DOI: 10.4103/dypj.dypj_5_26 ISSN: 2347-3665

Urban–Rural Differences in Healthcare-seeking Behavior, Selected Health Awareness Indicators, and Mental Health Among School-going Adolescents Aged 12–15 Years in Western Maharashtra: A Cross-sectional Study

Manu Menon, Ravi Nimonkar, Maninder P. S. Pardal, Jyoti Gupta
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Abstract

Background:

India hosts the world’s largest adolescent population, yet urban–rural gaps in healthcare-seeking behavior and awareness persist. Urban–rural differences in adolescent healthcare-seeking behavior, health awareness, and mental health remain poorly documented in Western Maharashtra. This study compared these domains among school-going adolescents aged 12–15 years in rural and urban areas.

Materials and Methods:

We conducted a descriptive cross-sectional study from January to July 2023 in one urban school and two rural schools in Western Maharashtra. A total of 770 adolescents participated (385 rural and 385 urban). Data were collected using the Indian Adolescent Health Questionnaire and the Strengths and Difficulties Questionnaire (SDQ). We summarized findings using descriptive statistics. Associations between categorical variables were examined with Pearson’s chi-square test, and Total Difficulties Scores were compared using the Mann–Whitney U test because the data were not normally distributed.

Results:

Urban adolescents more commonly reported always seeking formal health care when needed (42.3% vs. 14.5% in rural adolescents), whereas rural adolescents more often stated they never (22.3%) or rarely (31.4%) sought care, compared with 4.7% and 9.1% of urban adolescents, respectively. Home-based management was the leading reason for avoiding formal care in both groups. Rural adolescents cited greater use of traditional medicine and lack of an accompanying adult, whereas urban adolescents more frequently mentioned dissatisfaction with services. A higher proportion of rural adolescents had abnormal SDQ scores (19.0% vs. 13.5% urban), and this difference remained significant on Mann–Whitney U testing ( U = 64,693.5, Z = −3.057, P = 0.002). Urban adolescents placed greater importance on physical fitness. Awareness of human immunodeficiency virus was low overall, awareness of the harms of tobacco was high in both settings, and reported drug exposure was higher among rural adolescents (6.2% vs. 2.1%).

Conclusion:

Urban adolescents showed better formal healthcare utilization, whereas rural adolescents had lower formal healthcare utilization, higher mental health risk, and greater drug exposure. These findings highlight the need for context-specific interventions, including improved rural access to formal services, along with strengthened school-based health promotion, mental health screening, and targeted education in both settings.

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