Health care access for rural youth on equal terms? A mixed methods study protocol in northern Sweden

Effects of and Prospects for the Hierarchical Medical Policy in Beijing, China

Hierarchical medical policies are widely used worldwide to reduce healthcare costs, rationalize the use of healthcare resources, and improve accessibility and fairness of healthcare services. However, few case studies have evaluated the effects and prospects of such policies. Medical reform efforts in China have distinct goals and characteristics. Therefore, we investigated the effects of a hierarchical medical policy in Beijing and assessed the future potential of the policy to yield insights for other countries, especially developing countries. Different methods were used to analyze multidimensional data from official statistics, a questionnaire survey of 595 healthcare workers from 8 representative public hospitals in Beijing, a questionnaire survey of 536 patients, and 8 semi-structured interview records. The hierarchical medical policy had strong positive effects on improving access to healthcare services, balancing the workload of healthcare workers in various levels of public hospitals, and improving the management of public hospitals. The remaining obstacles include severe job stress among healthcare workers, the high cost of some healthcare services, and the need for improvement in the development level and service capacity of primary hospitals. This study provides useful policy recommendations regarding the implementation and extension of the hierarchical medical policy, including the need for governments to improve the hospital assessment system and for hospitals to actively participate in developing medical partnerships.

[Application of conceptual mapping in the regulation of access to public health services in the Federal District, Brazil]

Health regulation in the pursuit of equity is the goal of management and requires evaluation methods that improve work processes. The scope of this article is to analyze the application of conceptual mapping in the regulation of access to public health services. It is an exploratory and descriptive study, using a mixed approach, carried out at the Health Regulatory Complex of the Federal District. The data were collected between August and October 2019 and analyzed with the assistance of IRaMuTeQ and Concept Systems® software. There is a convergence of the 25 statements generated by the 71 participants, grouped into 4 clusters, on regulation towards the principle of equity. The healthcare priority level was presented as the focus of regulation and management, the driving force behind the integration of processes. Conceptual mapping is a tool that can support regulation planning and evaluation, as it makes it possible to identify priority points to be worked on by management in improving the regulatory processes identified in this study. These include the training of professionals, the transparency of information and the level of priority healthcare, for effective, equitable, rational and timely access for users of the health system.

Collective imaginaries of caring landscapes for rural youth: a concept mapping study in northern Sweden

Background

In the current study, the approach of ‘utopia as method’ was combined with the concept ‘landscapes of care’ to explore collective imaginaries of caring landscapes in relation to young people living in rural northern Sweden, while focusing specifically on what such landscapes should ideally look like, and how various strategies could help to realise the visions.

Methods

The research was conducted using a modified concept mapping methodology comprising three phases of data collection and analysis. This facilitated the integration of tacit knowledge and utopian visions of young people, professionals and policymakers living and working in various parts of northern Sweden.

Results

The results indicated that caring landscapes should: ‘provide services responsive to young people’s wishes and needs’, ‘be organised around values of safety, equity and youth participation’, and ‘rework metro-centredness’ in order to care for, with and about rural youth.

Conclusions

The findings can be viewed as an imaginary reconstitution of communities in rural northern Sweden, but also as hypothetical building blocks to be used for developing caring landscapes and a ‘good countryside’ where young people have the possibility to live a good life in decent health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12223-4.

Learning About HIV: Predicting the Sources of Knowledge That Matter Regarding HIV Testing Among a National Sample of Black and Latinx Adolescents and Young Adults in the United States

This study investigated the knowledge and beliefs of a nationally representative sample of youth and young adults about HIV based on the microsystems and mesosystems of the ecodevelopmental theory. We used a stratified sample (n = 538) of Black and Latinx adolescents and young adults in the United States, 15-24 years of age, at risk of becoming infected with HIV to assess the source of their HIV knowledge and its association with HIV testing to identify modifiable factors that can support the development of interventions addressing HIV-related risks. Using a logistic regression analysis, findings suggest that identifying protective health behaviors, such as providing adolescents and young adults with sexual health information that is accurate, trustworthy, and safe, could be one way to reduce their risk of HIV infection. Expanding knowledge about the important role and influence of sources of HIV-related knowledge on testing behaviors can inform HIV prevention and intervention programs specific to this population.

