Andersen's Model Research Articles

Do Immigrants Use Less Health Care than Non-immigrants? A Population-based Study among People living with Multimorbidity in Canada

Abstract Background Immigrants face unique health care barriers, which can negatively impact their health service use and overall health. Those with multimorbidity may face a particular challenge given its association with increased need for health care. The purpose of this study was to compare health care utilization, as measured by the number of visits to family physicians and specialists, between immigrants and Canadian-born individuals living with multimorbidity. Methods A cross-sectional analysis was carried out using data from the 2015-2016 cycles of Canadian Community Health Survey (CCHS) on 9,014 study participants living with multimorbidity. The study utilized Andersen and Newman's behavioral model as a conceptual framework to identify quantifiable predictors associated with health service utilization. For the entire sample as well as for male and female subsamples, statistical models were fitted using negative binomial regressions to account for the count nature of the outcome variables. Results After adjusting for relevant confounders, no statistically significant differences were observed between immigrants and Canadian-born respondents in the number of visits to family physicians or specialists. However, subgroup analysis revealed that female immigrants with multimorbidity had considerably fewer visits to family physicians than Canadian-born females (Incident Rate Ratio [IRR]=0.86, 95% CI: 0.76-0.98), while for males these differences were not significant (IRR=1.03, 95% CI: 0.87-1.21). Conclusions Future research should focus on longitudinal studies to track the health status of immigrants over time, particularly those living with multimorbidity. Moreover, public health policies should be implemented to reduce cultural and social barriers to health care, with a special focus on female immigrants.

Preterm Delivery and Increased Risk of Recurrent Cardiovascular Events in Australian Women.

Background: Women with a history of preterm delivery (PTD) have significantly increased risk of experiencing cardiovascular disease (CVD) later in life. However, the risk of long-term recurrence of CVD in this population remains unknown. Materials and Methods: The study was based on a cohort of Victorian women who had a singleton birth between 1999 and 2008. The primary outcome was a CVD event resulting in an Emergency Department visit/hospitalization or death. Women who do not have a PTD during the study period were adopted as the comparator. The Andersen and Gill model, which generalizes the Cox proportional hazards regression model, was used for the analysis of recurrent CVD, while adjusting for covariates, including indigenous status. Results: After excluding cases not meeting the inclusion criteria, 34,128 Victoria women who had a history of PTD and 374,538 women who had deliveries at terms were analyzed. A history of PTD was shown to be associated with significantly increased risk of recurrent CVD, while adjusting for all covariates, including indigenous status, with an adjusted hazard ratio (aHR) of 1.70 (95% confidence interval [CI]: 1.54-1.86, p < 0.0001). Aboriginal and Torres Strait Islander women had substantially increased risk of experiencing recurrent CVD after birth over their lifetime (aHR: 3.22, 95% CI: 2.39-4.35, p < 0.0001). Conclusions: Recognizing PTD as a nontraditional risk factor of CVD may play a role in the formulation of care plans for primary and secondary CVD prevention in women with such a history.

Investigating oral health-related quality of life in patients with ischaemic stroke in China.

The objective of the study was to explore factors associated with oral health-related quality of life (OHRQoL) in patients with ischaemic stroke in China, guided by the theory of planned behaviour (TPB) and Andersen's oral health outcome model. Recent studies have reported that the prevalence of stroke is increasing and that stroke patients are facing many oral health related problems. This study provided insights into the role of TPB in the OHRQoL among patients with ischaemic stroke. Three hundred eight patients with ischaemic stroke from the Department of Neurology of a third-grade class-A hospital in Xuzhou, China, were enrolled in this cross-sectional study between June and September 2020. They completed a questionnaire that included information on socio-demographic characteristics and health behaviours, the Montreal Cognitive Assessment Scale, the Modified Rankin Scale and the Chinese version of the Oral Health Impact Profile-14 scale (OHIP-14). Structural equation modelling (SEM) was used to examine the association among the selected variables based on the TPB and Andersen's oral health outcome model. Among the participants (mean age 65.6), most (57.5%) were male. Their mean OHIP-14 score was 13.3 ± 7.6. Based on the SEM path diagram, behavioural attitude, subjective norms and perceived behavioural control of oral health were positively associated with intention; intention was associated with OHRQoL. The degree of disability was negatively associated with intention. Cognitive function was positively associated with OHRQoL. The OHRQoL of hospitalised patients with ischaemic stroke in China is fair to poor and affected by their oral health behaviours. Improved oral health behavioural attitude, subjective norms and perceived behavioural control might help them form good intentions and improve their OHRQoL.

