Factors influencing health service utilisation among older adults in the Tamale metropolis: a cross-sectional study based on Andersen’s behavioural model

Background: Older adults represent only about 6% of Ghana’s total population, yet they account for over 80% of those who access healthcare annually. Despite this high utilisation, many older adults continue to face substantial barriers to care, including financial, structural, and health system challenges. This study applied Andersen’s Behavioural Model to examine how predisposing, enabling, and need factors are associated with health service utilisation among older adults in Northern Ghana. Methods: A community-based cross-sectional survey was conducted between January and March 2024 among 339 adults aged 60 years and above, selected from four communities using a multistage sampling approach. Data were collected through face-to-face interviews using a structured questionnaire. Health service utilisation was operationalised as at least one visit to a health facility in the 12 months preceding the study. Mann-Whitney U test, Kruskal-Wallis test, and hierarchical binary logistic regression were used to analyse the data. Results: The average age of the respondents was 68.7 years, with most being female (61.7%) and having no formal education (62.2%). A majority (94.4%) were enrolled in the National Health Insurance Scheme, and 72.9% reported at least one chronic condition. Overall, 83.8% of the participants reported using health services at least once in the past year. Predisposing factors (age and sex), enabling factors (employment status, health insurance status, and distance to the nearest health facility), and need factors (presence of chronic conditions) were significantly associated with utilization. The major health service utilisation factors were having a chronic condition (OR = 11.2, 95% CI [4.7, 26.6]), having health insurance (OR = 8.3, 95% CI [1.8, 39.0]), living more than 4 km from a facility (OR = 0.10, 95% CI [0.02, 0.38]), and being self-employed (OR = 0.07, 95% CI [0.01, 0.65]). Conclusions: Health service utilisation among older adults in Tamale was associated with a combination of predisposing, enabling, and need factors. While insurance coverage was high and contributed to health service utilisation, self-employment and living more than 4 km from a facility were major barriers. Community-based outreach, including mobile health clinics or targeted home-based care, may be a cost-effective approach to improving older adults’ access to and utilisation of health services.