Access Barriers Research Articles

Healthcare access barriers for Hispanic pediatric nephrology patients: a KICK study.

Hispanics, the fastest growing minority in the USA, suffer from high chronic kidney disease (CKD) burden. Barriers to accessing medical care increase disparities and quality of care for Hispanic children with CKD. As a part of the grant-funded "Kidney Initiative in Community Kids" (KICK), the voluntary "Barriers to Care Questionnaire" was distributed to self-identified Hispanic young adult patients (> 18years of age) or parents (if patient < 18years of age), between January 2021 to June 2021, in a single urban pediatric nephrology ambulatory clinic site. Survey was available in English and Spanish. Sociodemographic and health data was obtained from the medical record and Area Deprivation Index (ADI) was collected as a surrogate marker for socioeconomic disadvantage. Of the 179 completed surveys (49% Spanish, 51% English), skills (strategies necessary to navigate the healthcare system) and pragmatic (logistical issues that might delay/prevent utilization) barriers were identified with mean (± standard deviation) scores of 74 (± 26) and 75 (± 21), respectively (100 = no barriers). Spanish-speaking preference families had higher skills barriers (p < 0.001). The mean ADI was 55 ± 20: higher ADI score (more disadvantaged population) correlated with higher total barriers (p = 0.04) and was exacerbated by preferred language (p = 0.003). Hispanic pediatric patients with kidney disease have significant barriers which may impact their interaction with healthcare. Spanish-speaking families are particularly vulnerable. Prospective studies are necessary to advocate for program and policy changes to reduce racial and ethnic disparities in access to pediatric nephrology care.

The response to disability in higher education: an analysis of programs and services for people with disabilities: the case of the University of La Laguna

IntroductionThis study analyses the perceptions of students with disabilities and their lecturers at the University of La Laguna (ULL), focusing on the inclusion strategies implemented and their effectiveness in promoting educational equity.MethodsA mixed-methods design was employed, combining quantitative and qualitative approaches. Data were collected from 115 participants — 36 students with disabilities and 79 lecturers, between 2016 and 2018. Structured questionnaires and interviews were administered. Quantitative data were analysed using SPSS software, while qualitative data were examined through thematic content analysis.ResultsThe findings highlight the importance of fostering close collaboration among students, teaching staff, and the Programme for Students with Specific Support Needs (PAED). Key challenges identified include physical and communicative accessibility barriers, as well as a lack of training in addressing student diversity. Moreover, the absence of an inclusive institutional culture, as embedded within ULL’s policies and practices, was noted.DiscussionThe study highlights the urgent need to enhance inclusion strategies, particularly by improving accessibility and providing targeted training for academic and technical staff. Enhancing coordination between PAED, lecturers, and students is essential to creating a genuinely inclusive university environment. Despite limitations related to the sample size, the findings offer valuable insights for improving the institutional response to the diverse student population entering higher education.

Sociodemographic determinants of dental care utilization among children receiving public assistance in Japan: a one-year observational study

BackgroundAccess to dental care for all children is a matter of human rights. While public assistance (PA) programs can potentially improve access to dental care through income support for daily living and healthcare services among children in low-income households, other social vulnerabilities influence access. We aimed to investigate the sociodemographic determinants of dental care access for children on PA in Japan.MethodsThis study included all children receiving PA benefits in six municipalities. We extracted sociodemographic data as of April 2016 on age, sex, single-parenthood, parents’ working status, nationality, presence of siblings, disability certificates, and timing of households’ PA receipt, and observed them for one year. Medical assistance claim data was used to identify children’s dental care use as the outcome. Cumulative incidence ratios (CIR) for each variable were calculated using multivariable modified Poisson regression analysis.ResultsOf the 1,990 children on PA, the mean age was 8.32 (standard deviation; 4.12), 998 (50.2%) were girls, 1256 (63.1%) lived in single-parent households, and 532 (26.7%) were born into households already receiving PA, and 1085 (54.5%) children accessed dental care. Children living in single-parent households had a higher dental care use (CIR: 1.12, 95% CI: 1.03–1.23) than those in non-single-parent households. Children born in PA households had a lower dental care use (CIR: 0.88, 95% CI: 0.79–0.98) than those who began receiving PA after birth.ConclusionsDespite Japan’s comprehensive welfare PA system, dental care access barriers persist, particularly among children from non-single-parent households and those born into PA.