Factors Related to the Intention to Use Dental Care by Industrial Workers Due to COVID-19: Application of Anderson Model and Planned Behavior Theory.

The COVID-19 pandemic has affected medical and dental care in Korea. This study aimed to investigate the factors influencing the intention to use dental care in industrial workers, an economically active population. An online questionnaire survey was completed by 301 industrial workers. Stress and anxiety to viral epidemics-6 (SAVE-6), attitude, subjective norm, perceived behavior control, and intention to use dental care, based on the theory of planned behavior (TPB), were measured. Predisposing, enabling, and need factors based on the Andersen model were measured as control variables for influencing factors. In the final hierarchical multiple regression analysis, the most significant relevant factors affecting intention to use dental care were attitude (β = 0.598, p < 0.001), followed by experience of dental clinic visits (β = 0.237, p < 0.001), subjective norm (β = 0.125, p < 0.001), perceived behavior control (β = 0.114, p = 0.004), SAVE-6 (β = −0.073, p = 0.025), and gingival bleeding (β = 0.062, p = 0.029). Dental care use decreased to 58.5%, and socio-psychological factors based on TPB were closely associated with the intention to use dental care. Therefore, awareness must be raised regarding oral health practices to increase the use of dental care among industrial workers.

Factors associated with access to healthcare services for older adults with limited activities of daily living.

BackgroundLimited studies focused on the situation and related factors of access to healthcare services for older adults with limited activities of daily living (ADL) in China. This study explores factors associated with access to healthcare services of them based on Andersen's healthcare utilization model (namely, need, predisposing, and enabling dimensions).MethodsA total of 3,980 participants aged 65 years and older adults with limited ADL from the latest wave (2018) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included. Binary logistic regression was used to explore the influencing factors.ResultsFactors in enabling dimension were associated with access to healthcare services for older adults with limited ADL. Those who lived with better economic status (fair vs poor, OR = 2.98, P < 0.01; rich vs poor, OR = 7.23, P = 0.01), could afford daily life (yes vs no, OR = 2.33, P = 0.03), and lived in the eastern or central region of China (eastern vs western, OR = 2.91, P < 0.01; central vs western, OR = 2.40, P = 0.02) could access to healthcare services more easily. However, factors in predisposing dimension and need dimension showed no statistical significance. Meanwhile, inconvenience in the movement was the major barrier reported by some participants for not going to the hospital when they got sick.ConclusionAccess to healthcare services for older adults with ADL limitation was mainly related to the factors of economic status, affordability for daily life, and living regions in enabling dimension. Strategies focused on health insurance, healthcare system, barrier-free facilities, and social support were proposed to increase the access to healthcare services for participants, which could benefit their health.

Free-play street soccer environments: examining youth sport injury risk through a biopsychosocial lens

ABSTRACT This review of literature articulates how the ‘free-play’ street soccer environment creates the context for athletes to thrive in sport, while simultaneously minimizing the injury risks associated with such activity. Williams’ and Andersen's well-known model of stress and athletic injury outlines how athletes’ cognitive and physiological responses to potentially stressful athletic situations can influence sport injuries. This ‘stress response’ is influenced by the personality, history with stressors, and coping resources that athletes bring to the environment. Wiese-Bjornstal furthered theory in this domain by developing the biopsychosocial sport injury risk profile. Her framework identifies potential antecedents to injury that emerge across four categories, each of which holds various levels of risk exposure, risk behavior, and vulnerability to injury: biological, physical, psychological, and sociological. These models provided the framework for this narrative. Specifically, given its psychosocial nature, the free-play street soccer environment may act as a protective sport activity design insofar as it mitigates against known injury risk antecedents. Hence, the inherent risk mitigation of free-play, taken together with the potential it has to create psychological, physiological, and technical development among young people, support greater emphasis on street soccer as a powerful construct for youth development in the game of soccer.

