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Kumah E, Asana Y, Agyei SK, Kokuro C, Ankomah SE, Fusheini A. Does health insurance status influence healthcare-seeking behavior in rural communities? evidence from rural Ghana. HEALTH POLICY OPEN 2024; 6:100119. [PMID: 38680189 PMCID: PMC11047188 DOI: 10.1016/j.hpopen.2024.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 03/12/2024] [Accepted: 04/15/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction National health insurance programs are considered important mechanisms for ensuring equity in access to and utilization of healthcare services by removing financial barriers associated with seeking treatment in healthcare facilities. Although studies on health insurance schemes in many low-and-middle-income countries (LMICs) have demonstrated a significant relationship between health insurance status and healthcare-seeking behavior, data on the influence of this health financing policy on the decision to seek formal healthcare among rural inhabitants remains limited. Underpinned by the Andersen-Newman behavioral model of healthcare use, this study examined the influence of health insurance status on healthcare-seeking behavior among rural dwellers in Ghana. Methods A community-based cross-sectional study was conducted among 460 rural residents in Ghana from 8th September to 5th December 2022. Chi-square tests were used to study the significance level and association between healthcare-seeking behavior and selected independent variables. A multiple logistic regression model was fitted to test the association between health insurance status and healthcare-seeking behavior, introducing other selected explanatory variables as controls. Results The mean age of the respondents was 29.6 ± 6.8 years. A little above half (53.1 %) disclosed having insurance, whereas 46.1 % stated they were without coverage. Regarding healthcare-seeking behavior, the most commonly chosen treatment source was traditional healers (37.2 %), followed by the public healthcare system (28.3 %) and self-treatment (18.2 %). The private healthcare system was the least preferred, with only 16.3 % opting for it. While the bivariate analysis demonstrated a significant relationship between health insurance status and healthcare-seeking behavior (p-0.001), the logistic regression model results showed that health insurance status was not an independent predictor of healthcare-seeking behavior (p = 0.069). Conclusion It could, therefore, not be concluded that the respondents with health insurance coverage were more likely than the uninsured to use formal healthcare providers as their most frequent source of treatment during illness. This study provides vital information for policymakers aiming at increasing access to and utilization of facility-based formal care in rural and remote settings.
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Affiliation(s)
- Emmanuel Kumah
- Department of Health Administration and Education, Faculty of Science Education, University of Education, Winneba, Ghana
| | - Yussif Asana
- Department of Public Health, Faculty of Health Sciences, Catholic University, Ghana
| | - Samuel Kofi Agyei
- Department of Public Health, Presbyterrian University, Ghana, Asante Akyem Campus, Agogo, Ghana
| | - Collins Kokuro
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Samuel E. Ankomah
- Obstetrics and Gynecology Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Adam Fusheini
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Adigun S. Toward an emerging model of healthcare access: A theoretical framework. Int Nurs Rev 2024; 71:424-431. [PMID: 37784163 DOI: 10.1111/inr.12867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/23/2023] [Indexed: 10/04/2023]
Abstract
AIM To conceptualize an emerging framework of healthcare access for foreign-born persons based on well-known access models in the United States. BACKGROUND The COVID-19 outbreak significantly impacted all global communities, disproportionately affecting people of color and highlighting preexisting health disparities. Health and immigration policies concerning healthcare access for foreign-born people were examined. Regarding access to social benefits in the United States, the Affordable Care Act underscored initial restrictions imposed by the Deficit Reduction Act of 2005 and the Personal Responsibility and Work Opportunity Reconciliation Act in 1996 on certain underserved groups. METHODS Guided by the study's aim, electronic databases, including Scopus, PubMed, Web of Science, and CINAHL, were queried for relevant nursing-related literature published on Penchansky's and Andersen's models from 1968 to 2022. Compared with Penchansky's model, Andersen's model outcome measures have evolved over the years in response to dynamic health policy issues. RESULTS Penchansky's model has five constructs in its original form, whereas Andersen's model has three. The current study shows that each existing access model provides a unique method for evaluating various policies. In some cases, the studies are limited to a simple application of the original model with few modifications in studies specific to foreign-born groups in the United States. DISCUSSION There is a dearth of systematic theorization of access that incorporates social justice and health equity. Health disparities were further explained using metrics from existing access models. CONCLUSIONS An emerging access model conceptualizing existing access models was proposed, using constructs framed within the basic tenets of health equity and social justice. IMPLICATIONS FOR NURSING AND HEALTH POLICY Applying the emerging model's constructs to future studies is anticipated to highlight opportunities for stakeholders such as policymakers, healthcare providers, nursing professionals, and community leaders to support programs that could further reduce health disparities.
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Affiliation(s)
- Shade Adigun
- College of Nursing, University of Tennessee, Knoxville, Tennessee, USA
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3
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Gardeniers MKM, Huisman M, Meijboom EJ, Hoogendijk EO, Broese van Groenou MI. Transitions between care networks: a prospective study among older adults in the Netherlands. Eur J Ageing 2024; 21:22. [PMID: 39138707 PMCID: PMC11322471 DOI: 10.1007/s10433-024-00817-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2024] [Indexed: 08/15/2024] Open
Abstract
As health impairment increases, older adults utilize care from different types of caregivers, but little is known about changes in the composition of care networks. We mapped the transitions between different care networks to gain insight into which people develop care networks that include informal, privately and publicly paid care. We used three waves (2012-2015-2018) of the Longitudinal Aging Study Amsterdam with 1413 Dutch community-dwelling adults, aged 64-100. Network types were identified using six types of caregivers: (1) co-resident, (2) non-co-resident children, (3) other kin, (4) neighbours/friends/acquaintances, (5) publicly paid, (6) privately paid, in a latent transition analysis with mortality and moving to a care facility as missing states. Five types of care networks were identified: (1) no care, (2) privately paid, (3) mixed informal, (4) mixed publicly paid, (5) co-resident. The co-resident network was the most unstable and had a high transition rate to nursing homes. Participants from the privately paid care network often transitioned to a mixed informal network and rarely transitioned to a mixed publicly paid network. Transitions out of the no-care network were mostly to the privately paid network. The two mixed care networks were the most stable. Transitions appeared to be most triggered by deteriorating health. Transitions to institutional care were most likely in the mixed informal, mixed publicly paid and the co-resident network. Thus, these networks appear to require additional support to facilitate ageing in place.
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Affiliation(s)
- Maura K M Gardeniers
- Department of Sociology, Vrije Universiteit Amsterdam, De Boelelaan, 1081, Amsterdam, The Netherlands.
| | - Martijn Huisman
- Department of Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Erik Jan Meijboom
- Department of Sociology, Vrije Universiteit Amsterdam, De Boelelaan, 1081, Amsterdam, The Netherlands
| | - Emiel O Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Lee HY, Im H, Kyu Min K. Unmet medical needs and influencing factors among Korean police officers: a cross-sectional survey. BMJ Open 2024; 14:e080494. [PMID: 39134440 PMCID: PMC11331957 DOI: 10.1136/bmjopen-2023-080494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 07/26/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVES South Korea grapples with a disproportionately high incidence of unmet medical needs, a concern that is particularly acute among police officers, who are exposed to significant occupational risks. Given the pivotal role of police officers in upholding democratic values and public safety, their well-being holds critical societal implications. This study aims to determine the incidence of unmet medical needs among police officers and identify the influencing factors. DESIGN This is a retrospective and cross-sectional study. Applying the Andersen behavioural model and multiple logistic regression analysis, we explored factors impacting unmet medical needs. SETTING The study took place in South Korea and involved its total force of police officers. PARTICIPANTS Our analysis encompassed data from 6591 participants, representing 5.2% of South Korea's total police officers. OUTCOME MEASURES Unmet medical needs. RESULTS Our findings revealed several influencing factors. First, predisposing factors included sex, with women experiencing a higher incidence of unmet medical needs. Second, enabling factors highlighted the significance of job positions and reduced annual leave guarantees in influencing unmet medical needs. Finally, need factors demonstrated the substantial impact of chronic diseases, heightened levels of depression, reduced subjective health assessments, increased stress levels and exposure to rough physical activity on driving unmet medical needs. CONCLUSIONS To mitigate and pre-empt the long-term health repercussions associated with unmet medical needs, intervention strategies should prioritise these identified factors. An integrated healthcare programme emerges as a critical necessity for addressing the healthcare challenges faced by police officers.
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Affiliation(s)
- Hyo Young Lee
- Health Administration, Dongseo University, Busan, Republic of Korea
| | - Hyuk Im
- Social Welfare, Dongseo University, Busan, Republic of Korea
| | - Kim Kyu Min
- Health Administration, Dongseo University, Busan, Republic of Korea
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Crawford K, Wilson C, Mulley WR, Toussaint ND, Kennedy E, Andrew N, Ward A, Truong M. Factors Influencing Kidney Transplantation Experiences for Patients From Culturally and Linguistically Diverse Backgrounds: A Qualitative Study. Health Expect 2024; 27:e14166. [PMID: 39097762 PMCID: PMC11297906 DOI: 10.1111/hex.14166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 07/18/2024] [Accepted: 07/22/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND Disparities in aspects of chronic kidney disease progression and management exist for patients from culturally and linguistically diverse (CALD) backgrounds, including with treatment and outcomes for kidney transplantation. OBJECTIVE This study aimed to explore factors that impact kidney transplant outcomes from the perspective of kidney transplant recipients (KTRs) from CALD backgrounds and their family caregivers. METHODS A descriptive qualitative design was utilised. Participants were recruited from two tertiary hospitals in Victoria, Australia. Semi-structured interviews were conducted with KTRs who were born overseas in countries where English is not the primary language. Interviews were also conducted with family caregivers. Analysis was guided by the Framework Method, and emergent subcategories were mapped into the categories identified in Andersen's Health Service Utilisation Model. RESULTS Data from 21 KTRs and five caregivers were grouped under the categories of Population Characteristics, Environment, Health Behaviour and Outcomes. KTRs believed that neither culture nor religious beliefs impacted how they managed their transplant or healthcare utilisation. KTRs expressed satisfaction with their care, felt no inequity with how they were treated by health professionals and expressed gratitude for the Australian healthcare system. Language did not necessarily impact transplant outcomes, but there was a reliance on interpreters for non-English-speaking patients as most written information was in English. Caregivers were instrumental in providing support but discussed the challenges involved. CONCLUSION This study explored factors influencing kidney transplantation for KTRs from a CALD background. The study provided insight into how to deliver quality healthcare to these patients, highlighting the importance of health services providing information that is written in the patient's own language and respectively asking KTRs about their health beliefs or customs. Caregivers were instrumental in supporting KTRs, but there is a need to better prepare them for this role. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement was integrated into the design and delivery of the study. KTRs from CALD backgrounds assisted with framing the research questions and offering advice on the recruitment and data collection process.
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Affiliation(s)
| | - Catherine Wilson
- Nursing Institute of Health and WellbeingFederation UniversityMount HelenVictoriaAustralia
| | - William R. Mulley
- Department of NephrologyMonash Medical CentreClaytonVictoriaAustralia
- Centre for Inflammatory Diseases, Department of MedicineMonash UniversityClaytonVictoriaAustralia
| | - Nigel D. Toussaint
- Department of NephrologyThe Royal Melbourne HospitalParkvilleVictoriaAustralia
- Department of Medicine (RMH)University of MelbourneParkvilleVictoriaAustralia
| | - Elaine Kennedy
- Department of NephrologyMonash Medical CentreClaytonVictoriaAustralia
| | - Narissa Andrew
- Department of NephrologyThe Royal Melbourne HospitalParkvilleVictoriaAustralia
| | - Andrea Ward
- Department of NephrologyThe Royal Melbourne HospitalParkvilleVictoriaAustralia
| | - Mandy Truong
- Monash Nursing and MidwiferyMonash UniversityClaytonVictoriaAustralia
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Anaba EA, Alor SK, Badzi CD, Mbuwir CB, Muki B, Afaya A. Drivers of breast cancer and cervical cancer screening among women of reproductive age: insights from the Ghana Demographic and Health Survey. BMC Cancer 2024; 24:920. [PMID: 39080553 PMCID: PMC11290011 DOI: 10.1186/s12885-024-12697-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The two major causes of cancer-related deaths among women in Ghana are breast cancer (BC) and cervical cancer (CC). These types of cancers typically do not show any symptoms until they have progressed. Therefore, it is important to screen for early detection. This research aimed to investigate the rate of breast cancer and cervical cancer screening, as well as the factors associated with it, among women of reproductive age in Ghana. METHODS This study analysed data from the 2022 Ghana Demographic and Health Survey. A total of 15,014 women aged 15 to 49 years were included in the analysis. Descriptive statistics and binary logistic regression were employed to analyse the data with the aid of STATA/SE, version 17. RESULTS It was found that 18.4% and 5.0% of the women had screened for BC and CC, respectively. Women aged 45-49 years were about three times more likely (aOR = 2.83, 95% CI: 1.88-4.24) to screen for BC compared to those aged 15-19 years. Women who had tested for HIV had increased odds (aOR = 1.88, 95% CI: 1.56-2.25) of screening for BC compared to their counterparts. Women within the richest wealth index (aOR = 1.95, 95% CI: 1.40-2.72) had increased odds of screening for BC compared to those in the poorest wealth index. Regarding CC screening, women with higher education (aOR = 2.56, 95% CI: 1.53-4.29) were two times more likely to screen for CC compared to those with no formal education. Women who did not use tobacco (aOR = 0.45, 95% CI: 0.21-0.96) had decreased odds of CC screening compared to their counterparts. CONCLUSIONS This study showed that the uptake of BC and CC screening services among women in Ghana was very low. The drivers of BC and CC screening included enabling, predisposing, and need factors. Stakeholders can leverage the mass media to raise awareness and educate women in reproductive age about the importance of BC and CC screening. This study provides relevant information that can inform BC and CC policies and programmes in Ghana.
