Patients' attitude toward informal payments in Iran: an application of the cluster analysis method

E. Zarei, A. Nikkhah*, S. Khodakarim, M. Pavlova

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Introduction Attitude is a factor affecting the behaviour of consumers. In the literature, the effect of health care consumer's attitude on making informal payments has been highlighted. The purpose of this study was to investigate the attitude of Iranian patients regarding informal payments and socio-demographic factors associated with it.Methods In this cross-sectional study, conducted in 2017 in Tehran, 450 patients who were admitted to the clinics of four public hospitals for post-surgical care and follow-up, were invited to participate in the study. The data collection tool was a questionnaire, which validity and reliability were confirmed. Cluster analysis was used to identify the main attitudinal groups. To investigate the effect of socio-demographic factors on patients' attitudes, generalized linear model regression analysis was carried out in SPSS 22.Results Our findings showed that 57.3% of patients had agreeing attitude, 24.2% indifferent attitude, and 18.4% opposing attitude toward informal payments. Patients from rural areas and those from the high-income group had higher odds of having an agreeing attitude. There was a significant association between informal payment history and attitude. The odds of having agreeing attitude among patients with a history of informal payment were two times higher than among patients who did not have an informal payment history (p <= 0.05).Conclusion A positive attitude towards informal payments is an obstacle to the fight against this phenomenon. Therefore, changes in public attitudes regarding informal payments will be an essential strategy, among other strategies, for eradicating these payments. This could be achieved through public campaigns for raising people's awareness and knowledge.
Original languageEnglish
Pages (from-to)689-702
Number of pages14
JournalInternational Journal of Health Planning and Management
Issue number3
Early online date20 Jan 2021
Publication statusPublished - May 2021


  • attitude
  • cluster analysis
  • financing
  • informal payments


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