Landscapes of care and despair for rural youth - a qualitative study in the northern Swedish 'periphery'

Background

This study emerges as a response to the lack of youth perspectives when it comes to discussions about access to and experiences of health and social services in rural areas. It subsequently contributes to the literature by positioning young people at the centre of this debate, and by taking a more holistic approach to the topic than is typically the case. Specifically, based on the idea that a good life in proper health for young people may be contingent on notions of care that are bounded up in multi-layered social and spatial environments, the aim of this study was to explore what characterises ‘landscapes of care’ for rural youth.

Methods

In this qualitative study, the participants included young people and professionals residing in five diverse areas across the northern Swedish ‘peripheral’ inland. Individual interviews (16 in total) and focus group discussions (26 in total) were conducted with 63 youth aged 14–27 years and with 44 professionals operating across sectors such as health centres, school health, integration units, youth clinics and youth clubs. Following an emergent design and using thematic analysis, we developed one main theme, ‘landscapes of care and despair’, comprising the two themes: ‘(dis)connectedness’ and ‘extended support or troubling gaps’.

Results

The findings illustrate how various health-promoting and potentially harmful aspects acting at structural, organisational and interpersonal levels contributed to dynamic landscapes characterised simultaneously by care and despair. In particular, our study shows how rural youths’ feelings of belongingness to people and places coupled with opportunities to participate in society and access practical and emotional support appear to facilitate their care within rural settings. However, although the results indicate that some in the diverse group of rural youth were cared for and about, a negative picture was painted in parallel. These aspects of despair included youths’ senses of exclusion and marginalisation, degrading attitudes towards them and their problems, as well as recurrent gaps in the provision and practices of care.

Conclusions

To gain a more comprehensive understanding about the health of rural youth, this study highlights the benefits investigating ‘care-ful’ and ‘uncaring’ aspects bounded up in dynamic and multi-layered landscapes.

Characteristics and determinants of community physiotherapy utilization and supply

Background

Demand for Physiotherapy is on the rise due to increasing ageing population and consequent disability and morbidity. However, the costs of healthcare in developing countries are rising, and healthcare resources are limited making the supply of Physiotherapy services challenging in rural communities. Availability of Physiotherapy may help to reduce the burden of disability and enhance efficiency of healthcare systems. This study investigated the characteristics and associations of utilization and supply of community Physiotherapy in Nigeria.

Methods

Cross-sectional survey of 336 consenting community dwelling individuals from three selected communities in Nigeria was carried out. A three-section validated self-developed questionnaire which sought information on socio-demographics, utilization and supply of community Physiotherapy, as well as how to improve community Physiotherapy services was used. A household was used as the primary sampling unit in the study. Inferential and Descriptive statistics were used to assess the data.

Results

Lifetime, 12-month and point utilization of physiotherapy was 21.7, 7.4 and 2.7% respectively. Physiotherapy utilization was significantly associated with level of education (p = 0.007), belief on pain as “spiritual” (p = 0.020) and religious belief (p = 0.001). The respondents with primary, secondary and tertiary education were 14.3, 13.9 and 26 times more likely to utilize physiotherapy services, respectively. Those who ‘agree’ or were ‘not sure’ that their religious belief was against physiotherapy were 92 and 83% less likely to utilize physiotherapy services, respectively compared with those who ‘disagree’. Availability and supply of Physiotherapy services were mostly at the township teaching hospital (47.9%) and private hospitals (20.5%). The supply of Physiotherapy services within the communities was mostly on temporary basis (24.7%) and through visiting Physiotherapists (21.4%). Physiotherapy services utilized was mainly exercise (46.6%) and soft tissue mobilization (41.1%). Travel costs (32.6%), time constraints (27.9%) and work commitments (24.8%) were the constraints for Physiotherapy utilization while positive beliefs and higher education improved Physiotherapy utilization.

Conclusions

Utilization and supply of Physiotherapy services in Nigerian rural community was low. Low utilization of Physiotherapy services in Nigerian rural communities were most significantly influenced by low educational status and beliefs about pain.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-3994-4) contains supplementary material, which is available to authorized users.