Using Natural Language Processing to Describe the Use of an Online Community for Abortion During 2022: Dynamic Topic Modeling Analysis of Reddit Posts.

Abortion access in the United States has been in a state of rapid change and increasing restriction since the Dobbs v Jackson Women's Health Organization decision from the US Supreme Court in June 2022. With further constraints on access to abortion since Dobbs, the internet and online communities are playing an increasingly important role in people's abortion trajectories. There is a need for a broader understanding of how online resources are used for abortion and how they may reflect changes in the sociopolitical and legal context of abortion access. Research using online information and leveraging methods to work efficiently with large textual datasets has the potential to accelerate knowledge generation and provide novel insights into changing abortion-related experiences following Dobbs, helping address these knowledge gaps. This project sought to use natural language processing techniques, specifically topic modeling, to explore the content of posts to 1 online community for abortion (r/abortion) in 2022 and assess how community use changed during that time. This analysis described and explored posts shared throughout 2022 and for 3 subperiods of interest: before the Dobbs leak (December 24, 2021-May 1, 2022), Dobbs leak to decision (May 2, 2022-June 23, 2022), and after the Dobbs decision (June 24, 2022-December 23, 2022). We used topic modeling to obtain descriptive topics for the year and each subperiod and then classified posts. Topics were then aggregated into conceptual groups based on a combination of quantitative and qualitative assessments. The proportion of posts classified in each conceptual group was used to assess change in community interests across the 3 study subperiods. The 7273 posts shared in r/abortion in 2022 included in our analyses were categorized into 8 conceptual groups: abortion decision-making, navigating abortion access barriers, clinical abortion care, medication abortion processes, postabortion physical experiences, potential pregnancy, and self-managed abortion processes. Posts related to navigating access barriers were most common. The proportion of posts about abortion decision-making and self-management changed significantly across study periods (P=.006 and P<.001, respectively); abortion decision-making posts were more common before the Dobbs leak, whereas those related to self-management increased following the leak and decision. This analysis provides a holistic view of r/abortion posts in 2022, highlighting the important role of online communities as abortion-supportive online resources and changing interests among posters with abortion policy changes. As policies and pathways to abortion access continue to change across the United States, approaches leveraging natural language processing with sufficiently large samples of textual data present opportunities for timely monitoring, with the potential to reflect a broad range of abortion experiences, including those of people who have limited or no interaction with clinical abortion care.

Older Adults’ Behaviors and Preferences for Seeking Sexual Health Information

Objectives Sexual expression is important to many older adults, but this population may be overlooked by sexual health campaigns and services. This study sought to understand the sexual health information-seeking behaviors and preferences of older adults, including whether and where they seek this information, the characteristics associated with seeking it, as well as satisfaction, preferences, and reasons for not seeking it. Methods The data were gathered in 2021 via a cross-sectional online survey of Australians aged 60 and over. There were seven quantitative outcomes and one set of free-text comments. Quantitative outcomes were analyzed using descriptive statistics, chi2 test, and logistic regression. The free-text comments were analyzed using qualitative content analysis. Results The survey sample was comprised of 1,470 respondents with an equal balance of men (49.9%) and women (49.7%) and a median age of 69 years (range of 60–92 years). Findings showed that 41.2% (602/1,461; 95%CI 38.7–43.7) had sought information, and 63.6% were satisfied with the information found. Being male, STI testing, online dating, age 70–79, and urban-living were associated with information-seeking. Healthcare providers were the most utilized and trusted information source, and many respondents were willing to look online. One in five did not seek information when they needed it, outlining various barriers preventing them from doing so. Conclusions Many older adults seek sexual health information, and with some experiencing access barriers and one-third unsatisfied, there is room for improvement. Relevant, accessible information should be provided by healthcare professionals and credible websites.

