and transportation problems, workload and time constraints, use of alternative healthcare services (herbal medicine, faith-based healing, and self-medication) and poor health systems, such as long waiting time at the health facilities and poor patient-centred care and ineffective communication.

Conclusion: This is the first known study to examine the facilitators of and barriers to formal healthcare use among sickle cell patients in Ghana. The findings demonstrate several facilitators of and barriers to formal healthcare utilisation among the participants. The findings provide much evidence and information for developing policies and interventions that promote formal healthcare use among sickle cell patients in Ghana.