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Affiliation(s)
- Emmanuel Anongeba Anaba
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Stanley Kofi Alor
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana.
- Nursing and Midwifery Training College, 37 Military Hospital, Neghelli Barracks, Accra, Ghana.
| | - Caroline Dinam Badzi
- Department of Maternal and Child Health, School of Nursing and Midwifery, University of Ghana, Accra, Ghana
| | | | - Berienis Muki
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland
| | - Agani Afaya
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
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Lee B, Yang C, Yim MH. Real-world evidence of characteristics and factors influencing herbal medicine use for weight loss in adults. Front Pharmacol 2024; 15:1437032. [PMID: 39081960 PMCID: PMC11286466 DOI: 10.3389/fphar.2024.1437032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 06/24/2024] [Indexed: 08/02/2024] Open
Abstract
Background Obesity imposes a significant socioeconomic burden owing to its high prevalence. In response to the adverse outcomes associated with conventional pharmacotherapy and the challenges of low adherence to lifestyle interventions, herbal medicine has surfaced as an actively utilized approach for weight loss. Therefore, this study aimed to analyze the characteristics and influencing factors of herbal medicine users for weight loss in adults. Methods Overall, 22,080 participants were included based on data from the Korea National Health and Nutrition Examination Survey from 2010 to 2019. Simple logistic regression analyses were used to derive the associations between herbal medicine use for weight loss and individual characteristics. Three models were constructed utilizing multiple logistic regression analyses to assess the associations between herbal medicine use for weight loss and the combined characteristics of predisposing, enabling, and need factors according to Andersen's model. Results In the full adjustment model, women, younger adults, those with higher incomes, and individuals reporting higher levels of perceived stress were more prone to use herbal medicine for weight loss in the past year. Adults who identified body image as being fat/very fat, those who consumed alcohol, and those classified as severely obese by body mass index were also more prone to use herbal medicine for weight loss. In particular, adults with a higher rate and amount of weight loss in the past year were more likely to use herbal medicine for weight loss compared to those experiencing weight gain/no changes/loss of 0-3 kg. Conclusion Our study was the first to derive the characteristics and influencing factors of herbal medicine users for weight loss among adults. These findings hold significant promise for informing future research endeavors and policy decision-making for effective resource distribution for obesity treatment.
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Affiliation(s)
- Boram Lee
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Changsop Yang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Mi Hong Yim
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
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Grochtdreis T, König HH, Dams J. Migration-related determinants of health-care service utilization among persons with a direct migration background in Germany: an exploratory study based on the German Socio-Economic Panel (SOEP). THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-024-01708-9. [PMID: 39004694 DOI: 10.1007/s10198-024-01708-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND It is known that the health-care service utilization in primary care of persons with a direct migration background is lower compared to non-migrants. However, potential migration-related determinants of health-care service utilization are not known. Therefore, this study aimed to analyze the associations between health-care service utilization and migration-related characteristics of persons with a direct migration background in Germany. METHODS The migration samples (M1 and M2) of the German Socio-Economic Panel (SOEP) were used as the sample for this study. Associations between the number of visits to primary care physicians in the previous three months and migration-related characteristics were examined using generalized linear models. Associations between the hospitalization within one year and migration-related characteristics were examined using logit models. RESULTS The mean number of visits to primary care physicians was about 2, and 8% of persons were hospitalized. Being born in a country other than Russia was associated with a higher number of visits to primary care physicians (+ 26% to + 34%). Both, a very strong connectedness with the country of birth and very good oral German language skills were associated with higher number of visits to primary care physicians (both + 13%) compared to no connectedness and fairly bad oral German language skills. CONCLUSION Only the country of birth, connectedness with the country of birth and oral German language skills may be migration-related determinants of health-care service utilization with regard to the number of visits to primary care physicians by persons with a direct migration background in Germany. With regard to hospitalization, no potential migration-related determinants of health-care service utilization could be identified.
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Affiliation(s)
- Thomas Grochtdreis
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Choi NG, Marti CN, Choi BY. Mental Health Treatment Use, Perceived Treatment Need, and Reasons for Non-Use Among U.S. Adults with Serious Suicidal Thoughts During the COVID-19 Pandemic. Community Ment Health J 2024; 60:972-984. [PMID: 38372825 DOI: 10.1007/s10597-024-01249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/11/2024] [Indexed: 02/20/2024]
Abstract
Analyzing the 2021 National Survey on Drug Use and Health data with generalized linear models, we examined: (1) COVID pandemic-related and other correlates of mental health treatment use and unmet perceived treatment need among U.S. adults who experienced serious suicidal thoughts (N = 3,177); and (2) correlates of self-reported reasons for not receiving treatment. We found that 61% used any mental health treatment, and 48% of users and 37% of nonusers reported perceived treatment need. Significant correlates of treatment use were demographic factors, insurance, major depressive disorder, and illicit drug use disorder. Significant correlates of perceived treatment need were age 18-34, some college education, and major depressive episode. Perceived negative effect of the COVID pandemic on mental health was a significant factor for both treatment use and perceived need. The most frequent reasons for not getting treatment were the cost of treatment or lack of insurance and stigma-related concerns.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA.
| | - C Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth, Philadelphia, USA
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Weisz D, Gusmano MK, Amba V, Rodwin VG. Has the Expansion of Health Insurance Coverage via the Implementation of the Affordable Care Act Influenced Inequities in Coronary Revascularization in New York City? J Racial Ethn Health Disparities 2024; 11:1783-1790. [PMID: 37338791 DOI: 10.1007/s40615-023-01650-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND/PURPOSE In 2014, New York City implemented the Affordable Care Act (ACA) leading to insurance coverage gains intended to reduce inequities in healthcare services use. The paper documents inequalities in coronary revascularization procedures (percutaneous coronary intervention and coronary artery bypass grafting) usage by race/ethnicity, gender, insurance type, and income before and after the implementation of the ACA. METHODS We used data from the Healthcare Cost and Utilization Project to identify NYC patients hospitalized with the diagnosis of coronary artery disease (CAD) and/or congestive heart failure (CHF) in 2011-2013 (pre-ACA) and 2014-2017 (post-ACA). Next, we calculated age-adjusted rates of CAD and/or CHF hospitalization and coronary revascularization. Logistic regression models were used to identify the variables associated with receiving a coronary revascularization in each period. RESULTS Age-adjusted rates of CAD and/or CHF hospitalization and coronary revascularization in patients 45-64 years of age and 65 years of age and older declined in the post-ACA period. Disparities by gender, race/ethnicity, insurance type, and income in the use of coronary revascularization persist in the post-ACA period. CONCLUSIONS Although this health care reform law led to the narrowing of inequities in the use of coronary revascularization, disparities persist in NYC in the post-ACA period.
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Affiliation(s)
- Daniel Weisz
- Columbia University Robert N. Butler Columbia Aging Center, 722 West 168Th Street, New York, NY, 10032, USA.
| | - Michael K Gusmano
- Lehigh University College of Health, 124 East Morton Street, Bethlehem, PA, 18015, USA
- The Hastings Center, 21 Malcom Gordon Road, Garrison, NY, 10524, USA
| | - Vineeth Amba
- Rutgers University Robert Wood Johnson Medical School, 675 Hoes Lane West, Piscataway, NJ, 08854, USA
| | - Victor G Rodwin
- New York University Robert. F Wagner Graduate School of Public Service, 295 Lafayette St, New York, NY, 10012, USA
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Watts T, Orshak J, Ondoma C, Lauver D. Research Guided by the Theory of Care-Seeking Behavior: A Scoping Review. West J Nurs Res 2024; 46:468-477. [PMID: 38682743 DOI: 10.1177/01939459241247688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
BACKGROUND A particular Theory of Care-Seeking Behavior was developed to explain care-seeking behavior with psychosocial concepts, external conditions, and clinical and demographic factors. Having a careful review of studies based on this theory could guide future research on care-seeking behaviors. OBJECTIVES With a scoping review: describe characteristics of studies guided by a Theory of Care-Seeking Behavior, summarize support for the relationships of proposed, explanatory variables with care-seeking behaviors, and examine support for propositions in the theory. METHOD Searching 5 electronic databases, we sought studies that were: full-text, peer-reviewed, in English, data-based, guided by the theory, and published from January 1, 1992, to January 1, 2022. RESULTS Across 18 identified articles, the behaviors studied included: symptomatic screening (n = 8), asymptomatic screening (n = 7), and care-seeking behaviors for either screening or symptoms (n = 3). A total of 3328 adults participated in the studies. In 16 studies, all participants were female. In 60% to 83% of studies, researchers had reported findings that supported the relationships of explanatory concepts with care-seeking behavior. Among the 7 studies that tested the 2 propositions of theory, all 7 tests failed to support the proposition that clinical and demographic factors influence care-seeking behavior indirectly through psychosocial variables. Six tests supported the proposition that psychosocial variables influence behavior conditionally, on external conditions. CONCLUSIONS Relationships of these explanatory variables with care-seeking behaviors were supported, as was 1 of 2 propositions. The Theory of Care-Seeking Behavior can be applied to new clinical situations to continue to build knowledge of the theory and understanding of care-seeking behaviors.
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Affiliation(s)
- Theresa Watts
- Orvis School of Nursing, University of Nevada, Reno, NV, USA
| | - Jennifer Orshak
- School of Nursing, University of Wisconsin-Madison, WI, USA
- Department of Veterans Affairs, William S. Middleton Memorial Veterans Hospital, Madison Wisconsin, USA
| | - Cissy Ondoma
- School of Nursing, University of Wisconsin-Madison, WI, USA
| | - Diane Lauver
- School of Nursing, University of Wisconsin-Madison, WI, USA
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Sabin L, Haghparast-Bidgoli H, Miller F, Saville N. A systematic review of barriers and facilitators to antenatal screening for HIV, syphilis or hepatitis B in Asia: Perspectives of pregnant women, their relatives and health care providers. PLoS One 2024; 19:e0300581. [PMID: 38820339 PMCID: PMC11142523 DOI: 10.1371/journal.pone.0300581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/29/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Despite improvements, the prevalence of HIV, syphilis, and hepatitis B remains high in Asia. These sexually transmitted infections (STIs) can be transmitted from infected mothers to their children. Antenatal screening and treatment are effective interventions to prevent mother-to-child transmission (MTCT), but coverage of antenatal screening remains low. Understanding factors influencing antenatal screening is essential to increase its uptake and design effective interventions. This systematic literature review aims to investigate barriers and facilitators to antenatal screening for HIV, syphilis, and hepatitis B in Asia. METHODS We conducted a systematic review by searching Ovid (MEDLINE, Embase, PsycINFO), Scopus, Global Index Medicus and Web of Science for published articles between January 2000 and June 2023, and screening abstracts and full articles. Eligible studies include peer-reviewed journal articles of quantitative, qualitative and mixed-method studies that explored factors influencing the use of antenatal screening for HIV, syphilis or hepatitis B in Asia. We extracted key information including study characteristics, sample, aim, identified barriers and facilitators to screening. We conducted a narrative synthesis to summarise the findings and presented barriers and facilitators following Andersen's conceptual model. RESULTS The literature search revealed 23 articles suitable for inclusion, 19 used quantitative methods, 3 qualitative and one mixed method. We found only three studies on syphilis screening and one on hepatitis B. The analysis demonstrates that antenatal screening for HIV in Asia is influenced by many barriers and facilitators including (1) predisposing characteristics of pregnant women (age, education level, knowledge) (2) enabling factors (wealth, place of residence, husband support, health facilities characteristics, health workers support and training) (3) need factors of pregnant women (risk perception, perceived benefits of screening). CONCLUSION Knowledge of identified barriers to antenatal screening may support implementation of appropriate interventions to prevent MTCT and help countries achieve Sustainable Development Goals' targets for HIV and STIs.
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Affiliation(s)
- Lucie Sabin
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Faith Miller
- Institute for Global Health, University College London, London, United Kingdom
| | - Naomi Saville
- Institute for Global Health, University College London, London, United Kingdom
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Hayashi K, Rabu G, Cui Z, Klaire S, Homayra F, Milloy MJ, Nosyk B. Characterizing the Use of Healthcare Access Supports Among People Who Use Drugs in Vancouver, Canada, 2017 to 2020: A Cohort Study. SUBSTANCE USE & ADDICTION JOURNAL 2024:29767342241249870. [PMID: 38804580 DOI: 10.1177/29767342241249870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
BACKGROUND For structurally marginalized populations, including people who use drugs (PWUD), equitable access to healthcare can be achieved through healthcare access supports. However, few studies characterized utilization of formal (eg, outreach workers, healthcare professionals) and informal (eg, friends/family) supports. Therefore, we sought to estimate the prevalence of and factors associated with receiving each type of support among PWUD. METHODS We used data from 2 prospective cohort studies of PWUD in Vancouver, Canada, in 2017 to 2020. We constructed separate multivariable generalized linear mixed-effects models to identify factors associated with receiving each of the 3 types of supports (ie, healthcare professionals, outreach workers/peer navigators, and informal supports) compared to no supports. RESULTS Of 996 participants, 350 (35.1%) reported receiving supports in the past 6 months at baseline, through informal supports (6.2%), outreach workers (14.1%), and healthcare professionals (20.9%). In multivariable analyses, HIV positivity, chronic pain, and avoiding healthcare due to the past mistreatment were positively associated with receiving supports from each of healthcare professionals and outreach workers. Men were less likely to receive any types of the supports (all P < .05). CONCLUSIONS Utilization of healthcare access supports was relatively low in this sample. However, formal supports appeared to have reached PWUD exhibiting more comorbidities and experiencing discrimination in healthcare. Further efforts to make formal supports more available would benefit PWUD with unmet healthcare needs, particularly men.
