Health-Seeking Behavior and Perceptions of Care: A Qualitative Study Investigating the Underutilization of Public Health Care on the Galapagos Islands

Since Ecuador's vast restructuring of its health-care system in 2008, Ecuador has invested in new and improved public health-care infrastructure. As a result, the government was able to construct new hospital on San Cristobal Island, the provincial capital of the Galapagos Islands, with hopes that it would significantly reduce residents' need to travel to the mainland for care. Nonetheless, despite the hospital's enhanced technologies and free care, it has been underutilized since its opening, hindering the provision of care to island residents and perpetuating the burden on residents to seek costly care on the mainland. Interviews and one focus group were conducted to examine the perceptions of care and the factors deterring residents from utilizing hospital services. Andersen's behavioral model was used as a conceptual model and informed the decision to interview a variety of participants, including community members, hospital personnel, and local stakeholders. Audio recordings from the interviews and the focus group were transcribed and iteratively coded for themes using qualitative analysis software. Residents' perceptions that the hospital lacks specialists and is inefficient have deterred residents from seeking care there. Participants also voiced concerns with provider trust and overall health-care quality. These estimations have motivated residents to travel to the mainland for care, posing both financial and health burdens on individuals. Improvements to the hospital, including instituting a rotation of specialists, improving telemedicine, and establishing a simulation lab, as well as community outreach programs to engage residents and solicit feedback would improve health-care utilization. Further, residents' positive experiences at the new hospital could improve its reputation on the small island where word of community experience and approval spreads quickly.