Barriers to access and factors associated with health care utilization among the adult homeless population in Dhaka, Bangladesh - a mixed method cross-sectional study

Sep 30, 2026

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The study examines barriers that homeless individuals encounter when accessing healthcare and the determinants linked to healthcare utilization among adults in Dhaka, Bangladesh. A mixed-method cross-sectional design was conducted from November 2022 to July 2023, combining a survey of 452 adults with purposive qualitative interviews of 6 homeless individuals and 4 national-level policymakers. Quantitative analyses used chi-square tests and logistic regression, while qualitative data were transcribed and thematically analyzed. Financial constraints, limited knowledge, complex systems, lack of attendants, beliefs about natural healing, and discrimination were prominent.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages17

Reading Time43 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Background

Homelessness as a public health and social exclusion issue

Context in Bangladesh

Rabbani etal. BMC Public Health (2026) 26:81 BMC Public Health [https://doi.org/10.1186/s12889-025-24471-9](https://doi.org/10.1186/s12889-025-24471-9) RESEARCH Open Access Barriers to access and factors associated with health care utilization among the adult homeless population in Dhaka, Bangladesh: a mixed method cross-sectional study Md. Golam Rabbani 1,2*, Orin Akter 1, Halima Akter Prova 1, Md. Samiul Huda3, Tahseen Tawseef4, Md. Zahid Hasan 1, Taufique Joarder5, Shehrin Shaila Mahmood 1 and Hasnat M. Alamgir2,6 Abstract Background The barriers faced by homeless individuals in accessing healthcare and the factors associated with their healthcare utilization in low-and middle-income countries like Bangladesh remain understudied. This study aims to assess individual-level barriers to access healthcare and identify factors influencing its utilization among the homeless population. Methods We conducted a mixed-method study between November 2022 and July 2023 in Dhaka, Bangladesh. Across-sectional survey was conducted with 452 randomly selected adult males and females. Additionally, qualitative interviews were conducted with 6 purposively selected homeless individuals and 4 national-level policymakers. Quantitative data are presented as frequencies (n) and percentages (%) . The Chi-square test compared categorical variables, focusing on healthcare utilization, while the logistic regression model identified factors associated with greater healthcare utilization, controlling for confounders. Qualitative data was transcribed, translated, and systematically analyzed. Results Around 38% of participants had experienced acute illness in the 30 days preceding the survey, with 67% among them seeking treatment, primarily from local drug stores (65%) . Financial constraint (70%) was the primary barrier in this group for not seeking care for acute illness. Additionally, 46% of participants reported chronic illnesses lasting more than 12 months, with about 80% among them being unable to afford regular treatment due to financial constraints (90%) . Qualitative findings also reported financial barriers and identified other obstacles, including poor knowledge about care sources, complex healthcare systems, lack of attendants, belief in natural healing, and discrimination at health facilities. The regression model demonstrated that higher healthcare utilization was significantly associated with living with family (AOR: 4 . 58), having formal education (AOR: 3 .41), a shorter duration of homelessness (reference category), and not using illicit narcotic drug or alcohol (AOR: 5 . 71) . *Correspondence: Md. Golam Rabbani [rabbaniduihe@gmail.com](rabbaniduihe@gmail.com) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)icenses/by-nc-nd/4.0/. Rabbani et al. BMC Public Health (2026) 26:81 Page 2 of 17 Conclusion The homeless population faces persistent challe

FAQs

What was the study’s main objective in Dhaka, Bangladesh?

To assess individual-level barriers to accessing healthcare and to identify factors associated with healthcare utilization among the adult homeless population.

How were participants and data collected?

A mixed-method cross-sectional study surveyed 452 randomly selected adult males and females, and included qualitative interviews with 6 purposively selected homeless individuals and 4 national-level policymakers.

What barriers and factors were most strongly linked to healthcare utilization?

Financial constraints were a primary barrier, alongside poor knowledge of care sources, complex healthcare systems, lack of attendants, belief in natural healing, and discrimination at health facilities. Higher utilization was associated with living with family, formal education, shorter duration of homelessness, and not using illicit narcotic drugs or alcohol.

Sep 30, 2026

Uploaded by Aldword