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Affiliation(s)
- Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Gabrielle Rabu
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Zishan Cui
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Sukhpreet Klaire
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Interdepartmental Division of Addiction Medicine, Providence Health Care, Vancouver, BC, Canada
- Department of Family Practice, The University of British Columbia, Vancouver, BC, Canada
| | | | - Michael-John Milloy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Bohdan Nosyk
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
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Choi YJ, Lee HY, Yoon YJ, Blackburn J. Health Literacy among Korean American Immigrant Women in the USA: Role of Social Support. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:323-334. [PMID: 38421686 DOI: 10.1080/19371918.2024.2324148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Health literacy is associated with health behaviors and outcomes. Using Andersen's Behavioral Model of Health Services Use, this study examined the role of limited English proficiency (LEP) and social support for the health literacy of Korean American immigrant women, one of the most affected groups by LEP. Researchers surveyed 232 Korean American immigrant women in a metro area in a Southeastern state, U.S. Health literacy was measured by the CDC Behavioral Risk Factor Surveillance System Questionnaire and the California Health Interview Survey. Participants with better English proficiency and larger social support had higher health literacy. LEP and social support interaction was significantly associated with health literacy, illustrating social support as a buffer that mitigates the negative impact of LEP on health literacy. Community programs that enhance social support through community health advocates or peer educators may increase health literacy and reduce health disparities among Korean American immigrant women with LEP.
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Affiliation(s)
- Y Joon Choi
- School of Social Work, Georgia State University, Atlanta, Georgia, USA
| | - Hee Yun Lee
- School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA
| | - Young Ji Yoon
- Department of Social Work, Colorado State University Pueblo, Pueblo, Colorado, USA
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15
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Cha SE, Kim K, Lee S. Gendered Trends in Formal and Informal Care Utilization Among Older Adults in South Korea. J Aging Soc Policy 2024:1-16. [PMID: 38701195 DOI: 10.1080/08959420.2024.2349495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/10/2024] [Indexed: 05/05/2024]
Abstract
Drawing on data from two waves of the Korean Longitudinal Study of Ageing (2010 and 2018), this study examined how community-dwelling older men and women (65+) with functional limitations utilized formal and informal sources of care and how their patterns of care utilization changed over time. The usage patterns of formal and informal caregiving services were categorized into three groups: (a) informal help only, (b) formal-informal mix, and (c) no help from either. More men and women used both formal and informal help for their care needs in 2018 than in 2010 (15% compared to 7%). The proportion of older men who relied on informal help only remained similar across survey years, whereas a smaller proportion of older women relied on informal help only in 2018. Although formal care use has been expanded in South Korea, older men continue to utilize help from their families. However, for older women, the proportion who did not receive any help increased - despite an increase in formal care utilization. These findings highlight the importance of considering gendered resources in caregiving in Korea.
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Affiliation(s)
- Seung-Eun Cha
- Department of Child and Family Welfare, The University of Suwon, Hwaseong-si, Republic of Korea
| | - Kyungmin Kim
- Department of Child Development and Family Studies, Seoul National University, Seoul, Republic of Korea
| | - Seoyeon Lee
- Department of Home Economics Education, Chonnam National University, Gwangju, Republic of Korea
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16
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Moore WS, Maldonado-Molina MM, Mobley AR, Shelnutt KP, McVay MA. Parental Factors Associated With Intentions to Initiate a Family-Based Pediatric Weight Management Program. Child Obes 2024; 20:270-278. [PMID: 37366662 DOI: 10.1089/chi.2023.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Background: Childhood obesity can be addressed through family-based pediatric weight management; however, treatment enrollment in the United States is low. This study aimed to identify parental factors associated with intentions to initiate a family-based pediatric weight management program. Methods: Cross-sectional survey data were collected from an online panel of US parents with at least one 5- to 11-year-old child identified as likely to have overweight or obesity. Participants viewed a video about a hypothetical family-based pediatric weight management program, rated their 30-day initiation intentions for that program, and answered additional related questionnaires. Results: Participants (n = 158) identified as White/Caucasian (53%) or Black/African American (47%), were primarily female (61.4%) and married/cohabitating (81.6%) with children who were predominantly girls (53.2%) and, on average, 9-year-olds. Higher parents' perception of program effectiveness predicted initiation intentions (p < 0.001), while concern for their child's weight and parent depression and anxiety levels did not. Higher initiation intentions and perceived program effectiveness were reported by Black/African American participants (p < 0.01) and those with at least a bachelor's degree (p < 0.01) compared to White/Caucasian participants and those without a bachelor's degree, respectively. Initiation intentions were higher for those with greater financial security (p = 0.020) and fewer than three children in the home (p = 0.026). Participants endorsed initiation barriers of time constraints (25%), possible lack of enjoyment for the child (16.9%), and lack of family support (15%). Conclusions: Future program enrollment efforts may need to focus on strategies to increase perceived program effectiveness, although further research is needed that measures actual enrollment in real-world contexts.
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Affiliation(s)
- Wendy S Moore
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Mildred M Maldonado-Molina
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Amy R Mobley
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Karla P Shelnutt
- Department of Family, Youth, and Community Sciences, Institute of Food and Agricultural Science (IFAS), University of Florida, Gainesville, FL, USA
| | - Megan A McVay
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
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17
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da Costa Miranda AL, da Paixão ART, Pedroso AO, do Espírito Santo Lima L, Parente AT, Botelho EP, Polaro SHI, de Oliveira E Silva AC, Reis RK, Ferreira GRON. Demographic, social, and clinical aspects associated with access to COVID-19 health care in Pará province, Brazilian Amazon. Sci Rep 2024; 14:8776. [PMID: 38627601 PMCID: PMC11021420 DOI: 10.1038/s41598-024-59461-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
Internal social disparities in the Brazilian Amazon became more evident during the COVID-19 pandemic. The aim of this work was to examine the demographic, social and clinical factors associated with access to COVID-19 health care in Pará Province in the Brazilian Amazon. This was an observational, cross-sectional, analytical study using a quantitative method through an online survey conducted from May to August 2023. People were eligible to participate if they were current residents of Pará, 18-years-old or older, with self-reported diagnoses of COVID-19 through rapid or laboratory tests. Participants completed an electronic survey was developed using Research Electronic Data Capture (REDCap) software-The adapted questionnaire "COVID-19 Global Clinical Platform: Case Report Form for Post-COVID Condition". Questions focused on access to COVID-19 treatment, demographic characteristics, COVID-19 vaccine and clinical characteristics. Respondent-driven sampling was applied to recruit participants. Multiple logistic regression was utilized to identify the associated factors. Overall, a total of 638 participants were included. The average age was 31.1 years. Access to COVID-19 health care was 68.65% (438/638). The participants most likely to access health care were those with moderate or severe COVID-19 (p = 0.000; OR: 19.8) and females (p = 0.001; OR: 1.99). Moreover, participants who used homemade tea or herbal medicines were less likely to receive health care for COVID-19 in health services (p = 0.002; OR: 0.54). Ensuring access to healthcare is important in a pandemic scenario.
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Grants
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program – Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
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Affiliation(s)
| | | | - Andrey Oeiras Pedroso
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, 14040-092, Brasil
| | | | | | - Eliã Pinheiro Botelho
- Programa de Pós-Graduação Em Enfermagem, Universidade Federal Do Pará, Belém, 66075-110, Brasil
| | | | | | - Renata Karina Reis
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, 14040-092, Brasil
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Baiden P, Graaf G, Okine L, LaBrenz C. Association between Adverse Childhood Experiences and Unmet Health Care Needs among Children in the United States. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:261-275. [PMID: 38459692 DOI: 10.1080/19371918.2024.2323137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
Although studies have investigated and found an association between adverse childhood experiences and poor health and mental health outcomes, there is a dearth of studies investigating the association between adverse childhood experiences and unmet health care needs among children. The objective of this study is to examine the association between adverse childhood experiences and unmet health care needs after adjusting for predisposing, enabling, and need factors of health care service utilization. Data for this study came from the 2016-2017 National Survey of Children's Health. An analytic sample of 46,081 children (51.3% males; average age 11.5 years) was analyzed using negative binomial regression. Based on parent reports, about 3.5% of children had unmet health care needs, and half (50%) of the sample had experienced at least one childhood adversity. Controlling for other factors, children who experienced three or more childhood adversities had 4.51 times higher odds of having unmet health care needs (AOR = 4.51, p < .001, 95% CI = 3.15-6.45) when compared to their counterparts with no childhood adversity. Children with parents who have someone to turn to for everyday emotional support were 31% less likely to have unmet health care needs (AOR = .69, p < .01, 95% CI = .54-.89). Adverse childhood experiences have a detrimental effect on unmet health care needs. The findings of this study offer an important opportunity for further research on how best to prevent adverse childhood experiences and mitigate their impact on families.
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Affiliation(s)
- Philip Baiden
- School of Social Work, The University of Texas at Arlington, Arlington, Texas
| | - Genevieve Graaf
- School of Social Work, The University of Texas at Arlington, Arlington, Texas
| | - Lucinda Okine
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Catherine LaBrenz
- School of Social Work, The University of Texas at Arlington, Arlington, Texas
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19
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Ai W, Shi L, Tan RKJ, Wu D, Ong JJ, Qiu T, Marley G, Tucker JD, Chen Y, Yuan D, Fan C, Fu G, Tang W. HIV Services Uptake Among People Living with HIV in Jiangsu Province, China: A Cross-Sectional Study. AIDS Behav 2024:10.1007/s10461-024-04291-5. [PMID: 38493282 DOI: 10.1007/s10461-024-04291-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/18/2024]
Abstract
Healthcare disparities are common among people living with HIV (PLWH) in China and likely impact access to HIV services. This study aimed to assess the current status of access to HIV services among PLWH and explore the correlates of service uptake using baseline data from a prospective cohort study among PLWH in Jiangsu Province. Guided by Andersen's behavioral model, univariable and multivariable logistic regressions were conducted to identify factors associated with access to HIV services. Out of 8989 eligible PLWH included in this study, 46.4% perceived difficulty in seeing a healthcare professional for HIV treatment services in 2021-2022. PLWH aged 18-34 years (adjusted odds ratio [AOR] = 1.69, 95% CI 1.32-2.15), 35-39 years (AOR = 1.33, 95% CI 1.08-1.65), identified as a bisexual/other (AOR = 1.14, 95% CI 1.01-1.29), had a college and above education (AOR = 1.32, 95% CI 1.07-1.63), and perceived moderate (AOR = 1.70, 95% CI 1.51-1.91) and severe (AOR = 2.20, 95% CI 1.94-2.49) levels of HIV stigma were more likely to perceive difficulty in seeing healthcare professionals for HIV treatment in 2021-2022. Living in northern Jiangsu was also associated with increased odds of perceiving difficulty in seeing healthcare professionals for HIV treatment (AOR = 1.12, 95% CI 1.00-1.26). These findings underscore the need for innovative solutions to eliminate the practical barriers to HIV services utilization among PLWH who are bisexual, well-educated, and effective HIV-related stigma reduction interventions.
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Affiliation(s)
- Wei Ai
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Lingen Shi
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Rayner K J Tan
- University of North Carolina Project-China, Guangzhou, China
| | - Dan Wu
- School of Public Health, Nanjing Medical University, Nanjing, China
- University of North Carolina Project-China, Guangzhou, China
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Tao Qiu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Gifty Marley
- University of North Carolina Project-China, Guangzhou, China
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Yuheng Chen
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Defu Yuan
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Chengxin Fan
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Gengfeng Fu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.
| | - Weiming Tang
- School of Public Health, Nanjing Medical University, Nanjing, China.
- University of North Carolina Project-China, Guangzhou, China.
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20
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Zerriouh M, De Clifford-Faugère G, Nguena Nguefack HL, Pagé MG, Guénette L, Blais L, Lacasse A. Pain relief and associated factors: a cross-sectional observational web-based study in a Quebec cohort of persons living with chronic pain. FRONTIERS IN PAIN RESEARCH 2024; 5:1306479. [PMID: 38560482 PMCID: PMC10978597 DOI: 10.3389/fpain.2024.1306479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Objectives Randomized clinical trials are used to evaluate the efficacy of various pain treatments individually, while a limited number of observational studies have portrayed the overall relief experienced by persons living with chronic pain. This study aimed to describe pain relief in real-world clinical settings and to identify associated factors. Methods This exploratory web-based cross-sectional study used data from 1,419 persons recruited in the community. Overall pain relief brought by treatments used by participants was assessed using a 0%-100% scale (10-unit increments). Results A total of 18.2% of participants reported minimal pain relief (0%-20%), 60.0% moderate to substantial pain relief (30%-60%), and 21.8% extensive pain relief (70%-100%). Multivariable multinomial regression analysis revealed factors significantly associated with greater pain relief, including reporting a stressful event as circumstances surrounding the onset of pain, living with pain for ≥10 years, milder pain intensity, less catastrophic thinking, use of prescribed pain medications, use of nonpharmacological pain treatments, access to a trusted healthcare professional, higher general health scores, and polypharmacy. Factors associated with lower pain relief included surgery as circumstances surrounding pain onset, use of over-the-counter pain medications, and severe psychological distress. Discussion In this community sample of persons living with chronic pain, 8 out of 10 persons reported experiencing at least moderate relief with their treatment. The analysis has enabled us to explore potential modifiable factors as opportunities for improving the well-being of persons living with chronic pain.