Predisposing, enabling and need factors associated with past-year health service use for mental health reasons in adults with suicidal ideation in France

BackgroundWe aimed to determine the prevalence of past-year health service use for mental health reasons in a French representative sample of adults overall and in those reporting suicidal ideation in the past year and assess the factors associated with health service use according Andersen's model of healthcare seeking behaviors. MethodsData were drawn from the 2017 Health Barometer survey a large computer-assisted telephone survey on a representative sample of the general population aged 18–75 years living in France (n = 25,319). Logistic regression analyses were used to study past-year health service use for mental health reasons as a function of predisposing, enabling and need factors. Analyses were stratified according to suicidal ideation and sex. ResultsAmong individuals with suicidal ideation, 45.1 % of adults, 50.4 % of females and 37.6 % of males, reported past-year health service use for a mental health reason. Increased odds of health service use were observed regarding predisposing (female sex, younger age, higher education), enabling (income level), and need factors (prior suicide attempts, role impairment and major depression). Among males, the only significant factors included age 65–75 (aOR = 0.16, 95%CI = 0.03–0.84) and major depression (aOR = 2.79, 95%CI = 1.79–4.36). LimitationsSelf-reported service utilization. Cross-sectional survey. ConclusionsIn a country with a high level of medical coverage, further research is needed to identify sex-specific socio-demographic, economic and clinical differences in the use of different types of health services as well as perceived need for care, structural and attitudinal barriers to treatment.

Utilization of recycled construction powder in 3D concrete printable materials through particle packing optimization

With the enhancement of awareness of environmental protection and sustainable development, reuse of industrial solid waste has gradually attracted people’s attention. The utilization of recycled construction powder (RCP) and recycled construction aggregate(RCA)in the production of 3D concrete printable material(3DPM) can not only reduce carbon emissions, but also promote the application of 3D printing technology by reducing material costs. Considering the defect of low-reactivity and inferior property of RCP, the appropriate RCP is screened out according to the modified Andreasen and Andersen model to optimize the gradation of printable materials. Influence of RCP on the fresh property is investigated by rheological experiment and the incipient failure height test. The results show that the addition of 10%RCP would increase the yield stress from 1423Pa to 1573Pa and maintain the viscosity of the material. Moreover, unconfined compressive strength test, isothermal calorimetry and mercury intrusion porosimetry test are also used to characterize the properties of 3DPM. The results show that although the addition of RCP reduces the total heat release of 3DPM, it also reduces the macropore(¿1000 nm) of 3DPM from 10.7% to 7.1%, and keep the compressive strength within an acceptable range through the gradation optimization. Finally, the results of laboratory printing or industrial printing also confirm the printing performance of 3DPM.

Paid Care Services and Transitioning out of the Community Among Black and White Older Adults With Dementia.

Paid care provided in the home includes important support services for older adults with dementia such as cleaning and personal care assistance. By reducing unmet needs, these services could delay the transition to residential long-term care, but access may differ across racial groups. This study examined the relationship between paid care and transitioning out of the community among Black and White older adults with dementia. Using data from 303 participants (29.4% Black) with probable dementia in the 2011 National Health and Aging Trends Study, competing risk hazards models estimated the association between receiving paid care at baseline and the probability of transitioning out of the community over 8 years (through 2019). Covariate selection was guided by the Andersen model of health care utilization. Paid care was associated with lower risk of transitioning out of the community (subhazard ratios [SHR] = 0.70, 95% CI [0.50, 0.98]). This effect was similar after controlling for predisposing factors and most prominent after controlling for enabling and need for services factors (SHR = 0.65, 95% CI [0.44, 0.95]). There was no racial difference in the use of paid care despite evidence of greater care needs in Blacks. Furthermore, Black participants were less likely to transition out of the community than Whites. Paid care services may help delay transitions out of the community. Future research should seek to explain racial differences in access to and/or preferences for home-based, community-based, and residential care.