Addressing Socioeconomic Challenges Through Usage of Social Commerce in Business: A Social Network Theory and TAM Model Perspectives for Self-Help Groups

Information and communication technologies like social commerce have empowered self-help groups and micro-entrepreneurs to bridge socioeconomic challenges. These technologies help them to reduce the complexity of the task, improve accessibility, eliminate intermediaries, and break conventional barriers. However, many of the self-help groups and their consumers may not be ready to adopt and use the social commerce applications for their business, as they are not easy to use and not perceived as useful. Hence, the aim of the study is to examine the impact of social commerce constructs on social support and social commerce information-seeking behavior leading to purchase intention of the self-help group consumers. A conceptual model is developed to examine the impact of perceived usefulness and perceived ease of use with the mediating role of social commerce information seeking based on the technology acceptance model and social network theory. A total of 566 responses were collected through a questionnaire in India during 2023–2024 and analyzed using Structural Equation Modeling (SEM). The results reveal that social commerce constructs have a significant impact on social support. Social support is found to have a significant impact on social commerce information seeking. The indirect effects of perceived ease of use and perceived usefulness on purchase intention — mediated by social commerce information seeking — are found to be significant, demonstrating the strong mediating role of social commerce information seeking. This study provides empirical evidence for all the direct and unique indirect relationships in the model. The mediating role of social commerce information seeking in the relationships between perceived usefulness and purchase intention, as well as between perceived ease of use and purchase intention, has not been adequately explored in previous studies. The findings will help marketers understand that the antecedents like social commerce constructs and social support help in developing social commerce information seeking for the consumers of the self-help groups. Further, social commerce information seeking may invoke consumers to develop purchase intention. Thus, self-help groups and micro-entrepreneurs may design relevant marketing strategies for gaining social support and try to develop the ‘easy to use’ and useful online technological interface for their consumers. Using technological applications like social commerce for business will help in the upliftment of the self-help groups and mitigate socioeconomic challenges.

Practical Guidance on the Clinical Management of Ocular Adverse Events Associated with Belantamab Mafodotin for Patients with Relapsed/Refractory Multiple Myeloma: Latin American Expert Panel Recommendations.

Multiple myeloma is a significant cause of mortality worldwide, and although changes in the treatment landscape have improved outcomes overall, many patients become refractory to standard therapies. In Latin America, outcomes are especially poor, further compounded by access and equality barriers. Belantamab mafodotin is a novel antibody-drug conjugate, targeting anti-B-cell maturation antigen. Two recent phase3 trials, DREAMM-7 and DREAMM-8, have demonstrated notable efficacy with belantamab mafodotin combination regimens in patients with relapsed/refractory multiple myeloma. Ocular adverse events were also observed in these studies, as anticipated with antibody-drug conjugates containing monomethyl auristatinF. If belantamab mafodotin is approved for use in clinical practice, healthcare professionals will need clear, region-appropriate guidance on the management of ocular adverse events. A multidisciplinary panel of experts from Argentina, Brazil, Colombia, and Mexico was established, comprising 13 specialists in hematology/oncology and ophthalmology. The panel established a set of practical recommendations to address key clinical questions relating to identification of ocular events, management strategies, multidisciplinary collaboration, and patient-centric care. These recommendations were developed through detailed discussion, review of available evidence, and experience in clinical trials, and are intended to support healthcare professionals across Latin America in the treatment of patients with relapsed/refractory multiplemyeloma.

