Exploring the dimensions of access to health services: implications for nursing research and practice

Moms in motion: Predicting healthcare utilization patterns among mothers in Newfoundland and Labrador

Mothers have a significant influence on family dynamics, child development, and access to family services. There is a lack of literature on the typical Canadian maternal experience and its influence on access to services for mothers despite recognizing the importance of mothers. A cross-sectional study was conducted to address this research gap that employed Andersen's Behavioral Model of Health Service Use in conjunction with a feminist lens. A total of 1,082 mothers who resided in Newfoundland and Labrador (NL) participated in a province-wide survey in 2017 and reported on their wellbeing, family life, and healthcare utilization. Stepwise binomial logistic regressions and linear regressions were used to predict initiation and continued service utilization within the preceding 12 months, respectively. Mothers who participated in this survey were older, and were more likely to be in a relationship than those in the Canadian census, while no difference was observed in annual income. Approximately half of mothers accessed services for themselves over the previous 12-months, with the overwhelming majority accessing services for their children. Medical services were the most likely to be utilized, and mental health and behavioural services were the most likely services to be needed, but not available. Sociodemographic (e.g., age, education attainment), familial relationships and role satisfaction, health need, and health practices predicted maternal initiation and continued use of services, with a larger number of variables influencing maternal service initiation as compared to continuous use of services. Sociodemographic (e.g., maternal age, community population), maternal social support, health need, and maternal health practices predicted maternal access of at least one child service while family relationships, health need, and maternal health practices predicted maternal use of a range of child services conditional on initial access. These results can support the provincial health system to better support access to care by acknowledging the interdependent nature of maternal and child health care utilization. They also highlight the importance of equitable healthcare access in rural locations. Results are discussed in terms of their clinical relevance to health policy.

Expanding School-Based Health Centers: Sustainable Partnerships and Building Access

Children require accessible, affordable health care to support health and education outcomes. Health care access is affected by children's social determinants of health. School-based health centers (SBHC) bypass larger social structures and social determinants of health, providing accessible health care to children. New SBHC development should consider university collaboration partnerships to establish funding sustainability. University interprofessional health programs allow for high-quality, advanced practice nurse care models to staff SBHCs. When developing an SBHC, founders should utilize access theory to ensure conformity between the targeted population's needs and health services. The dimensions of the theory assist in building and evaluating access. As the pandemic continues to cause health care access barriers for children, advocates, and policymakers should focus efforts on sustaining and expanding SBHCs.

Equity analysis of health system accessibility from perspective of people with disability

Purpose

Self-evaluated access and accessibility has been found to be associated with healthcare seeking and quality of life. Studies have shown that, however, a vast majority of individuals with disability living in poor countries have limited access to healthcare influenced by several barriers. The purpose of this paper is to compare the perception of general accessibility of health care services and its association with access barriers and other contextual factors between people with physical disabilities and counterparts without disability.

Design/methodology/approach

This study is a cross sectional survey involving 213 individuals with physical disabilities and 213 counterparts without disability sampled using a multi-stage method. Data were collected using a structured questionnaire with sections on socioeconomic and living conditions, education, health, employment and access to health care. Data analysis involved usingχ2for proportions andT-test and multiple regressions (stepwise) method to determine significant factors that influence perception on accessibility.

Findings

The study finds that people with disabilities fared worse in various socioeconomic factors such as education, employment, income and assets possession. People with disabilities also experience more dimensional barriers and reported poor health system accessibility. The difference in accessibility continued after adjusting for other variables, implying that there are more inherent factors that explain the perception of access for people with disabilities.

Practical implications

Governments should ensure equitable access to health care delivery for people with disabilities through equitable health policies and services that are responsive to the needs of people with disabilities and promote the creation of enabling environment to enhance participation in health care delivery.

Originality/value

The authors confirm that the paper has neither been submitted to peer review, nor is in the process of peer reviewing or accepted for publishing in another journal. The author(s) confirms that the research in this work is original, and that all the data given in the paper are real and authentic. If necessary, the paper can be recalled, and errors corrected. The undersigned authors transfer the copyright for this work to theInternational Journal of Health Governance. The authors are free of any personal or business association that could represent a conflict of interest regarding the paper submitted, and the authors have respected the research ethics principles.

Factors affecting access to primary health care services for persons with disabilities in rural areas: a "best-fit" framework synthesis

Background

Access to primary health care (PHC) is a fundamental human right and central in the performance of health care systems, however persons with disabilities (PWDs) generally experience greater barriers in accessing PHC than the general population. These problems are further exacerbated for those with disabilities in rural areas. Understanding PHC access for PWDs is particularly important as such knowledge can inform policies, clinical practice and future research in rural settings.

Methods

We conducted a synthesis of published literature to explore the factors affecting access to PHC for PWDs in rural areas globally. Using an adapted keyword search string we searched five databases (CINAHL, EMBASE, Global Health, Medline and Web of Science), key journals and the reference lists of included articles. We imported the articles into NVivo and conducted deductive (framework) analysis by charting the data into a rural PHC access framework. We subsequently conducted inductive (thematic) analysis.

Results

We identified 36 studies that met our inclusion criteria. A majority (n = 26) of the studies were conducted in low-and middle-income countries. We found that PWDs were unable to access PHC due to obstacles including the interplay of four major factors; availability, acceptability, geography and affordability. In particular, limited availability of health care facilities and services and perceived low quality of care meant that those in need of health care services frequently had to travel for care. The barrier of geographic distance was worsened by transportation problems. We also observed that where health services were available most people could not afford the cost.