Mix design and characteristics evaluation of high-performance concrete with full aeolian sand based on the packing density theory

• A newly high-performance concrete was prepared by using aeolian sand. • The modified Andreasen & Andersen model was employed to determine the volume fractions of solid powders. • The optimization values of W/C, SP and FA content are 0.19, 1.0 and 25.86 respectively. • The internal pores of developed FAS-HPC are harmless and the pore porosity is 7.3%. • This study further enriches the raw materials for HPC and proposes a fully calculated design method. To solve the shortage issue of high-quality construction aggregates in desert areas and improve the utilization rate of aeolian sand, this study introduces the mix design and characteristics evaluation of high-performance concrete with full aeolian sand (FAS-HPC). The modified Andreasen & Andersen model is employed to determine the volume fractions of solid materials when the mixture system reaches the best packing density. Then the Response Surface Method (RSM) is utilized to conduct the orthogonal design and evaluate the effect of water-cementitious materials (W/C), superplasticizer (SP) and fly ash (FA) content on the flowability, mechanical properties, shrinkage and impermeability of the developed concrete, thus the raw materials proportion of FAS-HPC is optimized. After that, the pore structure and microstructure of the developed concrete are tested and analyzed to verify its durability and compactness. The results show that the volume fractions of AS, silica fume, and cement are determined as 0.482, 0.093, and 0.425 respectively, and the introduction of FA is found to be effective in improving the fluidity and impermeability while reducing the early strength and shrinkage. Under the determined response goals, the optimal values of W/C, SP and FA content are 0.19, 1.0 and 25.86 respectively. While the developed FAS-HPC formed by this ratio has a flowability of 220 mm, 28d flexural strength and compressive strengths of 20.26 MPa and 97.09 MPa respectively, meeting the requirements of HPC. Additionally, the developed FAS-HPC has a porosity of 7.3 % and 76.4 % pores are harmless, which can ensure its superior chloride resistance and durability. This study further enriches the raw materials for HPC and proposes a fully calculated design method, which is of great significance to the sustainable development of HPC.

Rheological characteristics of Ultra-High performance concrete (UHPC) incorporating bentonite

This study aims to optimize the rheological properties of Ultra-high performance concrete (UHPC) based on the rheology pre-control strategy. To be specific, bentonite is employed as a rheology controller, and the UHPC skeleton is developed by the Modified Andreasen and Andersen (MAA) model. Then, the rheological properties, mechanical properties, and microstructure of the developed UHPC are evaluated carefully. The obtained results reveal that the addition of bentonite can effectively regulate the rheological properties of UHPC. More exactly, When the bentonite content rises from 0 wt% to 15.0 wt%, the flowability of the UHPC slurry decreases by 55.71%, while the static yield stress, dynamic yield stress, plastic viscosity and thixotropy increase by about 17.05 times more, about 5.57 times more, about 1.16 times more and about 0.04 times more, respectively. Due to the improvement of the rheological properties of the developed UHPC matrix, the orientation and distribution of the utilized steel fibres can be significantly improved, which could bring a maximum increase of about 60% for the UHPC flexural strength. Additionally, based on the microstructure analysis results, there is optimal bentonite content, which is beneficial for obtaining a much denser structure of UHPC composite.