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Affiliation(s)
- Meriem Zerriouh
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - Gwenaelle De Clifford-Faugère
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - Hermine Lore Nguena Nguefack
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - M. Gabrielle Pagé
- Centre de Recherche, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
- Département d’Anesthésiologie et de Médecine de la Douleur, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Line Guénette
- Faculté de Pharmacie, Université Laval, Quebec City, QC, Canada
- Centre de Recherche, Centre Hospitalier Universitaire (CHU) de Québec—Université Laval, Axe Santé des Populations et Pratiques Optimales en Santé, Quebec City, QC, Canada
| | - Lucie Blais
- Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada
| | - Anaïs Lacasse
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
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Li X, Mohanty I, Chai P, Niyonsenga T. Healthcare utilization and its association with socioeconomic status in China: Evidence from the 2011-2018 China Health and Retirement Longitudinal Study. PLoS One 2024; 19:e0297025. [PMID: 38483924 PMCID: PMC10939203 DOI: 10.1371/journal.pone.0297025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 12/26/2023] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Healthcare utilization often favors the higher-socioeconomic status (SES) and having chronic diseases may exacerbate this inequality. This study aims to examine the trends in health service use over time, the effect of SES on healthcare utilization, and the role of chronic diseases in this association. METHODS Data used in this study were from the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, 2015, and 2018, which is the first nationally representative survey of the middle-aged and older. The sample included people aged 45 years and older who responded to all the waves. A total of 10,922 adults were included in this study. Healthcare utilization was categorized into outpatient and inpatient service use and SES was measured by per-capita household expenditure. A multilevel zero-inflated negative binomial regression model was performed to analyze outpatient and inpatient service use, separately. RESULTS The rates of outpatient service use in 2011, 2013, 2015, and 2018 were 19.11%, 21.45%, 20.12%, and 16.32%, respectively, while the rates of inpatient service use were 8.40%, 13.04%, 14.17%, and 18.79%, respectively. Compared to individuals in the lowest quintile of per-capita household expenditure, those in higher quintiles had higher odds of outpatient service use (Q2: odds ratio = 1.233, p < 0.0001; Q3: 1.416, p < 0.0001; Q4: 1.408, p < 0.0001; or Q5: 1.439, p < 0.0001) and higher rates of inpatient service use (Q2: incidence rate ratio = 1.273, p < 0.0001; Q3: 1.773, p < 0.0001; Q4: 2.071, p < 0.0001; or Q5: 1.992, p < 0.0001). Additionally, having morbidity generally increased healthcare utilization, but did not play a significant role in moderating the relationship between SES and healthcare utilization. CONCLUSIONS Healthcare utilization rates were overall low in China, but relatively high for people in higher quintiles of per-capita household expenditure or those with morbidity, compared to their counterparts. Policy actions are required to provide more health education to the public, to further optimize health insurance schemes targeting outpatient services, especially for the low-SES, and to establish new health delivery models for NCD management in the primary health care setting.
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Affiliation(s)
- Xi Li
- Health Research Institute (HRI), Faculty of Health, University of Canberra, Canberra, Australia
| | - Itismita Mohanty
- Health Research Institute (HRI), Faculty of Health, University of Canberra, Canberra, Australia
| | - Peipei Chai
- Department of Health Economics and National Health Accounts Research, China National Health Development Research Center, Beijing, China
| | - Theo Niyonsenga
- Health Research Institute (HRI), Faculty of Health, University of Canberra, Canberra, Australia
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Alves IB, Panunzi S, Silva AC, Loesch RBR, Pereira SCR, Martins MRO. Have immigrant children been left behind in COVID-19 testing rates? - A quantitative study in the Lisbon metropolitan area between march 2020 and may 2023. Front Public Health 2024; 12:1286829. [PMID: 38532979 PMCID: PMC10963449 DOI: 10.3389/fpubh.2024.1286829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/16/2024] [Indexed: 03/28/2024] Open
Abstract
Immigrant children often encounter additional barriers in accessing health care than their peers. However, there is a lack of evidence globally regarding how migrant status may have affected access to COVID-19 testing during the pandemic. This study aimed to analyze migrant status as a determinant of COVID-19 testing rates among children in the Lisbon metropolitan area, Portugal. This cross-sequential study included 722 children aged 2-8 years (47% non-immigrants; 53% immigrants). We collected data from a national surveillance system on laboratory-confirmed COVID-19 tests conducted between March 2020 and May 2023 and assessed whether children were ever tested for COVID-19 and testing frequency. We employed robust and standard Poisson regression models to estimate Adjusted Prevalence Ratios and Relative Risks with 95% confidence intervals. A total of 637 tests were performed. Immigrant children had lower testing rates (53% vs. 48%) and fewer tests per child (median: 2 vs. 3). Moreover, they were 17% less likely to be ever tested (PR = 0.83, 95% CI: 0.76-0.89) and performed 26% fewer tests (RR = 0.74, 95% CI: 0.67-0.82) compared to non-immigrant children. Caregiver's age, education, employment status, child's birth weight, and perceived health status were associated factors. Our findings suggest that the COVID-19 pandemic has left immigrant children somewhat behind. We conclude that specific interventions targeting vulnerable populations, such as immigrant children, are needed in future health crises.
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Affiliation(s)
- Iolanda B. Alves
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine (IHMT), NOVA University of Lisbon, Lisbon, Portugal
| | - Silvia Panunzi
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - António C. Silva
- Public Health Department, Regional Health Administration of Lisbon and Tagus Valley, Ministry of Health, Lisbon, Portugal
- AJPAS-Associação de Intervenção Comunitária, Desenvolvimento Social e de Saúde, Amadora, Portugal
| | - Regina B. R. Loesch
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine (IHMT), NOVA University of Lisbon, Lisbon, Portugal
| | - Sofia C. R. Pereira
- Amadora Primary Care Health Centre’s Group, Regional Health Administration of Lisbon and Tagus Valley, Ministry of Health, Lisbon, Portugal
| | - M. Rosário O. Martins
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine (IHMT), NOVA University of Lisbon, Lisbon, Portugal
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Strøm IF, Wentzel-Larsen T, Stensland S, Dyb G, Stene LE. Health care needs, experiences, and satisfaction after terrorism: a longitudinal study of parents of survivors of the Utøya attack. BMC Health Serv Res 2024; 24:277. [PMID: 38454472 PMCID: PMC10921612 DOI: 10.1186/s12913-024-10592-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 01/11/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND There is scarce knowledge on the health care follow-up of parents of terror attack survivors. This study focused on the mothers and fathers of survivors and examined (1) their perceived health care needs relative to their psychological reactions, physical health problems (unmet health care needs), and adaptation to work; (2) whether sociodemographic characteristics, health problems and social support were associated with unmet health care needs; and (3) how unmet health care needs, sociodemographic characteristics, and experiences with health services associated with overall dissatisfaction during the health care follow-up. METHODS Interview and questionnaire data from three waves of the Utøya parent study were analyzed (n = 364). Chi-square tests and t- tests were used to compare unmet physical and psychological health care needs, sociodemographic factors and post-terror attack health reported by mothers and fathers. Logistic regression analyses were used to examine whether sociodemographic characteristics, unmet health care needs, and health care experiences were associated with overall dissatisfaction among mothers and fathers of the survivors during the health care follow-up. RESULTS Among the mothers, 43% reported unmet health care needs for psychological reactions, while 25% reported unmet health care needs for physical problems. Among the fathers, 36% reported unmet health care needs for psychological reactions, and 15% reported unmet health care needs for physical problems. Approximately 1 in 5 mothers and 1 in 10 fathers reported "very high/high" needs for adaptation to work. Poorer self-perceived health, higher levels of posttraumatic stress and anxiety/depression symptoms, and lower levels of social support were significantly associated with reported unmet psychological and physical health care needs in both mothers and fathers. Parents with unmet health care needs reported significantly lower satisfaction with the help services received compared to parents whose health care needs were met. Low accessibility of help services and not having enough time to talk and interact with health care practitioners were associated with overall dissatisfaction with the help received. CONCLUSIONS Our findings highlight that parents of terror-exposed adolescents are at risk of having unmet psychological and physical health care needs and thus need to be included in proactive outreach and health care follow-up programs in the aftermath of a terror attack.
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Affiliation(s)
- Ida Frugård Strøm
- Norwegian Centre for Violence and Traumatic Stress Studies, Pb 181 Nydalen, 0409, Oslo, Norway.
| | - Tore Wentzel-Larsen
- Norwegian Centre for Violence and Traumatic Stress Studies, Pb 181 Nydalen, 0409, Oslo, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Synne Stensland
- Norwegian Centre for Violence and Traumatic Stress Studies, Pb 181 Nydalen, 0409, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Grete Dyb
- Norwegian Centre for Violence and Traumatic Stress Studies, Pb 181 Nydalen, 0409, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies, Pb 181 Nydalen, 0409, Oslo, Norway
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24
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Gao Q, Mak HW, Fancourt D. Longitudinal associations between loneliness, social isolation, and healthcare utilisation trajectories: a latent growth curve analysis. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02639-9. [PMID: 38429539 DOI: 10.1007/s00127-024-02639-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 02/12/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE To explore the longitudinal associations between eight-year trajectories of loneliness, social isolation and healthcare utilisation (i.e. inpatient, outpatient, and nursing home care) in US older adults. METHODS The study used data from the Health and Retirement Study in 2006-2018, which included a nationally representative sample of American adults aged 50 and above (N = 6,832). We conducted latent growth curve models to assess the associations between trajectories of loneliness and isolation and healthcare utilisation over 8 years. RESULTS Independent of sociodemographic and health-related confounders, social deficits were associated with a lower likelihood of baseline physician visits (loneliness β= -0.15, SE = 0.08; social isolation β= -0.19, SE = 0.08), but there was a positive association between loneliness and number of physician visits (β = 0.06, SE = 0.03), while social isolation was associated with extended hospital (β = 0.07, SE = 0.04) and nursing home stays (β = 0.05, SE = 0.02). Longer nursing home stays also predicted better trajectories of loneliness and isolation over time. CONCLUSION Loneliness and social isolation are cross-sectionally related to complex patterns of different types of healthcare. There was no clear evidence that social deficits led to specific trajectories of healthcare utilisation, but nursing home stays may over time help provide social contact, supporting trajectories of isolation and potentially loneliness. Non-clinical services such as social prescribing could have the potential to address unmet social needs and further promote patients' health-seeking profiles for improving healthcare equity.
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Affiliation(s)
- Qian Gao
- Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- School of Public Health, Imperial College London, London, UK
| | - Hei Wan Mak
- Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
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25
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Hsieh N. Unpacking Intersectional Inequities in Flu Vaccination by Sexuality, Gender, and Race-Ethnicity in the United States. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024; 65:38-59. [PMID: 37776198 PMCID: PMC10922600 DOI: 10.1177/00221465231199276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Health care research has long overlooked the intersection of multiple social inequalities. This study examines influenza vaccination inequities at the intersection of sexuality, gender, and race-ethnicity. Using data from the 2013 to 2018 National Health Interview Survey (N = 166,908), the study shows that sexual, gender, and racial-ethnic identities jointly shaped flu vaccination. Specifically, White gay men had the highest vaccination rate (56%), while Black bisexual women had the lowest rate (23%). Across Black, Hispanic, and White individuals, sexual minority women had lower vaccination rates than heterosexual women, but sexual minority men had higher or similar vaccination rates than heterosexual men. Economic enabling, noneconomic enabling, and need-based factors together explained a substantial portion of these gaps. However, they cannot explain all the disadvantages faced by Black lesbian, bisexual, and heterosexual women and Black heterosexual men. Findings offer new evidence of hidden health care inequities and inform health policies from an intersectional perspective.
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Affiliation(s)
- Ning Hsieh
- Michigan State University, East Lansing, MI, USA
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26
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Terefa DR, Geta ET, Shama AT, Desisa AE. What role does community-based health insurance play in the utilisation of health services among households in Ethiopia? A community-based comparative cross-sectional study. BMJ Open 2024; 14:e078733. [PMID: 38423776 PMCID: PMC10910592 DOI: 10.1136/bmjopen-2023-078733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 02/13/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE In Ethiopia, despite increased health service coverage, health service utilisation remains very low. However, evidence on the level of health service utilisation between insured and non-insured households in the study area was scanty. Therefore, this study aimed to assess health service utilisation and its predictors among insured and non-insured households of community-based health insurance in the East Wallaga Zone, Oromia region, Ethiopia, in 2022. METHODS A community-based comparative cross-sectional study was employed. Data were collected using semi-structured interviewer-administered pretested questionnaire by face-to-face interviewing of heads of the households or spouse from 1 January 2022 to 30 January 2022, on 900 (450 insured and 450 non-insured). Epi-Data V.3.1 and Statistical Package for Social Science V.26 were used for data entry and analysis, respectively. The association between dependent (health service utilisation) and independent variables was analysed first using binary logistic regression. Multivariable logistic regression was used to identify potential predictor variables at a p<0.05. RESULTS About 60.5% (95% CI 55.7% to 64.8%) of insured households had used health services compared with 45.9% (95% CI 41.4% to 50.9%) of non-insured households in the last 6 months. Family health status (Adjusted Odd Ratio (AOR) and 95% CI=2.74 (1.37 to 5.45), AOR and 95% CI=1.62 (1.01 to 3.14)); family with chronic disease (AOR and 95% CI=8.33 (5.11 to 13.57), AOR and 95% CI=4.90 (2.48 to 9.67)); perceived availability of drugs (AOR and 95% CI=0.34 (0.15 to 0.79), AOR and 95% CI=3.97 (1.69 to 9.34)); perceived transportation cost (AOR and 95% CI=0.44 (0.21 to 0.90), AOR and 95% CI=1.71 (1.00 to 2.93)); participated in indigenous community insurance (AOR and 95% CI=3.82 (1.96 to 7.45), AOR and 95% CI=0.13 (0.06 to 0.29)) and >10 km travel distance from nearby health facilities (AOR and 95% CI=1.52 (1.02 to 2.60), AOR and 95% CI=8.37 (4.54 to 15.45)) among insured and non-insured households, respectively, were predictors of health service utilisation. CONCLUSION Insured households were more likely to utilise health services compared with non-insured households. Family health status, family with chronic disease, perceived availability of drugs, perceived transportation cost, participation in indigenous community insurance and >10 km travel were predictors of health service utilisation among insured and non-insured households. Hence, the greatest emphasis should be given to enhancing enrolment in the community-based health insurance scheme to achieve universal health coverage.
