From Awareness to Adoption: Prevalence and Determinants of Ayushman Bharat Health Account (ABHA) Adoption among Adults in a Community- Based Study from South India

Abstract

Background: Electronic health records (EHRs) have altered healthcare by allowing for longitudinal
tracking of patient data, improved treatment coordination, and increased community health
surveillance. On September 27, 2021, India launched the Ayushman Bharat Digital Mission (ABDM),
one of the most ambitious national digital health initiatives in low- and middle-income nations, in
response to this worldwide issue. With the introduction of Ayushman Bharat Health Account (ABHA)
IDs under ABDM, more than 42 crore health records were linked, and more than 1.3 lakh healthcare
facilities—including 17,000 private institutions—were integrated into a single digital framework.
Despite this significant growth, there is still little published data on population-level awareness and
actual use of ABHA, and acceptance varies by location. Puducherry, a Union Territory in southern
India, provides a unique backdrop for ABDM implementation due to its hybrid public-private
healthcare system, linguistic diversity, and varying digital literacy. Strategies for expanding ABDM
throughout peninsular India can be informed by knowledge of awareness and acceptance trends in
such semi-urban and peri-urban environments. The purpose of this study was to investigate
independent predictors of ABHA adoption, identify characteristics related to awareness, and evaluate
the prevalence of ABHA awareness and use among adults in Puducherry.
Materials and Methods: Adults over the age of eighteen who had lived in specific Puducherry
regions for at least six months participated in a community-based analytical cross-sectional survey. To
find participants, systematic random sampling was used. A pretested, semi-structured, interviewer-
administered questionnaire created following a thorough literature review was used to gather data.
Digital health indicators, health behaviors, and sociodemographic traits were among the variables.
Using multivariable logistic regression to find independent predictors, statistical analysis examined
relationships between awareness/adoption and explanatory factors.
Results: Among the 336 adults, 32.7% were aware of ABHA, and 20.8% had an ABHA ID.
Awareness was considerably greater among ABHA ID holders (92.9% vs. 16.9%) and those with
health insurance (50.7% vs. 28.0%). Adoption was significantly correlated with insurance coverage
(36.0% vs. 16.3%), awareness (59.1% vs. 2.2%), and depression level (31.0% vs. 17.3%). The biggest
predictor of adoption, according to multivariable analysis, is awareness (AOR = 114.1; p < 0.001).
Adoption was influenced by educational achievement; individuals with intermediate/diploma (AOR =
10.20), middle school (AOR = 9.07), and illiterate participants (AOR = 5.73) had greater odds than
graduates. Adoption was higher in socioeconomic Class II (the largest group, 27.1%) and Class III
(AOR = 5.15) than in Class I. Gender, age, and occupation did not show any independent
significance.
Conclusion: According to this survey, just one-fifth of people in Puducherry had adopted ABHA,
despite the fact that one-third was aware of it. This indicates a glaring disparity between awareness
and utilization. The biggest independent predictor of adoption was awareness and those in middle
socioeconomic classes and with less education had higher probabilities, indicating that ABDM
outreach is effective with vulnerable populations. Adoption and awareness were aided by health
insurance, but after adjustment, its importance diminished. These results emphasize the necessity of
region-specific tactics, focused awareness campaigns, and digital literacy initiatives to increase
ABHA uptake. ABDM's objective of universal digital health integration can be accelerated by
addressing contextual constraints in semi-urban and peri-urban communities. Puducherry provides
insightful information for scaling equitable adoption across various Indian contexts.