“We have our reasons”: Exploring the acceptability of pre-exposure prophylaxis among gay, bisexual, and other men who have sex with men in Ghana

BackgroundGhanaian men who have sex with men (MSM) face significant HIV disparities compared to the general population in Ghana. Pre-exposure prophylaxis (PrEP) is a highly effective tool for HIV prevention. Previous studies on the perspectives of PrEP use among Ghanaian MSM identified high interest in PrEP among this population. However, the knowledge from the previous research, which was the best available evidence at the time, was primarily hypothetical because those data were collected before any real-world implementation of PrEP in Ghana. The analysis aims to identify and understand the factors currently influencing PrEP acceptance.MethodsWe analyzed focus group (n = 8) data with Ghanaian MSM. We transcribed, coded, identified, and analyzed the responses using descriptive thematic analysis.ResultsWe identified two broad themes. Under theme one, which indicated almost universal awareness of PrEP but inaccuracies about PrEP were common, these were the categories: (1) Awareness of PrEP and antiretroviral therapy [ART], (2) confusion between pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis, (3) event-driven perceptions of PrEP usage, (4) Mixed understanding of PrEP: distinguishing PrEP from ART, and (5) advocacy for a comprehensive educational approach. Theme two revealed that PrEP acceptability was influenced by a mix of individual and intrapersonal factors such as (1) hesitancy towards PrEP uptake due to perceived limited benefit, (2) extending HIV, sex, and same-gender sexual relations stigma to PrEP affects uptake, (3) perceived lack of information, concerns about side effects, and cost.ConclusionsTo bridge the gap between awareness, knowledge, and acceptability, HIV prevention programs should address access barriers and incorporate community-derived strategies.

Understanding the Impacts of Immigration Status on Access to Primary Healthcare Services: Evidence From the Lived Experiences of Ethiopian Immigrant Women in the United States.

ObjectivesHealth inequity is a significant and pressing concern in the United States, and multiple studies showed that immigrants are one of the groups with the poorest access to healthcare compared to native-born populations. This study focuses on developing an in-depth understanding of how immigration status impacts primary healthcare (PHC) access among African immigrant women, particularly Ethiopian immigrant women (EIW).DesignA cross-sectional qualitative design was used to examine how immigration status shaped the healthcare experiences of EIW. In-depth interviews were conducted with 21 EIW in-person and virtually. The interviews were audio recorded and transcribed verbatim. Data analysis followed an inductive thematic analysis using NVivo 12 software.ResultsFour major themes emerged from the analysis, demonstrating how immigration and immigration status shape EIW's healthcare access and experiences. These were: (1) Employment-based insurance, (2) Eligibility for primary healthcare services, (3) Work conditions and time, and (4) Fear of losing status and the unknown. Across all themes, participants' experiences were deeply gendered and tied to broader labor and sociocultural conditions, highlighting the vitality of immigration status in determining healthcare access.ConclusionThe findings demonstrated the crucial need to expand work authorization to all immigrant groups, streamline the application process, and extend document validity to mitigate healthcare access barriers and prevent immigrants from taking low-wage, unprotected, and hazardous jobs that heighten health risks. Expanding eligibility to different groups of immigrants for programs such as Medicaid and Children's Health Insurance Program, and providing clear, comprehensive healthcare information tailored for immigrant populations are recommended.

Disparities in postoperative surveillance and use of emergency health services following endovascular abdominal aortic aneurysm repair among Medicare beneficiaries.

Disparities in postoperative surveillance and use of emergency health services following endovascular abdominal aortic aneurysm repair among Medicare beneficiaries.

Socioeconomic status and choice of primary management of stress urinary incontinence: a retrospective cohort study.

Socioeconomic status and choice of primary management of stress urinary incontinence: a retrospective cohort study.

Assessing the Readability, Credibility, and Accuracy of Online Vaccine Information for Pregnant and Lactating Individuals: A Cross-Platform Analysis.