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Affiliation(s)
- Dufera Rikitu Terefa
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
| | - Edosa Tesfaye Geta
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
| | - Adisu Tafari Shama
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
| | - Adisu Ewunetu Desisa
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
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Rizk S, Ngui EM, Salgado Z, Bosak DL, Khetani MA. Medical Home Care and Educational Services for Children and Youth on the Autism Spectrum: A Scoping Review. J Autism Dev Disord 2024:10.1007/s10803-024-06235-3. [PMID: 38416384 DOI: 10.1007/s10803-024-06235-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2023] [Indexed: 02/29/2024]
Abstract
This scoping review examined current evidence on medical home care and its association with educational services for children and youth on the autism spectrum. We searched five databases and grey literature resulting in 328 publications. Publications meeting inclusion criteria were mapped to medical home care component(s) addressed, type(s) of educational services and their strength and type of association. The Andersen Behavioral Model of Health Services Use was used to summarize predisposing, enabling, and need factors considered. Eighteen publications were reviewed, including eight practice/policy reports and ten original research publications. Medical home care components most addressed included family-centered care (n = 10), referrals (n = 16), and effective care coordination (n = 13). Seven publications also addressed multiple educational service types. Two of the five publications that established a significant association between medical home care components and educational services had mixed results, with one publication reporting a negative association and the other publication reporting a positive association. Challenges to medical home care and educational services were most categorized as enabling factors. Results suggest three areas for further investigation: (1) limited evidence on the strength and type of association between medical home care components and educational services; (2) limited use of population data sources; and (3) the need to consider a broader range of factors when examining their association.
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Affiliation(s)
- Sabrin Rizk
- School of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
- Department of Occupational Therapy, University of Illinois Chicago, Chicago, IL, USA
| | - Emmanuel M Ngui
- Community and Behavioral Health Promotion, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Zurisadai Salgado
- Department of Occupational Therapy, University of Illinois Chicago, Chicago, IL, USA
| | - Dianna L Bosak
- Department of Occupational Therapy, University of Illinois Chicago, Chicago, IL, USA
| | - Mary A Khetani
- Department of Occupational Therapy, University of Illinois Chicago, Chicago, IL, USA.
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Nakyonyi MG, Birungi N, Mwesigwa CL, Åstrøm AN. Use of dental care services among adolescents living with HIV on Antiretroviral Treatment in Kampala, Uganda: a cross-sectional study. RESEARCH SQUARE 2024:rs.3.rs-3833085. [PMID: 38343817 PMCID: PMC10854281 DOI: 10.21203/rs.3.rs-3833085/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Objective The main purpose of this study to assess the prevalence and socio-behavioural determinants of ever-use of dental care services among the adolescents aged 10-18 years, living with HIV on Antiretroviral treatment (ART), attending selected HIV clinics in Kampala, Uganda. Methods A cross-sectional study was carried out between March and September 2020. The study conveniently recruited 154 adolescents between 10-18 years from 4 specific HIV clinics in Kampala. The Andersen's behavioral model guided the selection of variables in terms of ever use of dental care services as the outcome- and predisposing, enabling, need related factors and dental health related behavior as exposure variables. Data was analyzed using Fischer's exact test for cross-tabulation and modified Poisson regression for multivariate analysis. Results The prevalence of ever-use of dental care services was 12.3%. The adolescents aged 14-18 years were more likely to have used dental care services (Prevalence ratio (PR) of 3.35 (Confidence Interval (CI) 1.48-7.59) than those aged 10-13 years. Fear of spread of HIV was negatively associated with ever-use of dental care services (PR of 0.06 and CI of (0.01-0.44). Participants who were afraid of going to the dentist were more likely to have ever used dental care services (PR of 2.98 and CI of 1.41-6.30) than those not afraid. Failure to receive dental treatment because it was not part of the medical appointment had a positive association with ever-use of dental care services (PR of 4.50 (CI: 1.14-17.80). Those who were satisfied with their dental condition were less likely to have ever-used dental care services (PR of 0.21 and CI of (0.05-0.94). Bad oral odor was positively associated with ever-use of dental care services with a PR of 2.80 and CI of 1.19-6.60. Use of soap for toothbrushing was positively associated with ever-use of dental care services (PR of 2.51, CI of 1.47-4.28). Conclusion The study found low frequency of dental care use among HIV infected adolescents in Kampala, Uganda, with age being a predisposing factor. Enabling factors included fear of HIV spread, dental appointment failure, and satisfaction with dental condition and bad oral odor while under personal oral hygiene and dental practices, use of soap for toothbrushing was an important association of use of dental care.
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Chhetri Y, Khatri D, Gahatraj NR. Health Service Utilization and Its Determinants among Senior Citizens in the Semiurban Area of Western Nepal: A Cross-Sectional Study. J Aging Res 2023; 2023:3655259. [PMID: 38149286 PMCID: PMC10751160 DOI: 10.1155/2023/3655259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/09/2023] [Accepted: 11/28/2023] [Indexed: 12/28/2023] Open
Abstract
Background Senior citizens are usually infected by multiple chronic conditions and other health problems. Health needs and demand for healthcare services increase with age. However, healthcare services and facilities and their utilization are limited, particularly in developing countries. Aims To identify the utilization of health services among senior citizens and their contributing factors. Methods A cross-sectional analytic study was conducted among 293 senior citizens of the Kushma municipality, Nepal, from June to December 2019. A structured questionnaire was used as a data collection tool using a multistage sampling technique. Face-to-face interviews were conducted to collect data on the interview schedule. Reliability and validity were maintained by applying different strategies and carefully developing tools, pretesting, double entry, and validation. Data entry, management, and analysis were performed using Epi Data and SPSS software. Research ethics were maintained. Descriptive and inferential statistical tests were performed to infer the findings. Results Study participants had a mean age (±SD) of 70.08 (±7.6) years and had various preexisting chronic diseases such as hypertension (46%), gastritis (41.9%), arthritis (34.3%), and asthma (28.7%). Only eight out of ten senior citizens had used health services in the past year. Factors such as age, ethnicity, residency, household income, family support, the presence of chronic diseases, and being under medication were found to have statistically significant associations with the utilization of health services among senior citizens with a p value less than 0.05 and 95% confidence interval. Conclusions A remarkable proportion of older people reported using health services in the last year. However, a substantial proportion did not utilize health services that require further interventions to enable them. Efforts are required to promote the health and well-being of Nepal's growing elderly population, including potential enhancements to rural healthcare infrastructure by policymakers.
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Affiliation(s)
- Yamuna Chhetri
- Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal
| | - Dhurba Khatri
- School of Health and Allied Sciences, Pokhara University, Pokhara, Kaski, Nepal
- Kathmandu Institute of Child Health, Hepaliheight, Kathmandu, Nepal
| | - Nand Ram Gahatraj
- School of Health and Allied Sciences, Pokhara University, Pokhara, Kaski, Nepal
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Krzyż EZ, Antunez Martinez OF, Lin HR. Uses of Andersen health services utilization framework to determine healthcare utilization for mental health among migrants-a scoping review. Front Public Health 2023; 11:1284784. [PMID: 38170142 PMCID: PMC10761300 DOI: 10.3389/fpubh.2023.1284784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/22/2023] [Indexed: 01/05/2024] Open
Abstract
Background Migration is a worldwide occurrence that carries significant implications for healthcare systems, and it entails challenges to mental healthcare. The Andersen Behavioral Model is widely used by researchers to determine healthcare service utilization among many populations, including migrants. Our study aimed to explore the ways of using the Andersen Health System Utilization Framework in the literature to discover the utilization of mental healthcare by migrants. Methods This scoping review was based on Arksey and O'Malley's framework. A comprehensive search was performed across five electronic databases. Results A total of 12 articles from January 1992 to July 2023 identified various versions of the Andersen Behavioral Model to provide an overview of mental health services utilization among migrants. The analysis identified four significant trends in the literature. First, there is a predominant focus on individual characteristics over contextual factors. Second, researchers tend to integrate multiple versions of the Andersen Behavioral Model, and the most is the version from 1995. Third, additional factors specific to migrant populations are incorporated into the model, but the categorization is sometimes unclear. Finally, the majority of studies have used a quantitative approach and are based in North America, suggesting a focus on the significance of mental health in migrant communities in that context. Conclusion In summary, our scoping review calls for further research using the Andersen Behavioral Model to study mental healthcare utilization among migrants. Notable findings include the adaptation of the model to migrant populations, a focus on individual characteristics, a need for more diverse research methods, and the proposal of a new conceptual model to guide research and policy development in this field.
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Affiliation(s)
- Ewa Zuzanna Krzyż
- PhD Program, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | | | - Hung-Ru Lin
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Uwimana G, Elhoumed M, Gebremedhin MA, Qi Q, Azalati MM, Wang L, Zeng L. Association between adequacy of antenatal care and neonatal outcomes in Rwanda: a cross-sectional study design using the Rwanda demographic and health surveys. BMC Health Serv Res 2023; 23:1379. [PMID: 38066497 PMCID: PMC10704762 DOI: 10.1186/s12913-023-10345-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Maternal and neonatal health services are life-saving interventions for neonatal health outcomes. As Rwanda endeavors to accomplish sustainable development goals, adequate ANC is essential to lessen of neonatal mortality. The utilization of ANC continues to be inadequate and high neonatal mortality rate persevere in Rwanda. Understanding the direct and indirect factors that affect newborn health outcomes is necessary for well-targeted interventions. However, few studies had been conducted in Rwanda to evaluate the importance of ANC in improving neonatal health. This study therefore assessed the association between ANC and neonatal outcomes. METHODS The Demographic and Health Surveys (DHS) are household surveys that are cross-sectional, nationally representative, and used to collect data on population, health, and nutrition. Data from the 2010,2015 and 2020 Rwanda Demographic and Health Surveys (RDHS) were used. The study involved 17,747 women between the ages of 15 and 49 who had a single live birth and at least one ANC visit in five years prior to each survey. Bivariate and multivariable logistic regression, a survey adjusted for clusters at multiple level, and the estimation of adjusted odds ratios (aOR) and 95% confidence intervals were used to evaluate the relationship between the outcome and independent variables. RESULTS Out of 17,747 women ;7638(42.91%) of the mothers had adequate ANC visits and low birth weight (LBW) was found among 833(4.63%) neonates. The birth of a LBW baby (aOR:4.64;95%CI:3.19,6.74) was directly related to increased odds of neonatal death. Mothers aged 20-34 years (aOR:0.40; 95%CI:0.20,0.81), a preceding birth interval of 24months or greater (aOR:0.41:95%CI:0.28,0.60), baby being female (aOR:0.72; 95%CI:0.54,0.96), having adequate ANC visits (aOR:0.64;95% CI:0.46,0.89) and the birth order of the newborn being ranked second or third (aOR:0.60; 95%CI:0.38,0.95) were negatively associated with neonatal death. CONCLUSION Health education programs targeting teen and primigravida mothers should be encouraged. Among the newborn survival interventions, addressing short birth intervals and the effective management of LBW cases should be explored. The findings confirm the fundamental importance of adequate ANC in the neonatal survival.
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Affiliation(s)
- Gérard Uwimana
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Mohamed Elhoumed
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
- National Institute of Public Health Research (INRSP), Nouakchott BP. 695, Nouakchott, Mauritania
| | - Mitslal Abrha Gebremedhin
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Qi Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Mougni Mohamed Azalati
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Liang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China.
- Center for Chronic Disease Control and Prevention, Global Health Institute, Xi'an Jiaotong University, Xi'an, China.
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, China.
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Jiao YC, Chang J, Liu C, Zhou SY, Ji Y, Meng Y. Factors influencing the help-seeking behavior in patients with mild cognitive impairment: a qualitative study. BMC Health Serv Res 2023; 23:1345. [PMID: 38042819 PMCID: PMC10693691 DOI: 10.1186/s12913-023-10281-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 11/06/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND The early diagnosis and intervention of mild cognitive impairment (MCI) patients is expected to delay the progression of AD. Delayed treatment will lead to MCI patients missing the best intervention expectation. At present, the medical help-seeking behavior of this group is not optimistic. This study aimed to explore influencing factors of help-seeking behavior among patients with MCI in China based on the help-seeking behavior model. METHODS Twenty-two patients with MCI were recruited to participate in semi-structured interviews via purposeful sampling with a qualitative, descriptive design. Data were analyzed by qualitative content analysis. RESULTS The study revealed the main influencing factors of help-seeking behavior among MCI patients in China included perceived disease threat, symptom attribution, disease knowledge, use of cognitive compensation strategies, sense of foreseeable burden, social support, economic condition, and accessibility of medical service. CONCLUSIONS The help-seeking behavior of patients with MCI is affected by multiple factors. There are some key factors in different stages of the help-seeking process. Healthcare providers can utilize these factors to design targeted interventions for promoting early help-seeking of patients with MCI.
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Affiliation(s)
- Yu-Chen Jiao
- School of Nursing, Nanjing Medical University, Nanjing, China
- Department of Radiotherapy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Chang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Chang Liu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Shi-Yu Zhou
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yan Ji
- School of Nursing, Nanjing Medical University, Nanjing, China.
| | - Yao Meng
- School of Nursing, Nanjing Medical University, Nanjing, China.