The effective hydrodynamic radius in the Stokes–Einstein relation is not a constant

Variants based on the assumption of effective hydrodynamic radius being a constant are usually adopted to test the Stokes–Einstein (SE) relation. The rationality of the assumption is examined by performing molecular dynamics simulations with the truncated Lennard-Jones-like (TLJ) model, Kob–Andersen model and ortho-terphenyl (OTP) model. The results indicate the assumption is generally not established except for special case. The effective hydrodynamic radius is observed to increase with decreasing temperature for TLJ model but is decreased for Kob–Andersen and OTP model; and which is almost a constant for TLJ particle with enough rigidity. The variant of SE relation is invalid for the three models except for the TLJ particle with enough rigidity. We propose similar inconsistency may be also existed in other liquids and the assumption should be critically evaluated when adopted to test the SE relation.

Understanding Diagnostic Delays for Kaposi Sarcoma in Kenya: A Qualitative Study.

Although HIV-associated Kaposi sarcoma (KS) is frequently diagnosed at an advanced stage in sub-Saharan Africa, reasons for diagnostic delays have not been well described. We enrolled patients >18 years with newly diagnosed KS between 2016 and 2019 into the parent study, based in western Kenya. We then purposively selected 30 participants with diversity of disease severity and geographic locations to participate in semistructured interviews. We used 2 behavioral models in developing the codebook for this analysis: situated Information, Motivation, and Behavior framework and Andersen model of total patient delay. We then analyzed the interviews using framework analysis. The most common patient factors that delayed diagnosis were lack of KS awareness, seeking traditional treatments, lack of personal efficacy, lack of social support, and fear of cancer, skin biopsy, amputation, and HIV diagnosis. Health system factors that delayed diagnosis included previous negative health care interactions, incorrect diagnoses, lack of physical examination, delayed referral, and lack of tissue biopsy availability. Financial constraints were prominent barriers for patients to access and receive care. Facilitators for diagnosis included being part of an HIV care network, living near health facilities, trust in the health care system, desire to treat painful or disfiguring lesions, and social support. Lack of KS awareness among patients and providers, stigma surrounding diagnoses, and health system referral delays were barriers in reaching KS diagnosis. Improved public health campaigns, increased availability of biopsy and pathology facilities, and health provider training about KS are needed to improve early diagnosis of KS.

Multiple effects of particle size distribution modulus (q) and maximum aggregate size (Dmax) on the characteristics of Ultra-High Performance concrete (UHPC): Experiments and modeling

Ultra-high Performance Concrete (UHPC) is a kind of advanced cement-based material normally designed based on particle close packing model, such as modified Andreasen and Andersen model. However, in the utilization of this model, some key parameters have not been deeply understood. Therefore, in this research, the multiple effect of typical parameters (q value and Dmax) on the properties of UHPC are clearly clarified based on mechanical property evaluation, wet packing density, low-field NMR and X-ray Computed tomography (X-CT). The obtained results show that when different maximum particle sizes are chosen, there is an optimized q value to develop UHPC (q 0.17 for Dmax 1.25 mm; q 0.23 for Dmax 2.19 mm; q 0.25 for Dmax 4.36 mm; q 0.25 for Dmax 6.61 mm) with the lowest porosity and largest strength. Comprehensively consider the performance of UHPC, the suggested Dmax should be 2.19 mm, while the chosen q value is 0.23. At last, stereological theory is employed to get the quantity distribution of aggregates, and the aggregate particles random packing model is established to visualize the real aggregate particles packing in UHPC. And a new design concept for UHPC mix proportion design is provided.

Effects of graphene oxide on mechanical properties and microstructure of ultra-high-performance lightweight concrete

Ultra-high-performance concrete (UHPC) has attracted much attention in civil engineering. However, the high deadweight of UHPC limits its application. To reduce the density of UHPC, this study developed an ultra-high-performance lightweight concrete (UHPLC) by combining the use of shale ceramic sand and nano-materials, according to the modified Andreasen and Andersen (MAA) model. Taking advantage of nanotechnology, graphene oxide (GO) was utilized to improve the mechanical performance of UHPLC, and the effects of GO on the workability, mechanical properties, and microstructure of UHPLC were systematically investigated. It was found that: 1) UHPLC with an apparent density of 2022 ∼ 2114 kg/m³ was prepared according to the MAA model; 2) Owing to the addition of GO, the flexural strength, compressive strength, and elastic modulus of UHPLC increased by 6.3 ∼ 22.4%, 7.6 ∼ 16.7%, and 4.1 ∼ 13.0%, respectively; 3) Considering the effects of GO on the mechanical properties and microstructure of UHPLC, the optimal content of GO was 0.06%.

