Abstract
BackgroundAccess to health care is a global public problem. In French Guiana, there exists social inequalities which are specially marked amongst immigrants who make up a third of the population. Health care inequalities are prevalent. The objective of this study was to determine factors associated with why health care amongst the poor population of Cayenne was renounced.The study was cross sectional. It focused on knowledge, attitudes, practices and beliefs of the population living in poor neighborhoods of the Cayenne area.MethodsPopulations coming at the Red Cross mobile screening unit in poor urban areas of Cayenne were surveyed from July 2013 to June 2014. Structured questionnaires consisted of 93 questions. Written informed consent was requested at the beginning of the questionnaire. The predictors for renouncing medical care were determined using logistic regression models and tree analysis.ResultsTwenty percent of persons had renounced care. Logistic regression showed that renouncement of health care was negatively associated with having no regular physician Adjusted Odds Ratio (AOR) = 0.43 (95 % CI = 0.24–0.79) and positively associated with being embarrassed to ask certain questions AOR = 6.81 (95 % CI = 3.98–11.65) and having been previously refused health care by a doctor AOR = 3.08 (95 % CI = 1.43–6.65). Tree analysis also showed that three of these variables were linked to renouncement, with feeling shy to ask certain questions as the first branching.ConclusionAlthough most people felt it was easy to see a doctor, one in five had renounced health care. The variables identified by the models suggest vulnerable persons generally had previous negative encounters with the health system and felt unwanted or non eligible for healthcare. Health care mediation and welcoming staff may be simple solutions to the above problems which were underscored in our observations.
Highlights
Access to health care is a global public problem
Previous studies in French Guiana have shown that undocumented immigrants reported a poorer health status [8]
The complexities of a poor immigrants’ life, of the health care system and of the administrative requirements to access to rights, the lack of transport, and the refusal by some private practitioners to see patients with universal health insurance are all potential determinants of a sick patient to renounce to see a doctor [12]
Summary
In French Guiana, there exists social inequalities which are specially marked amongst immigrants who make up a third of the population. The objective of this study was to determine factors associated with why health care amongst the poor population of Cayenne was renounced. It focused on knowledge, attitudes, practices and beliefs of the population living in poor neighborhoods of the Cayenne area. Health inequalities between countries and within countries remain salient [1]. Both absolute and relative material standards matter, with the later having a greater importance [2, 3]. Previous studies in French Guiana have shown that undocumented immigrants reported a poorer health status [8]. The complexities of a poor immigrants’ life, of the health care system and of the administrative requirements to access to rights, the lack of transport, and the refusal by some private practitioners to see patients with universal health insurance are all potential determinants of a sick patient to renounce to see a doctor [12]
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