Conclusion

Our synthesis noted that modifying the access framework to incorporate relationships among the barriers might help better conceptualize PHC access challenges and opportunities in rural settings. We also made recommendations for policy development, practice consideration and future research that could lead to more equitable access to health care. Importantly, there is the need for health policies that aim address rural health problems to consider all the dimensions and their interactions. In terms of practice, the review also highlights the need to provide in-service training to health care providers on how to enhance their communication skills with PWDs. Future research should focus on exploring access in geographical contexts with different health care systems, the perspectives of health care providers and how PWDs respond to access problems in rural settings.

Electronic supplementary material

The online version of this article (10.1186/s41256-018-0091-x) contains supplementary material, which is available to authorized users.

Discordant indigenous and provider frames explain challenges in improving access to arthritis care: a qualitative study using constructivist grounded theory

INTRODUCTION

Access to health services is a determinant of population health and is known to be reduced for a variety of specialist services for Indigenous populations in Canada. With arthritis being the most common chronic condition experienced by Indigenous populations and causing high levels of disability, it is critical to resolve access disparities through an understanding of barriers and facilitators to care. The objective of this study was to inform future health services reform by investigating health care access from the perspective of Aboriginal people with arthritis and health professionals.

METHODS

Using constructivist grounded theory methodology we investigated Indigenous peoples' experiences in accessing arthritis care through the reports of 16 patients and 15 healthcare providers in Alberta, Canada. Semi-structured interviews were conducted between July 2012 and February 2013 and transcribed verbatim. The patient and provider data were first analyzed separately by two team members then brought together to form a framework. The framework was refined through further analysis following the multidisciplinary research team's discussions. Once the framework was developed, reports on the patient and provider data were shared with each participant group independently and participants were interviewed to assess validity of the summary.

RESULTS

In the resulting theoretical framework Indigenous participants framed their experience with arthritis as 'toughing it out' and spoke of racism encountered in the healthcare setting as a deterrent to pursuing care. Healthcare providers were frustrated by high disease severity and missed appointments, and framed Indigenous patients as lacking 'buy-in'. Constraints imposed by complex healthcare systems contributed to tensions between Indigenous peoples and providers.

CONCLUSION

Low specialist care utilization rates among Indigenous people cannot be attributed to cultural and social preferences. Further, the assumptions made by providers lead to stereotyping and racism and reinforce rejection of healthcare by patients. Examples of 'working around' the system were revealed and showed potential for improved utilization of specialist services. This framework has significant implications for health policy and indicates that culturally safe services are a priority in addressing chronic disease management.

Dying in the margins: understanding palliative care and socioeconomic deprivation in the developed world

CONTEXT

Individuals from low socioeconomic (SE) groups have less resources and poorer health outcomes. Understanding the nature of access to appropriate end-of-life care services for this group is important.

OBJECTIVES

To evaluate the literature in the developed world for barriers to access for low SE groups.

METHODS

Electronic databases searched in the review included MEDLINE (1996-2010), CINAHL (1996-2010), PsychINFO (2000-2010), Cochrane Library (2010), and EMBASE (1996-2010). Publications were searched for key terms "socioeconomic disadvantage," "socioeconomic," "poverty," "poor" paired with "end-of-life care," "palliative care," "dying," and "terminal Illness." Articles were analyzed using existing descriptions for dimensions of access to health services, which include availability, affordability, acceptability, and geographical access.

RESULTS

A total of 67 articles were identified for the literature review. Literature describing end-of-life care and low SE status was limited. Findings from the review were summarized under the headings for dimensions of access.

CONCLUSION

Low SE groups experience barriers to access in palliative care services. Identification and evaluation of interventions aimed at reducing this disparity is required.

Use of healthcare access models to inform the patient protection and affordable care act

Health policy findings on access to care provide more substantive information if linked to a theory that provides meaningful structure and standard definitions. Three theories of access are reviewed here because they have been used to inform health policy: Penchansky's Model, The Institute of Medicine (IOM) Model of Access Monitoring, and The Behavioral Model of Health Services Use. Penchansky's model is useful when subjective experiences with health care access are needed to inform policy makers. The IOM model is used for monitoring quality of health care services provided. The Behavioral Model identifies explanatory/predictive factors associated with utilization of services. Each model uniquely evaluates different health policies. Given the passage of the Patient Protection and Affordable Care Act (PPACA) of 2010, researchers and policy makers must agree on the model that best monitors and evaluates these new policy initiatives.

Access in health services research: the battle of the frameworks

BACKGROUND

Access is an important concept in the study of the organization, financing and delivery of healthcare services. It is also an important political symbol and policy goal.

PURPOSE

This article reviews the major theoretical frameworks that have been used to support the study of access and measure the degree to which healthcare systems have met standards of access.

METHOD

The article uses a critical review of the major works of the leading theorists in the field of access studies.

DISCUSSION

Theories of access accept that it is a dynamic process where there is the potential for individuals and families to learn and modify their behavior. That learning and adaptation is less often explored in empirical research of access to health care.

CONCLUSION

Researchers should consider the more dynamic aspects of access as they attempt to understand how to improve the health care delivery system. Access models can be used to direct the formulation of better health policy if they reflect real world processes.