Pregnant and lactating individuals frequently rely on online sources for vaccine information. However, the readability, credibility, and accuracy of such content vary widely, potentially influencing vaccine hesitancy. This study evaluates the accessibility and reliability of online vaccine information across different digital platforms. A cross-sectional content analysis was conducted on vaccine-related content published between 2018 and 2022. Data were collected from official health websites (e.g., WHO, CDC), social media (Twitter, Facebook), blogs, and parenting forums. Readability was assessed using the Flesch-Kincaid (FK) and SMOG indices, while credibility was evaluated using the DISCERN tool and HONcode certification. Accuracy was determined by comparing claims against scientific evidence from authoritative health organizations. Statistical analyses, including one-way ANOVA and chi-square tests, were performed to examine readability differences and misinformation prevalence across platforms. Official health websites had the highest readability complexity (average FK grade level: 11.8 ± 1.2), while social media content was the most accessible (average FK grade level: 7.8 ± 1.0). However, social media also exhibited the highest misinformation prevalence (38%), whereas official sources maintained near-perfect accuracy (98% compliance with scientific evidence). Blogs and forums demonstrated moderate readability (FK grade level: 9.5 ± 1.4 and 8.7 ± 1.1, respectively) but varied in credibility (DISCERN scores: 40-50/80). Thematic analysis revealed dominant misinformation trends, including fear-based narratives (52% of misinformation cases) and scientific distortions (29%). Accessibility barriers were also identified, with only 10% of sources providing multilingual content, and disparities in digital health resources were observed between high- and low-income regions. This study highlights the trade-off between readability and credibility in online vaccine information. While official sources provide reliable content, their complexity may hinder comprehension. Addressing accessibility gaps through plain-language communication and misinformation mitigation strategies is crucial for improving digital health literacy and supporting informed maternal vaccine decision-making.

Augmented Reality and Information Marketing: Digital Transformation in Increase Experience Consumer

Augmented Reality has emerged as a transformative technology in digital marketing, reshaping how consumers interact with brands and product information. This study aims to explore the application of Augmented Reality in digital marketing, its impact on consumer experiences, and the effectiveness of related marketing strategies. Employing a qualitative systematic literature review, the research analyzed seven high-quality studies published between 2020 and 2025, selected through a rigorous process using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. The findings reveal that Augmented Reality enhances consumer experiences through personalized interactions, immersive engagement, and seamless integration of physical and digital platforms, fostering trust and loyalty. However, challenges such as high development costs, limited consumer digital literacy, and privacy concerns hinder widespread adoption. These insights highlight the need for user-friendly platforms and ethical data practices to maximize Augmented Reality’s potential. The study concludes that Augmented Reality significantly enriches digital marketing by offering innovative consumer experiences, but its success depends on overcoming technological and accessibility barriers. Future research should explore longitudinal impacts and applications in non-retail sectors to further advance marketing strategies.

A qualitative meta-synthesis of the perinatal healthcare experiences of people with disability.

A qualitative meta-synthesis of the perinatal healthcare experiences of people with disability.

PET Imaging in Psychiatric Disorders.

PET Imaging in Psychiatric Disorders.

Financial technology platforms and enhancing SME financing in Jordan

PurposeThis study investigates the impact of financial technology (fintech) platform in enhancing access to finance for small and medium enterprises’ (SMEs) in Jordan.Design/methodologyA mixed-methods design using an ex-post facto survey method. Primary data were collected from 383 SME owners via Google Forms distributed through WhatsApp and email. The study utilized snowball sampling and statistical analysis including Pearson’s correlation and multiple regression to examine relationships between fintech usage and access to finance.ResultsThe findings demonstrate that fintech platforms significantly optimize SMEs’ access to finance and encourage financial inclusion. Contributions from fintech platforms and financial inclusion factors were important predictors of financing access, but challenges and adoption barriers had no significant impact.ImplicationsThe study highlights the possibility of fintech to causeway financing gaps for SMEs in Jordan. It recommends that SME owners implement fintech instruments to improve financial management and credit access, whereas policymakers should encourage fintech adoption through digital literacy, cybersecurity regulation, and supportive policy frameworks.Originality/valueThis study is one of the few to empirically show the constructive role of fintech solutions for SME financing in Jordan. It provides novel insights into how fintech platforms can drive financial inclusion and economic development in emerging markets.

Internet-delivered mindfulness-based cognitive therapy (iMBCT) for chronic pain symptom management in adults: A pilot randomized controlled trial.