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Gumz A, Reuter L, Löwe B, Voderholzer U, Schwennen B, Fehrs H, Wünsch-Leiteritz W, Brunner R, Kästner D, Zapf A, Weigel A. Factors influencing the duration of untreated illness among patients with anorexia nervosa: A multicenter and multi-informant study. Int J Eat Disord 2023; 56:2315-2327. [PMID: 37814447 DOI: 10.1002/eat.24069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION The duration of untreated illness (DUI), that is, the interval between the onset of anorexia nervosa (AN) symptoms and start of specialized treatments, has a strong influence on the prognosis. OBJECTIVE To quantify modifiable predictors of the DUI and to derive recommendations for secondary prevention strategies. METHODS Within a multicenter, multi-informant study, DUI was assessed in interviews with patients undergoing first specialized AN treatment. Modifiable factors were assessed perspectives of AN-patients, their relatives, and primary care practitioners [PCPs]) with the FABIANA-checklist (Facilitators and barriers in anorexia nervosa treatment initiation). The effect of FABIANA-items on the DUI for each perspective was calculated using Cox Regression (control variables: age, eating disorder pathology, health care status, migration background, body mass index [BMI]). RESULTS We included data from N = 125 female patients with AN (72 adults, 53 adolescents, Mage = 19.2 years, SD = 4.2, MBMI = 15.7 kg/m2 , SD = 1.9), N = 89 relatives (81.8% female, 18.2% male, Mage = 46.0 years, SD = 11.0) and N = 40 PCPs (Mage = 49.7 years, SD = 9.0). Average DUI was 12.0 months. Watching or reading articles about the successful treatment of other individuals with AN (patients' perspective) and regular appointments with a PCP (PCPs' perspective) were related to a shorter DUI (HR = 0.145, p = .046/ HR = 0.395, p = .018). Patients whose relatives rated that PCPs trivialized patients' difficulties had a longer DUI (HR = -0.147, p = .037). PCPs and relatives rated PCPs' competence higher than patients did. DISCUSSION It is recommended (a) to incorporate treatment success stories in prevention strategies, (b) to inform PCPs about potential benefits of regular appointments during the transition to specialized care, and (c) to train PCPs in dealing with patients' complaints. PUBLIC SIGNIFICANCE Many individuals with AN seek treatment very late. Our study shows that a promising approach to facilitate earlier AN treatment is to inform patients about successful treatments of affected peers, to foster regular appointments with a PCP and, to motivate these PCPs to take individuals' with AN difficulties seriously. Thus, our study provides important suggestions for interventions that aim to improve early treatment in AN.
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Affiliation(s)
- Antje Gumz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Laurence Reuter
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Voderholzer
- Schön Clinic Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany
| | | | - Helge Fehrs
- Department of Psychosomatic Medicine and Psychotherapy, Asklepios Westklinikum Hamburg, Hamburg, Germany
| | | | - Romuald Brunner
- Department for Paediatric and Adolescent Medicine, Medical University Center Regensburg, Hamburg, Germany
| | - Denise Kästner
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Antonia Zapf
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Yang F, Leng A, Wang J, Jing J, Leiter RE, Sharma RK, Krakauer EL, Jia Z. Association Between Primary Decision-Maker and Care Intensity Among Patients With Advanced Cancer in Mainland China. Am J Hosp Palliat Care 2023; 40:1349-1356. [PMID: 36598338 DOI: 10.1177/10499091221150768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose: In China, decisions regarding the treatment of seriously ill patients are usually made by family caregivers. This study aimed to explore the association between the primary decision-makers and the intensity of care given to patients with advanced cancer in China. Methods: We conducted a survey of family members and other caregivers representing 828 cancer patients who died between July 2013 and July 2016. The survey asked: "After the physician conveyed that the disease is incurable, what treatment did the patient and caregiver prefer?" and "Who was the primary decision-maker?" We compared the treatment intensity with locus of decision-making using multivariable logistic regression, adjusting for socio-demographic and clinical covariates informed. Results: Of the 792 patients in our sample, the majority were male (67·2%), 60 years or older (64·0%), married (82·2%), lived with family (98·2%), had medical insurance (94·8%), earned below-average income (53·5%), lived rurally (61·5%), had a gastrointestinal cancer diagnosis (50·8%), experienced moderate or severe pain (86·3%), never received palliative care (80·4%) and had caregivers as primary decision-makers (70·6%). We found that patients were more likely to receive intensive disease-modifying treatments when the primary decision-maker were their children (adjusted odds ratio [AOR] = 1·86, 95% CI:1·26-2·74), spouse (AOR = 2·04, 95% CI:1·26-3·30), or other caregivers (AOR = 3·46, 95% CI:1·24-9·69). Conclusions: When patients with advanced cancer in China did not make their own medical decisions, they were more likely to receive intensive disease-modifying treatments at the end-of-life. Actions should be taken to better understand and ensure that caregivers' decisions reflect the values and presence of patients.
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Affiliation(s)
- Fei Yang
- Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
| | - Anli Leng
- School of Political Science and Public Administration, Shandong University, Jinan, China
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | - Jun Jing
- Department of Sociology and Public Health Research Center, Tsinghua University, Beijing, China
| | - Richard E Leiter
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rashmi K Sharma
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Eric L Krakauer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Zhimeng Jia
- Temmy Latner Centre for Palliative Care, Toronto, ON, Canada
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Xie Z, Hong YR, Jo A, Marlow NM. Telehealth Utilization During the COVID-19 Pandemic Among People With Functional Disabilities in the U.S.: A Preliminary Analysis of National Health Interview Survey 2020 Data. AJPM FOCUS 2023; 2:100149. [PMID: 37920402 PMCID: PMC10618695 DOI: 10.1016/j.focus.2023.100149] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Introduction Telehealth has been widely promoted and adopted at multiple levels in the U.S. healthcare system during the COVID-19 pandemic. However, this rapid expansion of telehealth services may have further exacerbated health inequities among marginalized groups. Methods Using the 2020 National Health Interview Survey, this study compared patterns of telehealth use between people with functional disabilities and people without disabilities during the first year of the pandemic. Results In the multivariable-adjusted logistic regression models, respondents with moderate disabilities were significantly more likely to report telehealth use, not pandemic related (OR=1.25, 95% CI=1.03, 1.52) and telehealth use, pandemic related (OR=1.43, 95% CI=1.28, 1.60) than people without disabilities. Similarly, respondents with severe disabilities were significantly more likely to report telehealth use, not pandemic related (OR=1.46, 95% CI=1.07, 2.00) and telehealth use, pandemic related (OR=2.06, 95% CI=1.72, 2.46). In addition, telehealth use varied by the number of limitations and disability type. Conclusions People with functional disabilities were more likely to report telehealth use than people without disabilities. Furthermore, these associations strengthened with increasing disability severity and number of limitations while varying by disability type. Additional studies are warranted to explore ways of providing patient-centered telehealth to responsively meet various healthcare needs of people with functional disabilities and improve their health outcomes.
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Affiliation(s)
- Zhigang Xie
- Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, Florida
| | - Young-Rock Hong
- Department of Health Services Research, Management & Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
- UF Health Cancer Center, Gainesville, Florida
| | - Ara Jo
- Department of Health Services Research, Management & Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Nicole M. Marlow
- Department of Health Services Research, Management & Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
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Wippold GM, Jowers T, Garcia KA, Frary SG, Murphy H, Brown S, Carr B, Jeter O, Johnson K, Williams TL. Understanding and Promoting Preventive Health Service Use Among Black Men: Community-Driven and Informed Insights. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01864-3. [PMID: 38017346 DOI: 10.1007/s40615-023-01864-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/30/2023]
Abstract
Black men experience high rates of adverse health that can be prevented or mitigated by the regular use of preventive health services. Efforts are urgently needed to promote this type of health service use among Black men. The U.S. Preventive Services Task Force and the Institute of Medicine indicate that such efforts must align with Black men's values, perspectives, and preferences. However, little guidance exists on how to align these efforts for Black men. The present qualitative study was developed to understand factors associated with preventive health service use among Black men and community-informed strategies to promote preventive health service use among these men. An approach rooted in community-based participatory research and ecological theory was used. A core leadership team consisting of five Black men from the area guided the project's development, implementation, and evaluation. The core leadership team conducted 22 interviews with Black men from their communities. Four themes emerged from these interviews: (1) holistic well-being challenges faced by Black men: interaction of mental, physical, and societal forces; (2) the interplay of financial, informational, and gendered barriers/facilitators to using preventative health services among Black men; (3) the importance of shared identity in peer health education about preventive health service use; and (4) the need for community-centered initiatives to improve preventive health service use among Black men that prioritize accessibility and information. Findings of the present study can be used to tailor preventive health service use efforts for Black men. Such efforts have the potential to promote health and mitigate health disparities.
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Affiliation(s)
- Guillermo M Wippold
- Department of Psychology, University of South Carolina, 1512 Pendleton Avenue, Barnwell College, Mailbox 38, Columbia, SC, 29208, USA.
| | - Terri Jowers
- Aiken Center, Aiken, SC, USA
- South Carolina Community Health Workers Association, Columbia, SC, USA
| | - Kaylyn A Garcia
- Department of Psychology, University of South Carolina, 1512 Pendleton Avenue, Barnwell College, Mailbox 38, Columbia, SC, 29208, USA
| | - Sarah Grace Frary
- Department of Psychology, University of South Carolina, 1512 Pendleton Avenue, Barnwell College, Mailbox 38, Columbia, SC, 29208, USA
| | | | - Steven Brown
- Dreams Imagination and Gift Development, Simpsonville, SC, USA
| | | | - Orion Jeter
- Free Medical Clinic of Aiken County, Aiken, SC, USA
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Lee HY, Kim NH, Jeong JY, Shin SJ, Park HJ, Kawachi I. Factors predicting different times for brushing teeth during the day: multilevel analyses. BMC Oral Health 2023; 23:916. [PMID: 38001518 PMCID: PMC10668384 DOI: 10.1186/s12903-023-03555-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/19/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The most effective and simple intervention for preventing oral disease is toothbrushing. However, there is substantial variation in the timing of brushing teeth during the day. We aimed to identify a comprehensive set of predictors of toothbrushing after lunch and after dinner and estimated contextual (i.e., geographic) variation in brushing behavior at different times of the day. METHODS We constructed a conceptual framework for toothbrushing by reviewing health behavior models. The main data source was the 2017 Community Health Survey. We performed a four-level random intercept logistic regression to predict toothbrushing behavior. (individual, household, Gi/Gun/Gu, and Si/Do). RESULTS Individuals under 30 years of age had higher likelihood of brushing after lunch, while brushing after dinner was higher among those aged 40-79 years. People engaged in service/sales, agriculture/fishing/labor/mechanics, as well as student/housewife/unemployed were 0.60, 0.41, and 0.49 times less likely to brush their teeth after lunch, respectively, compared to those working in the office, but the gap narrowed to 0.97, 0.96, 0.94 for brushing after dinner. We also found significant area-level variations in the timing of brushing. CONCLUSIONS Different patterns in association with various factors at individual-, household- and Si/Gun/Gu-levels with toothbrushing after lunch versus toothbrushing after dinner suggests a need for tailored interventions to improve toothbrushing behavior depending on the time of day.
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Affiliation(s)
- Hwa-Young Lee
- Graduate School of Public Health and Healthcare Management, The Catholic University of Korea, Seoul, South Korea
- Catholic Institute for Public Health and Healthcare Management, The Catholic University of Korea, Seoul, South Korea
- Department of Dental Hygiene, Mirae Campus, Yonsei University, Wonju, South Korea
| | - Nam-Hee Kim
- Department of Dental Hygiene, Mirae Campus, Yonsei University, Wonju, South Korea.
| | - Jin-Young Jeong
- Hallym Research Institute of Clinical Epidemiology, Hallym University, Chuncheon, South Korea
| | - Sun-Jung Shin
- Department of Dental Hygiene, College of Dentistry, Gangneung Wonju National University, Gangneung, South Korea
| | - Hee-Jung Park
- Department of Dental Hygiene, College of Health Science, Kangwon National University, Samcheok, South Korea
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Kang L, Li C, Du H. Predictors of Medical Care Delay or Avoidance Among Chinese Adults During the COVID-19 Pandemic. Patient Prefer Adherence 2023; 17:3067-3080. [PMID: 38027085 PMCID: PMC10680038 DOI: 10.2147/ppa.s436794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Medical care delay or avoidance increases morbidity and mortality risk and is costly for the national healthcare system. The objective of this study was to identify factors associated with medical care delay or avoidance among Chinese adults during the COVID-19 pandemic. Materials and Methods A cross-sectional analysis was conducted using data from the 2020 China Family Panel Study (CFPS). The CFPS was conducted from July to December 2020 during the COVID-19 pandemic. The final sample included 4369 adults. A logistic regression model was employed to identify the factors associated with medical care delay or avoidance. Results The empirical results indicate that regardless of rural-urban residence, older adults and adults with chronic conditions were less likely to delay or avoid medical care during the pandemic. However, individuals who had completed more than three years of college showed a higher likelihood of delaying or avoiding medical care. In urban areas, larger family sizes, greater general trust in physicians, and higher provider structural quality were associated with a decreased probability of delaying or avoiding medical care during the pandemic. In contrast, employed adults were more likely to delay or avoid medical care. In rural areas, current smokers were more likely to delay or avoid medical care during the pandemic. Conclusion This study has identified several factors affecting medical care delay or avoidance, some of which are amenable to policy changes. Policymakers can help improve the utilization of health facilities and patient health outcomes by implementing a series of reforms.
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Affiliation(s)
- Lili Kang
- School of Health Management, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Changle Li
- School of Health Management, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Huifeng Du
- School of Health Management, Inner Mongolia Medical University, Hohhot, People’s Republic of China
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Tran NC, Wells CR, Atchison KA, Bhoopathi V. A national sample of developmentally disabled adolescents with obesity and their utilization of preventive dental care services. FRONTIERS IN ORAL HEALTH 2023; 4:1285416. [PMID: 38024150 PMCID: PMC10665891 DOI: 10.3389/froh.2023.1285416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background Previous literature indicates that adolescents with developmental disabilities and obesity may have more oral health complications than healthy adolescents. However, dental care utilization among adolescents with developmental disabilities (DDs) and obesity is unclear. We investigated the differences in the utilization of preventive dental services between this high-risk group of adolescents and those with no DDs or obesity. Methods Parent-reported data of adolescents 10-17 years (n = 68,942) from the 2016 to 2019 National Survey of Children's Health was used. In addition to descriptive and bivariate statistics, we ran three multiple logistic regression models guided by Andersen's Behavioral Model of Health Services Use, predicting the use of dental cleanings, fluoride treatments, and dental sealants. Results Among adolescents with DDs and obesity, dental cleanings, fluoride treatments, and dental sealant utilization prevalence were 76%, 48%, and 21%, respectively. In comparison, adolescents with no DDs or obesity had a prevalence of 83%, 50%, and 19%, respectively. Multiple logistic regression analysis showed that adolescents with DDs and obesity did not significantly differ in their receipt of dental cleanings (p = .07), fluoride treatments (p = .55), and dental sealants (p = .23) compared to those with neither DDs nor obesity. Adolescents with DDs but no obesity were 22% and 30% more likely to receive fluoride treatments (p < .0001) and dental sealants (p < .0001), respectively. Conclusions Fewer than half of adolescents with DDs and obesity utilized fluoride treatments, and less than one quarter utilized dental sealants but used all three preventive services at the same rate as those with no DDs or obesity. Implications This study identified no differences in preventive dental care services utilization in adolescents with developmental disabilities (DDs) and obesity compared to those without DDs and obesity. However, the utilization of preventive dental services in this population is influenced by the federal poverty level and family background.