Assessment of Colorectal Cancer Screening Disparities in U.S. Men and Women Using a Demographically Representative Sample.

Timely receipt of colorectal cancer (CRC) screening can reduce morbidity and mortality. This is the first known study to adopt Andersen's model of health services use to identify factors associated with CRC screening among US adults. The data from National Health Interview Survey from 2019 was utilized to conduct the analyses. Multivariable logistic regression was used to separately analyze data from 7,503 age-eligible women and 6,486 age-eligible men. We found similar CRC screening levels among men (57.7%) and women (57.6%). Factors associated with higher screening odds in women were older age, married/cohabitating with a partner, Black race, >bachelor's degree, having a usual source of care, and personal cancer history. Factors associated with lower odds for women were American Indian/Alaska Native race, living in the US for ≤10 years, ≤138% federal poverty level (FPL), uninsured or having Medicare, and in fair/poor health. For men, factors associated with higher screening odds were older age, homosexuality, married/cohabitating with a partner, Black race, >high school/general educational development education, having military insurance, having a usual source of care, and personal cancer history. Factors associated with lower odds for men were being a foreign-born US resident, living in the South or Midwest, ≤138% FPL, and being uninsured or having other insurance. Despite lower screening rates in the past, Black adults show a significantly higher likelihood of CRC screening than White adults; yet, screening disparities remain in certain other groups. CRC screening efforts should continue to target groups with lower screening rates to eliminate screening disparities.

Depression rates and health-seeking behavior in primary care: Andersen model of health- care utilization

ABSTRACT Depression imposes a tremendous burden on the health-care systems. Many patients prefer informal (family & friends) over formal mental health services (MHS) provided by professionals. We aimed to investigate the prevalence of depression among primary care patients and to examine the factors predicting seeking MHS using the Andersen Health Care Utilization Model. We interviewed 300 primary care patients in Jordan. The mean age was 39.85 ± 14.45, and 80% were women. 35.7% had depression, and 28.7% had significant depression impairing daily function. The most commonly reported source of help was family members and less than one-third had the intention to seek formal MHS. The predisposing-factors domain was the only predictive of seeking MHS in depression and suicide, whereas the ‘enabling’ and ‘need’ domains were not. Knowledge, stigma and life satisfaction were predictive of seeking formal MHS. Raising awareness and empowering doctors to screen for depression is needed as less than a third would seek formal MHS.

Investigation of steel fiber reinforced high-performance concrete with full aeolian sand: Mix design, characteristics and microstructure

High-performance concrete with full aeolian sand (FA-HPC) has the characteristics of low water binder ratio, large cementitious materials content and no restriction of coarse aggregates, resulting in a high risk of shrinkage cracking. Aiming at reducing the shrinkage of FA-HPC and improving its cracking resistance, mechanical properties and durability, steel fibers with different lengths are employed to reinforce FA-HPC and develop a new type of cement-based composites (FA-HPFRC). For this purpose, the modified Andreasen & Andersen (MAA) model was adopted to determine the volume fractions of aeolian sand (AS), cement, fly ash (FA) and silica fume (SF). Then, the water binder ratio (W/C), superplasticizer (SP) and steel fiber content of FA-HPFRC were optimized through wet packing compactness, flowability, mechanical properties and shrinkage tests. Furthermore, the cracking resistance and microstructure of the developed FA-HPFRC were tested and analyzed from macro-micro perspectives. The results show that the volume fractions of AS, cement, FA and SF are determined as 0.482:0.316: 0.109:0.093 when the powder materials in FA-HPFRC are stacked to the most compact state. The wet packing compactness decreases with a higher W/C ratio while it increases first and then decreases with the increase of SP content. Considering the influences on mechanical properties, the W/C and SP content shall be 19% and 1% of the cementitious material separately. The introduction of steel fibers in FA-HPC reduces the concrete's flowability, destroys its dense packing system and lowers its wet packing compactness. However, the characteristics such as high toughness, and large elastic modulus of steel fibers endow FA-HPFRC with excellent mechanical properties, chloride resistance and shrinkage resistance. Especially steel fibers with 12 mm length perform well in improving the comprehensive performance of FA-HPFRC and increasing the cracking resistance 15.03% higher than that of 6 mm steel fibers. This research further improves FA-HPC's mechanical properties and durability, especially the shrinkage cracking resistance, and provides technical and theoretical support for the application of FA-HPFRC.