Internet-delivered mindfulness-based cognitive therapy (iMBCT) for chronic pain symptom management in adults: A pilot randomized controlled trial.

Development and Pilot-Testing of a WeChat-Based Problem-Solving Skills Training Program for Parents of Children With Cancer: A Nonrandomized Clinical Trial.

Problem-solving skills training (PSST) has been shown to improve psychosocial outcomes for parents managing childhood cancer. However, accessibility barriers hinder its in-person delivery, particularly in regions with limited psychological resources. This study aimed to develop a WeChat-based PSST (WB-PSST) intervention and pilot-test its feasibility and preliminary impact. The WB-PSST intervention was developed using an iterative process, including evidence synthesis, stakeholder interviews, intervention modeling, and expert consultation. The intervention included eight weekly sessions delivered via a WeChat mini-program titled "No problem", featuring interactive modules tailored to parents' typical caregiving challenges to practice problem-solving steps. A nonrandomized clinical trial using before-and-after comparisons was then conducted among parents of children with any type of cancer, who were required to own a smartphone with WeChat installed. Outcomes were assessed using the Reach-Effectiveness-Adoption-Implementation-Maintenance framework. Twenty parents enrolled and completed the intervention. Parents reported potential signals of improvement in problem-solving skills (difference, 6.95, p<0.001) and family adaptation (difference, 6.35, p=0.002) and reductions in depressive symptoms (difference, -2.80, p<0.001). Parental and pediatric quality of life showed a positive but non-significant trend. Parents logged into "No problem" an average of 33.45days over 8weeks, with high satisfaction (8.95-9.35 out of 10) and fidelity (93.0%). Qualitative feedback revealed emotional relief, strengthened decision-making, and a user-friendly design and tailored stepwise practice. The intervention was feasible and showed early indications of improvement in parental problem-solving skills, depressive symptoms, and family adaptation. Further full-scale randomized clinical trials are warranted. ChiCTR2400087599.

Embedded systems and human collaboration in healthcare: Revolutionizing patient care

This article examines the transformative impact of embedded systems and human collaboration in healthcare delivery. It explores how this technological-human partnership is revolutionizing patient care across multiple domains, including surgical assistance, rehabilitation support, patient care automation, and remote monitoring. The integration of embedded systems with artificial intelligence has enhanced diagnostic capabilities through medical imaging analysis, predictive analytics, and laboratory diagnostics. The article further highlights how these technologies provide crucial support for elderly and disabled individuals through assistive robots, smart home integration, and cognitive assistance devices. This collaboration addresses critical healthcare challenges such as workforce shortages, increasing healthcare demand, and accessibility barriers. Looking toward the future, emerging technologies including advanced biosensors, edge computing, improved natural language processing, and virtual/augmented reality applications will further strengthen this partnership, ultimately improving healthcare efficiency, accessibility, and patient outcomes.

Advancing Disability Equity and Inclusion in Undergraduate Medical Education: Proceedings From the Access in Medicine Summit.

The Access in Medicine (AIM) Summit, held in April 2024, convened 60 delegates from across the United States to generate practicable solutions for dismantling accessibility barriers in medical education. These proceedings outline the Summit's objective and present the resulting insights and actionable recommendations. The Summit featured an innovative design that engaged diverse delegates in collaborative, idea-generating activities that elevated the lived experiences of learners with disabilities. Inspired by guiding principles of social justice and accessibility, delegates recommended a bundle of action-oriented strategies for addressing social and structural barriers to disability equity and inclusion. The proposed action steps identified critical intervention points that span the continuum of undergraduate medical education (UME), from improving support of disabled learners in recruitment and admissions processes through to their residency application and post-graduation transition stages. Though medical education was the AIM Summit focus, delegates emphasized the generalizability of themes to broad training contexts (e.g., residency and other health professions education training), both in the socio-structural challenges they confronted and in the solutions they proposed. These proceedings highlight the vital steps necessary to build more equitable and inclusive learning environments for learners with disabilities.