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Affiliation(s)
- Nini C. Tran
- Section of Pediatric Dentistry, School of Dentistry, University of California, Los Angeles, Los Angeles, CA, United States
| | - Christine R. Wells
- Statistical Methods and Data Analytics, Office of Advanced Research Computing, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kathryn A. Atchison
- Section of Public & Population Health, School of Dentistry, University of California, Los Angeles, Los Angeles, CA, United States
| | - Vinodh Bhoopathi
- Section of Public & Population Health, School of Dentistry, University of California, Los Angeles, Los Angeles, CA, United States
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Aljohani M, Donnelly M, Al Sumaih I, O'Neill C. The relationship between region of residence, socio-demographic factors, and healthcare utilization among Saudi citizens: insights from the 2013 Saudi Health Interview Survey. Front Med (Lausanne) 2023; 10:1252340. [PMID: 38020173 PMCID: PMC10657865 DOI: 10.3389/fmed.2023.1252340] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background There is a dearth of research on the nature and extent of variation in patterns of health service use in Saudi Arabia. This is an important gap in knowledge, given ongoing efforts to improve service provision and delivery. This study examined the relationship between the region of residence and socio-demographic factors and patterns of health service use in Saudi Arabia. Methods Data were taken from the 2013 Saudi Health Interview Survey (SHIS), a national multistage survey of individuals aged 15 years and above in Saudi Arabia. Data included measures of service use, respondent health, socio-demographic characteristics, and region or area of residence. Descriptive statistics, Chi-square tests, and multivariable logistic regression analyses were used to describe the data and examine the likelihood of a respondent visiting a doctor or healthcare professional in the preceding 12 months. In addition, the analyses examined the role of health and socio-demographic characteristics within selected regions. Results The increased likelihood of using health services in terms of visiting a doctor or healthcare professional was related to poor health status, being female, married, having a low income, and residing in particular regions. Respondents aged <65 and who lived furthest from service providers were less likely to visit a doctor or other health professionals (p < 0.01). Residents who lived in Riyadh, Al Medina, Baha, or Aseer demonstrated a higher likelihood of service utilization compared to respondents residing in other regions (p < 0.05). In sub-group analyses, there was variation between regions with respect to socio-demographic status and distance to service. Conclusion Region of residence and income level, in particular, may help to explain the likelihood of primary care use in Saudi Arabia and the distinct patterns of service use in relation to regional and socio-demographic characteristics. The relationship between regional variation in service utilization and the socio-demographic characteristics of respondents may reflect differences with respect to population need, enabling, and predisposing factors as represented in Anderson's Behavioral Model (ABM) of health service use. The findings from this study underscore the importance of considering region or area of residence when seeking to understand the utilization of health services, particularly primary care services.
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Affiliation(s)
- Motab Aljohani
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
- Public Health Department, College of Health Science, Saudi Electronic, Riyadh, Saudi Arabia
| | - Michael Donnelly
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Ibrahim Al Sumaih
- Medical Supportive Services, King Fahad Hospital, Ministry of Health, Hofuf, Saudi Arabia
| | - Ciaran O'Neill
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
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Baert S, Fomenko E, Machiels A, Bicanic I, Van Belle S, Gemmel P, Gilles C, Roelens K, Keygnaert I. Mental health of sexual assault victims and predictors of their use of support from in-house psychologists at Belgian sexual assault care centres. Eur J Psychotraumatol 2023; 14:2263312. [PMID: 37819370 PMCID: PMC10569350 DOI: 10.1080/20008066.2023.2263312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 08/05/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Sexual assault (SA) can induce a negative impact on victims' mental health. Specialised SA services generally offer medical care and a forensic examination to SA victims. However, there is a large variation in how these services provide mental health support. OBJECTIVE This study aims to assess mental health problems of SA victims attending the Belgian Sexual Assault Care Centres (SACCs) and identify predictors for victims' use of support from in-house psychologists. METHOD Health records of victims ≥ 16 years who presented within one week post-SA to one of the three Belgian SACCs between 25 October 2017 and 31 October 2019 were reviewed. An AIC-based stepwise backward binary logistic regression was used to analyse the association between victim, assault, service use and mental health characteristics and follow-up by a SACC-psychologist. RESULTS Of the 555 victims, more than half had a history of mental health problems. Of those assessed, over 70% showed symptoms of posttraumatic stress disorder (PTSD), depression and/or anxiety disorder. One in two victims consulted a SACC-psychologist. Victims with a mental health history (OR 1.46, p = .04), victims accompanied by a support person during acute care (OR 1.51, p = .04), and victims who were assaulted by an acquaintance in comparison to those assaulted by a stranger (OR 1.60, p = .039) were more likely to attend their appointment with the SACC-psychologist. CONCLUSION The study reaffirms the high mental health burden among victims attending specialised SA services, stressing the need to provide effective mental health interventions at these services and improve their longer-term use by victims. Prescheduling of appointments with an in-house psychologist in combination with phone reminders may improve the uptake of such services. Health care providers must be vigilant about potential barriers faced by victims without a mental health history or social support in attending appointments with mental health professionals.
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Affiliation(s)
- Saar Baert
- Ghent University, Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent, Belgium
| | - Elizaveta Fomenko
- Ghent University, Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent, Belgium
| | - Aurélie Machiels
- Ghent University, Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent, Belgium
| | - Iva Bicanic
- National Psychotrauma Centre for Children and Youth, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Sara Van Belle
- Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Paul Gemmel
- Ghent University, Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent, Belgium
| | | | - Kristien Roelens
- Ghent University, Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent, Belgium
| | - Ines Keygnaert
- Ghent University, Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent, Belgium
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Au-Yeung C, Bowie CR, Montreuil T, Baer LH, Lecomte T, Joober R, Abdel-Baki A, Jarvis GE, Margolese HC, De Benedictis L, Schmitz N, Thai H, Malla AK, Lepage M. Predictors of treatment attrition of cognitive health interventions in first episode psychosis. Early Interv Psychiatry 2023; 17:984-991. [PMID: 36653167 DOI: 10.1111/eip.13391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/16/2022] [Accepted: 01/01/2023] [Indexed: 01/20/2023]
Abstract
AIM Dropping out of psychological interventions is estimated to occur in up to a third of individuals with psychosis. Given the high degree of attrition in this population, identifying predictors of attrition is important to develop strategies to retain individuals in treatment. We observed a particularly high degree of attrition (48%) in a recent randomized controlled study assessing cognitive health interventions for first-episode psychosis participants with comorbid social anxiety. Due to the importance of developing interventions for social anxiety in first episode psychosis, the aim of the present study was to identify putative predictors of attrition through a secondary analysis of data. METHODS Participants (n = 96) with first episode psychosis and comorbid social anxiety were randomized to receive cognitive behavioural therapy for social anxiety or cognitive remediation. Differences between completers and non-completers (<50% intervention completed) were compared using t-tests or chi-square analyses; statistically significant variables were entered into a multivariate logistic regression model. RESULTS Non-completers tended to be younger, had fewer years of education and had lower levels of social anxiety compared to completers. Lower baseline social anxiety and younger age were statistically significant predictors of non-completion in the logistic regression model. CONCLUSIONS Age and social anxiety were predictors of attrition in cognitive health interventions in first episode psychosis populations with comorbid social anxiety. In the ongoing development of social anxiety interventions for this population, future studies should investigate specific engagement strategies, intervention formats and outcome monitoring to improve participant retention in treatment.
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Affiliation(s)
- Christy Au-Yeung
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Christopher R Bowie
- Department of Psychology, Department of Psychiatry, Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Tina Montreuil
- Departments of Educational & Counselling Psychology and Psychiatry, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Child Health and Human Development, Montreal, Quebec, Canada
| | - Larry H Baer
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Tania Lecomte
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Amal Abdel-Baki
- Clinique JAP-Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal CRCHUM, Montréal, Québec, Canada
- Département de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
| | - G Eric Jarvis
- First Episode Psychosis Program, Jewish General Hospital, and Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Howard C Margolese
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Prevention and Early Intervention Program for Psychoses, McGill University Health Centre, Montreal, Quebec, Canada
| | - Luigi De Benedictis
- Département de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
- Connec-T Clinic (First Psychotic Episode and Early Intervention Program), Institut universitaire en santé mentale de Montréal, Department of Psychiatry and Addictology, University of Montreal, Montreal, Quebec, Canada
| | - Norbert Schmitz
- Department of Population-Based Medicine, Institute of Health Sciences, University Hospital Tuebingen, Tuebingen, Germany
| | - Helen Thai
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Ashok K Malla
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Martin Lepage
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Nkemdirim Okere A, Moussa RK, Ali A, Diaby VK. Development and validation of a tool to predict high-need, high-cost patients hospitalised with ischaemic heart disease. BMJ Open 2023; 13:e073485. [PMID: 37751949 PMCID: PMC10533782 DOI: 10.1136/bmjopen-2023-073485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/25/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE To develop and validate a tool to predict patients with ischaemic heart disease (IHD) at risk of excessive healthcare resource utilisation. DESIGN A retrospective cohort study. SETTING We identified patients through the State of Florida Agency for Health Care Administration (N=586 518) inpatient dataset. PARTICIPANTS Adult patients (at least 40 years of age) admitted to the hospital with a diagnosis of IHD between 1 January 2007 and 31 December 2016. PRIMARY OUTCOME MEASURES We identified patients whose healthcare utilisation is higher than presumed (analysis of residuals) and used logistic regression (binary and multinomial) in estimating the predictive models to classify individual as high-need, high-care (HNHC) patients relative to inpatient visits (frequency of hospitalisation), cost and hospital length of stay. Discrimination power, prediction accuracy and model improvement for the binary logistic model were assessed using receiver operating characteristic statistic, the Brier score and the log-likelihood (LL)-based pseudo-R2, respectively. LL-based pseudo-R2 and Brier score were used for multinomial logistic models. RESULTS The binary logistic model had good discrimination power (c-statistic=0.6496), an accuracy of probabilistic predictions (Brier score) of 0.0621 and an LL-based pseudo-R2 of 0.0338 in the development cohort. The model performed similarly in the validation cohort (c-statistic=0.6480), an accuracy of probabilistic predictions (Brier score) of 0.0620 and an LL-based pseudo-R2 of 0.0380. A user-friendly Excel-based HNHC risk predictive tool was developed and readily available for clinicians and policy decision-makers. CONCLUSIONS The Excel-based HNHC risk predictive tool can accurately identify at-risk patients for HNHC based on three measures of healthcare expenditures.
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Affiliation(s)
- Arinze Nkemdirim Okere
- Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, Tallahassee, Florida, USA
| | - Richard K Moussa
- Ecole Nationale Supérieure de Statistique et d'Économie Appliquée, Abidjan, Côte d'Ivoire
| | - Askal Ali
- Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, Tallahassee, Florida, USA
| | - Vakaramoko K Diaby
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
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Zahlan G, De Clifford-Faugère G, Nguena Nguefack HL, Guénette L, Pagé MG, Blais L, Lacasse A. Polypharmacy and Excessive Polypharmacy Among Persons Living with Chronic Pain: A Cross-Sectional Study on the Prevalence and Associated Factors. J Pain Res 2023; 16:3085-3100. [PMID: 37719270 PMCID: PMC10505027 DOI: 10.2147/jpr.s411451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/27/2023] [Indexed: 09/19/2023] Open
Abstract
Purpose Polypharmacy can be defined as the concomitant use of ≥5 medications and excessive polypharmacy, as the use of ≥10 medications. Objectives were to (1) assess the prevalence of polypharmacy and excessive polypharmacy among persons living with chronic pain, and (2) identify sociodemographic and clinical factors associated with excessive polypharmacy. Patients and Methods This cross-sectional study used data from 1342 persons from the ChrOnic Pain trEatment (COPE) Cohort (Quebec, Canada). The self-reported number of medications currently used by participants (regardless of whether they were prescribed or taken over-the-counter, or were used for treating pain or other health issues) was categorized to assess polypharmacy and excessive polypharmacy. Results Participants reported using an average of 6 medications (median: 5). The prevalence of polypharmacy was 71.4% (95% CI: 69.0-73.8) and excessive polypharmacy was 25.9% (95% CI: 23.6-28.3). No significant differences were found across gender identity groups. Multivariable logistic regression revealed that factors associated with greater chances of reporting excessive polypharmacy (vs <10 medications) included being born in Canada, using prescribed pain medications, and reporting greater pain intensity (0-10) or pain relief from currently used pain treatments (0-100%). Factors associated with lower chances of excessive polypharmacy were using physical and psychological pain treatments, reporting better general health/physical functioning, considering pain to be terrible/feeling like it will never get better, and being employed. Conclusion Polypharmacy is the rule rather than the exception among persons living with chronic pain. Close monitoring and evaluation of the different medications used are important for all persons, especially those with limited access to care.