Determinants of Outpatient Physician Visits in the General Adult German Population during Later Stages of the COVID-19 Pandemic.

The goal of this study was to investigate the determinants of outpatient physician visits in Germany during the later stages of the COVID-19 pandemic. Cross-sectional data were used from the general adult population in Germany with n = 3091 individuals (data collection in mid-March 2022). Determinants were selected based on the extended Andersen model. The number of GP visits as well as the number of specialist visits in the past 12 months were used as outcome measures. Negative binomial regressions showed that the number of GP visits was positively associated with a lower educational level, being retired, lower levels of loneliness, the presence of at least one chronic condition, lower self-rated health, being vaccinated against COVID-19, and the presence of depression. Moreover, negative binomial regressions showed that the number of specialist visits was positively associated with being female, a lower age, having children, being married, not being full-time employed, the presence of at least one chronic condition, lower self-rated health, the presence of depression, being vaccinated against COVID-19 and having a lower coronavirus anxiety. In conclusion, while our study showed that need factors are still a main driver of outpatient physician visits, our findings additionally showed that predisposing characteristics, enabling resources and psychosocial factors are also important for the number of outpatient physician visits in Germany during the COVID-19 pandemic. Knowledge about these determinants (e.g., vaccination status, loneliness or coronavirus anxiety) is also important to avoid under- or overuse of the healthcare system.

Barriers and Promotors to Health Service Utilization for Pelvic Floor Disorders in the United States: Systematic Review and Meta-analysis of Qualitative and Quantitative Studies.

We need a systematic approach to understanding health service utilization behavior in women with pelvic floor symptoms in the United States. The aim of this study was to determine the prevalence of pelvic floor care utilization and identify its barriers and promotors using Andersen's model, which theorizes care-seeking behavior with individual care needs, resources, predispositions, and macrostructures. This was a systematic search of studies on care-seeking patterns in women with symptomatic pelvic floor disorders, which included pelvic organ prolapse, lower urinary tract symptoms, and anal incontinence. We then performed meta-analyses with random-effects models and descriptive analysis to determine utilization rate and the impact of each identified determinant. The pooled utilization rate was 37% (95% confidence interval [CI], 30%-45%). Determinants were identified across all domains except at the macrostructure level. For individual care needs, increased symptom severity or duration and a history of depression (odds ratio [OR], 1.27; 95% CI, 1.07-1.51) were associated with higher utilization. In the resources domain, having social support and established primary/secondary care were promotors, whereas higher income and employed status trended as barriers. Under predispositions, age ≥50 years (OR, 1.29; 95% CI, 1.05-1.60), and pelvic floor awareness were associated with utilization, whereas Asian (OR, 0.60; 95% CI, 0.51-0.72) and Black (OR, 0.77; 95% CI, 0.55-1.08) women as well as women experiencing fear, misinformation, or normalization of pelvic floor disorders had decreased utilization. This review identified a low utilization rate for pelvic floor care and revealed multilayered, actionable items affecting care-seeking behavior. It highlights the need for more inclusive and multifaceted approaches in future pelvic floor disparity research and equity interventions.