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Affiliation(s)
- Ghita Zahlan
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | | | - Hermine Lore Nguena Nguefack
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Line Guénette
- Faculté de pharmacie, Université Laval, Quebec, Quebec, Canada
- Centre de recherche, CHU de Québec - Université Laval, Quebec, Quebec, Canada
| | - M Gabrielle Pagé
- Centre de recherche, Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Département d’anesthésiologie et de médecine de la douleur, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Lucie Blais
- Faculté de pharmacie, Université de Montréal, Montreal, Quebec, Canada
| | - Anaïs Lacasse
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
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Abri D, Boll T. Use of Assistive Technologies and Alternative Means by Older People: The "Actional Model of Older People´s Coping with Health-Related Declines". Integr Psychol Behav Sci 2023; 57:960-1001. [PMID: 36163456 DOI: 10.1007/s12124-022-09729-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 11/05/2022]
Abstract
This paper presents the "Actional Model of Older people´s Coping with Health-Related Declines" to explain the use of a broad range of action alternatives of older persons for dealing with current or anticipated diseases, functional declines, activity limitations and participation restrictions. The general background is the action-theoretical model of intentional self-regulation of human development (e.g., Brandtstädter, 2006; Rothermund & Brandtstädter, 2019). Yet, our model provides an increased specification of major model components toward the situation of older people coping with current or anticipated health-related declines. The model development follows an adapted theory construction methodology (TCM) by Borsboom et al. (Perspectives on Psychological Science, 16(4), 756-766, 2021) and adapted principles for constructing practically useful theories by Berkman & Wilson (Perspectives on Psychological Science, 16(4), 864-874, 2021). Regarding content, we further draw on models of the use of assistive technologies (ATs) and medical services, qualitative studies on reasons for using ATs, and quantitative studies on health-related goals. The resulting model includes these components: (1) Discrepancies between perceived or anticipated and desired health-related development, (2) health-related discrepancy reduction and prevention goals, (3) action possibilities for reducing or preventing health-related discrepancies, (4) further motivating and demotivating goals, (5) beliefs about effective means for reaching the goals (2) and (4), (6) generation of the particular coping actions by goals (2) and (4) in combination with beliefs about effective means, (7) external context factors, and (8) modes of joint decision-making and decision-making on behalf of older people. The explanatory and practical value of the model are discussed as well as its implications for future research and geropsychology teaching.
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Affiliation(s)
- Diana Abri
- Department of Behavioural and Cognitive Sciences, Institute for Lifespan Development, Family, and Culture, University of Luxembourg, 11, Porte des Sciences, L-4366, Esch-sur-Alzette, Luxembourg.
| | - Thomas Boll
- Department of Behavioural and Cognitive Sciences, Institute for Lifespan Development, Family, and Culture, University of Luxembourg, 11, Porte des Sciences, L-4366, Esch-sur-Alzette, Luxembourg
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Steinman L, Xing J, Court B, Coe NB, Yip A, Hill C, Rector B, Baquero B, Weiner BJ, Snowden M. Can a Home-Based Collaborative Care Model Reduce Health Services Utilization for Older Medicaid Beneficiaries Living with Depression and Co-occurring Chronic Conditions? A Quasi-experimental Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:712-724. [PMID: 37233831 DOI: 10.1007/s10488-023-01271-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 05/27/2023]
Abstract
Depression remains a major public health issue for older adults, increasing risk of costly health services utilization. While home-based collaborative care models (CCM) like PEARLS have been shown to effectively treat depression in low-income older adults living with multiple chronic conditions, their economic impact is unclear. We conducted a quasi-experimental study to estimate PEARLS effect on health service utilization among low-income older adults. Our secondary data analysis merged de-identified PEARLS program data (N = 1106), home and community-based services (HCBS) administrative data (N = 16,096), and Medicaid claims and encounters data (N = 164) from 2011 to 2016 in Washington State. We used nearest neighbor propensity matching to create a comparison group of social service recipients similar to PEARLS participants on key determinants of utilization guided by Andersen's Model. Primary outcomes were inpatient hospitalizations, emergency room (ER) visits, and nursing home days; secondary outcomes were long-term supports and services (LTSS), mortality, depression and health. We used an event study difference-in-difference (DID) approach to compare outcomes. Our final dataset included 164 older adults (74% female, 39% people of color, mean PHQ-9 12.2). One-year post-enrollment, PEARLS participants had statistically significant improvements in inpatient hospitalizations (69 fewer hospitalizations per 1000 member months, p = 0.02) and 37 fewer nursing home days (p < 0.01) than comparison group participants; there were no significant improvements in ER visits. PEARLS participants also experienced lower mortality. This study shows the potential value of home-based CCM for participants, organizations and policymakers. Future research is needed to examine potential cost savings.
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Affiliation(s)
- Lesley Steinman
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA.
- Hans Rosling Center, University of Washington, 3980 15th Avenue NE, UW Mailbox 351621, Seattle, WA, 98195, USA.
| | - Jingping Xing
- Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia, USA
| | - Beverly Court
- Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia, USA
| | - Norma B Coe
- Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA
| | - Andrea Yip
- Seattle-King County Aging and Disability Services, Seattle, USA
| | - Clara Hill
- Department of Human Development, Washington State University, Pullman, USA
| | - Bea Rector
- Washington State Department of Social and Health Services, Aging and Long-Term Support Administration, Lacey, USA
| | - Barbara Baquero
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA
| | - Bryan J Weiner
- Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, USA
| | - Mark Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
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Bhoopathi V, Wells C, Atchison KA. Dental care utilization among developmentally disabled adolescents experiencing difficulty with decayed teeth: A population-level study. SPECIAL CARE IN DENTISTRY 2023; 43:619-627. [PMID: 36575154 DOI: 10.1111/scd.12817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022]
Abstract
AIMS To determine if adolescents with developmental disabilities (DDs) who experienced difficulty with dental caries differed by dental visits in the past 12 months and receipt of preventive services (fluoride treatment and dental sealants) during those visits compared to adolescents with no DDs or difficulty with dental caries. METHODS AND RESULTS A cross-sectional study was conducted using data of 91 196 adolescents aged 10-17 years from the 2016-2020 National Survey of Children's Health. Descriptive and bivariate statistics and multivariable regression models were conducted. We derived the odds ratio for visiting a dental office (OR: 0.76, 95% CI: 0.57-1.03, p = .07), receiving fluoride treatments (OR: 1.20, 95% CI: 1.01-1.43, p = .04), and dental sealants (OR: 1.44, 95% CI: 1.19-1.75, p < .001) for DD adolescents who experienced difficulty with dental caries compared to adolescents with no DDs or difficulty with dental caries. CONCLUSIONS DD adolescents who experienced difficulty with dental caries were more likely to receive fluoride treatments and sealants during dental visits but were equally likely to have a dental visit in the past 12 months than adolescents with no DDs or difficulty with dental caries.
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Affiliation(s)
- Vinodh Bhoopathi
- Section of Public and Population Health, University of California at Los Angeles School of Dentistry, Los Angeles, California, USA
| | - Christine Wells
- Statistical Methods and Data Analytics, University of California at Los Angeles Office of Advanced Research Computing, Los Angeles, California, USA
| | - Kathryn Ann Atchison
- Section of Public and Population Health, University of California at Los Angeles School of Dentistry, Los Angeles, California, USA
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Wrotek M, Kalbarczyk M. Predictors of long-term care use - informal home care recipients versus private and public facilities residents in Poland. BMC Geriatr 2023; 23:512. [PMID: 37620838 PMCID: PMC10463875 DOI: 10.1186/s12877-023-04216-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND The population aging, together with the shrinking caring potential of families, is a major challenge for social policy in the coming years. The aim of the study is to identify the factors that determine not only the use of long-term care (LTC) but also the selection of individual types of such care in Poland. METHODS Using unique data collected from inpatient LTC facilities in Poland and the Survey on Health, Ageing and Retirement in Europe (SHARE) database, we estimate logistic regressions explaining the choice of LTC solution. RESULTS Our results suggest that social inequalities play a role in choosing the type of LTC. Better educated people choose private institutions, while people without support network use more often social residential homes. The impact of multimorbidity on choosing different types of inpatient facilities is limited, thus the number of ADL limitations remains a better indicator of long term care utilization. CONCLUSIONS The study confirms that social inequalities influence decisions about the choice of LTC. However, multi-morbidity is a predictor of using LTC to a limited extent. The differences in LTC selection determinants between women and men are noticeable.
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Affiliation(s)
- Małgorzata Wrotek
- Faculty of Economic Sciences, University of Warsaw, Długa 44/50, Warsaw, 00-241, Poland.
| | - Małgorzata Kalbarczyk
- Faculty of Economic Sciences, University of Warsaw, Długa 44/50, Warsaw, 00-241, Poland
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Wu J, Li Q, Bao C, Yang C, Li P, Zhang L. Nephrology workforce in China: describing current status and evaluating the optimal capacity based on real-world data. HUMAN RESOURCES FOR HEALTH 2023; 21:62. [PMID: 37553692 PMCID: PMC10410773 DOI: 10.1186/s12960-023-00851-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/03/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE This study aims to characterize the current status of the nephrology workforce in China and evaluate its optimal capacity based on real-world patient mobility data. METHODS Data on nephrologists in China were collected from two prominent online healthcare platforms using web crawlers and natural language processing techniques. Hospitalization records of patients with chronic kidney disease (CKD) from January 2014 to December 2018 were extracted from a national administrative database in China. City-level paths of patient mobility were identified. Effects of nephrology workforce on patient mobility were analyzed using multivariate Poisson regression models. RESULTS Altogether 9.13 nephrologists per million population (pmp) were in practice, with substantial city-level variations ranging from 0.16 to 88.79. The ratio of nephrologists to the estimated CKD population was 84.57 pmp. Among 6 415 559 hospitalizations of patients with CKD, 21.3% were cross-city hospitalizations and 7441 city-level paths of patient mobility with more than five hospitalizations were identified. After making adjustment for healthcare capacity, healthcare insurance, economic status, and travel characteristics, the Poisson regression models revealed that the number of nephrologists in both the source city (incidence rate ratio [IRR] 0.99, per 1 pmp increase) and destination city (IRR 1.07, per 1 pmp increase) were independently associated with patient mobility. An IRR plateau was observed when the number of nephrologists exceeded 12 pmp in the source city, while a rapidly increasing IRR was observed beyond 20 pmp in the destination city. CONCLUSIONS The nephrology workforce in China exhibits significant geographic variations. Based on local healthcare needs, an optimal range of 12-20 nephrologists pmp is suggested.
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Affiliation(s)
- Jingyi Wu
- Advanced Institute of Information Technology, Peking University, No.233 Yonghui Road, Xiaoshan District, Hangzhou, 311215, Zhejiang, China
| | - Qing Li
- Advanced Institute of Information Technology, Peking University, No.233 Yonghui Road, Xiaoshan District, Hangzhou, 311215, Zhejiang, China
| | - Chenlu Bao
- Advanced Institute of Information Technology, Peking University, No.233 Yonghui Road, Xiaoshan District, Hangzhou, 311215, Zhejiang, China
| | - Chao Yang
- Advanced Institute of Information Technology, Peking University, No.233 Yonghui Road, Xiaoshan District, Hangzhou, 311215, Zhejiang, China
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, 100034, China
| | - Pengfei Li
- Advanced Institute of Information Technology, Peking University, No.233 Yonghui Road, Xiaoshan District, Hangzhou, 311215, Zhejiang, China.
- National Institute of Health Data Science, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Luxia Zhang
- Advanced Institute of Information Technology, Peking University, No.233 Yonghui Road, Xiaoshan District, Hangzhou, 311215, Zhejiang, China.
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, 100034, China.
- National Institute of Health Data Science, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China.
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Zewude B, Siraw G, Engdawork K, Tadele G. Health seeking behavior of street connected children in Addis Ababa, Ethiopia. FRONTIERS IN SOCIOLOGY 2023; 8:1188746. [PMID: 37609109 PMCID: PMC10441109 DOI: 10.3389/fsoc.2023.1188746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/21/2023] [Indexed: 08/24/2023]
Abstract
Background Street children are the most neglected segments of the society with limited access to healthcare services. The vulnerability of street children to various health risks has been found by previous studies but little is known about their perceived susceptibility, preventive behavior and illness responses. Hence, the purpose of this study was to identify the health seeking behavior of street children in Addis Ababa. The study focuses on perceived susceptibility to various health risks, sources of health risks, and behaviors pertaining to responding to perceived risks and experienced health problems among the most marginalized groups in Addis Ababa. Methods Using a mixed research approach, quantitative and qualitative data were collected through survey and interview methods from selected street children. SPSS and NVivo software were used to analyze the quantitative and qualitative data, respectively. Results Whereas the street children perceive to be susceptible for ill-health risks related with their living situations, responding to the perceived susceptibility mainly by maintaining personal hygiene and undertaking physical exercises have been identified. The study also revealed that street children were found to be vulnerable for the situations affecting their health and wellbeing mainly due to self-reported engagements in risky behaviors such as smoking cigarette (67.3%), sniffing glue or benzene (68.2%), sharing of personal materials having the potential of transmitting diseases from one person to another (25.5%), and unprotected sexual activities (14.1%). Experiences of visiting healthcare facilities in response to illness symptoms have also constituted an aspect of the health seeking behavior of the street children. Conclusion Awareness of the presence of health risks and perceived susceptibility to the risks promoted both preventive behavior and positive compliance in relation to illness response among children of the street in Addis Ababa.
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Affiliation(s)
- Bewunetu Zewude
- Department of Sociology, College of Social Science and Humanities, Wolaita Sodo University, Sodo, Ethiopia
| | - Getahun Siraw
- Department of Sociology, College of Social Sciences and Humanities, Dilla University, Dilla, Ethiopia
| | - Kibur Engdawork
- Department of Sociology, College of Social Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getnet Tadele
- Department of Sociology, College of Social Science, Addis Ababa University, Addis Ababa, Ethiopia
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